Indian Journal of Critical Care Medicine

Register      Login

Current Issue

Volume 28, Number 4, April 2024
Total Views

EDITORIAL

Omender Singh, Deven Juneja, Prashant Nasa

Toxicoepidemiology of Acute Poisoning: A Classic Tale of Two Indias

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:2] [Pages No:315 - 316]

Keywords: Acute poisoning, Epidemiology, Insecticide poisoning, Intensive care units, Toxicology

   DOI: 10.5005/jp-journals-10071-24692  |  Open Access |  How to cite  | 

228

EDITORIAL

Saswati Sinha

Cardiopulmonary Resuscitation Training and Reinforcement: A Bulwark against Death

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:3] [Pages No:317 - 319]

Keywords: Advanced life support, BLS training, Cardiac arrest, Cardio pulmonary resuscitation, Cardiopulmonary resuscitation, Competency based training, Life-saving skill medical undergraduates, Questionnaires

   DOI: 10.5005/jp-journals-10071-24690  |  Open Access |  How to cite  | 

160

EDITORIAL

Dedeepiya Devaprasad Vidyasagar

Is it Time to Develop an Indian Sepsis-related Mortality Prediction Score?

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:3] [Pages No:320 - 322]

Keywords: 90-day mortality, Mortality prediction, Sepsis, Severity score

   DOI: 10.5005/jp-journals-10071-24693  |  Open Access |  How to cite  | 

162

EDITORIAL

Natesh Prabu Ravisankar

Venoarterial Partial Pressure of Carbon Dioxide Difference: Let's Trend It!

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:3] [Pages No:323 - 325]

Keywords: Acute circulatory failure, Integrate hemodynamic parameters, Partial pressure of carbon dioxide, Serum lactates and central venous oxygen saturation, Venoarterial difference in the partial pressure of carbon dioxide/venoarterial difference in the carbon dioxide content or partial pressure of carbon dioxide gap/arterial-to-venous oxygen content difference

   DOI: 10.5005/jp-journals-10071-24695  |  Open Access |  How to cite  | 

146

EDITORIAL

Lalita G Mitra, Jagdeep Sharma, Harsimran S Walia

Improving Work–life Balance and Satisfaction to Improve Patient Care

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:3] [Pages No:326 - 328]

Keywords: Compassion fatigue, ICU health workers, Psychosocial risk, Quality of work life

   DOI: 10.5005/jp-journals-10071-24689  |  Open Access |  How to cite  | 

250

Original Article

Narayanasamy Krishnasamy, R Narmadhalakshmi, Parameshwari Prahalad, R Jayalakshmi, R Lokesh, Jayanthi Ramesh, G Murali Mohan Reddy, Latha Durai

Determinants of Poison-related Mortality in Tertiary Care Hospital, South India

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:7] [Pages No:329 - 335]

Keywords: Acute poisoning, Corrosives, Insecticides, Mortality

   DOI: 10.5005/jp-journals-10071-24668  |  Open Access |  How to cite  | 

Abstract

Aims and background: Acute poisoning is one of the most common emergencies in India and around the world. Understanding the factors associated with mortality can aid us in devising appropriate preventive strategies to curtail deaths due to poisoning. Purpose of this study is to find various factors that determine the mortality among acute poisoning cases admitted in a tertiary care center. Materials and methods: A retrospective hospital records-based study was conducted at Chengalpattu Medical College Hospital. The study included 2,123 cases of various poisoning cases admitted for a year from January to December 2022. Cases of bites, stings, drowning, and hanging were excluded. Information on sociodemographic profile, type of poison, time since ingestion and admission, and treatment outcome were collected using a structured pro forma. Results: The mean age of the study population was 29.90 ± 14.98 years. Poisoning was found to be predominantly among males (56.42%) and residents of rural areas (58%). Insecticide consumption (27.0%) was the most common modality, followed by oleander poisoning (20%), corrosive poison (17%), rat poison (15%), tablet poison (13%), and other poisons. The overall case fatality rate (CFR) was 5.2%, with the highest CFR of 12.25% with insecticide poisoning. In multivariate analysis, Glasgow coma scale (GCS) score at admission is the only parameter showing a statistically significant association with mortality (adjusted odds-ratio 0.271(0.2–0.38, p-value < 0.01). Conclusion: Acute poisoning primarily affects the young and economically productive population. In the south Indian population, pesticides are still the major contributor though corrosives are a major contributor among children. Mortality is still significant, and GCS status admission is the only predictor of mortality.

