Invasive Monitoring in the Intensive Care Unit

The purpose of monitoring of the patient in an intensive care unit (ICU) is to improve patient care, like bringing about a change in the treatment or transfer of the patient to a step-down unit. Monitoring also shows the extent of compliance with a formulated standard of care or the degree of deviation from the expected standard of care. The monitoring used for a patient admitted to an ICU can be invasive or noninvasive. Invasive monitoring in an ICU includes arterial blood pressure, transesophageal Doppler, central venous pressure (CVP) measurement, pulmonary artery catheterization, arterial blood gas (ABG) analysis and measurement of intracranial pressure (ICP) and intra-abdominal pressure (IAP). Monitoring of the physiologic parameters depends on the underlying illness of the patient and the availability of equipment in the ICU.

Invasive Monitoring in the Intensive Care Unit.

The purpose of monitoring of the patient in an intensive care unit (ICU) is to improve patient care, like bringing about a change in the treatment or transfer of the patient to a step-down unit. Monitoring also shows the extent of compliance with a formulated standard of care or the degree of deviation from the expected standard of care. The monitoring used for a patient admitted to an ICU can be invasive or noninvasive. Invasive monitoring in an ICU includes arterial blood pressure, transesophageal Doppler, central venous pressure (CVP) measurement, pulmonary artery catheterization, arterial blood gas (ABG) analysis and measurement of intracranial pressure (ICP) and intra-abdominal pressure (IAP). Monitoring of the physiologic parameters depends on the underlying illness of the patient and the availability of equipment in the ICU.

Torsemide: A New Loop Diuretic.

Loop diuretics are often administered to hospitalized patients to augment urinary output. They play an essential role in the treatment of fluid overload in patients of congestive heart failure and chronic renal failure. Torsemide is a new loop diuretic that has revolutionized the therapy of fluid overload disorders. Torsemide has a higher bioavailability, greater potency and longer duration of action than frusemide. Torsemide causes significantly greater diuresis, natriuresis, lesser kaluresis, greater reduction in body weight and improvement in edema and ascites as compared to frusemide.

Glucose Tolerance in Nondiabetic Patients after First Attack of Acute Myocardial Infarction and its Outcome.

Aims: To find out the incidence of impaired glucose tolerance (IGT) and frank diabetes mellitus (DM) in patients of acute myocardial infarction (AMI) and to study the natural history of IGT in relation to AMI. Study Design: A crosssectional study was done in 60 patients of AMI in whom oral glucose tolerance test (OGTT) was performed after admission. Those with normal glucose tolerance on admission and till discharge were included in the study. Material and Methods: The study was conducted at the intensive coronary care unit (ICCU) of Shri Sayajirao General (SSG) Hospital, Vadodara, Gujarat. The study was done over a period of seven months in 60 patients of AMI. Results: The present study revealed that cardiovascular complications related to AMI were more common in patients with abnormal glucose tolerance. Conclusion: Glucometabolic abnormalities in nondiabetic patients with acute coronary event have an influence on in-hospital and short-term cardiovascular morbidity as well as mortality.

Evaluation of Cardiac Status of Patients with Sickle Cell Disease by 2D Echocardiography with Specific Reference to Pulmonary Hypertension.

Aims: To evaluate the cardiac status in patients with sickle cell anemia and sickle cell trait by 2D echocardiography (2D Echo) with specific reference to pulmonary hypertension (PH) and to assess prevalence and severity of PH in this population. Study design: A prospective, cross-sectional study was done in 50 patients with sickle cell disease in whom. 2D Echo was performed, which assessed their cardiac status with specific reference to PH. Material and methods: The study was conducted on outdoor and indoor patients of the Dept. of Medicine at Shri Sayajirao General (SSG) Hospital, Vadodara, Gujarat. The study was conducted over a period of 18 months in 50 patients with sickle cell anemia as well as sickle cell trait. Results: The present study revealed that PH was present in one-third of patients with sickle cell disease. Conclusion: Pulmonary arterial hypertension is one of the leading causes of morbidity and increased mortality in adults with sickle cell disease.

Antimicrobial Therapy in the Intensive Care Unit.

Severe sepsis and septic shock in the intensive care unit (ICU) needs emergent coverage with empirical broad-spectrum antibiotics, with a commitment to de-escalation once the organism and its susceptibility to a particular antibiotic becomes known. The dose and duration of antibiotic must be optimized according to standard guidelines to prevent emergence of resistant pathogens. Strategies of using Procalcitonin measurements in guiding the duration of antibiotic treatment and aerosolized antibiotics are helpful in optimizing antibiotic usage. Efforts are needed to prevent emergence of antibiotic resistance by pathogens, as the antibiotic pipeline is dwindling and the number of newly discovered multidrug-resistant (MDR) pathogens is increasing. Prevention of infection must be given top priority by strict adherence to asepsis measures.

Corrosive Poisoning.

Corrosive poisoning is a common emergency as corrosive agents are easily available for household use. Emetics and neutralizing agents should be avoided in treatment. Management of corrosive poisoning includes parenteral hydration and nutrition, H2-receptor antagonists or proton pump inhibitors. Upper gastrointestinal (GI) endoscopy should be done once the patient is hemodynamically stable and there are no signs of perforation. Urgent surgery is required in the event of perforation. Patients with Grade 0-1 injuries do not need hospitalization, while patients with Grade 2 and 3 injuries require intensive care unit (ICU) management.1