Journal of Acute Care

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2023 | January-April | Volume 2 | Issue 1

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EDITORIAL

Prahlada N Basavanthappa

Innovation: Doblin-KENT Way

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:1 - 3]

   DOI: 10.5005/jp-journals-10089-0058  |  Open Access |  How to cite  | 

416

Original Article

Krunalkumar J Patel, Anuj M Clerk, Nikita Desai

Outcome of Cardiac Arrest in a Tertiary Care Urban Hospital in India

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:6] [Pages No:4 - 9]

Keywords: Cardiac arrest, Cardiopulmonary resuscitation, In-hospital cardiac arrest, Out-of-hospital cardiac arrest, Registry, Survival

   DOI: 10.5005/jp-journals-10089-0059  |  Open Access |  How to cite  | 

Abstract

Introduction: Survival from cardiac arrest (CA) remains poor and for meaningful research in India, one needs to first standardize treatment and documentation, before multicentric data can be pooled to create a large database. The arrest outcome consortium (AOC) online Registry (www.aocregistry.com) is an online database created for the same. Initial analysis of single center data is presented here as a test of its functionality. Materials and methods: This is a retrospective observational study of cardiopulmonary resuscitation (CPR) data from 200-bed, urban hospitals for the year 2018. Data were collected in a standardized format, uploaded, and analyzed on the AOC registry web portal. Descriptive statistics were downloaded from the portal and statistical analysis was done by using statistical package for the social science (SPSS) software. Results: Out of 127 CAs, 111 received CPR [30 out-of-hospital CAs (OHCAs), 81 in-hospital CAs (IHCAs)]. The average age, equally in both genders was 57 years. The bystander CPR rate among OHCA was 6.7%. Pulseless Electrical Activity (PEA) was the most common first rhythm [58(52.2%)], followed by asystole [40(36%)] and ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) [13(11.7%)]. At discharge16.2% (18 of 111) were alive and 14.4% (16) had good [cerebral performance category (CPC) ≤2] neurological status. There was no significant difference in survival between males (12.8%) and females (21.9%) (p = 0.161). The best neurological survival was with VF/pVT as the first rhythm. Multivariate regression analysis showed first rhythm and admission lactate influence return of spontaneous circulation (ROSC) and first rhythm influences survival at discharge. Out of 18 survivors at discharge, 10 were alive, five died and three lost to follow-up, both at 6 and 12 months. Conclusion: Survival at discharge was more with VF/pVT as the first rhythm. AOC registry portal could provide descriptive statistics, which can be used for inferential analysis. A large sample size is required for statistical analysis among subgroups.

171

REVIEW ARTICLE

Raghunath Aladakatti, Aishwarya Sadashivamurthy

Difficult Weaning in ICU

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:5] [Pages No:10 - 14]

Keywords: Breathing Trial, Difficult extubation, Difficult weaning, Intensive care unit mortality, Spontaneous, Weaning, Weaning failure

   DOI: 10.5005/jp-journals-10089-0062  |  Open Access |  How to cite  | 

Abstract

Weaning or discontinuation of mechanical ventilation can be defined as the process of gradual or sudden ventilatory support withdrawal in critically ill patients. Weaning failure is defined as either failure of spontaneous breathing trial (SBT) or the need for reintubation within 48 hours following extubation. It is estimated that 40% of the time, the patient who has been intubated and ventilated will be dedicated to the process of weaning. Almost 50% of these patients did not require reintubation, suggesting that ventilation was unnecessarily prolonged. This delay in weaning will cause an increase in the length of intensive care unit (ICU) stay, length of hospital stay, number of ventilatory days, overall cost of care, and increased mortality. Delay in weaning can be a risk for ventilator-induced lung injury, hospital-acquired infection, especially ventilator-associated pneumonia, airway trauma due to the endotracheal tube, and prolonged sedation with its complications. On the other hand, early weaning or extubation can cause respiratory muscle fatigue and risk of reintubation. When the patient enters into difficult or prolonged weaning, there is also a risk of need for tracheostomy as well as an increase in mortality. Earlier, clinicians used to try SBTs for a longer duration, which adversely affected the weaning process as patients had to breathe with minimal support or without support against increased respiratory load. However, while weaning, most of the weaning failures can be identified within 30 minutes. Early identification for the readiness of weaning using weaning criteria and initiating SBT with pressure support 5–8 cm H2O, continuous positive airway pressure (CPAP) of 5 cm H2O is advisable. In patients at high risk for extubation failure, extubation to noninvasive preventive ventilation is suggested. Early physical and occupational therapy is safe and well tolerated, resulting in better functional outcomes.

