A 3 year old female child presented with three episodes of left sided pneumothorax in last four months. Patient has minimal respiratory distress in each admission with low grade fever in first two admissions. Intercostal drain was put in first two episodes and VATS with thoracoscopic lung biopsy was done in third episode from left upper lobe with no further episodes of pneumothorax. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.3013 Sri Lanka Journal of Critical Care Vol.2(1) 2011 29-32
{"title":"Recurrent spontaneous pneumothorax in a child","authors":"Pradnya S. Bendre, R. Nagargoje, M. Thakur","doi":"10.4038/SLJCC.V2I1.3013","DOIUrl":"https://doi.org/10.4038/SLJCC.V2I1.3013","url":null,"abstract":"A 3 year old female child presented with three episodes of left sided pneumothorax in last four months. Patient has minimal respiratory distress in each admission with low grade fever in first two admissions. Intercostal drain was put in first two episodes and VATS with thoracoscopic lung biopsy was done in third episode from left upper lobe with no further episodes of pneumothorax. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.3013 Sri Lanka Journal of Critical Care Vol.2(1) 2011 29-32","PeriodicalId":184615,"journal":{"name":"Sri Lanka Journal of Critical Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122387672","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Agarwal, L. Mishra, R. Agarwal, Ghanshyam S. Yadav
Background: Sepsis is one of the main causes of morbidity and mortality in the intensive care unit.[1] C Reactive Protein (CRP), is an acute-phase reactant, which increases markedly within hours after tissue injury.[4] Changes in plasma CRP levels can be useful in the diagnosis and followup.[5] Objective: To investigate the relation between CRP level and APACHE II score over the duration of illness in critically ill. Material & Methods: A prospective, randomized study was conducted, including 200 patients, aged 25-65 years, of either sex, fulfilling the systemic inflammatory response (SIRS)/sepsis criteria based on ACCP/SCCM definitions.[5] Patients were divided into two groups (I & II) based upon their outcome. Group I included patients who expired in the I.C.U and Group II patients were those who improved and were shifted from the ICU to their respective wards. At the time of admission and each day thereafter APACHE II scores and CRP levels were carried out till the patients were either shifted from the ICU to wards or expired. Collected data was divided into two groups. Serum CRP levels were measured using an immunochemistry analyzer. Results: Observations showed that the mean CRP values declined beyond day 4 in group II while, the values kept on increasing in group I (table 2, figure 1). The difference between the groups was significant (p Conclusion: The degree of sepsis and organ dysfunction cannot be identified by a single marker; rather a combination of parameters is more useful. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.1057 Sri Lanka Journal of Critical Care Vol.2(1) 2011 25-28
{"title":"Outcome correlation of change in CRP levels and APACHE II in critically sick patients","authors":"A. Agarwal, L. Mishra, R. Agarwal, Ghanshyam S. Yadav","doi":"10.4038/SLJCC.V2I1.1057","DOIUrl":"https://doi.org/10.4038/SLJCC.V2I1.1057","url":null,"abstract":"Background: Sepsis is one of the main causes of morbidity and mortality in the intensive care unit.[1] C Reactive Protein (CRP), is an acute-phase reactant, which increases markedly within hours after tissue injury.[4] Changes in plasma CRP levels can be useful in the diagnosis and followup.[5] Objective: To investigate the relation between CRP level and APACHE II score over the duration of illness in critically ill. Material & Methods: A prospective, randomized study was conducted, including 200 patients, aged 25-65 years, of either sex, fulfilling the systemic inflammatory response (SIRS)/sepsis criteria based on ACCP/SCCM definitions.[5] Patients were divided into two groups (I & II) based upon their outcome. Group I included patients who expired in the I.C.U and Group II patients were those who improved and were shifted from the ICU to their respective wards. At the time of admission and each day thereafter APACHE II scores and CRP levels were carried out till the patients were either shifted from the ICU to wards or expired. Collected data was divided into two groups. Serum CRP levels were measured using an immunochemistry analyzer. Results: Observations showed that the mean CRP values declined beyond day 4 in group II while, the values kept on increasing in group I (table 2, figure 1). The difference between the groups was significant (p Conclusion: The degree of sepsis and organ dysfunction cannot be identified by a single marker; rather a combination of parameters is more useful. