scholarly journals Prophylactic Positive End-Expiratory Pressure and Postintubation Hemodynamics: An Interventional, Randomized Study

2010 ◽  
Vol 17 (3) ◽  
pp. e45-e50 ◽  
Author(s):  
Olivier Lesur ◽  
Marie-Anaïs Remillard ◽  
Catherine St-Pierre ◽  
Simon Falardeau
Keyword(s):  
Intensive Care ◽  
Randomized Study ◽  
Final Analysis ◽  
Study Cohort ◽  
Emergency Setting ◽  
Positive End Expiratory Pressure ◽  
Medical Intensive Care ◽  
The Mean ◽  
The Difference ◽  
Present Trial

OBJECTIVE: To investigate the hemodynamic and outcome effects of implementing prophylactic positive end-expiratory pressure (PEEP) versus zero end-expiratory pressure (ZEEP) in patients during the postintubation period in the emergency setting.METHODS: The present study was a prospective, single-centre, interventional, single-blinded randomized trial performed in a 16-bed medical intensive care unit. The study cohort consisted of consecutive patients who urgently required intubation. During the postintubation period, patients received either 5 cmH2O PEEP or ZEEP. The primary aim was to assess the variation in mean arterial pressure (MAP) from baseline up to 90 min postintubation. The secondary aim was to determine the mean duration of intubation, level of MAP support after intubation and 28-day mortality.RESULTS: Seventy-five consecutive patients with similar mean (± SD) baseline characteristics and preintubation MAP (76±18 mmHg in the ZEEP group and 78.5±23 mmHg in the PEEP group, P=Not significant [NS]) were studied. The final analysis was performed in 33 patients in the ZEEP group and 30 patients in the PEEP group. Regarding outcome measures following intubation, delta MAP (ie, the difference between the lowest MAP values from baseline) was not differentially affected in either group (P=NS); the mean durations of intubation were similar (ZEEP 9.2±8.5 days versus PEEP 9.2±8.8 days, P=NS); 28-day mortality was not discriminative (ZEEP 14 of 33, PEEP nine of 30; P=NS); and levels of MAP support after intubation were comparable between the two groups.CONCLUSION: In the present trial, there was no evidence that implementing a prophylactic PEEP of 5 cmH2O adversely affects short-term hemodynamics or outcome in medical intensive care patients during the postintubation period.

Efficacy and Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

2020 ◽  
Vol 33 (1) ◽  
pp. 41-47
Author(s):  
Mohsena Akhter ◽  
Ishrat Bhuiyan ◽  
Zulfiqer Hossain Khan ◽  
Mahfuza Akhter ◽  
Gulam Kazem Ali Ahmad ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Close Contact ◽  
Randomized Study ◽  
Sarcoptes Scabiei ◽  
Efficacy And Safety ◽  
Common Skin ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice. Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies. Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. group A was subjected to oral Ivermectin and the group B to Permethrin 5% cream. Patients were followed up on day 7 and 14 for assessment of efficacy and safety. Result: The mean scoring with SD in group A (Ivermectin) and group B (Permethrin) were 8.26 ± 2.22 and 7.59 ± 2.01 respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) the mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7thdays. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001). Conclusion: Topical application of permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies. TAJ 2020; 33(1): 41-47

Reporting of Research by Matched Otolaryngology Residency Applicants

2020 ◽  
pp. 000348942093882
Author(s):  
Aatin K. Dhanda ◽  
Brittany Ward ◽  
Christopher J. Warren ◽  
Ben Birkenfeld ◽  
Kirolos Georges ◽  
...  
Keyword(s):  
Medical Students ◽  
Residency Program ◽  
Final Analysis ◽  
Program Directors ◽  
Residency Programs ◽  
Competitive Process ◽  
The Mean ◽  
The Difference ◽  
Number Of Publications

