Background: The rapid shallow breathing indexe is crucial considering the weaning of patients inprolonged mechanical ventilation. Objective: The purpose of the present study was to compare the high and low rapid shallow breathingindexes... more
Background: The rapid shallow breathing indexe is crucial considering the weaning of patients inprolonged mechanical ventilation. Objective: The purpose of the present study was to compare the high and low rapid shallow breathingindexes with weaning of patients in prolonged mechanical ventilation. Methodology: This cohort study was conducted in the Department of Anesthesia, Pain Palliative &Intensive Care Unit of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2014 toDecember 2015 for a period of two (02) years. Patients of ICU on mechanical ventilation more than 48hours with the age of 18 to 60 years were included in this study. Standard weaning criteria was consideredas resolution of the primary cause of respiratory failure, state of alertness, cooperation, response tocommands and Glasgow coma scale (GCS) scores ³9. Primary and daily setting of ventilators and thedecision to weaning of the patient was made by the ICU consultants. RSBI was then measured. Thedecision ...
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Background: Mechanical ventilation (MV) is a life-saving intervention in the intensive care unit that should be considered for patients with respiratory failure. Objective: The purpose of the present study was to compare the... more
Background: Mechanical ventilation (MV) is a life-saving intervention in the intensive care unit that should be considered for patients with respiratory failure. Objective: The purpose of the present study was to compare the clinico-demographic characteristics and rapid shallow breathing index of patients on mechanical ventilation at intensive care unit. Methodology: This prospective cohort study was conducted in the Department of Anesthesia, Pain Palliative & Intensive Care Unit of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2014 to December 2015 for a period of two (2) years. Patients on mechanical ventilation more than 48 hours with the age of 18 to 60 years after fulfilling the inclusion and exclusion criteria were included as study population. One type of ventilator (eVent Medical) was used in all patients. Primary and daily setting of ventilators and the decision to weaning of the patient was made by the ICU consultants. The rapid shallow breathing index (RS...
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Background: Tension-type headache is a common neurological problem among general population of Bangladesh. Objective: This study was undertaken to ascertain the frequency of subclinical and over hypothyroidism in patients with infrequent... more
Background: Tension-type headache is a common neurological problem among general population of Bangladesh. Objective: This study was undertaken to ascertain the frequency of subclinical and over hypothyroidism in patients with infrequent TTH. Methodology: This study was conducted in a tertiary care hospital Dhaka medical college in Bangladesh. The study subjects consisted of 200 patients primary headache disorders. Thyroid function test were performed. All four sub-types of tension type headache were considered to include in the study, namely: Infrequent episodic (or infrequent), frequent episodic (or frequent), chronic sub-type and probable sub-type. Result: Forty percent (40%) patients in this study had infrequent TTH, 30% had frequent episodic TTH, 21% had chronic sub-type of TTH and 9% patients had probable sub-type of TTH. overt hypothyroidism. Among 46 patients with frequent episodic TTH 10 patients had subclinical hypothyroidism and 4 patients had overt hypothyroidism. Out of...
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Background: Throughout the world multi-drug resistant hospital acquired infections (HAI) are one of the leading causes of deaths and morbidity amongst hospitalized patients. Objective: The aim of study was to identify prevalence and... more
Background: Throughout the world multi-drug resistant hospital acquired infections (HAI) are one of the leading causes of deaths and morbidity amongst hospitalized patients. Objective: The aim of study was to identify prevalence and variations of predominant microorganisms and their drug sensitivity and resistance pattern in a tertiary care public hospital, Dhaka, Bangladesh. Methodology: The study was conducted in Intensive Care Unit (ICU), High Dependency Unit (HDU), Post-operative ward and general wards of a tertiary care publicNeuro- hospital in Dhaka during 1st January, 2017 to 31st December, 2018. Patients admitted in any of the four units (ICU, HDU, Post-operative and general wards) of the hospital who were clinically suspected of having acquired any infection after 48 hours of admission to the ICUs were included. Depending on the clinical suspicion laboratory samples were collected from the patients. Samples were subjected to the testing and antibiotic sensitivity. Results: ...
