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Research paper thumbnail of Comparative Study of Continuous Versus Intermittent Subglottic Suction Drainage to Prevent Ventilator Associated Pneumonia in Intubated Patients

Birat Journal of Health Sciences, Dec 31, 2021

Introduc on Subglo c secre on drainage reduces the incidence of ven lator associated pneumonia (V... more Introduc on Subglo c secre on drainage reduces the incidence of ven lator associated pneumonia (VAP). The efficacy of Con nuous subglo c secre on drainage (CSSD) over Intermi ent subglo c secre on drainage (ISSD) for preven on of VAP is unknown. Objec ves Compare the efficacy of CSSD and ISSD in terms of incidence of VAP, mortality, dura on of mechanical ven la on, length of ICU stay and incidence of reintuba on. Methodology This was a prospec ve compara ve study conducted at Birat Medical College and Teaching Hospital. A total number of 80 intubated pa ents for at least 48 hours dura on were included. Con nuous and intermi ent endotracheal suc oning techniques were compared for preven on of VAP and secondary outcomes in terms of length of mechanical ven la on, length of ICU stay, mul organ failure, reintuba on and mortality rate. Result The incidence of VAP was 15% and 22.5 % in CSSD group while it was 17.5% and 27.5% in ISSD group in first 48 hours and 96 hours of mechanical ven la on respec vely.The length of mechanical ven la on was significantly less in con nuous group (4.78 ± 2.50 days) than in intermi ent group (7.18 ± 2.09 days) with p value of 0.023. The pa ents with CSSD had significantly shorter ICU stay (5.49 ± 3.16 days) as compared to the pa ents with ISSD (8.46 ± 2.06 days). The incidence of reintuba on was significantly higher in intermi ent group pa ents (p value 0.024). Pa ents in both the group had comparable incidence of mul organ failure, spontaneous breathing trial and mortality rate. Conclusion The incidences of VAP and mortality were comparable in CSSD and ISSD. However CSSD significantly decreased the dura on of mechanical ven la on, length of ICU stay and incidence of reintuba on..

Research paper thumbnail of Comparative Study of Intravenous Dexamethasone and Methylprednisolone in Severe COVID -19 Patients Requiring Respiratory Support in Intensive Care Unit

Journal of College of Medical Sciences-Nepal

Introduction: Numerous steroids have been used to combat the intense cytokine storms in severe CO... more Introduction: Numerous steroids have been used to combat the intense cytokine storms in severe COVID pneumonia. The study compares the use methylprednisolone and dexamethasone as an adjuvant steroid therapy in severe COVID-19 pneumonia. Methods: Prospective comparative study including total of 190 COVID-19 severe pneumonia cases admitted in intensive care unit with 93 patients randomly allocated to receive dexamethasone 6 mg and 97 patients allocated to receive methylprednisolone 1mg/kg in two divided doses both by intravenous route for 7 days. Mortality was compared as primary objective while oxygenation parameters and inflammatory markers, need for invasive mechanical ventilation, duration of ventilation, length of ICU-stay, incidence of multiorgan failure were assessed as secondary variables. Results: At day zero, the patient in methylprednisolone group had significantly lower PaO2/FIO2 ratio (258.3950.36 vs 285.1868.62, P=0.002). At day seven, methylprednisolone significantly im...

Research paper thumbnail of Knowledge on Sepsis among Health Care Providers of Birat Medical College and Teaching Hospital

Birat Journal of Health Sciences, 2020

Introduction: Knowledge and awareness of sepsis among various health care professionals is essent... more Introduction: Knowledge and awareness of sepsis among various health care professionals is essential for prompt diagnosis and appropriate initial resuscitation and management of patient with sepsis. Objective: To assess and compare the knowledge and awareness of sepsis among health care professionals working at Birat Medical College and Teaching Hospital. Methodology This was a questionnaire-based survey with comparative study in 200 health care professionals conducted at Birat Medical College and Teaching Hospital from July– September, 2019. Questions were designed to assess the knowledge on diagnosis, initial resuscitation and management of sepsis. The knowledge level of the participants was assessed with scoring system as good, average and poor which was finally compared between the various health care professionals. Result Out of 200, only 180 health care professionals were included for statistical analysis. While assessing the knowledge on diagnosis of sepsis, 55.6% consultant ...

