Comparison Between McCoy Laryngoscope and C-MAC Video Laryngoscope in Anticipated Difficult Airway: A Prospective Randomised Study.

OBJECTIVE: Prolonged laryngoscopy and failure to intubate are associated with increased morbidity and mortality. Need to improve glottic visualisation and ease of intubation has led to the introduction of various types of laryngoscopes. This study compares the effectiveness of C-MAC video laryngoscope (VL) with McCoy laryngoscope in patients with an anticipated difficult airway. METHODS: This prospective randomised single-blinded single-centre study included patients with modified Mallampati grades 3 and 4, divided into two groups I and II of 65 patients each. Group I was intubated using C-MAC and group II with McCoy Laryngoscope. Modified Cormack Lehane grade of visualisation, time to intubate, intubation difficulty scale score and complications were recorded. RESULTS: C-MAC VL provides a higher proportion of modified Cormack Lehane grade I visualisation (63% vs 35.3, p=0.0017), the lesser median time of intubation in seconds (15 vs 18, p=0.0007) and significantly lesser median intubation difficulty score (0 vs 3) when compared to McCoy. CONCLUSIONS: C-MAC VL provided better visualisation of glottis and easier tracheal intubation that too in a significantly lesser time. We conclude and recommend the use of C-MAC VL over McCoy for endotracheal intubation in patients with predicted difficult airways, especially in modified Mallampati grades 3 and 4.

Pandemics and consumer well-being: Provenance and research priorities.

This article advances the riveting discussion on how this special issue contributes to the consumer well-being literature. Specifically, this article endeavors to present an eclectic account of how the pandemics has had a lasting impact on the consumer well-being, its provenance and future research priorities for academics and practice. First, it briefly discusses the origin and relevance of the evolving issue of consumer well-being during pandemics. Second, it presents several directions for future research and third, it offers key insights for policymakers. It includes multiple research priorities that present vastly contrasting manifestations of consumer well-being. This article argues that future research will need to examine the drivers of consumer well-being during pandemics, the mechanisms that underlie the influence of pandemics on consumer well-being and the boundary conditions that accentuate/mitigate the influence of pandemic-induced factors.

Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness: A systematic review and meta-analysis.

BACKGROUND: The accuracy of respiratory variation of the inferior vena cava (rvIVC) in predicting fluid responsiveness, particularly in spontaneously breathing patients is unclear. OBJECTIVES: To consider the evidence to support the accuracy of rvIVC in identifying patients who are unlikely to benefit from fluid administration. DESIGN: Systematic review and meta-analysis. DATA SOURCE: We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILCAS and WHO Clinical Trial Registry from inception to June 2017. ELIGIBILITY CRITERIA: Case-control or cohort studies that evaluated the accuracy of rvIVC in living adult humans were included. A study was included in the meta-analysis if data enabling construction of 2 × 2 tables were reported, calculated or could be obtained from authors and met the above cited criteria. RESULT: A total of 23 studies including 1574 patients were included in qualitative analysis. The meta-analysis involved 20 studies and 761 patients. Pooled sensitivity and specificity of rvIVC in 330 spontaneously breathing patients were 0.80 [95% confidence interval (CI) 0.68 to 0.89] and 0.79 (95% CI 0.60 to 0.90). Pooled sensitivity and specificity of rvIVC in 431 mechanically ventilated patients were 0.79 (95% CI 0.67 to 0.86) and 0.70 (95% CI 0.63 to 0.76). CONCLUSION: Decreased inferior vena caval respiratory variation is moderately accurate in predicting fluid unresponsiveness both in spontaneous and mechanically ventilated patients. The findings of this review should be used in the appropriate clinical context and in conjunction with other clinical assessments of fluid status. IDENTIFIER: CRD 42017068028.

Diagnostic accuracy of delirium assessment methods in critical care patients.

