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Kiro VV, Sharma M, Srivastava S, Lalwani P, Aggarwal R, Soni KD, Malhotra R, Lalwani S, Mathur P, Trikha A. Secondary infections in COVID-19: Antemortem and postmortem culture study. INDIAN J PATHOL MICR 2024; 67:51-55. [PMID: 38358188 DOI: 10.4103/ijpm.ijpm_141_22] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024] Open
Abstract
Background Secondary bacterial infections during COVID-19 hospitalization have been reported in about 6-15% of patients. Aims To study the secondary bacterial infections that affected the COVID-19 patients during their hospitalisation and to unearth the bacteriological profile of samples obtained after their demise. Settings and Design This prospective study was carried out at a COVID-19 dedicated, apex tertiary care centre in North India from July 2020 to April 2021. Methods and Materials Samples of 268 patients were considered for the study. Nasopharyngeal swab specimen, blood, and tissue (lung) were collected from the deceased body as early as possible and processed. Statistical Analysis Statistical analyses were performed using STATA version 11.1 (Stata Corp., College Station, TX, USA). Results A total of 170 samples were received from patients before their death, which included blood, urine, respiratory samples, pus, and cerebrospinal fluid. Forty-four pathogens were isolated, which consisted of Acinetobacter baumannii (43.1%), Klebsiella pneumoniae (36.3%), Escherichia coli (11.3%), and Pseudomonas aeruginosa (4.5%), Enterococcus faecium (4.5%). Two hundred fifty-eight samples were collected from the deceased bodies wherein the nasopharyngeal sample was highest, followed by tissue and blood. A total of 43 pathogens were isolated among them which included A. baumannii (44.1%), followed by K. pneumoniae (25.5%), E. coli (20.9%), P. aeruginosa (6.97%) and Enterobacter cloacae (2.3%). All these isolates were highly resistant to antimicrobials. Conclusions In our study, bacterial profiles in antemortem and postmortem samples were found to be similar, suggesting that resistant pathogens may be the cause of mortality in COVID-19 infected hospitalised patients.
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Affiliation(s)
- Vandana V Kiro
- Department of Microbiology, Division of Forensic Pathology and Molecular DNA, New Delhi, India
| | - Meenakshi Sharma
- PhD Scholar, Division of Forensic Pathology and Molecular DNA, New Delhi, India
| | - Sharad Srivastava
- Division of Clinical Microbiology, Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Parin Lalwani
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Anaesthesia and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil D Soni
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Lalwani
- Division of Forensic Pathology and Molecular DNA, JPNATC, New Delhi, India
| | - Purva Mathur
- Division of Clinical Microbiology, Department of Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesia and Critical Care and 5Orthopedics, All India Institute of Medical Sciences, New Delhi, India
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Soni KD. Art of drafting a title: Balancing the allure and accuracy. Indian J Anaesth 2023; 67:935-936. [PMID: 38044927 PMCID: PMC10691612 DOI: 10.4103/ija.ija_895_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 09/16/2023] [Accepted: 09/17/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
- Kapil D Soni
- Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Soni KD. When do we need to do meta-analysis!!! Indian J Anaesth 2023; 67:673-674. [PMID: 37693030 PMCID: PMC10488575 DOI: 10.4103/ija.ija_333_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 04/18/2023] [Accepted: 07/27/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Kapil D. Soni
- Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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Kulshrestha A, Aggarwal R, Kodan P, Singh Y, Kumar R, Soni KD, Mathur P. Incidence of COVID-19-Associated Mucormycosis in COVID-19 Patients after Discharge from the COVID-19 Hospital. Indian J Community Med 2023; 48:364-368. [PMID: 37323725 PMCID: PMC10263042 DOI: 10.4103/ijcm.ijcm_967_22] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background There are studies available on the prevalence of coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM) in hospitalized patients but not on the incidence of CAM in post-discharge patients. The aim of our study was to find the incidence of CAM in the patients discharged from a COVID hospital. Material and Methods Adult patients with COVID discharged between March 1, 2021 and June 30, 2021 were contacted and enquired about sign and symptoms of CAM. Data of all included patients were collected from electronic records. Results A total of 850 patients responded, among which 59.4% were males, 66.4% patients had co-morbidities, and 24.2% had diabetes mellitus. Around 73% of patients had moderate to severe disease and were given steroids; however, only two patients developed CAM post discharge. Conclusion The incidence of CAM post discharge was low in our study, which could be attributed to protocolized therapy and intensive monitoring.
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Affiliation(s)
- Aayush Kulshrestha
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Critical and Intensive Care, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Kodan
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Yudhyavir Singh
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil D. Soni
- Critical and Intensive Care, JPNATC, All India Institute of Medical Sciences, New Delhi, India
| | - Purva Mathur
- Laboratory Medicine, JPNATC, All India Institute of Medical Sciences, New Delhi, India
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5
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Prakash K, Ganesh V, Ayub A, Aggarwal R, Singh Y, Kumar S, Singh A, Soni KD. No Major Age Shift During the Second Wave of COVID-19: A Mortality Analysis at a Tertiary-Level Hospital. Turk J Anaesthesiol Reanim 2023; 51:16-23. [PMID: 36847314 PMCID: PMC10081042 DOI: 10.5152/tjar] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The second wave of coronavirus epidemic affected India severely. We reviewed the in-hospital deaths during the second wave at a dedicated COVID hospital to better understand the clinical characteristics of patients who died during this period. METHODS Clinical charts of all patients who were admitted and died in-hospital due to COVID-19 between 1 April 2021 and 15 May 2021 were reviewed and clinical data were analysed. RESULTS The total number of patients admitted to hospital and the intensive care unit was 1438 and 306, respectively. The in-hospital and intensive care unit mortality was 9.3% (134 out of 1438 patients) and 37.6% (115 out of 306 patients), respectively. Septic shock with multiorgan failure was the cause of death in 56.6% of the deceased patients (n = 73) and acute respiratory distress syndrome in 35.3% (n = 47) patients. Of the deceased, 1 patient was less than 12 years old, 56.8% were between 13 and 64 years of age and 42.5% were geriatric, that is, 65 years of age or older. There were no comorbidities in 35.1% of the deceased patients. The cause of death did not vary with the age group. CONCLUSION The in-hospital and intensive care unit mortality during the second wave was 9.3% and 37.6%, respectively. There was no major age group shift in the second wave as compared to the first wave. However, a significant number of patients (35.1%) did not have any comorbidity. Septic shock with multiorgan failure was the most common cause of death followed by acute respiratory distress syndrome.
