Tracheobronchial Injury: Role of Virtual Bronchoscopy.

A tracheobronchial avulsion is a very rare and serious condition that occurs mostly due to blunt trauma chest caused by high-speed traffic accidents. In this article, we present a challenging case of a 20-year-old male who had a right tracheobronchial transection with carinal tear which was repaired on cardiopulmonary bypass (CPB) through right thoracotomy. Challenges faced and a review of literature will be discussed. How to cite this article: Kaur A, Singh VP, Gautam PL, Singla MK, Krishna MR. Tracheobronchial Injury: Role of Virtual Bronchoscopy. Indian J Crit Care Med 2022;26(7):879-880.

Institutional resuscitation protocols: do they affect cardiopulmonary resuscitation outcomes? A 6-year study in a single tertiary-care centre.

PURPOSE: Despite advances in cardiopulmonary resuscitation and widespread life-support trainings, the outcomes of resuscitation are variable. There is a definitive need for organizational inputs to strengthen the resuscitation process. Our hospital authorities introduced certain changes at the organizational level in our in-house resuscitation protocol. We aimed to study the impact of these changes on the outcomes of resuscitation. METHODS: The hospital code blue committee decided to reformulate the resuscitation protocols and reframe the code blue team. Various initiatives were taken in the form of infrastructural changes, procurement of equipment, organising certified training programs, conduct of mock code and simulation drills etc. A prospective and retrospective observational study was made over 6 years: a pre-intervention period, which included all cardiac arrests from January 2007 to December 2009, before the implementation of the program, and a post-intervention period from January 2010 to December 2012, after the implementation of the program. The outcomes of interest were response time, immediate survival, day/night survival and survival to discharge ratio. RESULTS: 2,164 in-hospital cardiac arrests were included in the study, 1,042 during the pre-intervention period and 1,122 during the post-intervention period. The survival percentage increased from 26.7 to 40.8 % (p < 0.05), and the survival to discharge ratio increased from 23.4 to 66.6 % (p < 0.05). Both day- and night-time survival improved (p < 0.05) and response time improved from 4 to 1.5 min. CONCLUSIONS: A strong hospital-based resuscitation policy with well-defined protocols and infrastructure has potential synergistic effect and plays a big role in improving the outcomes of resuscitation.

Do Intensive Care Unit treatment modalities predict mortality in geriatric patients: An observational study from an Indian Intensive Care Unit.

BACKGROUND: Ageing being a global phenomenon, increasing number of elderly patients are admitted to Intensive Care Units (ICU). Hence, there is a need for continued research on outcomes of ICU treatment in the elderly. OBJECTIVES: Examine age-related difference in outcomes of geriatric ICU patients. Analyze ICU treatment modalities predicting mortality in patients >65 years of age. MATERIALS AND METHODS: A retrospective observational study was conducted in 2317 patients admitted in a multi-specialty ICU of a tertiary care hospital over 2-year study period from January 1, 2011 to December 31, 2012. A clinical database was collected which included age, sex, specialty under which admitted, APACHE-II and SOFA scores, patient outcome, average length of ICU stay, and the treatment modalities used in ICU including mechanical ventilation, inotropes, hemodialysis, and tracheostomy. Patients were divided into two groups: <65 years (Control group) and >65 years (Geriatric age group). RESULTS: The observed overall ICU mortality rate in the study population was 19.6%; no statistical difference was observed between the control and geriatric age group in overall mortality (P > 0.05). Mechanical ventilation (P = 0.003, odds ratio [OR] =0.573, 95% confidence interval [CI] =0.390-0.843) and use of inotropes (P = 0.018, OR = 0.661, 95% CI = 0.456-0.958) were found to be predictors of mortality in elderly population. On multivariate analysis, inotropic support was found to be an independent ICU treatment modality predicting mortality in the geriatric age group (ß coefficient = 1.221, P = 0.000). CONCLUSION: Intensive Care Unit mortality rates increased in the geriatric population requiring mechanical ventilation and inotropes during ICU stay. Only inotropic support could be identified as independent risk factor for mortality.

