Mean Duration Of Ventilation Research Articles

Outcome of home mechanical ventilation.

To determine the outcome of patients discharged home on portable ventilator. Descriptive study. The Aga Khan University Hospital, Karachi from January 2000 to December 2004. All ventilator-dependent patients discharged home were contacted. Survivors were administered the EQ-5D Quality-of-Life instrument. SPSS version 13 was used to analyze data. Eleven patients were discharged home on invasive ventilation. Mean age was 49 years (range 10-98 years). Cause of ventilatory failure were cervical spine trauma in 36%, primary neurological disease in 27%, critical illness neuropathy and respiratory failure in 18% each. Survival rate was 73%, with three deaths. Mean duration of ventilation was 9.45 months (95% CI 3.24, 15.67). Rate of successful weaning after discharge was 36%, with 4 patients off all forms of ventilatory support and 2 on only nocturnal support. A 2.8 (95% CI 0.5, 16.6) relative risk towards successful weaning was associated with the presence of a family member as the primary care giver. Mean scores on the EQ-5D descriptive tool were; mobility 2 (-/+0.82), self-care 2 (-/+0.82), usual activities 1.86 (-/+0.69), pain/discomfort 1.43(-/+0.79), anxiety/depression 1.29 (-/+0.76). Mean score on the EQ-VAS was 48.2(-/+ 27.3). In carefully selected patients, home ventilation is a viable option with the expectation of successful weaning and survival. Patients discharged home on ventilation reported a reasonably good quality of life with proportionately more problems related to independence compared to overall well-being.

Transverse Sternal Split: a Safe Mini-invasive Approach for Perventricular Device Closure of Ventricular Septal Defect.

ObjectivePerventricular device closure of ventricular septal defect through midline sternotomy avoids the cardiopulmonary bypass, however, lacks the cosmetic advantage. Perventricular device closure of ventricular septal defect with transverse split sternotomy was performed to add the cosmetic advantage of mini-invasive technique.MethodsThirty-six pediatric patients with mean age 7.14±3.24 months and weight 5.00±0.88 kg were operated for perventricular device closure of ventricular septal defect through transverse split sternotomy in 4th intercostal space under transesophageal echocardiography guidance. In case of failure or complication, surgical closure of ventricular septal defect was performed through the same incision with cervical cannulation of common carotid artery and internal jugular vein for commencement of cardiopulmonary bypass. All the patients were postoperatively followed, and then discharged from hospital due to their surgical outcome, morbidity and mortality.ResultsProcedure was successful in 35 patients. Two patients developed transient heart block. Surgical closure of ventricular septal defect was required in one patient. Mean duration of ventilation was 11.83±3.63 hours. Mean intensive care unit and hospital stay were 1.88±0.74 days and 6.58±1.38 days, respectively. There was no in-hospital mortality. A patient died one day after hospital discharge due to arrhythmia. No patients developed wound related, vascular or neurological complication. In a mean follow-up period of 23.3±18.45 months, all 35 patients were doing well without residual defect with regression of pulmonary artery hypertension as seen on transthoracic echocardiography.ConclusionTransverse split sternotomy incision is a safe and effective alternative to a median sternotomy for perventricular device closure of ventricular septal defect with combined advantage of better cosmetic outcomes and avoidance of cardiopulmonary bypass.

Impact of serum magnesium levels in critically ill elderly patients—A study in a rural teaching hospital

Background/PurposeMagnesium deficiency has been a common, but easily ignored, electrolyte abnormality. Studies on magnesium deficiency are lacking in India, especially in a rural setting. Here, we have correlated serum magnesium levels with outcomes in elderly patients admitted to the medical intensive care unit with respect to the length of intensive care unit stay, need for mechanical ventilatory support and its duration, and outcome (discharge/death). MethodsA prospective, observational study was conducted in patients aged 60 years and older, who had been admitted to the intensive care unit of the medicine department for over a year. The chi-square test was applied to correlate hypomagnesemia with the outcome. ResultsIn our study, 59.30% of the elderly patients had hypomagnesemia. Compared with patients with a normal magnesium level, hypomagnesemic patients had no correlation with the duration of medical intensive care unit stay (5.57±6.10 days vs. 5.61±5.55 days), but the need for mechanical ventilation (57.84% vs. 45.71%), rate of discharge from the intensive care unit or cure (60.28% vs. 71.42% ), rate of death (39.21% vs. 28.57%), and mean duration of ventilation (3.07±5.05 days vs. 2.15±3.46 days) were higher. However, no significant statistical difference was found between these groups. ConclusionHypomagnesemia was associated with a slightly higher mortality rate. Requirement and duration of ventilatory support were also higher, although not statistically significant. Hypomagnesemia was not found to have any impact on the duration of medical intensive care unit stay. Monitoring of serum magnesium levels may have prognostic and perhaps therapeutic implications in the elderly.

