observational study of the risk factors and incidence of invasive fungal infections in ICU patients

The fungal infections have become a persistent health problem, still always remain under reported. A change in species distribution has been observed now a days with the emergence of many non-albicans candida species. Our study aimed at evaluating the incidence of invasive Candidiasis [Candida albicans and non-albicans] and to assess the risk factors and predictors of mortality in seriously ill patients. This prospective, observational study was conducted at Division of Intensive Care Unit, Institute of Medical Science, BHU, Varanasi [India], during the period of 2009 to 2011. Patients with >8 out of 16 risk factors, e.g. prolonged antibiotic use, IV cannulation, steroid use etc, Candida scores [CS] > 2, Age >12 years and ICU stay >2 days were included in the study. Those with Candida scores > 3 were prophylactically given fluconazole. A case report performa was completed for each patient, including demographic characteristics, dates of hospital and ICU admission and of discharge, vital sign status at discharge, previous treatment with antibiotics or immunosuppressive agents, presence of risk factors. Patients were followed till discharge from the ICU or death. Candida was isolated from blood in 53/206 patients. The P-value calculated in five risk groups, e.g. diabetics, patients receiving TPN, neutropenic patients, HIV and malignancy was significant [P<0.05]. For all other risk factors P-value was >0.05. Over half of the Candida isolates recovered from blood were non-albicans species. The overall mortality in candidaemia patients was 37/53 [69.81%]. Mortality was low with Candida tropicalis [57.7%] but number of patient was high among candida species. Multiple risk factors were found to be associated with invasive fungal infection in critically ill patients. In the ICU population studied, candidemia was due to non-albicans spp. The importance of Candida scores on predicting mortality was also observed

Challenges during prolonged mechanical ventilation of a morbidly obese lady with hypothyroidism and sleep apnea syndrome

Obesity, sleep apnea syndrome and hypothyroidism cause management of mechanical ventilation and weaning a difficult task. We report management of mechanical ventilation and subsequent weaning of a morbidly obese lady of BMI 42 kg/m2 with hypothyroidism and sleep apnea for 52 days. To make the matter worse, she had accidental extubations, multiple cardiac arrests, pneumonia and renal dysfunction during her ICU stay