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.1057 Sri Lanka Journal of Critical Care Vol.2(1) 2011 25-28","PeriodicalId":184615,"journal":{"name":"Sri Lanka Journal of Critical Care","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126973147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carbapenem induced convulsions are said to be commoner amongst critically ill patients. During a 1½ year study period we observed 4 of 15 patients receiving meropenem and 3 of 7 patients receiving imipenenm develop convulsions in an intensive care unit. The withdrawal of the offending drug rapidly resolved the problem in all but one. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.2265 Sri Lanka Journal of Critical Care Vol.2(1) 2011 13-15
{"title":"Carbapenem induced convulsions in the critically ill – A case series.","authors":"C. Goonasekera, G. Manchanayake","doi":"10.4038/SLJCC.V2I1.2265","DOIUrl":"https://doi.org/10.4038/SLJCC.V2I1.2265","url":null,"abstract":"Carbapenem induced convulsions are said to be commoner amongst critically ill patients. During a 1½ year study period we observed 4 of 15 patients receiving meropenem and 3 of 7 patients receiving imipenenm develop convulsions in an intensive care unit. The withdrawal of the offending drug rapidly resolved the problem in all but one. DOI: http://dx.doi.org/10.4038/sljcc.v2i1.2265 Sri Lanka Journal of Critical Care Vol.2(1) 2011 13-15","PeriodicalId":184615,"journal":{"name":"Sri Lanka Journal of Critical Care","volume":"120 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2011-12-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124794164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Goonasekera, S. P. Mudalige, A. N. W. Karunarathna, I. L. Wickramanayaka
{"title":"Pediatric workload in a multi-disciplinary tertiary care intensive care unit in Sri Lanka","authors":"C. Goonasekera, S. P. Mudalige, A. N. W. Karunarathna, I. L. Wickramanayaka","doi":"10.4038/SLJCC.V1I1.946","DOIUrl":"https://doi.org/10.4038/SLJCC.V1I1.946","url":null,"abstract":"","PeriodicalId":184615,"journal":{"name":"Sri Lanka Journal of Critical Care","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114636567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Editorial for the Inaugural Issue","authors":"S. Rajapakse","doi":"10.4038/SLJCC.V1I1.936","DOIUrl":"https://doi.org/10.4038/SLJCC.V1I1.936","url":null,"abstract":"","PeriodicalId":184615,"journal":{"name":"Sri Lanka Journal of Critical Care","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128721553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Gunawardane, R. Koggalage, R. Rodrigo, S. Rajapakse
12.00 Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} The safety of critically ill patients in intensive care units is an important aspect of medical care. Many human factors contribute to deficiencies and errors in patient care in the intensive care setting, such as long working hours, high levels of stress, lack of enough people, may cause human errors and affecting the effectiveness of the decisions of the physician. Several attempts have been made to increase the effectiveness of such decisions by issuing early alerts on adverse patient conditions. However, such alerts are based on single parameter variations, and not on the relationship between multiple parameter variations. We developed a computer-based model is an integrated solution which identifies adverse patient events based on multiple parameter variations, and then provides predictive treatment suggestions based on the likely clinical conditions which result in the parameter variations. The proposed system follows an interactive communication cycle in order to properly notify the responsible treating physicians at different tiers of responsibility. Our model is capable of early identification of adverse conditions and providing suitable treatment suggestions, thus acting as a decision support system to assist the treating physician. DOI: 10.4038/sljcc.v1i1.942