Research paper thumbnail of Comparison of Arterial Blood Gas Analysis versus Central Laboratory Electrolyte and Hemoglobin Determination in Birat Medical College and Teaching Hospital

Birat Journal of Health Sciences, 2020

Introduction: Electrolyte and hemoglobin measurement are the integral part of management of criti... more Introduction: Electrolyte and hemoglobin measurement are the integral part of management of critically ill patient. There can be a wide variation in the electrolyte and hemoglobin measurement in critically ill patient between arterial blood gas analyzer and central laboratory auto analyzer. Objective: To compare the electrolytes (sodium, potassium and chloride) and hemoglobin level measured by arterial blood gas analyzer and laboratory analyzer. Methodology: This was a prospective cross-sectional comparative study comparing the electrolytes (sodium, potassium and chloride) and hemoglobin measurement between arterial blood gas analyzer and laboratory auto analyzer. The study included 124 paired blood samples from the patient admitted in intensive care unit of Birat Medical College Teaching Hospital in two months duration. The arterial sample and venous sample for electrolytes and hemoglobin measurement were taken simultaneously or not more than one hour apart and analysis was done by...

Research paper thumbnail of Prevention of Shivering during Spinal Anesthesia: Comparison between Tramadol, Ketamine and Ondansetron

Journal of Nepal Medical Association, 2017

Introduction: Shivering is an unpleasant experience after spinal anesthesia. We conducted this st... more Introduction: Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering. Methods: In this prospective, randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I&II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0.25mg/kg (Group3) and Tramadol 0.5mg/kg (Group4). Incidence of shivering, effect on hemodynamics, nausea, vomiting, sedation and emergence reactions were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 20.0 software. Results: The patients were comparable in terms of demographic variables, baseline temperature, type of surgery, median level of sensory blockade, duration of surgery and anesthesia. Shivering was present in 17 (56.7%), 5 (1...

Research paper thumbnail of Comparative Study of Intra Operative Blood Sugar Level in Spinal Anesthesia and General Anesthesia in Patients undergoing Elective Surgery

Birat Journal of Health Sciences, 2018

Introduction: The aim of the study was to carry out the comparative study of variations in blood ... more Introduction: The aim of the study was to carry out the comparative study of variations in blood glucose levels intra operatively in patients undergoing surgical procedures in Spinal Anesthesia and General Anesthesia by capillary blood glucose level.Objective: To compare intra operative blood glucose level in Spinal and General Anesthesia.Methodology: Sixty non diabetic patients (30 in each group) aged between 20 – 60 years belonging to ASA I and ASA II status were enrolled for this prospective comparative study. Capillary blood glucose was measured preoperatively and thereafter at 15 minutes interval after incision in Spinal Anesthesia and after induction of General Anesthesia till one hour of surgery. For statistical analysis paired sample t – test was used for comparing mean of quantitative data. Difference was considered statistically significant if p < 0.05.Results: Blood sugar level was well controlled in patients receiving spinal anesthesia. General anesthesia produced mor...

Research paper thumbnail of Comparative Study of Continuous Versus Intermittent Subglottic Suction Drainage to Prevent Ventilator Associated Pneumonia in Intubated Patients

Birat Journal of Health Sciences, 2021

Introduction: Subglottic secretion drainage reduces the incidence of ventilator associated pneumo... more Introduction: Subglottic secretion drainage reduces the incidence of ventilator associated pneumonia (VAP). The efficacy of Continuous subglottic secretion drainage (CSSD) over Intermittent subglottic secretion drainage (ISSD) for prevention of VAP is unknown. Objectives: Compare the efficacy of CSSD and ISSD in terms of incidence of VAP, mortality, duration of mechanical ventilation, length of ICU stay and incidence of reintubation. Methodology: This was a prospective comparative study conducted at Birat Medical College and Teaching Hospital. A total number of 80 intubated patients for at least 48 hours duration were included. Continuous and intermittent endotracheal suctioning techniques were compared for prevention of VAP and secondary outcomes in terms of length of mechanical ventilation, length of ICU stay, multiorgan failure, reintubation and mortality rate. Results: The incidence of VAP was 15% and 22.5 % in CSSD group while it was 17.5% and 27.5% in ISSD group in first 48 ho...

