scholarly journals Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

2018 ◽  
Vol 16 (3) ◽  
pp. 336-339
Author(s):  
Subhash Prasad Acharya ◽  
Binita Bhattarai ◽  
Adheesh Bhattarai ◽  
Saurabh Pradhan ◽  
Mohan Raj Sharma
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Unit Mortality ◽  
Surgical Intensive Care Unit ◽  
Tertiary Level ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Neurosurgical Patients ◽  
One Year

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being pre-operative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.Keywords: Intensive care unit; mortality; neurosurgery; outcome.

scholarly journals Profile of Neurosurgical Patients in a Tertiary Level Intensive Care Unit in Nepal

2018 ◽  
Vol 16 (3) ◽  
pp. 336-339
Author(s):  
Subhash Prasad Acharya ◽  
Binita Bhattarai ◽  
Adheesh Bhattarai ◽  
Saurabh Pradhan ◽  
Mohan Raj Sharma
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Medical Advice ◽  
Surgical Intensive Care Unit ◽  
Tertiary Level ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Neurosurgical Patients ◽  
One Year

Background: Neurosurgery has developed as a separate specialty and neurosurgical patients are some of the most common admitted in the intensive care unit. The objective of the study was to study the profile of neurosurgical patients admitted in level III mixed, medical-surgical intensive care unit in a tertiary level teaching hospital in Nepal with the view to identify the causes of intensive care unit admission, types of neurosurgery performed, outcome of the patients, in terms of intensive care unit stay, mechanical ventilation days and mortality.Methods: A retrospective study was designed and all neurosurgical patients admitted to the intensive care unit of our center between 13 April 2017 and 13April 2018 (1st Baisakh 2074 to 30th Chaitra 2074) were enrolled in this study.Results: A total of 813 patients were admitted in ICU over a period of one year (2074 B.S.) of which 199 (24.48 %) were neurosurgical cases. Among these 170 (85.42%) cases were post-surgical, with 29 (14.58%) being preoperative patients. One hundred forty nine patients (74.9%) were on mechanical ventilation. One hundred and thirty two (66.3%) patients improved and were transferred to a step down ward. Forty-three (22.5%) died in the intensive care unit, 14 (7.03%) left the hospital against medical advice and 9 (4.5%) patients expired after withdrawal of life support.Conclusions: Despite improved care over the recent years the mortality and morbidity of neurosurgical patients is high.

scholarly journals Five years experiences in diagnosis and management of jejuno-ileal atresia in Kanti children’s hospital

2020 ◽  
Vol 23 (2) ◽  
pp. 4-8
Author(s):  
Anupama Basnet ◽  
Bijay Thapa ◽  
Prativa Dhoubadel ◽  
Anuj Kayastha
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ventilatory Support ◽  
Morbidity Rate ◽  
Surgical Intensive Care Unit ◽  
Ileal Atresia ◽  
Surgical Intensive Care ◽  
Mortality And Morbidity ◽  
Jejunoileal Atresia ◽  
End To End

Introduction: Jejuno-ileal atresia is a major cause of neonatal intestinal obstruction. The aim of this study is to evaluate the incidence, clinical presentation, management, and outcome of jejunoileal atresia at our institute over a period of five years. Methods: The medical records of the patients with the diagnosis of jejunoileal atresia during a period of five years (April 2014 to April 2019) were obtained from the hospital record section and surgical intensive care unit, and were reviewed and analyzed. Results: There were 61 cases of jejunoileal atresia among 144 cases of intestinal atresia. Twenty-nine (47.5%) of them were male. Laparotomy with resection of atretic part with anti-mesenteric tapering enteroplasty and end to end anastomosis was done in 15, and resection without tapering enteroplasty with end to end anastomosis was done in 39 patients. Thirty-eight patients (62.3%) were discharged while Twenty-three (37.7%) cases were lost to mortality. Conclusions: Although the mortality and morbidity rate are high in jejunoileal atresia, early diagnosis, improvement in surgical technique, modern ventilatory support and advanced in intensive care unit has led to the significant increase in the survival rate.

scholarly journals Modifiable risk factors of ventilator-associated pneumonia in non-intensive care unit versus intensive care unit

2021 ◽  
Vol 15 (10) ◽  
pp. 1471-1480
Author(s):  
Patpong Udompat ◽  
Daravan Rongmuang ◽  
Ronald Craig Hershow
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Risk Factor ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Proton Pump ◽  
Multidrug Resistant ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Neurosurgical Patients

