8 results on '"Ramanathan, Kollengode"'
Search Results
2. Association of anticoagulation use during continuous kidney replacement therapy and 90-day outcomes: A multicentre study.
- Author
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Lau YH, Li AY, Lim SL, Woo KL, Ramanathan K, Chua HR, Akalya K, Tan AY, Phua J, Tan JJ, Puah SH, Chia YW, Loh SC, Ahmed Khan F, Chatterjee S, Kaushik M, and See KC
- Subjects
- Humans, Retrospective Studies, Female, Male, Middle Aged, Aged, Singapore epidemiology, Logistic Models, Citric Acid therapeutic use, Renal Dialysis methods, Treatment Outcome, APACHE, Anticoagulants therapeutic use, Acute Kidney Injury therapy, Acute Kidney Injury epidemiology, Intensive Care Units, Continuous Renal Replacement Therapy methods, Heparin therapeutic use, Critical Illness
- Abstract
Introduction: Anticoagulation is recommended during continuous kidney replacement therapy (CKRT) to prolong the filter lifespan for optimal filter performance. We aimed to evaluate the effect of anticoagulation during CKRT on dialysis dependence and mortality within 90 days of intensive care unit (ICU) admission., Method: Our retrospective observational study evaluated the first CKRT session in critically ill adults with acute kidney injury (AKI) in Singapore from April to September 2017. The primary outcome was a composite of dialysis dependence or death within 90 days of ICU admission; the main exposure variable was anticoagulation use (regional citrate anticoagulation [RCA] or systemic heparin). Multivariable logistic regression was performed to adjust for possible confounders: age, female sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, liver dysfunction, coagulopathy (international normalised ratio[INR] >1.5) and platelet counts of less than 100,000/uL)., Results: The study cohort included 276 patients from 14 participating adult ICUs, of whom 176 (63.8%) experienced dialysis dependence or death within 90 days of ICU admission (19 dialysis dependence, 157 death). Anticoagulation significantly reduced the odds of the primary outcome (adjusted odds ratio [AOR] 0.47, 95% confidence interval [CI] 0.27-0.83, P=0.009). Logistic regression analysis using anticoagulation as a 3-level indicator variable demonstrated that RCA was associated with mortality reduction (AOR 0.46, 95% CI 0.25-0.83, P=0.011), with heparin having a consistent trend (AOR 0.51, 95% CI 0.23-1.14, P=0.102)., Conclusion: Among critically ill patients with AKI, anticoagulation use during CKRT was associated with reduced dialysis or death at 90 days post-ICU admission, which was statistically significant for regional citrate anticoagulation and trended in the same direction of benefit for systemic heparin anticoagulation. Anticoagulation during CKRT should be considered whenever possible., Competing Interests: The authors have no relevant financial or non-financial interests to disclose.
- Published
- 2023
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3. Basic echocardiography competence program in intensive care units: A multinational survey of intensive care units accredited by the College of Intensive Care Medicine.
- Author
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Rajamani A, Knudsen S, Ngoc Bich Ha Huynh K, Huang S, Wong WT, Ting I, McLean AS, Chi Wa Ng J, Parmar J, Salvi M, and Ramanathan K
- Subjects
- Australia, Clinical Competence, Humans, New Zealand, Singapore, Surveys and Questionnaires, Critical Care, Echocardiography, Intensive Care Units
- Abstract
In 2014, basic critical care echocardiography (BCCE) competence became a mandatory requirement for trainees registered with the College of Intensive Care Medicine (CICM). To determine the proportion of CICM intensive care units (ICUs) that conduct a BCCE competence program and to learn about the barriers/challenges and successful strategies, we conducted a survey of intensivists working in ICUs accredited by CICM for basic/advanced training in Australia, New Zealand, Hong Kong, Singapore, Ireland and India. Following consultations with content experts and a trial phase to improve clarity and minimise ambiguity, an 11-point questionnaire survey was sent to one intensivist from every CICM-accredited ICU by several methods. Participation was voluntary. Consent was implied. No incentives were offered. Results are reported as numbers and percentages. Of the 104 ICUs surveyed, 99 (95.1%) responded, with 75 (75.8%) having no BCCE teaching whatsoever. In the remaining 24 (24.2%) ICUs, the teaching process was widely variable. Only 5/99 (5.1%) ICUs provided a structured BCCE competence program through which trainees performed and archived BCCE scans, maintained a logbook and underwent formative and summative assessments for credentialling. Six more ICUs provided formative assessment but relied on external bodies for competence assessment. Overall, 20/99 (20.2%) ICUs allowed trainees to perform unsupervised scans for clinical management, even if they were not BCCE competent. Nineteen intensivists perceived management errors due to misinterpretation of echocardiographic findings. Very few CICM-accredited ICUs offer a structured BCCE competence program. To fulfil the objective of universal BCCE competence, potential solutions are presented.
