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Shanmugam N, Verma R, Sarkar S, Khanna P, Sinha R, Kashyap L, Shende DR, Ray BR, Anand RK, Maitra S, Singh AK, Lomi N. Functional near-infrared spectroscopy guided mapping of frontal cortex, a novel modality for assessing emergence delirium in children: A prospective observational study. Paediatr Anaesth 2023; 33:844-854. [PMID: 37313974 DOI: 10.1111/pan.14708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Despite an 18%-30% prevalence, there is no consensus regarding pathogenesis of emergence delirium after anesthesia in children. Functional near-infrared spectroscopy (fNIRS) is an optical neuroimaging modality that relies on blood oxygen level-dependent response, translating to a mean increase in oxyhemoglobin and a decrease in deoxyhemoglobin. We aimed to correlate the emergence delirium in the postoperative period with the changes in the frontal cortex utilizing fNIRS reading primarily and also with blood glucose, serum electrolytes, and preoperative anxiety scores. METHODS A total of 145 ASA I and II children aged 2-5 years, undergoing ocular examination under anesthesia, were recruited by recording the modified Yale Preoperative Anxiety Score after acquiring the Institute Ethics Committee approval and written informed parental consent. Induction and maintenance were done with O2, N2O, and Sevoflurane. The emergence delirium was assessed using the PAED score in the postoperative period. The frontal cortex fNIRS recordings were taken throughout anesthesia. RESULTS A total of 59 children (40.7%) had emergence delirium. The ED+ group had a significant activation left superior frontal cortex (t = 2.26E+00; p = .02) and right middle frontal cortex (t = 2.27E+00; p = .02) during induction, significant depression in the left middle frontal (t = -2.22E+00; p = .02), left superior frontal and bilateral medial (t = -3.01E+00; p = .003), right superior frontal and bilateral medial (t = -2.44E+00; p = .015), bilateral medial and superior (t = -3.03E+00; p = .003), and right middle frontal cortex (t = -2.90E+00; p = .004) during the combined phase of maintenance, and significant activation in cortical activity in the left superior frontal cortex (t = 2.01E+00; p = .0047) during the emergence in comparison with the ED- group. CONCLUSION There is significant difference in the change in oxyhemoglobin concentration during induction, maintenance, and emergence in specific frontal brain regions between children with and without emergence delirium.
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Affiliation(s)
- Nirmal Shanmugam
- Department of Anaesthesiology, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Rohit Verma
- Department of Psychiatry, AIIMS, New Delhi, India
| | - Soumya Sarkar
- Department of Anaesthesiology, AIIMS, Kalyani, India
| | - Puneet Khanna
- Department of Anaesthesiology, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Renu Sinha
- Department of Anaesthesiology, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Lokesh Kashyap
- Department of Anaesthesiology, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Dilip R Shende
- Department of Anaesthesiology, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Bikash Ranjan Ray
- Department of Anaesthesiology, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Rahul Kumar Anand
- Department of Anaesthesiology, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Akhil Kant Singh
- Department of Anaesthesiology, Pain Medicine & Critical Care, AIIMS, New Delhi, India
| | - Niewete Lomi
- Department of Ophthalmology, AIIMS, New Delhi, India
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Effect of Early Versus Delayed Parenteral Nutrition on the Health Outcomes of Critically Ill Adults: A Systematic Review. J Crit Care Med (Targu Mures) 2021; 7:160-169. [PMID: 34722919 PMCID: PMC8519384 DOI: 10.2478/jccm-2021-0011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 03/11/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives This systematic review aims to evaluate and summarise the findings of all relevant studies which identified the effect of early vs delayed parenteral nutrition (PN), early PN vs early supplemental PN and early PN vs standard care for critically ill adults. Methods The literature search was undertaken using PubMed, Embase, Medline, Clinical Key, and Ovid discovery databases. The reference lists of studies published from 2000 till June 2020 were hand searched. Result On screening 2088 articles, a total of five RCTs with 6,277 patients were included in this review. Only one clinical trial compared early PN and late PN; the results reported significantly shorter periods in intensive care unit (ICU) stay (p=0.02) and less ICU related infections (p=0.008) in the late PN group compared to the Early PN group. Two trials compared total parenteral nutrition (TPN) and enteral nutrition (EN) +TPN groups. Both found a significantly longer hospital stay duration (p<0.05 and p<0.01) with a higher mortality rate in the TPN group compared to the EN+TPN group. A statistically significant improvement was observed in patients' quality of life receiving early PN compared to standard care (p=0.01). In contrast, no significant difference was found in the supplemental PN vs the standard care group. Conclusion The supplemental PN patients had shorter ICU stay and lower mortality rates than TPN. However, these findings should be interpreted carefully as included studies have different initiation timing of nutritional support, and the patients' diagnosis varied.
