We found insufficient evidence about the effects of BIS monitoring for sedation in critically ill mechanically ventilated adults on clinical outcomes or resource utilization. The findings are uncertain due to the low- and very low-quality evidence derived from a limited number of studies.
Background
India is one of the seven identified countries in South-East Asia region regularly reporting dengue fever (DF)/dengue hemorrhagic fever (DHF) outbreaks. Even though the dengue prodrome and evolution of illness are most often similar in many patients, progress and outcome may differ significantly depending on the severity of illness as well as treatment instituted. We studied the clinical manifestations, outcome and factors predicting mortality of serology confirmed dengue fever cases admitted in Multidisciplinary Intensive Care Unit (MICU) of a high acuity healthcare facility in India.
Methodology
All patients with serology proven dengue fever admitted to MICU between 1st July 2015 and1st December 2015 were included in the study. Clinical presentation, laboratory findings, severity of illness scores and outcome were recorded.
Results
Majority of the patients (58.4%) belonged to 21–40 year age group. Hepatic (96.8%) followed by hematological (79.2%) involvement were the most common findings. CNS involvement observed among 27%. Survival to hospital discharge was 78.9%. Respiratory and gastrointestinal system involvement was associated with increased mortality. Acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and shock were the clinical syndromes associated with mortality. Serum lactate, aspartate transaminase (AST) and alanine transaminase (ALT) were significantly elevated among non survivors. Significant difference in sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation (APACHE) scores was also observed among survivors and non survivors.
Conclusion
Organ system involvement and higher disease severity scores are strong predictors of mortality. High index of suspicion for atypical manifestations of dengue is warranted.
How to cite this article
Padyana M, Karanth S, Vaidya S, Gopaldas JA. Clinical Profile and Outcome of Dengue Fever in Multidisciplinary Intensive Care Unit of a Tertiary Level Hospital in India. Indian J Crit Care Med 2019;23(6):270–273.
Serious intra-operative anaphylactic shock is an unusual complication. Identification of causative agents can be difficult due to the number of anaesthetic drugs administered in quick succession, many of which can potentially cause anaphylaxis. Most anaphylactic reactions respond to, and resolve with, adrenaline and steroids. However, they can be prolonged and life-threatening. Refractory anaphylaxis, unresponsive to repeated doses of adrenaline, is rare and associated with a high risk of mortality. Rupture of a hydatid cyst during surgery can cause anaphylaxis. Here, we present a rare case of refractory anaphylactic shock during surgical resection of a hepatic hydatid cyst, with severe haemodynamic instability requiring prolonged postoperative ventilation and triple inotropic support for seven days in the intensive care unit. We describe the management of this condition, primarily based on steroid therapy and escalating vasopressor support, particularly where limited response to adrenaline is encountered. Refractory anaphylaxis is a rare but life-threatening complication of hydatid cyst surgery. Therefore, anaphylactic reactions should always be anticipated, with the appropriate treatment and facilities readily available.
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