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Aryal D, Paneru HR, Koirala S, Khanal S, Acharya SP, Karki A, Dona DG, Haniffa R, Beane A, Salluh JIF. Incidence, risk and impact of ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study. Wellcome Open Res 2023. [DOI: 10.12688/wellcomeopenres.18381.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Background: Readmissions to Intensive Care Units (ICUs) result in increased morbidity, mortality, and ICU resource utilisation (e.g. prolonged mechanical ventilation), and as such, is a widely utilised metric of quality of critical care. Most of the evidence on incidence, characteristics, associated risk factors and attributable outcomes of unplanned readmission to ICU are from studies performed in high-income countries This study explores the determinants of risk attributable to unplanned ICU readmission in four ICUs in Kathmandu, Nepal. Methods: The registry-embedded eCRF reported data on case mix, severity of illness, in-ICU interventions (including organ support), ICU outcome, and readmission characteristics. Data were captured in all adult patients admitted between September 2019 and February 2021. Population and ICU encounter characteristics were compared between those with and without readmission. Independent risk factors for readmission were assessed using univariate analysis. Results: In total 2955 patients were included in the study. Absolute unplanned ICU readmission rate was 5.69 % (n=168) for all four ICUs. Median time from ICU discharge to readmission was 3 days (IQR=8,1). Of those readmitted, 29.17% (n=49) were discharged at night following their index admission. ICU mortality was higher following readmission to ICU(p=0.016) and mortality was increased further in patients whose primary index discharge was at night(p= 0.019). Primary diagnosis, age, and use of organ support in the first 24hrs of index admission were all independently attributable risk factors for readmission. Conclusions: Unplanned ICU readmission rates were adversely associated with significantly poorer outcomes, increased ICU resource utilisation. Clinical and organisational characteristics influenced risk of readmission and outcome.
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Aryal D, Paneru HR, Koirala S, Khanal S, Acharya SP, Karki A, Dona DG, Haniffa R, Beane A, Salluh JIF. Incidence, risk and impact of unplanned ICU readmission on patient outcomes and resource utilisation in tertiary level ICUs in Nepal: A cohort study. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.18381.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Unplanned readmissions to Intensive Care Units (ICUs) result in increased morbidity, mortality, and ICU resource utilisation (e.g. prolonged mechanical ventilation), and as such, is a widely utilised metric of quality of critical care. Most of the evidence on incidence, characteristics, associated risk factors and attributable outcomes of unplanned readmission to ICU are from studies performed in high-income countries This study explores the determinants of risk attributable to unplanned ICU readmission in four ICUs in Kathmandu, Nepal. Methods: The registry-embedded eCRF reported data on case mix, severity of illness, in-ICU interventions (including organ support), ICU outcome, and readmission characteristics. Data were captured in all adult patients admitted between September 2019 and February 2021. Population and ICU encounter characteristics were compared between those with and without readmission. Independent risk factors for readmission were assessed using univariate analysis. Results: In total 2948 patients were included in the study. Absolute unplanned ICU readmission rate was 5.60 % (n=165) for all four ICUs. Median time from ICU discharge to readmission was 3 days (IQR=8,1). Of those readmitted, 29.7% (n=49) were discharged at night following their index admission. ICU mortality was higher following readmission to ICU(p=0.016) and mortality was increased further in patients whose primary index discharge was at night(p= 0.019). Primary diagnosis, age, and use of organ support in the first 24hrs of index admission were all independently attributable risk factors for readmission. Conclusions: Unplanned ICU readmission rates were adversely associated with significantly poorer outcomes, increased ICU resource utilisation. Clinical and organisational characteristics influenced risk of readmission and outcome.
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Sharma S, Paneru HR, Shrestha GS, Shrestha PS, Acharya SP. Characteristics and Outcome of Patients with COVID-19 Undergoing Invasive Mechanical Ventilation for Respiratory Failure in a Tertiary Level Hospital in Nepal. J Nepal Health Res Counc 2021; 19:396-401. [PMID: 34601537 DOI: 10.33314/jnhrc.v19i2.3623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Corona virus disease 2019 has become a global health issue. The goal of this study was to investigate the characteristics and outcomes of patients with corona virus disease 2019 undergoing invasive mechanical ventilation and identify factors associated with mortality. METHODS Ninety four consecutive critically ill patients with confirmed corona virus disease 2019 undergoing invasive mechanical ventilation were included in this retrospective, single-center, observational study. The outcome variable was mortality of patients undergoing invasive mechanical ventilation and factors associated with it during intensive care unit stay. RESULTS Seventy nine (84%) out of 94 patients with confirmed corona virus disease 2019 who underwent invasive mechanical ventilation didn't survive. Ninety four percent of patients who had Type 2 Diabetes Mellitus did not survive in comparison to 72 percent of patients who didn't have Type 2 Diabetes Mellitus. Similarly, 48 (94.1%) out of 51 patients with a positive C-reactive protein value didn't survive in comparison to 31 (72%) out of 43 patients with a negative C-reactive protein. CONCLUSIONS The presence of Type 2 Diabetes Mellitus and a positive C-reactive protein value were strongly associated with mortality. Patients with a Sequential organ failure assessment score of more than eight at intensive care unit admission and peak D-dimer level of more than or equal to two during intensive care unit stay didn't show significant association with mortality. These findings need further exploration through larger prospective studies.