Prone position and pressure control inverse ratio ventilation in H1N1 patients with severe acute respiratory distress syndrome.

Aim:To observe the 28 and 90 days mortality associated with prone position and assist control-pressure control (with inverse ratio) ventilation (ACPC-IRV).Materials and Methods:All patients who were admitted to our medical Intensive Care Unit (ICU) who are positive for H1N1 viral infection with severe acute respiratory distress syndrome (ARDS) and requiring invasive mechanical ventilation in prone position were included in our prospective observational study. Six patients who are positive for H1N1 required invasive ventilation in prone position. These patients were planned to ventilate in prone for 16 h and in supine for 8 h daily until P/F ratio >150 with FiO2 of 0.6 or less and positive end-expiratory pressure <10 cm of H2 O.Results:At admission, among these six patients the mean tidal volume generated was about 376.6 ml which was in the range of 6–8 ml/kg predicted body weight. The mean lung injury score was 3.79, mean PaO2 /FiO2 ratio was 52.66 and mean oxygenation index was 29.83. The mean duration of ventilation was 9.4 days (225.6 h). The ICU length of stay was 11.16 days. There was no mortality at 28 and 90 days.Conclusion:Early prone combined with ACPC-IRV in H1N1 patients having severe ARDS can be used as a rescue therapy and it should be confirmed by large observational studies.

66. King Faisal experience for cardiac surgery in adults with congenital heart disease: Outcome of primary and redo surgery

Introduction Adult survivors with congenital heart diseases represent a growing population. Therefore, we aimed to review our experience in King Faisal Heart center for the outcome of adult patients with congenital heart disease who underwent either primary or redo surgery at our center. Methods We retrospectively reviewed all patients who underwent surgery either as the first surgery or as a reoperation for congenital heart disease aged greater than or equal to 16 years old at the time of cardiac surgery and in the period between 1st January 2008 and 1st January 2013. We looked for incidence of postoperative bleeding, arrhythmia, acute kidney injury, neurological complications, and duration of mechanical ventilation, hospital stay and ICU stay. Additionally, we assessed the mortality and 1 year survival rates. Results 98 patients were included in our study. Fifty-two (53%) females and 46 (47%) males, with mean age of 26 ± 8.4 years and mean weight of 62 ± 22.8 kg. Forty-nine patients (50%) required redo surgery. Ten patients (10%) suffered from postoperative bleeding. Eight patients (8%) had postoperative arrhythmias, of which 2 patients required permanent pacemaker insertion. Two patients (2%) had postoperative acute kidney injury, of which one required dialysis, and 7 (7%) patients suffered from neurological complications. The mean duration of ventilation was 1.3 ± 2 days, with mean ICU and hospital stay of 3.7 ± 3, and 10 ± 7 days, respectively. The overall mortality in our series was 4% with one year survival of 100%. Conclusion Adult patients with congenital heart disease are prone for immediate postoperative multiple system complications, yet the majority of it is reversible, and their one year survival rate is excellent. Further follow up studies are required.

Is the World Health Organization-recommended dose of pralidoxime effective in the treatment of organophosphorus poisoning? A randomized, double-blinded and placebo-controlled trial.

Background:Organophosphorus poisoning (OPP) is a major global public health problem. Pralidoxime has been used in a complimentary role to atropine for the management of OPP. World Health Organization (WHO) recommends use of pralidoxime but studies regarding its role have been inconclusive, ranging from being ineffective to harmful or beneficial.Materials and Methods:The present study was undertaken to evaluate the effectiveness of pralidoxime. Eddleston's study was the most compelling factor for our study, as he showed worst outcomes using pralidoxime. Our practice of continuous use of pralidoxime was based on the WHO guidelines and the study by Pawar (2006), which showed better outcome with higher doses of pralidoxime. These conflicting results suggested that a re-evaluation of its use in our clinical practice was indicated.Results:There was no difference in mortality rates, hemodynamic parameters and atropine requirements between the AP and A groups. Mean duration of ventilation (3.6 ± 4.6 in AP group vs. 3.6 ± 4.4 in A group) and Intensive Care Unit stay (7.1 ± 5.4 in AP group vs. 6.8 ± 4.7 in A group) was comparable. Serum sodium concentrations showed a correlation with mortality, with lower concentrations associated with better outcomes.Conclusion:The study suggests that add-on WHO-recommended pralidoxime therapy does not provide any benefit over atropine monotherapy. Adding pralidoxime does not seem to be beneficial and at the same time does not result in increased mortality rates. Our practice changed after completion of this study, and it has proven to be of significant benefit to patients who had to bear the expense of treatment.