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Affiliation(s)
- Kelika Prakash
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Venkata Ganesh
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Arshad Ayub
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Richa Aggarwal
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Yudhyavir Singh
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Shailendra Kumar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Abhishek Singh
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Kapil D Soni
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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6
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Srinivasan S, Kumar PG, Govil D, Gupta S, Kumar V, Pichamuthu K, Clerk AM, Kothekar AT, D'Costa PM, Toraskar K, Soni KD, John JK, Patel SJ, Savio RD, Jagadeesh KN, Jose C, Pandit RA, Gopal P, Chaudhry D, Dixit S, Mishra RC, Kar A, Samavedam S. Competencies for Point-of-care Ultrasonography in ICU: An ISCCM Expert Panel Practice Recommendation. Indian J Crit Care Med 2022; 26:S7-S12. [PMID: 36896358 PMCID: PMC9989871 DOI: 10.5005/jp-journals-10071-24199] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/12/2022] [Indexed: 11/06/2022] Open
Abstract
How to cite this article: Srinivasan S, Kumar PG, Govil D, Gupta S, Kumar V, Pichamuthu K, et al. Competencies for Point-of-care Ultrasonography in ICU: An ISCCM Expert Panel Practice Recommendation. Indian J Crit Care Med 2022;26(S2):S7-S12.
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Affiliation(s)
| | - Praveen G Kumar
- Critical Care Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta - The Medicity, Gurugram, Haryana, India
| | - Sachin Gupta
- Department of Critical Care Medicine, Narayana Superspeciality Hospital, Gurugram, Haryana, India
| | - Vivek Kumar
- Department of Critical Care, Sir HN Reliance Foundation Hospital, Mumbai, Maharashtra, India
| | - Kishore Pichamuthu
- Medical Intensive Care Unit, Christian Medical College Hospital, Vellore, Tamil Nadu, India
| | - Anuj M Clerk
- Department of Intensive Care, Sunshine Global Hospital, Surat, Gujarat, India
| | - Amol T Kothekar
- Department of Anaesthesia, Critical Care and Pain, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Kedar Toraskar
- Critical Care, Wockhardt Hospitals, South Mumbai, Maharashtra, India
| | - Kapil D Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Jojo K John
- Medical Trust Hospital, Kochi, Kerala, India
| | - Sweta J Patel
- Department of Critical Care Medicine, Medanta - The Medicity, Gurugram, Haryana, India
| | - Raymond D Savio
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - K N Jagadeesh
- Department of Critical Care Medicine, Apollo Proton Cancer Centre, Chennai, Tamil Nadu, India
| | - Chacko Jose
- Department of Critical Care Medicine, Majumdar Shaw Medical Center, Bengaluru, Karnataka, India
| | - Rahul A Pandit
- Department of Critical Care, Fortis Hospital, Mumbai, Maharashtra, India
| | | | - Dhruva Chaudhry
- Department of Pulmonary and Critical Care Medicine, University of Health Sciences, Rohtak, Haryana, India
| | - Subhal Dixit
- Department of CCM, Sanjeevan and MJM Hospital, Pune, Maharashtra, India
| | - Rajesh C Mishra
- Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India
| | - Arindam Kar
- Calcutta Medical Research Institute, Kolkata, West Bengal, India
| | - Srinivas Samavedam
- Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India
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7
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Rai N, Soni KD, Aggarwal R, Trikha A. Ventriculitis following neuraxial block. J Anaesthesiol Clin Pharmacol 2022; 38:679-680. [PMID: 36778818 PMCID: PMC9912876 DOI: 10.4103/joacp.joacp_672_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 12/31/2022] Open
Affiliation(s)
- Nitin Rai
- Department of Critical Care Medicine, King George’s Medical University, Lucknow, India
| | - Kapil D. Soni
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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8
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Kaur M, Aggarwal R, Ganesh V, Kumar R, Patel N, Ayub A, Soni KD, Trikha A. Clinical Course and Outcome of Critically Ill Obese Patients with COVID-19 Admitted in Intensive Care Unit of a Single Center: Our Experience and Review. Indian J Crit Care Med 2022; 25:1382-1386. [PMID: 35027798 PMCID: PMC8693112 DOI: 10.5005/jp-journals-10071-24047] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Obesity has been considered as one of the independent risk factors for a severe form of coronavirus disease-2019 (COVID-19) and relationship between obesity, critical illness, and infection is still poorly understood. We herein discuss clinical course and outcome of critically ill obese patients with COVID-19 admitted to critical care unit. Materials and methods We retrospectively analyzed data of critically ill obese patients hospitalized with COVID-19 over a span of 6 months. Management was guided according to the institutional protocol. Collected data included demographic parameters (age, sex, comorbidities, and body mass index (BMI)), complications, inflammatory markers (interleukin (IL)-6, Ferritin), length of mechanical ventilation, length of intensive care unit (ICU) stay, and inhospital death. Results There was no appreciable difference in terms of demographics, inflammatory markers, predictors of mortality scores, and comorbidity indices between the survivors and nonsurvivors. Among outcome analysis, there was a statistically significant difference between ventilator days between survivors and nonsurvivors (p = 0.003**). Conclusion Obesity itself is a significant risk factor for severe COVID-19 infection; however, if efficiently managed and in a protocol-determined manner, it can have a favorable outcome. How to cite this article Kaur M, Aggarwal R, Ganesh V, Kumar R, Patel N, Ayub A, et al. Clinical Course and Outcome of Critically Ill Obese Patients with COVID-19 Admitted in Intensive Care Unit of a Single Center: Our Experience and Review. Indian J Crit Care Med 2021;25(12):1382–1386.