Research paper thumbnail of Comparative Study of Continuous Versus Intermittent Subglottic Suction Drainage to Prevent Ventilator Associated Pneumonia in Intubated Patients

Birat Journal of Health Sciences, Dec 31, 2021

Introduc on Subglo c secre on drainage reduces the incidence of ven lator associated pneumonia (V... more Introduc on Subglo c secre on drainage reduces the incidence of ven lator associated pneumonia (VAP). The efficacy of Con nuous subglo c secre on drainage (CSSD) over Intermi ent subglo c secre on drainage (ISSD) for preven on of VAP is unknown. Objec ves Compare the efficacy of CSSD and ISSD in terms of incidence of VAP, mortality, dura on of mechanical ven la on, length of ICU stay and incidence of reintuba on. Methodology This was a prospec ve compara ve study conducted at Birat Medical College and Teaching Hospital. A total number of 80 intubated pa ents for at least 48 hours dura on were included. Con nuous and intermi ent endotracheal suc oning techniques were compared for preven on of VAP and secondary outcomes in terms of length of mechanical ven la on, length of ICU stay, mul organ failure, reintuba on and mortality rate. Result The incidence of VAP was 15% and 22.5 % in CSSD group while it was 17.5% and 27.5% in ISSD group in first 48 hours and 96 hours of mechanical ven la on respec vely.The length of mechanical ven la on was significantly less in con nuous group (4.78 ± 2.50 days) than in intermi ent group (7.18 ± 2.09 days) with p value of 0.023. The pa ents with CSSD had significantly shorter ICU stay (5.49 ± 3.16 days) as compared to the pa ents with ISSD (8.46 ± 2.06 days). The incidence of reintuba on was significantly higher in intermi ent group pa ents (p value 0.024). Pa ents in both the group had comparable incidence of mul organ failure, spontaneous breathing trial and mortality rate. Conclusion The incidences of VAP and mortality were comparable in CSSD and ISSD. However CSSD significantly decreased the dura on of mechanical ven la on, length of ICU stay and incidence of reintuba on..

Research paper thumbnail of Comparative Study of Intravenous Dexamethasone and Methylprednisolone in Severe COVID -19 Patients Requiring Respiratory Support in Intensive Care Unit

Journal of College of Medical Sciences-Nepal

Introduction: Numerous steroids have been used to combat the intense cytokine storms in severe CO... more Introduction: Numerous steroids have been used to combat the intense cytokine storms in severe COVID pneumonia. The study compares the use methylprednisolone and dexamethasone as an adjuvant steroid therapy in severe COVID-19 pneumonia. Methods: Prospective comparative study including total of 190 COVID-19 severe pneumonia cases admitted in intensive care unit with 93 patients randomly allocated to receive dexamethasone 6 mg and 97 patients allocated to receive methylprednisolone 1mg/kg in two divided doses both by intravenous route for 7 days. Mortality was compared as primary objective while oxygenation parameters and inflammatory markers, need for invasive mechanical ventilation, duration of ventilation, length of ICU-stay, incidence of multiorgan failure were assessed as secondary variables. Results: At day zero, the patient in methylprednisolone group had significantly lower PaO2/FIO2 ratio (258.3950.36 vs 285.1868.62, P=0.002). At day seven, methylprednisolone significantly im...

Research paper thumbnail of Knowledge on Sepsis among Health Care Providers of Birat Medical College and Teaching Hospital

Birat Journal of Health Sciences, 2020

Introduction: Knowledge and awareness of sepsis among various health care professionals is essent... more Introduction: Knowledge and awareness of sepsis among various health care professionals is essential for prompt diagnosis and appropriate initial resuscitation and management of patient with sepsis. Objective: To assess and compare the knowledge and awareness of sepsis among health care professionals working at Birat Medical College and Teaching Hospital. Methodology This was a questionnaire-based survey with comparative study in 200 health care professionals conducted at Birat Medical College and Teaching Hospital from July– September, 2019. Questions were designed to assess the knowledge on diagnosis, initial resuscitation and management of sepsis. The knowledge level of the participants was assessed with scoring system as good, average and poor which was finally compared between the various health care professionals. Result Out of 200, only 180 health care professionals were included for statistical analysis. While assessing the knowledge on diagnosis of sepsis, 55.6% consultant ...