Objectives: Matching to an otolaryngology residency program is a competitive process for medical students, and research performed by students is considered as a factor for granting interviews by program directors. Because abstracts, presentations and publications are all reported in combination by the National Resident Matching Program’s “Charting Outcomes in the Match” (ChOM) and may be weighted differently by PDs, we specifically investigated the number of publications by past applicants accepted to top otolaryngology residency programs. Methods: The top 25 otolaryngology residency programs were identified using Doximity, sorting by reputation. Current residents were determined from the programs’ websites. Using PubMed, each resident’s number of publications, authorship status, and journal type were recorded. Results: A total of 24 programs were included in the final analysis and the average number of manuscripts was 2.76 ± 4.01. The mean number of publications in otolaryngology journals was 1.03 ± 1.91. Conclusions: The difference between the investigated average number of publications (2.76) and those published by ChOM (10.4) represent a discrepancy due to the lack of delineation between abstracts, presentations and publications. The reported numbers for research may lead medical students to pursue alternate measures to increase their own research. Some options, such as adding a research year are not universally accessible. A clearer and more detailed approach to reporting research statistics would be beneficial to both applicants and PDs for otolaryngology programs.

scholarly journals Cefepime versus Imipenem-Cilastatin for Treatment of Nosocomial Pneumonia in Intensive Care Unit Patients: a Multicenter, Evaluator-Blind, Prospective, Randomized Study

2003 ◽  
Vol 47 (11) ◽  
pp. 3442-3447 ◽  
Author(s):  
G. Zanetti ◽  
F. Bally ◽  
G. Greub ◽  
J. Garbino ◽  
T. Kinge ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Pneumonia ◽  
Randomized Study ◽  
Single Agent ◽  
Multicenter Trial ◽  
Causative Organism ◽  
Secondary Resistance ◽  
Resistance Patterns ◽  
The Difference

ABSTRACT In a randomized, evaluator-blind, multicenter trial, we compared cefepime (2 g three times a day) with imipenem-cilastatin (500 mg four times a day) for the treatment of nosocomial pneumonia in 281 intensive care unit patients from 13 centers in six European countries. Of 209 patients eligible for per-protocol analysis of efficacy, favorable clinical responses were achieved in 76 of 108 (70%) patients treated with cefepime and 75 of 101 (74%) patients treated with imipenem-cilastatin. The 95% confidence interval (CI) for the difference between these response rates (−16 to 8%) failed to exclude the predefined lower limit for noninferiority of −15%. In addition, therapy of pneumonia caused by an organism producing an extended-spectrum β-lactamase (ESBL) failed in 4 of 13 patients in the cefepime group but in none of 10 patients in the imipenem group. However, the clinical efficacies of both treatments appeared to be similar in a secondary intent-to-treat analysis (95% CI for difference, −9 to 14%) and a multivariate analysis (95% CI for odds ratio, 0.47 to 1.75). Furthermore, the all-cause 30-day mortality rates were 28 of 108 (26%) patients in the cefepime group and 19 of 101 (19%) patients in the imipenem group (P = 0.25). Rates of documented or presumed microbiological eradication of the causative organism were similar with cefepime (61%) and imipenem-cilastatin (54%) (95% CI, −23 to 8%). Primary or secondary resistance of Pseudomonas aeruginosa was detected in 19% of the patients treated with cefepime and 44% of the patients treated with imipenem-cilastatin (P = 0.05). Adverse events were reported in 71 of 138 (51%) and 62 of 141 (44%) patients eligible for safety analysis in the cefepime and imipenem groups, respectively (P = 0.23). Although the primary end point for this study does not exclude the possibility that cefepime was inferior to imipenem, some secondary analyses showed that the two regimens had comparable clinical and microbiological efficacies. Cefepime appeared to be less active against organisms producing an ESBL, but primary and secondary resistance to imipenem was more common for P. aeruginosa. Selection of a single agent for therapy of nosocomial pneumonia should be guided by local resistance patterns.

scholarly journals Drug utilization study in medicine intensive care unit in tertiary care hospital

2019 ◽  
Vol 9 (1) ◽  
pp. 151
Author(s):  
Siddharth Suryakant Athawale ◽  
Madhuri D. Kulkarni
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tertiary Care ◽  
Utilization Rate ◽  
Valuable Insight ◽  
Care Hospital ◽  
Life Threatening ◽  
Potassium Clavulanate ◽  
Medical Intensive Care ◽  
The Mean

