Temporomandibular joint ankylosis is a unique disease where fracture of the mandibular condyle or any other cause leading to ankylosis of the joint can lead to multiple problems if not detected and treated early. If affected in early years of life, it may cause facial dysmorphism, restricted mouth opening, and difficulty in eating, speech, and sleep. Early surgery and physiotherapy can restore the joint function to a great extent. Anesthetizing a pediatric patient with this disorder is a definite challenge which needs expertise in difficult airway management.
A
bstract
Introduction
Although various preventive strategies have been advocated, delirium is common in critically ill patients and is associated with increased morbidity, mortality, and long-term adverse effects. The efficacy of a novel delirium prevention bundle in mechanically ventilated critically ill patients was investigated in this study.
Methods
In this randomized controlled trial, 50 mechanically ventilated adult patients in a tertiary care medical-surgical intensive care unit (ICU) were randomized to receive either delirium prevention bundle protocol or standard of care protocol. Delirium was assessed daily using the Confusion Assessment Method for the ICU (CAM-ICU) score by an independent investigator up to 28 days or death or discharge. The primary outcome was the incidence of new-onset delirium. Secondary outcomes were duration of mechanical ventilation, ICU length of stay (ICU-LOS), hospital LOS, and other adverse events.
Results
There was a 20% reduction in the incidence of delirium in the intervention group (36 vs 56%;
p
= 0.156). The 28-day mortality (28 vs 24%;
p
= 0.747), duration of mechanical ventilation (9 vs 12 days;
p
= 0.281), ICU-LOS (11 vs 12 days;
p
= 0.221), and hospital LOS (16 vs 20 days;
p
= 0.062) were similar between the groups.
Conclusion
Implementation of delirium prevention bundle does not reduce the incidence of delirium compared to standard of care protocol in mechanically ventilated critically ill patients.
How to cite this article
Malik AK, Baidya DK, Anand RK, Subramaniam R. A New ICU Delirium Prevention Bundle to Reduce the Incidence of Delirium: A Randomized Parallel Group Trial. Indian J Crit Care Med 2021;25(7):754–760.
A
bstract
Background
Administration of vitamin D to unselected heterogeneous critically ill patients did not demonstrate outcome benefit. The current study was undertaken to identify if early administration of vitamin D can reduce intensive care unit (ICU) length of stay and improve clinical outcomes in critically ill patients with sepsis.
Methods
This single-center randomized double-blind placebo-controlled trial was done in the ICU and emergency inpatient ward of a tertiary care teaching institute in New Delhi, India. A total of 126 adult patients aged 18 to 80 years of either sex diagnosed to have sepsis were included within 24 hours of admission to the hospital and randomized into vitamin D or placebo groups. The patients in the intervention group received vitamin D3 540,000 units dissolved in 45 mL of milk. The placebo group received 45 mL of milk.
Results
The median length of ICU stay (8 vs 9 days;
p
= 0.32), median length of hospital stay (12 vs 12 days;
p
= 0.33), median duration of vasopressors requirement (4 vs 3 days;
p
= 0.84), median duration of mechanical ventilation (5 vs 7 days;
p
= 0.23), requirement of tracheostomy (34 vs 39%;
p
= 0.71), and 90-day mortality [35 vs 46%;
p
= 0.29; HR 0.72 (0.42–1.24)] were similar in vitamin D and placebo arm.
A subgroup analysis in patients with severe vitamin D deficiency (vitamin D <12 ng/mL) revealed a significantly decreased incidence of tracheostomy (28 vs 57%;
p
= 0.04), a trend toward decreased 90-day mortality [34 vs 66%;
p
= 0.08; HR 0.44 (0.19–1.01)], and duration of mechanical ventilation (6 vs 11 days;
p
= 0.05) in patients receiving vitamin D.
Conclusion
Administration of large-dose vitamin D within 24 hours of admission does not reduce the length of ICU stay in critically ill sepsis patients.
How to cite this article
Bhattacharyya A, Subramaniam R, Baidya DK, Aggarwal P, Wig N. Effect of Early Administration of Vitamin D on Clinical Outcome in Critically Ill Sepsis Patients: A Randomized Placebo-controlled Trial. Indian J Crit Care Med 2021;25(10):1147–1154.
How to cite this article:
Nair PR, Maitra S, Ray BR, Anand RK, Baidya DK, Subramaniam R. Neutrophil-to-lymphocyte Ratio and Platelet-to-lymphocyte Ratio as Predictors of the Early Requirement of Mechanical Ventilation in COVID-19 Patients. Indian J Crit Care Med 2020;24(11):1143–1144.
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