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Zirpe KG, Tiwari AM, Kulkarni AP, Vaidya HS, Gurav SK, Deshmukh AM, Suryawanshi PB, Kapse US, Bhoyar AP, Dhawad PA, Mukherjee S. The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (PCO 2 Gap) during Resuscitation Affects ICU Outcomes: A Prospective Observational Study. Indian J Crit Care Med 2024; 28:349-354. [PMID: 38585325 PMCID: PMC10998525 DOI: 10.5005/jp-journals-10071-24680] [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] [Received: 12/12/2023] [Accepted: 01/19/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction The usual methods of perfusion assessment in patients with shock, such as capillary refill time, skin mottling, and serial serum lactate measurements have many limitations. Veno-arterial difference in the partial pressure of carbon dioxide (PCO2 gap) is advocated being more reliable. We evaluated serial change in PCO2 gap during resuscitation in circulatory shock and its effect on ICU outcomes. Materials and methods This prospective observational study included 110 adults with circulatory shock. Patients were resuscitated as per current standards of care. We recorded invasive arterial pressure, urine output, cardiac index (CI), PCO2 gap at ICU admission at 6, 12, and 24 hours, and various patient outcomes. Results Significant decrease in PCO2 gap was observed at 6 h and was accompanied by improvement in serum lactate, mean arterial pressure, CI and urine output in (n = 61). We compared these patients with those in whom this decrease did not occur (n = 49). Mortality and ICU LOS was significantly lower in patients with low PCO2 gap, while more patients with high PCO2 gap required RRT. Conclusion We found that a persistently high PCO2 gap at 6 and 12 h following resuscitation in patients with shock of various etiologies, was associated with increased mortality, need for RRT and increased ICU LOS. High PCO2 gap had a moderate discriminative ability to predict mortality. How to cite this article Zirpe KG, Tiwari AM, Kulkarni AP, Vaidya HS, Gurav SK, Deshmukh AM, et al. The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (PCO2 Gap) during Resuscitation Affects ICU Outcomes: A Prospective Observational Study. Indian J Crit Care Med 2024;28(4):349-354.
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Affiliation(s)
- Kapil G Zirpe
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Anand M Tiwari
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Atul P Kulkarni
- Department of Anaesthesia and Critical Care, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | | | - Sushma K Gurav
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Abhijit M Deshmukh
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | | | - Abhaya P Bhoyar
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Piyush A Dhawad
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Shameek Mukherjee
- Neurotrauma Intensive Care Unit, Ruby Hall Clinic, Pune, Maharashtra, India
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Tiwari AM, Zirpe KG, Gurav SK, Bhirud LB, Suryawanshi RS, Kulkarni SS. Case of Suspected SARS-CoV-2 Vaccine-induced Immune Thrombotic Thrombocytopenia (VITT): The Dilemma for Organ Donation. Indian J Crit Care Med 2022; 26:514-517. [PMID: 35656057 PMCID: PMC9067495 DOI: 10.5005/jp-journals-10071-24184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/23/2022] Open
Affiliation(s)
- Anand M Tiwari
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
- Anand M Tiwari, Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India, Phone: +91 7798255626, e-mail:
| | - Kapil G Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Sushma K Gurav
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Lomesh B Bhirud
- Department of Neurology, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Shilpa S Kulkarni
- Department of Critical Care, Ruby Hall Clinic, Pune, Maharashtra, India
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Zirpe KG, Dixit S, Kulkarni AP, Pandit RA, Ranganathan P, Prasad S, Amanulla ZK, Kothari V, Ambapkar S, Gurav SK, Shastrabuddhe S, Gosavi V, Joshi M, Mulakavalupil B, Saldhanah C, Ambapkar S, Bapte M, Singh S, Deshmukh A, Khatib K, Zirpe A, Sayiprasad G, Joshi A. The Second- vs First-wave COVID-19: More of the Same or a Lot Worse? A Comparison of Mortality between the Two Waves in Patients Admitted to Intensive Care Units in Nine Hospitals in Western Maharashtra. Indian J Crit Care Med 2022; 25:1343-1348. [PMID: 35027792 PMCID: PMC8693103 DOI: 10.5005/jp-journals-10071-24042] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 12/15/2022] Open
Abstract