192

Original Article

Ayush Agarwal, Upendra Baitha, Piyush Ranjan, Neeraj K Swarnkar, Gyaninder P Singh, Dalim K Baidya, Rakesh Garg, Nishkarsh Gupta, Arindam Choudhury, Arvind Kumar, Ambuj Roy, Nitish Naik, Maroof Ahmed Khan, Naveet Wig

Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:7] [Pages No:336 - 342]

Keywords: Cardiopulmonary resuscitation, Healthcare workers, Knowledge, Skills training

   DOI: 10.5005/jp-journals-10071-24670  |  Open Access |  How to cite  | 

Abstract

Aim and background: High-quality cardiopulmonary resuscitation (CPR) is associated with improved patient outcomes, but healthcare workers (HCWs) may be frequently undertrained. This study aimed to assess baseline knowledge and skills among HCWs about basic and advanced life support and the effect of simulation-based training on it. Methods: It was a single-center prospective quasi-interventional study among resident doctors and nurses at a Tertiary Center in New Delhi, India. A questionnaire-based assessment was done to assess baseline knowledge. The participants then underwent simulation-based training followed by questionnaire-based knowledge assessment and skill assessment. A repeat questionnaire-based assessment was done 6 months post-training to assess knowledge retention. Results: A total of 82 HCWs (54 doctors and 28 nurses) were enrolled. The participants scored 22.28 ± 6.06 out of 35 (63.65%) in the pre-training knowledge assessment, with low scores in post-cardiac arrest care, advanced life support, and defibrillation. After the training, there was a significant rise in scores to 28.32 ± 4.08 out of 35 (80.9%) (p < 0.01). The retention of knowledge at 6 months was 68.87% (p < 0.01). The participants scored 92.61 ± 4.75% marks in skill assessment with lower scores in chest compressions and team leadership roles. There was a positive correlation (r = 0.35) between knowledge and skills scores (p < 0.01). Conclusion: There is a progressive decrease in baseline knowledge of HCWs with the further steps in the adult chain of survival. The simulation training program had a positive impact on the knowledge of HCWs. The training programs should focus on defibrillation, advanced life support, post-cardiac arrest care, and leadership roles.

Supplementary File

221

Original Article

Natthaka Sathaporn, Bodin Khwannimit

Comparative Predictive Accuracies of the Simplified Mortality Score for the Intensive Care Unit, Sepsis Severity Score, and Standard Severity Scores for 90-day Mortality in Sepsis Patients

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:6] [Pages No:343 - 348]

Keywords: Intensive care unit, Mortality, Risk prediction, Severity score

   DOI: 10.5005/jp-journals-10071-24673  |  Open Access |  How to cite  | 

Abstract

Background: The standard severity scores were used for predicting hospital mortality of intensive care unit (ICU) patients. Recently, the new predictive score, Simplified Mortality Score for the ICU (SMS–ICU), was developed for predicting 90-day mortality. Objective: To validate the ability of the SMS–ICU and compare with sepsis severity score (SSS) and original severity scores for predicting 90-day mortality in sepsis patients. Method: An analysis of retrospective data was conducted in the ICU of a university teaching hospital. Also, 90-day mortality was used for the primary outcome. Results: A total of 1,161 patients with sepsis were included. The 90-day mortality was 42.4%. The SMS–ICU presented the area under the receiver operating characteristic curve (AUROC) of 0.71, whereas the SSS had significantly higher AUROC than that of the SMS–ICU (AUROC 0.876, p < 0.001). The acute physiology and chronic health evaluation (APACHE) II and IV, and the simplified acute physiology scores (SAPS) II demonstrated good discrimination, with an AUROC above 0.90. The SMS–ICU provides poor calibration for 90-day mortality prediction, similar to the SSS and other standard severity scores. Furthermore, 90-day mortality was underestimated by the SMS–ICU, which had a standardized mortality ratio (SMR) of 1.36. The overall performance by Brier score demonstrated that the SMS–ICU was inferior to the SSS (0.222 and 0.169, respectively). Also, SAPS II presented the best overall performance with a Brier score of 0.092. Conclusion: The SMS–ICU indicated lower performance compared to the SSS, standard severity scores. Consequently, modifications are required to enhance the performance of the SMS–ICU.

