Indian Journal of Critical Care Medicine
An open access publication of ISCCM™ 
Users online: 28 
     Home | Login
  About Current Issue Archive Search Instructions Online Submission Subscribe Etcetera Contact  
   Navigate here  
     Current Issue
     Submit Article 
     My Preferences 


Export selected to
Reference Manager
Medlars Format
RefWorks Format
BibTex Format
   Table of Contents - Current issue
July 2015
Volume 19 | Issue 7
Page Nos. 375-438

Online since Wednesday, July 08, 2015

Accessed 3,326 times.

PDF access policy
Journal allows immediate open access to content in HTML + PDF

EPub access policy
Full text in EPub is free except for the current issue. Access to the latest issue is reserved only for the paid subscribers.
View as eBookView issue as eBook
Author Institution MappingAuthor Institution Mapping
Access StatisticsIssue statistics
Hide all abstracts  Show selected abstracts  Export selected to  Add to my list

Fluid responsiveness in critically ill patients Highly accessed article p. 375
Abele Donati, Andrea Carsetti, Elisa Damiani, Erica Adrario, Rocco Romano, Paolo Pelaia
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Predicting the intermediate syndrome in organophosphorus poisoning p. 377
James Coulson
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Does magnesium matter in patients of Medical Intensive Care Unit: A study in rural Central India p. 379
Sunil Kumar, Akshay Honmode, Shraddha Jain, Vijay Bhagat
Introduction: Hypomagnesemia has been common, but mostly underdiagnosed electrolyte abnormality. Studies regarding this is lacking in India especially in rural setting. Here, we have correlated serum magnesium (Mg) level with outcome in patients of medicine Intensive Care Unit (ICU) with respect to length of ICU stay, need for mechanical ventilatory support and its duration and ultimate outcome (discharge/death). Materials and Methods: This is a prospective observational study carried out over a period of 1-year enrolling 601 patients of Medical ICU (MICU). The Chi-square test is applied to correlate hypomagnesemia with the outcome. Result and Observation: About 25% patients had admission hypomagnesemia. When compared with the normal Mg group, there was significant association of hypomagnesemia with outcome in terms of duration of MICU stay 5.46 (5.75) versus 3.93 (3.88), need for mechanical ventilation (56.86% vs. 24.33%), discharge/cured from ICU (61.43% vs. 85.26%), and death (38.56% vs. 14.73%). However, no significant difference was found in the duration of ventilation between the two groups. Conclusion: Hypomagnesemia is associated with a higher mortality rate in critically ill patients. The need for ventilatory support, but not its duration is significantly higher in hypomagnesemic patients. Hypomagnesemia is commonly associated with sepsis and diabetes mellitus. The duration of MICU stay is significantly higher in patients with low serum Mg.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Serum creatine phosphokinase as predictor of intermediate syndrome in organophosphorus poisoning p. 384
G Chetan Kumar, K Bhuvana, PN Venkatarathnamma, N Sarala
Background: Organophosphorus (OP) compounds are commonly used pesticides. In OP poisoning, intermediate syndrome (IMS) manifests between the end of the acute cholinergic crisis and delayed neuropathy. Respiratory paralysis in IMS, if identified early can reduce the need for ventilator support, morbidity, and mortality. Serum creatine phosphokinase (CPK) is elevated in IMS. The objectives of our study were to measure serum CPK level, correlate CPK levels with severity of poisoning and estimate atropine dose used. Materials and Methods: A prospective, observational study was conducted for 1-year. Patients diagnosed with OP poisoning were included. Demographic characteristics, type of poison, time since poisoning, Peradeniya Organophosphorus Poisoning (POP) score, serum pseudocholinesterase, CPK levels, atropine dose, and outcome of treatment were documented. Results: Seventy-five patients were recruited of which 57% and 43% were males and females, respectively, with a mean age of 31.48 ± 11.76 years. The most common OP compound was chlorpyriphos followed by triazophos and methylparathion. The time required to reach hospital was 181.26 ± 89.53 min. About 73.3% and 26.7% of patients had mild and moderate poisoning, respectively, as per POP scale. Pseudocholinesterase level was 364 (205-2168) IU. The amount of atropine used was 190.66 ± 78.83 mg. Serial serum CPK values were 279.72 ± 350.21 IU, 389.78 ± 376.33 IU and 163.13 ± 155.15 IU at admission, 48 h, and 96 h after admission, respectively. A weak positive correlation between serum CPK levels and severity of poisoning (r = 0.352) was observed. All patients recovered completely within 10.69 ± 5.57 days. Three patients developed IMS, and their serial CPK levels were 1837.33 ± 243.19 IU/L, 1935 ± 97.41 IU/L, and 714.66 ± 394.82 IU/L; and recovered in 17 ± 5.6 days. Conclusion: Increased serum CPK levels at 48 h after poisoning was observed in all the patients, but three patients had more than 1500 IU/L, who manifested with IMS. Early diagnosis of IMS by serial estimation of CPK may help in timely intervention and reduce further life-threatening complications.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Hemodynamic monitoring in Nigerian patients undergoing high-risk surgery p. 388
