Does Cricoid Pressure Increase the Laryngoscopy Force During Rapid Sequence Induction?-A Randomized Study.

OBJECTIVE: Cricoid pressure, a manoeuver used to prevent pulmonary aspiration during rapid sequence induction, can result in deterioration of laryngeal view and increased haemodynamic changes. Its effect on laryngoscopy force remains unevaluated. The study aimed to assess the impact of cricoid pressure on laryngoscopy force and intubation characteristics during rapid sequence induction. METHODS: Seventy American Society of Anaesthesiologists I/II patients, both sexes, aged 16-65, having non-obstetric emergency surgery were randomly assigned to the cricoid group, which received 30 N cricoid pressure during rapid sequence induction, and the sham group, which received 0 N pressure. Propofol, fentanyl, and succinylcholine were used to produce general anaesthesia. The primary outcome was the peak force of laryngoscopy. Secondary outcomes were the laryngoscopic view, time to execute endotracheal intubation, and intubation success rate. RESULTS: With the application of cricoid pressure, the peak forces of laryngoscopy increased significantly, with a mean difference (95% CI) of 15.5 (13.8-17.2) N. With and without CP, the mean peak forces were 40.758 (4.2) and 25.2 (2.6) N, respectively, P < .001. Without cricoid pressure, the intubation success rate was 100%, compared to 85.7% with cricoid pressure, P = .025. The proportions of CL1/2A/2B patients with and without cricoid pressure were 5/23/7 and 17/15/3, respectively, with P = .005. With cricoid pressure, there was a considerable increase in intubation duration, with a mean difference (95% CI) of 24.4 (2.2-19.9) seconds. CONCLUSION: Cricoid pressure increases peak forces during laryngoscopy, resulting in worse intubation characteristics. This demonstrates the need of exercising care while performing this manoeuver.

Bacterial coinfections and secondary infections in COVID-19 patients from a tertiary care hospital of northern India: Time to adhere to culture-based practices.

OBJECTIVE: Bacterial co-pathogens are common in various viral respiratory tract infections, leading to increased disease severity and mortality. Still, they are understudied during large outbreaks and pandemics. This study was conducted to highlight the overall burden of these infections in COVID-19 patients admitted to our tertiary care hospital, along with their antibiotic susceptibility patterns. MATERIAL AND METHODS: During the six-month study period, clinical samples (blood samples, respiratory samples, and sterile body fluids, including cerebrospinal fluid [CSF]) of COVID-19 patients with suspected bacterial coinfections (at presentation) or secondary infections (after 48 hours of hospitalization) were received and processed for the same. RESULTS: Clinical samples of 814 COVID-19 patients were received for bacterial culture and susceptibility. Out of the total patient sample, 75% had already received empirical antibiotics before the samples were sent for analysis. Overall, 17.9% of cultures were positive for bacterial infections. Out of the total patients with bacterial infection, 74% (108/146) of patients had secondary bacterial infections (after 48 hours of hospitalization) and 26% (38/146) had bacterial coinfections (at the time of admission). Out of the 143 total isolates obtained, the majority (86%) were gram-negative organisms, of which Acinetobacter species was the commonest organism (35.6%), followed by Klebsiella pneumoniae (18.1%). The majority (50.7%) of the pathogenic organisms reported were multidrug resistant. CONCLUSION: The overall rate of secondary bacterial infections (SBIs) in our study was lower (7.9%) than reported by other studies. A rational approach would be to adhere to the practice of initiating culture-based guidance for antibiotics and to restrict unnecessary empirical antimicrobial therapy.

Lived experiences of the corona survivors (patients admitted in COVID wards): A narrative real-life documented summaries of internalized guilt, shame, stigma, anger.

COVID-19 pandemic has emerged as a disaster for the human beings. All the Governments across the globe have been preparing to deal with this medical emergency, which is known to be associated with mortality in about 5% of the sufferers. Gradually, it is seen that, many patients with COVID-19 infection have mild symptoms or are asymptomatic. Due to the risk of infecting others, persons with COVID-19 infection are kept in isolation wards. Because of the isolation, the fear of death, and associated stigma, many patients with COVID-19 infection go through mental distress. In this report, we discuss the experience of 3 persons diagnosed with COVId-19 infection and admitted to the COVID ward.