Effectiveness of "Physician Prompt Clinical Decision Criteria" in Weaning Outcome Prediction for Neurocritical Patients

Endotracheal intubation and invasive mechanical ventilation are fundamental components for the resuscitation of neurocritically ill patients to achieve various goals which include ensuring the protection of the airway, participating in tissue oxygen delivery and indirectly modulating cerebral vascular reactivity. The neurocritical patients demand special attention to their systemic involvement regarding weaning. Physician prompt clinical decision criteria (PPC) can play a better role in weaning of such patients. The aim of this study was to evaluate the effectiveness of 'Physician prompt clinical decision criteria' for successful weaning in neurocritical patients. This prospective observational study was conducted in the ICU, Department of Anaesthesia, Analgesia, Palliative & Intensive Care Medicine, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh from March 2018 to April 2020. In total 100 neurocritical patients who fulfilled the inclusion criteria were taken as samples by informed written consent. The outcome was observed as successful weaning or as failed weaning. Finally, the existence of Standard extubation criteria (SEC) was compared with Physician prompt clinical decision criteria (PPC). Weaning was succeeded in 80.0% of patients and failed in 20.0% according to the Standard extubation criteria (SEC) while weaning was succeeded in 85.7% of patients and failed in 14.28% according to the Physician prompt clinical decision criteria (PPC). There were some differences in results but no significant differences were observed statistically between the groups in predicting the weaning outcome. Physician prompt clinical decision criteria were found to be 75.0% sensitive and specificity was 50.0%. Positive predictive value for Physician prompt clinical decision criteria was 85.70% with a Positive likelihood ratio for these criteria was 1.5 times. So, according to the study findings, accuracy of Physician prompt clinical decision criteria was 70.0%. According to the findings of this current study we can conclude that Physician prompt clinical decision criteria are an effective weaning readiness predictor in neurocritical patients.

Multidisciplinary Team Effort Results in Better Outcomes in Critically Ill Obstetric Patients Admitted in ICU

Management of critically ill obstetric patients is a great challenge for the ICU team. The safety of both mother and fetus are of real concerns. Teamwork is essential for better outcome in obstetric patients in the ICU. A 26 years old female was admitted in Dhaka Medical College Hospital, Dhaka, Bangladesh on 18 August 2019 with 7 months pregnancy with brain tumor (later diagnosed as Gliosarcoma) and was managed surgically by left temporal craniotomy with excision of the tumor. The patient was shifted to the ICU due to repeated convulsions and need mechanical ventilator support. Later on, she was suffering from sepsis with pseudomonas in blood culture, grade IV pressure ulcer and electrolyte imbalance and needed tracheostomy for airway management. On 34th weeks of her pregnancy she developed antepartum hemorrhage with respiratory distress. Emergency LUCS was done and she delivered a LBW baby who was managed in NICU. Mother was managed in the ICU and later on both mother and child were discharge with good conditions. Multidisciplinary team work is vital for better management of critically ill obstetric patients.