BackgroundCommunity-acquired gram-negative bacillary meningitis is rare to occur without preexisting conditions like trauma, organ dysfunction, and immunocompromised state, and very few case reports with Escherichia coli have been described in literature till now. Presence of ventriculitis along with meningitis makes the incidence further sparse.Case presentationA review of literature identified a total of only 45 community-acquired E. coli meningitis from 1945 till to date. Here, we have described a case of community-acquired E. coli meningitis with ventriculitis in an adult with past history of completely repaired CSF leak secondary to trauma nearly 23 years ago, without current radiological evidence of persistent CSF leak and therefore described as spontaneously acquired. Post-contrast T1 images of MRI were suggestive of subtle ependymal enhancement of ventricles, and patient was treated in lines of ventriculitis. Initial CSF was suggestive of acute pyogenic meningitis, and the organism grown was pan-sensitive E. coli. Patient was treated with antibiotics according to the culture sensitivity pattern and was given a prolonged course of 6 weeks of antibiotic therapy in view of ventriculitis.ConclusionCommunity-acquired E. coli meningitis with possible ventriculitis in adults is described as a rare entity and is likely to be underrated and under-recognized.
Background Improvements in intensive care in the last few decades have shifted the focus from mortality to quality of life of survivors as a more important outcome measure. Allocation of public resources towards intensive care is an important challenge for healthcare administrators. This challenge is made more arduous in resource limited countries like India. Thus, it is imperative to consider patient centerd outcomes and resource utilisation to guide allocation of funds. The aim of this study was to evaluate the quality of life of long-term survivors, and to perform cost-effectiveness and cost-utility analysis. Methods Data was retrieved from the records and included age, gender, admission diagnosis, length of ICU stay and mortality. Costing methodology used was top down approach. Quality of life was assessed by SF 36 scoring which was done with personal interview and telephonically. Cost-effectiveness analysis was done on the basis of years of life added. Cost utility was done by QALY gained. Results A total of 1232 adult patients were admitted in the period with 758 (61%) being successfully discharged from ICU with a mortality rate of 39%. Out of 758, we could contact 113 (15%) patients. 86 patients were alive at the time of contact who could fill the forms for quality of life. The patients discharged from ICU had scores almost similar to the general population. Lesser scores were noted in physical functioning and general health perceptions, though this difference was not statistically significant. The life years gained were significantly more in younger patients. The cost per life gained was more in patients aged more than 50 years compared to those who were younger. Conclusion The quality of life after survival from ICU is as good as in the general population. The intensive care provided in our ICU is cost effective. How to cite this article Mishra SB, Poddar B et al, Quality of Life After Intensive Care Unit Discharge in a Tertiary Care Hospital in India: Cost Effectiveness Analysis. Indian J Crit Care Med 2019;23(3):122-126.
BackgroundMany COVID19 pneumonia patients progress to Acute respiratory distress syndrome and end up in Intensive Care Units. Given that it is a novel viral infection, the progress of the disease, its management and associated outcomes are yet to be studied in detail. ARDS associated with COVID 19 is the same as before or different and the timing of intubation in such patients is a topic up for debate. This survey aimed to assess the opinion regarding management of COVID 19 ARDS and the timing of intubation in those patients.Methods292 clinicians including anesthesiologists, intensivists and others involved in managing COVID 19 ARDS patients at various centres were surveyed with web-based questionnaire cross sectionally within the time period of 10th June 2020 to 31st August 2020 after taking prior consent. Their responses were recorded and analyzed with statistical software IBM SPSS version 25.0.Results Among 292 included participants, 172 were intensivist, 84 were anesthesiologists and rest were others. Most of the intensivists (51.2%) had seen more than 100 COVID 19 severe ARDS patients. Around 82% of clinicians were agreed that COVID 19 ARDS was different from another form of ARDS. 67.1% of participants were agreed with patient induced self-inflicted injury could have happened in this disease. Likewise, around 91.8% of doctors involved in managing patients were believed that HFNC could be helpful if there were falling of saturation. 37% of participants were not agreed with early intubation, which may increase the risk of mortality and nosocomial infections.Conclusions and RelevanceThere was confusion in most doctors with intubation timing even if there was an indication for intubation. These confusions may be due to non-availability of specific recommendation regarding intubation in COVID 19 severe ARDS patients. However, most of the literature recommended for early intubation in these patients when indicated.
Since APACHE II score is for prediction of outcome and ScvO 2 can be surrogate marker for tissue oxygenation which indirectly related to outcome the objectives of our study were to calculate the APACHE II score in critically ill patient on admission, measure
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.