Anesthesia and COVID-19: What We Should Know and What We Should Do

Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), was first reported in Wuhan, Hubei, China, and has spread to more than 200 other countries around the world. COVID-19 is a highly contagious disease with continuous human-to-human transmission. The origin of the virus is unknown. Airway manipulations and intubations, which are common during anesthesia procedures may increasingly expose anesthesia providers and intensive care unit team members to SARS-CoV-2. Through a comprehensive review of existing studies on COVID-19, this article presents the epidemiological and clinical characteristics of COVID-19, reviews current medical management, and suggests ways to improve the safety of anesthetic procedures. Owing to the highly contagious nature of the virus and the lack of therapeutic drugs or vaccines, precautions should be taken to prevent medical staff from COVID-19.

Study of outcome of obstetric emergencies admitted to intensive care unit

Background: Critically ill obstetric patients pose challenges to the intensive care unit team due to their altered physiology as well as due the presence of the foetus and safety of both the mother and the foetus is of paramount importance.Methods: All antenatal and postnatal cases within 42days of delivery requiring ICU admission from October 2014 to September 2016. Detailed history taken and outcome noted. Results were subjected to statistical evaluation using SSP software.Results: (n=75): obstetric reasons (n=51, 68%) of which 21(28%) had PPH and 17(22.6) had hypertensive disorders of pregnancy. Non-obstetric reasons (n=24, 32%) of which 7(9.3%) cases had jaundice and 4(5.3%) had malaria. Mechanical ventilation was needed in the majority of cases (n=44, 58.7%) followed by inotropic support (n=30, 40%).Maternal mortality was 16%. Mortality was higher (n=8, 66.6%) among patients admitted for obstetric reasons as opposed to non-obstetric indications (n=4, 33.3%).Conclusions: Early detection and prompt referral to the tertiary centre with intensive care facilities should be promoted among the medical fraternity to reduce the incidence of ICU admissions and maternal mortality. All residents of obstetrics and gynaecology should have short mandatory training phase in critical care. Multicentre randomised studies are required for formulating evidence-based national guidelines.

Demography and Feeding Practices of ICU Patient of Government and Private Hospitals of Jorhat District, Assam

The aim of the present study was to analyze the characteristics and feeding practices of patient admitted to medicine ICUs. All relevant clinical and dietary information were collected for patients admitted to ICUs of selected Government and private hospitals of Jorhat district, Assam. This information was abstracted with the help of pre-structured schedule from the Medical Record Department and Intensive Care Unit team and analysed. A total of 1034 patients were admitted during the study period. Majority of the patients (49.61%) were from the age group of 60years and above. Majority incidence of diseases is a reason of admission in ICUs of both the hospitals was non-communicable diseases and patients were admitted via emergency OPD. Highest length of stay of 10-15 days was observed among the majority of patient from government hospital while it was shorter (6-10 days) for private hospital. The daily feeding pattern of each of the patients was recorded. Patients dependent on homemade blenderized foods for nutritional support were more in Government hospital while compare to the patient using both the commercial formulae as well as homemade food till the last day of stay in private hospitals. Increased cost of hospitalization and better outcome of patient in terms of short stay at hospitals and better nutritional status of the patient admitted to private hospitals were not feasible for low income groups patients admitted in Government hospital. The results of the present study will help the need of formulation and development of patient specific homemade foods with its ingredients used and nutritional requirement in it are taken account for both oral and enteral feedings in the hospitals with higher standard values with all demonstration on the development of protocols for clean techniques in the preparation, safe handling and storage of handmade enteral feeds.

Supplementing Intensivist Staffing With Nurse Practitioners: Literature Review

In the United States, providing health care to critically ill patients is a challenge. An increase in patients older than 65 years, a decrease in critical care physicians, and a decrease in work hours for residents cause intensivist staffing issues. In this article, use of nurse practictioners to fill the intensive care unit intensivist staffing gap is assessed and evidence-based recommendations are identified to better incorporate nurse practitioners as part of intensive care unit intensivist staffing. The literature reveals that when nurse practitioners are part of a staffing model, outcomes are either positively impacted or no different from physician outcomes. However, successfully integrating nurse practitioners into an intensive care unit team is not adequately discussed in the literature. This gap is addressed and 3 mechanisms to integrate nurse practitioners into the intensive care unit are identified: (1) use of a multidisciplinary staffing model, (2) completion of onboarding programs, and (3) evaluation of nurse practitioner productivity.