17 research outputs found
The Comparative Effects of Listening to Prayer Recitation and Music Therapy Intraoperatively on Postoperative Pain
No full textIntroduction: Non-pharmacological interventions are considered as successful adjuncts to manage pain. We are studying the comparative effects of listening to prayer recitation and music therapy intraoperatively as non-pharmacological interventions on postoperative pain and intraoperative haemodynamics. Materials and Methods: Seventy two muslim patients with acute appendicitis requiring open, emergency appendicectomies under general anaesthesia were recruited and randomised into three groups: Group A: patients who listened to prayer recitation, Group B: patients who listened to music, Group C: control group - patients who did not listen to any prayer or music. Intraoperative blood pressure, heart rate and postoperative pain scores were monitored. Results: The demographic data, pre- and post-headphones application haemodynamics were compared. There were significantly lower heart rates at 10, 20, 30, 40, 50, 60 minutes for Group A and at 50 and 60 minutes for Group B patients when compared to Group C. Significant reduction in postoperative pain scores were seen in Group A patients at 30 minutes and 8 hours as compared to Group C patients. No significant differences in pain scores were seen between Group B and C patients. No significant differences in additional analgesic requirements postoperatively were seen in all three groups. Conclusion: Listening to prayer recitation or music intraoperatively significantly lowered intraoperative heart rates, however only prayer recitation significantly reduced postoperative pain scores as compared to the control group
Venous Thromboembolism Risk Assessment and Prophylaxis Modalities in Critically Ill Patients
No full textThe decisive study: defining beta-lactam concentration in Intensive care unit patients.
No full textSummary of Research Findings:
1. Patients age, estimated CLcr and recent surgery significantly predicted the Vd and CL of both beta-lactams. Piperacillin and meropenem concentrations were highly-variable with coefficient of variation (COV) of ≥67.7%. Forty-nine patients (58.3%) achieved the PK/PD target and they tend to be older, with slower CLcr and receiving continuous infusion. Based on the most parsimonious logistic regression model, higher CLcr and intermittent infusion were significant predictors of sub-optimal PK/PD target attainment.
2. Malaysian physicians are receptive to PK/PD approach in antibiotic optimization among ICU patients. Nonetheless, there is still a gap in the knowledge of antibiotic PK/PD as well as its application in the critically ill, especially for β-lactams. We also found variable compliance to guidelines for antibiotic choice, as well as antibiotic dosing, for commonly encountered infections in ICU. This warrants further study and interventions in order to improve guideline compliance among local physician.
3. Early and appropriate administration of antimicrobial therapy remains the most important intervention in managing sepsis. To achieve favourable outcomes, the goal is to achieve effective drug concentrations at the site of infection. In critically ill patients, development of organ failure may complicate antibiotic dosing. Two pharmacokinetic parameters that vary with greatest significance in patients with MODS are Vd and drug CL. In presence of AKI, antibiotic dose adjustments in patients with reduced clearance are commonly applied to avoid adverse effects. Augmented renal clearance is another important phenomenon which is a manifestation of enhanced renal function. Early recognition of patients at risk of ARC allows further intervention to prevent antibiotic failure. In patients with ARC, higher doses of renal eliminated antibiotics are recommended or administration of non-renally eliminated drugs should be considered
Air in the pericardial sac post tracheostomy: One should be aware
No full textAbstractPneumopericardium is a rare clinical presentation and is an unusual complication of tracheostomy. Its isolated presentation without associated air in other potential space such as mediastinum or pleura causes difficulty in diagnosis especially in patient with invasive ventilation. We report a case of 72-year-old lady who developed isolated pneumopericardium following tracheostomy. The progression into cardiac tamponade was halted by administration of fluid resuscitation and modifying ventilation mode to spontaneous setting. A flexometallic endotracheal tube was inserted through the tracheostomy stoma with the aid of fibre-optic scope while she was breathing spontaneously; and the cuff was inflated distal to the site of the tracheal wall injury. This technique successfully ceased the air leak across the injury. The endotracheal tube was changed to an adjustable flange tracheostomy tube size 8.5mm internal diameter once available and subsequent serial chest radiographs showed resolving pneumopericardium. Based on this case, we believed that a prompt diagnosis of isolated pneumopericardium may prevent its catastrophic progression into a fatal cardiac tamponade and thus, these rare findings were reported with the intention to raise awareness amongst clinicians