{"title":"A Computer-Based ICU Patient Alert And Decision Support System","authors":"S. Gunawardane, R. Koggalage, R. Rodrigo, S. Rajapakse","doi":"10.4038/SLJCC.V1I1.942","DOIUrl":"https://doi.org/10.4038/SLJCC.V1I1.942","url":null,"abstract":"12.00 Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ \u0000 table.MsoNormalTable \u0000 {mso-style-name:\"Table Normal\"; \u0000 mso-tstyle-rowband-size:0; \u0000 mso-tstyle-colband-size:0; \u0000 mso-style-noshow:yes; \u0000 mso-style-priority:99; \u0000 mso-style-qformat:yes; \u0000 mso-style-parent:\"\"; \u0000 mso-padding-alt:0in 5.4pt 0in 5.4pt; \u0000 mso-para-margin:0in; \u0000 mso-para-margin-bottom:.0001pt; \u0000 mso-pagination:widow-orphan; \u0000 font-size:11.0pt; \u0000 font-family:\"Calibri\",\"sans-serif\"; \u0000 mso-ascii-font-family:Calibri; \u0000 mso-ascii-theme-font:minor-latin; \u0000 mso-fareast-font-family:\"Times New Roman\"; \u0000 mso-fareast-theme-font:minor-fareast; \u0000 mso-hansi-font-family:Calibri; \u0000 mso-hansi-theme-font:minor-latin; \u0000 mso-bidi-font-family:\"Times New Roman\"; \u0000 mso-bidi-theme-font:minor-bidi;} \u0000 The safety of critically ill patients in intensive care units is an important aspect of medical care. Many human factors contribute to deficiencies and errors in patient care in the intensive care setting, such as long working hours, high levels of stress, lack of enough people, may cause human errors and affecting the effectiveness of the decisions of the physician. Several attempts have been made to increase the effectiveness of such decisions by issuing early alerts on adverse patient conditions. However, such alerts are based on single parameter variations, and not on the relationship between multiple parameter variations. We developed a computer-based model is an integrated solution which identifies adverse patient events based on multiple parameter variations, and then provides predictive treatment suggestions based on the likely clinical conditions which result in the parameter variations. The proposed system follows an interactive communication cycle in order to properly notify the responsible treating physicians at different tiers of responsibility. Our model is capable of early identification of adverse conditions and providing suitable treatment suggestions, thus acting as a decision support system to assist the treating physician. DOI: 10.4038/sljcc.v1i1.942","PeriodicalId":184615,"journal":{"name":"Sri Lanka Journal of Critical Care","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132468838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preface: Message from the Director, PGIM","authors":"R. Sheriff","doi":"10.4038/SLJCC.V1I1.935","DOIUrl":"https://doi.org/10.4038/SLJCC.V1I1.935","url":null,"abstract":"","PeriodicalId":184615,"journal":{"name":"Sri Lanka Journal of Critical Care","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123129067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
12.00 Normal 0 false false false EN-US X-NONE X-NONE 12.00 Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Acute kidney injury (AKI) occurs in a significant proportion of patients with severe sepsis, and is an important cause of mortality in such patients. Current concepts of pathogenesis of AKI are shifting from vasoconstriction-ischaemia induced injury to toxic and immune mediated injury and hyperaemic injury resulting in apoptosis of renal cells. Renal replacement therapy is the mainstay of management of AKI. Adequacy of dialysis is likely to be linked to better outcome, but there is still no clear consensus on the timing, modality, intensity or frequency of dialysis. Haemodynamically unstable patients usually require modes of continuous renal replacement therapy. Biocompatible dialyser membranes are likely to be safer than older cellulose membranes. Bicarbonate is preferred to acetate and lactate as dialysate buffer. Anticoagulation has to be undertaken with care to prevent excessive haemorrhage in the setting of already deranged haemostasis. Adequate volume resuscitation and maintenance of renal perfusion by the use of vasopressors is beneficial; norepinephrine is the vasopressor of choice. There is no place for the use of low- or renal-dose dopamine, mannitol or frusemide in the setting of sepsis-induced AKI, and in fact they may be detrimental. Prevention of kidney damage by nephrotoxic drugs and radio-contrast media is of vital importance. Careful dose management of nephrotoxic drugs will prevent renal injury. Hydrati
