Background:
Ventilator-associated pneumonia (VAP) with multidrug-resistant (MDR) gram negative organisms is a common problem in intensive care unit (ICU). Aerosolized antibiotics enhance the efficacy of systemic antibiotics when added as adjuvants.
Aim:
The primary objective of the study was to compare the clinical and bacteriological outcome of patients with VAP who were administered intravenous (IV) antibiotics alone with those patients who were treated with adjunctive nebulized colistin (NC) along with IV antibiotics. The secondary objective was to study the occurrence of any adverse events during colistin nebulization.
Settings and Design:
The study was a prospective, randomized, double-blinded controlled study conducted at a tertiary-care teaching institution.
Materials and Methods:
Ninety-eight children from surgical ICU aged less than 12 years who were diagnosed with VAP due to gram negative bacteria following cardiac surgery were chosen and divided randomly into two groups. The experimental group (NC group) was treated with systemic antibiotics along with NC, whereas the control group (NS group) was administered systemic antibiotics with nebulized normal saline (NS). Clinical and bacteriological outcomes were noted. Statistical analysis was done using SPSS Version 20.0 software. The patient characteristics were compared using independent Student's t test and Chi-square test.
Results:
There was a statistically significant reduction in the duration of mechanical ventilation, postoperative ICU and hospital stay (P < 0.05) in the NC group compared with the NS group.
Conclusion:
Aerosolized colistin may be considered as an adjunct to systemic IV antibiotics in pediatric patients with VAP due to gram negative bacteria susceptible to colistin.
Background: Awareness during anesthesia is a frightening experience. Benzodiazepines like lorazepam have been used to decrease awareness and also to cause amnesia. However, there is insufficient evidence established regarding their efficacy and effectiveness. This study was carried out to evaluate the efficacy of benzodiazepines in minimizing the awareness during general anesthesia. Methods: This randomized controlled trial was undertaken on 100 patients who underwent various elective surgical procedures. Each group consisted of 50 participants who were randomly allocated based on the computer-generated random numbers. The experimental group received midazolam as a premedicant in addition to atropine, while the control group received only atropine. Results: In this study, the overall incidence of awareness was 16%. The incidence was higher in the control group (24%) compared to that in the experimental group (8%). In the control group, awareness was characterized by hearing conversation/music in 58.3% of the participants, followed by remembrance of intraoperative events in 41.6% of the participants. In the experimental group, awareness was pertained to dreaming in all the four participants (100%). Conclusion: There was a significant higher incidence of awareness under anesthesia in the patients who had received only atropine as premedication. Hence, it is recommended to include benzodiazepine like midazolam, a water-soluble agent, routinely as a premedicant to decrease the incidence of awareness.
BACKGROUNDBlood lactate is a product of anaerobic metabolism. Tissue hypoxia because of hypo perfusion or impaired oxygen extraction causes rise in blood lactate levels. An elevated blood lactate level has been postulated as a marker for adverse outcomes and increased mortality risk in patients undergoing cardiac surgery under cardiopulmonary bypass (CPB). This study was carried out to evaluate the association between blood lactate levels and mortality following cardiac surgery.
METHODSThis retrospective record-based cross-sectional study was carried out among 503 patients who underwent cardiac surgery under CPB. Apart from baseline lactate value, serum lactate was measured every thirty minutes during CPB (CPBL1, CPBL2, CPBL3 and so on) and during post-operative period (POL1, POL2, POL3 and so on). Duration of the CPB, lowest temperature attained during the CPB, duration of mechanical ventilation, IABP usage, maximum number of inotropes and vasopressors used and mortality in the peri-operative period were noted.
RESULTSThe incidence of mortality in this study was 2.2%. Blood Lactate levels were high in the third measurement during CPB (CPBL3) and for all the post-operative measurements among those who did not survive. There was a significant association between lactate levels and intra operative lowest temperatures (p<0.05).
CONCLUSIONSLactate levels during CPB and post-operative period can be used as a predictor of increased mortality and morbidity. Prolonged bypass and deeper levels of hypothermia is associated with increased lactate levels.
HOW TO CITE THIS ARTICLE:Bhat A, Balajibabu PR, Raghu C. Role of blood lactate levels in predicting morbidity and mortality outcomes following cardiac surgeries.
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