Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine
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Indian J Crit Care Med · Dec 2017
Predictive Value of Serum Myoglobin and Creatine Phosphokinase for Development of Acute Kidney Injury in Traumatic Rhabdomyolysis.
Rhabdomyolysis (RM) is a condition where there is injury to striated muscle fibers causing release of myoglobin, creatine phosphokinase (CPK), and other intracellular contents into the circulation. High myoglobin levels cause acute kidney injury (AKI). Trauma is the most common cause of RM and development of complications related to the degree of myoglobin released. Currently, the degree of RM is assessed and treatment is instituted based on serum CPK. As myoglobin is the direct cause of AKI, we set out to determine if serum myoglobin is a more reliable predictor than CPK for the development of AKI in traumatic RM. ⋯ Following traumatic RM, in patients on "crush protocol," serum myoglobin is a more sensitive and specific test than serum CPK, for predicting AKI.
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Indian J Crit Care Med · Oct 2017
Dyspnea, Eosinopenia, Consolidation, Acidemia and Atrial Fibrillation Score and BAP-65 Score, Tools for Prediction of Mortality in Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Comparative Pilot Study.
Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) being common and often fatal, prognostic tools in AECOPD are lacking. ⋯ Both DECAF and BAP-65 scores were found to be good predictors of mortality and need for ventilation in this pilot study.
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Indian J Crit Care Med · Sep 2017
Pain Measurement in Mechanically Ventilated Patients with Traumatic Brain Injury: Behavioral Pain Tools Versus Analgesia Nociception Index.
Pain is highly prevalent in critically ill trauma patients, especially those with a traumatic brain injury (TBI). Behavioral pain tools such as the behavioral pain scale (BPS) and critical-care pain observation tool are recommended for sedated noncommunicative patients. Analysis of heart rate variability (HRV) is a noninvasive method to evaluate autonomic nervous system activity. The analgesia nociception index (ANI) device (Physiodoloris®, MDoloris Medical Systems, Loos, France) allows noninvasive HRV analysis. The ANI assesses the relative parasympathetic tone as a surrogate for antinociception/nociception balance in sedated patients. The primary aim of our study was to evaluate the effectiveness of ANI in detecting pain in TBI patients. The secondary aim was to evaluate the impact of norepinephrine use on ANI effectiveness and to determine the correlation between ANI and BPS. ⋯ Our results suggest that ANI is effective in detecting pain in ventilated sedated TBI patients, including those patients treated with norepinephrine.
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Indian J Crit Care Med · Sep 2017
Case ReportsDual Oxygen Therapy in Patient on Bilevel Positive Airway Pressure Prevented Invasive Mechanical Ventilation.
During noninvasive bilevel positive airway pressure (BiPAP) ventilation it is found that several times patients are unable to maintain oxygen saturation and develop breathing difficulty despite its high setting and high oxygen flow, further management requires invasive positive pressure mechanical ventilation. Increasing oxygen concentration inside the BiPAP mask using nasal cannula with addition of another flow meter not only increase oxygen saturation but also make the patient more comfortable and prevent intubation and its complications. ⋯ High-flow nasal cannula oxygen therapy has many advantages over traditional oxygen delivery systems. Here, we are going to report two cases of patients on BiPAP in which invasive positive pressure ventilation was prevented using dual oxygen therapy using nasal cannula with flow meter and BiPAP mask with addition another flow meter in a single sitting.
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Ventilator-induced lung injury (VILI) results from mechanical disruption of blood-gas barrier and consequent edema and releases of inflammatory mediators. A transpulmonary pressure (PL) of 17 cmH2O increases baby lung volume to its anatomical limit, predisposing to VILI. Viscoelastic property of lung makes pulmonary mechanics time dependent so that stress (PL) increases with respiratory rate. ⋯ Limitation of stress (PL) rather than strain (tidal volume [VT]) is the safe strategy of mechanical ventilation to prevent VILI. Driving pressure is the noninvasive surrogate of lung strain, but its relations to PL is dependent on the chest wall compliance. Determinants of lung stress (VT, driving pressure, positive end-expiratory pressure, and inspiratory flow) can be quantified in terms of mechanical power, and a safe threshold can be determined, which can be used in decision-making between safe mechanical ventilation and extracorporeal lung support.