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Critically ill patients are under stress, leading to a catabolic response and higher energy expenditure. The associated malnutrition leads to adverse outcomes.
This study aims to assess the nutritional adequacy (>80% of prescribed calories) in mechanically ventilated (MV) patients and its effects on patients' outcomes. It also aims to identify the causes of deviation from the nutrition prescription.
This is a prospective observational study involving all adult critically ill patients requiring MV for >48 hours. Patients were prescribed enteral nutrition (EN) targeted to achieve 25 kcal/kg (IBW) of energy and 1.2 g/kg of proteins daily. Standard polymeric formula feeds were initiated as continuous infusion as per the feeding protocol in the intensive care unit (ICU). Data were collected on demography, body mass index (BMI), indication for ICU admission, admission category, and admission APACHE II and SOFA scores, and nutritional risk was captured with mNUTRIC score. Nutritional data on type of feedons were reasons for nutritional inadequacy. Nutritional adequacy had no impact on clinical outcomes.
Despite following guidelines and feeding protocols, there exists a wide gap between prescribed nutrition and what is actually delivered in MV patients.
Kalaiselvan MS, Arunkumar AS, Renuka MK, Sivakumar RL. Nutritional Adequacy in Mechanically Ventilated Patient Are We Doing Enough? Indian J Crit Care Med 2021;25(2)166-171.
Kalaiselvan MS, Arunkumar AS, Renuka MK, Sivakumar RL. Nutritional Adequacy in Mechanically Ventilated Patient Are We Doing Enough? Indian J Crit Care Med 2021;25(2)166-171.
Incontinence-associated dermatitis (IAD) is a potentially serious skin injury that can lead to pressure ulcers (PUs). Many studies have indicated the need for evidence to find the most effective skin care protocol to reduce the incidence and severity of IAD in critically ill patients.
To develop a need-based interventional skin care protocol on IAD after identifying the risk of developing IAD in critically ill patients and by assessing the nurse's knowledge and practice on IAD.
Quantitative research approach with an exploratory research design was adopted in the study. A total of 40 staff nurses and 100 patients were included. To assess the knowledge of staff nurses regarding IAD, a knowledge questionnaire was administered and the IAD prevention practice among staff nurses was assessed with the help of an observation checklist. The risk of IAD among 100 critically ill patients was observed by the investigator, using a perineal risk assessment tool. The obtained data were analyzed by using descriptive and inferential statistics. this website The protocol was developed by the researcher and it was validated by 5 experts.
The results revealed that most of patients (60%) had a high risk for development of IAD. Most of the nurses had poor knowledge (40%) and had poor practice in assessment, perineal area, and prevention of infection area. Hence considering all these aspects, a protocol was developed.
The researchers developed a need-based skin care protocol to decrease the development of IAD.
Sharma P, Latha S, Sharma RK. Development of a Need-based Interventional Skin Care Protocol on Incontinence-associated Dermatitis among Critically Ill Patients. Indian J Crit Care Med 2021;25(2)158-165.
Sharma P, Latha S, Sharma RK. Development of a Need-based Interventional Skin Care Protocol on Incontinence-associated Dermatitis among Critically Ill Patients. Indian J Crit Care Med 2021;25(2)158-165.
This study aimed at evaluating the role of presepsin in early identification of sepsis and prediction of mortality in intensive care unit (ICU) patients in comparison to systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) score.
Forty patients were selected randomly after admission to adult ICU. Data from emergency room (ER) triaging, and initial laboratory results were gathered to calculate qSOFA score, SIRS criteria, and SOFA score. Presepsin measurement was performed within 6 hours from ER triaging.The patients were categorized into sepsis and nonsepsis groups depending on the clinical and microbiological criteria and SOFA score changes.
Twenty-six patients were diagnosed as septic with an average age of 68.04 ± 18.60 years, while 14 patients were nonseptic with an average age of 51.71 ± 24.88 years.Presepsin with a cutoff value >640 pg/mL (area under the curve [AUC] of 0.848 (
< 0.001) had a significant diagnostic accuracy of identifying sept of Presepsin for the Diagnosis of Sepsis and ICU Mortality A Prospective Controlled Study. Indian J Crit Care Med 2021;25(2)153-157.
Aspiration-induced lung injury accounts for a significant proportion of acute pulmonary dysfunction. Few studies were conducted to study the use of early bronchoscopy in mechanically ventilated patients with aspiration pneumonitis. This study aimed at assessing the clinical impact of early bronchoscopy for removal of gastric fluid and solid particles in the first 24 hours of mechanical ventilation (MV) on the progression of aspiration, MV days, intensive care unit (ICU) stay, development of pneumonia, and ICU mortality.
The study was an open-label randomized control trial and included 76 adult subjects mechanically ventilated due to aspiration pneumonitis, half the subjects received early bronchoscopy in the first 24 hours after aspiration for removal of aspirated material and bronchoalveolar lavage sampling, the other half received standard treatment.
The intervention group had a significant reduction in the rate of development of pneumonia at 60.5 vs 81.6%,
= 0.043 through the first week of admission, the intervention group has a significantly better hypoxic index (HI), white blood count, clinical pulmonary infection score, lung injury score, and sepsis-related organ failure assessment (SOFA) score compared to the control group. Although there was a reduction in mechanical ventilation days and ICU mortality in the intervention group vs control group that difference did not reach statistical significance.
Early bronchoscopy in mechanically ventilated patients with aspiration pneumonitis can be beneficial in improving respiratory functions and decreasing the incidence of development of aspiration pneumonia and may guide the de-escalation of antibiotic therapy.
Megahed MM, El-Menshawy AM, Ibrahim AM. Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis. Indian J Crit Care Med 2021;25(2)146-152.
Megahed MM, El-Menshawy AM, Ibrahim AM. Use of Early Bronchoscopy in Mechanically Ventilated Patients with Aspiration Pneumonitis. Indian J Crit Care Med 2021;25(2)146-152.