Clinical Utility of Arterial Blood Gas Test in an Intensive Care Unit: An Observational Study.

BACKGROUND: Arterial blood gas (ABG) analysis is a common test ordered in critically ill patients. Often, it is performed very frequently without influencing patient care. Hence, we decided to check the utility of the ABG test in our intensive care unit (ICU). MATERIALS AND METHODS: The data of the previous day ABGs were captured by reviewing the chart in an online pro forma which was filled by the authors. Data relating to patient's details, who ordered ABGs, reason for ordering ABGs, and did the ABG influence patient's management were entered. A total of 985 ABGs were performed in 173 patients for 2 months which was analyzed. RESULTS: Out of 985 ABGs, in 259 instances (26.29%), interventions were done after reviewing an ABG. The major interventions among these ABGs were ventilator settings adjustment in 134 ABGs (13.6%). A total of 790 ABGs were done routinely with no specific indication (80.20%), while doctors ordered one following an event for 195 ABGs (19.80%). CONCLUSION: Our data suggest that 80% of ABG tests were ordered as part of a routine test. HOW TO CITE THIS ARTICLE: Chandran J, D'Silva C, Sriram S, Krishna B. Clinical Utility of Arterial Blood Gas Test in an Intensive Care Unit: An Observational Study. Indian J Crit Care Med 2021;25(2):172-175.

Prospective Observational Study on Evaluation of Cardiac Dysfunction Induced during the Weaning Process.

CONTEXT: Weaning induced cardiac dysfunction can occur without underlying heart disease. Changes in intrathoracic pressure, systemic vascular resistance, preload and afterload leading to heart-lung interactions are the possible explanatory mechanisms. AIMS: The aim of the current study was whether the assessment and identification of cardiac dysfunction induced during the weaning process could predict the outcome of extubation. SETTINGS AND DESIGN: A prospective observational study with convenience sampling method was conducted from May 2015 to April 2016 after institutional ethical committee approval (ref 161/2015). MATERIALS AND METHODS: Patients over eighteen and planned for extubation were included. Weaning method used was a spontaneous breathing trial (SBT) by pressure support-positive end-expiratory pressure (PS-PEEP). Baseline characteristics, weaning, and echocardiography parameters were collected pre extubation. Post-extubation echocardiographic parameters were collected within six hours as per the protocol. The primary outcome was extubation failure (reintubation within 48 hours). Secondary outcomes were ICU length of stay and ICU mortality. STATISTICAL ANALYSIS: Statistical method used is STATA™ (Version14, College Station TX). RESULTS: Out of one hundred and sixty-one patients, twenty-one failed extubation (13.04 %). Pre-extubation echocardiographic parameters were similar in two groups except for preexisting LV systolic dysfunction. Post-extubation E/e` (9.30 vs. 7.71 p = 0.018) was higher in the extubation failure group. Extubation failure group had higher intensive care unit (ICU) length of stay and ICU mortality. CONCLUSION: In our study E/e` during a weaning trial did not predict extubation success. Cardiac dysfunction induced during weaning may get masked during weaning and manifests postextubation. This needs to be verified in subsequent studies. KEY MESSAGES: Cardiac dysfunction induced during the weaning process may get masked and manifests post-extubation. Echocardiographic assessment during the weaning process and post-extubation helps to evaluate and identify the patients at risk of reintubation. HOW TO CITE THIS ARTICLE: Amarja H, Bhuvana K, Sriram S. Prospective Observational Study on Evaluation of Cardiac Dysfunction Induced during the Weaning Process. Indian Journal of Critical Care Medicine, January 2019;23(1):15-19.

Evaluation of Quality Indicators in an Indian Intensive Care Unit Using "CHITRA" Database.

BACKGROUND: Quality indicators (QIs) are essential for maintaining quality of care in the critically ill. The Indian Society of Critical Care Medicine proposed benchmarks and enabled Indian Intensive Care Units (ICUs) to capture data in an electronic database: Customized Health in Intensive Care Trainable Research and Analysis (CHITRA) tool. The purpose of this study is to report QIs in an Indian ICU using this database. MATERIALS AND METHODS: Data from patients admitted to ICU between October 2015 and January 2017 were entered into CHITRA. The following QIs were analyzed: standardized mortality ratio (SMR), length of ICU stay (LOS-ICU), pressure ulcer (PU) rate, patient fall rate (FR), ICU readmission rate, reintubation rate, ventilator-associated condition (VAC), central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and iatrogenic pneumothorax rate. RESULTS: A total of 2642 patient's information was suitable for analysis. Median age of ICU admission was 53 years (interquartile range [IQR]: 36-65), with a mean APACHE score of 18 (SD 7.7). Median LOS-ICU was 3 days (IQR 2-6) and SMR was 1.1 (95% confidence interval 1.05-1.38). Pneumothorax rate, PU rate, and FR were 2.6, 4.1, and 0.3 per 1000 respectively, whereas readmission rate was 0.7% and reintubation rate was 3.5%. VAC, CLABSI, and CAUTI were 8.5, 23, 3.1 per 1000 ventilator and catheter days, respectively. CONCLUSION: This study has successfully evaluated a range of QIs in a mixed ICU of a tertiary hospital utilizing CHITRA database.