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BACKGROUND: Deviceassociated infections (DAIs) increase the morbidity and mortality in the intensive care unit (ICU). Studies from the neurosurgical ICU in developing countries are sparse. AIMS: The aim of this study was to assess the incidence of device-associated healthcare associated infections, pathogens isolated, antibiotic resistance, and mortality in neurosurgical ICU. SETTINGS AND DESIGN: A retrospective study was conducted in the neurosurgical ICU of a tertiary care center. MATERIALS AND METHODS: This study was done by analyzing data of patients admitted in a neurosurgical ICU with one or more devices during the period from January 2011 to July 2017. STATISTICAL ANALYSIS: Quantitative variables were expressed as mean and standard deviation; qualitative variables were expressed as frequency and percentage. RESULTS: During this period, 6788 patients with devices were admitted in the ICU, and 316 patients developed DAI. Two hundred and forty-eight patients had catheter-associated urinary tract infection (CAUTI), 78 had ventilator-associated pneumonia (VAP), and 53 had central line-associated bloodstream infection (CLABSI). The incidence rate for CAUTI was 17.83, VAP - 16.83, and CLABSI - 4.39 per 1000 device days. The device utilization ratio was highest for urinary catheter - 0.76, followed by central line - 0.66 and ventilator - 0.25. Predominant pathogens were Klebsiella - 90, Escherichia coli - 77, Pseudomonas - 40, Candida - 39, Acinetobacter - 30, and Enterobacter - 21. Carbapenem resistance was found in Acinetobacter (73.4%), Pseudomonas (45%), and Enterobacter (38%). S. aureus isolated in six cases; four being MRSA (66.7%). Multidrug resistance was found in Acinetobacter (80%), Pseudomonas (60%), Enterobacter (52.3%), Klebsiella (42.3%), and E. coli (33.7%). No colistin resistant Gram negative bacilli or vancomycin resistant enterococci were isolated. During this period 124 patients with DAI died, of which 52 patients had sepsis. The crude mortality rate was 1.83%. CONCLUSION: The DAI with the highest incidence was CAUTI, followed by VAP and CLABSI. With the implementation of insertion bundles and adherence to aseptic precautions, the DAI rate had come down.
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BACKGROUND: Patients undergoing corrective surgery for scoliosis may require postoperative ventilation for various reasons. AIM: The aim was to study the correlation of preoperative (pulmonary function test [PFT], etiology, and Cobb's angle) and intraoperative factors (type of surgery, number of spinal segments involved, blood transfusion, and temperature at the end of surgery) on postoperative ventilation following scoliosis surgery. SETTINGS AND DESIGN: patients' medical records of scoliosis surgery at a tertiary care center during 2010-2016 were retrospectively analyzed. MATERIALS AND METHODS: We studied retrospectively 108 scoliosis surgeries done in our institute during this period by the same group of anesthetists using standardized anesthesia technique. We analyzed preoperative (etiology, preoperative PFT, and Cobb's angle) and intraoperative factors (type of surgery, number of spinal segments involved, blood transfusion, and temperature) influencing postoperative ventilation. STATISTICAL ANALYSIS: For all the continuous variables, the results are either given in mean ± standard deviation, and for categorical variables as a percentage. To obtain the association of categorical variables, Chi-square test was applied. RESULTS: Patients with Cobb's angle above 76° and spinal segment involvement of 11 ± 3 required postoperative ventilation. Forced expiratory volume in 1 s (FEV1%) <38 and forced vital capacity (FVC%) <38.23 of the predicted could not be extubated. Increased blood transfusion and hypothermia were found to affect postoperative ventilation. CONCLUSION: Preoperative factors such as etiology of scoliosis, Cobb's angle, spirometric values FEV1% and FVC% of predicted and intraoperative factors like number of spinal segments involved, affect postoperative ventilation following scoliosis surgery. Increased blood transfusion and hypothermia are the preventable factors leading to ventilation.
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CONTEXT: Total knee arthroplasty (TKA) is associated with severe postoperative pain which increases morbidity and mortality. AIMS: The aim of the study was to compare the analgesic efficacy and motor blockade of continuous infusion of 0.125% bupivacaine and 0.2% ropivacaine in femoral nerve block following unilateral TKA and to assess the effectiveness of femoral nerve block. SETTINGS AND DESIGN: One hundred and fifty patients undergoing unilateral total knee replacement surgery were included in this prospective observational comparative study. SUBJECTS AND METHODS: Patients are divided into two groups of 75 each. Femoral nerve catheter was placed at the end of surgery using ultrasound. Postoperative analgesia and motor blockade were compared for the next 24 h using visual analog scale (VAS) score, additional analgesic requirement, and Bromage scale. STATISTICAL ANALYSIS: Student's t-test and Chi-square test were applied. RESULTS: There was no statistically significant difference in pain between the two groups though VAS score (during rest and movement) and opioid consumption were lower in bupivacaine group. Nearly 28.6% patients experienced pain and required additional analgesics. Seventy-two percent among them complained of pain in the popliteal region supplied by sciatic nerve. Eight patients excluded from the study also had pain in the popliteal fossa. There was a statistically significant difference in motor blockade between the two groups at 12, 18, and 24 h after starting infusion. Bupivacaine group had a higher percentage of type three blocks compared to ropivacaine group. CONCLUSION: Continuous femoral nerve block (CFNB) with 0.125% bupivacaine infusion provided better analgesia with denser motor blockade compared to 0.2% ropivacaine infusion. CFNB alone is not sufficient to provide adequate analgesia following unilateral TKA.