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Background: The number of organisms developing resistance to commonly used antibiotics is increasing day by day. The exact national scenario of antimicrobial sensitivity pattern is not well known in Bangladesh owing to the absence of... more
Background: The number of organisms developing resistance to commonly used antibiotics is increasing day by day. The exact national scenario of antimicrobial sensitivity pattern is not well known in Bangladesh owing to the absence of proper guideline for prescribing antibiotics. Aims: The aim of this study is to identify the group of organisms developing resistanceso that antibiotic policy can be formulated for the proper and effective use of antibiotics. Settings and Design: This observational study was conducted for a period of 1 year from January 2018 to December 2018 in a tertiary care hospital in Bangladesh. Materials and methods: This descriptive cross-sectional study was conducted in the Department of Microbiology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from January 2018 to December 2018, using the convenient sampling technique. Tracheal secretions from patients in the intensive care unit (ICU), tested in Department of Microbiology, National Insti...
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Background: The weaning success in intensive care unit patients under mechanical ventilation is very important. Objective: The purpose of this study was to investigate the efficacy and effects of rapid shallow breathing index (RSBI) in... more
Background: The weaning success in intensive care unit patients under mechanical ventilation is very important. Objective: The purpose of this study was to investigate the efficacy and effects of rapid shallow breathing index (RSBI) in predicting weaning success in patients with prolonged mechanical ventilation more than 48 hours. Methodology: This prospective cohort study was conducted in the Department of Anesthesia, Pain Palliative & Intensive Care Unit of Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2014 to December 2015 for a period of two (02) years. Patients on mechanical ventilation more than 48 hours with the age of 18 to 60 years were included in this study. During the weaning process, the arterial blood gases (ABG) values was checked and the patients was separated from mechanical ventilation. After measuring RSBI, patients was separated from mechanical ventilator and given T-piece trial (1 to 4 hours) and finally extubated as per advice of ICU consultant...
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Background: Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop signs of AKI. AKI incidence is very high worldwide among intensive care unit patients. Previously long known term, acute renal failure (ARF)... more
Background: Approximately 7% of all hospitalized patients and 20% of acutely ill patients develop signs of AKI. AKI incidence is very high worldwide among intensive care unit patients. Previously long known term, acute renal failure (ARF) is largely replaced by acute kidney injury (AKI), reflecting the recognition that smaller decrements in kidney function that do not result in overt organ failure are of substantial clinical relevance and are associated with increased morbidity and mortality. Objectives: We designed this study to diagnose even mild renal dysfunction earlier than usual time frame with the combined effect of both serum creatinine and urine output criteria, when compared with serum creatinine criterion alone. To establish this objective we used RIFLE serum creatinine and urine output (UO) criteria combined (Scr+UO) and compared with RIFLE serum creatinine (Scr) alone to diagnose AKI early (in days). Design: Prospective observational cohort study. Duration of the study ...
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We present a case of a 45 years old male, diabetic and hypertensive who was admited into hospital with a history ofrestlessness, blurring of vision and breathlessness for one day. Inspite of conservative treatment for 10 hours, hisgeneral... more
We present a case of a 45 years old male, diabetic and hypertensive who was admited into hospital with a history ofrestlessness, blurring of vision and breathlessness for one day. Inspite of conservative treatment for 10 hours, hisgeneral condition gradually detoriated and he was shifted to ICU. He was kept on mechanical ventilator. Hislaboratory results showed severe high anion gap metabolic acidosis not corrected by sodibicarb and adequate fluidresuscitation. MRI of brain showed bilateral putamenal lesion suspecting methanol intoxication. His acidosis persistedand after giving 3 sessions of Sustained Low Efficiency Dialysis (SLED), metabolic acidosis was corrected withnormalization of renal function. After six months in a follow-up, patient complained of total blindness and fundalphotography showed bilateral optic atrophy. Bangladesh Crit Care J September 2019; 7(2): 111-112
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Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of... more
Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute mo...