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Affiliation(s)
| | | | - Venkata Ganesh
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Patel
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Arshad Ayub
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil D Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India
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9
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Kundu R, Baidya DK, Anand RK, Maitra S, Soni KD, Subramanium R. Integrated ultrasound protocol in predicting weaning success and extubation failure: a prospective observational study. Anaesthesiol Intensive Ther 2022; 54:156-163. [PMID: 35413786 PMCID: PMC10156490 DOI: 10.5114/ait.2022.115351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 01/30/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Difficulty in weaning from mechanical ventilation is encountered in appro-ximately 20% of patients in the intensive care unit. We assessed the utility of a combined lung, diaphragmatic, and cardiac ultrasound protocol to predict extubation failure. MATERIAL All patients extubated following a successful spontaneous breathing trial (SBT) were included in the study. Lung ultrasonography score (LUS), diaphragmatic thickness fraction (DTF), changes in velocity time integral (VTI) to passive leg raise at the beginning of SBT, and change in LUS following SBT were recorded. RESULTS A total of 60 patients who underwent successful SBT were included in the study. Twenty-seven patients required either non-invasive or invasive mechanical ventilation during the next 48 hours and were classified as weaning failure (Group F). The remaining 33 patients were designated as weaning success (Group S). Compared to group S, patients in Group F had significantly longer ICU length of stay (6.96 ± 4.30 days vs. 11.66 ± 3.85 days, P < 0.001), higher LUS change during SBT (1 [0-2] vs. 2 [1-4], P < 0.001), lower DTF (30.87 ± 5.32 vs. 27.88 ± 6.24, P = 0.04), and showed lower VTI increment to PLR (13.63 ± 3.44 vs. 9.11 ± 4.59, P < 0.001). Using a binary logistic regression model, DTF < 26% (odds ratio 6.20, 95% CI: 1.06-36.04) and VTI change to PLR < 10.2% (odds ratio 6.16, 95% CI: 1.14-33.13) were found to be significant predictors of weaning failure (P < 0.05). The AUROC for VTI and DTF for predicting weaning failure were 0.79 and 0.64, respectively. CONCLUSIONS An integrated ultrasound protocol using a combination of lung, diaphragm, and cardiac sonography was a reliable predictor of weaning failure.
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Affiliation(s)
- Riddhi Kundu
- Department of Critical Care Medicine, Manipal Hospitals, New Delhi, India
| | - Dalim K. Baidya
- Department of Anaesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences(AIIMS), New Delhi, India
| | - Rahul K. Anand
- Department of Anaesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences(AIIMS), New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences(AIIMS), New Delhi, India
| | - Kapil D. Soni
- Department of Trauma and Critical Care, All India Institute of Medical Sciences(AIIMS), New Delhi, India
| | - Rajeshwari Subramanium
- Department of Anaesthesiology, Pain Medicine, and Critical Care, All India Institute of Medical Sciences(AIIMS), New Delhi, India
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10
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Trikha A, Venkateswaran V, Soni KD. Extracorporeal Membrane Oxygenation in COVID-19 Patients: More Hype than Substance? Indian J Crit Care Med 2021; 25:1322-1323. [PMID: 34866835 PMCID: PMC8608628 DOI: 10.5005/jp-journals-10071-24005] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Trikha A, Venkateswaran V, Soni KD. Extracorporeal Membrane Oxygenation in COVID-19 Patients: More Hype than Substance? Indian J Crit Care Med 2021;25(11):1322–1323.
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Affiliation(s)
- Anjan Trikha
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Venkateswaran
- Department of Anaesthesiology, Pain Medicine and Critical Care, University College of Medical Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil D Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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11
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Kumar A, Aggarwal R, Khanna P, Kumar R, Singh AK, Soni KD, Trikha A. Correlation of the SpO2/FiO2 (S/F) ratio and the PaO2/FiO2 (P/F) ratio in patients with COVID-19 pneumonia. Med Intensiva 2021; 46:408-410. [PMID: 34812212 PMCID: PMC8598943 DOI: 10.1016/j.medin.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A Kumar
- Department of Anaesthesiology, Critical Care and Pain Medicine, AIIMS, New Delhi, India
| | - R Aggarwal
- Critical and Intensive Care, JPNATC, AIIMS, India
| | - P Khanna
- Department of Anaesthesiology, Critical Care and Pain Medicine, AIIMS, New Delhi, India
| | - R Kumar
- Department of Anaesthesiology, Critical Care and Pain Medicine, AIIMS, New Delhi, India
| | - A K Singh
- Department of Anaesthesiology, Critical Care and Pain Medicine, AIIMS, New Delhi, India
| | - K D Soni
- Critical and Intensive Care, JPNATC, AIIMS, India
| | - A Trikha
- Department of Anaesthesiology, Critical Care and Pain Medicine, AIIMS, New Delhi, India
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12
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Singh Y, Singh A, Rudravaram S, Soni KD, Aggarwal R, Patel N, Wig N, Trikha A. Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Markers for Predicting the Severity in COVID-19 Patients: A Prospective Observational Study. Indian J Crit Care Med 2021; 25:847-852. [PMID: 34733022 PMCID: PMC8559739 DOI: 10.5005/jp-journals-10071-23906] [Citation(s) in RCA: 4] [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: 01/10/2023] Open
Abstract
Background: Coronavirus disease-2019 (COVID-19) pandemic has shown unpredictable course in individual patients. Few patients develop severe disease with progression after admission to a healthcare facility. Multiple parameters have been investigated to identify a marker to predict disease progression. Neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte (PLR) ratio has shown some promise. The current investigation explores the role of NLR and PLR to predict the disease progression. Materials and methods: After obtaining ethics committee approval, 608 patients were screened for inclusion in the prospective observational study, and 201 patients were included in the final analysis. The NLR and PLR were derived from routinely obtained complete blood count analysis. The patients were followed to determine the development of severity of the disease during the course. The NLR and PLR were analyzed in both univariate and multivariable models to assess the association and prediction. Results: In nonsevere (NS) group, the mean age of patients was 50.9 ± 16.3 years, and 66 (61.2%) were male, while in severe group (S), the mean age of patients was 53.7 ± 16.4 years, and 65 (69.89%) were male. NLR at day 1 and day 3 was significantly lower in survivors as compared to nonsurvivors, while the relation of PLR in both the groups was not statistically significant. The NLR is better in predicting the severity of disease as well as mortality than PLR. Conclusion: The NLR calculated at the time of admission has high predictive value for disease deterioration and adverse clinical outcome. How to cite this article: Singh Y, Singh A, Rudravaram S, Soni KD, Aggarwal R, Patel N, et al. Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Markers for Predicting the Severity in COVID-19 Patients: A Prospective Observational Study. Indian J Crit Care Med 2021;25(8):847–852.
