Background and Aims: Chest compression fraction is the proportion of time spent on chest compression during cardiopulmonary resuscitation (CPR). The aims of this study were to know the quality of CPR ...provided during in-hospital cardiac arrest (IHCA) by analysing the chest compression fraction and to see the correlation of chest compression fraction with return of spontaneous circulation (ROSC) in the hospital setting. Methods: This prospective observational study was conducted in patients aged >18 years who developed IHCA. An observer would assess the quality of CPR provided by noting the time spent on chest compression. The chest compression fraction was calculated and correlated in patients with ROSC and without ROSC. Patients who survived were followed until discharge, and their neurological score was determined using the cerebral performance category (CPC). Results: We included 126 patients in the study; the mean chest compression fraction achieved was 78% (standard deviation SD ± 5). A total of 73 (58%) patients achieved ROSC and among them, 11 patients (9%) survived to hospital discharge. We found that the patients with ROSC had a significantly higher chest compression fraction of 80% (SD ± 5), as compared to 75% (SD ± 5), in whom ROSC could not be achieved. A multivariate logistic regression test showed higher odds (1.125) of ROSC in patients with high chest compression fraction. The mean CPC among the survivors was 1.4 (SD ± 0.5). Conclusion: Our study shows that health-care providers in our hospital provide high-quality CPR, and chest compression fraction is independently associated with ROSC in IHCA.
Paraquat is a bipyridilium herbicide which is highly toxic. Due to its corrosive effects, it can lead to esophagitis, esophageal rupture, and gastritis. It leads to the formation of reactive oxygen ...species which causes multiorgan damage, prominent among those being pulmonary, renal, and liver dysfunction. One of the rare causes of respiratory distress after paraquat poisoning is spontaneous pneumothorax due to pneumocyte injury, also known as the “Daisley Barton Syndrome.” We report a case of paraquat poisoning who developed alveolitis initially and later had bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and the patient recovered initially but later deterorated due to other complications. We should be aware of this phenomenon, and sudden worsening of the respiratory parameters should alert the clinician for prompt treatment.
Fahr's syndrome is a rare cause of seizures during pregnancy. It typically presents in the third decade of life, and it may be associated with gait instability, paroxysmal choreoathetosis, speech ...impairment, a neuropsychiatric disorder, myoclonus, and even seizures and coma. Neurological imaging revealing the symmetrical bilateral calcification along with pseudohypoparathyroidism helps in the diagnosis. Prompt treatment of the endocrine abnormalities associated with it can halt the disease process and result in neurological improvement. Thus, evaluation of seizures also requires an endocrine workup of the patient, keeping in mind rare causes like the Fahr's syndrome.
Since weaning failure is multifactorial, comprehensive weaning scores encompassing not only the respiratory component but also nonrespiratory aspects are quintessential for successful weaning ...prediction.
This was a single-center prospective observational study on 128 intensive care unit (ICU) patients undergoing spontaneous breathing trials (SBT). The extubation prediction score (ExPreS), heart rate, acidosis, consciousness, oxygenation, respiratory rate (HACOR), and weaning parameters, endotracheal tube size, arterial blood gas analysis, nutrition, secretions, neuromuscular affecting agents, obstructive airway problems and wakefulness (WEANSNOW) scores were compared for their diagnostic accuracy for successful weaning prediction.
Out of 128 patients, 49 (38.3%) patients had weaning failure, and 79 (61.7%) had weaning success. The patients in the weaning failure group had significantly higher APACHE II scores, WEANSNOW scores, HACOR scores, MV days, and significantly lower ExPreS scores as compared to the successful weaning group. Multivariable regression analysis showed that ExPreS score
= 0.015, adjusted OR 0.960, 95% CI (0.929-0.992) and HACOR score
< 0.001, adjusted OR 1.357, 95% CI (1.176-1.567) were independent predictors of weaning failure. The HACOR score had an AUC of 0.830, cut-off ≥5,
< 0.001, sensitivity 76%, specificity 68%, diagnostic accuracy 70% to predict weaning failure. The ExPreS score had an AUC of 0.735, cut-off ≥69,
< 0.001, sensitivity of 70.9%, specificity of 69.4%, and diagnostic accuracy of 70.3% to predict weaning success. Both the HACOR and ExPreS scores were good models for predicting weaning outcomes (model quality 0.76 and 0.64 respectively).
