Indian Journal of Critical Care Medicine

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2019 | May | Volume 23 | Issue 5

EDITORIAL

Sunil T Pandya, Shwetha Mogal

Obstetric ICU: Analysing and Understanding the Data is Important

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:2] [Pages No:201 - 202]

PDF  |  DOI: 10.5005/jp-journals-10071-23158  |  Open Access |  How to cite  | 

EDITORIAL

Stress in ICU Caregivers: Does it Lie in the Eyes of the Beholder?

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:2] [Pages No:203 - 204]

PDF  |  DOI: 10.5005/jp-journals-10071-23159  |  Open Access |  How to cite  | 

EDITORIAL

Watch out, Someone is Watching You!

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:1] [Pages No:205 - 205]

PDF  |  DOI: 10.5005/jp-journals-10071-23160  |  Open Access |  How to cite  | 

ORIGINAL ARTICLE

Vamseedharan Muthukumar, Durga Karki, Bhojani Jatin

Concept of Lethal Triad in Critical Care of Severe Burn Injury

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:4] [Pages No:206 - 209]

Keywords: Burns, Critical care, Lethal triad, Mortality

PDF  |  DOI: 10.5005/jp-journals-10071-23161  |  Open Access |  How to cite  | 

Abstract

Background: The trinity of hypothermia, acidosis and coagulopathy, the lethal triad in trauma setting is a well-known risk factor associated with high risk of death. Burn is also a pathological situation where inflammatory response, endothelial injury, hypovolemia, reduced end-organ perfusion, cellular hypoxia, and myocardial depression are frequently encountered. This study aimed to study the occurrence and outcome of patients presenting with the ‘triad of death’ in burn population. Methods: The study population included patients between 18 years and 60 years presenting to the department with thermal and scald burns with total body surface area involving 50–70%. The study was conducted for a period of 180 days and patients were followed up for 30 days. A p value <0.05 was considered statistically significant. Results: One hundred and ninety-six patients were admitted during study period. Fifty patients out of them were eligible and were included in the study. The average abbreviated burns score index was 11 in lethal triad subgroup when compared to eight in the subgroup without the lethal triad. The mortality in the subgroup with lethal triad was higher (68.8% vs 17.6%, p = 0.0009). The “on admission” acidosis, hypothermia, and coagulopathy were independently associated with significantly increased mortality. The overall relative risk of mortality in the presence of lethal triad was 3.896. Conclusion: This study reiterates the fact that the lethal triad is seen in burn patient. Burn associated with on admission lethal triad has significantly higher mortality rates. There are only countable studies addressing this issue in burn setting.

ORIGINAL ARTICLE

Ishtiyaq Qadri, Ishaq Malik, Kaisar Ahmed

Staphylococcus aureus Infection in a Pediatric ICU: A Hospital Based Prospective Observational Study

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:3] [Pages No:210 - 212]

Keywords: Mortality, MRSA, PICU, Staphylococcus aureus

PDF  |  DOI: 10.5005/jp-journals-10071-23162  |  Open Access |  How to cite  | 

Abstract

Introduction: Admission to a pediatric intensive care unit (PICU) with a Staphylococcus aureus (SA) infection is associated with considerable mortality and morbidity. There is paucity of data about epidemiology of SA infection in a PICU. This study was aimed at elucidating the clinicoepidemiological profile and outcome of children admitted to ICU with S. aureus infection. Methods: This study was carried out in a PICU at a tertiary care hospital in northern India. Children admitted with culture positive S. aureus infection were enrolled in this study. Children suspected of having S. aureus infection on clinical grounds only without a positive culture were excluded from the study. Baseline characteristics of the subjects were recorded on admission and daily follow up maintained till death or discharge from PICU. The course during PICU stay, ensuing complication, and outcome was recorded. Results: There were 2,480 total admissions to the PICU during study period of one year, out of which 120 (4.83%) admissions had a culture proven S. aureus infection. Fifty-six (46.6%) were male and 64 (53.3%) were female. Most of the subjects fell in the age groups of 1–5 years and 10–15 years having 56 (46.6%) and 40 (33.3%) subjects, respectively. Pneumonia (43.3%), septicaemia (20.8), and bone/joint space infections (15%) were the three main clinical manifestations. Forty-two (35%) of specimens were reported as methicillin resistant. Incidence of methicillin resistant SA (MRSA) infection was 1.6 and that of methicillin sensitive SA (MSSA) 3.1 per 100 admissions to PICU. On sensitivity testing, none of the specimens was found to be vancomycin resistant. There were 240 total deaths in PICU during study period out of which 25 (10.4%) were observed from the study group. Mortality rate was 20.8%. Mortality was high in the MRSA group. Conclusion: The incidence of S. aureus infection and associated mortality is high in PICU. MRSA infection was more common in children admitted with chronic disease and is associated with higher mortality. Our study found a bimodal age distribution for serious staph infection, a finding that needs further evaluation.