Effects of Shen Men Auricular Acupressure on Haemodynamics During Laryngoscopy and Intubation and Preoperative Anxiety
No full textINTRODUCTION: Laryngoscopy and endotracheal intubation is known to cause tachycardia and increase in blood pressure during general anaesthesia. This study was designed to assess if auricular acupressure has beneficial effects in attenuating the haemodynamic changes during laryngoscopy and intubation. Secondly, this study aimed to evaluate the effectiveness of auricular acupressure in reducing preoperative anxiety. MATERIALS AND METHODS: Eighty patients who were scheduled for surgery under general anaesthesia were randomised to receive either active auricular acupressure over bilateral Shen Men (Group A) or sham auricular acupressure (Group B). A total of three stimulations of auricular acupressure with ten minutes interval were performed before induction of anaesthesia. Haemodynamic parameters (heart rate and blood pressure) were recorded ten minutes after each stimulation, during laryngoscopy and intubation and every minute for ten minutes after intubation. Visual analogue scale for anxiety was documented before and at 30 minutes post first stimulation. RESULTS: The heart rate and mean arterial pressure were statistically higher in Group B comparing to Group A during intubation (p=0.043 and p=0.049 respectively). There was statistically significant reduction in blood pressure after intubation in both groups as compared to baseline (p<0.003 respectively). However, there was no significant difference when comparing both groups (p>0.05). There was no significant reduction of preoperative anxiety level in both groups after auricular acupressure (p=0.879). CONCLUSION: Auricular acupressure over bilateral Shen Men helped to attenuate the haemodynamic changes during intubation. However, it did not reduce preoperative anxiety
SOFA Score Trends in Predicting Mortality in Critically Ill COVID-19 Patients
No full textThe COVID-19 pandemic increased demand for intensive care unit (ICU) beds, requiring reliable disease severity scoring tools to optimise patient management and resource allocation. This retrospective study investigated the accuracy of the Sequential Organ Failure Assessment (SOFA) score in predicting mortality among critically ill COVID-19 patients. Data from 357 patients aged 18 years and above admitted to the ICU with COVID-19 category 5a and above, requiring ventilatory support throughout 2021, were analysed. The SOFA scores were calculated on days 1, 3 and 5 of ICU admission. The highest score and trends were noted; whether scores increased, were maintained or decreased was also determined. Patient outcomes were classified as survivors and non-survivors. There were significant differences in SOFA score trends between survivors and non-survivors. The high sensitivity (83.95%) and positive predictive value (PPV) (86.08%) in those with increased SOFA score trends showed that a SOFA score of ≥9 strongly predicted mortality, albeit with moderate specificity (65.63%). High sensitivity (81.85%) with low PPV (49.45%) was seen in those with decreased SOFA score trends. A high negative predictive value (87.50%) was observed for survivors. The SOFA score trend is effective in prognosticating survival in critically ill patients with COVID-19 infection, making it useful for critical care resource management
Evaluation of a PCR-based lateral flow device for detecting Aspergillus and Candida species from clinical specimens