Background India, along with the rest of the world, faced the challenging severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. The second wave in India lagged behind that in the Western world, due to different timing of seasons. There is scarce data about the differences between the two waves, for intensive care unit (ICU) patients. We present the data of 3,498 patients from 9 ICUs of western Maharashtra. Materials and methods We collected prospective data of hospitalized, RT-PCR confirmed, coronavirus-2019 (COVID-19) patients, from nine tertiary centers, after institutional ethics committee (IEC) approval. Then, we segregated and analyzed the data of patients admitted to the ICU, for comorbidities, high-resolution computed tomography (HRCT) score, ventilatory support, etc. The primary outcomes were ICU and hospital mortality. We also performed multivariable analysis for predictors of ICU mortality. Results Overall, there were 3,498 ICU patients. In the first wave, 1,921 patients needed ICU admission, while in the second wave, 1,577 patients. Patients in the second wave had significantly higher ICU (26.1 vs 13.4%, p <0.001) and hospital mortality (29.9 vs 18.2%, p <0.001) and need for ventilatory support of any type. More patients received steroids during the second wave. On multivariable regression, male gender, ICU admission during the second wave, increasing HRCT score, and need for intubation and mechanical ventilation were significant predictors of ICU mortality. Conclusion ICU patients admitted during the two waves were of the similar age, but there were more females, and more patients had comorbidities during the second wave. The ICU and hospital mortality were significantly higher during the second wave. How to cite this article Zirpe KG, Dixit S, Kulkarni AP, Pandit RA, Ranganathan P, Prasad S, et al. The Second- vs First-wave COVID-19: More of the Same or a Lot Worse? A Comparison of Mortality between the Two Waves in Patients Admitted to Intensive Care Units in Nine Hospitals in Western Maharashtra. Indian J Crit Care Med 2021; 25(12):1343-1348.
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Affiliation(s)
- Kapil G Zirpe
- Department of Neurotrauma Unit, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Atul P Kulkarni
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | | | - Priya Ranganathan
- Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sayi Prasad
- Department of Critical Care Medicine, Diamond Superspeciality Hospital, Kolhapur, Maharashtra, India
| | - Zafer Khan Amanulla
- Department of Medicine, Noble Hospital Pvt Ltd ICU, Pune, Maharashtra, India
| | - Vatsal Kothari
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | - Sushma K Gurav
- Department of Neurotrauma Unit, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India
| | - Shrikant Shastrabuddhe
- Department of Pulmonology and Critical Care Medicine, Medicover Hospital, Aurangabad, Maharashtra, India
| | - Vinod Gosavi
- Marathwada Medical Research Centre and Kamalnayan Bajaj Hospital, Aurangabad, Maharashtra, India
| | | | | | - Charlotte Saldhanah
- Department of Medicine, Noble Hospital Pvt Ltd ICU, Pune, Maharashtra, India
| | | | - Madhura Bapte
- Department of Medicine, Noble Hospital Pvt Ltd ICU, Pune, Maharashtra, India
| | - Sweta Singh
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Abhijit Deshmukh
- Department of Neurotrauma Unit, Ruby Hall Clinic, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Anmol Zirpe
- SKN Medical College, Pune, Maharashtra, India
| | - Gowri Sayiprasad
- Department of Critical Care Medicine, Diamond Superspeciality Hospital, Kolhapur, Maharashtra, India
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Zirpe K, Pote P, Deshmukh A, Gurav SK, Tiwari AM, Suryawanshi P. A Retrospective Analysis of Risk Factors of COVID-19 Associated Mucormycosis and Mortality Predictors: A Single-Center Study. Cureus 2021; 13:e18718. [PMID: 34790473 PMCID: PMC8584128 DOI: 10.7759/cureus.18718] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/15/2022] Open
Abstract
Background Mucormycosis has been identified with increasing frequency in patients with coronavirus disease 2019 (COVID-19). Aims We aimed to determine the in-hospital outcome of patients with COVID-19 associated mucormycosis (CAM). Materials and methods This was a single-center, retrospective, observational study. We included patients diagnosed with CAM from a tertiary care hospital in Pune, India. Clinical, laboratory, and in-hospital outcomes were noted. We analyzed factors associated with in-hospital mortality. Results Between February 2021 and June 2021, we identified 84 patients of CAM. The mean age was 49.3 ± 12.1 years. Of the included patients, 64.3% had diabetes mellitus, and 83.3% had received steroids. Mucormycosis was diagnosed after a median of 11 days from the COVID-19 diagnosis. Orbital and central nervous system (CNS) involvement was seen in 29.8% and 23.8% of patients, respectively. During a mean hospital stay of 12.5 ± 8.5 days, 15.5% of patients died. Compared to survivors, the presence of chronic kidney disease (CKD) (p<0.0001), orbital involvement (p=0.039), use of tocilizumab (p<0.0001), and development of renal dysfunction during hospitalization (p<0.0001) were seen in a significantly higher proportion of nonsurvivors. The proportion of patients with diabetes, those receiving steroids, and mean glycosylated hemoglobin (HbA1c) levels did not differ significantly in survivors and nonsurvivors. Conclusion In-hospital mortality in CAM is relatively lower in our institution. CKD, orbital involvement, use of tocilizumab, and renal dysfunction during hospital stay were found to be strong predictors of mortality.
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Affiliation(s)
- Kapil Zirpe
- Neuro Trauma Intensive Care Unit, Ruby Hall Clinic, Pune, IND
| | - Prajakta Pote
- Neuro Trauma Intensive Care Unit, Ruby Hall Clinic, Pune, IND
| | | | - Sushma K Gurav
- Neuro Trauma Intensive Care Unit, Ruby Hall Clinic, Pune, IND
| | - Anand M Tiwari
- Neuro Trauma Intensive Care Unit, Ruby Hall Clinic, Pune, IND
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Zirpe KG, Nimavat BD, Gurav SK. Age as Maestro or Solo Instrument in Opera of Death. Indian J Crit Care Med 2021; 25:606-607. [PMID: 34316133 PMCID: PMC8286407 DOI: 10.5005/jp-journals-10071-23868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Zirpe KG, Nimavat BD, Gurav SK. Age as Maestro or Solo Instrument in Opera of Death. Indian J Crit Care Med 2021;25(6):606-607.
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Affiliation(s)
- Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Sushma K Gurav
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
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Zirpe KG, Tiwari AM, Gurav SK, Deshmukh AM, Suryawanshi PB, Wankhede PP, Kapse US, Bhoyar AP, Khan AZ, Malhotra RV, Kusalkar PH, Chavan KJ, Naik SA, Bhalke RB, Bhosale NN, Makhija SV, Kuchimanchi VN, Jadhav AS, Deshmukh KR, Kulkarni GS. Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome. Indian J Crit Care Med 2021; 25:493-498. [PMID: 34177166 PMCID: PMC8196392 DOI: 10.5005/jp-journals-10071-23816] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Severe acute respiratory distress syndrome associated with coronavirus disease-2019 (COVID-19) (CARDS) pneumonitis presents a clinical challenge as regards to the timing of intubation and ambiguity of outcome. There is a lack of clear consensus on when to switch patients from trials of noninvasive therapies to invasive mechanical ventilation. We investigated the effect of the timing of intubation from the time of admission on the clinical outcome of CARDS. Aim and objective The aim and objective was to analyze the effect of timing of intubation early (within 48 hours of admission to critical care unit) versus delayed (after 48 hours of admission to critical care unit) on mortality in severe CARDS patients. Materials and methods A retrospective observational study performed in a 28-bedded COVID-19 intensive care unit of a tertiary care hospital in Pune, India. All patients admitted between April 1, 2020, and October 15, 2020, with confirmed COVID-19 (RT-PCR positive) requiring mechanical ventilation were included in the study. Results The primary outcome was in-hospital mortality. Among 2,230 patients that were admitted to the hospital, 525 required critical care (23.5%), invasive mechanical ventilation was needed in 162 patients and 147 (28%) of critical care admission were included in the study cohort after exclusion. Seventy-five patients (51%) were intubated within 48 hours of critical care admission (early group) and 72 (48.9%) were intubated after 48 hours of critical care admission (delayed group). With regards to the total of 147 included patients; male patients were 74.1% with a median age of 59 years (interquartile range, 51-68 years). Diabetes (44.9%) and hypertension (43.5%) were the most common comorbidities. Higher admission acute physiology and chronic health evaluation II scores and lower absolute lymphocyte count were observed in patients intubated within 48 hours. The early intubated group had a mortality of 60% whereas the same was observed as 77.7% in delayed intubation group, and this difference was statistically significant (p = 0.02). Conclusion Current study concludes that early intubation is associated with improved survival rates in severe CARDS patients. How to cite this article Zirpe KG, Tiwari AM, Gurav SK, Deshmukh AM, Suryawanshi PB, Wankhede PP, et al. Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome. Indian J Crit Care Med 2021;25(5):493-498.