ORIGINAL ARTICLE

Maria Vargas, Annachiara Marra, Pasquale Buonanno, Carmine Iacovazzo, Vincenzo Schiavone, Giuseppe Servillo

Obstetric Admissions in ICU in a Tertiary Care Center: A 5-Years Retrospective Study

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:7] [Pages No:213 - 219]

Keywords: Intensive care unit, Obstetric patient, Postpartum patient, Tertiary care facility

PDF  |  DOI: 10.5005/jp-journals-10071-23163  |  Open Access |  How to cite  | 

Abstract

Background and Aim: Obstetric patients admitted to intensive care unit (ICU) represent a challenge to physicians. The purpose of this study is to evaluate the incidence, characteristics, and mortality of pregnant and postpartum patients requiring ICU admission. Materials and Methods: A retrospective cohort study was performed between January 2008 and December 2013 at the University Hospital Federico II of Naples including pregnant and puerperal women until the 42nd day of postpartum and admitted to ICU. Results: Patients admitted with an obstetric diagnosis had a higher incidence of at least one previous cesarean section, were treated more with hysterectomy, had an increasing incidence of hemodynamic instability, had more postpartum admission, had a higher TISS-28 score, and required more endotracheal intubation than patients admitted with non-obstetrics diagnosis. Conclusion: A shared approach including a close collaboration between ICU and obstetric ward may be useful to reduce ICU admission and to improve maternal and foetal outcomes.

ORIGINAL ARTICLE

Thiruchengodu Raju Kanmani, Ramappa M Thimmappur, Raju Birudu, Krishna Reddy N, Prabhu Raj

Burden and Psychological Distress of Intensive Care Unit Caregivers of Traumatic Brain Injury Patients

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:4] [Pages No:220 - 223]

Keywords: Family burden, ICU caregivers, Psychological distress, Traumatic brain injury

PDF  |  DOI: 10.5005/jp-journals-10071-23164  |  Open Access |  How to cite  | 

Abstract

Aim: Admission to Intensive Care Unit (ICU) is a stressful event and unforeseen crisis for the caregivers. Burden and psychosocial distress among caregivers in the ICU were unexplored. Therefore, the current study was aimed to assess the caregivers’ burden and psychological distress among caregivers of traumatic brain injury (TBI) patients at emergency ICU during hospitalization. Materials and Methods: A total of 60 caregivers recruited by using purposive sampling method with descriptive research design. Consent was obtained. Interview schedule of family for depression, anxiety, stress scale (DAS-21) were administered. The data were analyzed by using SPSS. Descriptive statistics and independent burden t-test were used. Results: Results revealed that male caregivers (75%) and female caregivers (25%) took part in the study. Caregivers\' mean age was found to be 35.22±11.29 years. Most of the TBI survivors admitted in ICU had severe injury (8.30±3.63). Mean scores showed that caregivers had experienced financial burden (6.28±2.36), severe depression (12.15±4.84), and a moderate level of anxiety (12.85±5.20). Independent t-test showed significant difference in caregiving burden between male and female caregivers at ICU (Male = 18.43±4.83; Female = 14.29±4.83; t = 2.16; p <0.035). Overall, caregivers experienced higher family burden and severe psychological distress at ICU. Conclusion: There is an immediate need to assess psychological distress and family burden of caregivers at ICU and provide timely psychosocial intervention.