The parsimonious HACOR score is comparable to the ExPreS score for the prediction of weaning outcomes in critically ill patients.
Nayak G, Chaudhuri S, Ravindranath S, Todur P. Comparison of the Recent ExPreS Score, WEANSNOW Score, and the Parsimonious HACOR Score as the Best Predictor of Weaning: An Externally Validated Prospective Observational Study. Indian J Crit Care Med 2024;28(3):273-279.
Holistic intensive care management involves the treatment of critically ill patients in the intensive care unit (ICU) as well as catering to family psychosocial needs helping in bettering ...satisfaction/perception of care. There is scarce data in the Indian intensive care setting regarding the same, especially in times of increasing end-of-life practices. Our study aimed to determine the factors impacting family perception/satisfaction with intensive care.
A total of 336 family bystanders of patients in ICU with more than 72 hours of stay were surveyed using family satisfaction in the ICU 24 revised (FS-ICU 24R) questionnaire.
Multivariable logistic regression analysis showed that the significant factors associated with the satisfaction among bystanders of ICU patients were the treatment of patient's physical symptoms like pain/breathlessness (Adjusted OR 3.73,
= 0.003), ICU staff's approach to family's need consideration (Adjusted OR 4.44,
< 0.001), concern and care towards patients' family (Adjusted OR 2.67,
= 0.023). Participation in patient care, ICU waiting room atmosphere, and emotional support are the other factors independently associated with satisfaction with ICU care. Family satisfaction was not associated with the patient's survival (
= 0.331, Chi-square test) or the length of ICU (
= 0.328, Chi-square test) and hospital stay (
= 0.865, Chi-square test).
Treatment of a patient's physical symptoms like pain, approach to family's needs consideration, and concern/care towards the patient's family are independent factors associated with optimal satisfaction among family members of ICU patients, which even takes precedence over the survival outcomes or length of ICU stay.
Atri V, Bhatt MT, Chaudhuri S, Mitra A, Maddani SS, Ravindranath S. Family's Perceived Needs and Satisfaction with Intensive Care Services: A Questionnaire-based Prospective Observational Study. Indian J Crit Care Med 2024;28(5):483-494.
Coronavirus disease-2019 (COVID-19) pandemic has exposed healthcare workers (HCWs) to a unique set of challenges and stressors. Our frontline workers are under tremendous psychological pressure ...because of the ever-rising crisis. This study was done to assess the magnitude of the psychological impact of the COVID-19 pandemic on clinical and nonclinical HCWs in India.
It was a cross-sectional, online survey that was done from June 1, 2020, to July 4, 2020. A total of 313 clinical and nonclinical HCWs, who were directly or indirectly involved in patient care, participated in the study. The psychological impact was assessed in terms of four variables: insomnia, anxiety, depression, and stress. Insomnia was assessed by the Insomnia Severity Index (ISI). Anxiety and depression were assessed via the Patient Health Questionnaire-4 (PHQ-4), which included a 2-item anxiety scale and a 2-item depression scale (PHQ-2). Stress was assessed via the Perceived Stress Scale (PSS). We also compared the psychological impact of this pandemic between clinical and nonclinical HCWs.
