Publications by authors named "Sulagna Bhattacharjee"

45 Publications

Comparison of ultrasound guided dorsal radial artery cannulation and conventional radial artery cannulation at the volar aspect of wrist: A pilot randomized controlled trial.

J Vasc Access 2022 Apr 26:11297298221093953. Epub 2022 Apr 26.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Background: Distal radial artery cannulation at the "anatomical snuffbox" carries several theoretical advantages over conventional radial arterial cannulation at the wrist. However, these two techniques have not been evaluated in perioperative settings.

Methods: In this randomized controlled trial,  = 200 patients requiring arterial cannulation for perioperative monitoring were recruited. Patients were randomized to either ultrasound guided distal radial artery cannulation group (group D) or ultrasound guided conventional radial artery cannulation group (group W). Primary outcome of this study was first attempt cannulation success rate.

Results: First attempt cannulation success rate was significantly lower in distal radial artery cannulation (57% in group D and 77% in group W;  = 0.003). Use of alternative cannulation site was significantly higher in group D when compared to group W ( = 0.015) and number of attempts for successful cannulation was significantly higher in group D when compared to group W ( = 0.015). None of the patients in any group developed thrombosis and related complications and intraoperative catheter dislodgement. Time to puncture the artery ( < 0.0001), total cannulation time ( < 0.0001), and actual catheter insertion time ( < 0.0001) were significantly higher in group D in comparison to group W.

Conclusion: Distal radial artery cannulation was associated with lower first attempt cannulation success rate and requires longer time to perform. As distal radial artery is a new technique, further studies are required in different clinical settings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/11297298221093953DOI Listing
April 2022

Intraoperative lung protective ventilation in peritonitis patients undergoing emergency laparotomy: A randomised controlled trial.

Indian J Anaesth 2021 Nov 23;65(11):798-805. Epub 2021 Nov 23.

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Background And Aims: Lung protective ventilation (LPV) is recommended in acute respiratory distress syndrome. However, role of intraoperative LPV in elective laparotomy is controversial and it has not been evaluated in emergency laparotomy (EL). The aim of the study was to identify whether use of intraoperative LPV in EL in peritonitis patients reduces postoperative pulmonary complications (POPC).

Methods: After institutional ethics committee approval and informed written consent, 98 adult patients undergoing EL for peritonitis were randomised into two groups. Patients in group 1 received LPV (tidal volume 6-8 ml/kg, positive end expiratory pressure (PEEP) 6-8 cm HO and recruitment manoeuvre every 30 min) and patients in group 2 received conventional ventilation (tidal volume 10-12 ml/kg, without PEEP/recruitment). Primary outcome was incidence of POPC on day 7.

Results: Data of 94 patients (n = 45 in group 1 & n = 49 in group 2) were available. Baseline demographic & laboratory parameters were comparable. Incidence of POPC was similar in both the groups [42.9% in group 1 vs. 53.3% in group 2; risk difference -10.4% (-30.6%, 9.6%); = 0.31]. Mortality during hospital stay was 26.7% patients in group 1 and 26.5% patients in group 2 [risk difference (95% CI) 0.14%, (-17.7, 18.0); = 0.98]. Length of hospital stay [median interquartile range (IQR) 13 (9-18) days in group 1 vs. 13 (8-21) days in group 2; = 0.82] and length of intensive care unit stay [median (IQR) 7 (4-10) days vs. 6 (3-12) days; = 0.88] were also similar in both groups.

Conclusion: LPV during EL in peritonitis patients does not reduce the incidence of POPC compared to conventional ventilation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/ija.ija_573_21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8680419PMC
November 2021

Epidemiology and clinical characteristics of COVID- 19 patients requiring critical care in a Tertiary care teaching hospital.

J Anaesthesiol Clin Pharmacol 2021 Jul-Sep;37(3):366-370. Epub 2021 Oct 12.

Department of Anaesthesiology, Pain Medicine and Critical Care, JPNATC, AIIMS, New Delhi, India.

Background And Aims: We describe the epidemiological and clinical characteristics, and 28 day outcome of critically ill COVID-19 patients admitted to a tertiary care centre in India.

Material And Methods: We included 60 adult critically ill COVID-19 patients in this prospective observational study, admitted to the intensive care unit (ICU) after obtaining ethics committee approval and informed consent. Demographics, clinical data, and treatment outcome at 28 days were assessed.

