Introduction: Knowledge and awareness of sepsis among various health care professionals is essential for prompt diagnosis and appropriate initial resuscitation and management of patient with sepsis. Objective: To assess and compare the knowledge and awareness of sepsis among health care professionals working at Birat Medical College and Teaching Hospital. Methodology This was a questionnaire-based survey with comparative study in 200 health care professionals conducted at Birat Medical College and Teaching Hospital from July– September, 2019. Questions were designed to assess the knowledge on diagnosis, initial resuscitation and management of sepsis. The knowledge level of the participants was assessed with scoring system as good, average and poor which was finally compared between the various health care professionals. Result Out of 200, only 180 health care professionals were included for statistical analysis. While assessing the knowledge on diagnosis of sepsis, 55.6% consultant doctors, 42.8% medical officers and 21.5% nursing/paramedics answered correctly on an average. Similarly, 51.7 % consultant doctors, 33.7% medical officers and 26.6% nursing/ paramedics gave correct answers while assessing knowledge on initial resuscitation and management. The nursing/paramedics had comparatively lower knowledge level on sepsis than the doctors. Around 31.7%, 51.2% and 17% of health care professionals working in Emergency, ICU and Anesthesiology departments had good, average and poor knowledge on sepsis respectively as compared to 14.2%, 28.5% and 57.1% of participants working in other departments. Conclusion: The nursing/paramedics had lower knowledge level on sepsis as compared to the doctors while health care professionals working in Emergency,ICU and Anesthesiology departments had better knowledge on sepsis as compared to staffs working in other departments.
Introduction: It is essential that all the medical professionals should have adequate skill for basic life support (BLS) for better outcome of cardiac arrest patients. The objective of the study is to assess the knowledge and awareness of BLS among the medical doctors, nursing staffs and health care paramedics working in Birat Medical College and Teaching Hospital, Biratnagar. Methodology: A three-month duration observational questionnaire-based survey was conducted at Birat Medical College and Teaching Hospital, Biratnagar to assess the knowledge, awareness of basic life support among the medical doctors, nursing staffs and health care paramedics. A total of ten questions were designed to assess the knowledge and awareness regarding BLS skill. Three questions were designed to assess the previous experiences on cardiac arrest situation and BLS training. Similarly, two additional questions were added to assess the self-grading of BLS knowledge which included poor, below average, good and excellent. Result: It was observed that only 14% participants had previous BLS training. Surprisingly, 76% of the participants had encountered cardiac arrest situation in their clinical practice but they were managing those cases with limited knowledge on BLS. The correct answer to the self-structured questionnaire were ticked by less than 50% of participants and majority of the participants came below average on self-grading of the knowledge and awareness suggesting the need of easy accessibility of BLS training centers in the eastern part of Nepal. Conclusion: This study revealed that the knowledge and awareness of basic life support skills among the various staffs was mostly below average to poor. Significant amount of cost effective BLS trainings must be conducted so as to develop competent staffs by various training centers
A bstract Introduction Spontaneous breathing trial (SBT) is always successful in mechanically ventilated patients. This study was conducted to assess the prediction of successful SBT and extubation of trachea by bedside lung ultrasound in mechanically ventilated patients. Methodology This was a prospective observational study for 1 year conducted at a tertiary teaching hospital ICU on 102 patients with age more than 18 years and who were mechanically ventilated for more than 24 hours. Bedside lung ultrasound was used to assess the lung ultrasound score (LUS) and lung profiles in patients who clinically met the criteria for SBT. The LUS at the beginning of SBT and 30 minutes after SBT were used to predict the successful SBT and tracheal extubation. Result Spontaneous breathing trial and tracheal extubation were successful in 73 (71.6%) and 57 (55.8%) of the patients. The AUC for lung ultrasound in predicting successful SBT at the beginning and 30 minutes of SBT were 0.781 (CI 95% 0.674–0.888, p < 0.001) and 0.841 (CI 95% 0.742–0.941, p < 0.001) with a cut-off value of 17.5 and 19.5, respectively. Similarly, AUC for LUS in relation to tracheal extubation was 0.786 (CI 95% 0.694–0.879, p < 0.001) and 0.841(CI 95% 0.756–0.925, p < 0.001) at 0 and 30 minutes. About 57.5% of the patients with A profiles tolerated successful SBT while 48.3% of the patients having C profile had failed SBT ( p < 0.001). COPD, lung ultrasound, higher SOFA score, and longer duration of mechanical ventilation had a statistically significant negative correlation with successful SBT. Conclusion Lower LUS and A profiles lung ultrasound are associated with more successful weaning and tracheal extubation in mechanically ventilated patients. How to cite this article Rajbanshi LK, Bajracharya A, Devkota D. Prediction of Successful Spontaneous Breathing Trial and Extubation of Trachea by Lung Ultrasound in Mechanically Ventilated Patients in Intensive Care Unit. Indian J Crit Care Med 2023;27(7):482–487.