{"title":"Management of Sepsis-Induced Acute Kidney Injury","authors":"S. Rajapakse, C. Rodrigo, Eranga S. Wijewickrema","doi":"10.4038/SLJCC.V1I1.937","DOIUrl":"https://doi.org/10.4038/SLJCC.V1I1.937","url":null,"abstract":"12.00 Normal 0 false false false EN-US X-NONE X-NONE 12.00 Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ \u0000 table.MsoNormalTable \u0000 {mso-style-name:\"Table Normal\"; \u0000 mso-tstyle-rowband-size:0; \u0000 mso-tstyle-colband-size:0; \u0000 mso-style-noshow:yes; \u0000 mso-style-priority:99; \u0000 mso-style-qformat:yes; \u0000 mso-style-parent:\"\"; \u0000 mso-padding-alt:0in 5.4pt 0in 5.4pt; \u0000 mso-para-margin:0in; \u0000 mso-para-margin-bottom:.0001pt; \u0000 mso-pagination:widow-orphan; \u0000 font-size:11.0pt; \u0000 font-family:\"Calibri\",\"sans-serif\"; \u0000 mso-ascii-font-family:Calibri; \u0000 mso-ascii-theme-font:minor-latin; \u0000 mso-fareast-font-family:\"Times New Roman\"; \u0000 mso-fareast-theme-font:minor-fareast; \u0000 mso-hansi-font-family:Calibri; \u0000 mso-hansi-theme-font:minor-latin; \u0000 mso-bidi-font-family:\"Times New Roman\"; \u0000 mso-bidi-theme-font:minor-bidi;} \u0000 /* Style Definitions */ \u0000 table.MsoNormalTable \u0000 {mso-style-name:\"Table Normal\"; \u0000 mso-tstyle-rowband-size:0; \u0000 mso-tstyle-colband-size:0; \u0000 mso-style-noshow:yes; \u0000 mso-style-priority:99; \u0000 mso-style-qformat:yes; \u0000 mso-style-parent:\"\"; \u0000 mso-padding-alt:0in 5.4pt 0in 5.4pt; \u0000 mso-para-margin:0in; \u0000 mso-para-margin-bottom:.0001pt; \u0000 mso-pagination:widow-orphan; \u0000 font-size:11.0pt; \u0000 font-family:\"Calibri\",\"sans-serif\"; \u0000 mso-ascii-font-family:Calibri; \u0000 mso-ascii-theme-font:minor-latin; \u0000 mso-fareast-font-family:\"Times New Roman\"; \u0000 mso-fareast-theme-font:minor-fareast; \u0000 mso-hansi-font-family:Calibri; \u0000 mso-hansi-theme-font:minor-latin; \u0000 mso-bidi-font-family:\"Times New Roman\"; \u0000 mso-bidi-theme-font:minor-bidi;} \u0000 Acute kidney injury (AKI) occurs in a significant proportion of patients with severe sepsis, and is an important cause of mortality in such patients. Current concepts of pathogenesis of AKI are shifting from vasoconstriction-ischaemia induced injury to toxic and immune mediated injury and hyperaemic injury resulting in apoptosis of renal cells. Renal replacement therapy is the mainstay of management of AKI. Adequacy of dialysis is likely to be linked to better outcome, but there is still no clear consensus on the timing, modality, intensity or frequency of dialysis. Haemodynamically unstable patients usually require modes of continuous renal replacement therapy. Biocompatible dialyser membranes are likely to be safer than older cellulose membranes. Bicarbonate is preferred to acetate and lactate as dialysate buffer. Anticoagulation has to be undertaken with care to prevent excessive haemorrhage in the setting of already deranged haemostasis. Adequate volume resuscitation and maintenance of renal perfusion by the use of vasopressors is beneficial; norepinephrine is the vasopressor of choice. There is no place for the use of low- or renal-dose dopamine, mannitol or frusemide in the setting of sepsis-induced AKI, and in fact they may be detrimental. Prevention of kidney damage by nephrotoxic drugs and radio-contrast media is of vital importance. Careful dose management of nephrotoxic drugs will prevent renal injury. Hydrati","PeriodicalId":184615,"journal":{"name":"Sri Lanka Journal of Critical Care","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125968120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Haniffa, H. Ariyaratne, S. D. Fernando, S. Rajapakse
12.00 Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} Introduction: We studied the choice of antibiotic/s prescribed on admission and microbiological investigations, in patients hospitalised with community-acquired pneumonia, and compared such choice with published consensus guidelines. Methods: Adult patients admitted to medical wards of the National Hospital of Sri Lanka with clinical features of pneumonia, with subsequent radiological confirmation, were eligible for inclusion (n=112). Patients who had been in hospital within 10 days of admission, and those with diagnoses of lung malignancy, lung fibrosis, bronchiectasis or tuberculosis were excluded. We obtained data from the patients' case