ABSTRACT
Background: Accuracy of hemoglobin (Hb) measured by arterial blood gas (ABG) analyzer is considered inferior to laboratory (lab) measurements as it could overestimate Hb levels. Aim of the Study: The study aims to compare Hb measured using ABG versus conventional lab method at the time of major blood loss and in the preoperative and immediate postoperative periods. Settings and Design: It was a prospective, nonrandomized observational study conducted in a tertiary care center. Materials and Methods: The study was conducted in 24 patients undergoing major head-and-neck surgeries. Simultaneous blood samples were sent for Hb measurement by ABG analysis and lab method at induction of anesthesia, when intraoperative blood loss exceeded maximum allowable blood loss, and in the immediate postoperative period. Statistical Analysis Used: Chi-square test, independent sample's t-test, and paired t-test were used for statistical analysis. Results: Mean Hb values obtained by both techniques were significantly different at all time points. Hb obtained by ABG analysis was significantly higher than lab value preoperatively (12.78 ± 2.51 vs. 12.05 ± 2.2, P = 0.038), at maximum blood loss (11.00 ± 2.57 vs. 9.87 ± 2.06, P = 0.006), and in the immediate postoperative period (11.96 ± 2.00 vs. 10.96 ± 2.24 P < 0.001). ABG Hb values were found to be approximately 1 g.dL-1 greater than lab values. Conclusion: Hb measured by ABG analysis was significantly higher than that measured by lab method at the time of major blood loss, preoperatively, and at the immediate postoperative period in patients undergoing major head-and-neck surgeries, with a good correlation of values obtained by both the techniques.
ABSTRACT
BACKGROUND: Deviceassociated infections (DAIs) increase the morbidity and mortality in the intensive care unit (ICU). Studies from the neurosurgical ICU in developing countries are sparse. AIMS: The aim of this study was to assess the incidence of device-associated healthcare associated infections, pathogens isolated, antibiotic resistance, and mortality in neurosurgical ICU. SETTINGS AND DESIGN: A retrospective study was conducted in the neurosurgical ICU of a tertiary care center. MATERIALS AND METHODS: This study was done by analyzing data of patients admitted in a neurosurgical ICU with one or more devices during the period from January 2011 to July 2017. STATISTICAL ANALYSIS: Quantitative variables were expressed as mean and standard deviation; qualitative variables were expressed as frequency and percentage. RESULTS: During this period, 6788 patients with devices were admitted in the ICU, and 316 patients developed DAI. Two hundred and forty-eight patients had catheter-associated urinary tract infection (CAUTI), 78 had ventilator-associated pneumonia (VAP), and 53 had central line-associated bloodstream infection (CLABSI). The incidence rate for CAUTI was 17.83, VAP - 16.83, and CLABSI - 4.39 per 1000 device days. The device utilization ratio was highest for urinary catheter - 0.76, followed by central line - 0.66 and ventilator - 0.25. Predominant pathogens were Klebsiella - 90, Escherichia coli - 77, Pseudomonas - 40, Candida - 39, Acinetobacter - 30, and Enterobacter - 21. Carbapenem resistance was found in Acinetobacter (73.4%), Pseudomonas (45%), and Enterobacter (38%). S. aureus isolated in six cases; four being MRSA (66.7%). Multidrug resistance was found in Acinetobacter (80%), Pseudomonas (60%), Enterobacter (52.3%), Klebsiella (42.3%), and E. coli (33.7%). No colistin resistant Gram negative bacilli or vancomycin resistant enterococci were isolated. During this period 124 patients with DAI died, of which 52 patients had sepsis. The crude mortality rate was 1.83%. CONCLUSION: The DAI with the highest incidence was CAUTI, followed by VAP and CLABSI. With the implementation of insertion bundles and adherence to aseptic precautions, the DAI rate had come down.