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Background : This study is a sub analysis of data submitted on behalf of Bangladesh to an international study (2013-2014) involving Asian ICUs and merits comparison with prior study done in Bangladesh in 2007 which had similar objective.... more
Background : This study is a sub analysis of data submitted on behalf of Bangladesh to an international study (2013-2014) involving Asian ICUs and merits comparison with prior study done in Bangladesh in 2007 which had similar objective. Objective : To assess structure, organization and delivery of ICU care in ICUs of Bangladesh with attention to hospital organizational characteristics, ICU organizational characteristics, staffing etc. Method : Prospective cohort study involving ICUs of 51 hospitals of Bangladesh done in 2013-2014. The hospitals in our study were divided into three groups : clinics/hospitals less than 50 beds (n =18), clinics/hospitals more than 50 beds(n=24) and Govt. hospitals/academic hospitals/ medical colleges hospitals (n=9). Results : Most respondent hospitals were from Dhaka (77.4%). Only 17.6% hospitals were university affiliated. The average number of hospital beds were 225. The average number of ICU beds were 14. 19.6 % hospitals had infection control com...
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Renal artery stenosis (RAS) is most common cause of secondary hypertension and accounts for approximately 1–3% of all causes of hypertension. Fibromuscular dysplasia (FMD) is important cause of RAS in young patients. Various therapeutic... more
Renal artery stenosis (RAS) is most common cause of secondary hypertension and accounts for approximately 1–3% of all causes of hypertension. Fibromuscular dysplasia (FMD) is important cause of RAS in young patients. Various therapeutic options are currently available for patients with renovascular hypertension: medical antihypertensive therapy, surgical revascularisation and transluminal angioplasty including stent implantation. We present in this report a female patient with left renal artery & left renal atrophy and segmental marked stenosis of supra renal aorta who presented with hypertensive encephalopathy & viral meningitis. Patient was successfully treated with antiviral agent.Bangladesh Crit Care J September 2018; 6(2): 102-104
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Myasthenia gravis (MG) is an autoimmune neurologic disease that affects the post synaptic portion of the neuromuscular junction. Usually MG occur in young adults or in the elderly characterized by weakness of fatigue of skeletal muscles... more
Myasthenia gravis (MG) is an autoimmune neurologic disease that affects the post synaptic portion of the neuromuscular junction. Usually MG occur in young adults or in the elderly characterized by weakness of fatigue of skeletal muscles due to repetitive use.1-2 It represents a challenge for clinicians due to the diversity of disease manifestations. It is therefore important to monitor the neuromuscular blockade (NMB) due to the multiple presentations of MG. In our case the patient presented with clinical features suggestive of Guillen Barre Syndrome (GBS) which is an autoimmune disease against myelin nerve sheath. Initially he was planned to be treated as GBS because of it’s unusual descending paralysis like presentation. Nerve conduction studies were done a few times and were found to be normal. Anti acetylcholine receptor antibody test was found positive. Plane X Ray of chest and CT scan of Chest showed a mediastinal mass suggestive of Thymoma. Patient recovered dramatically afte...
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Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity and mortality. The influence of intermittent subglottic secretion drainage (SSD) in preventing VAP has been supported by literature studies.Objective: To find out... more
Context: Ventilator-associated pneumonia (VAP) causes substantial morbidity and mortality. The influence of intermittent subglottic secretion drainage (SSD) in preventing VAP has been supported by literature studies.Objective: To find out the effectiveness of subglottic secretion drainage (SSD) on prevention of ventilator associated pneumonia (VAP) using endotracheal tube with subglottic secretion drainage (ETT-SSD).Methodology: This study was carried out in the 10 beded medical-care Intensive Care Unit (ICU) of BIRDEM Hospital, Dhaka over a period of one and half year, enrolling 48 subjects. Patients expected to require mechanical ventilation (MV) for more than >48 hrs were randomly assigned to one of two groups: one was ventilated with ETT-SSD and the other with conventional endotracheal tube (ETT-C).Results: Primary outcome was the overall incidence of VAP based on quantitative culture of distal pulmonary samplings performed after each clinical suspicion. Other outcomes includ...