Indian Journal of Critical Care Medicine最新文献

Aims and background: Competency-based medical education has been widely accepted across the globe and it has been adopted in the undergraduate curriculum in India from 2019. One introduction to this curriculum is the Electives postings. Electives are chosen by the students. The objectives of this project were to document the implementation of electives in emergency medicine for the medical undergraduates and to assess its effectiveness in terms of improving the knowledge and changing in perceptions of students.

Materials and methods: The Analysis, Design, Development, Implementation, and Evaluation (ADDIE) instructional design approach was followed to prepare this electives module. The cross-sectional study was conducted on eight students who chose the emergency medicine elective for two consecutive years. The students were engaged in teaching learning activities and assessments for a duration of 15 days. They completed a pre- and post-course survey forms, pre- and post-tests and were given feedback on daily activities conducted.

Results: All students gave positive response in terms of course conduct, satisfaction, gain in knowledge, and core skills of emergency medicine procedures. There was significant difference in student perception regarding the role of an emergency physician, triaging patients, taking history, examination, and management of life-threatening emergencies following the posting. All students showed noteworthy improvement in post-test scores compared with pre-course test.

Conclusion: A structured 2-week elective posting in emergency medicine has a positive impression on student's perception regarding the specialty and has a remarkable advancement in knowledge and core skills of emergency medicine competencies.

How to cite this article: Sampangiramaiah S, Shettian AD, Bhat NM, Tekkunje NG, Martis M, Shetty K, et al. Implementation of Electives in Emergency Medicine for Medical Undergraduates and Evaluation of Its Effectiveness. Indian J Crit Care Med 2024;28(12):1112-1117.

How to cite this article: Bhosale SJ, Joshi M, Dhakane P, Ojha S, Kulkarni AP. Challenges in the Management of Hemorrhagic Shock in Patients with Bombay Blood Group in the ICU: What the H? Indian J Crit Care Med 2024;28(12):1185-1186.

Introduction: Transferring patients between hospitals is an important aspect and is often the weak link in the health system. Robust real-time communication before transfer may be a valuable tool to improve the emergency care of children. Our study was aimed at developing evidence for the effectiveness of efficient communication networks between a tertiary care hospital and the referring hospitals in improving patient outcomes.

Materials and methods: We carried out a prospective observational study conducted in two phases. After the collection of baseline data in phase I, a communication network was established between our hospital and referring hospitals as the part of intervention. The effectiveness of the intervention was ascertained in the second phase.

Results: A total of 3,460 pediatric patients sought care from the emergency department of our hospital during the study period, 1,658 during phase I and 1,802 in phase II. Of the total patients admitted in pediatric emergency, 1,436 (86.61%) survived in the pre-establishment phase (phase I), and 1,762 (97.62%) survived in the post-intervention phase (phase II). The duration of stay during phase II was lower than in phase I, the difference being statistically significant. Propensity score matching analysis and interrupted time series analysis using a control chart also suggested improved survival of children during phase II after the intervention.

Conclusions: Our study showed that the establishment of a communication network improved the outcome of children attending our pediatric emergency. Further research is needed to assess if the usefulness of the intervention was not due to secular trends or the difference in patient profiles between the two phases.

How to cite this article: Antony J, Parameswaran N, Ramanathan, Kathavarayan R, Pothapregada S, Kumar S. Improving the Outcome of Sick Children Referred from District Hospitals in and around Puducherry by Establishing a Communication Network: A Community-based Quality Improvement Initiative. Indian J Crit Care Med 2024;28(12):1153-1158.

Objectives: Heart rate control using beta-blockers in sepsis has traditionally been avoided because of concerns with worsening cardiac index and organ perfusion. Recent studies has explored the possible beneficial effects of targeted heart rate control in patients with septic shock who have tachycardia despite initial resuscitation. We performed a systematic review and meta-analysis to explore the effects of heart rate control in septic shock patients.

Methods: A systematic review and meta-analysis was conducted searching for studies from PubMed, Cochrane Central, and Embase registers for randomized controlled trials (RCTs) that compared the mortality of patients with sepsis and septic shock treated with targeted rate control. The literature search was done to include studies from January 2013 to December 2023. Two independent researchers independently assessed the studies and included RCTS in which adult patients (>18 years of age) with septic shock were treated with targeted heart rate control vs placebo after initial resuscitation due to persistent tachycardia. The study data was extracted by two independent researchers. A random effects model was used to present the results. A trial sequential analysis (TSA) was performed for the primary outcome of 28-day mortality.

Results: A total of 9 studies with a pooled sample size of 807 participants were included in the analysis.Eight of the included studies with a pooled sample size of 766 reported 28-day mortality. Targeted heart rate control was associated with a trend toward lower 28-day mortality [risk ratio (RR): 0.78; 95% CI: 0.62-0.99; p = 0.04; I ² = 48%]. Trial sequential analysis showed the cumulative effect lying within the zone of uncertainty, with diversity-adjusted required information size of 1,756 and pooled effect size of the pooled RR 0.78 (alpha-spending adjusted 95% CI: 0.53-1.15). There was a statistically significant lower heart rate associated with rate control (MD: -16.66; 95% CI: -23.89 to -9.42; p-value < 0.001) but no difference in mean arterial pressure. cardiac index, lactate levels, norepinephrine (NE) requirements, and ICU length of stay (LOS) in between the groups.