7.3% of HCWs were having moderate insomnia, 3.8% had severe insomnia, and 20.8% were having subthreshold insomnia. Severe anxiety and depression were found in 6.7% of respondents. 8.0 and 32.3% of the respondents had moderate and mild anxiety-depression, respectively. 6.4% had high perceived stress. 47.6 and 46.0% of the respondents had moderate and low stress, respectively. There was a statistically significant difference in severe insomnia between clinical and nonclinical HCWs, whereas no significant difference in anxiety, depression, and stress between clinical and nonclinical HCWs.
This study suggests that psychological morbidity is prevalent among both clinical and nonclinical HCWs and both males and females. Early intervention may be beneficial to prevent this issue.
Sunil R, Bhatt MT, Bhumika TV, Thomas N, Puranik A, Chaudhuri S,
Weathering the Storm: Psychological Impact of COVID-19 Pandemic on Clinical and Nonclinical Healthcare Workers in India. Indian J Crit Care Med 2021;25(1):16-20.
Background:
Coronavirus disease 2019 (COVID-19) pandemic has caused a huge burden on healthcare services worldwide, severely affecting the management of non-COVID-19 patients as well. The Government ...of India has updated guidelines for the clinical management of COVID-19 illness, including severe acute respiratory infections (SARI) definition for triaging suspected COVID-19 cases in an isolated intensive care unit (ICU). The aim of this study was to estimate the adherence of clinicians in triaging COVID-19 suspects as per SARI definition to SARI ICU. This study also observed the impact of such triaging on admission, diagnosis, and treatment process of non-COVID-19 patients admitted to SARI ICU.
Patients and methods:
This cross-sectional study was conducted in a designated SARI ICU of two tertiary care medical college hospitals involving 78 patients from the month of June to July 2020. Data related to demographics, the severity of illness, advanced life supports, delay in diagnosis, intervention, and treatment of patients in SARI ICU due to suspected COVID-19 status were documented.
Results:
Adherence to SARI definition for triaging COVID-19-suspect cases was 19.2%. Despite hindrance in diagnosis (17.9%) and treatment (12.8%), mortality among patients in SARI ICU was limited to 14.10%. Results were insignificant when checked for various factors associated with mortality.
Conclusion:
Nonadherence to SARI definition may lead to undue delay in diagnosis, intervention, and treatment of non-COVID-19 cases. This may result in increased morbidity, mortality, and economic burden on patients and the healthcare system.
key message:
A rationale and just utilization of healthcare resources are need of the hour in the face of an enormous volume of SARI cases during COVID-19 pandemic. SARI criteria as implemented by the Ministry of Health and Family Welfare (MOHFW), Government of India, are a very important tool in triaging of COVID-19-suspect cases. Adequate measures should be in place in order to mitigate the inadequacies and deficiencies in the treatment of non-COVID-19 cases, which have occurred as a result of COVID-19 pandemic.
How to cite this article:
Arunachala S, Venkatesh BT, Bhatt MT, Puranik A, Rao S, Ravindranath S. COVID-19 Pandemic: Impact on Admission, Diagnosis, and Treatment of Non-COVID-19 Patients Admitted to SARI ICU. Indian J Crit Care Med 2021;25(8):853–859.
Programmable Metallization Cell (PMC) memory is a non-volatile memory which stores data states as programming current-dependent resistance levels via growth or dissolution of a metallic ...electrodeposit between two electrodes. This research demonstrates that PMC memory is capable of being integrated into flexible electronics. Most flexible electronics systems are fabricated on flexible polymer substrates, which are incompatible with standard semiconductor fabrication temperatures and chemicals. However, PMC devices are fabricated by depositing and patterning materials that are gaining acceptance in standard semiconductor manufacturing facilities; are fabricated at lower temperatures compared to other devices; have mechanical characteristics comparable with those of flexible polymer substrates; and, are patterned using chemistries compatible with flexible substrates. This thesis describes the development of fabrication processes for PMC devices that are compatible with flexible substrates and the characterization of these devices when subjected to mechanical stress, which shows that these devices are likely to perform better than conventional memory devices when flexed.
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