Unplanned prolonged postanaesthesia care unit length of stay and factors affecting it

To identify the factors that prolong the length of stay in the post anaesthesia care unit [PACU]. This audit was conducted in the PACU of a university hospital. A special form was designed and filled for those patients who stayed unplanned in the PACU for more than two hours. All patients who were admitted to the PACU after surgery were included. Patients undergoing cardiothoracic surgery, those directly shifted to ICU and cases done under local anaesthesia were excluded. Data was collected for 20 months by a designated recovery nurse for all included patients including those admitted outside the scheduled surgery hours. The total number of patients who were admitted to the PACU during the audit period were 13644, out of these 1114 [8.1%] stayed in the PACU for more than 2 hours. The percentage of overstay patients on monthly basis ranged from 6.4% to 10%. The commonest reason was the need for postoperative monitoring 578 [51.8%], unavailability of beds in the special care areas 264 [23.7%], pain management 68 [6.1%] and 61 [5.4%] for postoperative ventilation. Our results show that majority of patients stayed in the PACU for more than two hours either because they needed postoperative monitoring or because of unavailability of bed in the special care areas

Pneumoperitoneum following mechanical ventilation in child

A case of spontaneous pneumoperitoneum in a 5 months old child is being described. This child developed massive pneumoperitoneum while being mechanically ventilated. This possibility should always be kept in mind specially if child develops pneumoperitoneum in the presence of very high airway pressures. A 5 month old baby girl with a history of loose motions and fever for 1 week was presented in the emergency room of our hospital. Her past medical history was unremarkable. On examination she was restless, her heart rate was 140/min, respiratory rate was 65/min, and oxygen saturation 59%. Her blood pressure was 100/60. She had a cardiopulmonary arrest in the emergency room. She was resuscitated and shifted to ICU and put on mechanical ventilation. Further examination and investigations revealed that she was suffering from rickets, pneumonia and hypocalcemia. One the 1st day of admission, she was put on pressure control ventilation. Her pressure control was set at 8 cms H20, respiratory rate was 20/min, FiO2 was kept at 0.5. Her arterial blood gases were showing a pH of 7.43, PaCO2 of 32 mmHg, PaO2 of 80 mmHg, HCO3 was 21 meq/l and SaO2 was 98%. Her chest x-ray revealed evidence of surgical emphysema in the neck and hyperinflation in both lungs. On 3rd day in the ICU deterioration in lung function was noted. Her chest x-ray revealed pneumomediastinum and irregular densities in the lung field suggesting onset of respiratory distress syndrome

Ectopic placement of central venous catheter, importance of x-ray chest

A case of malpositioning of central venous catheter which was judged to be correctly placed on clinical criteria is being presented. Abberant positioning was picked up on X-ray chest

Complications of endotracheal intubation in mechanically ventilated patients in a general intensive care unit

During a period of one year, 126- patients were prospectively audited to analyse complications of endotracheal intubation in a general intensive care unit setting. A total of 62 complications were observed in 48 patients. The most frequent complications during intubation were hypotension and bradycardia. The blockage of endotracheal tubes significantly increased with the duration of intubation. Sore throat was the commonest [22%] complication following extubation. Other complications like stridor and ulceration of mouth and lips which followed extubation were not related to the duration of intubation