Introduction: Ventilator-associated pneumonia patients are treated in non-intensive care units because of a shortage of intensive care unit beds in Thailand. Our objective was to assess whether the type of unit and medications prescribed to the patient were associated with ventilator‑associated pneumonia and multidrug resistant ventilator‑associated pneumonia. Methodology: A matched case-control study nested in a prospective cohort of mechanical ventilation adult patients in a medical-surgical intensive care unit and five non-intensive care units from March 1 through October 31, 2013. The controls were randomly selected 1:1 with cases and matched based on duration and start date of mechanical ventilation. Results: 248 ventilator-associated pneumonia and control patients were analyzed. The most common bacteria were multidrug resistant Acinetobacter baumannii (82.4%). Compared with patients in the intensive care unit, those in the neurosurgical/surgical non-intensive care units were at higher risk (p = 0.278). Proton pump inhibitor was a risk factor (p = 0.011), but antibiotic was a protective factor (p = 0.054). Broad spectrum antibiotic was a risk factor (p < 0.001) for multidrug resistant ventilator-associated pneumonia. Conclusions: Post-surgical and neurosurgical patients treated in non-intensive care unit settings were at the highest risk of ventilator-associated pneumonia. Our findings suggest that alternative using proton pump inhibitors should be considered based on the risk-benefit of using this medication. In addition, careful stewardship of antibiotic use should be warranted to prevent multidrug resistant ventilator-associated pneumonia.

Neurosurgical Admissions to the Intensive Care Unit

Neurosurgery ◽  
1981 ◽  
Vol 8 (4) ◽  
pp. 438-442 ◽  
Author(s):  
William A. Knaus ◽  
Elizabeth Draper ◽  
Diane E. Lawrence ◽  
Douglas P. Wagner ◽  
Jack E. Zimmerman
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nursing Care ◽  
Active Treatment ◽  
Electronic Monitoring ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Intensive Monitoring ◽  
Neurosurgical Patients ◽  
Hospital Wards

Abstract Among 624 consecutive admissions to a medical-surgical intensive care unit (ICU), we identified 289 patients admitted for concentrated nursing care and intensive monitoring of whom only 44 (15%) received active treatment before discharge. Within this group were 82 patients admitted after uncomplicated elective neurosurgery. Only 1 of these patients required active treatment before discharge. None had any major physiological abnormality detected by electronic monitoring, and no patient required readmission to the ICU or died during hospitalization. These 82 neurosurgical admissions accounted for 13% of the total admissions over the study period and 10.5% of the total number of ICU days. The admission of these patients to the ICU was prompted by the need for labor-intensive services, such as hourly neurological checks, that were not available on the regular hospital floor. For stable postoperative neurosurgical patients, improved staffing of hospital wards could lead to a reduction in the number of admissions to the ICU.

scholarly journals Association of hidden fluid administration with development of fluid overload reveals opportunities for targeted fluid minimization

2020 ◽  
Vol 8 ◽  
pp. 205031212097946
Author(s):  
Trisha Branan ◽  
Susan E Smith ◽  
Andrea Sikora Newsome ◽  
Rebecca Phan ◽  
W Anthony Hawkins
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Fluid Overload ◽  
Binary Logistic Regression ◽  
Fluid Volume ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Poor Outcomes ◽  
The Impact

Background: Fluid overload is associated with poor outcomes, but mitigating its occurrence poses significant challenges. Objective: This study sought to assess the impact of hidden fluid volume on fluid overload. Methods: This study was a multi-center, retrospective evaluation of adults admitted to a medical or surgical intensive care unit for at least 72 h. Patients were divided into tertiles (low, moderate, and high) based on the hidden fluid volume received. Hidden fluids were defined as intravenous medications, line flushes, blood products, and enteral nutrition. The primary outcome was the incidence of fluid overload at intensive care unit (day 3). Secondary outcomes included mechanical-ventilation free days and association of hidden fluid volume with fluid overload, length of stay, and mortality. Results: A total of 219 (73 per tertile) were included, with hidden fluid volume comprising ⩽2500, 2501–4400, and >4400 mL in the low, moderate, and high tertiles, respectively. Incidence of fluid overload was significantly different across groups (low: 3%, moderate: 14%, high: 25%; p < 0.001). No difference existed in mechanical-ventilation free days or in-hospital mortality across tertiles. In binary logistic regression, hidden fluid volume received at 3 days was independently associated with fluid overload (odds ratio = 1.40, 95% confidence interval = 1.15–1.70). Conclusion: The volume of hidden fluid volume administered by intensive care unit day 3 independently predicted development of fluid overload.

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