No full textObjectives: The diagnosis of invasive fungal diseases (IFDs) is time consuming and lacks sensitivity. In this research a rapid and easy to use immunochromatography-based DNA biosensor system was developed to detect Candida and Aspergillus pathogens at genus level, while specifically detecting Candida glabrata, Candida krusei and Aspergillus terreus. This system combines multiplex PCR with a lateral flow assay (LFA) dipstick. Methods: Three separate multiplexed PCR reactions were designed together with a testing algorithm, using biotin, digoxigenin and Tamra fluorophore-labelled fungal internal transcribed spacer universal fungal primers, fungal genera-specific primers, and species-specific primers to produce labelled PCR products that were detected on the LFA dipstick. The LFA dipstick, in a modified sandwich format, utilises immobilised antibodies complementary to the fluorophore labels on the PCR products, and gold nanoparticles to form a visible red line that indicates the presence of the targeted fungus. To validate the developed system, 203 clinical samples suspected of fungal infection were collected from two hospitals in Kuala Lumpur and tested. Results: The limits of detection of the multiplexed PCR were in the range of 5–100 CFU/mL for fungal spiked human blood samples. Against the clinical diagnosis of proven or probable IFDs, the findings show that the LFA system produced a high specificity of 99.4 % while the sensitivity was only moderate at 47.8 % due to the difficulty of extracting fungal DNA from blood samples. The positive and negative predictive values however were promising at 91.7 % and 93.7 %, respectively. Conclusion: The developed LFA system has great potential for further refinement to be used as a new tool in the detection of IFDs
Antibiotic prescribing in an intensive care unit: findings from a public Malaysian setting
No full textIntroduction: Data on antibiotic prescribing together with its knowledge and perception in Malaysian ICU is lacking. Objectives: To explore knowledge, perception, and antibiotic prescribing among specialists and advanced trainees in Malaysian ICU. Materials and Methods: A cross-sectional survey was employed which consisted of three sections namely knowledge, perception, and practice. Three case vignettes consisted of hospital-acquired pneumonia (HAP), infected necrotising pancreatitis (INP), and catheter-related bloodstream infection (CRBSI) were presented in the practice section to gather information on prescribing practice. Results: About 868 respondents were approached but only 104 responded (12.0% response rate). Seven different classes of antibiotics giving a total of 390 were empirically prescribed for the three cases combined. Antibiotic prescribing compliance which indicates correct choice of antibiotics and dosing were 66.3%, 56.7%, and 19.2% for HAI, INP, and CRBSI respectively. In perception, 97.2% and 85.6% of respondents conceded that antibiotic concentration is inadequate, and that dosing be based on MIC respectively. Majority (94.2%) perceived that antibiotic dosing follows PK/PD profile but only half (50.9%) agreed that therapeutic drug monitoring be routinely performed. Comprehension on antibiotics showed that all respondents acknowledged PK/PD profile of antibiotics but only 64.4% able to correlate given antibiotic with their respective PK/PD. Only 13.5% of respondents able to identify the best PD approach for Î-lactam antibiotics in sepsis patients. Conclusion: Antibiotic prescribing was somewhat appropriate in Malaysian ICU. Prolong therapy and inadequate coverage are the hallmark need to be considered especially in CRBSI. Clinicians are conversant with available antibiotics but apprehension in its PK/PD is scan
Enteral feeding protocol: a quality improvement project on feeding interruptions and clinical outcomes in a tertiary intensive care unit
No full textPurposeEvaluation of the effectiveness of the feeding protocol in improving feeding interruption (FI) and clinical outcome in critically ill patients.Materials and methodsThis was a single-center, retrospective, and prospective cohort study design evaluating the nutritional characteristics and adequacy, and the causes and clinical outcomes of FI, pre- and post-feeding protocol implementation. The risk factor for ICU mortality was also identified.ResultsIn total, 430 patients were included, 217 in the pre-protocol group and 213 in the post-protocol group. After protocol implementation, energy and protein intake significantly improved, and the total target nutrition was achieved. The post-protocol group was prescribed a more energy-dense formula (29.0% vs. 55.4%, p < 0.001), a protein supplement (27.6% vs. 56.3%, p < 0.001), and a prokinetic agent (38.7% vs. 48.8%, p = 0.03). There was no difference in the duration of feeding interruption (28 h vs. 30 h, p = 0.60). Implementation of feeding protocol did not affect ICU mortality (OR 0.508, CI 0.250–1.032, p = 0.06). The mortality predictors were SOFA score, underweight, and illness-related FI episode.ConclusionImplementation of the feeding protocol improved feeding strategies and overall nutritional intake; however, it did not improve FI. Illness-related FI was associated with a reduction in survival of critically ill patients
