Indian Journal of Critical Care Medicine
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   Table of Contents - Current issue
April 2015
Volume 19 | Issue 4
Page Nos. 197-247

Online since Monday, April 06, 2015

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Peripheral venous pressure to monitor fluid resuscitation in burns-more confusing than helpful? p. 197
Lavrentieva Athina
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Peripheral venous pressure as a reliable predictor for monitoring central venous pressure in patients with burns p. 199
Lulu Sherif, Vikas S Joshi, Anjali Ollapally, Prithi Jain, Kishan Shetty, Karl Sa Ribeiro
Background: Optimizing cardiovascular function to ensure adequate tissue oxygen delivery is a key objective in the care of critically ill patients with burns. Hemodynamic monitoring may be necessary to optimize resuscitation in serious burn patients with reasonable safety. Invasive central venous pressure (CVP) monitoring has become the corner stone of hemodynamic monitoring in patients with burns but is associated with inherent risks and technical difficulties. Previous studies on perioperative patients have shown that measurement of peripheral venous pressure (PVP) is a less invasive and cost-effective procedure and can reliably predict CVP. Objective: The aim of the present prospective clinical study was to determine whether a reliable association exists between changes in CVP and PVP over a long period in patients admitted to the Burns Intensive Care Unit (BICU). Subjects and Methods: The CVP and PVP were measured simultaneously hourly in 30 burns patients in the BICU up to 10 consecutive hours. The predictability of CVP by monitoring PVP was tested by applying the linear regression formula and also using the Bland-Altman plots of repeated measures to evaluate the agreement between CVP and PVP. Results: The regression formula revealed a reliable and significant association between CVP and PVP. The overall mean difference between CVP and PVP was 1.628 ± 0.84 mmHg (P < 0.001). The Bland-Altman diagram also showed a perfect agreement between the two pressures throughout the 10 h period. Conclusion: Peripheral venous pressure measured from a peripheral intravenous catheter in burns patients is a reliable estimation of CVP, and its changes have good concordance with CVP over a long period of time.
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Prevalence of hypoxemia in under-five children with pneumonia in an emergency pediatrics hospital in Sudan p. 203
Elmuntasir Taha Salah, Samah Hamadnalla Algasim, Alamin Saeed Mhamoud, Nazik Elmalaika Obaid Seid Ahmed Husian
Context: Hypoxemia is a common and potentially lethal complication of acute respiratory infection in children under-five, particularly among those with severe disease. Aims: The aim of this study was to determine the prevalence of hypoxemia in under-five Sudanese children with pneumonia. Settings and Design: A cross-sectional study conducted in a pediatrics hospital in a developing country. Subjects and Methods: Data were collected using structured questionnaire and oxygen saturation was measured using a pulse oximeter. Hypoxemia was defined as arterial blood oxygen saturation <90%. Results: Of 150 studied patients, 86 (57.3%) were males and 46 (32%) were in the age group 2 to ≤12 months. Of the total number, 42.7% had hypoxemia (with pulse oximeter oxygen saturation <90%), out of them 36 (56.25%) were in the age group <2 months. Of the hypoxic patients, 30 (46.88%) had severe pneumonia, and 7 (10.94) had very severe pneumonia (P < 0.001). Conclusions: The prevalence of hypoxemia was 42.7% among the studied population. There was a significant association between the hypoxemia and small age group and very severe pneumonia. In limited resource settings pulse oximeter can be used to correctly identify hypoxemia in under-five children particularly among those diagnosed clinically as very severe pneumonia.
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Scrub typhus: Clinical spectrum and outcome p. 208
Pradeep M Venkategowda, S Manimala Rao, Dnyaneshwar P Mutkule, Mallela V Rao, Alai N Taggu
Background: Scrub typhus is one of the differential diagnoses for fever with thrombocytopenia. ARDS associated with Scrub typhus has high morbidity and mortality. Aims: To evaluate clinical features, lab values, and outcome in patients with scrub typhus and comparison in patients with or without ARDS. Methods: A prospective observational study was conducted on 109 patients with febrile illness and thrombocytopenia during a period of 12 months. All 109 patients were tested with both Immune-chromatography test and Weil felix test. Patients having either Immune-chromatography test/Weil felix test positive have been included and considered as scrub typhus positive whereas negative for both Immune-chromatography and Weil felix test were excluded. Clinical features, lab parameters, and outcome were evaluated in all patients with scrub typhus. Statistical analysis used in this study was T-test. Results: Among 58 patients who were included (After exclusion of 51 patients among total of 109 patients) 34 patients had no ARDS and 24 patients had ARDS. The clinical feature like dyspnoea, cough, low blood pressure (MAP<65 mmHg), IVC collapsibility (by ultrasound) and laboratory parameters like decreased Hemoglobin, Hematocrit, Serum albumin, and increased serum creatinine, serum total bilirubin, SGOT, SGPT, LDH, CPK, and serum lactate were statistically significant (P < 0.0001) in scrub typhus patients group with ARDS. The higher titers of Weil-felix can be correlated with more severe form of disease according to our observation. All 34 Scrub typhus patients without ARDS recovered completely. Among 24 Scrub typhus patients with ARDS, 22 patients recovered, and 2 patients died. Conclusion: Scrub typhus is an important differential diagnosis in a patients having fever with thrombocytopenia. Scrub typhus associated with ARDS has high morbidity and mortality. Early diagnosis and treatment with doxycycline can prevent the occurrence of ARDS
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Exchange transfusion in complicated pediatric malaria: A critical appraisal p. 214
Himesh Barman
Complicated falciparum malaria is a killer disease resulting in high mortality in spite of appropriate treatment. Some workers have reported improved survival when adjunct exchange blood transfusion is included in the treatment modality while others opine against it. This review is an effort to address and critically appraise current evidence for the treatment mode for severe malaria. The literature was searched with a specified search strategy to identify reports of children who underwent exchange transfusion for severe malaria. Total 23 children who underwent exchange transfusion for severe falciparum malaria published by 9 authors were identified. Age ranged from 5 months to 16 years with a mean age of 6.4 years. The average preprocedure parasite index (PI) was 41.4% (95confidence interval [CI]; 31.2-51.4). The average blood volume exchanged was 118.6% (95% CI; 94.7-143) of the circulating blood volume. The average postexchange reduction in PI was 34.1% (95% CI; 25.4-42.8). Three out of 23 children encountered some complications. All the children survivedKeywords: Exchange blood transfusion, parasite index, pediatric Intensive Care Unit, red cell exchange, severe falciparum malaria.