A study on the role of noninvasive ventilation in mild-to-moderate acute respiratory distress syndrome.

Aim:There is sparse data on the role of noninvasive ventilation (NIV) in acute respiratory distress syndrome (ARDS) from India. Herein, we report our experience with the use of NIV in mild to moderate ARDS.Materials and Methods:This was a prospective observational study involving consecutive subjects of ARDS treated with NIV using an oronasal mask. Patients were monitored clinically with serial arterial blood gas analysis. The success of NIV, duration of NIV use, Intensive Care Unit stay, hospital mortality, and improvement in clinical and blood gas parameters were assessed. The success of NIV was defined as prevention of endotracheal intubation.Results:A total of 41 subjects (27 women, mean age: 30.9 years) were included in the study. Tropical infections followed by abdominal sepsis were the most common causes of ARDS. The use of NIV was successful in 18 (44%) subjects, while 23 subjects required intubation. The median time to intubation was 3 h. Overall, 19 (46.3%) deaths were encountered, all in those requiring invasive ventilation. The mean duration of ventilation was significantly higher in the intubated patients (7.1 vs. 2.6 days, P = 0.004). Univariate analysis revealed a lack of improvement in PaO2/FiO2 at 1 h and high baseline Acute Physiology and Chronic Health Evaluation II (APACHE II) as predictors of NIV failure.Conclusions:Use of NIV in mild to moderate ARDS helped in avoiding intubation in about 44% of the subjects. A baseline APACHE II score of >17 and a PaO2/FiO2 ratio <150 at 1 h predicts NIV failure.

Tissue perfusion in neonates undergoing open-heart surgery using autologous umbilical cord blood or donor blood components

This study evaluates the hemoglobin-oxygen relationship and tissue perfusion during cardiopulmonary bypass (CPB) in neonates undergoing open-heart surgery using autologous umbilical cord blood or donor blood components. We compared perioperative hematocrit (Hct), fetal hemoglobin (HbF), p(50)O(2), pH, pCO(2), serum lactate, duration of mechanical ventilation and intensive care unit (ICU) length of stay in neonates undergoing open-heart surgery using autologous umbilical cord blood (Group I, N=45) or donor blood components (Group II, N=65). The groups were similar with respect to diagnosis, weight, type of procedure, duration of CPB and duration of myocardial ischemia. Mean p(50)O(2) was significantly lower in Group I during CPB (19.7 vs. 22.3 mmHg, p=0.004) and at the end of CPB (20.1 vs. 22.8 mmHg, p=0.003). Median peak lactate during CPB was higher in Group I (4.8 vs. 2.2 mmol/l, p<0.001). Carbon dioxide tension was identified as an independent predictor of higher p(50)O(2) during CPB in Group I (β=0.88, p=0.002), but not Group II. Bodyweight, Hct, duration of CPB, pre-CPB lactate level and pCO(2) affected peak lactate level during CPB. Although mean duration of ventilation was longer in Group II (mean 51 vs. 43, p=0.004), the groups experienced similar duration of ICU stay (5.8 vs. 5.9 days, p=0.280). Despite the fact that the oxyhemoglobin dissociation curve is shifted leftward in patients who receive autologous umbilical cord blood, tissue oxygen delivery appears to be preserved in neonates who undergo open-heart surgery using autologous umbilical cord blood.

Predictors of poor outcomes after significant chest trauma in multiply injured patients: a retrospective analysis from the German Trauma Registry (Trauma Register DGU®).

BackgroundBlunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality.MethodsAll patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002–2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed.Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma.Results22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days).Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality.Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval.ConclusionsWe demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a devastating prognosis following blunt chest trauma.