Supplementary File

208

Original Article

Kapil G Zirpe, Anand M Tiwari, Atul P Kulkarni, Hrishikesh S Vaidya, Sushma K Gurav, Abhijit M Deshmukh, Prasad B Suryawanshi, Upendrakumar S Kapse, Abhaya P Bhoyar, Piyush A Dhawad, Shameek Mukherjee

The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (PCO2 Gap) during Resuscitation Affects ICU Outcomes: A Prospective Observational Study

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:6] [Pages No:349 - 354]

Keywords: Cardiac index, Circulatory shock, Hemodynamic resuscitation, PCO2 gap, Serum lactate

   DOI: 10.5005/jp-journals-10071-24680  |  Open Access |  How to cite  | 

Abstract

Introduction: The usual methods of perfusion assessment in patients with shock, such as capillary refill time, skin mottling, and serial serum lactate measurements have many limitations. Veno-arterial difference in the partial pressure of carbon dioxide (PCO2 gap) is advocated being more reliable. We evaluated serial change in PCO2 gap during resuscitation in circulatory shock and its effect on ICU outcomes. Materials and methods: This prospective observational study included 110 adults with circulatory shock. Patients were resuscitated as per current standards of care. We recorded invasive arterial pressure, urine output, cardiac index (CI), PCO2 gap at ICU admission at 6, 12, and 24 hours, and various patient outcomes. Results: Significant decrease in PCO2 gap was observed at 6 h and was accompanied by improvement in serum lactate, mean arterial pressure, CI and urine output in (n = 61). We compared these patients with those in whom this decrease did not occur (n = 49). Mortality and ICU LOS was significantly lower in patients with low PCO2 gap, while more patients with high PCO2 gap required RRT. Conclusion: We found that a persistently high PCO2 gap at 6 and 12 h following resuscitation in patients with shock of various etiologies, was associated with increased mortality, need for RRT and increased ICU LOS. High PCO2 gap had a moderate discriminative ability to predict mortality.

218

Original Article

Laura del P Quinones-Rozo, Gladys Eugenia Canaval-Erazo, Lina M Sandoval-Moreno

Predictors of Quality of Work Life in Health Care Workers at Adult Critical Care Units: A Cross-sectional Study

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:9] [Pages No:355 - 363]

Keywords: Compassion fatigue, Critical care, Health workforce, Psychosocial risk, Quality of life, Work

   DOI: 10.5005/jp-journals-10071-24681  |  Open Access |  How to cite  | 

Abstract

Aim and background: Satisfaction with the quality of work life reflects the inadequate distribution of the workforce in critical care units and is not enough; on many occasions, they work in precarious conditions and with high levels of physical, emotional, spiritual, and social demands, impacting the quality of care. Aim: To identify predictors of the quality of work life of healthcare workers in adult critical care units (ACCU). Materials and methods: Quantitative study, cross-sectional analytical design with stratified two-stage sampling; three instruments were applied to 209 healthcare professionals in adult critical care units in different sites in a region of Colombia, concerning Quality of Life at Work—GOHISALO, Copenhagen Psychosocial Questionnaire—COPSOQ and Professional Quality of Life—ProQoL V. Multiple ordinal logistic regression was performed with exposure variables from the COPSOQ and ProQoL domains; the outcome variables were the dimensions of the Quality of Work Life instrument. Ethical standards for research involving human subjects were ensured. Results: According to the results of the multiple logistic models, quality of work life is predicted by job integration and predictability (OR = 6.93; 95% CI = 3.6–13.9), leisure time management and double presence (OR = 4.5; 95% CI = 1.22–8.79). Both job satisfaction and job security are related to leadership quality (OR=3.82; 95% CI = 2.27–6.55 and OR = 3.18; 95% CI = 1.22–8.79), respectively. Conclusions: The quality of work life of healthcare workers in adult intensive care units is predicted by quantitative demands, double presence, emotional demands, work pace, predictability, vertical trust, and quality of leadership.