ORIGINAL RESEARCH

Shruti Sharma, Vipul Khandelwal, Gajendra Mishra

Video Surveillance of Hand Hygiene: A Better Tool for Monitoring and Ensuring Hand Hygiene Adherence

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:3] [Pages No:224 - 226]

Keywords: Compliance monitoring, Hand hygiene, Video surveillance, WHO five key moments

PDF  |  DOI: 10.5005/jp-journals-10071-23165  |  Open Access |  How to cite  | 

Abstract

Introduction: Hand hygiene practice, as correctly said, is the backbone of infection control and it has been proven to limit infections in hospital settings. Currently most healthcare facilities monitor hand hygiene compliance by direct observation technique. We decided to use video surveillance as a tool to monitor hand hygiene compliance and its impact. Materials and Methods: This study was conducted over a period of 6 months from March 2018 to August 2018 at Apex Hospital, Jaipur, India. We compared direct observation of ICU, High Dependency Units, and Emergency with video surveillance in these areas. Results and Observations: In this study, direct observation and video audit were compared from March 2018 to August 2018. During March to August, average compliance rates of direct observation and video surveillance were compared. In month of march, they were 67% and 20%, respectively and in the month of august, they were 81% and 47%, respectively. Conclusion: In our study, We can conclude in our study that video monitoring combined with direct observation can produce a significant and sustained improvement in hand hygiene compliance and can improve quality of patient care.

ORIGINAL ARTICLE

Mohit Goyal

Impact of Educational and Training Programs on Knowledge of Healthcare Students Regarding Nosocomial Infections, Standard Precautions and Hand Hygiene: A Study at Tertiary Care Hospital

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:5] [Pages No:227 - 231]

Keywords: Hand hygiene, Knowledge, Nosocomial infections, Standard precautions

PDF  |  DOI: 10.5005/jp-journals-10071-23166  |  Open Access |  How to cite  | 

Abstract

Background and Objectives: Nosocomial infections are significant public health problems in developed as well as developing countries. To tackle this problem, it is vital to sensitize healthcare students (HCSs) at early period of their clinical practise. Thus, this study was conducted to access the existing knowledge among HCSs and determine the impact of educational and training programs regarding nosocomial infections, standard precautions, and hand hygiene. Methods: This was a cross-sectional cum interventional, questionnaire based, single center study. Total 728 MBBS, BDS and BSC nursing students were targeted for workshop on nosocomial infections, standard precautions, and hand hygiene based on the Centers for Disease Control and prevention (CDC) and World Health Organization (WHO) guidelines. Infection control standardized questionnaire (ICSQ) was administered as a pretest and posttest. Results were analyzed by SPSS software. Results: A paired-samples t-test was conducted to access the impact of educational and training programs on knowledge of HCS. There was a significant difference in the scores of pretests (M = 37.30, SD = 4.81) and posttests (M = 42.03, SD = 4.55); t (727) = 22.162, p ≤0.005 and also statistically significant difference in scores of all 3 domains- 1. Nosocomial infections: Pretest (M = 6.61, SD = 1.57) and Posttest (M = 7.98, SD = 4.65); t (727) = 20.589, p ≤ 0.005; 2. Standard Precautions: Pretest (M = 20.81, SD = 3.06) and Posttest (M = 41.88, SD = 4.30); t (727) = 4.584, p ≤ 0.005; 3. Hand Hygiene: Pretest (M = 9.88, SD = 2.68) and Posttest (M = 12.54, SD = 2.92); t (727) = 19.527, p ≤ 0.005. The results suggest that educational and training programs have positive impact on knowledge of HCS. Conclusion: This study highlighted the need for regular educational and training programs in primary training time for retention of knowledge regarding nosocomial infections and reinforcement of the principals of standard precautions and hand hygiene.

BRIEF COMMUNICATION

Amita Kaul, Kapil Jadhav, Sachin Shah

Peritoneal Dialysis in an Extremely Low Birth Weight Neonate with Ileostomy

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:2] [Pages No:232 - 233]

Keywords: Acute peritoneal dialysis, Extremely low birth weight, Ileostomy

PDF  |  DOI: 10.5005/jp-journals-10071-23167  |  Open Access |  How to cite  | 

Abstract

Background: Acute kidney injury (AKI) is a common complication in sick, extremely low birth weight (ELBW) neonates. Peritoneal dialysis (PD) is the treatment modality but is seldom attempted in this patient population. We present a 40-day-old ELBW neonate previously operated for necrotizing enterocolitis with ileostomy who developed AKI. Peritoneal dialysis was started by a modifying intercostal drain. Results: Doing a simple procedure and using a few modifications helped the baby to come out of acute kidney injury. Conclusion: Peritoneal dialysis can be technically quite challenging in ELBW neonates but is possible with certain innovative modifications.

