Incidence and Predictors of Delirium After Cardiac Surgery.

BACKGROUND: The overall purpose of this study was to determine the incidence and perioperative factors that predispose to cause delirium in postoperative cardiac surgery patients in our Intensive Care Unit. METHODS: We performed a prospective, observational study. Following institutional review board approval, this study included 234 patients above the age of 18 years meeting the inclusion criteria for cardiac surgery in Shahid Gangalal National Heart Center from July 2018 to December 2018. Preoperative, intraoperative and postoperative data for possible risk factors were obtained. Daily assessment of delirium was done during Intensive Care Unit stay of the patient. Collected data were analysed by means of statistical software SPSS-21. RESULTS: The incidence of delirium was 15.6% (35/224) in our study. Delirium was seen in 14 out of 58 (24.1%) patients with age >60 years which was found to be statistically significant. Preoperative risk factor for developing delirium were carotid artery disease and Hemoglobin level <10gm/dl. Intraoperative risk factor for developing delirium were blood transfusion, longer cardiopulmonary bypass time. Post-operative factors for developing delirium included longer Intensive Care Unit stay, mechanical ventilation time ,duration on inotropes , blood transfusion, use of non-invasive ventilation, sleep deprivation, use of intra-aortic balloon pump, Pao2<70. CONCLUSIONS: As shown in our study, delirium is a frequent occurrence in the cardiac surgical population. The incidence of delirium after cardiac surgery was 15.6%. Several risk factors pre-operatively like age>60 years, carotid artery disease, Hb<10gm/dl, intra-operative factors like longer cardiopulmonary bypass time, blood transfusion and post-operatively longer duration of Mechanical ventilation, Intensive Care Unit stay, blood transfusion, use of intra-aortic balloon pump and Non-invasive ventilation were found to be predictors of delirium.

Tofacitinib as an Adjunct Immunomodulator for Treatment of a Patient with Severe COVID-19: A Case Report.

Severe coronavirus disease 2019 can be associated with progressive respiratory failure. In addition to respiratory support and other supportive care, use of corticosteroids has shown to improve outcome. Despite the use of steroids, a significant proportion of patients progressively worsen. Adjunct immunomodulators have been studied in addition to steroids in these patients. Here we present a successful use of tofacitinib, a Janus Kinase inhibitor, in conjunction with dexamethasone for a patient with rapid worsening of respiratory status and with high level of serum inflammatory biomarkers.

Knowledge of COVID-19 among Health Care Workers at a Tertiary Care Hospital of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Health care workers are at higher risk of infection with the coronavirus disease as they are directly involved in the treatment of infected patients and perform aerosol-generating procedures. Proper knowledge of this disease can influence the positive attitude, good practices and enhance their safety. We aim to study the knowledge of COVID-19 among health care workers of the tertiary care hospital of Nepal. METHODS: A descriptive cross-sectional study was conducted among health care workers of Shahid Gangalal National Heart Centre from May 20 to June 19, 2020. Ethical approval was taken from the Institutional Review Board (IRB No: 4-2020). Written informed consent was taken from all respondents. Correct answers were summated to reflect the mean knowledge, expressed as a percentage. Data analysis was done using Statistical Package for the Social Sciences version 21. RESULTS: The mean general knowledge score was 95.7%. The mean medical knowledge score was 70.5%. Only 42 (56.8%) of physicians and 103 (53.6%) of nurses had a higher level of medical knowledge regarding COVID-19. Likewise, very few lab technicians 7 (21.9%) and none of the pharmacists had a higher level of medical knowledge. CONCLUSIONS: The healthcare workers of this centre have adequate knowledge regarding COVID-19. However, periodic training for all workers, especially the nurses and allied workers, may help to update the knowledge and hence enhance their safety and that of their patients.

Apnea testing with continuous positive airway pressure for the diagnosis of brain death in a patient with poor baseline oxygenation status.

Apnea testing is a key component in the clinical diagnosis of brain death. Patients with poor baseline oxygenation may not tolerate the standard 8-10 min apnea testing with oxygen insufflation through tracheal tube. No studies have assessed the safety and feasibility of other methods of oxygenation during apnea testing in these types of patients. Here, we safely performed apnea testing in a patient with baseline PaO2 of 99.1 mm Hg at 100% oxygen. We used continuous positive airway pressure (CPAP) of 10 cm of H2O and 100% oxygen at the flow rate of 12 L/min using the circle system of anesthesia machine. After 10 min of apnea testing, PaO2 decreased to 75.7 mm Hg. There was a significant rise in PaCO2 and fall in pH, but without hemodynamic instability, arrhythmias, or desaturation. Thus, the apnea test was declared positive. CPAP can be a valuable, feasible and safe means of oxygenation during apnea testing in patients with poor baseline oxygenation, thus avoiding the need for ancillary tests.