197

Original Article

Teena Sharon, Shalini Ganesh Nayak, Vishal Shanbhag, Suvarna Hebbar

An Observational Study of Nutritional Assessment, Prescription, Practices, and Its Outcome among Critically Ill Patients Admitted to an Intensive Care Unit

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:5] [Pages No:364 - 368]

Keywords: Clinical outcomes, Critically ill patients, Intensive care units, mNUTRIC score, Malnutrition, Observational study Quadriceps muscle mass, Quadriceps muscle mass index, Ultrasound

   DOI: 10.5005/jp-journals-10071-24676  |  Open Access |  How to cite  | 

Abstract

Aim and background: Optimal feeding strategy for critically ill patients of intensive care unit (ICU) is often a matter of debate as patients admitted to ICU are highly catabolic and reduction in muscle mass is very common. We aimed at early achievement of nutritional goals in preventing skeletal muscle breakdown and improving clinical outcomes among critically ill patients with high risk of malnutrition. Materials and methods: Nutrition risk in the critically ill (mNUTRIC) Score was used to identify the risk of malnutrition within 24 hours of admission. Quadriceps muscle mass index was measured within 24 hours of admission to ICU and repeated on 7th day. Enteral feeding was monitored by the nutrition expert as part of routine patient care and clinical outcomes were monitored. Results: A total of 287 patients admitted in ICU were screened for malnutrition and 60 (20.9%) of them had high score (>5). There was no statistically significant reduction in the quadriceps muscle mass index (p < 0.05) (t = 0.601) measured within 24 hours of admission and on the 7th day of ICU stay, signifying that the nutritional prescription and monitoring may be useful in preserving the muscle mass. This study did not find statistically significant association between the high mNUTRIC score on admission and the clinical outcomes, such as 28 days mortality, incidence of pressure ulcers, length of ICU stay, and hospital-acquired infection (p > 0.05). Conclusion: Early initiation and maintenance of enteral nutrition is essential for meeting target calories and protein requirements. It may help to preserve muscle mass in critically ill patients who are otherwise at high risk of malnutrition.

212

Original Article

Kamil Inci, Gül Gürsel

Accuracy of Pocket-sized Ultrasound Devices to Evaluate Inferior Vena Cava Diameter and Variability in Critically Ill Patients

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:6] [Pages No:369 - 374]

Keywords: Inferior vena cava, Inferior vena cava diameter, Pocket-sized ultrasound device, Standard ultrasound device

   DOI: 10.5005/jp-journals-10071-24674  |  Open Access |  How to cite  | 

Abstract

Purpose: By using inferior vena cava (IVC) measurements, clinicians can detect fluid status and responsiveness and find out the etiology of hypotension, acute heart failure, and sepsis easier. Pocket-sized ultrasound devices (PSUD) may take this advantage a few steps further by their lower costs, user-friendly interface, and easily applicable structure. In this study, we aimed to determine the diagnostic value of a PSUD compared with a standard ultrasound device (SD) for the measurement of IVC diameter (IVCD) and its respiratory variability. Materials and methods: We measured the inspiratory, expiratory diameters of IVC, and calculated the inferior vena cava collapsibility index (IVCCI). We investigated 42 intensive care unit (ICU) patients. Results: There was no difference in inspiratory (PSUD: 1.34 ± 0.67 cm; SD: 1.35 ± 0.68 cm) and expiratory (PSUD: 1.98 ± 0.53 cm; SD: 2.01 ± 0.49 cm) IVCD among measurements with PSUD and SD (p > 0.05). There was also no difference between IVCCI's measured with PSUD (39 ± 20%) and SD (39 ± 20%) (p > 0.05). The Bland–Altman analysis revealed that the width of 95% limits of agreement were similar for both devices. There was a good inter-device agreement among PSUD and SD for measurements of IVCD, and there was no difference between IVCCI's measured using both ultrasound devices. Conclusion: We support that the idea of a PSUD is as reliable as a SD for IVC measurements.