Pulmonary infections in ICU patients without underlying disease on ventilators.

Background:At present, the use of ventilator support is an important part of treatment in ICU patients. However, aside from its well-known advantages, the use of these devices is also associated with complications, the most important of which is pulmonary infection (PI). PI has a high rate of morbidity and mortality.Objectives:This study aimed to evaluate the prevalence of PI in mechanically-ventilated patients and the role that factors, such as age, sex, and duration of intubation, play in this regard.Materials and Methods:This descriptive cross-sectional study evaluated the prevalence of PI in mechanically ventilated patients, with no underlying condition which could compromise their immune system. Age, sex, and duration of intubation were assessed. Data were analyzed using SPSS (version 16) software.Results:A total of 37 ICU patients on ventilators were evaluated, including 21 males (56.8%) and 16 females (43.2%). The mean age of the patients was 54 ± 19 years (range 19 to 86 years), with a mean age of 52 ± 20 years in men, and 56 ± 18 years in women (P = 0.52). The mean duration of ventilation was 6 ± 4 days (range 2 to 20 days). The mean duration of ventilation was 5 ± 2 days in men, and 6 ± 5 days in women (P = 0.42). A total of 16 patients (43.2%) developed ventilator-associated pneumonia (VAP); of whom, 50% were male and 50% female (P = 0.46). Patients who developed a pulmonary infection had a significantly longer duration of ventilation. The mean duration of ventilation was 8 ± 4 days in patients who had developed VAP, while this duration was 4 ± 2 days in the non-affected patients (P = 0.005). Overall, 17 patients died, and 7 of these deaths were attributed to VAP.Conclusions:The prevalence of VAP in this study was approximately 43%, which is relatively high. In total, the percentage of deaths due to VAP among the patients was 18.91%. Duration of ventilator support was significantly correlated with the prevalence of PI.

English

INTRODUCTION: Care of the critically ill parturient is a unique challenge in obstetrics particularly because of its unpredictability. Hemorrhage, toxemia, anemia and septicemia are common causes of mortality and morbidity in these patients. Obstetric critical care in developing countries continues to be radically different from developed countries. AIMS AND OBJECTIVES: To analyze all cases of critically ill obstetric patients admitted to an obstetric intensive care unit in relation to causes for admissions, interventions required, course during their ICU stay and fetal maternal outcome. MATERIALS AND METHODS: A one year retrospective analysis of all obstetric admissions to the ICU at our referral hospital was conducted, observations made and results were analyzed. RESULTS AND ANALYSIS: There were 24 ICU admissions with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33%, n=20, P<0.05) with more patients presenting with obstetric complications (91.66%, n=22, P<0.01) as compared to medical complications (8.32%, n=2). Obstetric hemorrhage (n=15, 62.5%) and hemodynamic instability (n=20, 83.33%) were considered to be significant risk factors for ICU admission (P=0.000). Inotropic support was required in 22 patients (91.66%) while 17 patients (70.83%) required ventilatory support. The mean duration of ventilation (30.17±21.65 h) and ICU stay (39.42±33.70 h) were of significantly longer duration in survivors (P=0.01, P=0.00 respectively) versus non-survivors. The observed mortality n=10, 41.67% was significantly higher since ours is a referral tertiary center and delay in reaching the tertiary center from the place of occurrence of the mishap is a usual occurrence. CONCLUSION: Obstetric hemorrhage leading to hemodynamic instability remains the leading cause of ICU admissions and maternal mortality.

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Introduction: The purpose of this study was to evaluate the use of a daily awakening and spontaneous breathing trial (DA-SBT) protocol and to identify opportunities to improve use. Hypothesis: It was hypothesized that a survey of ICU team members would reveal areas for DA-SBT protocol improvement relating to communication and documentation. Methods: This study assessed use of a DA-SBT protocol in two medical intensive care units and surveyed nurses, respiratory therapists, and prescribers about how closely the protocol was followed and how the ICU team communicated about sedation and analgesia. Survey responses were compared between respondents using the Wilcoxon rank sum test. The following were retrospectively collected: demographic and clinical data, sedative and analgesic use, percentage of time patients spent at their goal levels of pain and sedation, and duration of mechanical ventilation, ICU stay, and hospitalization. Rates of self-extubation were compared to the three years preceding protocol implementation. Results: Data were gathered on 87 eligible subjects hospitalized over 7 months. The mean age was 65, 49.4% were male, and the mean acute physiology score and chronic health evaluation II score was 20. Subjects spent 54.3% of the time at their goal sedation level and 38.4% of the time below their goal level of consciousness. The mean duration of ventilation was 162.4 hours, mean ICU stay was 9.6 days, and mean hospital stay was 15.7 days. The rates of self-extubation and re-intubation were unchanged versus the previous three years. The survey response rate was 43% (70 of 163). Opportunities for improving use of the protocol related to agreement in pain and sedation scoring and communicating patient status and sedation plans between team members. Comparison of responses from nurses and respiratory therapists versus providers revealed significantly different perceptions of the clarity of sedation plans and consistency in pain and sedation scoring, with providers feeling that plans were communicated more clearly and pain and sedation scoring was more consistent. Conclusions: Use of a DA-SBT protocol may be improved with better multidisciplinary communication and greater consistency in scoring pain and sedation.

