Indian Journal of Critical Care Medicine

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2014 | January | Volume 18 | Issue 1

EDITORIAL

To heparinize or not to heparinize: Effect on arterial blood gas measurements

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:2] [Pages No:1 - 2]

PDF  |  DOI: 10.4103/0972-5229.125422  |  Open Access |  How to cite  | 

EDITORIAL

Chronic hyperglycemia in critically ill: Another piece in the glycemic control puzzle

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:3] [Pages No:3 - 5]

PDF  |  DOI: 10.4103/0972-5229.125423  |  Open Access |  How to cite  | 

EDITORIAL

Suchitra Ranjit

Hyperglycemia in the pediatric intensive care unit: Innocent bystander or villain of the piece?

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:2] [Pages No:6 - 7]

PDF  |  DOI: 10.4103/0972-5229.125424  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Vinayak Krishnarao Patki, Swati Balasaheb Chougule

Hyperglycemia in critically ill children

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:6] [Pages No:8 - 13]

Keywords: Critically ill children, hyperglycemia, pediatric intensive care unit

PDF  |  DOI: 10.4103/0972-5229.125427  |  Open Access |  How to cite  | 

Abstract

Objectives: To determine the incidence and study association of hyperglycemia with outcome of critically ill children. Setting and Design: This was a prospective observational study conducted in eight bedded pediatric intensive care unit (PICU) of a tertiary care hospital. Materials and Methods: One hundred and one critically ill non-diabetic children between ages of 1 month to 16 years were studied from the day of admission till discharge or death. Serial blood sugars were determined first at admission, thereafter every 12 hourly in all children. Blood glucose level above 126 mg/dl (>7 mmol/dl) was considered as hyperglycemia. Children with hyperglycemia were followed 6 hourly till blood glucose fellbelow 126 mg/dl. Hyper and non-hyperglycemic children were compared with respect to length of stay, mechanical ventilation, use of inotrops and final outcome. Survivors and non-survivors were compared in relation to admission blood glucose, peak blood glucose level and duration of hyperglycemia. Results : Seventy (69.3%) children had hyperglycemia. Requirement of ventilation [(23) 32.9% vs.(3) 9.7%], requirement of inotropic support [(27) 38.6% vs.(5) 16.1%], Mean length of stay in PICU (7.91 ± 5.01 vs. 5.58 ± 1.95 days) and mortality (28.6% vs. 3.2%) among hyperglycemic children was significantly higher (P < 0.05) than that of non-hyperglycemic. Logistic regression analysis showed Peak blood glucose level and duration of hyperglycemia has independent association with increased risk of death. Conclusion: Incidence of hyperglycemia is high in critically ill children and it is associated with high morbidity and mortality.

RESEARCH ARTICLE

Pallavi Goyal, Viswas Chhapola, Sandeep Kumar

Is liquid heparin comparable to dry balanced heparin for blood gas sampling in intensive care unit?

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:7] [Pages No:14 - 20]

Keywords: Blood gas analysis, dry balanced heparin, liquid heparin, pre-analytic error

PDF  |  DOI: 10.4103/0972-5229.125428  |  Open Access |  How to cite  | 

Abstract

Introduction: Blood gas (BG) analysis is required for management of critically ill patients in emergency and intensive care units. BG parameters can be affected by the type of heparin formulations used-liquid heparin (LH) or dry balanced heparin (DBH). This study was conducted to determine whether blood gas, electrolyte, and metabolite estimations performed by using DBH and LH are comparable. Materials and Methods: A prospective study was conducted at pediatric intensive care unit (PICU) of a tertiary care hospital. Paired venous samples were collected from 35 consecutive children in commercially prepared DBH syringes and custom-prepared LH syringes. Samples were immediately analyzed by blood gas analyzer and compared for pH, pCO 2, pO 2, HCO 3 -, Na +, K +, Cl -, and lactate. Paired comparisons were done and agreement was assessed by Bland-Altman difference plots. The 95% limits of absolute agreement (LOA) were compared with the specifications for total allowable error (TEa). Results: The P values were significant for all measured parameters, with the exception of pCO 2 and K +. Bland-Altman difference plots showed wide LOA for pCO 2, pO 2, HCO3 -, Na +, K +, and Cl - when compared against TEa. For pCO 2, HCO3 -, Na +, K +, and Cl -, 40%, 23%, 77%, 34%, and 54% of samples were outside the TEa limits, respectively, with LH. Conclusion: Our study showed that there is poor agreement between LH and DBH for the BG parameters pCO2, pO2, HCO3 -, K +, Na +, and Cl - and, thus, are not comparable. But for pH and lactate, LH and DBH can be used interchangeably.