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Affiliation(s)
- Yudhyavir Singh
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Singh
- Department of Anaesthesiology, Critical Care and Pain Medicine, New Delhi, India
| | - Swetha Rudravaram
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil D Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Nishant Patel
- Department of Anaesthesiology, Critical Care and Pain Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India
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Venkateswaran V, Chaturvedi A, Soni KD, Aggarwal R, Trikha A. COVID-19 Illness in a Patient With Anti-Glomerular Basement Membrane Disease: A Clinical Dilemma. Cureus 2021; 13:e14912. [PMID: 34123612 PMCID: PMC8191424 DOI: 10.7759/cureus.14912] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Anti-glomerular basement membrane (anti-GBM) disease is a rare autoimmune disease affecting the kidneys and lungs. COVID-19 infection in a patient with pre-existing anti-GBM disease presents a unique set of clinical challenges. The formulation of a judicious treatment plan balancing both disease processes is tricky, especially with regard to anticoagulation. We present the case of a young patient with anti-GBM disease who acquired COVID-19 infection and eventually succumbed to his illness.
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Affiliation(s)
- Vineeta Venkateswaran
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, IND
| | - Apoorv Chaturvedi
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, IND
| | - Kapil D Soni
- Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, IND
| | - Richa Aggarwal
- Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, IND
| | - Anjan Trikha
- Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, IND
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Venkateswaran V, Chaturvedi A, Soni KD, Aggarwal R, Trikha A. Bronchopleural Fistula after High-flow Nasal Cannula Use in Patient with COVID-19. Indian J Crit Care Med 2021; 25:830-831. [PMID: 34316183 PMCID: PMC8286376 DOI: 10.5005/jp-journals-10071-23890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Venkateswaran V, Chaturvedi A, Soni KD, Aggarwal R, Trikha A. Bronchopleural Fistula after High-flow Nasal Cannula Use in Patient with COVID-19. Indian J Crit Care Med 2021;25(7):830–831.
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Affiliation(s)
- Vineeta Venkateswaran
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Apoorv Chaturvedi
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil D Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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15
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Vaishnav M, Elhence A, Kumar R, Mohta S, Palle C, Kumar P, Ranjan M, Vajpai T, Prasad S, Yegurla J, Dhooria A, Banyal V, Agarwal S, Bansal R, Bhattacharjee S, Aggarwal R, Soni KD, Rudravaram S, Singh AK, Altaf I, Choudekar A, Mahapatra SJ, Gunjan D, Kedia S, Makharia G, Trikha A, Garg P, Saraya A. Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding. J Clin Exp Hepatol 2021; 11:327-333. [PMID: 33519132 PMCID: PMC7833290 DOI: 10.1016/j.jceh.2020.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/28/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND/OBJECTIVE There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with Coronavirus disease -2019 (COVID-19) amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. METHODS In this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22nd April to 22nd July 2020, were included. RESULTS The mean age of patients was 45.8 ± 12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay. CONCLUSION Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis.
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Key Words
- AD, Acute decompensation
- AIH, Autoimmune hepatitis
- AIMS65, Albumin, international normalized ratio, mental status, systolic blood pressure, age > 65
- CLD, Chronic liver disease
- COVID-19, Coronavirus disease −2019
- CRS, Clinical Rockall Score
- Carvedilol
- Endoscopy
- FFP, Fresh frozen plasma
- GAVE, Gastric antral vascular ectasia
- GBS, Glasgow-Blatchford bleeding score
- GI, Gastrointestinal
- HE, Hepatic encephalopathy
- HVPG, Hepatic venous pressure gradient
- INR, International normalized ratio
- LGI, Lower gastrointestinal
- Liver transplant
- MOHFW, Ministry of Health and Family Welfare
- NSAIDs, Non-steroidal anti-inflammatory drugs
- PPE, Personal protective equipment
- PRBC, Packed red blood cells
- Prognosis
- Proton pump inhibitors
- RR, Respiratory rate
- RT-PCR, Reverse transcriptase polymerase chain reaction
- SARS-CoV2, Severe acute respiratory syndrome Coronavirus 2
- UGI, Upper gastrointestinal
- Variceal bleeding
- mGBS, Modified Glasgow-Blatchford bleeding score
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Affiliation(s)
- Manas Vaishnav
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anshuman Elhence
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna, India
| | - Srikant Mohta
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Chandan Palle
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Peeyush Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Mukesh Ranjan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanmay Vajpai
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Shubham Prasad
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Jatin Yegurla
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anugrah Dhooria
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Vikas Banyal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Samagra Agarwal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajat Bansal
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Sulagna Bhattacharjee
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Richa Aggarwal
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Kapil D Soni
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Swetha Rudravaram
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Ashutosh K Singh
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Irfan Altaf
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Avinash Choudekar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Soumya J Mahapatra
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Gunjan
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Kedia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Govind Makharia
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain and Critical Care, All India Institute of Medical Sciences, New Delhi
| | - Pramod Garg
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Saraya
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
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Aggarwal R, Bhatia R, Kulshrestha K, Soni KD, Viswanath R, Singh AK, Iyer KV, Khanna P, Bhattacharjee S, Patel N, Aravindan A, Gupta A, Singh Y, Ganesh V, Kumar R, Ayub A, Kumar S, Prakash K, Venkateswaran V, Bhoi D, Soneja M, Mathur P, Malhotra R, Wig N, Guleria R, Trikha A. Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center. Indian J Crit Care Med 2021; 25:622-628. [PMID: 34316140 PMCID: PMC8286396 DOI: 10.5005/jp-journals-10071-23848] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background and objective A large number of studies describing the clinicoepidemiological features of coronavirus disease-2019 (COVID-19) patients are available but very few studies have documented similar features of the deceased. This study was aimed to describe the clinicoepidemiological features and the causes of mortality of COVID-19 deceased patients admitted in a dedicated COVID center in India. Methodology This was a retrospective study done in adult deceased patients admitted in COVID ICU from April 4 to July 24, 2020. The clinical features, comorbidities, complications, and causes of mortality in these patients were analyzed. Pediatric deceased were analyzed separately. Results A total of 654 adult patients were admitted in the ICU during the study period and ICU mortality was 37.7% (247/654). Among the adult deceased, 65.9% were males with a median age of 56 years [interquartile range (IQR), 41.5-65] and 94.74% had one or more comorbidities, most common being hypertension (43.3%), diabetes mellitus (34.8%), and chronic kidney disease (20.6%). The most common presenting features in these deceased were fever (75.7%), cough (68.8%), and shortness of breath (67.6%). The mean initial sequential organ failure assessment score was 9.3 ± 4.7 and 24.2% were already intubated at the time of admission. The median duration of hospital stay was 6 days (IQR, 3-11). The most common cause of death was sepsis with multi-organ failure (55.1%) followed by severe acute respiratory distress syndrome (ARDS) (25.5%). All pediatric deceased had comorbid conditions and the most common cause of death in this group was severe ARDS. Conclusion In this cohort of adult deceased, most were young males with age less than 65 years with one or more comorbidities, hypertension being the most common. Only 5% of the deceased had no comorbidities. Sepsis with multi-organ dysfunction syndrome was the most common cause of death. How to cite this article Aggarwal R, Bhatia R, Kulshrestha K, Soni KD, Viswanath R, Singh AK, et al. Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center. Indian J Crit Care Med 2021; 25(6):622-628.
