New markers in sepsis

Sepsis is a complex disease associated with high morbidity and mortality. Early diagnosis, administration of appropriate antimicrobial therapy and source control are the cornerstones of treatment. The use of biomarkers to guide management of sepsis has been extensively investigated and is well described in the literature. However no single biomarker has been validated for the diagnosis of sepsis, prognostication or to guide antimicrobial prescribing. So their role in clinical practice is still unclear. An approach that integrates data from various combinations of biomarkers with the clinical information available at the bedside shows promise but requires further evaluation

Protocolized eye care prevents corneal complications in ventilated patients in a medical intensive care unit

Eye care is an essential component in the management of critically ill patients. Standardized eye care can prevent corneal complications in ventilated patients. This study was designed to compare old and new practices of corneal care for reduction in corneal complications in ventilated patients. This study was done in three phases each of six month duration. Phase 1 was the ongoing practice of eye care in the unit. Before the start of phase 2, a new protocol was made for eye care. Corneal complications were observed in terms of haziness, dryness, and ulceration. All nursing staffs were educated and made compliant with the new protocol. In phase 2, a follow-up audit was done to check the effectiveness and compliance to protocol. In phase 3, a follow-up audit was started 3 months after phase 2. In phase 1, total ventilated patients were 40 with 240 ventilator days. The corneal dryness rate was 40 per 1000 ventilator days while the haziness and ulceration rate was 16 per 1000 ventilator days each. In the second phase 2, total ventilated patients were 53 making 561 ventilator days. The rate of corneal haziness and dryness was 3.52 and 1.78 per 1000 ventilator days, respectively, with no case of corneal ulceration. In phase 3, the number of ventilated patients was 91 with 1114 ventilator days. The corneal dryness rate was 2.69 while the haziness and ulceration rate was 1.79 each. Protocolized eye care can reduce the risk of corneal complications in ventilated patients

Bronchoscopy as a rescue therapy in patients with status asthmaticus: two case reports and review of literature

Management of status asthmaticus requires more than guidelines-guided therapy. Occasionally, uncommon therapeutic interventions and procedures may provide significant benefits. The role of bronchoscopy in fatal asthma is still not clearly defined. We illustrate two cases of severe status asthmaticus on mechanical ventilation who showed remarkable improvement after therapeutic bronchoscopy