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Purpose: Skeletal muscle ultrasound is a valuable tool for assessing muscle wasting in ICU. Previous studies on skeletal muscle ultrasound in ICU have been performed on lower limb muscles. The current study is formulated to assess the feasibility and reliability of anterior temporalis (AT) muscle ultrasound for measuring muscle wasting in ICU., Methods: In this prospective cohort study in 48 critically ill patients with sepsis, muscle layer thicknesses (MLTs) and mean grayscale (GS) values of anterior temporalis muscles and quadriceps femoris (Q) were measured at baseline and serially till 7 days. Correlation was made between baseline and change in MLT and GS values of AT and Q muscle and these parameters were compared between ICU survivors and non survivors., Results: Baseline anterior temporalis MLTs or their longitudinal changes over 7 days did not correlate significantly with the corresponding parameters of quadriceps femoris muscles. The baseline GS values of two muscle groups correlated weakly at baseline, but the change in GS over 7 days showed no correlation. The baseline MLTs of both muscle groups and their longitudinal change over 7 days did not correlate with ICU length of stay. The change in MLT of AT over 7 days was significantly greater in ICU non-survivors compared to survivors., Conclusion: Measurement of ultrasonographic muscle layer thickness and grayscale parameters of anterior temporalis muscle did not show good correlation with that of quadriceps muscle., (© 2022. Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB).)

Background: Intravenous fluid optimization is an essential component of managing patients in a critical care setting. A cumulative positive fluid balance is consistent with poor outcomes in patients admitted to the intensive care unit (ICU). The overall utility of net cumulative fluid balance as a surrogate for assessing fluid overload has been interrogated. Materials and methods: This study was a prospective single-center observational study, which was done to correlate body weight changes with fluid balance in ICU patients and evaluate its impact on clinical outcomes. Inclusion criteria consisted of adult patients who were admitted to the critical care unit on specialized beds with integrated weighing scales between September 2017 and December 2018. The evaluation of the effect of changes in body weight on ICU survival was the primary objective of the study. Results: We enrolled 105 patients in this study. The ICU mortality was 23.80% with non-survivors showing more weight gain than the survivors. Statistically significant weight gain was documented in the non-survivors on days 3 and 4 (1.9 vs 1.05; p = 0.0084 and 2.6 vs 1.6; p = 0.0030) of ICU admission. Non-survivors had greater cumulative positive fluid balance on fourth, fifth, and sixth days post-ICU admission when compared to survivors (3586 vs 1659 mL, p = 0.0322; 5418 vs 1255 mL, p = 0.0017; and 5430 vs 2305 mL p = 0.0264, respectively). In multivariate regression analysis, cumulative fluid balance did not correlate with days on mechanical ventilation or length of stay in ICU. Changes in body weight and cumulative fluid balance showed a good correlation. Conclusion: In patients admitted to the ICU, weight gain on third and fourth days of admission is concordant with increased ICU mortality. Body weight changes were seen to correlate well with the cumulative fluid balance. [ABSTRACT FROM AUTHOR]

The overarching principal of medical care is to provide safe and quality care to all patients. Obstetric patients have changes in physiology and anatomy compared to non-parturients which places them at a higher risk during anesthesia care.[[6]] Obstetric anesthesia presents unique sets of challenges not only due to patient physiology, higher rate of emergency surgeries but also due to the need to balance anesthetic techniques to provide safe anesthesia to "two lives" at risk. Establishing antenatal anesthesia clinics can help in timely predelivery optimization, patient counselling, education, and formulation of plan in case of operative delivery. [Extracted from the article]

Background: Self-extubation is a common event in intensive care units (ICUs) world-wide. The most common factor attributed in various studies is lack of optimal sedation. However, the factors that lead to this inadequacy of sedation are not analyzed. Aims: The present study aimed to evaluate the determinants of factors leading to self-extubation in our ICU. Relation of patient profile, nature of sedation and any diurnal variation in extubation frequency was analyzed. Materials and Methods: Retrospective explorative analysis was carried out for patients admitted to ICU from January 2011 to January 2012. Information from medical records for the above parameters was extracted and descriptive statistics was used for assessing the outcomes. Results: In the present study, there was a higher incidence of self-extubation in ventilated ICU patients during the changeover periods of the ICU staff. There was no relation of frequency of self-extubation with the medications used for sedation once the sedation was titrated to a common endpoint. A higher incidence of self-extubation was seen in the surgical and younger age group of patients. Conclusions: It is recommended that the duty shift finishing time of ICU staff (medical and paramedical) staff should be staggered and should have minimal overlap to prevent self-extubation. A continuous reassessment of level of sedation of patients independent of the type sedative medication should be carried out. [ABSTRACT FROM AUTHOR]

The clinical sedation scores available for assessing sedation in the intensive care unit (ICU) have drawbacks and limit their usefulness in paralyzed and deeply sedated patients. An objective tool, the bispectral index (BIS), could prove beneficial in such circumstances. We evaluated the ability of BIS to assess the level of sedation and its correlation with the Richmond agitation sedation scale (RASS) in ICU. Twenty-four, mechanically ventilated, critically ill patients of either sex, 15–65 years of age, were studied over a period of 24 h. They received a standard sedation regimen consisting of a bolus dose of propofol 0.5 mg/kg and fentanyl 1 μg/kg followed by infusions of propofol and fentanyl ranging from 1.5 to 5 mg/kg/h and 0.5 to 2.0 μg/kg/h, respectively. Hemodynamic parameters, temperature, end-tidal carbon dioxide, BIS and RASS values were recorded. The correlation of BIS and RASS was expressed as Kendall correlation coefficients (τ). A p value of <0.05 was considered statistically significant. A total of 414 readings was obtained. On comparing BIS values for all patients with the corresponding RASS values, there was a statistically highly significant correlation between the two. ( τ = 0.56, p < 0.0001). For adequate sedation as judged by a RASS value of 0 to −3, the median BIS value was found to be 56 (range 42–89). A BIS value of 70 had a high sensitivity (85%) and specificity (80%) to differentiate adequate from inadequate sedation. Our results illustrate that BIS correlates well with RASS when assessing the level of sedation in mechanically ventilated critically ill patients. BIS reliably differentiates inadequate from adequate sedation. [ABSTRACT FROM AUTHOR]