- Published
- 2020
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4. Expanding the utility of the ROX index among patients with acute hypoxemic respiratory failure.
- Author
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Li, Andrew, Cove, Matthew Edward, Phua, Jason, Puah, Ser Hon, Ng, Vicky, Kansal, Amit, Tan, Qiao Li, Sahagun, Juliet Tolentino, Taculod, Juvel, Tan, Addy Yong-Hui, Mukhopadhyay, Amartya, Tay, Chee Kiang, Ramanathan, Kollengode, Chia, Yew Woon, Sewa, Duu Wen, Chew, Meiying, Lew, Sennen J. W., Goh, Shirley, Dhanvijay, Shekhar, and Tan, Jonathan Jit-Ern
- Subjects
INTENSIVE care units ,NASAL cannula ,BLOOD gases - Abstract
Background: Delaying intubation in patients who fail high-flow nasal cannula (HFNC) may result in increased mortality. The ROX index has been validated to predict HFNC failure among pneumonia patients with acute hypoxemic respiratory failure (AHRF), but little information is available for non-pneumonia causes. In this study, we validate the ROX index among AHRF patients due to both pneumonia or non-pneumonia causes, focusing on early prediction. Methods: This was a retrospective observational study in eight Singapore intensive care units from 1 January 2015 to 30 September 2017. All patients >18 years who were treated with HFNC for AHRF were eligible and recruited. Clinical parameters and arterial blood gas values at HFNC initiation and one hour were recorded. HFNC failure was defined as requiring intubation post-HFNC initiation. Results: HFNC was used in 483 patients with 185 (38.3%) failing HFNC. Among pneumonia patients, the ROX index was most discriminatory in pneumonia patients one hour after HFNC initiation [AUC 0.71 (95% CI 0.64–0.79)], with a threshold value of <6.06 at one hour predicting HFNC failure (sensitivity 51%, specificity 80%, positive predictive value 61%, negative predictive value 73%). The discriminatory power remained moderate among pneumonia patients upon HFNC initiation [AUC 0.65 (95% CI 0.57–0.72)], non-pneumonia patients at HFNC initiation [AUC 0.62 (95% CI 0.55–0.69)] and one hour later [AUC 0.63 (95% CI 0.56–0.70)]. Conclusion: The ROX index demonstrated moderate discriminatory power among patients with either pneumonia or non-pneumonia-related AHRF at HFNC initiation and one hour later. [ABSTRACT FROM AUTHOR]
- Published
- 2022
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5. Non-invasive Oxygen Strategies to Manage Confirmed COVID-19 Patients in Indian Intensive Care Units: A Survey.