Implications of dedicated tracheostomy care nurse program on outcomes.

PURPOSE: Tracheostomy is a common occurrence in intensive care units (ICU), and a greater number of tracheostomized patients are shifted from ICU to non-critical areas. Tracheostomy care needs a multidisciplinary approach, particularly involving the nurses, and complications such as tube blockage, infection, and bleeding can be prevented by good bedside nursing. The aim was to study the impact of dedicated tracheostomy care nurse program on outcomes of tracheostomized patients. METHODS: A tracheostomy care nurse program was improvised by the critical care physicians, with the objective of improving care of tracheostomized patients, wherein nursing staff from noncritical areas were selected for training purposes. The training included evidence-based knowledge and hands-on training. After a written assessment and a skill test, they were certified as 'Tracheostomy Care Nurse.' At least one of the tracheostomy care nurses was supposed to be responsible for tracheostomy care in specific wards. Comparative data of two periods, a pre-intervention period from January 2011 to November 2011 and a post-intervention period from December 2011 to October 2012, were analyzed. RESULTS: During the pre-intervention period, of 82 tracheostomized patients, 28 (34.15 %) had complications including 20 (24.39 %) readmissions to the ICU. During the post-intervention period, 107 patients had a tracheostomy, of which 7 (6.54 %) had complications with only 2 (1.87 %) readmissions, which was significant (p < 0.05). Decannulations nonsignificantly increased during the post-intervention period (25 vs. 16 %, p > 0.05). The average length of hospital stay (ALOS) decreased from 36 to 27 days (p < 0.05). CONCLUSION: The support of a specialist tracheostomy nurse can decrease complication rates and readmissions to the ICU and reduce ALOS.

Refractory hyperkalemia related to heparin abuse.

Hyperkalemia is a potentially life-threatening condition, which may occur in many clinical settings. Heparin-induced hyperkalemia is less well-recognized than other side effects of heparin therapy. Even lesser known is heparin abuse amongst drug addicts. We report a case of fatal hyperkalemia related to long-term heparin abuse, which was refractory to anti-hyperkalemia therapy including hemodialysis. The objective is to alert the clinicians to possible abuse of heparin in drug addicts, which can be a cause for refractory hyperkalemia. We also briefly review the available literature on heparin-induced hyperkalemia.

Impact of advanced cardiac life support training program on the outcome of cardiopulmonary resuscitation in a tertiary care hospital.

BACKGROUND: Guidelines on performing cardiopulmonary resuscitation (CPR) have been published from time to time, and formal training programs are conducted based on these guidelines. Very few data are available in world literature highlighting the impact of these trainings on CPR outcome. AIM: The aim of our study was to evaluate the impact of the American Heart Association (AHA)-certified basic life support (BLS) and advanced cardiac life support (ACLS) provider course on the outcomes of CPR in our hospital. MATERIALS AND METHODS: An AHA-certified BLS and ACLS provider training programme was conducted in our hospital in the first week of October 2009, in which all doctors in the code blue team and intensive care units were given training. The retrospective study was performed over an 18-month period. All in-hospital adult cardiac arrest victims in the pre-BLS/ACLS training period (January 2009 to September 2009) and the post-BLS/ACLS training period (October 2009 to June 2010) were included in the study. We compared the outcomes of CPR between these two study periods. RESULTS: There were a total of 627 in-hospital cardiac arrests, 284 during the pre-BLS/ACLS training period and 343 during the post-BLS/ACLS training period. In the pre-BLS/ACLS training period, 52 patients (18.3%) had return of spontaneous circulation, compared with 97 patients (28.3%) in the post-BLS/ACLS training period (P < 0.005). Survival to hospital discharge was also significantly higher in the post-BLS/ACLS training period (67 patients, 69.1%) than in the pre-BLS/ACLS training period (12 patients, 23.1%) (P < 0.0001). CONCLUSION: Formal certified BLS and ACLS training of healthcare professionals leads to definitive improvement in the outcome of CPR.