Wellschambers2426

Checking responsiveness is the mainstay in cardiopulmonary resuscitation (CPR). It is rare in the clinical situation when the patient requires resuscitation despite the presence of wakefulness. We report a case in which the patient presented with flat arterial line and absence carotid pulse while he was awake. A thorough literature review will also be discussed. How to cite this article Asghar A, Salim B, Tahir S, Islam F, Khan MF. Awareness during Cardiopulmonary Resuscitation. Indian J Crit Care Med 2020;24(2)136-137. Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.Critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and critical illness polyneuromyopathy (CIPNM) are the group of disorders that are commonly presented as neuromuscular weakness in intensive care unit (ICU) settings. They are responsible for prolonged ICU stay and failure to wean off from mechanical ventilation. We report a case of young female who was admitted with undiagnosed type I diabetes mellitus with diabetic ketoacidosis, severe hypokalemia, sepsis developed acute onset quadriplegia, and diaphragmatic palsy within 72 hours of ICU admission. On detailed investigation, CIPNM was diagnosed. In view of high morbidity, mortality, and poor prognosis, a guided approach to diagnose and treat in earliest possible duration might give better improvement and outcome of the illness. Despite all the odds, our patient showed good clinical improvement and finally got discharged. How to cite this article Mahashabde M, Chaudhary G, Kanchi G, Rohatgi S, Rao P, Patil R, et al. An Unusual Case of Critical Illness Polyneuromyopathy. Indian J Crit Care Med 2020;24(2)133-135. Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.Objective The aim of this study was to measure the effects of a bundle of interventions in children admitted with severe sepsis or septic shock in the first hour after diagnosis on mortality. Materials and methods A retrospective study was conducted at a pediatric intensive care unit (PICU) between January 2014 and January 2016. Three interventions (intravenous [IV] antibiotic, fluid boluses, and vasopressor administration) applied in the first hour of severe sepsis or septic shock diagnosis were analyzed according to their adherence rates. The main outcome was mortality. Odds ratios were calculated. Results Of a total of 530 PICU admissions, 105 patients met the criteria for sepsis, 53 (50.5%) with severe sepsis and 52 (49.5%) with septic shock. Seventy-two (68.6%) patients received IV antibiotic within the first hour, 65 (61.9%) received IV fluid bolus, and 55 (53.3%) received a vasopressor drug. Fifty-two (49.5%) patients received concomitant IV antibiotics and fluid bolus. Blood cultures were collected beith lower mortality. How to cite this article Barboza CL, Valete COS, da Silva ARA. Bundle Adherence of Intravenous Antibiotic Fluid Resuscitation and Vasopressor in Children with Severe Sepsis or Septic Shock. Indian J Crit Care Med 2020;24(2)128-132. Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.Objective To examine the safety and complications associated with percutaneous tracheostomy (PT) in critically ill coagulopathic patients under real-time ultrasound guidance. Materials and methods Coagulopathy was defined as international normalized ratio (INR) ≥1.5 or thrombocytopenia (platelet count ≤50,000/mm3). Neck anatomy was assessed for all patients before the procedure and was characterized as excellent, good, satisfactory, and unsatisfactory based on the number of vessels in the path of needle. Percutaneous tracheostomy was performed under real-time ultrasound (USG) guidance, with certain modifications to the technique, and patients in both groups were assessed for immediate complications including bleeding. Results Six hundred and fifty-two patients underwent USG-guided PT. Three hundred and forty-five (52.9%) were coagulopathic before the procedure. Ninety-nine patients (15.2%) had an excellent neck anatomy on USG scan, and 112 patients (62 in coagulopathy group vs 50 in noncoagulopathy group, p v20;24(2)122-127. Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.Background and aims Despite the increased rates of acute kidney injury (AKI) in intensive care units (ICU) and associated mortality, information on the epidemiology of AKI is sparse in sub-Saharan Africa (SSA). We investigated the rates and predictors of AKI and associated mortality in a tertiary ICU. Materials and methods This retrospective study analyzed 280 hospital records of patients admitted to the ICU at a tertiary teaching hospital who were aged ≥15 years from January 2017 to May 31, 2018. The outcome parameters of the study were rates of AKI in the ICU, associated risk factors, and mortalities. Acute kidney injury and ICU mortality were established by the multivariate logistic analysis. Results The median age was 36 years (IQR 28, 52). The rate of AKI was 52.9%, and the presence of human immunodeficiency virus (HIV) and oliguria was 2.3-fold (0.004) and 4-fold (0.016) positive predictors of ICU-AKI, respectively. Male gender (0.003), diabetes mellitus (DM) (0.010), respiratory disease (0.001), inotropes (0.004), and ventilator support (0.017) were predictors for ICU mortality after controlling for confounders. Conclusion The rate of AKI is significantly higher in a referral tertiary hospital in Zambia compared to developed countries and the presence of HIV and noncommunicable diseases such as DM impacts severely on outcomes. How to cite this article Banda J, Chenga N, Nambaya S, Bulaya T, Siziya S. Predictors of Acute Kidney Injury and Mortality in Intensive Care Unit at a Teaching Tertiary Hospital_ID. Indian J Crit Care Med 2020;24(2)116-121. Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.Background Sepsis-induced myocardial dysfunction has implications on outcome. For lack of echocardiography in resource-limited settings, myocardial biomarkers may be an alternative monitoring tool. Objective This study was planned to explore the longitudinal behavior of creatine phosphokinase-MB (CPK-MB) in children with sepsis with and without shock, and its correlation with clinical and echocardiographic parameters over the first 10 days. Design Prospective observational study. Setting Tertiary care hospital in a lower-middle-income economy of South Asia. Patients Children (3 months to 12 years) with nonshock sepsis (NSS) (n = 40) and septic shock survivors (SSSs) (n = 40) after optimal resuscitation. Patients with catecholamine refractory shock, preexisting heart disease, and cardiorespiratory event within the past 1 month were excluded from the study. Measurements and main results Pediatric logistic organ dysfunction (PeLOD) score, vasoactive inotrope score (VIS), CPK-MB, and echocardiographic measures ofdiographic Measures of Myocardial Dysfunction in Pediatric Sepsis Are Patients with Shock Different from Those without? Indian J Crit Care Med 2020;24(2)109-115. Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.Background Several studies have shown the neuroprotective role afforded by hypoxic and ischemic preconditioning in cerebrovascular disorders. There are several clinical conditions which simulate the hypoxic and ischemic conditioning in humans. The aim of this retrospective study is to identify whether the presence of any clinical scenarios mimicking the hypoxic and ischemic conditions prior to the current acute ischemic stroke (AIS) has a neuroprotective role in these patients. Materials and methods Data were collected for patients >18 years of age who underwent endovascular treatment for AIS from January 2009 to June 2015. A good outcome was defined as modified Rankin score (mRS) of 0 to 3 at discharge and a poor outcome as mRS of 4-6. A logistic regression analysis was performed to identify independent predictors of outcomes at discharge in both groups. A p value of less then 0.05 was considered statistically significant for all analyses. Results A total of 102 patients, aged 67 ± 16 years with median preprocedural National Institute of Health Stroke Scale (NIHSS) score 17.5 (1-36), were included. Twenty-one (21%) patients had a good outcome (mRS 0-3) and 81 (79%) had a poor outcome (mRS 4-6). A logistic regression analysis identified higher NIHSS score [odds ratio (OR) 1.251, confidence interval (CI) 1.11-1.40, p = 0.0002] and history of transient ischemic attack (TIA; OR 7.881, CI 1.05-21.01, p less then 0.04) as predictors of a poor outcome at discharge. Conclusion Our data suggest that the occurrence of TIA preceding an AIS may be associated with the poor outcomes in patients with AIS, although this finding needs confirmation in larger studies. How to cite this article Athiraman U, Tempelhoff R, Karanikolas M. Effects of Hypoxic and Ischemic Clinical Conditions on the Outcomes of Acute Ischemic Stroke Patients. Indian J Crit Care Med 2020;24(2)104-108. Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.Aims of this study Severe acute pancreatitis has been defined recently based on the persistence of organ failure at 48 hours of admission. The bedside index for severity in acute pancreatitis (BISAP) score, a simplified scoring system to predict severity of acute pancreatitis, is proposed to be useful in early risk stratification of acute pancreatitis. Our aim was to prospectively compare BISAP score with the already established acute physiology and chronic health evaluation II (APACHE II) and modified computed tomography severity index (CTSI) scores in predicting the severity of acute pancreatitis. Materials and methods A total of 87 consecutive cases presenting with the first attack of acute pancreatitis were included in the study. Acute physiology and chronic health evaluation II and BISAP scores were calculated from the worst parameters in the first 24 hours, and modified CTSI was reported at 48 hours of admission. Receiver-operating characteristic (ROC) curves were plotted, and predictive accuracy of eacSajjan B, Nagar VS. Comparison of Acute Physiology and Chronic Health Evaluation II, Modified Computed Tomography Severity Index, and Bedside Index for Severity in Acute Pancreatitis Score in Predicting the Severity of Acute Pancreatitis. https://www.selleckchem.com/products/pf-06873600.html Indian J Crit Care Med 2020;24(2)99-103. Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.Background Acute kidney injury (AKI) requiring dialysis is associated with high mortality and morbidity. Red blood cell distribution width (RDW) has been shown as a predictor of mortality in different subsets of patients admitted to intensive care unit (ICU). This study compares the predictive ability of RDW and other severity illness prognostic models on 30 days mortality in adult patients admitted to ICUs with AKI necessitating dialysis. Materials and methods Thirty patients were evaluated using five different prognostic scoring models. Sequential organ failure assessment (SOFA) score, acute tubular necrosis-individual severity index (ATN-ISI), version II of acute physiology and chronic health evaluation (APACHE II), vasoactive-inotropic score (VIS), version II of simplified acute physiology score (SAPS II), and RDW as a marker were used to prognosticate the severity of illness. The scores were calculated using the values of clinical and laboratory parameters at the time of admission. Results The prognostic abilities of the scores were compared for their discriminatory power using receiver-operating characteristic (ROC) curves.