194

Original Article

Pooja Jaiswal, Suman Saini, Priyanka H Chhabra

Subclavian Vein Cannulation via Supraclavicular or Infraclavicular Route Which is Better? A Prospective Randomized Controlled Trial

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:6] [Pages No:375 - 380]

Keywords: Access, Complications, Infraclavicular, Route, Subclavian, Supraclavicular, Ultrasound

   DOI: 10.5005/jp-journals-10071-24686  |  Open Access |  How to cite  | 

Abstract

Background and objectives: The subclavian vein is frequently cannulated using ultrasound. There are two techniques of subclavian vein catheterization (SVC): Supraclavicular (SC) and infraclavicular (IC). Though the IC route is often preferred, the SC approach offers several distinct advantages. This study was planned to compare the technique of SVC using SC and IC approaches in terms of catheterization technique and complications in elective surgeries in adults. Methods: Sixty American Society of Anesthesiologists (ASA) 1, 2, or 3 adult patients posted for elective surgeries under general anesthesia were recruited. Patients were divided into SC or IC groups randomly. Right-sided subclavian vein was cannulated in both the groups (n = 30). Visualization time, Likert scale, subclavian vein diameter, skin-to-subclavian vein depth, number of attempts, puncture time, ease of guidewire insertion, catheter insertion time, and total procedural time were observed. A comparison of complications for each approach was noted. Results: Total procedural time, time to visualization of the subclavian vein, and puncture time was lower for group SC and higher for group IC. Catheter insertion time was higher with the IC approach than with the SC approach. Better ultrasound view scores were seen in group SC than in group IC. The first attempt success rate was higher in group SC than in group IC. Comparatively, lower complications both during and after the procedure were noted in the SC approach than the IC approach. Conclusion: Ultrasonography (USG) guidance guided SC approach to access the subclavian vein is quicker, relatively secure, and a better technique than the IC approach. Additionally, the SC approach is associated with comparatively fewer immediate and delayed complications.

162

Original Article

Emerson Boschi, Gilberto Friedman, Rafael B Moraes

Effects of Glycemic Variability in Critically Ill Patients with Coronavirus Disease 2019: A Retrospective Observational Study

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:6] [Pages No:381 - 386]

Keywords: Coronavirus 2019, Critical care, Diabetes mellitus, Glycemic variability, Hyperglycemia, Respiratory distress syndrome

   DOI: 10.5005/jp-journals-10071-24688  |  Open Access |  How to cite  | 

Abstract

Aim and background: Hyperglycemia is considered an adaptive metabolic manifestation of stress and is associated with poor outcomes. Herein, we analyzed the association between glycemic variability (GV) and hospital mortality in patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU), and the association between GV and mechanical ventilation (MV), ICU stay, length of hospital stays, renal replacement therapy (RRT), hypoglycemia, nosocomial infections, insulin use, and corticosteroid class. Materials and methods: In this retrospective observational study, we collected information on blood glucose levels during the first 10 days of hospitalization in a cohort of ICU patients with COVID-19 and its association with outcomes. Results: In 239 patients, an association was observed between GV and hospital mortality between the first and last quartiles among patients without diabetes [odds ratio (OR), 3.78; confidence interval, 1.24–11.5]. A higher GV was associated with a greater need for RRT (p = 0.002), regular insulin (p < 0.001), and episodes of hypoglycemia (p < 0.001). Nosocomial infections were associated with intermediate GV quartiles (p = 0.02). The corticosteroid class had no association with GV (p = 0.21). Conclusion: Glycemic variability was associated with high mortality in patients with COVID-19 and observed in the subgroup of patients without diabetes. Clinical significance: Glycemic control in critically ill patients remains controversial and hyperglycemia is associated with worse outcomes. Diabetes mellitus (DM) is one of the most prevalent comorbidities in patients with COVID-19. In addition, they require corticosteroids due to pulmonary involvement, representing a challenge and an opportunity to better understand how glycemic changes can influence the outcome of these patients.

