RESUMO
Background: In diabetic patients, the glycemic control is usually represented by hemoglobin A1c (HbA1c), fasting plasma glucose (FPG) and postprandial glucose (PPG), which are usually referred as the “glucose triad”. Apart from these three, “glucose variability” (GV) has been considered as an additional marker, and may be equally important. Materials and methods: The study was a prospective observational study conducted in critical care unit of NRI General Hospital. The study has included all the critically ill neurological patients admitted in the study setting during the study period. A total of 114 participants were included in the study. All critically ill neurological patients were included in the study and were assessed with hourly Glucometric random blood sampling (GRBS) for 6 hours for initial 15 days of admission. Glycemic Pasha SA, Pasha SA, Kusuma B, T. Suhasini. Association between the glycemic variability and mortality in critically ill neurological patients - A hospital based observational study. IAIM, 2016; 3(7): 42-49. Page 43 variables have been recorded including Mean blood glucose (MBG), Glycemic liability index (GLI), Standard deviation of blood glucose. APACHE II scores were also recorded. Results: The mean age of the study participants was 51.69 (±20.21) years. Males constituted 57% and females constituted 43% of study population. The proportion of subjects with diabetes was 51.8%.The mean days of ICU stay was 8.19 (±3.86) days. The morality risk in study population was 28%. Univariate logistic regression analysis showed highest mortality in < 30 year age group. When compared to below 30 year age group, the risk of mortality in 30 to 49 year group was 44%, was 27.6% in 50 to 69 years age group and 71.4% in above 70 years age group. The mortality was almost similar in both genders. The mean APACHE II score was 4 units higher in mortality group, compared to non-mortality group (95% CI 1.64 to 6.37, p value 0.001). Even though the mean GLI, SD GLI values were 39.24 and 73.67 times higher in people with mortality these differences were statistically not significant. The differences in the mean values of mean blood glucose and SDBG were very negligible between the subjects with and without mortality. Conclusion: The study findings reveal that though, APACHE II scores seem to positively associated with mortality among critically ill neurological patients, the glycemic variability though positively influenced the mortality, it is not significant. Further studies assessing the role of GV specifically among such patient groups with a larger sample might reveal the true influence of such interaction.
RESUMO
PURPOSE: The objective of this study is to determine the role of quantitative cultures of non-bronchoscopic samples such as blinded bronchial sampling (BBS) and endotracheal aspirates (ETA) in the management of ventilator associated pneumonia (VAP). The study also evaluates the clinical diagnosis of VAP based on the inclusion of Gram stain results of BBS/ETA samples into modified clinical pulmonary infection score (CPIS). METHODS: Fifteen out of the 120 patients admitted to respiratory intensive care unit under mechanical ventilation for more than 48 hours with a clinical suspicion of VAP, were included in this study. Quantitative cultures of BBS and ETA were performed from all the 15 patients. RESULTS: VAP was confirmed in 11 out of 15 cases by quantitative cultures of either the BBS or ETA samples. The condition of 8/11 VAP confirmed patients improved significantly with the change in antibiotic therapy. The overall mortality rate was found to be 18%. The agreement between BBS and ETA results was found to be 83.3%. Modified-clinical pulmonary infection score (CPIS) increased significantly when Gram stain results of BBS/ETA samples were included, thereby strengthening the clinical diagnosis of VAP. CONCLUSIONS: Quantitative culture of lower respiratory tract samples obtained by non-bronchoscopic methods may be a useful alternative to bronchoscopy, in the diagnosis of VAP. Inclusion of Gram stain results of BBS/ETA into modified-CPIS may augment the diagnostic evaluation of VAP.