A Prospective Observational Study Comparing Oxygen Saturation/Fraction of Inspired Oxygen Ratio with Partial Pressure of Oxygen in Arterial Blood/Fraction of Inspired Oxygen Ratio among Critically Ill Patients Requiring Different Modes of Oxygen Supplementation in Intensive Care Unit.

Background: Intensive care unit (ICU) patients face a significant rise in mortality rates due to acute hypoxemic respiratory failure (AHRF). The diagnosis of AHRF is based on the PF ratio, but it has limitations in resource-constrained settings. Instead, the Kigali modification suggests using the oxygen saturation/fraction of inspired oxygen (SF) ratio. This study aims to correlate SF ratio and arterial oxygen pressure (PF) ratio in critically ill adults with hypoxemic respiratory failure, who required O2 therapy through different modes of oxygen supplementation. Materials and methods: In an ICU, a prospective observational study included 125 adult AHRF patients receiving oxygen therapy, with data collected on FiO2, PaO2, and SpO2. The SF ratio and PF ratio were calculated, and their correlation was assessed using statistical analysis. The receiver operator characteristics (ROC) curve analysis was conducted to assess the diagnostic precision of the SF ratio in identifying AHRF. Results: Data from a total of 250 samples were collected. The study showed a positive correlation (r = 0.622) between the SF ratio and the PF ratio. The SF threshold values of 252 and 321 were established for PF values of 200 and 300, respectively, featuring a sensitivity of 69% and specificity of 95%. Furthermore, it is worth noting that the PF ratio and SF ratio are interchangeable, regardless of the type of oxygen therapy, as the median values of both the PF ratio and SF ratio displayed statistical significance (p < 0.01) in both acidosis and alkalosis conditions. Conclusion: For patients with AHRF, the noninvasive SF ratio can effectively serve as a substitute for the invasive PF ratio across all oxygen supplementation modes. How to cite this article: Alur TR, Iyer SS, Shah JN, Kulkarni S, Jedge P, Patil V. A Prospective Observational Study Comparing Oxygen Saturation/Fraction of Inspired Oxygen Ratio with Partial Pressure of Oxygen in Arterial Blood/Fraction of Inspired Oxygen Ratio among Critically Ill Patients Requiring Different Modes of Oxygen Supplementation in Intensive Care Unit. Indian J Crit Care Med 2024; 28(3):251-255.

Agreement Between Virtual Reality Perimetry and Static Automated Perimetry in Various Neuro-Ophthalmological Conditions: A Pilot Study.

Our objective was to compare the agreement between virtual reality perimetry (VRP) (order of magnitude, OM) and static automated perimetry (SAP) in various neuro-ophthalmological conditions. We carried out a retrospective analysis of visual field plots of patients with various neuro-ophthalmological conditions who underwent visual field testing using VRP and SAP and between 1 January and 31 May 2022. Two fellowship-trained neuro-ophthalmologists compared the visual field defects observed on both devices. Per cent agreement was used to compare the interpretation of the two examiners on both techniques. The study criteria were met by 160 eyes from 148 patients (mean age 44 years, range 17-74 years). The most common aetiologies were optic atrophy due to various causes, optic neuritis, ischaemic optic neuropathy, and compressive optic neuropathy. Overall, we found good agreement between VRP and SAP for bitemporal (93.8%), hemianopic (90.8%), altitudinal (79.4%), and generalised visual field defects (86.4%). The agreement was acceptable for central/centrocaecal scotomas and not acceptable for enlarged blind spots. Between the two examiners there was good agreement for bitemporal (92.3%), hemianopic (82%), altitudinal (83%), and generalised field defects (76.4%). The results of our study suggest that VRP gives overall good agreement with SAP in various neuro-ophthalmological conditions, especially those likely to produce hemianopic, altitudinal, and generalised visual field defects. This could be useful in various settings; however, future larger studies are needed to explore real-world utilisation.

Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India.

BACKGROUND: This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury. METHODS: We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson's correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P<0.01. RESULTS: In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively. CONCLUSIONS: The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome.

