Browsing by Author "S.K. Mathur"

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Acute renal failure in the intensive care unit
(2006) J. Prakash; A.S. Murthy; R. Vohra; M. Rajak; S.K. Mathur
Background: Acute renal failure (ARF) in the intensive care unit (ICU) is associated with high mortality. A thorough understanding of the clinical spectrum of the disease is needed in order to devise methods to improve the final outcome due to this problem. Aims and Objectives: The aim of the present study was to analyze the clinical spectrum, causes, risk and prognostic factors and final outcome of ARF in the setting of ICU. Method: This prospective study involved patients admitted to ICU during the period between September 2003 to January 2005 (17 months). Patients who developed ARF during the ICU stay were included in the study. The clinical and laboratory data were collected at admission and then on daily basis. Data recorded included; patient characteristics, underlying medical conditions responsible for ICU admission, dialytic status, need for ventilation, total duration of ICU stay, APACHE-III score and final outcome, and these data were analyzed for predicting survival using univariate and multivariate analysis. Results: Twelve hundred and fifteen (1215) patients were admitted to ICU from September 2003 to January, 2005 and 46 (3.79%) patients developed ARF after admission to ICU. Mean age of patients was 44.9 ± 17 years and 56.5% were males. Comorbidity was seen in 24 (52%) patients; hypertension (34.7%), diabetes mellitus (28.3%), coronary artery disease (30.4%) and chronic kidney disease (13%). ARF had developed complicating medical and surgical conditions in 33 (71.7%) and 11 (23.7%) patients respectively. The etiology of ARF was multifactorial and included; hypotension (71.74%), volume depletion (17.4%), nephrotoxic drugs (67.39%), and sepsis (69.5%). Multiple organ system failure (MOSF) was noted in 63% of cases and dialysis was required in 25 (54.3%) patients. Mortality occurred in 63% of patients. MOSF and sepsis were found to be significant adverse prognostic factors when multiple logistic regression analysis was done. Conclusions: ARF was seen in 3.79% of cases in our ICU and associated with poor prognosis. Presence of sepsis, MOSF, higher APACHE - III scores and ventilation need were correlated with higher mortality in ARF patients in the intensive care unit. © JAPI.
Comparing semi-recumbent lateral position vs semi-recumbent position in preventing VAP and ARDS in traumatic brain injury patients requiring mechanical ventilation
(Churchill Livingstone, 2024) Neelesh Anand; S.K. Mathur; Manjaree Mishra
Background and aims: Ventilator-associated pneumonia is a common nosocomial infection in the intensive care unit among traumatic brain injury patients, resulting in increased morbidity and mortality. We have assessed the effectiveness of semi-recumbent lateral positioning in comparison with semi-recumbent positioning to prevent ventilator-associated pneumonia and acute respiratory distress syndrome in traumatic brain injury patients requiring mechanical ventilation. Methods: In a single-blind prospective randomised clinical trial, 100 patients were recruited in the intensive care unit and randomly assigned to the control group (n = 50) and intervention group (n = 50). Patients in control group maintained semi-recumbent position with 30–45° head of bed elevation and intervention group maintained semi-recumbent lateral position with lateral turning ≥45° and head of bed elevation 30–45° every 4 h. Bronchoalveolar lavage for diagnosis of ventilator-associated pneumonia, Glasgow Coma Score, clinical pulmonary infection score, duration of mechanical ventilation, PaO2/FiO2 ratio and incidence of acute respiratory distress syndrome were investigated for 10 days. Results: Comparing semi-recumbent position with semi-recumbent lateral position, the latter showed significant decrease in ventilator-associated pneumonia with lower clinical pulmonary infection score at day 3 (6.5 ± 2.9; 1.8 ± 2.1; p < 0.001), day 7 (6.6 ± 2.6; 2.6 ± 2.3; p < 0.001) and day 10 (7.7 ± 2.9; 2.3 ± 2.3; p = 0.001) and decreased incidence of positive bronchoalveolar lavage cultures at day 3 (p = 0.02), day 7 (p < 0.001) and day 10 (p = 0.001). Duration of mechanical ventilation was significantly reduced at day 7 (p = 0.04) and day 10 (p < 0.001). The incidence of acute respiratory distress syndrome was not different. Conclusion: Semi-recumbent lateral position results in significant less incidence of ventilator-associated pneumonia and reduced duration of mechanical ventilation. Trial registration number: ICMR-NIMS CTRI/2019/01/016829. © 2024 Elsevier Ltd
Role of neomycin polymyxin sulfate solution bladder wash for prevention of catheter associated urinary tract infection in traumatic brain injury patient admitted to Intensive Care Unit: A prospective randomized study
(Medknow Publications, 2018) Neeraj Kumar; Yashpal Singh; Ghanshyam Yadav; S.K. Mathur; Umesh Kumar Bhadani
Background: Catheter - associated urinary tract infection (CAUTI) remains a critical threat for patients in intensive care unit especially in traumatic brain injury patients with low Glasgow coma score (GCS). Almost all patients in ICU receive antibiotic either prophylactic or therapeutic based on local antibiogram of particular ICU or hospital. For prophylaxis, systemic antibiotics are used. It will be helpful to avoid systemic side effects by introducing antibiotics locally through bladder irrigation. The indwelling urinary catheter is an essential part of modern medical care. Aims and Objectives: The primary objective was to study the effect of Neomycin and Polymyxin sulphate solution for bladder wash on CAUTI in traumatic brain injury patients. The secondary objectives was to study the various organisms causing CAUTI and their antibiotic sensitivity and resistance pattern. Materials and Methods: This was a prospective randomized controlled study performed on 100 patients who met the inclusion criteria at the trauma intensive care unit of Banaras Hindu University between September and February 2016. The patients were randomized into two groups - one was the study group which received Neomycin and Polymyxin Sulphate solution bladder wash, while the other was the control group that received Normal saline bladder wash. Urine samples were collected at certain days and sent for culture and sensitivity. Results: There was significant reduction in the incidence of CAUTI in neomycin/polymyxin test group in comparison to normal saline irrigated control group.Out of 50 patients in test group 8 patients and in control group 26 patients was identified as CAUTI positive and they were statistically significant. In our study pseudomonas aeruginosa (51%) was the commonest isolated pathogen. Conclusions: Neomycin and Polymyxin Sulphate bladder wash was effective in preventing CAUTI. It can thus decrease the antibiotic usage thereby preventing the emergence of antibiotic resistance. © 2018 International Journal of Critical Illness and Injury Science.
Thoracic epidural catheterization leading to delayed transient neurological symptoms with normal imaging findings
(2008) S.K. Mathur; A. Chakraborty; S. Jain; A. Jain
Paraparesis after epidural catheterization is rare but may be multifactorial. We report a case of temporary paraparesis in a 32-year-old female patient after thoracic epidural catheterization performed analgesia. A 16 G epidural needle was introduced at the T7-T8 interspace but as frank blood came through, it was withdrawn and was reinserted at the T8-T9 interspace. An 18 G epidural catheter was introduced and 10 ml of 0.125% bupivacaine with buprenorphine 150 mcg was given. Further top-ups were given for 48 h on complain of pain. There was an episode of hypotension after giving the epidural drug but later on the patient remained haemodynamically stable. On the fourth post-operative day, the patient reported paraparesis with heaviness and tingling sensation in both lower extremities. MRI was normal with no evidence of spinal cord compression, oedema, haematoma or abscess. The patient improved gradually within a period of 3 days. The possible causes of delayed onset of neurological symptoms are discussed. © 2008 The Authors.