Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine最新文献

{"title":"Knowledge, Attitudes, and Perceived Barriers of Healthcare Providers toward Early Mobilization of Adult Critically Ill Patients in Intensive Care Unit.","authors":"Pooja M Akhtar,&nbsp;Priyanka K Deshmukh","doi":"10.5005/jp-journals-10071-23835","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23835","url":null,"abstract":"<p><strong>Background: </strong>Early mobilization (EM) of critically ill adult patients in intensive care units (ICUs) is a newer concept. It is known to improve overall outcomes, but little is known regarding the attitude and knowledge of healthcare providers (HCPs) and multidisciplinary barriers to its use in the Indian scenario.</p><p><strong>Aims and objectives: </strong>To study the knowledge and attitude of HCPs in ICU about the EM of adult patients who are critically ill and identify perceived barriers to the application of EM.</p><p><strong>Materials and methods: </strong>In a cross-sectional survey conducted in a tertiary care academic institute, the HCPs, namely, physicians, anesthetists, surgeons, nursing staff, and physiotherapists working in ICU were interviewed using a self-structured questionnaire. The data were presented as descriptive statistics.</p><p><strong>Results: </strong>There was 80% response rate. The benefits of EM as shortened length of mechanical ventilation (MV) were acknowledged by 78% respondents and 54% believed that it maintains muscle strength. It was considered crucial by 44% respondents, who opined that it should be started as the patient's cardiorespiratory status stabilizes. The favorable attitudes observed were recognition of benefits for patients under MV exceeded the risks and readiness by physicians to reduce sedation levels and change the parameters of MV. The main barriers identified were the absence of written guidelines or protocols for EM, limited staff to mobilize patients, inadequate training of HCP to facilitate EM, excessive sedation, and medical instability.</p><p><strong>Conclusion: </strong>There exists an awareness of the benefits of EM and favorable attitudes to its application. However, the actual performance of EM was perceived as a challenge due to barriers identified in the study.</p><p><strong>How to cite this article: </strong>Akhtar PM, Deshmukh PK. Knowledge, Attitudes, and Perceived Barriers of Healthcare Providers toward Early Mobilization of Adult Critically Ill Patients in Intensive Care Unit. Indian J Crit Care Med 2021;25(5):512-518.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"512-518"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c6/c5/ijccm-25-512.PMC8196375.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39112197","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Microbiology in the Intensive Care Unit: Time for Intensivists to Rejuvenate this Lost Art.","authors":"Isabella Princess,&nbsp;Rohit Vadala","doi":"10.5005/jp-journals-10071-23810","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23810","url":null,"abstract":"<p><p>We live in an era of evolving microbial infections and equally evolving drug resistance among microorganisms. In any healthcare facility, intensivists play the most pivotal role with critically ill patients under their direct care. Majority of the critically ill patients already harbor a microorganism at admission or acquire one in the form of healthcare-associated infections during their course of intensive care unit stay. It is therefore rather imperative for intensivists to possess sound knowledge in clinical microbiology. On a negative note, most clinicians have very meager and remote knowledge acquired during their undergraduate years. This knowledge is rather theoretical than applied and wanes over the years becoming nonbeneficial in intensive patient care. We, therefore, intend to explore important concepts in applied microbiology and infection control that intensivists should know and implement in their clinical practice on a day-to-day basis. <b>How to cite this article:</b> Princess I, Vadala R. Clinical Microbiology in the Intensive Care Unit: Time for Intensivists to Rejuvenate this Lost Art. Indian J Crit Care Med 2021;25(5):566-574.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"566-574"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a7/2f/ijccm-25-566.PMC8196372.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39031510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU Patients.","authors":"Giovanni Giordano,&nbsp;Alice Purgatori,&nbsp;Federico Bilotta","doi":"10.5005/jp-journals-10071-23822","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23822","url":null,"abstract":"<p><p><b>How to cite this article:</b> Giordano G, Purgatori A, Bilotta F. Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU Patients. Indian J Crit Care Med 2021;25(5):595-596.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"595-596"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/16/59/ijccm-25-595.PMC8196371.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39043664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperammonemia after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Report of Three Cases with Unusual Presentation.","authors":"Vivekanand Sharma,&nbsp;Sohan Lal Solanki,&nbsp;Avanish P Saklani","doi":"10.5005/jp-journals-10071-23821","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23821","url":null,"abstract":"<p><p>Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment modality for peritoneal surface malignancies. A variety of metabolic derangements have been reported in the perioperative period in these patients, most of which are a result of the complex interaction of peritoneal denudation, chemotherapy bath, and fluid imbalance. We report three cases of hyperammonemia-related neurological dysfunction seen in HIPEC patients. To the best of our knowledge, this is the first report of this presentation. Timely recognition of this condition needs a high degree of suspicion, and unless aggressively treated, is likely to be associated with poor outcome. <b>How to cite this article:</b> Sharma V, Solanki SL, Saklani AP. Hyperammonemia after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy: A Report of Three Cases with Unusual Presentation. Indian J Crit Care Med 2021;25(5):590-593.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"590-593"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/41/07/ijccm-25-590.PMC8196376.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39043662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Response to Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU patients.","authors":"Christian Ertmer","doi":"10.5005/jp-journals-10071-23823","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23823","url":null,"abstract":"<p><p><b>How to cite this article:</b> Ertmer C. In Response to Colloids Use in Asian ICU Patients: Do not Mix Oranges with Apples. Consider the Proven Concerns on Hydroxyethyl Starch Use in ICU Patients. Indian J Crit Care Med 2021;25(5):597.