Outcome and predictors of cardiopulmonary resuscitation among patients admitted in Medical Intensive Care Unit in North India.

BACKGROUND: Outcome and predictors of survival after cardiopulmonary resuscitation (CPR) in Intensive Care Units (ICUs) have been extensively studied in western world, but data from developing countries is sparse. OBJECTIVES: To study the outcome and predictors of survival after CPR in a Medical ICU (MICU) of a tertiary level teaching hospital in North India. MATERIALS AND METHODS: A 1-year prospective cohort study. RESULTS: Of 105 in-MICU CPRs, forty patients (38.1%) achieved return of spontaneous circulation (ROSC). Only one patient (0.9%) survived up to hospital discharge. The predictors of ROSC were ventricular tachycardia/ventricular fibrillation as first monitored rhythm, intubation during CPR and CPR duration ≤ 10 min. CPR duration > 10 min was a significant factor for resuscitation failure. CONCLUSIONS: The rate of survival to hospital discharge after in-MICU CPRs is extremely poor. Our data may aid treating physicians, resuscitation teams, and families in understanding the likely outcome of patients after in-MICU CPRs.

Critical care aspects of malaria.

Malaria remains a major health problem in much of Asia and Africa. A steady number of cases of imported malaria are also seen in many countries of the developed world. Plasmodium falciparum malaria and to some extent malaria caused by other species of Plasmodium can lead to many complications such as acute respiratory distress syndrome (ARDS), cerebral malaria, acute renal failure, severe anemia, thrombocytopenia, and bleeding complications. About 10% of patients with severe malaria die, usually as a result of multiorgan dysfunction. Critical care physicians should be aware of the complications and management of severe malaria. There has been significant progress in the understanding of pathogenesis of severe malaria over the last decade. Effective management of severe malaria includes early suspicion, prompt diagnosis, early institution of appropriate antimalarial chemotherapy, and supportive care, preferably in an intensive care unit. In this article, we review the different manifestations of severe malaria as relevant to critical care physicians and discuss the principles of laboratory diagnosis and management.

Epidemiology of adult obstructive sleep apnoea syndrome in India.

There is a paucity of published Indian studies on the prevalence and risk factors of obstructive sleep apnoea (OSA) in adults. The limited published literature, however, does not suggest significant differences in the prevalence and risk factors for OSA and obstructive sleep apnoea syndrome (OSAS) as compared to western studies. Well designed studies are required from all parts of India. Patients should be screened carefully before referring them to costly investigations such as overnight polysomnography. With the background of increasing urbanization, fast growing economy and changes in lifestyle, India will have an epidemic of obesity. Therefore, future studies on the association of OSA and metabolic syndrome should carefully evaluate confounding effect of obesity on metabolic abnormalities in patients with OSA.

Prognostic Role of B-Type Natriuretic Peptide in Adults with Acute Dyspnea Requiring Emergency Admission.

OBJECTIVE: The aim of the study was to evaluate the role of B-type natriuretic peptide (BNP) in patients presenting with acute dyspnea admitted in emergency services. MATERIALS AND METHODS: A prospective observational study was conducted on 100 patients presenting to the emergency of Dayanand Medical College and Hospital and Hero DMC Heart Institute with acute dyspnea of <48 h duration, in which BNP levels were done on arrival to emergency. RESULTS: BNP levels were significantly higher in patients having left ventricular dysfunction, both systolic and diastolic. Patients with systolic dysfunction had slightly higher BNP (1251.50 ±950.14 pg/mL) compared to patients with diastolic dysfunction (905.62±618.10 pg/mL) though statistically insignificant (P = 0.055). BNP levels were also inversely related to ejection fraction. Mean BNP levels in patients with EF <31%, 31%-45%, 46%-59%, and ≥60% were 1464.63 ± 1058.29, 968.24 ± 751.59, 841.64 ± 503.41 and 781.67 ± 504.21 (P = 0.009), respectively. Patients having higher BNP levels had significantly prolonged duration of stay compared to patients with lower BNP. Patients who expired had slightly higher levels of BNP though statistically nonsignificant. BNP had no significant statistical relation with age, heart rate, creatine phosphokinase-MB, Trop-T levels, systolic blood pressure. CONCLUSION: We conclude that high BNP levels are a marker of cardiac dysfunction and increased duration of hospital stay in patients presenting to the emergency with acute dyspnea. Hence, BNP can be used as a screening test for the evaluation and management of dyspnea.

Seasonal variation in 24 h blood pressure profile in healthy adults- A prospective observational study.