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Affiliation(s)
- Kapil G Zirpe
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Anand M Tiwari
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sushma K Gurav
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Abhijit M Deshmukh
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Prasad B Suryawanshi
- Department of Critical Care, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Prajkta P Wankhede
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Upendrakumar S Kapse
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Abhaya P Bhoyar
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Afroz Z Khan
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Ria V Malhotra
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Pranoti H Kusalkar
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Kaustubh J Chavan
- Department of Cardiac Anaesthesia, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Seema A Naik
- Department of Cardiac Anaesthesia, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Rahul B Bhalke
- Department of Cardiac Anaesthesia, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Ninad N Bhosale
- Department of Critical Care, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sonika V Makhija
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Venkata N Kuchimanchi
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Amol S Jadhav
- Department of Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Kedar R Deshmukh
- Department of Cardiac Anaesthesia, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Gaurav S Kulkarni
- Department of Cardiac Anesthesia and Intensive Care, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
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Abstract
In the era of evidence-based medicine, healthcare professionals are bombarded with plenty of trials and articles of which randomized control trial is considered as the epitome of all in terms of level of evidence. It is very crucial to learn the skill of balancing knowledge of randomized control trial and to avoid misinterpretation of trial result in clinical practice. There are various methods and steps to critically appraise the randomized control trial, but those are overly complex to interpret. There should be more simplified and pragmatic approach for analysis of randomized controlled trial. In this article, we like to summarize few of the practical points under 5 headings: "5 'Rs' of critical analysis of randomized control trial" which encompass Right Question, Right Population, Right Study Design, Right Data, and Right Interpretation. This article gives us insight that analysis of randomized control trial should not only based on statistical findings or results but also on systematically reviewing its core question, relevant population selection, robustness of study design, and right interpretation of outcome. How to cite this article: Nimavat BD, Zirpe KG, Gurav SK. Critical Analysis of a Randomized Controlled Trial. Indian J Crit Care Med 2020;24(Suppl 4):S215-S222.