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Affiliation(s)
- Richa Aggarwal
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Ridhima Bhatia
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | | | - Kapil D Soni
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Renjith Viswanath
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Ashutosh K Singh
- Department of Pulmonary and Sleep Medicine, AIIMS, New Delhi, India
| | - Karthik V Iyer
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
| | | | - Nishant Patel
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Ajisha Aravindan
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Anju Gupta
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Yudhyavir Singh
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Venkata Ganesh
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Rakesh Kumar
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Arshed Ayub
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Shailender Kumar
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Kellika Prakash
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | | | - Debesh Bhoi
- Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | | | - Purva Mathur
- Department of Laboratory Medicine, AIIMS, New Delhi, India
| | | | - Naveet Wig
- Department of Medicine, AIIMS, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary and Sleep Medicine, AIIMS, New Delhi, India
| | - Anjan Trikha
- Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India
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Sarkar S, Khanna P, Soni KD. Are the steroids a blanket solution for COVID-19? A systematic review and meta-analysis. J Med Virol 2020; 93:1538-1547. [PMID: 32881007 DOI: 10.1002/jmv.26483] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/21/2020] [Accepted: 08/28/2020] [Indexed: 12/13/2022]
Abstract
Steroids may play a critical role in the current pandemic of coronavirus disease-2019 (COVID-19), given the dearth of specific therapeutic options. This review was conducted to evaluate the impact of glucocorticoid therapy in patients with COVID-19 based on the publications reported to date. A comprehensive screening was conducted using electronic databases up to August 19, 2020. The randomized controlled trials (RCTs) and cohort studies evaluating the effectiveness and safety of steroids in patients with COVID-19 are included for the meta-analyses. Our search retrieved twelve studies, including two RCTs and 10 cohort studies, with a total of 15,754 patients. In patients with COVID-19, the use of systemic glucocorticoid neither reduce mortality (odds ratio [OR] = 1.94, 95% confidence interval [CI]: 1.11-3.4, I2 = 96%), nor the duration of hospital stay (mean difference [MD] = 1.18 days, 95% CI: -1.28 to 3.64, I2 = 93%) and period of viral shedding (MD = 1.42 days, 95% CI: -0.52 to 3.37, I2 = 0%). Systemic steroid therapy may not be effective for reducing mortality, duration of hospitalization, and period of viral shedding. Studies are mostly heterogeneous. Further RCTs are required.
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Affiliation(s)
- Soumya Sarkar
- Department of Anaesthesia Pain Medicine, and Critical Care, AIIMS, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesia Pain Medicine, and Critical Care, AIIMS, New Delhi, India
| | - Kapil D Soni
- Department of Critical and Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
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18
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Sarkar S, Soni KD, Khanna P. Convalescent plasma is a clutch at straws in COVID-19 management! A systematic review and meta-analysis. J Med Virol 2020; 93:1111-1118. [PMID: 32776573 PMCID: PMC7436491 DOI: 10.1002/jmv.26408] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [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] [Received: 07/21/2020] [Revised: 08/02/2020] [Accepted: 08/04/2020] [Indexed: 12/12/2022]
Abstract
In the absence of definitive therapy for coronavirus disease (COVID‐19), convalescent plasma therapy (CPT) may be a critical therapeutic option. This review was conducted to evaluate the impact of CPT in COVID‐19 patients based on the publications reported to date. A robust screening of electronic databases was conducted up to 10th July 2020. Randomized controlled trials (RCTs), cohort studies, and case series with a control group evaluating the effectiveness and safety of CPT in patients with COVID‐19 are included for the meta‐analyses. Our search retrieved seven studies, including two RCTs and five cohort studies, with a total of 5444 patients. In patients with COVID‐19, the use of CPT reduces mortality (odd's ratio [OR] 0.44; 95% CI, 0.25‐0.77), increases viral clearance (OR, 11.29; 95% CI, 4.9‐25.9) and improves clinically (OR, 2.06; 95% CI, 0.8 to 4.9). However, the evidence is of low quality (mortality reduction, and viral clearance), and very low quality (clinical improvement). CPT may be beneficial for reducing mortality, viral shedding and improving clinical conditions in COVID‐19 patients. However, further randomized control trials (RCT) are required to substantiate the safety margin, initiation, optimal dosage, titre and duration of CPT.
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Affiliation(s)
- Soumya Sarkar
- Department of Anaesthesia, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Kapil D Soni
- Department of Critical & Intensive Care, JPN Apex Trauma Centre, AIIMS, New Delhi, India
| | - Puneet Khanna
- Department of Anaesthesia, Pain Medicine & Critical Care, AIIMS, New Delhi, India
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Mitra B, Kumar V, O'Reilly G, Cameron P, Gupta A, Pandit AP, Soni KD, Kaushik G, Mathew J, Howard T, Fahey M, Stephenson M, Dharap S, Patel P, Thakor A, Sharma N, Walker T, Misra MC, Gruen RL, Fitzgerald MC. Prehospital notification of injured patients presenting to a trauma centre in India: a prospective cohort study. BMJ Open 2020; 10:e033236. [PMID: 32565447 PMCID: PMC7311027 DOI: 10.1136/bmjopen-2019-033236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. DESIGN Longitudinal prospective cohort study with preintervention and postintervention cohorts. SETTING Major trauma centre in India. PARTICIPANTS Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. INTERVENTION A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. MAIN OUTCOME MEASURES The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. RESULTS Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). CONCLUSIONS The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. TRIAL REGISTRATION NUMBER NCT02877342.
