Indian Journal of Critical Care Medicine

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2012 | April | Volume 16 | Issue 2

RESEARCH ARTICLE

Mohd Ashraf, Tanveer Iqbal Dar, Khursheed Alam Wani, Aijaz Malik, Sanjeed Ahmad, Tariq A Gojwari, Arshad Iqbal

Low molecular weight heparin in prophylaxis of deep vein thrombosis in Asian general surgical patients: A Kashmir experience

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:4] [Pages No:71 - 74]

Keywords: Heparin, prophylaxis, thrombosis

PDF  |  DOI: 10.4103/0972-5229.99107  |  Open Access |  How to cite  | 

Abstract

Background and Objectives: Deep vein thrombosis (DVT) occurs at a lower rate in Asia than in the rest of the world. We wanted to study the significance and efficacy of low molecular weight heparin (LMWH) in prophylaxis of DVT in major general surgical patients in the Kashmir Valley (India, Asia) so as to make it a routine in our patients. Patients and Methods: This was a prospective study in which the effect of LMWH was compared with no prophylaxis. Results: LMWHs are more effective than no prophylaxis in the prevention of DVT and pulmonary thromboembolism in highest-risk general surgical patients (odds ratio = 16.64; 95% confidence interval = 3.63-1130.03; P-value = 0.014). Conclusion: LMWHs have a significant prophylactic effect on DVT in general surgical patients, with a higher benefit to risk ratio, and, in spite of the low incidence of DVT in Asia, its prophylaxis should routinely be considered in this part of the world as well, preferably in the form of LMWHs.

RESEARCH ARTICLE

Khaled M. Mahmoud, Amany S. Ammar

Norepinephrine supplemented with dobutamine or epinephrine for the cardiovascular support of patients with septic shock

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:6] [Pages No:75 - 80]

Keywords: Cardiovascular support, dobutamine, epinephrine, norepinephrine, septic shock

PDF  |  DOI: 10.4103/0972-5229.99110  |  Open Access |  How to cite  | 

Abstract

Background and Aims: Sepsis management remains a great challenge for intensive care medicine. The aim of this study was to evaluate the effect of adding dobutamine versus epinephrine to norepinephrine in treating septic shock patients refractory to fluid therapy. Materials and Methods: Sixty adult patients with the diagnosis of septic shock were included in this study. Norepinephrine infusion was started at a dose of 0.05 μg/kg/min, and increased gradually up to 0.1 μg/kg/min. Upon reaching this dose, patients with mean arterial pressure <70 mmHg were further divided randomly into two equal groups. In group I: the patients continued on norepinephrine and dobutamine was added at a starting dose of 3 μg/kg/min and increased in increments of 2 μg/kg/min up to 20 μg/kg/min. In group II: the patients continued on norepinephrine and epinephrine was added in a starting dose of 0.05 μg/kg/ min and increased in increments of 0.03 μg/kg/min up to 0.3 μg/kg/min. Results: Group II patients developed significantly better cardiovascular parameters, lower arterial pH and higher serum lactate and urine output; however, the 28-day mortality and major adverse effects were comparable in both groups. Conclusions: The addition of epinephrine to norepinephrine has positive effects on the cardiovascular parameters but negative results on the serum lactate concentration and systemic pH compared with the addition of dobutamine to norepinephrine.

RESEARCH ARTICLE

Michel Georges dos Santos El Halal, Evandro Barbieri, Ricardo Mombelli Filho, Eliana de Andrade Trotta, Paulo Roberto Antonacci Carvalho

Admission source and mortality in a pediatric intensive care unit

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:6] [Pages No:81 - 86]

Keywords: Child, intensive care units, mortality, patient admission, pediatric

PDF  |  DOI: 10.4103/0972-5229.99114  |  Open Access |  How to cite  | 

Abstract

Background and Aims: Studies carried out in different countries have shown that source of patient admission in Intensive Care Units (ICUs) is associated to death. Patients admitted from wards show a greater ICU mortality. The aim of the present study was to investigate the association between admission source and outcome in a Pediatric Intensive Care Unit (PICU). Materials and Methods: We studied all PICU admissions that took place between January 2002 and December 2005 in a tertiary hospital in Brazil. The major outcome studied was death while in the PICU. The independent variable analyzed was admission source, defined either as pediatric emergency room (PER), wards, operating room (OR) of the same hospital or other sources. Results: A total of 1823 admissions were studied. The overall expected mortality based on the Pediatric Index of Mortality 2 was 6.5% and the observed mortality was 10.3%. In adjusted analysis, the mortality was doubled in patients admitted from wards when compared with the PER patients. Conclusions: Observed mortality rates were higher in patients admitted from wards within the same hospital, even after adjustment.