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Evolving concepts of hemodynamic monitoring for critically ill patients Highly accessed article p. 220
Olfa Hamzaoui, Xavier Monnet, Jean-Louis Teboul
The last decades have been characterized by a continuous evolution of hemodynamic monitoring techniques from intermittent toward continuous and real-time measurements and from an invasive towards a less invasive approach. The latter approach uses ultrasounds and pulse contour analysis techniques that have been developed over the last 15 years. During the same period, the concept of prediction of fluid responsiveness has also been developed and dynamic indices such as pulse pressure variation, stroke volume variation, and the real-time response of cardiac output to passive leg raising or to end-expiration occlusion, can be easily obtained and displayed with the minimally invasive techniques. In this article, we review the main hemodynamic monitoring devices currently available with their respective advantages and drawbacks. We also present the current viewpoint on how to choose a hemodynamic monitoring device in the most severely ill patients and especially in patients with circulatory shock.
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Evolving paradigm of illnesses presented to medical Intensive Care Unit in body builders: Cases from tertiary care center p. 227
Sunil Kumar Garg
Bodybuilding is the use of progressive resistance exercise to control and develop one's musculature. With the rise in number of persons adopting this activity, there is evolving paradigm of illnesses presented to intensive care in this population subset. Strict adherence to details of bodybuilding and avoidance of unsupervised medications are essential to prevent untoward effects.
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Thrombotic thrombocytopenic purpura and focal segmental glomerulosclerosis associated with the use of ecstasy p. 230
Yusuf Kayar, Nuket Bayram Kayar, Venkatanarayana Gangarapu
Ecstasy is a drug, which causes serious side effects and sometimes it can be lethal. These effects are due to idiosyncratic reactions as a result of various stimulations in adrenergic receptors. Here we present a case of a 36-year-old male patient who was diagnosed with thrombotic thrombocytopenic purpura associated with the use of ecstasy. Plasmapheresis along with methylprednisolone treatment restores patient condition to normal.
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Scorpion bite, a sting to the heart! p. 233
Avinash Agrawal, Anand Kumar, Shuchi Consul, Ambuj Yadav
Scorpion bites are common in India. Usually, these bites are harmless but sometimes have serious clinical sequelae, including death. We report herein a case of scorpion bite with electrocardiographic abnormalities simulating early myocardial infarction. Pulmonary edema and congestive heart failure accompanied these electrocardiographic changes as well as serum cardiac markers. The etiology of cardiovascular manifestations in severe scorpion sting is related to venom effect on sympathetic nervous system and the adrenal secretion of catecholamines as well as to the toxic effect of the venom on the myocardium itself. It is a rare case of scorpion sting presented as myocardial infarction and heart failure, successfully treated with Intensive Care Unit care, noninvasive ventilation, vasopressors, and antiischemic treatment.
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Nasocardiac reflex during aspiration and injection through a nasogastric tube: An infrequent occurrence p. 237
Rudrashish Haldar, Jasleen Kaur, Sukhminder Jit Singh Bajwa
Nasocardiac reflex is a relatively less discussed variant of trigeminovagal reflex where the afferent arc of the reflex is represented by any of the branches of the trigeminal nerves, and the efferent arc is via the vagus nerve. Elicitation of this reflex is commonly seen during surgical manipulation and is manifested as bradycardia or even asystole. We report a case where nasocardiac reflex was unusually observed in a patient when aspiration and injection were done through a nasogastric tube.
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End-of-life care policy: An integrated care plan for the dying p. 240
B Sadananda Naik, Sangram Biradar
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Author's Reply p. 240
Raj Kumar Mani, Sheila Nainan Myatra, Naveen S Salins
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Acute ammonium dichromate poisoning in a 2-year-old child p. 241
Mahmood Dhahir Al-Mendalawi
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A comparative study of complications and long-term outcomes of surgical tracheostomy and two techniques of percutaneous tracheostomy: Comments p. 242
Mohd Saif Khan
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Avoiding iatrogenic harm by integrating physical examination findings with a point-of-care lung ultrasonography p. 243
Gentle Sunder Shrestha, Ananda Khanal, Sharad Paudel
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Extreme hemodynamic fluctuations: Importance of understanding the principles of syringe pump function p. 244
Chakrabarti Dhritiman, Byrappa Vinay
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Drug interaction resulting in massive chest wall hematoma in a patient on therapeutic anticoagulation p. 246
Pradeep Rangappa, Tejaswini Arunachala Murthy, Ipe Jacob
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Online since 7th April '04
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