215

Original Article

Vikramjeet Singh, Jyotsna Agarwal, Soumya S Nath, Avneesh Sharma

Evaluation of Direct Antimicrobial Susceptibility Testing from Positive Flagged Blood Cultures in Sepsis Patients

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:6] [Pages No:387 - 392]

Keywords: Categorical agreement, Direct antimicrobial susceptibility testing, Enterobacterales, Essential agreement, Flagged blood culture, Gram-positive bacteria, Non-fermenters, Time to release report

   DOI: 10.5005/jp-journals-10071-24687  |  Open Access |  How to cite  | 

Abstract

Background: Presently, many laboratories are equipped with automated system for antimicrobial susceptibility testing (AST) for minimum inhibitory concentration-based reporting which enables the clinician to choose the right antimicrobial for timely treatment of sepsis. The study aimed to assess performance of direct AST from blood culture positive broth using automated AST system for accuracy and time taken to release the report. Materials and methods: The present study conducted in a 25-bedded ICU in North India for 12 months. Single morphotype of bacteria on gram stain from positively flagged blood culture bottles were included, which was directly identified (using an in-house protocol) with MALDI-TOF-MS from positive blood culture broths. DAST was carried out from 200 such blood culture broths and results were compared with reference AST (RAST) which was also done using VITEK-2 using overnight grown bacterial colonies as per standard protocol. Results: Among 60 isolates of Enterobacterales, 99% categorical agreement for both E. coli and K. pneumoniae observed by two methods were tested for AST. Among non-fermenters, Pseudomonas aeruginosa showed a categorical agreement of 99.6%, as compared with Acinetobacter spp. and exotic GNBs, which showed 95–96% agreement. A significant difference of 18–24 hours was noted in time to release the report between DAST and RAST, for GNB and GPC both. Conclusion: Direct AST from positive flagged blood culture bottles can significantly reduce the time to release the bacterial susceptibility report by up to 24 hours, at the same time maintaining the accuracy.

Supplementary File

243

Original Article

Anjana Ramachandran, Pradeep Bhatia, Sadik Mohammed, Manoj Kamal, Swati Chhabra, Bharat Paliwal

Gastric Insufflation with High Flow Nasal Oxygen Therapy in Adult Patients Admitted to Intensive Care Unit: An Observational Study

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:6] [Pages No:393 - 398]

Keywords: Air, Critically ill, Oxygen therapy, Stomach, Ultrasound

   DOI: 10.5005/jp-journals-10071-24691  |  Open Access |  How to cite  | 

Abstract

Background: With the provision of a small positive end-expiratory pressure (PEEP) effect, high-flow nasal oxygen (HFNO) therapy carries a risk of stomach distension. The present study was conducted to find out the air leak in the gastric antrum leading to gastric distension in adult patients with acute respiratory failure receiving HFNO therapy. Materials and methods: Adult patients with early hypoxemic respiratory failure requiring HFNO therapy were enrolled in this trial. Before initiation of HFNO therapy, baseline gastric volume (GV) and the average number of peristaltic contractions over one minute were measured using ultrasound. Once the patient was stabilized on HFNO therapy, a 2nd, 3rd, and 4th ultrasound scans were acquired at 10, 20, and 30 minutes respectively. Vitals and blood gas values were recorded at the baseline and after 30 min of initiation of HFNO therapy. Patient comfort, duration of HFNO therapy, and outcome were also recorded. Results: The GV at 10, 20, and 30 minutes were significantly larger (p < 0.001) compared to baseline. This increase in GV was associated with a significantly increased number of peristaltic contractions and had a significant positive correlation with the HFNO flow (r = 0.541; p < 0.001). The HFNO therapy was well tolerated by most of the patients and led to a significant improvement in the vitals and blood gas parameters at 30 minutes after initiation of HFNO therapy. Conclusion: In adult patients with hypoxemic respiratory failure, the use of HFNO therapy produces gas leaks into the stomach leading to increased gastric volume. The gastric distension increases the peristaltic contraction and higher flows result in more distension.