Background: The medical intensive care unit (MICU) is a setting were patients who are critically ill are admitted and thus usually receive a large number of drugs of different pharmacological classes due to life threatening illnesses which may be fatal. The various drugs used in MICU and there clinical outcome was investigated in this study.Methods: Patients admitted between January 2017 to June 2018 in Medicine ICU of GMC Aurangabad were included in this study.Results: Total of 351 prescriptions was analyzed from the medicine intensive care unit. Out of 351 patients 243 (69.23%) were male, while 108 (30.77%) were female. The mean age of the patients admitted in MICU was 42.78±18.14 years. The most common type of patients admitted in MICU have the diagnosis of organophosphorous poisoning (25.36%), followed by cerebrovascular accident (15.95%), pneumonitis (10.26%), snake bite (7.12%), chronic kidney disease (5.98%), diabetic ketoacidosis (5.70%) and seizure disorder (3.42%). The most common drugs used were ranitidine (99.71%) and ondansetron (99.43%). Among antibiotics cephalosporins were most commonly used, ceftriaxone (39.03%), cefotaxim (40.46%), cefoperazone and sulbactum (24.22%). Other antibiotics most commonly used were metronidazole (61.25%), amoxicillin and potassium clavulanate (26.78%), piperacillin and tazobactum (11.68%), meropenem (11.40%).Conclusions: In conclusion, we found that in MICU utilization rate of gastroprotective (ranitidine), antiemetic (ondansetron) and antibiotics (cephalosporins) was high. The present study provides valuable insight about the overall pattern of drugs used in medicine intensive care unit.

Comparison of nasogastric tube securing methods and tube types in medical intensive care patients

1995 ◽  
Vol 4 (3) ◽  
pp. 198-203 ◽  
Author(s):  
SM Burns ◽  
M Martin ◽  
V Robbins ◽  
T Friday ◽  
M Coffindaffer ◽  
...  
Keyword(s):  
Intensive Care ◽  
Nasogastric Tube ◽  
Convenience Sample ◽  
Intensive Care Patients ◽  
Medication Delivery ◽  
Nasogastric Tubes ◽  
Gastric Tubes ◽  
Medical Intensive Care ◽  
The Mean ◽  
Mean Time

BACKGROUND: Nasogastric tube displacement can result in serious complications such as aspiration and inadvertent migration of the tube into the lungs. Replacement of the tubes is costly, time- and effort-intensive, uncomfortable for the patients, and potentially dangerous. OBJECTIVE: To determine the best of three methods for securing nasogastric tubes in a medical intensive care population and to identify variables related to the failure of tube securing methods. METHODS: A convenience sample of 103 patients requiring duodenal or standard gastric tubes for feeding, medication delivery, or decompression were randomly assigned to one of three taping methods: pink tape, clear tape, or "butterfly," for a total of 264 taping episodes. Data collection included the mean time until failure of the securing methods as well as variables such as patient alertness and mobility. RESULTS: The mean time until failure was 100 hours with pink tape versus 56 hours with clear tape and 30 hours with the "butterfly." Differences were significant. Duodenal tubes stayed secured longer than standard sump tubes (mean time until failure was 86 vs 41 hours) for all taping methods, but not significant relationship was demonstrated between mean time until failure and variables such as alertness, sedation, confusion, mobility, and the use of restraints. CONCLUSION: Our results showed that the pink tape method was superior. Nasogastric tube securing methods in adult critical care patients vary in efficacy and should be selected carefully.

scholarly journals Effects of manual chest compression on expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure maneuver in patients on mechanical ventilation

2019 ◽  
Vol 45 (3) ◽  
Author(s):  
Ana Carolina Otoni Oliveira ◽  
Daiane Menezes Lorena ◽  
Lívia Corrêa Gomes ◽  
Bianca Lorrane Reges Amaral ◽  
Márcia Souza Volpe
Keyword(s):  
Mechanical Ventilation ◽  
Chest Compression ◽  
Randomized Study ◽  
Positive End Expiratory Pressure ◽  
Respiratory Therapists ◽  
Hand Grip ◽  
Airway Clearance ◽  
Manual Chest Compression ◽  
The Mean ◽  
Expiratory Flow