Babatunde Babasola Osinaike
Background: Hemodynamic monitoring (HM) and optimization of cardiac output and parameters of dynamic fluid responsiveness is said to improve perioperative outcome in high-risk surgical patients (HRSP). There is insufficient data to determine the burden of care and HM practices in HRSP in Nigeria. Hence, the need to assess and document the current hemodynamic management practices of anesthetists in Nigeria regarding patients undergoing high-risk surgery. Methods: An electronic mail (E-mail) based survey was conducted among 180 consultant members of the Nigeria Society of Anaesthetists. The survey contained 24 questions that range from practice location, experience in the perioperative management of high-risk patients, expectations of care, to what is available to the anesthetists to provide such care. The survey was on for 3 months. Results: A total of 157 E-mail messages were delivered, and 73 responses were received, giving a response rate of 46.5%. The survey showed that 67 (91.8%) of respondents provide or directly supervise anesthesia for HRSP, 50 (84%) of them do this 1-5 times a week. Noninvasive blood pressure (83.6%) was routinely monitored while the central venous pressure (CVP 35.6%), invasive blood pressure (28.8%), and cardiac output (1.4%) monitored less often. Urine output, arterial blood pressure, pulse rate, and clinical experience were considered best indicators of volume expansion. Most respondents were of the opinion that oxygen delivery to tissues is of major importance during the management of HRSP. Conclusion: Nigerian consultant anesthetists employ mostly noninvasive blood pressure, CVP, and invasive blood pressure for HM in HRSP. Though a good knowledge of hemodynamic goals was demonstrated, most rated their practice as inadequate.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The comparison of stroke volume variation with central venous pressure in predicting fluid responsiveness in septic patients with acute circulatory failure p. 394
Santhalakshmi Angappan, Satyen Parida, Arumugam Vasudevan, Ashok Shankar Badhe
Purpose: The present study was designed to investigate the efficacy of stroke volume variation (SVV) in predicting fluid responsiveness and compare it to traditional measures of volume status assessment like central venous pressure (CVP). Methods: Forty-five mechanically ventilated patients in sepsis with acute circulatory failure. Patients were not included when they had atrial fibrillation, other severe arrhythmias, permanent pacemaker, or needed mechanical cardiac support. Furthermore, excluded were patients with hypoxemia and a CVP >12. Patients received volume expansion in the form of 500 ml of 6% hydroxyethyl starch. Results: The volume expansion-induced increase in  cardiac index (CI) was >15% in 29 patients (labeled responders) and <15% in 16 patients (labeled nonresponders). Before volume expansion, SVV was higher in responders than in nonresponders. Receiver operating characteristic curves analysis showed that SVV was a more accurate indicator of fluid responsiveness than CVP. Before volume expansion, an SVV value of 13% allowed discrimination between responders and nonresponders with a sensitivity of 78% and a specificity of 89%. Volume expansion-induced changes in CI weakly and positively correlated with SVV before volume expansion. Volume expansion decreased SVV from 18.86 ± 4.35 to 7.57 ± 1.80 and volume expansion-induced changes in SVV moderately correlated with volume expansion-induced changes in CI. Conclusions: When predicting fluid responsiveness in mechanically ventilated patients in septic shock, SVV is more effective than CVP. Nevertheless, the overall correlation of baseline SVV with increases in CI remains poor. Trends in SVV, as reflected by decreases with volume replacement, seem to correlate much better with increases in CI.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Early goal-directed therapy reduces mortality in adult patients with severe sepsis and septic shock: Systematic review and meta-analysis Highly accessed article p. 401
Legese Chelkeba, Arezoo Ahmadi, Mohammad Abdollahi, Atabak Najafi, Mojtaba Mojtahedzadeh