1541 Evaluation of Sedation - Analgesia Buy Scale Comfort B in Ventilated Children

IntroductionIn children, the use of scale COMFORT B and a written protocol would allow the obtaining of an adequate level of sedation-analgesia, the adjustment of the dosages of midazolam and...

Surgical repair of truncus arteriosus in children: early results and long-term outcomes

To recite early results and long-term outcomes after surgical repair of persistent truncus arteriosus (PTA). The clinic data of 54 patients underwent surgical repair for PTA from January 1999 to December 2009 was analyzed retrospectively. There were 36 male and 18 female patients, with a mean age of (9 ± 10) months (range, 1 to 38 months; median, 5 months). Preoperative mechanical ventilation was required in 5 patients. The surgical procedures were closure of ventricular septal defect and re-establishment of continuity between right ventricle and pulmonary artery. The right ventricular outflow tract (RVOT) was reconstructed by direct anastomosis pulmonary artery to right ventriculotomy with anterior wall patch enlargement (28 cases), or by inserting conduits (26 cases). Valvuloplasty were performed in 4 patients with truncal valves moderate to severe insufficiency and aortoplasty in 3 patients with interrupted aortic arch (IAA). There were 3 patients (5.6%) died of pulmonary hypertensive crisis in hospital. The mean duration of ventilation was 6.8 days in 5 patients who were intubated before operation, while the others were 3.6 days. Forty-seven (92.2%) patients were followed-up for mean (6.8 ± 2.5) years (from 2.5 to 11.0 years). There were 2 patients with mild to moderate aortic regurgitation. One patient with aortic arch obstruction underwent balloon dilatation 2 years postoperatively. Among those patients who underwent direct anastomoses, 8 (32.0%) patients had pulmonary branch stenosis at 7 months to 1.5 years postoperatively, 12 (48.0%) patients were freedom from surgical reintervention 5.0 to 11.0 years postoperatively. Among those inserting conduits, 7 patients (31.8%) had conduit stenosis at 2.8 to 7.0 years after operation. Reoperations were performed for RVOT in 15 patients and there was no mortality. It is difficult to treat the PTA patients with IAA, intra-mural coronary artery or mechanical ventilation support before operation. The technique of direct anastomosis between pulmonary artery and right ventricle offers the potential growth for RVOT, but bilateral pulmonary branch stenosis may be occurred at earlier period of postoperation in some patients.

P73 Epidemiology and long term outcomes of patients with chronic obstructive pulmonary disease admitted to Scottish intensive care units

Introduction Patients admitted to intensive care units (ICUs) with an exacerbation of chronic obstructive pulmonary disease (COPD) are thought to have poor outcomes. Few studies have reported the impact of ICU admission on long-term outcomes. We aimed to describe the epidemiology of patients admitted to all Scottish ICUs with an exacerbation of COPD, and to ascertain the importance of admission on long-term mortality and hospital readmission rates. Methods We used a retrospective cohort design linking the Scottish Intensive Care Society Audit Group national database of ICU admissions to the national Scottish hospital discharges and death registry databases. The study cohort comprised all patients admitted to Scottish ICUs in 2005 aged =35 years with a primary ICU admission diagnosis of COPD, or respiratory infection/sepsis as the primary and COPD as the secondary diagnosis. Mortality was defined as death within 4 years of ICU admission. Logistic regression identified factors independently associated with mortality. Hospital readmission rates for the 3 years prior to and following discharge from the index hospitalisation were calculated. Results 249 of 7727 (3.2%) first admission episodes to Scottish ICUs in 2005 were with an exacerbation of COPD. Mean age: 67 years; female: 52%; median admission Simplified Acute Physiology Score II: 35 (IQR 26–45). 83% of patients received mechanical ventilation; 24% required tracheostomy. Mean duration of ICU and hospital stays: 6.9 and 28.0 days, respectively. Mean duration of ventilation: 5.7 days (ICU survivors 5.9, non-survivors 5.2). Mortality at ICU and hospital discharge was 23.8% and 34.7%, respectively. It was 46.4% at 1 year and 66.1% at 4-year spost-ICU admission. Only age (p Conclusion This Scottish national cohort had comparable short-term mortality rates to those seen in a general ICU population. The poorer long-term mortality rate and increased readmission rates after hospital discharge may be useful to consider alongside other factors when deciding on ICU admission for patients with COPD.