ABSTRACT Objective: To investigate the effects of manual chest compression (MCC) on the expiratory flow bias during the positive end-expiratory pressure-zero end-expiratory pressure (PEEP-ZEEP) airway clearance maneuver applied in patients on mechanical ventilation. The flow bias, which influences pulmonary secretion removal, is evaluated by the ratio and difference between the peak expiratory flow (PEF) and the peak inspiratory flow (PIF). Methods: This was a crossover randomized study involving 10 patients. The PEEP-ZEEP maneuver was applied at four time points, one without MCC and the other three with MCC, which were performed by three different respiratory therapists. Respiratory mechanics data were obtained with a specific monitor. Results: The PEEP-ZEEP maneuver without MCC was enough to exceed the threshold that is considered necessary to move secretion toward the glottis (PEF − PIF difference > 33 L/min): a mean PEF − PIF difference of 49.1 ± 9.4 L/min was achieved. The mean PEF/PIF ratio achieved was 3.3 ± 0.7. Using MCC with PEEP-ZEEP increased the mean PEF − PIF difference by 6.7 ± 3.4 L/min. We found a moderate correlation between respiratory therapist hand grip strength and the flow bias generated with MCC. No adverse hemodynamic or respiratory effects were found. Conclusions: The PEEP-ZEEP maneuver, without MCC, resulted in an expiratory flow bias superior to that necessary to facilitate pulmonary secretion removal. Combining MCC with the PEEP-ZEEP maneuver increased the expiratory flow bias, which increases the potential of the maneuver to remove secretions.

scholarly journals Anterior Chamber OCT Changes Following Penetrating Keratoplasty

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
N M I Elmowafy ◽  
M M Elfiky ◽  
H O Rashed ◽  
R M A Alrialy
Keyword(s):  
Anterior Chamber ◽  
Penetrating Keratoplasty ◽  
Wide Spectrum ◽  
Randomized Study ◽  
Major Complication ◽  
Angle Closure ◽  
P Value ◽  
Infectious Keratitis ◽  
The Mean ◽  
The Difference

Abstract Background penetrating keratoplasty (PKP) is performed for a wide spectrum of corneal disorders. Glaucoma due to pupillary block or synechial angle closure or aqueous misdirection is a major complication after keratoplasty. Peripheral anterior synechia (PAS) is recognized as one of the risk factors for graft rejection and may occasionally cause intraocular pressure (IOP) elevation, it is important to evaluate anterior chamber (AC) angle in eyes after PKP Aim of the Work to document OCT changes in the anterior chamber angle after PKP for different pathologies. Patients and Methods this prospective non-randomized study included 10 eyes of 10 patients undergoing penetrating keratoplasty (PKP) for a variety of indications. The patients age ranged from 20 to 60 years. Results the mean postoperative IOP was higher (15.4 ± 4.03 mmHg) than preoperative IOP (12.5 ± 2.46 mmHg), but this difference was not statistically significant [P value = 0.088]. The postoperative mean Temporal TISA was lower (0.24 ± 0.08 mm2) than preoperative Temporal TISA (0.3 ± 0.1 mm2). This difference was statistically significant [P value = 0.015]. The postoperative mean Nasal TISA was lower (0.26 ± 0.1 mm2) than preoperative Nasal TISA (0.34 ± 0.15 mm2). This difference was statistically significant [P value = 0.010]. The postoperative mean IOP in infectious keratitis was higher (16.14 ± 4.63 mmHg) than postoperative mean IOP in keratoconus (13.67 ± 1.53 mmHg), but this difference was not statistically significant [P value = 0.565]. Conclusion there is an increase in IOP post PKP but the difference was not statistically significant. There is narrowing in angle post PKP. The difference was statistically significant in temporal and nasal angles but not statistically significant in superior and inferior angles. The mean IOP was higher in infectious keratitis than keratoconus but the difference was not statistically significant. There is no correlation between corneal diameter and the changes in IOP and angle measurements.

scholarly journals The FREQUENCY OF STRESS HYPERGLYCEMIA AND MORTALITY IN PATIENTS WITH HYPERGLYCEMIA IN MEDICAL INTENSIVE CARE UNIT