Results: Demographic characteristics of the COVID-19 patients reveal that compared to the survivors, the non-survivors were significantly older [57.5 vs. 47.5 years], had more comorbid disease [Charlson's comorbidity index 4 vs. 2], higher Apache II scores [19 vs. 8.5], and had significantly higher percentage of smokers. Diabetes mellitus and hypertension were the most common comorbidities. Dyspnea, fever, and cough were the most common presenting symptoms. Total leucocyte count as well as blood lactate level were significantly higher in non-survivors. Around 47% patients had severe ARDS, and 60% patients required invasive mechanical ventilation. 28 day ICU mortality was 50%, with a mortality of 75% in patients receiving invasive mechanical ventilation. Mortality was higher in males than females (57% vs. 33%). Acute kidney injury and septic shock were the most common non-pulmonary complications during ICU stay. Incidence of liver dysfunction, septic shock, and vasopressor use was significantly higher in the non-survivors.

Conclusion: This study demonstrates a high 28 day mortality in severe COVID-19 patients. Further well designed prospective studies with larger sample size are needed to identify the risk factors associated with poor outcome in such patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/joacp.JOACP_585_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8562446PMC
October 2021

Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center.

Indian J Crit Care Med 2021 Jun;25(6):622-628

Department of Anaesthesiology, Pain Medicine and Critical Care, AIIMS, New Delhi, India.

Background And Objective: A large number of studies describing the clinicoepidemiological features of coronavirus disease-2019 (COVID-19) patients are available but very few studies have documented similar features of the deceased. This study was aimed to describe the clinicoepidemiological features and the causes of mortality of COVID-19 deceased patients admitted in a dedicated COVID center in India.

Methodology: This was a retrospective study done in adult deceased patients admitted in COVID ICU from April 4 to July 24, 2020. The clinical features, comorbidities, complications, and causes of mortality in these patients were analyzed. Pediatric deceased were analyzed separately.

Results: A total of 654 adult patients were admitted in the ICU during the study period and ICU mortality was 37.7% (247/654). Among the adult deceased, 65.9% were males with a median age of 56 years [interquartile range (IQR), 41.5-65] and 94.74% had one or more comorbidities, most common being hypertension (43.3%), diabetes mellitus (34.8%), and chronic kidney disease (20.6%). The most common presenting features in these deceased were fever (75.7%), cough (68.8%), and shortness of breath (67.6%). The mean initial sequential organ failure assessment score was 9.3 ± 4.7 and 24.2% were already intubated at the time of admission. The median duration of hospital stay was 6 days (IQR, 3-11). The most common cause of death was sepsis with multi-organ failure (55.1%) followed by severe acute respiratory distress syndrome (ARDS) (25.5%). All pediatric deceased had comorbid conditions and the most common cause of death in this group was severe ARDS.

Conclusion: In this cohort of adult deceased, most were young males with age less than 65 years with one or more comorbidities, hypertension being the most common. Only 5% of the deceased had no comorbidities. Sepsis with multi-organ dysfunction syndrome was the most common cause of death.

How To Cite This Article: Aggarwal R, Bhatia R, Kulshrestha K, Soni KD, Viswanath R, Singh AK, Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center. Indian J Crit Care Med 2021; 25(6):622-628.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5005/jp-journals-10071-23848DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8286396PMC
June 2021

Outcome of Conservative Therapy in Coronavirus disease-2019 Patients Presenting With Gastrointestinal Bleeding.

J Clin Exp Hepatol 2021 May-Jun;11(3):327-333. Epub 2020 Oct 3.

Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.

Background/objective: There is a paucity of data on the management of gastrointestinal (GI) bleeding in patients with Coronavirus disease -2019 (COVID-19) amid concerns about the risk of transmission during endoscopic procedures. We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19.

Methods: In this retrospective analysis, 24 of 1342 (1.8%) patients with COVID-19, presenting with GI bleeding from 22nd April to 22nd July 2020, were included.

