Risk Factors and Outcomes of Post-traumatic Acute Kidney Injury Requiring Renal Replacement Therapy: A Case-Control Study.

Background: Acute kidney injury (AKI) following severe trauma is common. However, the requirement of renal replacement therapy (RRT) in these patients is rare and is associated with high morbidity and mortality. The primary objective of this study was to identify odds of risk factors, in particular, hypotension at presentation, for the requirement of RRT in patients with AKI following trauma. Methods: We performed a case-control study involving patients who were admitted to the intensive care unit (ICU) at a level I trauma center for at least 24 hours. The primary outcome measure was a study of the odds of risk factors associated with the requirement of RRT in such patients. Univariate comparisons and multiple logistic regression analyses were done to identify other risk factors. Results: The presence of crush injury, sepsis, and elevated serum creatinine (sCr) on arrival were identified to be independent risk factors for RRT requirement. Hypotension and exposure to radiocontrast or nephrotoxic antimicrobials were not found to be associated with the need for RRT. Acute kidney injury requiring RRT was associated with significantly increased ICU length of stay (15 days vs 5 days; p < 0.001) and higher mortality (83% vs 35%; p < 0.001). Conclusion: The presence of crush injury, sepsis, and elevated sCr on presentation were identified to be independent risk factors while hypotension association was insignificant for AKI requiring RRT in our investigation. How to cite this article: Soni KD, Singh A, Tyagi A, Singh Y, Aggarwal R, Trikha A. Risk Factors and Outcomes of Post-traumatic Acute Kidney Injury Requiring Renal Replacement Therapy: A Case-Control Study. Indian J Crit Care Med 2023;27(1):22-25.

Comparison of colloid and crystalloid using goal-directed fluid therapy protocol in non-cardiac surgery: a meta-analysis of randomized controlled trials.

PURPOSE: A few randomized controlled trials (RCTs) have compared crystalloid-based goal-directed fluid therapy (GDFT) with starch-based GDFT in patients undergoing major surgical procedures with conflicting results. In this meta-analysis, colloid-based GDFT was compared with crystalloid-based GDFT. METHODS: In this meta-analysis, RCTs comparing colloid- and crystalloid-based GDFT in patients undergoing non-cardiac surgery were included. Binary outcomes were reported as risk ratio (RR) and continuous outcomes were reported as mean difference (MD) with 95% confidence interval (95% CI). PubMed, PubMed central, The Cochrane Library database and EMBASE were searched for potentially eligible trials from inception to 28 February 2020. RESULTS: Data of 2392 patients from nine RCTs were included in this meta-analysis. Mortality at the longest available follow-up [RR (95% CI) 1.44 (0.88, 2.34); p = 0.15], postoperative kidney dysfunction [RR (95% CI) 1.07 (0.72, 1.60); p = 0.73], postoperative length of hospital stay [MD (95% CI) - 0.29 ( - 1.25, 0.66) d; p = 0.55], cardiovascular complications [RR (95% CI) 1.20 (0.50, 2.88); p = 0.68], wound complications [RR (95% CI) 1.08 (0.76, 1.54); p = 0.66], pulmonary complications [RR (95% CI) 0.90 (0.71, 1.140); p = 0.40] and bleeding [RR (95% CI) 1.24 (0.77, 1.99); p = 0.37] were similar in both the groups. Postoperative major complications were also similar between patients who received colloid and crystalloid [RR (95% CI) 0.79 (0.48, 1.29); p = 0.34]. CONCLUSION: Colloids in goal-directed fluid therapy protocol does not offer any benefit over crystalloid-based goal-directed fluid therapy protocol in patients undergoing major non-cardiac surgical procedure.

Emergency anesthetic management of an achondroplastic elderly gravida with polytrauma.

A 42-year-old pregnant female, diagnosed with achondroplasia, presented to our trauma center with multiple injuries after being involved in a motor vehicle accident. During her hospitalization, she underwent multiple surgeries and required admission in the intensive care unit. We describe the emergency anesthetic management of this patient, highlighting the effects of skeletal dysplasia on airway, cardiorespiratory system, and ventilatory mechanics. These effects, when superimposed upon with physiological changes of pregnancy, can lead to an unanticipated ventilatory challenge as we describe in this report.

Nonpneumatic Anti-Shock Garment versus Intermittent Sequential Compression Device for Prevention of Postspinal Hypotension in Patients Undergoing Cesarean Section: A Randomized Controlled Study.