Introduction: Survival sepsis campaign guidelines have promoted early goal-directed therapy (EGDT) as a means for reduction of mortality. On the other hand, there were conflicting results coming out of recently published meta-analyses on mortality benefits of EGDT in patients with severe sepsis and septic shock. On top of that, the findings of three recently done randomized clinical trials (RCTs) showed no survival benefit by employing EGDT compared to usual care. Therefore, we aimed to do a meta-analysis to evaluate the effect of EGDT on mortality in severe sepsis and septic shock patients. Methodology: We included RCTs that compared EGDT with usual care in our meta-analysis. We searched in Hinari, PubMed, EMBASE, and Cochrane central register of controlled trials electronic databases and other articles manually from lists of references of extracted articles. Our primary end point was overall mortality. Results: A total of nine trails comprising 4783 patients included in our analysis. We found that EGDT significantly reduced mortality in a random-effect model (RR, 0.86; 95% confidence interval [CI], 0.72–0.94; P = 0.008;   I 2 =50%). We also did subgroup analysis stratifying the studies by the socioeconomic status of the country where studies were conducted, risk of bias, the number of sites where the trials were conducted, setting of trials, publication year, and sample size. Accordingly, trials carried out in low to middle economic income countries (RR, 0.078; 95% CI, 0.67–0.91; P = 0.002; I2 = 34%) significantly reduced mortality compared to those in higher income countries (RR, 0.93; 95% CI, 0.33–1.06; P = 0.28; I2 = 29%). On the other hand, patients receiving EGDT had longer length of hospital stay compared to the usual care (mean difference, 0.49; 95% CI, –0.04–1.02; P = 0.07; I2 = 0%). Conclusion: The result of our study showed that EGDT significantly reduced mortality in patients with severe sepsis and septic shock. Paradoxically, EGDT increased the length of hospital stay compared to usual routine care.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Level of knowledge about anaphylaxis and its management among health care providers p. 412
HS Drupad, H Nagabushan
Objectives: This study was conducted to assess the level of knowledge of health care providers regarding anaphylaxis and its management at a tertiary care teaching hospital. Materials and Methods: A pretested structured questionnaire was administered to interns, MBBS Phase II students, and nursing students. The subjects were asked to answer the questionnaire, which included questions regarding anaphylaxis and its management. Results: Of 265 subjects, 151 (56.9%) of subjects answered correctly that adrenaline is the first line of drug for the treatment of anaphylaxis. Among 151 subjects, 40 (26.4%) answered the correct dose of adrenaline, of which 25 (16.5%) subjects selected intramuscular injection as the most appropriate route of administration. Medical students' performance was better than interns and nursing students on questions regarding dose, route, and site of adrenaline administration. Conclusion: Knowledge regarding the management of anaphylaxis was inadequate in almost all the health care providers who were included in the study. Improved education and training of health care providers are necessary for better management of anaphylaxis.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Epstein-Barr virus infection-Related hemophagocytic lymphohistiocytosis p. 416
Navin Kumar, Chitra Mehta, Smita Sarma, Sumit Singh, Yatin Mehta
We report a case of 27-year-old female diagnosed with hemophagocytic lymphohistiocytosis (HLH) following a recent Epstein-Barr virus (EBV) infection. A known case of relapsing remitting multiple sclerosis on corticosteroids for last 6 months presented to the critical care unit with fever, maculopapular rash and difficulty in breathing. A rapid and correct diagnosis with the precise treatment led to complete recovery of this patient. The HLH is a rare complication of primary EBV infection.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Sepsis of unknown origin with multiorgan failure syndrome: Think of hemophagocytic lymphohistiocytosis p. 419
Namrata Maheshwari, Amit Kumar Mandal, Neeru Sahni
Hemophagocytic lymphohistiocytosis is a clinic pathologic entity characterized by increased proliferation and activation of benign macrophages with hemophagocytosis throughout the reticuloendothelial system. It is a potentially lethal disorder due to an uncontrolled immune response to a triggering agent. HPS may be primary, or secondary to malignancy, infections, auto-immune diseases, and pharmacotherapy. HPS is a rare, but life-threatening complication. Herein, we described a female patient with HPS with secondary sepsis. Our objective was to raise the importance of early diagnosis of HFS by presenting a representative case.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