RESEARCH ARTICLE

Jacob John, Karen Ruby Lionel, Nagamani Sen

Glycated hemoglobin A: A predictor of outcome in trauma admissions to intensive care unit

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:5] [Pages No:21 - 25]

Keywords: Diabetes mellitus, glycosylated hemoglobin A, intensive care, stress induced hyperglycemia, trauma

PDF  |  DOI: 10.4103/0972-5229.125431  |  Open Access |  How to cite  | 

Abstract

Background and Aim: Although large studies have demonstrated the association between hyperglycemia and adverse intensive care unit (ICU) outcomes, it is yet unclear which subset of patients benefit from tight sugar control in ICU. Recent evidence suggests that stress induced hyperglycemia (SIH) and co-incidentally detected diabetes mellitus are different phenomena with different prognoses. Differentiating SIH from diabetic hyperglycemia is challenging in ICU settings. We followed a cohort of trauma patients admitted to a surgical intensive care unit (SICU) to evaluate if initial glycated hemoglobin A (HbA 1 c) level predicts the outcome of admission. Materials and Methods: A cohort of 120 consecutive admissions to SICU following trauma were recruited and admission blood sugar and HbA 1 c were measured. Outcomes were prospectively measured by blinded ICU doctors. A logistic regression model was developed to assess if HbA 1 c predicts poor outcomes in these settings. Results: Nearly 24% of the participants had HbA 1 c ≥ 6. Those with HbA 1 c ≥ 6 had 3.14 times greater risk of poor outcome at the end of hospital stay when compared to those with HbA 1 c < 6 and this risk increased to an odds ratio of 4.57 on adjusting for other significant predictors: Acute Physiology and Chronic Health Evaluation II, injury severity score, admission blood sugar and age at admission. Conclusions: Substantial proportion of trauma admissions has underlying diabetes. HbA 1 c, a measure of pre admission glycaemic status is an important predictor of ICU outcome in trauma patients.

RESEARCH ARTICLE

Neeta Bose, Hasmukh Patel, Hemlata Kamat

Evaluation of ultrasound for central venous access in ICU by an in experienced trainee

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:7] [Pages No:26 - 32]

Keywords: Central venous catheter, inexperienced, intensive care unit, ultrasonography

PDF  |  DOI: 10.4103/0972-5229.125433  |  Open Access |  How to cite  | 

Abstract

Background and Aims: Central venous catheter placement is an important procedure for ICU (Intensive Care Unit) patients. We studied the usefulness of ultrasonography for placement of central venous catheter by in-experienced anesthetists. Materials and Methods: A prospective observational study of 32 patients requiring central venous access (CVA) in surgical ICU (SICU). Data collected were patient′s demographics, indication, type of catheter, success rate, attempts, complication rate and access time were recorded and compared with other studies. Result: The overall success rate was 89.5% in the IJV (Internal Jugular Vein) and 92.3% for SCV (Subclavian Vein) group. The success rates for insertion at first, second, and third attempt were 52.6%, 31.6%, and 5.2% for IJV and 46.2% and 53.8% for SCV. Average number of attempts made for IJV cannulation was 1.74 +/- 1.04 and 1.54 +/- 0.51 for SCV. The total time taken for IJV access was 858.78 +/- 381.9 sec, whereas in the SCV group, it was 984 +/- 328.98 seconds. In our study, overall rate of complication was 21.05% (4/19 patients) for IJV and 23.07% (3/13 patients) for SCV insertion. Incidence of various complications like arterial puncture, misplacement of CVC, hematoma, pneumothorax, and hemothorax were also noted. Conclusion: This study concludes that real time ultrasound guidance during IJV and SCV cannulation can achieve higher success rate, fewer complications, number of attempts, and failure rate among inexperienced anesthetists.

SHORT COMMUNICATION

Vikas Gupta, Anupama Sharma, Dishant , Jaya Shankar Kaushik

Aluminum phosphide (celphos) poisoning in children: A 5-year experience in a tertiary care hospital from northern India

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:4] [Pages No:33 - 36]

Keywords: Magnesium sulfate, mortality, pediatric intensive care

PDF  |  DOI: 10.4103/0972-5229.125434  |  Open Access |  How to cite  | 

Abstract

Background: Aluminum phosphide (ALP) (celphos) is an agricultural pesticide commonly implicated in poisoning. Literature pertaining to the clinical manifestations and treatment outcome of its poisoning among children is limited. Materials and Methods: A retrospective chart review was conducted of the medical records of 30 children aged less than 14 years admitted to pediatric intensive care unit (PICU) of a tertiary care hospital in northern India. Demographic, clinical, and laboratory parameters were recorded. The outcome was categorized into \"survivors\" and \"nonsurvivors.\" Results: The Mean (SD) age of the enrolled children [19 males (63.3%)] was 8.55 (3.07) years. Among the 30 children, 14 (46.67%) were nonsurvivors and the rest 16 (53.33%) were survivors. Nonsurvivors had ingested significantly higher doses of ALP (P < 0.001), and showed higher time lag to PICU transfer (P 0.031), presence of abnormal radiological findings on chest skiagram (P = 0.007), and a higher Pediatric Risk of Mortality (PRISM) III score (P < 0.001) at admission. Use of magnesium sulfate was associated significantly with survival [odds ratio (OR) (95% CI): 0.11 (0.02-0.66); P 0.016]. Conclusion: The present study highlights that survival among children with ALP poisoning is predicted by dose of ALP ingestion, time lag to medical attention, and higher PRISM score at admission. Use of magnesium sulfate could be associated with better survival among them.