RESEARCH ARTICLE

Mritunjay Kumar, Chandralekha

Percutaneous dilatational tracheostomy: Griggs guide wire dilating forceps technique versus ULTRA-perc single-stage dilator - A prospective randomized study

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:6] [Pages No:87 - 92]

Keywords: Intensive care, percutaneous, tracheostomy

PDF  |  DOI: 10.4103/0972-5229.99117  |  Open Access |  How to cite  | 

Abstract

Percutaneous dilatational tracheostomy (PDT) is a frequently performed surgical procedure on critically ill patients. This study was designed to compare its two methods: Griggs guide wire dilating forceps (GWDF) technique and the ULTRA-perc single-stage dilator technique. Materials and Methods: Thirty Intensive Care Unit (ICU) patients on prolonged mechanical ventilation and requiring tracheostomy were included in our prospective randomized study. The first group (GP-GWDF) underwent PDT by the GWDF technique and the second group by the ULTRA-perc technique (GP-UP). Time for the procedure and early and late procedural complications were recorded and compared in between the two groups. Results: Time taken for tracheostomy was 11.68 ± 6.48 min for GP-GWDF and 13.93 ± 11.54 min for GP-UP (P-value 0.486). Desaturation was noted in two patients in GP-GWDF versus five in GP-UP (P-value = 0.195). Hypercapnea and rise in peak airway pressure occurred in one patient in GP-GWDF versus two in GP-UP (P-value = 0.543). Loss of airway was recorded in two patients in GP-UP and in none in GP-GWDF (P-value = 0.143). Subcutaneous emphysema, pneumothorax and pneumomediastinum occurred in one patient in GP-UP. No major complications were observed in GP-GWDF (P-value = 0.309). Hoarseness of voice was noted in one patient in each group (P-value = 0.659). Conclusion: Both the techniques seem to be equally reliable for carrying out PDT at bedside in the ICU.

RESEARCH ARTICLE

Gagan Brar, Jose Chacko, Ramanathan Moorthy, Nikahat Jahan

Isolated inhalational injury: Clinical course and outcomes in a multidisciplinary intensive care unit

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:7] [Pages No:93 - 99]

Keywords: Inhalational injury, intensive care, outcomes

PDF  |  DOI: 10.4103/0972-5229.99120  |  Open Access |  How to cite  | 

Abstract

Background and Aims: Although smoke inhalation is well known to cause acute lung injury, there are few reports in literature that study the evolution, clinical course and outcomes of isolated inhalational lung injury in a modern intensive care setting. A major fire disaster provided us the opportunity to study victims of isolated inhalational injury admitted to our Multidisciplinary Intensive Care Unit (MICU). Materials and Methods: We studied the clinical course, ICU and hospital outcomes of 13 victims of a fire disaster who required mechanical ventilation for isolated inhalational lung injury. All patients were followed up at regular intervals, and their functional status was assessed at 8 months after hospital discharge. Results: The Lung Injury Scores (LIS) worsened to reach a nadir on Day 3 of injury. There was a significant correlation between the LIS on Day 3 and duration of mechanical ventilation (r = 0.8; P = 0.003), ICU (r = 0.8; P = 0.002) and hospital (r = 0.6; P = 0.02) days. Late-onset airway complications were encountered in four patients. Three of them required long-term artificial airways - two with a tracheostomy while the third patient required surgical insertion of a “T” tube. Persistent problems with phonation occurred in two patients. At 8 months postdischarge, all patients were independent with activities of daily living; all were back to work, except for two who continued to need artificial airways. Conclusions: Inhalational lung injury progresses over the first few days and is worst after 72 h. Late-onset airway complications may manifest after several weeks and require repeated intervention.

RESEARCH ARTICLE

Yiu Ming Ho, A. Peter Wysocki, James Hogan, Hayden White

An audit of characteristics and outcomes in adult intensive care patients following tracheostomy

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:6] [Pages No:100 - 105]

Keywords: Intensive care, mechanical ventilation, tracheostomy

PDF  |  DOI: 10.4103/0972-5229.99124  |  Open Access |  How to cite  | 

Abstract

Background: Tracheostomies are commonly performed on critically ill patients requiring prolonged mechanical ventilation. The purpose of this study was to review our experience with surgical and percutaneous tracheostomies and identify factors affecting outcome. Materials and Methods: Patients who underwent tracheostomy between January 1999 and June 2008 were identified on the basis of Diagnostic Related Group coding and the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification procedural code. The primary endpoint was in-hospital mortality. Contingency tables were generated for clinical variables and a chi-squared test was used to determine significance. Results: One hundred and sixty-eight patients underwent tracheostomy between January 1999 and 30 June 2008. In-hospital mortality was 22.6%. The probability of death was found to be independent of timing of tracheostomy, technique used (percutaneous vs. surgical), number of failed extubations and obesity. On univariate analysis, the null hypothesis of independence was rejected for age on admission (P = 0.014), diagnosis of sepsis (P = 0.0008) or cardiac arrest (P = 0.0016), Acute Physiology and Chronic Health Evaluation II score (P = 0.0319) and the Australasian Outcomes Research Tool for Intensive Care calculated risk of death (P = 0.0432). Conclusion: Although a number of patient factors are associated with worse outcome, tracheostomy appears to be a relatively safe technique in the Intensive Care Unit population.