Research paper thumbnail of Comparison of Arterial Blood Gas Analysis versus Central Laboratory Electrolyte and Hemoglobin Determination in Birat Medical College and Teaching Hospital

Birat Journal of Health Sciences, 2020

Introduction: Electrolyte and hemoglobin measurement are the integral part of management of criti... more Introduction: Electrolyte and hemoglobin measurement are the integral part of management of critically ill patient. There can be a wide variation in the electrolyte and hemoglobin measurement in critically ill patient between arterial blood gas analyzer and central laboratory auto analyzer. Objective: To compare the electrolytes (sodium, potassium and chloride) and hemoglobin level measured by arterial blood gas analyzer and laboratory analyzer. Methodology: This was a prospective cross-sectional comparative study comparing the electrolytes (sodium, potassium and chloride) and hemoglobin measurement between arterial blood gas analyzer and laboratory auto analyzer. The study included 124 paired blood samples from the patient admitted in intensive care unit of Birat Medical College Teaching Hospital in two months duration. The arterial sample and venous sample for electrolytes and hemoglobin measurement were taken simultaneously or not more than one hour apart and analysis was done by...

Research paper thumbnail of Prevention of Shivering during Spinal Anesthesia: Comparison between Tramadol, Ketamine and Ondansetron

Journal of Nepal Medical Association, 2017

Introduction: Shivering is an unpleasant experience after spinal anesthesia. We conducted this st... more Introduction: Shivering is an unpleasant experience after spinal anesthesia. We conducted this study to evaluate the efficacy of ondansetron, ketamine and tramadol for prevention of shivering. Methods: In this prospective, randomized controlled study, 120 patients aged 18-65 years of American Society of Anesthesiologist (ASA) physical status I&II undergoing various surgical procedures were included and allocated alternately to one of the 4 groups; Normal saline (Group1), Ondansetron 4mg (Group2), Ketamine 0.25mg/kg (Group3) and Tramadol 0.5mg/kg (Group4). Incidence of shivering, effect on hemodynamics, nausea, vomiting, sedation and emergence reactions were recorded. Data was analyzed using SPSS (The Statistical Package for Social Sciences) version 20.0 software. Results: The patients were comparable in terms of demographic variables, baseline temperature, type of surgery, median level of sensory blockade, duration of surgery and anesthesia. Shivering was present in 17 (56.7%), 5 (1...

Research paper thumbnail of Comparative Study of Intra Operative Blood Sugar Level in Spinal Anesthesia and General Anesthesia in Patients undergoing Elective Surgery

Birat Journal of Health Sciences, 2018

Introduction: The aim of the study was to carry out the comparative study of variations in blood ... more Introduction: The aim of the study was to carry out the comparative study of variations in blood glucose levels intra operatively in patients undergoing surgical procedures in Spinal Anesthesia and General Anesthesia by capillary blood glucose level.Objective: To compare intra operative blood glucose level in Spinal and General Anesthesia.Methodology: Sixty non diabetic patients (30 in each group) aged between 20 – 60 years belonging to ASA I and ASA II status were enrolled for this prospective comparative study. Capillary blood glucose was measured preoperatively and thereafter at 15 minutes interval after incision in Spinal Anesthesia and after induction of General Anesthesia till one hour of surgery. For statistical analysis paired sample t – test was used for comparing mean of quantitative data. Difference was considered statistically significant if p < 0.05.Results: Blood sugar level was well controlled in patients receiving spinal anesthesia. General anesthesia produced mor...

Research paper thumbnail of Comparative Study of Continuous Versus Intermittent Subglottic Suction Drainage to Prevent Ventilator Associated Pneumonia in Intubated Patients

Birat Journal of Health Sciences, 2021

Introduction: Subglottic secretion drainage reduces the incidence of ventilator associated pneumo... more Introduction: Subglottic secretion drainage reduces the incidence of ventilator associated pneumonia (VAP). The efficacy of Continuous subglottic secretion drainage (CSSD) over Intermittent subglottic secretion drainage (ISSD) for prevention of VAP is unknown. Objectives: Compare the efficacy of CSSD and ISSD in terms of incidence of VAP, mortality, duration of mechanical ventilation, length of ICU stay and incidence of reintubation. Methodology: This was a prospective comparative study conducted at Birat Medical College and Teaching Hospital. A total number of 80 intubated patients for at least 48 hours duration were included. Continuous and intermittent endotracheal suctioning techniques were compared for prevention of VAP and secondary outcomes in terms of length of mechanical ventilation, length of ICU stay, multiorgan failure, reintubation and mortality rate. Results: The incidence of VAP was 15% and 22.5 % in CSSD group while it was 17.5% and 27.5% in ISSD group in first 48 ho...