records regarding indicators of severity, the antibiotic prescribed on admission, and route of administration. The microbiological investigations performed were also recorded. We compared the practices with guidelines for management of community-acquired pneumonia published by the British Thoracic Society in 2001. Results: The respiratory rate, a core clinical adverse prognostic feature, was documented in only 13% of case records. Oral amoxicillin was the most common antibiotic prescribed on admission, with 29% of hospitalized patients receiving it. Erythromycin was included in the drug regimen in only 18% of all patients. Intravenous antibiotics were started for 44% of cases without any documented adverse prognostic features on admission. Sputum was sent for acid-fast bacilli staining in 48% of patients and for bacterial culture in 11%. Blood culture was performed in 5% of patients. Conclusion: Documentation of severity criteria is often incomplete. There is inadequate utilization of oral macrolide antibiotics to cover atypical pathogens. Intravenous antibiotics are overused in hospitalized patients with community-acquired pneumonia. DOI: 10.4038/sljcc.v1i1.941
{"title":"Initial Management Of Patients With Community-Acquired Pneumonia In A Tertiary Hospital In Sri Lanka","authors":"R. Haniffa, H. Ariyaratne, S. D. Fernando, S. Rajapakse","doi":"10.4038/SLJCC.V1I1.941","DOIUrl":"https://doi.org/10.4038/SLJCC.V1I1.941","url":null,"abstract":"12.00 Normal 0 false false false EN-US X-NONE X-NONE /* Style Definitions */ \u0000 table.MsoNormalTable \u0000 {mso-style-name:\"Table Normal\"; \u0000 mso-tstyle-rowband-size:0; \u0000 mso-tstyle-colband-size:0; \u0000 mso-style-noshow:yes; \u0000 mso-style-priority:99; \u0000 mso-style-qformat:yes; \u0000 mso-style-parent:\"\"; \u0000 mso-padding-alt:0in 5.4pt 0in 5.4pt; \u0000 mso-para-margin:0in; \u0000 mso-para-margin-bottom:.0001pt; \u0000 mso-pagination:widow-orphan; \u0000 font-size:11.0pt; \u0000 font-family:\"Calibri\",\"sans-serif\"; \u0000 mso-ascii-font-family:Calibri; \u0000 mso-ascii-theme-font:minor-latin; \u0000 mso-fareast-font-family:\"Times New Roman\"; \u0000 mso-fareast-theme-font:minor-fareast; \u0000 mso-hansi-font-family:Calibri; \u0000 mso-hansi-theme-font:minor-latin; \u0000 mso-bidi-font-family:\"Times New Roman\"; \u0000 mso-bidi-theme-font:minor-bidi;} \u0000 Introduction: We studied the choice of antibiotic/s prescribed on admission and microbiological investigations, in patients hospitalised with community-acquired pneumonia, and compared such choice with published consensus guidelines. Methods: Adult patients admitted to medical wards of the National Hospital of Sri Lanka with clinical features of pneumonia, with subsequent radiological confirmation, were eligible for inclusion (n=112). Patients who had been in hospital within 10 days of admission, and those with diagnoses of lung malignancy, lung fibrosis, bronchiectasis or tuberculosis were excluded. We obtained data from the patients' case records regarding indicators of severity, the antibiotic prescribed on admission, and route of administration. The microbiological investigations performed were also recorded. We compared the practices with guidelines for management of community-acquired pneumonia published by the British Thoracic Society in 2001. Results: The respiratory rate, a core clinical adverse prognostic feature, was documented in only 13% of case records. Oral amoxicillin was the most common antibiotic prescribed on admission, with 29% of hospitalized patients receiving it. Erythromycin was included in the drug regimen in only 18% of all patients. Intravenous antibiotics were started for 44% of cases without any documented adverse prognostic features on admission. Sputum was sent for acid-fast bacilli staining in 48% of patients and for bacterial culture in 11%. Blood culture was performed in 5% of patients. Conclusion: Documentation of severity criteria is often incomplete. There is inadequate utilization of oral macrolide antibiotics to cover atypical pathogens. Intravenous antibiotics are overused in hospitalized patients with community-acquired pneumonia. DOI: 10.4038/sljcc.v1i1.941","PeriodicalId":184615,"journal":{"name":"Sri Lanka Journal of Critical Care","volume":"81 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2009-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115222489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：