Reckoning the Inhaled Sedation in Critically Ill Patients (INSTINCT) Study.

How to cite this article: Karim HMR, Mitra JK. Reckoning the Inhaled Sedation in Critically Ill Patients (INSTINCT) Study. Indian J Crit Care Med 2022;26(11):1227-1228.

Ketamine Sedation for Noninvasive Ventilation in Distressed Elderly Patients with Acute Decompensated Heart Failure: Is it Safe?

How to cite this article: Karim HMR, Esquinas AM. Ketamine Sedation for Noninvasive Ventilation in Distressed Elderly Patients with Acute Decompensated Heart Failure: Is it Safe? Indian J Crit Care Med 2022;26(10):1161.

Alveolar-arterial Oxygen Gradient in COVID-19 Pneumonia Initiated on Noninvasive Ventilation: Looking into the Mortality-prediction Ability.

How to cite this article: Karim HMR, Esquinas AM. Alveolar-arterial Oxygen Gradient in COVID-19 Pneumonia Initiated on Noninvasive Ventilation: Looking into the Mortality-prediction Ability. Indian J Crit Care Med 2022;26(10):1152.

Secretion management in patients with ineffective airway clearance with non-invasive mechanical ventilation use: Expert guidance for clinical practice.

Non-invasive ventilation (NIV) is a mainstay of management of chronic respiratory failure in many disorders which are known to cause abnormal airway secretion clearance. Currently, there is no guidance regarding either the secretion handling during NIV use or the role of NIV in secretion management in these patients. The aim of this document was to provide an overview of the various techniques available in the management of respiratory secretions and their use in conjunction with NIV. Literature search was performed using the keywords, "(secretion OR secretions) AND (noninvasive ventilation OR NIV)" on PubMed and EMBASE. The search yielded 1681 and 509 titles from PubMed and EMBASE, respectively. After screening, 19 articles were included in this review. Suggestions of the expert panel were formulated by mutual consensus after reviewing the relevant literature. The draft of the expert panel's suggestions was circulated among all authors via electronic mail for comments. Any conflicts were resolved by mutual discussion to achieve agreement. The final document was approved by all. This document by the International Network for Airway Secretions Management in NIV describes various airway secretion clearance techniques. It provides the expert panel's suggestions for the use of these techniques in conjunction with NIV for patients with muco-obstructive and neuromuscular disorders.

Predictors of Mortality in Acute Kidney Injury Patients in an Intensive Care Unit: Is Hemodialysis No Good?

How to cite this article: Karim HMR, Panda CK. Predictors of Mortality in Acute Kidney Injury Patients in an Intensive Care Unit: Is Hemodialysis No Good? Indian J Crit Care Med 2019;23(9):439.

Prevalence and impact of abnormal routine pre-operative test results among elective surgical patients with or without co-morbidity: An observational comparative study.

BACKGROUND: At present, selective and clinical assessment-based pre-operative investigations are advocated, but it is yet far from routine practice. AIM: This study aims to assess the prevalence and impact of abnormal routine pre-operative test results among co-morbid and non-co-morbid elective surgical patients. METHODS: Data for this prospective study were collected by reviewing the medical charts of the patients attending pre-anaesthetic clinic from December 2016 to April 2017. The cohort was divided into non-co-morbid and co-morbid. Routine pre-operative tests were done, their results and impacts of abnormal test results were noted; number needed to investigate (NNI) was calculated. Data were compared using Fisher's exact test, unpaired t-test, etc., P < 0.05 was considered statistically significant. RESULTS: Data from 887 patients; 322 (36.30%) co-morbid were analysed. Co-morbid patients were older (53.79 ± 14.99 vs. 40.33 ± 15.68 year). No difference was found in the number of tests done in co-morbid patients except significantly higher number of electrocardiogram and echocardiography (P < 0.0001). Abnormal test results were significantly higher among co-morbid (relative risk - 1.63, P < 0.0001). Impacts were similar in co-morbid as compared to non-co-morbid for most of the tests, but thyroid function and blood sugar tests showed NNI for significant impact below 10 in co-morbid group. CONCLUSION: Co-morbid patients have more abnormal results than non-co-morbid patients, but impacts of such tests are nearly indifferent. Routine testing is not favourable even in co-morbid patients. Selective or co-morbid disease-specific tests are having more significant impacts and should replace the 'routine testing' even in co-morbid patients.

Scrub typhus masquerading as HELLP syndrome and puerperal sepsis in an asymptomatic malaria patient.

Scrub typhus and malaria can involve multiple organ systems and are notoriously known for varied presentations. However, clinical malaria or scrub typhus is unusual without fever. On the other hand, altered sensorium with or without fever, dehydration, hemorrhage and hemolysis may lead to low blood pressure. Presence of toxic granules and elevated band forms in such patients can even mimic sepsis. When such a patient is in the peripartum period, it creates a strong clinical dilemma for the physician especially in unbooked obstetric cases. We present such a case where a 26-year-old unbooked female presented on second postpartum day with severe anemia, altered sensorium, difficulty in breathing along with jaundice and gum bleeding without history of fever. Rapid diagnostic test for malaria was negative and no eschar was seen. These parameters suggested a diagnosis of HELLP (Hemolysis, Elevated Liver enzymes, Low Platelet) syndrome with or without puerperal sepsis. Subsequently she was diagnosed as having asymptomatic malaria and scrub typhus and responded to the treatment of it. The biochemical changes suggestive of HELLP syndrome also subsided. We present this case to emphasize the fact that mere absence of fever and eschar does not rule out scrub typhus. It should also be considered as a differential diagnosis in patients with symptoms and signs suggesting HELLP syndrome. Asymptomatic malaria can complicate case scenario towards puerperal sepsis by giving false toxic granules and band form in such situations.