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Affiliation(s)
- Biswadev Mitra
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Pulic Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
| | - Vineet Kumar
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Gerard O'Reilly
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Pulic Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
| | - Peter Cameron
- Emergency & Trauma Centre, The Alfred Hospital, Melbourne, VIC, Australia
- School of Pulic Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
| | - Amit Gupta
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Amol P Pandit
- Department of Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India
| | - Kapil D Soni
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Gaurav Kaushik
- JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Joseph Mathew
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Teresa Howard
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Madonna Fahey
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
| | - Michael Stephenson
- School of Pulic Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Ambulance Victoria, Doncaster, VIC, Australia
- Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, VIC, Australia
| | - Satish Dharap
- Department of Surgery, Topiwala National Medical College & B.Y.L. Nair Ch. Hospital, Mumbai, Maharashtra, India
| | - Pankaj Patel
- Department of Orthopaedic Surgery, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Advait Thakor
- Department of Emergency Medicine, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Naveen Sharma
- Department of General Surgery, All India Institute of Meical Sciences Jodhpur, Jodhpur, Rajasthan, India
| | - Tony Walker
- Ambulance Victoria, Doncaster, VIC, Australia
| | - Mahesh C Misra
- Surgical Disciplines, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
| | - Russell L Gruen
- College of Health & Medicine, Australian National University, Canberra, ACT, Australia
| | - Mark C Fitzgerald
- National Trauma Research Institute, The Alfred Hospital, Melbourne, VIC, Australia
- Trauma Service, The Alfred Hospital, Melbourne, VIC, Australia
- Central Clinical School, Monash University, Melbourne, VIC, Australia
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20
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Katiyar AK, Agarwal H, Priyadarshini P, Kumar A, Kumar S, Gupta A, Mishra B, Aggarwal R, Soni KD, Mathur P, Sagar R, Srivastava A, Banerjee N, Sagar S. Primary vs delayed primary closure in patients undergoing lower limb amputation following trauma: A randomised control study. Int Wound J 2019; 17:419-428. [PMID: 31860942 DOI: 10.1111/iwj.13288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/25/2019] [Accepted: 12/05/2019] [Indexed: 11/27/2022] Open
Abstract
Lower limb crush injury is a major source of mortality and morbidity in trauma patients. Complications, especially surgical site infections (SSIs) are a major source of financial burden to the institute and to the patient as it delays rehabilitation. As such, every possible attempt should be made to reduce any complications. We, thus, aimed to compare the outcomes in early vs delayed closure of lower extremity stumps in cases of lower limb crush injury requiring amputation, so as to achieve best possible outcome. A randomised controlled study was conducted in the Division of Trauma Surgery & Critical Care at Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi from 1 September 2018 to 30 June 2019 and included patients undergoing lower limb amputation below hip joint. Patients were randomised in two groups, in one group amputation stump was closed primarily, while in the second group delayed primary closure of stump was performed. We compared rate of SSI, length of hospital stay, and number of surgeries in both the groups. Fifty-six patients with 63 amputation stumps were recruited in the study. Mean age of patients in the study was 34 years, of which about 95% patients were males. The most common mechanism of injury was road traffic injury in 66% of patients. Mean injury severity score was 12.28 and four patients had diabetes preoperatively. Total 63 extremities were randomised with 30 cases in group I and 33 cases in group II as per computer-generated random number. Above knee amputations was commonest (57.14%) followed by below knee amputations (33.3%). Two patients died in the current study. In group I, In-hospital infection was detected in 7 cases (23.3%) and in group II 9 cases (27.3%) had SSI during hospital admission (P > .05). Mean hospital stay in group I was 10.32 ± 7.68 days and in group II was 11 ± 8.17 days (P > .05). Road traffic injuries and train-associated injuries are a major cause of lower limb crush injuries, leading to limb loss. Delayed primary closure of such wounds requires extra number of surgical interventions than primary closure. There is no difference in extra number of surgical interventions required in both the groups. Thus, primary closure can be safely performed in patients undergoing lower limb amputations following trauma, provided that a good lavage and wound debridement is performed.
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Affiliation(s)
- Anand K Katiyar
- Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Harshit Agarwal
- Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | | | | | - Subodh Kumar
- Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Amit Gupta
- Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Biplab Mishra
- Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Richa Aggarwal
- Department of Critical and Intensive care, JPNATC, AIIMS, New Delhi, India
| | - Kapil D Soni
- Department of Critical and Intensive care, JPNATC, AIIMS, New Delhi, India
| | - Purva Mathur
- Department of Laboratory Medicine, JPNATC, AIIMS, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, AIIMS, New Delhi, India
| | | | - Niladri Banerjee
- Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
| | - Sushma Sagar
- Division of Trauma Surgery & Critical Care, JPNATC, AIIMS, New Delhi, India
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O'Reilly GM, Mathew J, Roy N, Gupta A, Joshipura M, Sharma N, Mitra B, Cameron PA, Fahey M, Howard T, Kumar V, Jarwani B, Soni KD, Thakor A, Dharap S, Patel P, Jhakal A, Farrow NC, Misra MC, Gruen RL, Fitzgerald MC. A checklist for trauma quality improvement meetings: A process improvement study. Injury 2019; 50:1599-1604. [PMID: 31040028 DOI: 10.1016/j.injury.2019.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/22/2019] [Accepted: 04/06/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Each year approximately five million people die from injuries. In countries where systems of trauma care have been introduced, death and disability have decreased. A major component of developed trauma systems is a trauma quality improvement (TQI) program and trauma quality improvement meeting (TQIM). Effective TQIMs improve trauma care by identifying and fixing problems. But globally, TQIMs are absent or unstructured in most hospitals providing trauma care. The aim of this study was to implement and evaluate a checklist for a structured TQIM. METHODS This project was conducted as a prospective before-and-after study in four major trauma centres in India. The intervention was the introduction of a structured TQIM using a checklist, introduced with a workshop. This workshop was based on the World Health Organization (WHO) TQI Programs short course and resources, plus the developed TQIM checklist. Pre- and post-intervention data collection occurred at all meetings in which cases of trauma death were discussed. The primary outcome was TQIM Checklist compliance, defined by the discussion of, and agreement upon each of the following: preventability of death, identification of opportunities to improve care and corrective actions and a plan for closing the loop. RESULTS There were 34 meetings in each phase, with 99 cases brought to the pre-intervention phase and 125 cases brought to the post-intervention phase. There was an increase in the proportion of cases brought to the meeting for which preventability of death was discussed (from 94% to 100%, p = 0.007) and agreed (from 7 to 19%, OR 3.7; 95% CI:1.4-9.4, p = 0.004) and for which a plan for closing the loop was discussed (from 2% to 18%, OR 10.9; 95% CI:2.5-47.6, p < 0.001) and agreed (from 2% to 18%, OR 10.9; 95% CI:2.5-47.6, p < 0.001). CONCLUSION This study developed, implemented and evaluated a TQIM Checklist for improving TQIM processes. The introduction of a TQIM Checklist, with training, into four Indian trauma centres, led to more structured TQIMs, including increased discussion and agreement on preventability of death and plans for loop closure. A TQIM Checklist should be considered for all centres managing trauma patients.