Introduction: The pneumoperitoneum created during laparoscopic surgery has numerous effects on the patient ranging from respiratory to hemodynamics. The two common methods of ventilator are volume control and pressure control. The volume control method has been commonly used during general anesthesia. Pressure control method has been used in intensive care unit for improving the respiratory mechanics. Objective: The study aims to compare the effects of pressure control to volume control ventilation in patients undergoing laparoscopic surgery. The hypothesis of the study is that pressure control method improves the respiratory mechanics by decreasing the peak airway pressure and increasing the lung compliance. Methodology: The total of 100 patients who underwent laparoscopic surgery were undertaken for this study. The 50 in each group (PCV and VCV) were allotted randomly. As per predicted body weight, the tidal volume was adjusted to 8 ml/kg, for both the modes of ventilation, peep 5 mm of Hg with fio2 of 100% and I:E-1:2,. The variations in peak airway pressure, mean airway pressure, lung compliance, SPO2 and hemodynamic parameters were observed at baseline (T1), at pneumoperitoneum (T2), after 10 minutes of pneumoperitonium (T3) and at 20 minutes after pneumoperitonium (T4). Results: The pressure control group on comparison to volume control mode group showed significant decrease in peak airway pressure while increase in mean airway pressure and increase in lung compliance at different points of pneumoperitoneum. However there was no significant change in hemodynamics between the two groups in patient undergoing laparoscopic surgery. Conclusion: We conclude that respiratory mechanics improve when the patient is on pressure control ventilation in compared to volume control method of ventilation. Whereas there is no difference in hemodynamic parameters between the two methods.
Introduction: Numerous steroids have been used to combat the intense cytokine storms in severe COVID pneumonia. The study compares the use methylprednisolone and dexamethasone as an adjuvant steroid therapy in severe COVID-19 pneumonia. Methods: Prospective comparative study including total of 190 COVID-19 severe pneumonia cases admitted in intensive care unit with 93 patients randomly allocated to receive dexamethasone 6 mg and 97 patients allocated to receive methylprednisolone 1mg/kg in two divided doses both by intravenous route for 7 days. Mortality was compared as primary objective while oxygenation parameters and inflammatory markers, need for invasive mechanical ventilation, duration of ventilation, length of ICU-stay, incidence of multiorgan failure were assessed as secondary variables. Results: At day zero, the patient in methylprednisolone group had significantly lower PaO2/FIO2 ratio (258.3950.36 vs 285.1868.62, P=0.002). At day seven, methylprednisolone significantly improved PaO2/FIO2 ratio (266.5260.73 vs 244.8175.36, P=0.029) and there was substantial decrease in inflammatory markers CRP, Ferritin (P<0.05). PEEP requirement was significantly less with methylprednisolone (P=0.007). Methylprednisolone significantly reduced the incidence of multiorgan failure, need of invasive mechanical ventilation and duration of mechanical ventilation (P<0.05). However, there was no significant difference in terms of duration of ICU stay and 30 days in hospital mortality between the two groups Conclusions: Intravenous methylprednisolone significantly improved the oxygenation of COVID -19 pneumonia patients and decreased the inflammatory reactions as compared to similar dose of dexamethasone when given for week duration. However, methylprednisolone did not seem to be superior to dexamethasone in terms of improving mortality.
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