The rabies early death phenomenon: A report of ineffective administration of rabies vaccine during symptomatic disease p. 422
Mahmoud Sadeghi, Shams-ali Hadizadeh Moallem, Elham Yousefi-Abdolmaleki, Mohammad Montazeri
It was reported that in some individuals who received postexposure rabies vaccine, clinical features of rabies developed at the shorter time compared to individuals who were exposed, but not received the vaccine, which called "early death" phenomenon. We reported an early death phenomenon in a 67-year-old woman who was bitten by a jackal, although receiving three dose of rabies vaccine. Results show that the immune response to rabies has a dual role, sometimes has a favorable effect on survival but sometimes amplification the disease.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Reversal of severe lactic acidosis with thiamine in a renal allograft recipient p. 425
K Nanda Kumar, Veena R Shah, Beena K Parikh, Sumedha Sonde
A 48-year-old female patient with end-stage renal failure developed unexplained severe lactic acidosis (LA) associated with hyperglycemia during robotic-assisted laparoscopic renal transplantation. Initial treatment with sodium bicarbonate and insulin infusion were ineffective in treating acidemia. Postoperatively, intravenous administration of thiamine resulted in rapid improvement of LA and blood sugar levels. Uremia and chronic hemodialysis might be the causes behind the quantitative/qualitative deficiency of thiamine unmasked during the surgical stress. Though a rare entity, acute thiamine deficiency should be considered in the differential diagnosis of unexplained severe LA in patients with chronic kidney disease and hemodialysis who undergo major surgery or admitted to critical illness care units.
[ABSTRACT]  [HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Unusual occurrence of ventricular tachycardia induced by single bee sting p. 429
Zoran Stajic, Predrag Djuric, Aleksandra Grdinic, Zdravko Mijailovic
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Peripheral venous pressure as a reliable predictor for monitoring central venous pressure in patients with burns p. 430
Shakti Bedanta Mishra, Afzal Azim
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Complications during the management of pediatric refractory status epilepticus with benzodiazepine and pentobarbital infusions p. 431
Mahmood Dhahir Al-Mendalawi
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Scrub typhus and acute respiratory distress syndrome p. 432
Shakti Bedanta Mishra, Afzal Azim
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Conducting a national survey p. 433
Sunil Kumar Raina
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Recurring tragedy of road traffic accidents in India: Challenges and opportunities p. 434
Kalaivani Annadurai, Geetha Mani, Raja Danasekaran
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

An unusual presentation of deltamethrin poisoning p. 435
Renu Bala, Navdeep Kaur, Arnab Bannerji, Rashmi Virmani
[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta

Extra corporeal carbon dioxide removal: A reliable modality in refractory hypercapnia to prevent invasive ventilation: Retraction p. 438

[HTML Full text]  [PDF]  [Mobile Full text]  [EPub]  [Sword Plugin for Repository]Beta
Online since 7th April '04
Published by Wolters Kluwer - Medknow