461

REVIEW ARTICLE

Kolli S Chalam

Difficult Airway Management in Surgical Intensive Care Unit

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:7] [Pages No:15 - 21]

Keywords: Airway, Critically ill patients, Intensive care units

   DOI: 10.5005/jp-journals-10089-0066  |  Open Access |  How to cite  | 

Abstract

A considerable number of patients in the surgical intensive care unit (ICU) require advanced airway management in terms of intubation or laryngeal mask airway (LMA) placements. It is not uncommon to come across difficult airways in ICU. A difficult airway cart with a fiberoptic bronchoscope and trained personnel are fundamental to the practice of surgical critical care. So, clinicians in ICU should be capable of carrying bronchoscopic intubation in sedated as well as awake patients. Anesthetizing techniques for awake fiberoptic bronchoscopic intubation (FOBI) such as airway blocks or topicalization and monitoring during the procedure are of considerable interest. It is equally important to keep the patient comfortable, maintaining spontaneous breathing and hemodynamic stability. Finally, combined techniques such as fiberoptic bronchoscope in combination with LMA or video laryngoscope (VL) do improve success rates of advanced airway management in surgical ICU (SICU).

201

CASE REPORT

Vinay Krishnamurthy, PC Narendra, Raghavendra Goudar, Gururaj V Gunda, Mahesha Padyana

A Rare Case of Primary Ventriculitis Secondary to Community-acquired Extended-spectrum β-lactamase Escherichia coli Meningitis

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:22 - 25]

Keywords: Case report, Escherichia coli meningitis, Extended spectrum β-lactamase Escherichia coli, Gram-negative meningitis, Primary ventriculitis

   DOI: 10.5005/jp-journals-10089-0060  |  Open Access |  How to cite  | 

Abstract

Introduction: Gram negative bacterial meningitis is common among hospitalized patients with Traumatic brain injury, Neurosurgical patients and healthcare associated meningitis. Community acquired Gram negative bacillary meningitis is common in neonates but very uncommon in adults. Case description: Hereby we present a case of community acquired extended-spectrum β-lactamase (ESBL) Escherichia coli (E. coli) meningitis with CSF and blood culture positivity by the same organism. The patient also developed primary bacterial ventriculitis on serial neuroimaging, which has been described in only seven adult cases so far. Discussion: Incidence of community acquired E. coli meningitis is limited to few case reports and review of literature suggests that incidence is less than one case per year from 1946 to till date. The incidence of primary community-acquired ventriculitis is very uncommonly reported with no specific guidelines for management. Hence, the duration of total antimicrobial therapy was extended to a total duration of 6 weeks. Conclusion: This case report addresses the emerging challenge of primary bacterial ventriculitis complicating community acquired meningitis due to an extremely uncommon ESBL E. coli pathogen and also addresses the need for development of formal recommendations, definition and guidelines for management of Primary Ventriculitis.