CONTEXT: Postspinal hypotension remains a frequent complication of subarachnoid block during cesarean section causing further maternal and fetal adverse effects. AIMS: This study aims to evaluate and compare a continuous pressure nonpneumatic anti-shock garment (NASG) and an intermittent sequential compression device (SCD) with a control group for prevention of postspinal hypotension in women undergoing elective cesarean section. SETTINGS AND DESIGN: A randomized, observer blind, controlled study at single university hospital. SUBJECTS AND METHODS: Ninety singleton term parturients between 18 and 35 years of age undergoing cesarean section with spinal anesthesia were randomly assigned to be applied with NASG, SCD, or no device; n = 30 in each group. A standardized protocol for cohydration and anesthetic technique was followed. The primary outcome measure was incidence of hypotension defined as a decrease in systolic blood pressure of more than 20% from baseline or an absolute value <100 mmHg, whichever was higher. The secondary outcome measures were median dose of ephedrine required, incidence of maternal nausea and vomiting, and neonatal Apgar scores. STATISTICAL ANALYSIS USED: Results were expressed as mean (±standard deviation), median (range), or number (%) as appropriate. Nominal data were compared using Chi-square/Fischer's exact test. Continuous data were compared using ANOVA one-way test. Nonparametric data were compared using Kruskal-Wallis test. RESULTS: In Groups NASG, SCD, and C, incidence of hypotension was 60%, 83%, and 90%, respectively (P = 0.021), with significant reduction in incidence of hypotension in Group NASG versus Group C (P < 0.001, odds ratio 0.17, 95% confidence interval 0.04-0.68). Median (interquartile range) dose of ephedrine required was significantly less in Group NASG compared with Groups SCD and C, respectively (P = 0.002, P < 0.001). CONCLUSIONS: NASG proved to be a more effective device for prevention of postspinal hypotension when compared with application of SCD or no device.

Prone Positioning for Management of Fat Embolism Syndrome in a Patient with Spine Fracture; An Unusual Scenario and Review of Literature.

Fat embolism syndrome is a rare but fatal complication seen commonly in patients with polytrauma. Its earliest manifestation is hypoxemia due to deposition of fat globules in pulmonary circulation which can progress to severe acute respiratory distress syndrome, the treatment of which is mainly supportive. We describe the case of a 17-year-old male who was admitted in our intensive care unit (ICU) for severe hypoxemia due to fat embolism. He had burst fracture of 5th lumbar vertebra with canal compromise along with other fractures. Failing conventional ventilation, the patient was placed in prone position taking proper precautions in positioning giving due consideration to his unstable lumbar spine. There was no neurological insult and in the next two days, he was weaned off from the ventilator. Though prone position is relatively contraindicated in patients with unstable spine, we employed early prone positioning taking adequate precautions, the benefit of which we believe outweighed the risk.

Low tidal volume ventilation strategy and organ functions in patients with pre-existing systemic inflammatory response.

BACKGROUND AND AIMS: Ventilation can induce increase in inflammatory mediators that may contribute to systemic organ dysfunction. Ventilation-induced organ dysfunction is likely to be accentuated if there is a pre-existing systemic inflammatory response. MATERIAL AND METHODS: Adult patients suffering from intestinal perforation peritonitis-induced systemic inflammatory response syndrome and scheduled for emergency laparotomy were randomized to receive intraoperative ventilation with 10 ml.kg-1 tidal volume (Group H) versus lower tidal volume of 6 ml.kg-1 along with positive end-expiratory pressure (PEEP) of 10 cmH2O (Group L), (n = 45 each). The primary outcome was postoperative organ dysfunction evaluated using the aggregate Sepsis-related Organ Failure Assessment (SOFA) score. The secondary outcomes were, inflammatory mediators viz. interleukin-6, tumor necrosis factor-α, procalcitonin, and C-reactive protein, assessed prior to (basal) and 1 h after initiation of mechanical ventilation, and 18 h postoperatively. RESULTS: The aggregate SOFA score (3[1-3] vs. 1[1-3]); and that on the first postoperative day (2[1-3] vs. 1[0-3]) were higher for group L as compared to group H (P < 0.05). All inflammatory mediators were statistically similar between both groups at all time intervals (P > 0.05). CONCLUSIONS: Mechanical ventilation with low tidal volume of 6 ml/kg-1 along with PEEP of 10 cmH2O is associated with significantly worse postoperative organ functions as compared to high tidal volume of 10 ml.kg-1 in patients of perforation peritonitis-induced systemic inflammation undergoing emergency laparotomy.

Perception among Healthcare Professionals of the Use of Social Media in Translating Research Evidence into Clinical Practice in Mangalore.

INTRODUCTION: Social media has a potential to bring about major changes in the healthcare system. OBJECTIVE: To find out the pattern of use of social media among healthcare professionals (HCPs) and perception, facilitators, and barriers of using social media, to translate evidence into clinical practice. METHOD: We conducted a cross-sectional study among 196 HCPs of institutions attached to a university using a self-administered questionnaire. RESULT: 97.3% used social media; however, only 63.4% used it for research. YouTube was the most preferred media. Majority of people believed that social media enables wide range of evidence over the shorter span of time, poses a threat to privacy, and cannot replace face to face interaction. Perceived barriers were the privacy concern, unprofessional behavior, lack of reliability, and information overload. CONCLUSION: There is a need for the development of appropriate guidelines for sharing the research output among various stakeholders using social media.