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Affiliation(s)
- Sachit Sharma
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Hem Raj Paneru
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Gentle Sunder Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Pramesh Sunder Shrestha
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
| | - Subhash Prasad Acharya
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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Aryal D, Beane A, Dondorp AM, Green C, Haniffa R, Hashmi M, Jayakumar D, Marshall JC, McArthur CJ, Murthy S, Webb SA, Acharya SP, Ishani PGP, Jawad I, Khanal S, Koirala K, Luitel S, Pabasara U, Paneru HR, Kumar A, Patel SS, Ramakrishnan N, Salahuddin N, Shaikh M, Tolppa T, Udayanga I, Umrani Z. Operationalisation of the Randomized Embedded Multifactorial Adaptive Platform for COVID-19 trials in a low and lower-middle income critical care learning health system. Wellcome Open Res 2021; 6:14. [PMID: 33604455 PMCID: PMC7883321 DOI: 10.12688/wellcomeopenres.16486.1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
The Randomized Embedded Multifactorial Adaptive Platform (REMAP-CAP) adapted for COVID-19) trial is a global adaptive platform trial of hospitalised patients with COVID-19. We describe implementation in three countries under the umbrella of the Wellcome supported Low and Middle Income Country (LMIC) critical care network: Collaboration for Research, Implementation and Training in Asia (CCA). The collaboration sought to overcome known barriers to multi centre-clinical trials in resource-limited settings. Methods described focused on six aspects of implementation: i, Strengthening an existing community of practice; ii, Remote study site recruitment, training and support; iii, Harmonising the REMAP CAP- COVID trial with existing care processes; iv, Embedding REMAP CAP- COVID case report form into the existing CCA registry platform, v, Context specific adaptation and data management; vi, Alignment with existing pandemic and critical care research in the CCA. Methods described here may enable other LMIC sites to participate as equal partners in international critical care trials of urgent public health importance, both during this pandemic and beyond.
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Affiliation(s)
- Diptesh Aryal
- Critical Care and Anaesthesia, Nepal Mediciti Hospital, Lalitpur, Bagmati Pradesh, 44600, Nepal
| | - Abi Beane
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand, 10400, Thailand.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Arjen M Dondorp
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand, 10400, Thailand.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Cameron Green
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine Monash University, Melbourne, Victoria, Australia
| | - Rashan Haniffa
- Critical Care, Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Central Thailand, 10400, Thailand.,Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Madiha Hashmi
- Department of Critical Care, Ziauddin University, Karachi, Sindh, Pakistan
| | - Devachandran Jayakumar
- Chennai Critical Care Consultants, Chennai, Tamil Nadu, 600 040, India.,Critical Care Medicine, Apollo Specialty Hospital OMR, Chennai, Tamil Nadu, India
| | - John C Marshall
- The Keenan Research Centre for Biomedical Science, St Michael's Hospital, Toronto, Ontario, Canada
| | - Colin J McArthur
- Department of Critical Care Medicine, Auckland City Hospital, Auckland, New Zealand.,Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia School of Medicine, Vancouver, British Columbia, Canada
| | - Steven A Webb
- Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine Monash University, Melbourne, Victoria, Australia.,School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.,St John of God Hospital, Subiaco, Western Australia, Australia
| | - Subhash P Acharya
- Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Bagmati Pradesh, 44600, Nepal
| | - Pramodya G P Ishani
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Issrah Jawad
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Sushil Khanal
- Critical Care Medicine, Grande International Hospital, Kathmandu, Bagmati Pradesh, 44600, Nepal
| | - Kanchan Koirala
- Critical Care and Anaesthesia, Nepal Mediciti Hospital, Lalitpur, Bagmati Pradesh, 44600, Nepal
| | - Subekshya Luitel
- Nepal Intensive Care Foundation, Kathmandu, Bagmati Pradesh, Nepal
| | - Upulee Pabasara
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Hem Raj Paneru
- Pulmonary and Critical Care, Hospital for Advanced Medicine and Surgery, Kathmandu, Bagmati Pradesh, Nepal
| | - Ashok Kumar
- Department of Chest Medicine and Critical Care, Ziauddin University, Karachi, Sindh, Pakistan
| | - Shoaib Siddiq Patel
- South East Asian Research in Critical care and Health, Remedial Centre Hospital, Karachi, Sindh, Pakistan
| | | | - Nawal Salahuddin
- Pulmonary & Critical Care Medicine, National Institute of Cardiovascular Diseases, Karachi, Sindh, Pakistan
| | - Mohiuddin Shaikh
- South East Asian Research in Critical care and Health, Remedial Centre Hospital, Karachi, Sindh, Pakistan
