ABSTRACT
Purpose: It is rationale to predict fluid responsiveness for optimum hemodynamic management. Passive Leg Raising (PLR) causes reversible increase in cardiac output (CO) and changes in end-tidal CO 2 pressure (ETCO 2 ) can be considered surrogate for CO variations. We aimed to assess the variations in EtCO2 with PLR and fluid challenge (FC) and also compared it with systolic arterial pressure (SAP), mean arterial pressure (MAP), heart rate (HR) and central venous pressure (CVP). Methodology: This Prospective study was conducted in the ICU of a tertiary care teaching public hospital. PLR was performed before FC in patients of circulatory failure on mechanical ventilation. ETCO 2 and hemodynamics were monitored and compared and correlated after PLR and FC. ROC curve of parameters, based on their Area under the Curve (AUC) was compared. MS Excel, PSPP version 1.0.1 was used for analysis. Results: Among hundred patients studied, 74 showed ETCO2 change? 2 mmHg (>5%) and were fluid responders. Increase in Etco2 after PLR at 1minute and FC at 30 minutes was statistically significant (p=2.73×10 -73 ) so is SAP(p=4.02×10 -75 ) and MAP(p=1.75×10 -75 ). AUC of predictive performance of parameters showed change in ETCO 2 (AUC ROC 0.985 [0.938 to 0.999]) had significantly outperformed CVP (AUCROC 0.822 [0.733-0.892]), SAP (AUCROC 0.793 [0.701–0.868]), MAP (AUCROC 0.810 [0.719–0.881]), HR (AUCROC 0.574 [0.471–0.673]). Conclusion: Variations in ETCO 2 >5% induced by PLR can predict fluid responsiveness and is a reliable, non-invasive, easy, quick, and reversible method. ETCO 2 is better predictor than SAP, MAP, CVP, and HR during PLR and FC. We may recommend PLR-induced changes in ETCO2 to predict fluid responsiveness in mechanically ventilated patients.
ABSTRACT
Introduction: The Guillian Barre syndrome (GBS) is characterised by acute areflexic paralysis with albumincytological dissociation. Study was undertaken to analyze the electrophysiological studies, clinical profile and outcome of GBS at our institute. Material and Methods: This study was a hospital based descriptive and prospective study was conducted on patients admitted in the Medical intensive care unit. Patients with age more than 18 years, irrespective of their sex, diagnosed as GBS, fulfilling the criteria as modified by Asbury were included in the current study. Association between qualitative variables was assessed by Chi-Square test. Quantitative data was represented using mean ± SD, median. Results: Out of 50 enrolled, 21 patients belonged to age 21 to 40. 33 pts were male and 17 pts were female, 7 patients expired. Two peak of occurrence of GBS was found in age one in age group 21 to 41years and another in age more than 51 years.13 patients had history of antecedent infection. 35 patients had albumin-cytological dissociation. As per the results of nerve conduction study, patients were categorized in the following 3 groups AMAN-24, AIDP-14 and ASMAN-12. Conclusions: The independent predictors for the need of mechanical ventilation were history of breathlessness on admission, SBC of equal to or less than 10, upper or lower limb power of less than or equal to 2 (P valve <0.01). The predictors of poor outcome were presence of sepsis, need for mechanical ventilation, VAP, SBC of < 10 and lower limb power < 2.