The clinical and experimental data on seasonal variation in blood pressure is mainly from office and home blood pressure (BP) monitoring studies. There are few studies from temperate climates on seasonal changes with ambulatory blood pressure (ABP) monitoring and none from India. This is a prospective, observational study among healthy adults. ABP was measured in four different seasons in 28 subjects. Mean arterial pressure (MAP), ambulatory systolic blood pressure (SBP), and ambulatory diastolic blood pressure (DBP) were significantly higher in winter compared to summer season. 24-hour MAP was lowest in summer while highest MAP was recorded in winter (97.04 ± 8.30 and 103.89 ± 8.54, respectively). The mean difference was -6.86 mm Hg (95% CI: -10.74 to -2.97, p = 0.001). This difference was mainly due to increase in day time MAP. There was no difference in 24 h systolic and diastolic blood pressure between summer and winter. There was significant difference between summer and winter in the SBP (day time) [125.61 ± 11.44 and 131.93 ± 9.46, mean difference -6.32 (95% CI: -10.69 to -1.95, p = 0.005)] and DBP (day time) [79.57 ± 9.95 and 87.07 ± 9.9, mean difference -7.50 (95% CI: -12.49 to -2.51, p = 0.003)]. The night time systolic and diastolic BP was similar during winter and summer. Thus, BP increases significantly during winter compared to summer season. This change is primarily in the day time systolic, diastolic and mean blood pressures. Larger studies are required to further validate our findings.

Effect of antituberculosis treatment on cardiopulmonary responses to exercise in miliary tuberculosis.

BACKGROUND & OBJECTIVES: Tuberculosis (TB) is a major health problem in the developing world. In this preliminary study, we report the effect of antituberculosis treatment (ATT) on cardiopulmonary responses to exercise in patients with miliary tuberculosis (MTB). METHODS: The prospective study of cardiopulmonary responses to exercise in patients with MTB within one month of starting (n=14), on completion of ATT (n=7) and in 15 healthy subjects using the incremental exercise test was performed on a bicycle ergometer. RESULTS: In MTB patients, mean body mass index (BMI), exercise duration (3.1 vs 4.6 min), work load (63 vs 91.4 watts), resting tachycardia, tachypnoea and the mean oxygen saturation improved significantly (P<0.05) with ATT. Mean oxygen consumption (V . O(2)) at anaerobic threshold (546.7 vs 580.9 ml/min) and maximum exercise (1008.1 vs 1022 ml/min) were similar before and after ATT. In MTB patients, post-treatment mean body weight, BMI, resting heart rate, respiratory rate and oxygen saturation during maximum exercise were similar, but exercise duration (4.6 vs 6.2 min, P<0.05), work load (91.4 vs 145.5 watts, P<0.05), V . O(2) and oxygen pulse were significantly lower as compared to healthy subjects. INTERPRETATION & CONCLUSION: In MTB patients, though there was significant improvement in clinical parameters, functional abnormalities persisted on exercise testing after completion of ATT. As most patients with MTB are young and economically active, these observations obviously have long-term implications for these individuals.

Outdoor air pollution and emergency room visits at a hospital in Delhi.

Several reports from large metropolitan cities have indicated significant association between acute morbidity and mortality from cardio-respiratory disorders and daily levels of major pollutants in the ambient air. Despite the wide-spread public concern about the adverse health effects of air pollution, there is substantial uncertainty regarding the effects of these pollutants at a concentration typical of Delhi, which is one of the ten most polluted cities in the world and the most polluted city in India. This study was undertaken to correlate the daily levels of various pollutants with the number of patients visiting the All India Institute of Medical Sciences (AIIMS, New Delhi) casualty for aggravation of certain defined cardiorespiratory disorders. Daily counts of patients visiting the emergency room of the AIIMS for acute asthma, acute exacerbation of chronic obstructive airway disease (COAD) and acute coronary event was obtained in prospective manner from January 1997 to December 1998. Daily mean levels of ambient CO, NOx and SO2 were monitored along with temperature and humidity. Data was analysed using one day time lag for events of interest. Time series analysis was undertaken using Poisson regression and population averaged general estimation equation, correcting for auto-correlation, days of the weak and season. The ambient levels of pollutants exceeded the national air quality standards on most of the days, over the two year period. Further, emergency room visits for asthma, COAD and acute coronary events increased by 21.30%, 24.90% and 24.30% respectively on account of higher than acceptable levels of pollutants. It is concluded that there is considerable burden of cardiorespiratory diseases in Delhi due to high levels of ambient air pollution.