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Affiliation(s)
| | - Kapil G Zirpe
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Sushma K Gurav
- Department of Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
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Zirpe KG, Seta B, Gholap S, Aurangabadi K, Gurav SK, Deshmukh AM, Wankhede P, Suryawanshi P, Vasanth S, Kurian M, Philip E, Jagtap N, Pandit E. Incidence of Medication Error in Critical Care Unit of a Tertiary Care Hospital: Where Do We Stand? Indian J Crit Care Med 2020; 24:799-803. [PMID: 33132563 PMCID: PMC7584841 DOI: 10.5005/jp-journals-10071-23556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Medication error in developed countries is of primary concern when there is a question of adversity to a patient's health, but in developing countries like India, it is just a term and its significance is undervalued. The incidence of medication error is essential to estimate the proper medical care provided in the healthcare system. Objective The main objective of the study is to determine the incidences of medication error in critical care unit and to evaluate its risk outcomes. Materials and methods This is a prospective observational study conducted over a period of 6 months in a critical care unit of a tertiary care hospital. Medication chart review method was opted for data collection. The medication errors were mainly classified as prescription, transcription, indenting, dispensing, and administration error. A total of 6,705 charts were reviewed. The NCCMERP risk index was used to evaluate the outcome of errors. Results Of the total 6,705 charts, 410 medication errors were found, i.e., 6.11%. The most common error is transcription error that constitutes 44.1% of the total errors, followed by prescription error 40%, and administration error 14%. The frequency of indenting and dispensing errors is negligible with 1.5% and 0.5%, respectively. The main causes of medication errors are due to incomplete prescription 50.2% and wrong doses 22.9%. In drug class, antibiotics and antihypertensive agents are most prone to medication error. About 87.1% errors belonged to the Category B of National Coordinating Council for Medication Error Reporting and Prevention risk index. Conclusion Majority of the errors are transcription errors followed by prescription and administration errors. Consultant doctors have to be more vigilant during prescribing and verifying the medication charts. Clinical pharmacists should act as a checkpoint at each step of medication process to identify and prevent medication errors. How to cite this article Zirpe KG, Seta B, Gholap S, Aurangabadi K, Gurav SK, Deshmukh AM, et al. Incidence of Medication Error in Critical Care Unit of a Tertiary Care Hospital: Where Do We Stand? Indian J Crit Care Med 2020;24(9):799–803.
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Affiliation(s)
- Kapil G Zirpe
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Bhavika Seta
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Sharvari Gholap
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Sushma K Gurav
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Abhijeet M Deshmukh
- Neuro Trauma Stroke Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Prajkta Wankhede
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | | | - Swapna Vasanth
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Mariamma Kurian
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Elizabeth Philip
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Nirmala Jagtap
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
| | - Esther Pandit
- Neuro Trauma Unit, Grant Medical Foundation, Pune, Maharashtra, India
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Gurav SK, Zirpe KG, Wadia RS, Naniwadekar A, Pote PU, Tungenwar A, Deshmukh AM, Mohopatra S, Nimavat B, Surywanshi P. Impact of "Stroke Code"-Rapid Response Team: An Attempt to Improve Intravenous Thrombolysis Rate and to Shorten Door-to-Needle Time in Acute Ischemic Stroke. Indian J Crit Care Med 2018; 22:243-248. [PMID: 29743763 PMCID: PMC5930528 DOI: 10.4103/ijccm.ijccm_504_17] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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] [Indexed: 11/19/2022] Open
Abstract
Objective: “Stroke code” (SC) implementation in hospitals can improve the rate of thrombolysis and the timeline in care of stroke patient. Materials and Methods: A prospective data of patients treated for acute ischemic stroke (AIS) after implementation of “SC” (post-SC era) were analyzed (2015–2016) and compared with the retrospective data of patients treated in the “pre-SC era.” Parameters such as symptom-to-door, door-to-physician, door-to-imaging, door-to-needle (DTN), and symptom-to-needle time were calculated. The severity of stroke was calculated using the National Institutes of Health Stroke Score (NIHSS) before and after treatment. Results: Patients presented with stroke symptoms in pre- and post-SC era (695 vs. 610) and, out of these, patients who came in window period constituted 148 (21%) and 210 (34%), respectively. Patients thrombolyzed in pre- and post-SC era were 44 (29.7%) and 65 (44.52%), respectively. Average DTN time was 104.95 min in pre-SC era and reduced to 67.28 min (P < 0.001) post-SC implementation. Percentage of patients thrombolyzed within DTN time ≤60 min in pre-SC era and SC era was 15.90% and 55.38%, respectively. Conclusion: Implementation of SC helped us to increase thrombolysis rate in AIS and decrease DTN time.