Conclusion: Targeted heart rate control in patients with septic shock may be tolerated from a hemodynamic standpoint. However, the beneficial effect on mortality is less certain than was reported in the initial studies.

How to cite this article: Datta PK, Sathe P, Roy A, Baronia T, Bhattacharjee A, Kundu R. The Clinical Utility of Targeted Heart Rate Control in Septic Shock: A Systematic Review and Meta-analysis of Randomized Controlled Trials with Trial Sequential Analysis. Indian J Crit Care Med 2024;28(12):1170-1179.

How to cite this article: Kumar R, Singh AK. "Right Lower Lobe Lung Pathology": A Potential Mimic of Pneumoperitoneum. Indian J Crit Care Med 2024;28(12):1182-1183.

Background: This study aims to assess the knowledge of Palestinian critical care nurses regarding the prevention of ventilator-associated pneumonia (VAP), an acquired infection that affects critically ill patients on ventilators in hospitals. Nurses caring for these patients may not always be aware of the most effective methods to prevent VAP.

Materials and methods: A descriptive cross-sectional study was conducted in five government hospitals in Gaza Strip, Palestine over 3 months. A convenience sample technique (72) of critical care nurses was selected. Data were collected through a self-administered questionnaire divided into; demographic characteristics and knowledge about critical care nurses of preventive interventions for VAP. Statistical analysis was performed using SPSS version 25.

Results: More than half of the critical care nurses (67%) were male and the majority of critical care nurses (63%) were aged between 20 and 29 years. Furthermore, 32% of critical care nurses were from Alshifa Medical Complex. The overall mean knowledge among critical care nurses to prevent VAP was 72%, indicating correct answers to knowledge-related queries.

Conclusion: Our study indicated that the knowledge of critical care nurses about VAP prevention was inadequate. Age, marital status, and years of experience were significantly associated with a good level of knowledge about the prevention of VAP (p < 0.05). However, there was no significant association between knowledge about VAP prevention of VAP and gender, qualification level, and type of intensive care unit (ICU).

How to cite this article: El-Kass SM, Alruwili HA, Alrowily MA, Ellayan OM, El-Kass LM, Hijo EE, et al. Critical Care Nurses' Knowledge on Prevention of Ventilator-associated Pneumonia: A Cross-sectional Study. Indian J Crit Care Med 2024;28(12):1122-1129.

How to cite this article: Gudivada KK. Targeted Heart Rate Control in Sepsis: A Promising Path or a Double-edged Sword? Indian J Crit Care Med 2024;28(12):1093-1095.

How to cite this article: Finsterer J. Before Acute Liver Failure is Attributed to High Altitude, Other Causes Must be Ruled Out. Indian J Crit Care Med 2024;28(12):1180.

Background: The red cell distribution width (RDW) has been investigated as a predictive factor for complications and mortality in several critical illnesses, including cardiovascular diseases.

Objective: The current study aimed to assess the relationship of RDW with severity and in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI).

Materials and methods: A prospective hospital-based observational study was conducted at a tertiary care institute of Northern India. Fifty patients of STEMI who underwent coronary angiography/primary coronary intervention were enrolled as cases and equal number of age- and sex-matched individuals not suffering from any cardiac disease were taken as controls. The RDW admission values of the cases were compared with that of controls. Red cell distribution width values were also compared across the outcome groups among cases.

Results: The mean RDW-SD of the cases was 49.0 ± 4.6 fL whereas it was 44.7 ± 3.5 fL for controls, the difference being statistically significant (p < 0.001). Among the total patients, 4 (8.0%) expired during hospital stay and the rest 46 (92.0%) were discharged alive. The mean RDW-SD of expired patients was significantly higher than that of patients who remained alive (p = 0.002). There was a significant positive correlation between RDW and global registry of acute coronary events (GRACE) score (p = 0.02) and a significant negative correlation between RDW and left ventricular ejection fraction (LVEF) (p = 0.04). Area under the receiver operating characteristics (ROC) curve for RDW was higher than that of LVEF, showing superiority of RDW to LVEF in predicting mortality among the STEMI patients.

Conclusion: Red cell distribution width may serve as a promising prognostic biomarker and tool for risk stratification in patients with STEMI.

How to cite this article: Raval R, Gupta S, Gupta N, Bashar MA. Red Cell Distribution Width as a Marker of Disease Severity and In-hospital Mortality in Patients with ST-segment Elevation Myocardial Infarction. Indian J Crit Care Med 2024;28(12):1101-1106.

How to cite this article: Kulkarni AP, Khasne RW. Is SOLUTE the Solution to Which Solution (to Use)? Indian J Crit Care Med 2024;28(12):1096-1100.