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BACKGROUND: Tracheostomy is integral in long-term intensive care of coronavirus disease-2019 (COVID-19) patients. There is a paucity of studies on weaning outcomes and mortality after tracheostomy in COVID-19 in Indian scenario. MATERIALS AND METHODS: We conducted a retrospective, single-center, observational study of severe COVID-19 patients who underwent elective tracheostomy (n = 65) during critical care in a tertiary care institute in Central India from May 1, 2020, to April 30, 2021. Data were collected from Medical records, ICU charts, and follow-up visits by patient. A primary objective was to study the clinical characteristics, tracheostomy complications, weaning outcomes, and mortality at 28 and 60 days of ICU admission. We categorized the cohort into two groups (deceased and survivor) and studied association of clinical parameters with 28-day mortality. Cox Proportional regression analysis was applied to calculate the hazard ratio among the predictors of mortality with p value <0.05 as significant. RESULTS: Elective tracheostomy was done in 69 of 436 (15.8%) patients on invasive mechanical ventilation, of which 65 were included. Tracheostomy was percutaneous in 45/65 (69%) and surgical in 20/65 (31%) with timing from intubation as early in 41/65 and late in 24/65 with most common indication as weaning failure followed by anticipated prolonged ventilation. Tracheostomy complications were present in 29/65 (45%) patients with no difference in complication rates between timing and type of tracheostomy. Downsizing, decannulation, and weaning were successful in 22%, 32 (49%), and 35/65 (54%) patients after tracheostomy. The 28-day mortality was 30/65 (46%). The fractional inspired oxygen concentration (FiO2) requirement in survivors was lower (0.4-0.6, p = 0.015) with a higher PaO2/FiO2 ratio (118-200, p = 0.033). Early tracheostomy within 7 days of intubation was not associated with weaning or survival benefit. CONCLUSIONS: We suggest that tracheostomy should be delayed to after 7 days of intubation, especially till FiO2 reduces to 0.5 with improvement in PaO2/FiO2 for better outcomes and avoiding a wasted procedure (CTRI/2021/07/034768). STUDY HIGHLIGHTS: Tracheostomy is integral in care of COVID-19 patients needing prolonged ventilation. There is no difference in complications in early/late or percutaneous dilatational/surgical technique. We observed successful weaning post-tracheostomy in 54% patients. Mortality at 28 days was 46%. Early tracheostomy within 7 days of intubation did not improve weaning or survival. HOW TO CITE THIS ARTICLE: Karna ST, Trivedi S, Singh P, Khurana A, Gouroumourty R, Dodda B, et al. Weaning Outcomes and 28-day Mortality after Tracheostomy in COVID-19 Patients in Central India: A Retrospective Observational Cohort Study. Indian J Crit Care Med 2022;26(1):85-93.
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How to cite this article: Anand A, Saigal S, Panda R, Kodamanchili S, Shrivastava P, Das A, et al. Simple Mobile Application for Calculating "Ergotrauma" Made Using an Excel Sheet. Indian J Crit Care Med 2021;25(9):1081.
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Background. EEG is an effective tool due to its ability to capture and interpret the changes in brain activity under different situations. Quantitative EEG (qEEG) can be essential in evaluating and treating children's learning problems. Methods and procedure. Fifty school-going children with difficulty in learning were studied. Analysis of the difference between pre-intervention and postintervention EEG power ratio of frequency bands, including Theta to Beta and Theta to Alpha, while eyes-closed, eyes-open, hyperventilation, writing, and reading conditions and the values for relative powers were calculated. The study correlated postintervention theta/beta ratio (TBR) and theta/alpha ratio (TAR) values with behavioral measures. Results. The findings suggested that there was a significant difference in pre-intervention and postintervention relative TAR and TBR power values. A significant increase of TAR and TBR power values was observed in eyes-closed (resting), hyperventilation, writing, and reading task conditions, indicative of a state of arousal at FP1FP2, T3T4, and O1O2 scalp locations. During eye open conditions, the TAR and TBR were significantly low at all 3 scalp locations, indicating a relaxed, conscious, and aware state of mind. Postintervention TAR and TBR values were significantly correlated with behavioral measures during 5 task conditions on several scalp locations. Conclusion. These quantitative electroencephalogram findings in children with learning problems indicate that with the increased complexity of the cognitive tasks, TAR and TBR increase, while postintervention, children could attain a relaxed and conscious state of mind during eyes-open condition.