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Affiliation(s)
- Sushma K Gurav
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Kapil G Zirpe
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - R S Wadia
- Department of Neurology, Ruby Hall Clinic, Pune, Maharashtra, India.,Deapartment of Medicine, BJMC, Pune, Maharashtra, India
| | | | - Prajakta U Pote
- Neuro Trauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | - Amit Tungenwar
- Resident General Medicine, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Srikanta Mohopatra
- Department of Accident and Emergency, Ruby Hall Clinic, Pune, Maharashtra, India
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Abstract
BACKGROUND Although majority of neurotrauma patients require long term ventilatory support but the timing of tracheostomy in such patients is controversial. METHOD This retrospective study was conducted at a Tertiary Care Hospital, Pune, India. Patients >18 years of age, who underwent percutaneous tracheostomy (PCT) from June 2010 to November 2014 at neurotrauma unit (NTU) of hospital, were included. Patients were divided in two groups according to the timing of tracheostomy, early tracheostomy (ET) group (≤5 days; N=100) and late tracheostomy (LT) group (>5 days; N=64). The nonparametric Mann-Whitney test, and Chi-square tests were used to compare these groups. RESULT There were no significant differences between the groups in terms of age, sex, APACHE II and GCS Score. Patients in the ET group had a significantly shorter stay in the NTU compared to patients in the LT group (mean, 18 vs. 21.2 days, p=0.005), fewer mechanical ventilation days (mean, 8.1 vs. 11.7 days, P=0.000) and shorter length of stay in hospital (mean, 28.8 vs. 34.37 days, P=0.019). There was no difference between ET and LT groups in post PCT ventilator free days (mean, 8.2 vs. 9.4 days; P=0.094). Mortality rates in ET vs. LT groups were also comparable (35% vs. 29.7%; P=0.480). CONCLUSION Results suggest that ET in neurotrauma patients might be associated with shorter length of stay in NTU and hospital, and shorter duration of mechanical ventilation however there was no mortality difference.
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Affiliation(s)
- Kapil G. Zirpe
- Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
| | | | | | - Sushma K. Gurav
- Neurotrauma Unit, Ruby Hall Clinic, Pune, Maharashtra, India
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Gurav SK, Zirpe KG, Wadia RS, Pathak MK, Deshmukh AM, Sonawane RV, Goli N. Problems and limitations in thrombolysis of acute stroke patients at a tertiary care center. Indian J Crit Care Med 2015; 19:265-9. [PMID: 25983432 PMCID: PMC4430744 DOI: 10.4103/0972-5229.156468] [Citation(s) in RCA: 9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: (1) To evaluate the number of patients thrombolysed within 1 h of arrival to emergency room (ER) (2) To identify reasons for delay in thrombolysis of acute stroke patients. Materials and Methods: All patients admitted to ER with symptoms suggestive of stroke from January 2011 to November 2013 were studied. Retrospective data were collected to evaluate ER to needle (door to needle time [DTNt]) time and reasons for delay in thrombolysis. The parameters studied (1) onset of symptoms to ER time, (2) ER to imaging time (door to imaging time [DTIt]), (4) ER to needle time (door to needle) and (5) contraindications for thrombolysis. Results: A total of 695 patients with suspected stroke were admitted during study period. 547 (78%) patients were out of window period. 148 patients (21%, M = 104, F = 44) arrived within window period (<4.5 h.). 104 (70.27%) were contraindicated for thrombolysis. Majority were intracerebral bleeds. 44 (29.7%) were eligible for thrombolysis. 7 (15.9%) were thrombolysed within 1 h. The mean time for arrival of patients from onset of symptoms to hospital (symptom to door) 83 min (median - 47). The mean door to neuro-physician time (DTPt) was 32 min (median - 15 min). The mean DTIt was 58 min (median - 50 min). The mean DTNt 104 (median - 100 min). Conclusion: Reasons for delay in thrombolysis are: Absence of stroke education program for common people. Lack of priority for triage and imaging for stroke patients.
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Affiliation(s)
- Sushma K Gurav
- Intensivist, Neuro-Trauma Unit, Ruby Hall Clinic, Pune, India
| | - Kapil G Zirpe
- Director, Neuro-Trauma Unit, Ruby Hall Clinic, Pune, India
| | - R S Wadia
- Director, Neuro-Sciences, Ruby Hall Clinic, Pune, India
| | | | | | | | - Nikhil Goli
- Chief Resident, Medicine, Ruby Hall Clnic, Pune, India
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