Browsing by Author "Subash Sankaralingam"

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A 2x1 oral care strategy (2% chlorhexidine + 1% sodium bicarbonate) significantly lowers VAP rates in mechanically ventilated CKD patients
(Faculty of Anaesthesia, Pain and Intensive Care, AFMS, 2025) Subash Sankaralingam; Arvind Bhalekar; Atul Kumar Singh; Sandeep Loha; Sanjeev Kumar; Aditya Prakash Nayak
Background & objective: Chronic kidney disease (CKD) patients in the ICU have elevated ventilator-associated pneumonia (VAP) risk. Chlorhexidine (CHX) oral care is standard, but efficacy may be enhanced by adding sodium bicarbonate (NaHCO₃) to alkalinize the oral environment and inhibit pathogenic colonization. We conducted this study to determine whether combining 2% CHX with 1% NaHCO₃ reduces VAP incidence versus CHX alone in mechanically ventilated CKD patients. Methodology: In this prospective, randomized, double-blind, placebo-controlled trial, 100 CKD patients (18–65 yrs) ventilated > 48 h were randomized to 2% CHX + 1% NaHCO₃ (n = 50) or 2% CHX + saline placebo (n = 50) twice daily for 5 days. Primary outcome: VAP incidence (CPIS ≥ 6 + clinical/radiological criteria). Secondary: oral pH, oropharyngeal colonization, microbiology, ventilation/ICU/hospital stay, mortality. Data analyzed with appropriate parametric/non-parametric tests; P < 0.05 significant. Results: Baseline characteristics were comparable. VAP incidence was halved with combination care (16.0% vs 32.0%; P = 0.048), with delayed onset (median 4.5 vs 3.0 days, P = 0.032) and higher Day-5 VAP-free survival (84% vs 68%). Oral pH rose significantly from Day 3 in the intervention arm (Day 5: 7.54 vs 7.29; P = 0.001). Heavy oral colonization was lower, but non-significant. MDRO rates (37.5% vs 56.3%) and carbapenem resistance were reduced. Ventilation duration (6.2 ± 2.1 vs 7.8 ± 2.5 days, P = 0.004) and ICU stay (8.9 ± 3.0 vs 10.5 ± 3.4 days, P = 0.011) were shorter. However, the mortality differences were non-significant. Conclusions: In high-risk CKD ICU patients, adding 1% NaHCO₃ to standard 2% CHX oral care halved VAP incidence, delayed onset, improved oral pH, reduced resistance rates, and shortened ventilation/ICU stays. This simple, low-cost measure warrants incorporation into VAP prevention bundles. © 2025, Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
Intractable post dural puncture headache in a patient with undiagnosed intrathoracic meningocele
(Turkish Society of Algology, 2025) Reena; Subash Sankaralingam; Swati Singh; Amrita Rath; J. Manikandan; Ashutosh Vikram
Post dural puncture headache (PDPH) is a troublesome complication of dural puncture. Although its risk factors and management have been extensively discussed in the literature, the underlying cause may sometimes remain unclear, making treatment challenging for anaesthesiologists. We describe a noteworthy case of PDPH following spinal anaesthesia administered for an emergency cesarean section in a patient with known neurofibromatosis. Despite conservative and pharmacological treatment, followed by an autologous epidural blood patch, no symptomatic relief was achieved. Neuroimaging of the brain and spine revealed a large intrathoracic meningocele (IM). Although rare, intrathoracic meningocele should be considered in patients with neurofibromatosis who develop intractable PDPH after dural puncture, with neuroimaging being the most effective diagnostic tool. © 2025 Turkish Society of Algology.