ABSTRACT
Background: Intensive Care Unit (ICU) readmissions during the same hospitalization are associated with increased hospital stays, morbidity and mortality. Whereas mortality rates in patients admitted to the ICU for the first time may range from 10 to 20% depending on various factors, readmission mortality rates can be up to 50 to 70%. Factors leading to readmission in ICU in Indian Armed Forces Hospitals have not been well studied till date. Methods: This was a record based cross sectional descriptive study conducted at the ICU of a tertiary care Armed Forces hospital. Demographic and clinical data of ICU patients were analysed. ICU admission and discharge data for the duration of last three years were acquired from admission and discharge registers and Hospital Informatics system (HIS) software. The primary outcome was readmission rates to ICU during the same hospitalization. Secondary outcomes included diagnosis at time of index admission (first time admission) to ICU and at readmission, multiple readmissions to ICU and mortality rates in readmitted patients. Results: There were 3021 admissions to the ICU during the study period. 422 patients succumbed to illness during initial admission resulting in a mortality rate of 14%. 198 patients were readmitted to the ICU. The readmission rate to the ICU was 7.8%. The mortality rate in readmitted patients was 31% as compared to the ICU mortality rate of 14%. The triggering factors for readmission were usually respiratory or cardiac decompensations. Conclusion: Readmission to ICU occurred in about 7.8 % of all ICU patients in our study. ICU readmissions increase the risk of adverse outcomes. Objective measures in the form of a discharge protocol incorporating the stability and work index for transfer (SWIFT Score) may help minimizing readmission to ICU. Such protocols must be in place while shifting any patients from ICU so as to improve outcomes in patients of tertiary care hospitals.
ABSTRACT
Background: Spinal anaesthesia is one of thecommonest anaesthetic techniques for infra-umbilicalsurgeries. Administration of dexmedetomidine forsedation during spinal anaesthesia is found to prolongthe duration of block. Aim and Objectives: To evaluating the effect of intravenous dexmedetomidine onblock characteristic of spinal anaesthesia withhyperbaric bupivacaine. Material and Methods: Atotalof 120 patients scheduled for various elective surgeriesunder spinal anaesthesia with hyperbaric bupivacainewere included in the study. The patients were dividedinto two groups of each containing 60 subjects. GroupD received 1µg/kg bolus dexmedetomidine over 10minutes immediately after spinal anaesthesia followedby 0.5µg/kg/hr infusion till the end of surgery andGroup S received similar amount of saline. Datacollected include onset of sensory and motor blockade,time for two segmental regression of block, duration ofanalgesia and sedation score were noted. Results:Onset of sensory block was faster in group D(2.38±1.48 min) as compared to Group S (3.03±0.22min). Onset of motor block was significantly faster inGroup D (6.97±0.93 min) as compared to Group S(8.01±0.85 min). Time required for two segmentregression was prolonged in Group D (122.67±7.15min) as compared to Group S (65.76±4.71 min). Totalduration of analgesia was also prolonged in group D(4.29 ±1.04 hr) compared to Group S (2.24±0.29 hr).Conclusion: Intravenous administration of dexmedetomidine prolongs the duration of sensory and motorblockade with arousable sedation.