137

CASE REPORT

Girish I Ramagondawar, Sanjay O Patangi

Prone Positioning to Improve Oxygenation on VV-ECMO after Pulmonary Endarterectomy

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:26 - 29]

Keywords: Acute respiratory distress syndrome, Case report, Prone ventilation, Pulmonary endarterectomy, Pulmonary hemorrhage, Venovenous

   DOI: 10.5005/jp-journals-10089-0061  |  Open Access |  How to cite  | 

Abstract

Patients on venovenous extracorporeal membrane oxygenator (VV-ECMO) can develop refractory hypoxemia, and various rescue measures are available. We present two cases of refractory hypoxemia noted postoperatively (post-op) due to reperfusion injury associated with pulmonary hemorrhage. These patients were supported with VV-ECMO and received prone ventilation (PV) due to refractory hypoxia. We noted an improvement in oxygenation with PV, which facilitated lung recruitment and successful weaning from VV-ECMO.

141

CASE REPORT

Anish Joshi, Vivek Dave

Case of Cytomegalovirus Colitis: A Rare Cause of Abdominal Pain and Diarrhea in an Adult Patient

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:2] [Pages No:30 - 31]

Keywords: Case report, Cytomegalovirus colitis, Diarrhea in immunocompetent, Endoscopic biopsy

   DOI: 10.5005/jp-journals-10089-0056  |  Open Access |  How to cite  | 

Abstract

Cytomegalovirus (CMV) is common in immunocompromised patients and in patients taking immunosuppressants. Infection with CMV can manifest as an exacerbation of mucosal inflammation. Whether CMV is an active pathogen or “an innocent bystander” in the exacerbation of ulcerative colitis remains controversial. Though rare, still CMV colitis must be considered in the differential diagnosis in immunocompetent patients in whom there is no relief in diarrhea or abdominal pain with antibiotics. If not diagnosed promptly there can be a bowel perforation leading to poor prognosis. In unexplained diarrhea cases, endoscopic biopsy and measurement of CMV immunoglobulin (Ig) M antibody level are warranted. We present a case study of a 51-year-old male with complaints of loose motions, abdominal pain, and generalized weakness. He was not on immunomodulators like steroids and was managed as a routine case of infective bacterial diarrhea. Initially, the patient's symptoms resolved but later because of drowsiness and abdominal distension, he had to be shifted to the intensive care unit (ICU). His endoscopic biopsy was done which was suggestive of CMV colitis. He was prescribed ganciclovir—intravenous (IV) and considerable improvement was seen. The patient was discharged in a hemodynamically stable condition. From this case one can conclude that CMV colitis in immunocompetent hosts is rare but strong clinical vigilance can help in preventing further worsening of symptoms.

139

CASE REPORT

Spoorthy Holla, KM Ganesh, Garud S Chandan

A Rare Case of Artery of Percheron Infarction

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:3] [Pages No:32 - 34]

Keywords: Artery of Percheron, Bilateral thalamic infarct, Case report, Ischemic infarct

   DOI: 10.5005/jp-journals-10089-0065  |  Open Access |  How to cite  | 

Abstract

One of the atypical and unusual presentations of ischemic stroke is an occlusion of the “artery of Percheron” (AOP) which leads to infarction of thalami and mesencephalon. AOP is a rare variant vessel, and its acute occlusion can cause a bilateral symmetrical thalamic stroke. Vertical gaze palsy, memory loss, disorientation, sleepiness, hypersomnolence, or comas are the usual symptoms of bilateral paramedian thalamic infarcts caused by the obstruction of AOP. There are several variants of thalamic blood supply, identifying the potential presence and infarction of an AOP is crucial for diagnosis and treatment of ischemic strokes affecting the thalami and mesencephalon, especially because of the unusual and variable presentation of these forms of ischemic strokes. We describe a case of a 61-year-old man who was otherwise healthy and experienced abrupt onset giddiness followed by loss of consciousness and was later identified with an AOP infarct.