Results: The mean age of patients was 45.8 ± 12.7 years; 17 (70.8%) were males; upper GI (UGI) bleeding: lower GI (LGI) 23:1. Twenty-two (91.6%) patients had evidence of cirrhosis- 21 presented with UGI bleeding while one had bleeding from hemorrhoids. Two patients without cirrhosis were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors-somatostatin in 17 (73.9%) and terlipressin in 4 (17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood cells (PRBCs), fresh frozen plasma (FFPs) and platelets were transfused in 14 (60.9%), 3 (13.0%) and 3 (13.0%), respectively. The median PRBCs transfused was 1 (0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia, while another had rebleed 19 days after discharge. Three (12.5%) cirrhosis patients succumbed to acute hypoxemic respiratory failure during hospital stay.

Conclusion: Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy. The decision for proceeding with endoscopy should be taken by a multidisciplinary team after consideration of the patient's condition, response to treatment, resources and the risks involved, on a case to case basis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jceh.2020.09.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7833290PMC
October 2020

A simple solution to fogging inside goggles used as a part of personal protective equipment.

J Anaesthesiol Clin Pharmacol 2020 Jul-Sep;36(3):413-414. Epub 2020 Sep 15.

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/joacp.JOACP_434_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7812946PMC
September 2020

Comparison of colloid and crystalloid using goal-directed fluid therapy protocol in non-cardiac surgery: a meta-analysis of randomized controlled trials.

J Anesth 2020 12 27;34(6):865-875. Epub 2020 Jul 27.

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Room No: 5013, 5th Floor Teaching Block, New Delhi, 110029, India.

Purpose: A few randomized controlled trials (RCTs) have compared crystalloid-based goal-directed fluid therapy (GDFT) with starch-based GDFT in patients undergoing major surgical procedures with conflicting results. In this meta-analysis, colloid-based GDFT was compared with crystalloid-based GDFT.

Methods: In this meta-analysis, RCTs comparing colloid- and crystalloid-based GDFT in patients undergoing non-cardiac surgery were included. Binary outcomes were reported as risk ratio (RR) and continuous outcomes were reported as mean difference (MD) with 95% confidence interval (95% CI). PubMed, PubMed central, The Cochrane Library database and EMBASE were searched for potentially eligible trials from inception to 28 February 2020.

Results: Data of 2392 patients from nine RCTs were included in this meta-analysis. Mortality at the longest available follow-up [RR (95% CI) 1.44 (0.88, 2.34); p = 0.15], postoperative kidney dysfunction [RR (95% CI) 1.07 (0.72, 1.60); p = 0.73], postoperative length of hospital stay [MD (95% CI)  - 0.29 ( - 1.25, 0.66) d; p = 0.55], cardiovascular complications [RR (95% CI) 1.20 (0.50, 2.88); p = 0.68], wound complications [RR (95% CI) 1.08 (0.76, 1.54); p = 0.66], pulmonary complications [RR (95% CI) 0.90 (0.71, 1.140); p = 0.40] and bleeding [RR (95% CI) 1.24 (0.77, 1.99); p = 0.37] were similar in both the groups. Postoperative major complications were also similar between patients who received colloid and crystalloid [RR (95% CI) 0.79 (0.48, 1.29); p = 0.34].

Conclusion: Colloids in goal-directed fluid therapy protocol does not offer any benefit over crystalloid-based goal-directed fluid therapy protocol in patients undergoing major non-cardiac surgical procedure.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00540-020-02832-5DOI Listing
December 2020

Facing Post-Cyclone Disaster in Times of COVID-19 Pandemic in India: Possible Testing Strategy to Reduce Further Spread of Disease.

Asia Pac J Public Health 2020 Sep-Oct;32(6-7):376. Epub 2020 Jul 24.

All India Institute of Medical Sciences, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1010539520944717DOI Listing
July 2020

Correlation Between Doppler Derived Carotid Artery Corrected Flow Time and Pressure Transducer Derived Radial Artery Corrected Flow Time: A Prospective Observational Study.

Cardiovasc Eng Technol 2020 04 16;11(2):128-133. Epub 2020 Jan 16.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Purpose: Carotid artery corrected flow time (cFT) derived from Doppler USG is a known predictor of volume responsiveness. However, it can't be obtained continuously, and is operator dependent. In this prospective study, correlation between Doppler derived carotid artery cFT and pressure transducer derived radial artery cFT was evaluated in adult patients undergoing surgery under general anaesthesia.

