Association of hyperglycaemia at-admission & diabetes mellitus with 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection: A retrospective study

Background & objectives: The association between hyperglycaemia at admission, diabetes mellitus (DM) status and mortality in hospitalized SARS-CoV-2 infected patients is not clear. The purpose of this study was to determine the relationship between DM, at-admission hyperglycaemia and 28 day mortality in patients admitted with moderate-severe SARS-CoV-2 infection requiring intensive care. Methods: All consecutive moderate-to-severe patients with SARS-CoV-2 infection admitted to the intensive care units (ICUs) over six months were enrolled in this single-centre, retrospective study. The predicators for 28 day mortality were analysed from the independent variables including DM status and hyperglycaemia at-admission. Results: Four hundred and fifty two patients with SARS-CoV-2 were admitted to the ICU, with a mean age of 58.5±13.4 yr, 78.5 per cent being male, HbA1c of 7.2 per cent (6.3-8.8) and 63.7 per cent having DM. Overall, 28 day mortality was 48.9 per cent. In univariate analysis, mortality in diabetes patients was comparable with non-diabetes (47.9 vs. 50.6%, P=0.58), while it was significantly higher in hyperglycaemic group (60.4 vs. 35.8%, P<0.001). In multivariate Cox regression analysis, after adjusting for age, sex and comorbidities, hyperglycaemia at-admission was an independent risk factor of mortality [hazard ratio (HR) 1.45, 95% confidence interval (CI) (1.06-1.99), P<0.05]. Interpretation & conclusions: This study showed that the presence of hyperglycaemia at-admission in critically ill SARS-CoV-2 patients was an independent predictor of 28 day mortality. However, the findings may be susceptible to unmeasured confounding, and more research from prospective studies is required.

Comparison between marked versus unmarked introducer needle in real‑time ultrasound‑guided central vein cannulation: A prospective randomized study.

Introduction: Introducer needle tip is not clearly visible during the real‑time ultrasound (US)‑guided central vein cannulation (CVC). Blind tip leads to mechanical complications. This study was designed to evaluate whether real‑time US‑guided CVC with a marked introducer needle is superior to the existing unmarked needle. Methodology: Sixty‑two critically ill patients aged 18–60 years of either sex were included in the study. The patients were randomized into two groups based on whether a marked or unmarked introducer needle was used. Both groups underwent real‑time US‑guided CVC by a single experienced operator. Aseptically, introducer needle was indented with markings spaced 0.5 cm (single marking) and every 1 cm (double marking). This needle was used in the marked group. Approximate depths (centimeter) of the anterior and posterior wall of the internal jugular vein, anterior wall of the internal carotid artery, and lung pleura were appreciated from the midpoint of the probe in short‑axis view at the level of the cricoid cartilage. Access time (seconds) was recorded using a stopwatch. A number of attempts and complications such as arterial puncture, hematoma, and pneumothorax of either procedure were compared. Results: Both marked needle and unmarked needle groups were comparable with regard to age, gender, severity scores, platelet counts, prothrombin time, and distance from the midpoint of the probe to the vein, artery, and pleura and skin‑to‑guide wire insertion access time. However, an average number of attempts (P = 0.03) and complications such as hematoma were significantly lower (P = 0.02) with the marked introducer needle group. Pneumothorax was not reported in any of the groups. Conclusion: Our study supports the idea that marked introducer needle can further reduce the iatrogenic complications of US‑guided CVC.

Use of optimized ultrasound axis along with marked introducer needle to prevent mechanical complications of internal jugular vein catheterization.

Internal jugular vein (IJV) catheterization is a routine technique in the intensive care unit. Ultrasound (US) guided central venous catheter (CVC) insertion is now the recommended standard. However, mechanical complications still occur due to non‑visualization of the introducer needle tip during US guidance. This may result in arterial or posterior venous wall puncture or pneumothorax. We describe a new technique of (IJV) catheterization using US, initially the depth of the IJV from the skin is measured in short‑axis and then using real time US long‑axis view guidance a marked introducer needle is advanced towards the IJV to the defined depth measured earlier in the short axis and the IJV is identified, assessed and cannulated for the CVC insertion. Our technique is simple and may reduce mechanical complications of US guided CVC insertion.

Continuous hypertonic saline for acute liver failure.

Acute liver failure (ALF) is a clinical condition with high mortality. The most common cause of death in ALF is cerebral edema. We present a 12-year-old boy with hepatitis A-related acute liver failure in grade IV hepatic encephalopathy successfully managed in the ICU using continuous hypertonic saline as the preferred osmotherapy.