Diaphragmatic excursion: does it predict successful weaning from mechanical ventilation?

Objective: To measure the diaphragmatic excursion and its outcome on weaning from mechanical ventilation

Study Design: Cross-sectional comparative study

Place and Duration of Study: Medical Intensive Care Unit [ICU], Military Hospital [MH], Rawalpindi, Pakistan, from January to December 2014

Methodology: Diaphragmatic excursion [DE] in cm was measured through ultrasound by marking liver and spleen displacement in patients who fulfilled the criteria of removal from ventilatory support. The patients were followed up for 48 hours and classified according to the outcome as successful weaning and weaning failure

Results: Out of 100 cases, 76 patients had a successful weaning while 24 had a failed weaning outcome. At a diaphragmatic excursion of 1.2 cm and more, out of 67 cases, 60 had a successful weaning [89.55%] while 7 cases [10.45%] had a weaning failure. At an excursion of less than 1.2 cm, 17 out of 33 cases [51.5%] had successful weaning while 16 [48.48%] had weaning failure. At this cut off point [1.2 cm], the sensitivity and specificity for successful weaning were 78.95% and 70.83%, respectively. The positive and negative likelihood ratio [LR] for these values being 2.70 and 0.29, respectively. The positive predictive value was 82.35% and negative predictive value 60.00%

Conclusion: Ultrasonographic measurement of diaphragmatic excursion is a good method for predicting weaning outcome from mechanical ventilation

Correlation of inferior vena cava [IVC] diameter and central venous pressure [CVP] for fluid monitoring in ICU

To determine intravdar fluid status in mitidy ill patients using inferior vena cava diameter and correlating it with central venous pressure. Cross sectional study. Intensive care dement, h4Xitary Hospital Rawalpindi from Jan 2013 to Aug 2013. We included 115 adult patients af both genders in age range of 18 to 87 years by consecutive sampling admitted in intensive care unit. U1txasound guided IVC diameter was assessed in supine patients. Data was simultaneously collected from the CVP catheter. Variables included in study were age, gender, CVP, IVC diameter. CVP ranged from 4 to 26 an H20 with mean of 8 cxn H20 [SD = 6.24]. Mean IVC diameter; increased with increase in CVP. Correlation between CVP and max IVC diameter was moderate and significant [r = 0.53, p < 0.001]. Correlation between CVP and min IVC diameter was also moderate and significant [r = 0.58, p < 0.001]. A simple bedside sonography of inferior vena cava diameter correlates well with extremes of CVP values and can be helpkd in assessing intravascular fluid status in these patients

Frequency of positive tuberculin skin test in BCG-vaccinated asymptomatic adults in Pakistan

To determine the frequency of positive tuberculin skin test [TST] in BCG-vaccinated asymptomatic healthy Pakistani adults. Cross sectional study. The study was carried out in Military Hospital, Rawalpindi in 2008 over six months. One hundred and thirty six individuals fulfilling inclusion and exclusion criteria of study were recruited after consent. They were subjected to TST [Mantoux test] and results were interpreted after 72 hours of injection. Test was recorded as positive if the indurated area was >/= 10 mm, and strongly positive if >/= 15 mm. All participants were male with the mean age of 26.35 +/- 6.164 years. The overall frequency of positive TST was 41.2%. Out of these, 9.6% were strongly positive. In healthy, BCG-vaccinated adult Pakistani population, TST is found to be positive in high frequency, and even induration of more than 15 mm was seen in significant number. In view of low specificity, TST should not be relied upon for the diagnosis of active tuberculosis [TB]

Frequencies of anaemia and thrombocytopenia in patients of malaria: a hospital based study

To determine the frequencies of anaemia and thrombocytopenia in patients of malaria. Descriptive study. Study was conducted from June 2008 to February 2009 at the Combined Military Hospital Quetta, a tertiary care hospital. Study included all the patients presenting with blood film proven malaria. Their hematological parameters including hemoglobin, total white cell count and platelets were studied. Anemia was seen in 61% [120 patients] of the patients with malaria and thrombocytopenia in 74% [146 patients] of cases. Frequency of anemia and thrombocytopenia in patients of malaria was quite high. It is suggested that the index of suspicion for malaria should be kept high in patients presenting with fever associated with anemia and/or thrombocytopenia