CASE REPORT

Ashvini Kumar, Ashima Malhotra, Prakash Sharma, Nikhil Malhotra

Transpleural central venous catheter discovered during thoracotomy

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:3] [Pages No:37 - 39]

Keywords: Central venous catheter, infraclavicular, thoracotomy, transpleural

PDF  |  DOI: 10.4103/0972-5229.125435  |  Open Access |  How to cite  | 

Abstract

We report an uncommon complication of subclavian central venous catheterization, discovered at thoracotomy. The central venous catheter (CVC) was placed by left infraclavicular route after induction of general anesthesia. CVC was secured after aspiration of blood and satisfactory central venous tracing. On thoracotomy, CVC was noticed to traverse the pleural cavity while the tracing was normal. CVC was thus removed consequent to which bleeding from each puncture site was noticed, that were secured surgically.

CASE REPORT

Ashish Garg, C. Vignesh, Vinod Kumar Singh

Acute right heart syndrome: Rescue treatment with inhaled nitric oxide

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:3] [Pages No:40 - 42]

Keywords: After load, heart failure, nitric oxide

PDF  |  DOI: 10.4103/0972-5229.125436  |  Open Access |  How to cite  | 

Abstract

Acute right heart syndrome is a common occurrence in intensive care units and is associated with a poor prognosis. There is lack of understanding of the involved pathophysiology, standard diagnostic protocols and treatment guidelines. Management goals include ensuring adequate right ventricle (RV) filling, maximizing RV contraction and reducing RV afterload. We describe a 39-year-old female with acute decompensated right heart failure secondary to multiple causes. She was managed with inhaled nitric oxide. Her condition improved, which was evident by a decrease in her pulmonary artery systolic pressure on serial echocardiography, decreased requirement of vasopressors and successful weaning from the ventilator.

CASE REPORT

Supradip Ghosh

Self-injection of intravenous carbolic acid and multiorgan failure

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:3] [Pages No:43 - 45]

Keywords: Acute Respiratory Depres Syndrome, central nervous system depression, intravascular hemolysis, intravenous phenol, renal failure

PDF  |  DOI: 10.4103/0972-5229.125437  |  Open Access |  How to cite  | 

Abstract

Intravenous self-injection of phenol resulting in multi-organ failure is reported. The case is discussed, because of the unique nature of exposure to phenol and rapid involvement of multiple organ systems including the central nervous, pulmonary, renal and hematological systems.

CASE REPORT

Omender Singh, Suneel Kumar Garg, Joy Dev Mukherji

Hyperkalemia: A rare cause of acute flaccid quadriparesis

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:3] [Pages No:46 - 48]

Keywords: Acute flaccid paralysis, hyperkalemia, quadriparesis

PDF  |  DOI: 10.4103/0972-5229.125439  |  Open Access |  How to cite  | 

Abstract

Acute flaccid quadriparesis secondary to hyperkalemia is a very rare and serious but reversible medical emergency. We present a case of a 73-year-old female who was admitted with rapidly progressive ascending paraparesis progressing to quadriparesis in about 10 h due to hyperkalemia. Patient was treated with antihyperkalemic measures. Her power improved dramatically as potassium levels normalized and she had an uneventful recovery.

LETTERS TO THE EDITOR

Nagarajan Muthialu

Unusual presentation of pericardial effusion

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:1] [Pages No:49 - 49]

PDF  |  DOI: 10.4103/0972-5229.125440  |  Open Access |  How to cite  | 

EDITORIAL

Anuradha Borle, Preet Mohinder Singh

Are we infusing acids into our patient′s blood?

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:2] [Pages No:49 - 50]

PDF  |  DOI: 10.4103/0972-5229.125442  |  Open Access |  How to cite  | 

Authors' reply

Viktor Rosival

Author′s reply

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:1] [Pages No:50 - 50]

PDF  |  DOI: 10.5005/ijccm-18-1-50  |  Open Access |  How to cite  | 

LETTER TO EDITOR

Meta-analysis: Adding apples and oranges?

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:2] [Pages No:50 - 51]

PDF  |  DOI: 10.4103/0972-5229.125444  |  Open Access |  How to cite  | 

LETTER TO EDITOR

John Moran

Authors′ reply

[Year:2014] [Month:January] [Volume:18] [Number:1] [Pages:1] [Pages No:51 - 51]

PDF  |  DOI: 10.4103/0972-5229.125445  |  Open Access |  How to cite  | 

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