Role of prophylactic surfactant in preterm infants

Respiratory distress syndrome (RDS) in preterm neonates is caused by a deficiency or dysfunction of pulmonary surfactant. The physiological function of surfactant includes the ability to lower surface tension, as well as the ability to rapidly adsorb and spread. A wide variety of surfactant products have been formulated and studied in clinical trials. The present study was designed to find out whether prophylactic administration of surfactant leads to a significant decrease in the risk of neonatal mortality and neonatal morbidity. This was an experimental study in which a total of 125 preterm newborns less than 34 weeks gestation were studied. One hundred preterm newborns (controls) less than 34 weeks gestation were managed in the conventional manner as per the existing protocols in the neonatal intensive care unit. Twenty-five consecutively delivered preterm newborns less than 34 weeks gestation were administered surfactant. Data regarding clinical outcomes including mortality and morbidity profile was collected and analysed. The mean duration of ventilation in the ventilated babies in the control group and the surfactant group was 129.8 ± 43 hours and 85.7 ± 46 hours, respectively; the difference being statistically significant. In the surfactant group, four babies (16%) died and in the control group, 27 babies (27%) died. The difference was not statistically significant. The number of babies developing retinopathy of prematurity and needing laser treatment for retinopathy of prematurity was greater in the surfactant group. Prophylactic administration of surfactant in preterm newborns of gestational age < 34 weeks is associated with a significant decrease in mean duration of ventilation and an increase in the incidence of retinopathy of prematurity.

Role of Hemocoagulase in Pulmonary Hemorrhage in Preterm Infants: A Systematic Review

Pulmonary hemorrhage (PH) in neonates is associated with significant morbidity and mortality. Hemocoagulase is an established hemostatic agent and may be beneficial in neonates with severe PH.This systematic review was performed to investigate the clinical efficacy and safety of hemocoagulase therapy in preterm infants with Pulmonary hemorrhage (PH). The search strategy of the Cochrane Neonatal Review Group was used to determine outcomes following PH in neonates. The primary outcomes were mortality, duration of PH and length of mechanical ventilation. Other morbidities included: Respiratory Distress Syndrome, sepsis, intraventricular hemorrhage, necrotizing enterocolitis and bronchopulmonary dysplasia. The Cochrane Library, MEDLINE, EMBASE and CINAHL and bibliographies of identified trials were searched. The standard methods of the Cochrane Neonatal Review Group and van Tulder's guidelines were followed independently by the authors to assess study quality, enter data and report outcomes. Typical treatment effects were calculated using fixed confidence intervals (CI). Heterogeneity tests were performed. Two 'randomized' controlled studies related to the role of hemocoagulase in neonates were identified: One for treatment of PH and the other for prevention of PH. All preterm infants' of gestational age ≤ 32weeks and birth weight ≤ 1500g with PH were included in the study. A total of 48 and 72 preterm infants were enrolled and randomized into two groups in trial 1 and trial 2 respectively. Mortality risk was significantly lower in the treatment group (RR 0.52; 95%CI 0.31, 0.89, p < 0.02) when hemocoagulase was used as therapy compared to prophylactic use in neonates (RR 0.52; 95%CI 0.26, 1.07, p = 0.07). Duration of PH and mean duration of ventilation were shorter in both treatment and prophylactic groups. Use of hemocoagulase appeared to be effective in preventing PH in premature infants and reduced mortality. However, the potential risks of use of hemocoagulase including adverse effects and the effectiveness of hemocoagulase still remain uncertain due to the lack of good quality large randomized controlled studies. This needs further evaluation, before routine use can be recommended.