Endotracheal Intubation with King Vision Video Laryngoscope vs Macintosh Direct Laryngoscope in ICU: A Comparative Evaluation of Performance and Outcomes.

Background: Endotracheal intubation to protect airway patency in critically ill patients with the use of videolaryngoscopes has been emerging and their expertise to handle is crucial. Our study focuses on the performance and outcomes of King Vision video laryngoscope (KVVL) in intensive care unit (ICU) compared to Macintosh direct laryngoscope (DL). Materials and methods: This comparative study was conducted by randomizing 143 critically ill patients in ICU into two groups: KVVL and Macintosh DL (n = 73; n = 70). The intubation difficulty was assessed by Mallampati score III or IV, apnea syndrome (obstructive), cervical spine limitation, opening mouth <3 cm, coma, hypoxia, anesthesiologist nontrained (MACOCHA) score. The primary endpoint was the glottic view measured by Cormack-Lehane (CL) grading. The secondary endpoints were a first-pass success, the time required for intubation, airway morbidities, and manipulations required. Results: The KVVL group showed the primary endpoint of significantly improved glottic visualization measured in terms of CL grading compared with the Macintosh DL group (p < 0.001). In the KVVL group, the first pass success rate was higher (95.7%) compared to the Macintosh DL group (81.4%) (p < 0.05). The time required for intubation in the KVVL group (28.77 ± 2.63 seconds) was significantly less compared with Macintosh DL (38.84 ± 2.72 seconds) group (p < 0.001). The airway morbidities observed were similar in both groups (p = 0.5) and the manipulation required for endotracheal intubation was significantly less (p < 0.05) in our KVVL group (16 cases; 23%) compared to the Macintosh DL group (8 cases; 10%). Conclusion: We found that the performance and outcomes of KVVL in intubating critically ill ICU patients were promising when handled by experienced operators who are experts in anesthesiology and airway management. How to cite this article: Dharanindra M, Jedge PP, Patil VC, Kulkarni SS, Shah J, Iyer S, et al. Endotracheal Intubation with King Vision Video Laryngoscope vs Macintosh Direct Laryngoscope in ICU: A Comparative Evaluation of Performance and Outcomes. Indian J Crit Care Med 2023;27(2):101-106.

Clinical and Genetic Profile of Leber's Hereditary Optic Neuropathy in a Cohort of Patients From a Tertiary Eye Care Center.

PURPOSE: To identify and describe the clinical profile at presentation in patients diagnosed as having Leber's hereditary optic neuropathy with primary and secondary mutations and correlate with treatment. METHODS: A review of electronic medical records from January 2016 to December 2020 for proven cases of Leber's hereditary optic neuropathy was conducted. A total of 157 patients with clinically suspected Leber's hereditary optic neuropathy (143 males and 14 females) underwent genetic testing and 55 were found to have a mutation for Leber's hereditary optic neuropathy. Data of 55 consecutive patients were retrieved and analyzed for their clinical profile, investigations, mutations identified, treatment, and outcome. RESULTS: All 55 patients were male, and the mean age was 23.80 ± 9.90 years (range: 9 to 53 years). The median duration of symptoms before the first physician examination was 6 months. The mean duration between the first hospital visit and genetically proven diagnosis of Leber's hereditary optic neuropathy was 9.03 ± 19.61 months (median: 2 months). More than half of the patients (n = 32; 58.2%) presented with severe to profound vision impairment in the better eye and 72.7% (n = 40) in the worse eye. Bilateral temporal disc pallor was more frequent in 38.2% (n = 21) and 36.4% (n = 20) had bilateral optic atrophy. Primary single mutations were detected in 61.81% (n = 34) and secondary mutations were detected in 38.2% (n = 21). The most common mutation was G11778A. One novel secondary mutation (A13615C) was identified in the cohort. Idebenone was used for treatment in 15 patients, and half of them (n = 8) showed an improvement in vision at 2 to 7 months of follow-up. CONCLUSIONS: The current cohort is the largest study to date in an Indian population that has analyzed the clinical presentations and mutations of Leber's hereditary optic neuropathy. G11778A was the most common primary mutation and several secondary mutations were identified. A delay in referral, inadequate compliance, and cost of care contributed to the outcomes. [J Pediatr Ophthalmol Strabismus. 2022;59(5):344-349.].