179

Medical Philately

Pradeep Rangappa

Pioneers of Compassion in Healthcare

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:2] [Pages No:35 - 36]

Keywords: Compassion, Healthcare, World Compassion Day

   DOI: 10.5005/jp-journals-10089-0067  |  Open Access |  How to cite  | 

Abstract

Compassion is a sympathetic consciousness and concern for the suffering of other's distress together with a desire to alleviate it. Compassion is extolled as a cornerstone of quality healthcare by parents, families, clinicians, and policymakers. Compassion, empathy, and committed loving care constitute the tenets of healthcare delivery. World Compassion Day which is commemorated every year on 28th November is a day for global icons to share their ideologies, values, and principles of compassion relevant to our time. It is important to remember the pioneers who advocated the principles of compassion in dealing with people in daily life.

188

INTERESTING IMAGE

Sushrita Sahoo

Interesting Image: Chest X-ray after Biventricular Assist Device (BiVAD) Implantation

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:1] [Pages No:37 - 37]

   DOI: 10.5005/jp-journals-10089-0068  |  Open Access |  How to cite  | 

130

BRIEF RESEARCH COMMUNICATION

Jay Prakash, Khushboo Saran, Pradip K Bhattacharya, Sharmili Sinha, Shio Priye

Role of Statin and Clinical Outcomes in COVID-19 Patients: A Protocol for Systematic Review and Meta-analysis of Randomized Controlled Trials

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:4] [Pages No:38 - 41]

Keywords: Coronavirus disease 2019, Outcome, Statin

   DOI: 10.5005/jp-journals-10089-0038  |  Open Access |  How to cite  | 

Abstract

Objectives: Statins have significant therapeutic implications in patients having high cardiovascular risk or preexisting cardiovascular disorders. Exploring the correlation between statin therapy and outcomes in coronavirus disease 2019 (COVID-19) patients is the objective of the current meta-analysis. Data sources: PubMed, Web of Science, Google Scholar, and Cochrane Library database, as well as preprint services like medRxiv, Research Square, and Social Science Research Network (SSRN). Study selection: All citations will be double-checked, and any differences will be examined and, if required, addressed with the help of a third author. Two authors will separately evaluate abstracts and titles of all potentially essential citations in two phases. Data extraction: A data extraction table will be used to extract published outcomes from each study. Data synthesis: The pooled risk ratio with a 95% confidence interval (CI) will be used to compute pooled effect size. DerSimonian and Laird random-effects models will be employed for heterogeneity greater than 50%; otherwise, the fixed-effects model will be implemented. To construct study weights, an inverse variance approach will be employed, and a funnel plot will also be examined to see whether there is any publishing bias. Trial registry: International prospective register of systematic reviews (Prospero) acquired a prospective registration for this meta-analysis in the trial registry (CRD42022304331). Study highlights: The evidence supporting the use of statins in COVID-19 patients will be reviewed in this study. Early statin has been correlated to a decreased risk of unfavorable effects in patients with COVID-19. At the time, these trials were predominantly observational, and all published meta-analyses were based on observational studies. Randomized controlled trials have recently been performed for reliable evidence, but no meta-analyses.

131

MEDICAL EDUCATION/CME

HM Surya, Amrita Shah, Pradeep Rangappa, Ipe Jacob, Karthik Rao

Double Plasma Molecular Adsorption System: A Modality of Treating Fulminant Hepatic Failure

[Year:2023] [Month:January-April] [Volume:2] [Number:1] [Pages:2] [Pages No:42 - 43]

Keywords: Artificial liver support system, BS330, Double plasma molecular adsorption system, Fulminant hepatic failure, HA330

   DOI: 10.5005/jp-journals-10089-0064  |  Open Access |  How to cite  | 

Abstract

Fulminant hepatic failure (FHF) secondary to hepatitis A is a relatively rare but sometimes fatal condition. Treatment is largely supportive, with definitive treatment involving a liver transplant. Among the newer modalities developed to support the patient is the double plasma molecular adsorption system (DPMAS), which works on the principle of hemoadsorption. The system consists of two hemadsorption cartridges containing porous resin beads which adsorb toxins such as bilirubin and ammonia. We report such a case of FHF secondary to hepatitis A, which was treated with DPMAS.

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