Background: Laryngeal injuries following intubation have a reported incidence from 63 to 94% and permanent sequelae are reported to be about 10 to 22% in the world literature. While several studies assessing the laryngeal complications are available in Caucasoid populations, minimal data is available in the literature regarding south Indian population. Aim: The aim of this study was to evaluate laryngeal lesions in patients after prolonged intubation (>24 h), to correlate these lesions with the variables involved in the process of intubation and to determine the risk factors. Materials and Methods: This is a prospective study for 1 year of patients who were intubated for more than 24 h in our critical care unit. Patients underwent laryngeal video endoscopy on the day of extubation and after 3 weeks by an ENT surgeon who was blinded to the intubation variables. Result: About 51 patients were included in the study. Laryngeal abnormalities were seen in 41 patients on the day of extubation. At the end of third week after extubation, only 10 patients had abnormal laryngeal findings. A multivariate stepwise regression model showed that bigger tube size ( P =0.02), longer duration of intubation ( P =0.01) and emergency intubation ( P = 0.02) was associated with higher incidence of laryngeal complications on the day of extubation. At the end of third week laryngeal findings were influenced only by the duration of intubation ( P =0.001). Conclusion: Laryngeal sequelae after extubation is directly associated with duration of intubation.

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Background: The demand for critical care beds among the medical services has already exceeded its supply. Thus allocating intensive care unit (ICU) beds to emergency cases is even more difficult task after doing triage for high risk scheduled elective cases as they fulfill the threshold for post operative intensive care. Materials and Methods: Retrospective observational study was done at Level-3 surgical ICU at tertiary referral hospital. Patients requiring mandatory postoperative ventilatory support and/ or ionotropic support who needed continuous haemodynamic monitoring were included in study. They were studied in two groups of elective and emergency cases against three headings of requisitions received for admissions, beds allotted for surgeries and patients admitted for postoperative intensive care. Intervention: One ICU bed was provided for emergency surgical case on daily basis. Other surgical admissions were triaged in three stages. Triage-1: It was done during preanaesthetic check-up and high risk patients were identified. Requisition forms in prescribed proforma were sent for level 2 triage, a day prior to surgery in all pre-booked elective cases. Triage-2: Urgency, refusals or appropriateness for admission was reassessed on prescribed proforma at second level triage by ICU in-charge. Triage-3: This was done for all operated patients in OT or recovery room by OT anaesthetist in consultation with operating surgical team. Result: Beds were allotted for 85.4% of emergency cases as against 74.7% of elective cases of total requisitions received for admissions. Out of these, 11.4% of emergency cases didn't meet the criteria for postoperative ICU care as against 51.2% of elective cases even when the beds were confirmed preoperatively. We admitted 124 cases over 6 months. Pearson's Chi Square test was used as test of significance. Conclusion: Individual institutional triage policy was helpful in equitable, ethical and efficient use of ICU beds for emergency services.

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Atypical antipsychotic drugs are associated with metabolic disturbances like weight gain, type 2 diabetes hyperglycaemia and dyslipedemia, which can result in serious health risk in patients. Diabetic ketoacidosis resulting in serious metabolic acidosis, occurring in a schizophrenic patient on treatment with clozapine is being reported to draw attention this association. Frequent monitoring of the blood sugar and lipids is advised before and during therapy with atypical antipsychotic drugs.

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Spinal cord injury without radiological abnormality is rare in adults. Below we present a case report of 20 yrs old male with isolated cervical cord injury, without accompanying vertebral dislocation or fracture involving the spinal canal rim. He fell down on plain and smooth ground while carrying 40 kg weight overhead and developed quadriparesis with difficulty in respiration. Plain radiographs of the neck revealed no fractures or dislocations. MRI showed bulky spinal cord and an abnormal hyper intense signal on the T2W image from C2 vertebral body level to C3/4 intervertebral disc level predominantly in the anterior aspect of the cord The patient was managed conservatively with head halter traction and invasive ventilatory support for the initial 7 days period in the ICU. In our patient recovery was good and most of the neurological deficit improved over 4 weeks with conservative management.

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Aim: To study the prevalence of symptoms suggestive of post-traumatic stress disorder in relatives of severe trauma patients admitted to the ICU. Materials and Methods: 177 relatives of trauma patients admitted to the ICU were studied to evaluate the negative psychological impact resulting from this admission by using the impact of event scale-revised [IES-R]. About 76 of these relatives could be followed up again with questionnaire after 2 years. Result: Of the 177 relatives, 85 (48%) were males and 92 (52%) females with no statistically significant difference in their scores. About 7 days after admission, 34-54% of the 177 relatives had moderate and 19-41% had severe symptoms suggestive of PTSD. For the 76 relatives who participated in both 2002 and 2004, symptoms suggestive of PTSD were moderate in 39-61% and severe in 12-39% initially. After 2 years the scores were moderate in 12-14% and severe in 4-5%. Maximum scores amongst the three subscales were for hyperarrousal symptom with mean scores of 2.1±1. In the group-which could be followed up after 2 years, initially 79% of the respondents had sum of IES-R scores ?26 suggesting severe symptoms, which declined to 14% after 2 years. Conclusion: Findings of this study suggest that 79% of the relatives of severe trauma patients develop PTSD symptoms following ICU admission. In most, the scores reduced with time but 14% continued to have severe scores at the end of 2 years suggesting the presence of persisting psychological disturbance in them.

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Organophosphate (OP) poisoning is very common form of poisoning in Indian population because of its availability and easy access. Intoxication occurs following the absorption of OP agents through gastrointestinal tract, skin and respiratory tract and rarely by intramuscular or intravenous route. The clinical features depend on the amount of the poison consumed, it's concentration, the route of administration and the time of instituting therapy. We are reporting a case of an intravenous monochrotophos poisoning, an unusual way of intoxication, which was managed in our ICU.

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Background: Adrenal insufficiency is a common occurrence in the critically ill and it is essential that intensivists and endocrinologists involved in the care of these patients have a good understanding of the concepts related to this condition. Objectives: To assess the knowledge, attitudes and practices about adrenal insufficiency in the critically ill among the endocrinologists and intensivists practicing in the city of Chennai. Materials and Methods: Questionnaires containing ten questions pertaining to adrenal insufficiency in the critically ill were sent to a total of six endocrinologists and 52 intensivists practicing in Chennai. Results: About 77% of all the respondents agreed to the fact that adrenal insufficiency is a frequent occurrence in critical illness. But 57% of them felt that there is no need for routine evaluation of critically ill patients for adrenal insufficiency. Random serum cortisol was selected by 62% of the responders as the method for evaluating adrenal function in the critically ill. There is clearly no agreement among the endocrinologists or the intensivists on the various cut off levels for diagnosis. Neither is there a clear consensus on the method followed for treatment of patients with adrenal insufficiency in the critical care unit. Conclusion: There is no concordance in the knowledge, attitudes or practices on adrenal insufficiency in the critically ill among the endocrinologists and intensivists in Chennai. There is a need for developing standard diagnostic and treatment guidelines and making it available for all the practicing endocrinologists and intensivists.

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