BRIEF COMMUNICATION

Katherine Pollard, Brian Todd Wessman

Development of a Standardized Communication Intervention Bundle for Use at a Medical Training Hospital Intensive Care Unit

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:2] [Pages No:234 - 235]

PDF  |  DOI: 10.5005/jp-journals-10071-23168  |  Open Access |  How to cite  | 

BRIEF COMMUNICATION

Gyaninder Pal Singh, Navdeep Sokhal

Does Real Time Ultrasonography Confer Any Benefit During Bronchoscopy Guided Percutaneous Tracheostomy: A Preliminary, Randomized Controlled Trial

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:3] [Pages No:236 - 238]

Keywords: Bronchoscopy, Percutaneous dilatational tracheostomy, Ultrasonography

PDF  |  DOI: 10.5005/jp-journals-10071-23169  |  Open Access |  How to cite  | 

Abstract

Background: There are studies comparing USG guided percutaneous dilatational tracheostomy (PDT) with bronchoscopy guided PDT. We have compared USG guided PDT to conventional landmark guided PDT using bronchoscopy in both the groups. Objective: The primary outcome was the time of procedure and the secondary outcome was incidence of complications in USG guided PDT in comparision to the conventional PDT. Materials and Methods: Seventy adult patients were randomly allocated in two groups, i.e., conventional landmark percutaneous dilatational tracheostomy (PDT) and ultrasonography (USG) guided PDT. Demographic data, injury severity score, time taken for the procedure, attempts of tracheal puncture, major and minor complications, and outcome were compared. Results: The median time taken for the procedure was 12 minutes [min., max.; 8, 20] in conventional group 1 and 16 minutes [9, 24] in group 2 (USG guided) which was statistically significant. Minor bleeding was seen in 7 (20%) patients in group 1 and only in 4 patients (11.5%) in group 2. The rate of other complications and the long term outcome were similar in both the groups. Conclusion: The use of real time USG during PDT may confer advantage over conventional PDT when using bronchoscopy in terms of decreasing the incidence of minor bleeding but duration of the procedure gets prolonged.

CASE REPORT

Muhammad Zuberi, Pramod Kumar Guru, Vikas Bansal, Jose Diaz-Gomez, Beth Grieninger, David Alejos

Undifferentiated Shock and Extreme Elevation of Procalcitonin Related to Kratom Use

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:3] [Pages No:239 - 241]

Keywords: Kratom, Procalcitonin, Vasopressors

PDF  |  DOI: 10.5005/jp-journals-10071-23170  |  Open Access |  How to cite  | 

Abstract

An 18-year-old male with history of polysubstance abuse presented to the emergency department with intractable vomiting, diarrhea, and abdominal pain for one day after the consumption of kratom. Examination revealed arterial hypotension, tachycardia, and prolonged capillary refill. Laboratory studies showed white blood cell count (WBC) of 23.6 x 109/L, serum creatinine 4.0 mg/dL, lactate 6 mmol/L, and procalcitonin >200 ng/mL. Urine and blood drug screen were unremarkable. Radiology and echocardiogram were noncontributory. He received fluid resuscitation and broad spectrum antibiotics. Vasopressors were subsequently added to manage persistent shock. He remained afebrile, and his blood cultures were negative. His shock and associated organ dysfunctions improved over the next 72 hours. On discharge, his procalcitonin level decreased to 9.55 ng/mL, leukocytosis resolved, and the creatinine returned to baseline. This case describes an extremely rare presentation related to kratom, an herb marketed as an opioid alternative, with significant potential for addiction and withdrawal syndrome.

CASE REPORT

Dhiraj Ramdas Jadhav, Ramesh Gugloth

Poisoning due to Arisaema triphyllum Ingestion

[Year:2019] [Month:May] [Volume:23] [Number:5] [Pages:2] [Pages No:242 - 243]

Keywords: Airway compromise, Arisaema triphyllum, Hypersalivation

PDF  |  DOI: 10.5005/jp-journals-10071-23171  |  Open Access |  How to cite  | 

Abstract

Plants of arum family are beautiful and attractive but, at the same time, they are poisonous. The toxic effects are due to calcium oxalate crystals. The toxicity ranges from minor oral cavity edema to lethal airway obstruction.

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