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Affiliation(s)
- G M O'Reilly
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - J Mathew
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Australia
| | - N Roy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; WHO Collaborating Centre for Research in Surgical Care Delivery in LMICs, BARC Hospital (Govt of India), Mumbai, India
| | - A Gupta
- Division of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - M Joshipura
- Academy of Traumatology (India), Ahmedabad, India
| | - N Sharma
- Department of Surgery, All India Institute of Medical Sciences, Jodhpur, India
| | - B Mitra
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - P A Cameron
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Emergency and Trauma Centre, The Alfred, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - M Fahey
- Central Clinical School, Monash University, Melbourne, Australia; Tasmanian Health Service, Australia
| | - T Howard
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia
| | - V Kumar
- Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - B Jarwani
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | - K D Soni
- Division of Trauma Surgery and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - A Thakor
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | - S Dharap
- Topiwala National Medical College and B.Y.L. Nair Charitable Hospital, Mumbai, India
| | - P Patel
- Smt. NHL Municipal Medical College, Ahmedabad, India
| | - A Jhakal
- Emergency Department, J.P.N.A. Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - N C Farrow
- Central Clinical School, Monash University, Melbourne, Australia; Safer Care Victoria, Melbourne, Australia
| | - M C Misra
- Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
| | - R L Gruen
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - M C Fitzgerald
- National Trauma Research Institute, The Alfred, Melbourne, Australia; Central Clinical School, Monash University, Melbourne, Australia; Trauma Service, The Alfred, Melbourne, Australia
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Soni KD, Arasu T, Aggarwal R, Darlong V. A unique way of securing the tracheostomy tube in a case of facial and neck burns. J Anaesthesiol Clin Pharmacol 2019; 35:412-413. [PMID: 31543601 PMCID: PMC6747993 DOI: 10.4103/joacp.joacp_278_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kapil D Soni
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, New Delhi, India
| | - Thanigai Arasu
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, New Delhi, India
| | - Richa Aggarwal
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, New Delhi, India
| | - Vanlal Darlong
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Bhattacharjee S, Soni KD, Maitra S. Recruitment maneuver does not provide any mortality benefit over lung protective strategy ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis and systematic review of the randomized controlled trials. J Intensive Care 2018; 6:35. [PMID: 29983985 PMCID: PMC6019312 DOI: 10.1186/s40560-018-0305-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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] [Received: 05/14/2018] [Accepted: 06/11/2018] [Indexed: 01/03/2023] Open
Abstract
Background Clinical benefits of recruitment maneuver in ARDS patients are controversial. A number of previous studies showed possible benefits; a large recent study reported that recruitment maneuver and PEEP titration may even be harmful. This meta-analysis was designed to compare the clinical utility of recruitment maneuver with low tidal volume ventilation in adult patients with ARDS. Methods Randomized controlled trials comparing recruitment maneuver and lung protective ventilation strategy with lung protective strategy ventilation protocol alone in adult patients with ARDS has been included in this meta-analysis. PubMed and Cochrane Central Register of Controlled Trials were searched from inception to 10 November 2017 to identify potentially eligible trials. Pooled risk ratio (RR) and standardized mean difference (SMD) were calculated for binary and continuous variables respectively. Results Data of 2480 patients from 7 randomized controlled trials have been included in this meta-analysis and systemic review. Reported mortality at the longest available follow-up [RR (95% CI) 0.93 (0.80, 1.08); p = 0.33], ICU mortality [RR (95% CI) 0.91 (0.76, 1.10); p = 0.33] and in-hospital mortality [RR (95% CI) 0.95 (0.83, 1.08); p = 0.45] were similar between recruitment maneuver group and standard lung protective ventilation group. Duration of hospital stay [SMD (95% CI) 0.00 (− 0.09, 0.10); p = 0.92] and duration of ICU stays [SMD (95% CI) 0.05 (− 0.09, 0.19); p = 0.49] were also similar between recruitment maneuver group and standard lung protective ventilation group. Risk of barotrauma was also similar. Conclusion Use of recruitment maneuver along with co-interventions such as PEEP titration does not provide any benefit in terms of mortality, length of ICU, and hospital stay in ARDS patients. Electronic supplementary material The online version of this article (10.1186/s40560-018-0305-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sulagna Bhattacharjee
- 1Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Room No. 5011, 5th Floor Teaching block, Ansari Nagar New Delhi, 110029 India
| | - Kapil D Soni
- 2Department of Trauma Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute Medical Sciences, New Delhi, India
| | - Souvik Maitra
- 1Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Room No. 5011, 5th Floor Teaching block, Ansari Nagar New Delhi, 110029 India
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Soni KD, Garg N, Aggarwal R, Ambuj A. Percutaneous dilatational tracheostomy through paramedian technique and lateral approach in a patient with cervical esophagostomy-a case report. Int J Burns Trauma 2017; 7:47-49. [PMID: 28804685 PMCID: PMC5545430] [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] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 07/17/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Percutaneous dilatational tracheostomy (PDT) is a common surgical procedure and established as first choice for securing the airway in critically ill patients needing prolonged mechanical ventilation. There are case reports of open tracheostomy through paramedian approach without complications. This case report presents a case of PDT through paramedian approach. CASE REPORT An 18 year old female, case of firearm injury underwent cervical esophagostomy on the left side of neck approaching midline. So we perform PDT through paramedian technique and lateral approach safely with use of real time ultrasound and fiberoptic bronchoscope. DISCUSSION PDT can be done through paramedian technique and lateral approach to trachea safely with help of ultrasound and fiberoptic bronchoscope in the conditions where midline approach is not feasible and unsafe.