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Subramaniam, Ashwin, Haji, Jumana Y., Kumar, Prashant, Ramanathan, Kollengode, and Rajamani, Arvind
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INTENSIVE care units ,VIRAL pneumonia ,COVID-19 ,ACADEMIC medical centers ,POSITIVE pressure ventilation ,NASAL cannula ,PHYSICIANS' attitudes ,FISHER exact test ,ARTIFICIAL respiration ,NURSE anesthetists ,OXYGEN therapy ,CRITICAL care medicine ,QUESTIONNAIRES ,CASE studies ,PUBLIC hospitals ,DESCRIPTIVE statistics ,PROPRIETARY hospitals ,DATA analysis software ,HYPOXEMIA - Abstract
Background: About 5% of hospitalized coronavirus disease 2019 (COVID-19) patients will need intensive care unit (ICU) admission for hypoxemic respiratory failure requiring oxygen support. The choice between early mechanical ventilation and noninvasive oxygen therapies, such as, high- flow nasal oxygen (HFNO) and/or noninvasive positive-pressure ventilation (NPPV) has to balance the contradictory priorities of protecting healthcare workers by minimizing aerosol-generation and optimizing resource management. This survey over two timeframes aimed to explore the controversial issue of location and noninvasive oxygen therapy in non-intubated ICU patients using a clinical vignette. Materials and methods: An online survey was designed, piloted, and distributed electronically to Indian intensivists/anesthetists, from Private Hospitals, Government Hospitals, and Medical College Hospitals (the latter two referred to as first-responder hospitals), who are directly responsible for admitting/managing patients in ICU. Results: Of the 204 responses (125/481 in phase 1 and 79/320 in phase 2), 183 responses were included. Respondents from first-responder hospitals were more willing to manage non-intubated hypoxemic patients in neutral pressure rooms, while respondents from private hospitals preferred negative-pressure rooms (p < 0.001). In both the phases, private hospital doctors were less comfortable to use any form of noninvasive oxygen therapies in neutral-pressure rooms compared to first-responder hospitals (low-flow oxygen therapy: 72 vs 50%, p < 0.01; HFNO: 47 vs 24%, p < 0.01 and NPPV: 38 vs 28%, p = 0.20). Interpretation: Variations existed in practices among first-responder and private intensivists/anesthetists. The resource optimal private hospital intensivists/anesthetists were less comfortable using noninvasive oxygen therapies in managing COVID-19 patients. This may reflect differential resource availability necessitating resolution at national, state, and local levels. [ABSTRACT FROM AUTHOR]
- Published
- 2020
6. State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic: A Nationwide Survey.
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Haji, Jumana Yusuf, Subramaniam, Ashwin, Kumar, Prashant, Ramanathan, Kollengode, and Rajamani, Arvind
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INTENSIVE care units ,COVID-19 ,MEDICAL protocols ,DESCRIPTIVE statistics ,PERSONAL protective equipment ,MEDICAL waste disposal ,COVID-19 pandemic ,N95 respirators - Abstract
Background: Optimal personal protective equipment (PPE) preparedness is key to minimize healthcare workers (HCW) infection with COVID- 19. This two-phase survey evaluated PPE preparedness (adherence to Ministry of Health India (MoH) PPE-recommendations; HCW-training; PPE-inventory; PPE-breach management) in Indian intensive care units (ICU). Materials and methods: The phase 1 survey was distributed electronically to intensivists from 481 Indian hospitals between March 25, 2020, and April 06, 2020, as part of a multinational survey. Phase 2 was repeated in 320 Indian hospitals between April 20, 2020, and April 30, 2020. Results: Response rate was 25% from 22 states. PPE practice varied between states and between private, government, and medical colleges. Between phase 1 and phase 2, all aspects of PPE training improved: donning/doffing 43% vs 66%, respectively; p value <0.01); safe waste disposal practices (38% vs 52%; p value = 0.09); intubation training (18% vs 31%; p value = 0.05); and transport (18% vs 31%; p value = 0.05). Perception of confidence for adequate PPE-training improved from 39 to 53% (p value = 0.26). In all, 47 to 60% ICUs adhered to MoH recommendations. Wearing N95-masks at all times increased from 47 to 60% (p value = 0.89). Very few ICUs provided quantitative/qualitative N95 masks fit testing (12% vs 29%; p value <0.01). Low-cost practices like "buddy-system" for donning-doffing (27% vs 44%; p value = 0.02) and showering after PPE breach (10% vs 8%; p value = 0.63) were underutilized. There was reluctance to PPE reuse. In all, 71% were unaware/diffident about PPE inventory. Conclusion: Despite interstate variability, most ICUs conformed to MoH recommendations. This survey conducted during initial pandemic phase demonstrated improved PPE preparedness uniformly across India with scope for further improvement. We suggest implementation of quality improvement measures to improve pandemic preparedness and minimize HCW infection rates, focused on regular PPE training, buddy system, and PPE-breach management. [ABSTRACT FROM AUTHOR]