Spectrum of Guillain-Barré syndrome in tertiary care hospital at Kolkata

Objective:In childhood Guillain–Barré syndrome (GBS), the clinical profiles using intravenous immunoglobulin (IVIg) in addition to supportive care were studied.Materials and Methods:This was a retrospective analysis of 139 children with severe GBS admitted to our respiratory care unit managed with the IVIg as an adjunct intervention to conventional supportive and respiratory care.Results:In our case series of 139 cases, motor weakness was the most common presenting feature. Antecedent illness was found in 66.7% of cases in the preceding two weeks, which included nonspecific illness, acute respiratory infection, diarrhea, and chickenpox. At onset, sensory symptoms (pain and paresthesia) were noted in 59% of the cases and limb weakness in 77%. On admission, a majority (61.54%) were in Hughes neurological disability grading stage V; all had limb weakness at the peak deficit, autonomic disturbance was seen in 35.8%, and bulbar palsy in 52%. Duration of illness was less than three weeks in 67% of cases. The mean duration of ventilation was 21.5 days (range, 5-60 days).Conclusions:Male preponderance and motor weakness was the most common presenting illness and a majority achieved full recovery in our series. Although IVIg may be useful in the treatment of GBS, the key issue is excellent intensive care unit management.

Obstetric critical care: A prospective analysis of clinical characteristics, predictability, and fetomaternal outcome in a new dedicated obstetric intensive care unit

A 1 year prospective analysis of all critically ill obstetric patients admitted to a newly developed dedicated obstetric intensive care unit (ICU) was done in order to characterize causes of admissions, interventions required, course and foetal maternal outcome. Utilization of mortality probability model II (MPM II) at admission for predicting maternal mortality was also assessed. During this period there were 16,756 deliveries with 79 maternal deaths (maternal mortality rate 4.7/1000 deliveries). There were 24 ICU admissions (ICU utilization ratio 0.14%) with mean age of 25.21±4.075 years and mean gestational age of 36.04±3.862 weeks. Postpartum admissions were significantly higher (83.33% n=20, P<0.05) with more patients presenting with obstetric complications (91.66%, n=22, P<0.01) as compared to medical complications (8.32% n=2). Obstetric haemorrhage (n=15, 62.5%) and haemodynamic instability (n=20, 83.33%) were considered to be significant risk factors for ICU admission (P=0.000). Inotropic support was required in 22 patients (91.66%) while 17 patients (70.83%) required ventilatory support but they did not contribute to risk factors for poor outcome. The mean duration of ventilation (30.17±21.65 h) and ICU stay (39.42±33.70 h) were of significantly longer duration in survivors (P=0.01, P=0.00 respectively) versus non-survivors. The observed mortality (n=10, 41.67%) was significantly higher than MPM II predicted death rate (26.43%, P=0.002). We conclude that obstetric haemorrhage leading to haemodynamic instability remains the leading cause of ICU admission and MPM II scores at admission under predict the maternal mortality.

Venoatrial Shunt-Assisted Cavopulmonary Anastomosis

The bidirectional Glenn shunt operation is conventionally performed under cardiopulmonary bypass. Between June 2007 and September 2009, 218 consecutive patients underwent off-pump bidirectional Glenn shunt institution for single ventricle with pulmonary stenosis complex. Their mean age was 4.72 ± 1.80 years (range, 4 months to 6 years) and median weight was 10.12 kg (range, 4.1-19 kg). A temporary shunt was created between the innominate vein and the right atrium, with a 3-way connector for de-airing. Fifty-five patients had bilateral cavae. The mean internal jugular venous pressure on clamping the superior vena cava was 24.69 ± 1.81 mm Hg. Continuous end-tidal CO₂ and O₂ saturation were monitored. Adequate oxygen saturation and blood pressure were maintained by optimizing inotropics, volume, and inspired oxygen. The mean duration of ventilation was 10.17 ± 8.96 h (range, 1-73 h). There were no gross neurological complications. Postoperative pleural effusion developed in 6 (2.75%) patients, and 4 (1.83%) had nodal rhythm. Four (1.83%) patients died in the immediate postoperative period due to low cardiac output syndrome. Venoatrial shunt-assisted bidirectional Glenn shunt surgery can be performed safely by optimizing intraoperative management strategies. It is economical and avoids the deleterious effects cardiopulmonary bypass.