| | - Timo Tolppa
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Ishara Udayanga
- National Intensive Care Surveillance- MORU, Borella, Colombo, Western Province, 08, Sri Lanka
| | - Zulfiqar Umrani
- Office of Research, Innovation & Commercialization (ORIC), Zuiddin University, Karachi, Pakistan
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Shrestha GS, Paneru HR, Acharya SP, Shrestha SK, Sigdel MR, Tiwari S, Yadav BK, Rijal B, Karki L, Neupane Y, Thapa N, Lakhey S. Preparedness for Coronavirus Disease in Hospitals of Nepal: A Nationwide Survey. ACTA ACUST UNITED AC 2020; 58:248-251. [PMID: 32417862 PMCID: PMC7580458 DOI: 10.31729/jnma.4941] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Introduction: Coronavirus disease (COVID-19) pandemic has affected large number of people globally and has continued to spread. Preparedness of individual nations and the hospitals is important to effectively deal with the surge of cases. We aimed to obtain nation wide data from Nepal, about hospital preparedness for COVID-19. Methods: Online questionnaire was prepared in accordance with the Center for Disease Control recommendations to assess preparedness of hospitals for COVID-19. The questionnaire was circulated to the over 800 doctors across the nation, who are the life members of six medical societies. Results: We obtained 131 completed responses from all seven provinces. Majority of respondents had anaesthesiology as the primary specialty. Only 52 (39.7%) participants mentioned that their hospital had policy to receive suspected or proven cases with COVID-19. Presence of isolation ward was mentioned by 83 (63.4%) respondents, with only 9 (6.9%)mentioning the presence of airborne isolation. Supply of personal protective equipment (PPE) was inadequate as per 124 (94.7%) respondents. Critical care services for COVID-19 patients were possible only in hospitals of 42 (32.1%)respondents. RT-polymerase chain reaction could be performed only in the hospital of 6 (4.6%) respondents. Conclusions: It is apparent that most of the hospitals are not well prepared for management of patients with COVID-19. Resource allocation and policy making should be aimed to enhance national preparedness for the pandemic.
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Affiliation(s)
| | - Hem Raj Paneru
- Department of Anaesthesiology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | | | - Mahesh Raj Sigdel
- Department of Nephrology, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sanjeeb Tiwari
- Department of General Practice and Emergency Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Bharat Kumar Yadav
- Department of General Practice and Emergency Medicine, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Badri Rijal
- Department of Orthopaedics, National Trauma Center, Kathmandu, Nepal
| | - Lochan Karki
- Department of Internal Medicine, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Yogesh Neupane
- Department of ENT and Head & Neck Surgery, Ganesh Man Singh Memorial Academy of ENT - Head & Neck Studies, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Narmaya Thapa
- Department of ENT and Head & Neck Surgery, Ganesh Man Singh Memorial Academy of ENT - Head & Neck Studies, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sanjay Lakhey
- Department of Internal Medicine, B&B Hospital Pvt Ltd, Lalitpur, Nepal
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Shrestha GS, Tamang S, Paneru HR, Shrestha PS, Keyal N, Acharya SP, Marhatta MN, Shilpakar S. Colistin and tigecycline for management of external ventricular device-related ventriculitis due to multidrug-resistant Acinetobacter baumannii. J Neurosci Rural Pract 2016; 7:450-2. [PMID: 27365967 PMCID: PMC4898118 DOI: 10.4103/0976-3147.176194] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acinetobacter baumannii is an important cause of nosocomial ventriculitis associated with external ventricular device (EVD). It is frequently multidrug resistant (MDR), carries a poor outcome, and is difficult to treat. We report a case of MDR Acinetobacter ventriculitis treated with intravenous and intraventricular colistin together with intravenous tigecycline. The patient developed nephrotoxicity and poor neurological outcome despite microbiological cure. Careful implementation of bundle of measures to minimize EVD-associated ventriculitis is valuable.
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Affiliation(s)
- Gentle Sunder Shrestha
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sushil Tamang
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Hem Raj Paneru
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Pramesh Sunder Shrestha
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Niraj Keyal
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Subhash Prasad Acharya
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Moda Nath Marhatta
- Department of Anaesthesiology, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Sushil Shilpakar
- Department of Surgery, Neurosurgery Unit, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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