173

BRIEF RESEARCH COMMUNICATION

Chinmoy Sahu, Radhika Chaudhary, Chitra Bhartiya, Sangram S Patel, Nidhi Bhatnagar

A Retrospective Study on UTI by Myroides Species: An Emerging Drug Resistant Nosocomial Pathogen

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:5] [Pages No:399 - 403]

Keywords: Multidrug resistance, Myroides species, Nosocomial infection, Urinary tract infection

   DOI: 10.5005/jp-journals-10071-24683  |  Open Access |  How to cite  | 

Abstract

Aim and background: Myroides (M.) species are ubiquitous in the environment and cause a variety of infections like urinary tract infections (UTI), sepsis, meningitis, cholecystitis, pneumonia, and soft tissue infections, especially among immunocompromised populations. These are usually resistant to multiple antibiotics. This study aimed to demonstrate the clinical profile, underlying comorbidities, and antimicrobial susceptibility of Myroides isolates obtained from nosocomial UTI cases. Materials and methods: A sudden rise in the isolation of Myroides spp. from the repeated urine samples of admitted patients alerted us to conduct this retrospective observational study. Urine cultures that grew M. species were included in this study. Antibiotic susceptibility was performed and the patient's clinical data was analyzed. Results: A total of 14 Myroides spp. isolates were obtained from urine culture. The maximum number of cases (71.4%) were from the Nephrology ward and ICUs. The average (mean) age of patients was 46 years (range 2–80 years). All patients were catheterized. All isolates were multidrug resistant. Minocycline and doxycycline were the only drugs found effective in this study. Conclusions: Myroides species are emerging rare pathogens that can cause UTI in immunocompromised and catheterized patients. Minocycline may be used for treating such infections.

182

LETTER TO THE EDITOR

Dipasri Bhattacharya, Antonio M Esquinas, Mohanchandra Mandal

Parasternal Intercostal Muscle Thickness Fraction (PICTF%): Ultrasound a New Tool for Weaning Prediction?

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:1] [Pages No:404 - 404]

Keywords: Airway extubation, Coronavirus disease-19, Critical illness, Diaphragm, Intercostal muscles, Maximal respiratory pressures, Mechanical ventilation, Parasternal intercostal muscle thickness, Respiratory rate, Ventilators

   DOI: 10.5005/jp-journals-10071-24665  |  Open Access |  How to cite  | 

177

LETTER TO THE EDITOR

Arjun Ramaswamy, Nitesh Gupta

Author Response

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:1] [Pages No:405 - 405]

Keywords: Diaphragm, Paracostal muscles, Weaning

   DOI: 10.5005/jp-journals-10071-24671  |  Open Access |  How to cite  | 

144

LETTER TO THE EDITOR

Sounira Mehri, Josef Finsterer

Impact of Quality Standards on Stroke Management and Outcome Requires Appropriately Designed Studies

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:2] [Pages No:406 - 407]

Keywords: Intracerebral bleeding, Ischemic stroke, Outcome, Quality standards, Thrombolysis

   DOI: 10.5005/jp-journals-10071-24669  |  Open Access |  How to cite  | 

167

LETTER TO THE EDITOR

Bijoy K Panda, Vaibhav R Suryawanshi, Gargi Attarde, Nilima Borkar, Shivakumar Iyer, Jignesh Shah

Author Response

[Year:2024] [Month:April] [Volume:28] [Number:4] [Pages:2] [Pages No:408 - 409]

Keywords: Clinical outcomes, Intracerebral hemorrhage, Ischemic stroke, Quality metrics

   DOI: 10.5005/jp-journals-10071-24685  |  Open Access |  How to cite  | 

174

© Jaypee Brothers Medical Publishers (P) LTD.