CASE REPORT

Alakendu Ghosh, Rudra Prosad Goswami, Swati Mondal, Subrata Basu, Partha Sarathi Karmakar

A sound sleep

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:3] [Pages No:106 - 108]

Keywords: Benzodiazepine, bilateral basal ganglia hyperintensity, India, MRI, poisoning

PDF  |  DOI: 10.4103/0972-5229.99128  |  Open Access |  How to cite  | 

Abstract

Benzodiazepine is a commonly encountered agent of poisoning, which is readily diagnosed by a pertinent history of drug ingestion and the clinical scenario. In the absence of a proper drug history, the diagnosis becomes challenging. Proper clinical assessment, urine assays and imaging play a very important role in reaching the diagnosis. We present a case of acute benzodiazepine poisoning without a history of drug intake. The key pointers toward diagnosis were an unarousable state with obstructive apnea. Magnetic resonance imaging (MRI) of the brain revealed peculiar symmetrical isolated globus pallidus T2 hyperintensity. We believe this to be the first report of isolated bilateral basal ganglia T2-weighted hyperintensity in MRI in the setting of acute benzodiazepine poisoning from India.

CASE REPORT

Mayra Gonçalves Menegueti, Anibal Basile-Filho, Olindo Assis Martins-Filho, Maria Auxiliadora-Martins

Severe arrhythmia after lithium intoxication in a patient with bipolar disorder admitted to the intensive care unit

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:3] [Pages No:109 - 111]

Keywords: Bipolar disorder, intensive care unit, life-threatening cardiac manifestations, lithium poisoning

PDF  |  DOI: 10.4103/0972-5229.99134  |  Open Access |  How to cite  | 

Abstract

Despite its narrow therapeutic index, lithium remains widely used as a mood stabilizer for the treatment of bipolar disease. The cardiac side-effects of lithium have been well documented, and may induce non-specific T-wave flattening, prolonged QT interval, sinus node dysfunction and also ventricular tachycardia and ventricular fibrillation. We report the case of a 61-year-old male patient diagnosed with bipolar disorder who developed life-threatening cardiac manifestations secondary to severe lithium poisoning. Although hemodialysis was performed and the arrhythmias were adequately treated, the patient died on the sixth day after hospital admission due hemorrhagic complications after tracheostomy.

LETTER TO THE EDITOR

Viroj Wiwanitkit, Somsri Wiwanitkit

Hot climate and perioperative outcome: Relationship?

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:1] [Pages No:112 - 112]

PDF  |  DOI: 10.4103/0972-5229.99138  |  Open Access |  How to cite  | 

LETTER TO THE EDITOR

Palepu Haranath

Patient communication in intensive care unit

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:2] [Pages No:112 - 113]

PDF  |  DOI: 10.4103/0972-5229.99139  |  Open Access |  How to cite  | 

LETTER TO EDITOR

Mani Anand, Harveen K. Gulati, Avinash R. Joshi

Pseudoleukopenia due to ethylenediaminetetraace-tate induced leukoagg-lutination in a case of hypovolemic shock

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:2] [Pages No:113 - 114]

PDF  |  DOI: 10.4103/0972-5229.99140  |  Open Access |  How to cite  | 

LETTER TO EDITOR

Vivek B. Kute, Hargovind L. Trivedi, Pankaj R. Shah, Manoj R. Gumber, Himanshu V. Patel, Jigar D. Shrimali, Aruna V. Vanikar, Mohan P. Patel

Loss of dialysis catheter guide-wire: How to prevent?

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:3] [Pages No:114 - 116]

PDF  |  DOI: 10.4103/0972-5229.99141  |  Open Access |  How to cite  | 

LETTER TO EDITOR

Uma Srivastava, Archana Agarwal, Sweta

Inadvertent insertion of nasogastric tube into the trachea of a conscious patient

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:2] [Pages No:116 - 117]

PDF  |  DOI: 10.4103/0972-5229.99142  |  Open Access |  How to cite  | 

LETTER TO EDITOR

Prathiba Chandershekar

Advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital: Real scenario

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:2] [Pages No:117 - 118]

PDF  |  DOI: 10.4103/0972-5229.99143  |  Open Access |  How to cite  | 

LETTER TO EDITOR

Rakesh Sharma

A simple method to prevent devastating complications

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:1] [Pages No:118 - 118]

PDF  |  DOI: 10.4103/0972-5229.99144  |  Open Access |  How to cite  | 

LETTER TO EDITOR

Ritesh G. Menezes

Cartap poisoning: Additional thoughts

[Year:2012] [Month:April] [Volume:16] [Number:2] [Pages:1] [Pages No:119 - 119]

PDF  |  DOI: 10.4103/0972-5229.99145  |  Open Access |  How to cite  | 

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