PURPOSE: Delirium is a disorder of decreased ability to focus, sustain or shift attention, change in cognition and or perception. The main objective was to evaluate the diagnostic accuracy of Confusion Assessment Method for the ICU (CAM-ICU) and Intensive Care Delirium Screening Checklist (ICDSC) among the nursing and medical staff in a multidisciplinary ICU. METHODS AND MATERIAL: Three hundred ten verbally communicating and non-communicating patients (mean age in years 47.9, standard deviation [SD] 14.5, mean Acute Physiology and Chronic Health Evaluation II score 13.8, SD 6.4) were assessed by a psychiatrist, nurse and intensivist for delirium. Inter-rater agreement was measured by Cohen's kappa coefficient. Sensitivity, specificity, predictive values, likelihood ratios and diagnostic odds ratio (DOR) were calculated. RESULTS: CAM-ICU showed higher sensitivity and DOR (84%, 86.1) compared to ICDSC (78%, 36.9). ICDSC had specificity and positive predictive value (94.5%, 92%) equal to that of CAM-ICU. For both the assessment methods (CAM-ICU and ICDSC), DORs for intensivists (120.5, 53.0) were relatively higher than nurses (67.0, 27.0). CONCLUSIONS: In our mixed ICU population, CAM-ICU remained more sensitive than ICDSC. Though sensitivity and DOR were higher for medical staff, other diagnostic parameters were similar for both medical and nursing staff.

How Useful is Extravascular Lung Water Measurement in Managing Lung Injury in Intensive Care Unit?

CONTEXT: The primary goal of septic shock management is optimization of organ perfusion, often at the risk of overloading the interstitium and causing pulmonary edema. The conventionally used end points of resuscitation do not generally include volumetric parameters such as extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI). AIMS: This study aimed to assess the prognostic value of EVLWI and PVPI by calculating their correlation with the severity of lung injury. SETTINGS AND DESIGN: This prospective observational study included twenty mechanically ventilated critically ill patients with Acute Physiology and Chronic Health Evaluation score (APACHE II) >20. SUBJECTS AND METHODS: EVLWI and PVPI were measured using transpulmonary thermodilution, and simultaneously, PaO2:FiO2 ratio, alveolar-arterial gradient of oxygen (AaDO2), and chest radiograph scores from two radiologists were obtained. STATISTICAL ANALYSIS: The correlation of EVLWI and PVPI with chest radiograph scores, PaO2:FiO2 ratio, and AaDO2 were calculated. The inter-observer agreement between the two radiologists was tested using kappa test. RESULTS: EVLWI and PVPI correlated modestly with PaO2:FiO2 (r = -0.32, P = 0.0004; r = -0.39, P = 0.0001). There was a better correlation of EVLWI and PVPI with PaO2:FiO2 ratio (r = -0.71, P < 0.0001; r = -0.58, P = 0.0001) in the acute respiratory distress syndrome (ARDS) subgroup. The EVLWI values correlated significantly with corresponding chest radiograph scores (r = 0.71, P < 0.0001 for observer 1 and r = 0.68, P < 0.0001 for observer 2). CONCLUSIONS: EVLWI and PVPI may have a prognostic significance in the assessment of lung injury in septic shock patients with ARDS. Further research is required to reveal the usefulness of EVLWI as an end point of fluid resuscitation in the management of septic shock with ARDS.

Difficult airway management from Emergency Department till Intensive Care Unit.

We report a case of "can ventilate but can't intubate" situation which was successfully managed in the Emergency Department and Intensive Care Unit by the use of ProSeal laryngeal mask airway and Frova Intubating Introducer as bridging rescue devices. Use of appropriate technique while strictly following the difficult airway algorithm is the mainstay of airway management in unanticipated difficult airway situations. Although the multiple airway devices were used but each step took not more than 2 min and "don't struggle, skip to the next step principle" was followed. With the availability of many advanced airway management tools, the intensivists should have a training and experience along with preparedness in order to perform such lifesaving airway managements.

Disseminated intravascular coagulation in malaria: A case report.

Disseminated intravascular coagulation (DIC) is seen in <5% of patients with severe Plasmodium falciparum malaria and is more common in cerebral malaria. Here, we report the diagnosis and management of a case of severe P. falciparum malaria with DIC.