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"597"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/34/3f/ijccm-25-597.PMC8196391.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39043665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defecation and Micturition may Cause Syncope in COVID-19 Patients on High Oxygen Requirement.","authors":"Shagufta Naaz,&nbsp;Abhyuday Kumar,&nbsp;Nishant Sahay,&nbsp;Rajnish Kumar,&nbsp;Erum Ozair,&nbsp;Akhil Valiaparambath","doi":"10.5005/jp-journals-10071-23809","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23809","url":null,"abstract":"<p><p><b>How to cite this article:</b> Naaz S, Kumar A, Sahay N, Kumar R, Ozair E, Valiaparambath A. Defecation and Micturition may Cause Syncope in COVID-19 Patients on High Oxygen Requirement. Indian J Crit Care Med 2021;25(5):599-600.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"599-600"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/09/68/ijccm-25-599.PMC8196378.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39043667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room.","authors":"Neelima Singh,&nbsp;Geetanjli Kalyan,&nbsp;Sukhwinder Kaur,&nbsp;Muralidharan Jayashree,&nbsp;Sandhya Ghai","doi":"10.5005/jp-journals-10071-23818","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23818","url":null,"abstract":"<p><strong>Aim and objective: </strong>To reduce the incidence of infiltration and phlebitis by 50% over 2 months among children admitted to the emergency room (ER) of a tertiary care hospital.</p><p><strong>Materials and methods: </strong>The study was conducted in the pediatric ER of a tertiary care hospital in North India. All children aged >28 days, receiving intravenous (IV) medication and/or fluids, were enrolled between June (2017) and September (2017). Existing practices of IV line insertion and maintenance were observed and recorded. The visual infusion phlebitis score and infiltration assessment scale were to grade the extent of two. The intervention classified as \"IV line insertion and maintenance bundle\" included the introduction of low-cost mobile sterile compartment trays, audit and feedback, organizational change, introduction of infection control nurse and quality improvement (QI) team formations were implement in different Plan-Do-Study-Act (PDSA) cycles. Reduction in the \"incidence of phlebitis and infiltration\" was outcome measures while \"scores on checklist of IV line insertion and IV line maintenance and administration of drugs\" were process measures.</p><p><strong>Result: </strong>The process measures, for IV line insertion, maintenance and administration of drugs through IV line, revealed an increase in scores on the checklist. There was a significant decrease in the incidence of infiltration and phlebitis from 82.9 and 96.1% to 45 and 55%, respectively, postimplementation of all PDSA cycles.</p><p><strong>Conclusion: </strong>Multifaceted QI IV line insertion and maintenance bundle reduced the incidence of infiltration and phlebitis. These interventions when integrated into daily work bundles along with continuous education and motivation help in sustaining the goal and attaining long-term success.</p><p><strong>How to cite this article: </strong>Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021;25(5):557-565.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"557-565"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e8/0f/ijccm-25-557.PMC8196366.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39031509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathogenetic Mechanism of Procalcitonin in COVID-19.","authors":"Franz J Wiedermann","doi":"10.5005/jp-journals-10071-23812","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23812","url":null,"abstract":"<p><p><b>How to cite this article:</b> Wiedermann FJ. Pathogenetic Mechanism of Procalcitonin in COVID-19. Indian J Crit Care Med 2021;25(5):594.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"594"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/bd/4f/ijccm-25-594.PMC8196395.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39043663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is it Time to Go Back to Basics?","authors":"Apoorv Chaturvedi,&nbsp;Anjan Trikha","doi":"10.5005/jp-journals-10071-23808","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23808","url":null,"abstract":"<p><p><b>How to cite this article:</b> Chaturvedi A, Trikha A. Is it Time to Go Back to Basics? Indian J Crit Care Med 2021;25(5):598.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"598"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4a/7f/ijccm-25-598.PMC8196384.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39043666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Timing of Invasive Mechanical Ventilation and Mortality among Patients with Severe COVID-19-associated Acute Respiratory Distress Syndrome.","authors":"Kapil G Zirpe,&nbsp;Anand M Tiwari,&nbsp;Sushma K Gurav,&nbsp;Abhijit M Deshmukh,&nbsp;Prasad B Suryawanshi,&nbsp;Prajkta P Wankhede,&nbsp;Upendrakumar S Kapse,&nbsp;Abhaya P Bhoyar,&nbsp;Afroz Z Khan,&nbsp;Ria V Malhotra,&nbsp;Pranoti H Kusalkar,&nbsp;Kaustubh J Chavan,&nbsp;Seema A Naik,&nbsp;Rahul B Bhalke,&nbsp;Ninad N Bhosale,&nbsp;Sonika V Makhija,&nbsp;Venkata N Kuchimanchi,&nbsp;Amol S Jadhav,&nbsp;Kedar R Deshmukh,&nbsp;Gaurav S Kulkarni","doi":"10.5005/jp-journals-10071-23816","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23816","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Aim and objective: </strong>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.</p><p><strong>Materials and methods: </strong>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.</p><p><strong>Results: </strong>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 (<i>p</i> = 0.02).</p><p><strong>Conclusion: </strong>Current study concludes that early intubation is associated with improved survival rates in severe CARDS patients.</p><p><strong>How to cite this article: </strong>Zirpe KG, Tiwari AM, Gurav SK, Deshmukh AM, Suryawanshi PB, Wankhede PP, <i>et al.</i> 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.</p>","PeriodicalId":520643,"journal":{"name":"Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine","volume":" ","pages":"493-498"},"PeriodicalIF":2.0,"publicationDate":"2021-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/3a/ijccm-25-493.PMC8196392.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39112194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}