Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. The main objective of this study was to identify the outcome of patients with sepsis and septic shock. Methods: A prospective observational study was done in a surgical ICU over a period of one year. We included all adult patients admitted to ICU with features of sepsis and septic shock. Data related to demography, co-existing illnesses, parameters to assess Sequential Organ Failure Assessment (SOFA) scores, other relevant laboratory data, source of infection, organ failures and supportive measures instituted were recorded. Patients were followed till discharge or death from the ICU. Results: 160 patients were included in this study. The mortality rate was significantly higher among females compared with males. The most common co-existing illnesses were hypertension and type II diabetes mellitus. The SOFA scores at admission were high among non-survivors. Older age, presence of anaemia (defined as haemoglobin less than 13 g/dL in males and 12 g/dL in females), renal dysfunction (creatinine level more than 1.3 g/dL), and acute respiratory distress syndrome (ARDS) were associated with higher mortality. Haematocrit, total leucocyte count, serum bilirubin and SOFA scores were significantly higher among non-survivors. Conclusion: Our findings suggest that septic shock occurs frequently in ICU patients and mortality remains high. Several critical scoring systems are useful for the early prediction of mortality. A sepsis mortality based on SOFA scores and haemoglobin has greater predictive power.
Background: One of the most prevalent regional methods in paediatric anaesthesia is the caudal epidural block. It is a safe, simple procedure that has proven to be quite beneficial in children following infra-umbilical surgery. Ropivacaine causes differential neuraxial blockade, which is associated with less motor block and lower cardiovascular damage. To extend the duration of action of local anaesthetics, several adjuvants are administered. Our goal was to see how fentanyl affected the duration of postoperative analgesia when used in conjunction with ropivacaine in a paediatric population of children aged 3 to 8 years following infraumbilical operations. Methods: On 100 paediatric patients receiving elective infraumbilical operations, a prospective, comparative, and randomised investigation was done. Patients were randomised into two 50-person groups at random. Caudal anaesthesia was administered once the airway was secured. 0.2 percent ropivacaine 0.5ml/kg was given to Group R, while 0.2 percent ropivacaine 0.5ml/kg with fentanyl 0.5mcg/kg was given to Group RF. Face, legs, activity, cry, and consolability pain rating scales were used to measure postoperative pain for 24 hours. The length of the motor blockage and any negative effects were recorded. Hemodynamics, post-operative analgesia duration, and the number of rescue analgesics required were all recorded and statistically evaluated. Results: The mean duration of analgesia in ropivacaine group was 440.60±101.29 minutes (7.25hrs) and in ropivacaine fentanyl group was 891±312.84 (14.76hrs). Statistically, the difference was highly significant. Conclusion: In children having infraumbilical surgery, using fentanyl as an adjuvant to ropivacaine for caudal block enhanced analgesic effectiveness and extended post-operative analgesia.
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