Acute Gastrointestinal Injury in Critically Ill Patients in a South Indian Intensive Care Unit: A Prospective, Observational, Preliminary Study.

Introduction The acute gastrointestinal injury (AGI) score was proposed by the Working Group on Abdominal Problems of the European Society of Intensive Care Medicine (ESICM) as a tool to define and grade gut dysfunction. There have not been any studies in India to validate this tool. The objective of this preliminary study was primarily to study the frequency of AGI in the first week of ICU stay in critically ill patients in our intensive care unit (ICU). We also sought to determine the risk factors predisposing to the development of AGI and to determine the prognostic implication of gastrointestinal (GI) injury in critically ill patients. Materials and methods A prospective, observational, preliminary, single-center study was conducted on critically ill patients (APACHE II > 8) who were on enteral tube feeds and admitted to a mixed ICU of a tertiary care hospital. Anthropometric data, admission diagnosis, APACHE II score, and comorbidities were recorded. Data of daily heart rate, mean arterial pressure, dose of vasopressors, intra-abdominal pressure, fluid balance, feeding intolerance, mechanical ventilation, and laboratory tests were noted for the first seven days of ICU stay or till ICU discharge, whichever was earlier. The occurrence of AGI score (1-4) during the first seven days of critical illness was the primary outcome of interest. Patient outcome at 28 days was recorded and the impact of the occurrence of AGI on patient outcome was analyzed using the Chi-square test. The patient characteristics associated with AGI were characterized as risk factors and analyzed using a multivariate model. Results Data were collected from 33 patients over 201 patient days. The frequency of acute GI dysfunction in the first seven days of ICU stay in our group of patients was 45.45% (15/33). APACHE II, fluid balance, creatinine, and lactate were identified as possible predictors of GI injury based on existing literature. These four variables were entered into an ordinal logistic regression model to assess their ability to predict the occurrence of GI Injury. When fitted into a predictive model, only fluid balance and creatinine were predictive of the final model (p-value < 0.05). A greater fluid balance was predictive in the final model of the development of GI injury; however, it showed negligible clinical significance (OR: 1.00033, 95% CI: 1.000051-1.00061). Lower creatinine levels were predictive in the final model of the development of AGI Injury, as demonstrated by the negative coefficient. Creatinine also had a greater clinical significance (OR: 0.63, 95% CI: 0.44-0.90) in the development of AGI. The impact of the AGI scores on mortality was analyzed. The number of patient days with higher AGI scores was significantly associated with increased mortality at 28 days (p-value < 0.001). Conclusion The study showed that nearly half of the critically ill patients included in the study developed acute GI dysfunction. We could not identify any predictors of GI injury based on our results. The result suggested an association between the severity of GI dysfunction and mortality at 28 days.

Is It Time to Revisit Remdesivir Use for Severe COVID-19?

How to cite this article: Taggarsi DA. Is It Time to Revisit Remdesivir Use for Severe COVID-19? Indian J Crit Care Med 2022;26(9):983-984.

A Rare Case of Spontaneous Anterior Abdominal Wall Necrotizing Soft Tissue Infection Caused by Finegoldia magna.

Necrotizing fasciitis is a highly invasive disease characterized by rapidly worsening inflammation of the fascia associated with necrosis of the subcutaneous tissue. It is a rare, life-threatening disease and needs early diagnosis through acute clinical awareness. It warrants urgent and aggressive surgical management. We report a rare and fatal case of spontaneous necrotizing soft tissue infection (NSTI) of the anterior abdominal wall caused by Finegoldia magna in a chronic diabetic patient. The initial presentation and radiological features suggested a pelvic abscess. Other acute abdomen differentials were also considered, and the patient underwent an exploratory laparotomy where a necrotic anterior abdominal wall with copious purulent secretions was noted. The organism Finegoldia magna was identified from the necrotic tissue sample with other cultures coming back negative. The risk posed by NSTIs is very high, and hence though the incidence is low, clinicians should be aware of the potential dangers of this disease to avoid delays in initiating appropriate treatment.

Placenta in the Critically Ill Mother.

The placenta is a temporary, multifunctional organ composed of both maternal and fetal components. It maintains homeostasis to ensure the growth of the fetus and well-being of the mother. Abnormalities in placental development have been known to be responsible for several disorders of pregnancy. Conditions coincident with pregnancy can upset the homeostasis and result in critical illness, which can greatly impact placental function and in turn affect the fetus. Decreased blood flow, acidemia, hypercarbia, and hypoxia seen in critically ill pregnant mothers can result in fetal death. Understanding the physiological changes and functioning of the maternal-fetal-placental unit will aid in better management of critically ill mothers. How to cite this article: Taggarsi DA, Krishna B. Placenta in the Critically Ill Mother. Indian J Crit Care Med 2021;25(Suppl 3):S200-S205.