- Published
- 2020
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7. Multidisciplinary Extubation Protocol in Cardiac Surgical Patients Reduces Ventilation Time and Length of Stay in the Intensive Care Unit
- Author
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Pauline Oh, Chen Ying, Matthew E. Cove, Ramanathan Kollengode, Chuen Seng Tan, Siow Eng Oon, Juvel Taculod, and Graeme MacLaren
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Airway Extubation ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Clinical Protocols ,Multidisciplinary approach ,law ,medicine ,Humans ,030212 general & internal medicine ,Postoperative Period ,Cardiac Surgical Procedures ,Aged ,Retrospective Studies ,Mechanical ventilation ,Protocol (science) ,business.industry ,Retrospective cohort study ,Length of Stay ,Middle Aged ,Prognosis ,Intensive care unit ,Respiration, Artificial ,Cardiac surgery ,Surgery ,Intensive Care Units ,Emergency medicine ,Ventilation (architecture) ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Protocolized care bundles may improve patient care by reducing medical errors, minimizing practice variability, and reducing mortality. We hypothesized that the introduction of a multidisciplinary extubation protocol would reduce duration of mechanical ventilation and intensive care unit length of stay in a tertiary cardiothoracic intensive care unit.A multidisciplinary extubation protocol was created. The protocol was applied to all elective postoperative cardiac surgery patients. Data were collected 3 months before and 3 months after protocol initiation. Patients were excluded if they experienced events that contraindicated application of the protocol.Two hundred one patients undergoing elective open cardiac surgery were included: 99 patients before protocol implementation (preprotocol) and 102 patients after implementation (postprotocol). Median extubation time was reduced by 35% (620 minutes versus 405 minutes; p0.001), whereas adjusted extubation time remained significantly reduced by 144 minutes (p0.001). Intensive care unit length of stay was reduced from 2 days preprotocol to 1 day postprotocol (p0.001). Reintubation rate was the same in both groups (2.06% versus 1.96%; p = 1.0).A simple multidisciplinary extubation protocol is safe and associated with a significant reduction in the duration of mechanical ventilation and intensive care unit length of stay after elective cardiac surgery.
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- 2015
8. Outcomes of Pediatric Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis.
- Author
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Farhat, Abdelaziz, Ling, Ryan Ruiyang, Jenks, Christopher L., Poon, Wynne Hsing, Yang, Isabelle Xiaorui, Li, Xilong, Liu, Yulun, Darnell-Bowens, Cindy, Ramanathan, Kollengode, Thiagarajan, Ravi R., and Raman, Lakshmi
- Subjects
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CARDIOPULMONARY resuscitation , *CHILD patients , *CARDIAC arrest , *HEART diseases , *DATA extraction , *INTENSIVE care units , *RESEARCH , *META-analysis , *RESEARCH methodology , *SYSTEMATIC reviews , *PEDIATRICS , *EXTRACORPOREAL membrane oxygenation , *MEDICAL cooperation , *EVALUATION research , *RISK assessment , *COMPARATIVE studies - Abstract
Objective: The goal of this work is to provide insight into survival and neurologic outcomes of pediatric patients supported with extracorporeal cardiopulmonary resuscitation.Data Sources: A systematic search of Embase, PubMed, Cochrane, Scopus, Google Scholar, and Web of Science was performed from January 1990 to May 2020.Study Selection: A comprehensive list of nonregistry studies with pediatric patients managed with extracorporeal cardiopulmonary resuscitation was included.Data Extraction: Study characteristics and outcome estimates were extracted from each article.Data Synthesis: Estimates were pooled using random-effects meta-analysis. Differences were estimated using subgroup meta-analysis and meta-regression. The Meta-analyses Of Observational Studies in Epidemiology guideline was followed and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation system. Twenty-eight studies (1,348 patients) were included. There was a steady increase in extracorporeal cardiopulmonary resuscitation occurrence rate from the 1990s until 2020. There were 32, 338, and 1,094 patients' articles published between 1990 and 2000, 2001 and 2010, and 2010 and 2020, respectively. More than 70% were cannulated for a primary cardiac arrest. Pediatric extracorporeal cardiopulmonary resuscitation patients had a 46% (CI 95% = 43-48%; p < 0.01) overall survival rate. The rate of survival with favorable neurologic outcome was 30% (CI 95% = 27-33%; p < 0.01).Conclusions: The use of extracorporeal cardiopulmonary resuscitation is rapidly expanding, particularly for children with underlying cardiac disease. An overall survival of 46% and favorable neurologic outcomes add credence to this emerging therapy. [ABSTRACT FROM AUTHOR]- Published
- 2021
- Full Text
- View/download PDF
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