2021 ◽  
Vol 71 (3) ◽  
pp. 753-56
Author(s):  
Shahzeb Ahmed Satti ◽  
Abdul Latif Khattak ◽  
Abdul Moueed Tariq ◽  
Sultan Mehmood Majoka ◽  
Arshad Naeem ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Sugar ◽  
Medical Intensive Care Unit ◽  
Stress Hyperglycemia ◽  
Stress Hyperglycaemia ◽  
Study Population ◽  
Medical Intensive Care ◽  
The Mean

Objective: To assess the frequency of stress hyperglycemia and mortality in patients with hyperglycemia admitted in medical Intensive Care Unit. Study Design: Cross-sectional study. Place and Duration of Study: Medical Intensive Care Unit, Combined Military Hospital Quetta, from Nov 2018 to Jun 2019. Methodology: A total of 150 adult patients of age between 18-80 years, of both genders, with Intensive Care Unit stay >24 hours, who were treated in medical Intensive Care Unit during study period, were included in the study. Those patients with duration of stay <24 hours, paediatric patients, surgical and pregnant patients and those who were on chronic steroid therapy and those who were given TPN and dextrose infusions were excluded. The blood sugar fasting was measured daily and blood sugar random was measured on admission and twice daily. The patients were segregated into three groups: Normoglycemia, Diabetes mellitus and Stress hyperglycaemia. The frequency of patients and outcome of patients in terms of death was observed in all groups. Results: The mean age of study population was 55.02 ± 18.14 years, with 99 (66%) were males while 51 (34%) were females. Among study population 77 (51.3%) had normoglycemia, 46 (30.7%) had Diabetes Mellitus while 27 (18%) had stress hyperglycaemia. Out of 77 patients with normoglycemia 10 (12.9%) died, while number of deaths in patients with diabetes mellitus and stress hyperglycaemia was 21 (45.6%) and 15 (55.5%) respectively. The mean maximum blood glucose in those who survived and died was 214.39 ± 100.69 mg/dl and 295.26 ± 122.60................ 

Oropharyngeal flora in patients admitted to the medical intensive care unit: clinical factors and acid suppressive therapy

2013 ◽  
Vol 62 (5) ◽  
pp. 778-784 ◽  
Author(s):  
Wesam Frandah ◽  
Jane Colmer-Hamood ◽  
Hoda Mojazi Amiri ◽  
Rishi Raj ◽  
Kenneth Nugent
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill Patients ◽  
Medical Intensive Care Unit ◽  
Upper Airway ◽  
Suppressive Therapy ◽  
Oral Flora ◽  
History Of ◽  
Medical Intensive Care ◽  
The Mean

Acid suppression therapy in critically ill patients significantly reduces the incidence of stress ulceration and gastrointestinal (GI) bleeding; however, recent studies suggest that proton pump inhibitors (PPIs) increase the risk of pneumonia. We wanted to test the hypothesis that acid suppressive therapy promotes alteration in the bacterial flora in the GI tract and leads to colonization of the upper airway tract with pathogenic species, potentially forming the biological basis for the observed increased incidence of pneumonia in these patients. This was a prospective observational study on patients (adults 18 years or older) admitted to the medical intensive care unit (MICU) at a tertiary care centre. Exclusion criteria included all patients with a diagnosis of pneumonia at admission, with infection in the upper airway, or with a history of significant dysphagia. Oropharyngeal cultures were obtained on day 1 and days 3 or 4 of admission. We collected data on demographics, clinical information, and severity of the underlying disease using APACHE II scores. There were 110 patients enrolled in the study. The mean age was 49±16 years, 50 were women, and the mean APACHE II score was 9.8±6.5. Twenty per cent of the patients had used a PPI in the month preceding admission. The first oropharyngeal specimen was available in 110 cases; a second specimen at 72–96 h was available in 68 cases. Seventy-five per cent of the patients admitted to the MICU had abnormal flora. In multivariate logistic regression, diabetes mellitus and PPI use were associated with abnormal oral flora on admission. Chronic renal failure and a higher body mass index reduced the frequency of abnormal oral flora on admission. Most critically ill patients admitted to our MICU have abnormal oral flora. Patients with diabetes and a history of recent PPI use are more likely to have abnormal oral flora on admission.

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