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Panditrao A, Shafiq N, Kumar-M P, Sekhon AK, Biswal M, Singh G, Kaur K, Ray P, Malhotra S, Gautam V, Gupta R, Gupta V, Yadav TD, Laroiya I, Kumar H, Salvania A. Impact of an antimicrobial stewardship and monitoring of infection control bundle in a surgical intensive care unit of a tertiary-care hospital in India. J Glob Antimicrob Resist 2021; 24:260-265. [PMID: 33476838 DOI: 10.1016/j.jgar.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Antimicrobial stewardship (AMS) in resource-limited settings lacks models that can be readily adapted to their settings. Here we discuss the impact of a combined strategy of AMS and monitoring of infection control practices in a tertiary-care centre of a developing country. METHODS This study was undertaken in the surgical unit of a tertiary-care hospital over an 8-month period. In the first 2 months (baseline phase), prospective audit and feedback alone was undertaken, while in the next 6 months (intervention phase) this was supplemented with strategies such as antimicrobial timeout, correction of doses and bundle approach for prevention of hospital-acquired infections. RESULTS A total of 337 patients were included (94 in the baseline phase and 243 in the intervention phase). There was a decrease in days of therapy per 1000 patient-days (1000PD) (1112.3 days vs. 1048.6 days), length of therapy per 1000PD (956 days vs. 936.3 days) and defined daily doses (DDD) per 1000PD for most antimicrobials. A decrease in double cover for Gram-negative infections (9.6% vs. 2.9%) but an increase in double anaerobic cover (4.2% vs. 7.4%) was observed. There was a decrease in the incidence of ventilator-associated pneumonia per 1000 ventilator-days in the intervention phase (46.4 vs. 35.4), whereas central line-associated bloodstream infections per 1000 central line-days remained the same (14.7 vs. 14.8). CONCLUSION This study shows that implementation of routine AMS activities with monitoring of infection control practices can help decrease overall antimicrobial use. With furtherance of measures to control infection, antimicrobial use may be further curtailed.
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Affiliation(s)
- Aditi Panditrao
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Amritpal Kaur Sekhon
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Gurpreet Singh
- Department of General Surgery, PGIMER, Chandigarh, India
| | | | - Pallab Ray
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Vikas Gautam
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Rajesh Gupta
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Vikas Gupta
- Department of General Surgery, PGIMER, Chandigarh, India
| | - T D Yadav
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Ishita Laroiya
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Hemanth Kumar
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Ajay Salvania
- Department of General Surgery, PGIMER, Chandigarh, India
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Parenteral Nutrition Administration by Critical Care Nurses in Iran: A Performance Evaluation. JOURNAL OF INFUSION NURSING 2019; 42:197-202. [PMID: 31283662 DOI: 10.1097/nan.0000000000000327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In Iran, nurses are responsible for administering parenteral nutrition (PN) to hospitalized patients in intensive care units (ICUs). However, little information is available among nurses in Iran regarding best practices in PN administration. This study evaluates the performance of critical care nurses in Iran in the administration of PN. The performance of 50 nurses in the administration of PN in the ICU was observed 3 times during a 5-month period for a total of 150 observations. A researcher-developed checklist, "Critical Care Nurses' Performance in Parenteral Nutrition Administration," was used for data collection. The total score in this checklist ranged from 0 to 52. Based on the procedural steps in the checklist and whether the steps were performed appropriately, nurses' performance was scored as poor, moderate, or good. The mean score of nurses' performances in PN administration skills was 24.6 ± 2.5. This study found that 46 nurses had moderate skill levels in PN administration, and 3 demonstrated poor skills. Overall, the results indicated that critical care nurses in Iran have poor to moderate PN administration skills.
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Chowdhury R, Lobaz S. Nutrition in critical care. BJA Educ 2019; 19:90-95. [PMID: 33456876 PMCID: PMC7808007 DOI: 10.1016/j.bjae.2018.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- R. Chowdhury
- Sheffield Teaching Hospitals, Sheffield, UK
- University of Sheffield, Sheffield, UK
| | - S. Lobaz
- University of Sheffield, Sheffield, UK
- Barnsley NHS Foundation Trust, Barnsley, UK
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Mutrie L, Hill B. Providing nutritional support for patients in critical care. Nurs Stand 2018; 33:77-82. [PMID: 29781257 DOI: 10.7748/ns.2018.e10804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2017] [Indexed: 11/09/2022]
Abstract
The provision of nutritional support for patients who are critically ill is complex and multifaceted, in part because of the variety and complexity of potential clinical presentations. This article explores the importance of providing nutritional support for patients who are critically ill and explains the pathophysiology of nutrition in altered health states. It discusses nutritional screening and assessment, the various routes of nutrition administration and the nursing considerations involved in providing nutritional support in critical care.
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Affiliation(s)
- Lorraine Mutrie
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, England
| | - Barry Hill
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, England
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Ratcliffe A, Baker A, Smith D. Successful management of 70% acetic acid ingestion on the intensive care unit: A case report. J Intensive Care Soc 2017; 19:56-60. [PMID: 29456603 DOI: 10.1177/1751143717711062] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Acetic acid is an organic acid available in concentrations from 2 to 80%. Whilst lower concentrations of 2-6% are more commonly used as the table top condiment, vinegar, much stronger solutions are regularly used in Eastern Europe as food preservatives and cleaning solutions. Oral ingestion of greater than 12% has been reported to cause haemolysis, renal failure, shock and death. Most reported cases of deliberate or accidental poisoning are from Russia and Eastern Europe in the 1980s, with very little currently in western publications. We present the case of a female patient who attempted suicide by drinking 250 ml of 70% acetic acid. Her widespread gastrointestinal injuries were managed conservatively, and despite suffering extensive upper airway and renal complications, she was successfully decannulated and discharged home after a prolonged intensive care and hospital stay.
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Affiliation(s)
| | - Andrew Baker
- Bradford Teaching Hospitals Foundation Trust, Bradford, UK
| | - Daniel Smith
- Bradford Teaching Hospitals Foundation Trust, Bradford, UK
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