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Affiliation(s)
- Kapil D Soni
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical SciencesNew Delhi, India
| | - Neha Garg
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical SciencesNew Delhi, India
| | - Richa Aggarwal
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical SciencesNew Delhi, India
| | - Ambuj Ambuj
- Department of Anaesthesia and Critical Care, All India Institute of Medical SciencesNew Delhi, India
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Bhattacharjee S, Soni KD, Maitra S, Baidya DK. Levosimendan does not provide mortality benefit over dobutamine in adult patients with septic shock: A meta-analysis of randomized controlled trials. J Clin Anesth 2017; 39:67-72. [PMID: 28494911 DOI: 10.1016/j.jclinane.2017.03.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/11/2017] [Accepted: 03/04/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Despite of advancement in intensive care medicine, sepsis and septic shock carry a high mortality. Levosimendan, an inodilator, may be promising for septic shock patients with myocardial dysfunction; however, firm evidence is lacking. In this meta- analysis of randomized controlled trials, levosimendan has been compared with dobutamine in adult patients with sepsis and septic shock. DESIGN Meta-analysis of randomized controlled trial. SETTING Intensive-care unit. PARTICIPANTS Adult septic shock patients. INTERVENTION Adult septic shock patients received dobutamine or levosimendan. MAIN OUTCOME MEASURE Mortality at longest follow-up, blood lactate level, cardiac index and noradrenaline requirement. RESULTS Data from 7 randomized trials have been included in this meta-analysis. Levosimendan has no benefit in terms of mortality at longest follow up in comparison to dobutamine (Odds ratio 0.77, 95% CI 0.45, 132; p=0.34) and length of ICU stay (MD -4.7days, 95% CI -10.3, 0.9days, p=0.10). Patients received levosimendan had less blood lactate level (standardized mean difference -0.95; 95% CI -1.64, -0.27; p=0.006) and higher cardiac index (mean difference 0.44; 95% CI 0.17, 0.71; p=0.001). Noradrenaline requirements are similar in both the groups. CONCLUSION There is no evidence that levosimendan is superior to dobutamine in adult patients with sepsis and septic shock. Further large randomized trials are necessary in this area.
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Affiliation(s)
- Sulagna Bhattacharjee
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil D Soni
- Department of Trauma Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Gupta S, Singh P, Soni KD, Aggarwal R, Yadav D. Percutaneous tracheostomy in post-cervical spine fixation patients: challenging the dogma. Am J Emerg Med 2016; 34:910-1. [PMID: 26944106 DOI: 10.1016/j.ajem.2016.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/01/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sumit Gupta
- Department of Anesthesia, Intensive Care and Pain Medicine, AIIMS, New Delhi, Delhi, India.
| | - Pushpendra Singh
- Department of Anesthesia, Intensive Care and Pain Medicine, AIIMS, New Delhi, Delhi, India
| | - Kapil D Soni
- Department of Intensive Care, JPNATC, AIIMS, New Delhi, Delhi.
| | - Richa Aggarwal
- Department of Intensive Care, JPNATC, AIIMS, New Delhi, Delhi, India
| | - Devender Yadav
- Department of Anesthesia, Intensive Care and Pain Medicine, AIIMS, New Delhi, Delhi, India
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Gupta B, Agrawal P, Soni KD, Yadav V, Dhakal R, Khurana S, Misra M. Enteral nutrition practices in the intensive care unit: Understanding of nursing practices and perspectives. J Anaesthesiol Clin Pharmacol 2012; 28:41-4. [PMID: 22345944 PMCID: PMC3275970 DOI: 10.4103/0970-9185.92433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [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: 01/15/2023] Open
Abstract
Background: Adequate nutritional support is important for the comprehensive management of patients in intensive care units (ICUs). Aim: The study was aimed to survey prevalent enteral nutrition practices in the trauma intensive care unit, nurses’ perception, and their knowledge of enteral feeding. Study Design: The study was conducted in the ICU of a level 1 trauma center, Jai Prakash Narayan Apex Trauma Centre, AIIMS, New Delhi, India. The study design used an audit. Materials and Methods: Sixty questionnaires were distributed and the results analyzed. A database was prepared and the audit was done. Results: Forty-two (70%) questionnaires were filled and returned. A majority (38) of staff nurses expressed awareness of nutrition guidelines. A large number (32) of staff nurses knew about nutrition protocols of the ICU. Almost all (40) opined enteral nutrition to be the preferred route of nutrition unless contraindicated. All staff nurses were of opinion that enteral nutrition is to be started at the earliest (within 24–48 h of the ICU stay). Everyone opined that the absence of bowel sounds is an absolute contraindication to initiate enteral feeding. Passage of flatus was considered mandatory before starting enteral nutrition by 86% of the respondents. Everyone knew that the method of Ryle's tube feeding in their ICU is intermittent boluses. Only 4 staff nurses were unaware of any method to confirm Ryle's tube position. The backrest elevation rate was 100%. Gastric residual volumes were always checked, but the amount of the gastric residual volume for the next feed to be withheld varied. The majority said that the unused Ryle's tube feed is to be discarded after 6 h. The most preferred (48%) method to upgrade their knowledge of enteral nutrition was from the ICU protocol manual. Conclusion: Information generated from this study can be helpful in identifying nutrition practices that are lacking and may be used to review and revise enteral feeding practices where necessary.
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Affiliation(s)
- Babita Gupta
- Department of Anaesthesia and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
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