Newer insights into the clinical profile of posterior lenticonus in children and its surgical, visual, refractive outcomes.

PURPOSE: To analyze the clinical profile of patients with posterior lenticonus and their surgical, visual, and refractive outcomes. RESULTS: Retrospective interventional case series of 84 eyes of 63 patients with posterior lenticonus. The incidence of posterior lenticonus was 3.98% during a study period of 5 years. One-third of cases had bilateral posterior lenticonus. The mean age was 4.78 ± 4.28 years (unilateral cases were significantly older than bilateral, P = 0.0001). Males were 54%. Mean axial length and keratometry were 21.49 mm and 44.88 D, respectively. Eyes with the bilateral disease were significantly shorter (axial length, P = 0.0012) and smaller (horizontal corneal diameter, P < 0.0001) compared to those with unilateral disease. While 88% were pseudophakic; 12% were aphakic. The posterior capsular defect was noted intraoperatively in 44%. Sixty-eight percent of eyes had a pre-operative diagnosis of posterior lenticonus, 32% were diagnosed intraoperatively. The mean follow-up period was 1.3 years. Best-corrected visual acuity (BCVA) at 6 months was fair to poor in two-third of patients (median 20/100). The mean ± SD visual acuity (LogMAR) and spherical equivalence for unilateral and bilateral cases were 0.70 ± 0.27, 0.67 ± 0.26D (p = 0.57) and 2.04 ± 2.74, 5.15 ± 3.73D (p = 0.0001), respectively. Visual outcomes were better in children who are aged 2 years or more (P = 0.0056). Eight percent needed a second surgery. CONCLUSION: We report a higher prevalence of bilateral posterior lenticonus in this cohort. The clinical profile of bilateral disease differs from unilateral disease. The diagnosis is not always clinical. In the bag, intra-ocular lens (IOL) implantation is possible in the majority. The visual outcomes remain fair to poor, possibly due to late presentation and the presence of dense refractory amblyopia. SYNOPSIS: The manuscript consists of the largest series of posterior lenticonus to date. It provides the prevalence of posterior lenticonus along with characteristics difference between unilateral and bilateral cases of posterior lenticonus. Newer insights in terms of diagnostics, pre-operative pick-up rate, how to improve, visual and refractive outcomes of unilateral and bilateral cases are described.

Pivoting to teleconsultation for paediatric ophthalmology and strabismus: Our experience during COVID-19 times.

PURPOSE: The objective is to analyse and report the data of teleconsultations provided to paediatric ophthalmology and strabismus patients during COVID-19 times and to elaborate our experience for guiding future teleconsultation practices to General, paediatric Ophthalmologists and Strabismologists. METHODS: Retrospective analysis of electronic medical record data of teleconsultations provided in the department of Strabismus, Paediatric and Neuro-ophthalmology was done. Patients with optic nerve related disorders were excluded. Study period was one month. Statistical analysis of collected data was done using Microsoft excel. RESULTS: A total of 198 patients were provided teleconsultations (an average of seven teleconsultations/day). The final analysis included 161 patients after excluding optic nerve related disorders. The median age was seven years. We had a near equal gender distribution (53% males and 47% females) of whom a third were new cases. Video calling was used in 14%, review of clinical photos shared was used in 53%. Rest of the 33% were given telephonic advice. Allergic conjunctivitis (14%), pseudophakia (9%), strabismus (12%), status post strabismus surgery (8%), cranial nerve palsies (11%) were common diagnoses. 19% (n = 30) were advised/needed visit in emergency services on same or next day. CONCLUSION: Our experience of teleconsultation during COVID-19 times for paediatric ophthalmology and strabismus patients was very encouraging. Pivoting teleconsultation platform can provide primary eye care to most of the patients and work as essential forward triage for rest. As we continue to further explore the currently available avenues in multimedia such as video conferencing and web/mobile based applications, we believe that tele-ophthalmology platform can provide a reliable service in patient care.