Methods: Doppler derived carotid artery cFT were obtained from n = 51 adult patients at n = 125 time points. Simultaneously, pressure transducer waveforms were saved at the time of measurement of carotid artery cFT. Later, images were analyzed by an image processing computer software; both pulse pressure variation and cFT were estimated from pressure transducer waveform.

Results: Radial artery flow times measured by two independent observers, were significantly correlated (r = 0.99, p < 0.00001). Bland-Altman analysis found limits of agreement - 8.3 to 6.3 ms [mean difference (95% CI) - 0.98 (- 1.63, - 0.32)]. Doppler derived carotid artery cFT & pressure transducer derived radial artery cFT were also significantly correlated [r = 0.78, p < 0.0001]. However, radial artery cFT was significantly higher than carotid artery cFT [p < 0.0001, paired sample t test]. Radial artery cFT > 404.4 ms had an sensitivity and specificity of 87.34% and 85% respectively with a grey zone was between 393.7 and 417 ms to predict PPV ≥ 12%.

Conclusion: Pressure transducer derived radial artery cFT correlated with Doppler derived carotid artery cFT and may be a reasonable predictor of volume responsiveness. Further studies are required to confirm its role in various clinical scenario for prediction of volume responsiveness.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s13239-020-00455-1DOI Listing
April 2020

Carotid Artery Corrected Flow Time and Respiratory Variations of Peak Blood Flow Velocity for Prediction of Hypotension After Induction of General Anesthesia in Adult Patients Undergoing Elective Surgery: A Prospective Observational Study.

J Ultrasound Med 2020 Apr 24;39(4):721-730. Epub 2019 Oct 24.

Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India.

Objectives: Hypotension is common after induction of general anesthesia, and intraoperative hypotension is associated with postoperative end-organ injury such as acute kidney injury and myocardial ischemia. This study was designed to determine the utility of the carotid corrected flow time (cFT) and carotid artery peak blood flow velocity variation (ðV ) for prediction of hypotension after induction of general anesthesia.

Methods: Adult patients (n = 112) undergoing any elective surgery under general anesthesia who fasted for at least 6 to 8 hours were recruited in this prospective observational study. The common carotid artery cFT and ðV were measured with ultrasound 10 minutes before induction of general anesthesia. After that, general anesthesia with propofol was used, and hemodynamic data were collected until 3 minutes after induction of anesthesia.

Results: The carotid cFT was significantly correlated with percentages of the fall in the systolic blood pressure at 2 minutes (P < .0001) and 3 minutes (P < .0001) and percentages of the fall in the mean arterial pressure at 1 minute (P = .0006), 2 minutes (P < .0001), and 3 minutes (P < .0001). The cFT was a predictor of hypotension after induction of general anesthesia, with an area under the receiver operating characteristic curve of 0.91. The best cutoff value obtained from this study was 330.2 milliseconds or less, which predicted postinduction hypotension with sensitivity and specificity of 85.7% and 96.8%, respectively. The ðV was an inferior predictor of postinduction hypotension, with an area under the receiver operating characteristic curve of 0.68. The optimum cutoff value was 18.8%, with sensitivity and specificity of 61.9% and 67.4%.

Conclusions: The cFT measured in the common carotid artery is a reasonable predictor of hypotension after induction of general anesthesia in American Society of Anesthesiologists physical status I and II patients. Further studies are required to identify its role in high-risk patients such as older groups and patients with cardiovascular diseases and also to identify interobserver and intraobserver variability of cFT and ðV measurements.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jum.15151DOI Listing
April 2020

Noninvasive Ventilation and Oxygen Therapy after Extubation in Patients with Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials.

Indian J Crit Care Med 2019 Sep;23(9):414-422

Department of Anesthetics, Bradford Teaching Hospital, Bradfordshire, United Kingdom.

Background: Role of noninvasive ventilation (NIV) following extubation in patients with acute respiratory failure is debatable. NIV may provide benefit in post surgical patients, but its role in nonsurgical patients is controversial.

Materials And Methods: PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched (from 1946 to 20 November 2017) to identify prospective randomized controlled trials, where postextubation NIV has been compared with standard oxygen therapy in adult patients with acute respiratory failure.

Results: Data of 1525 patients from 11 randomized trials have been included in this meta-analysis. Two trials used NIV to manage post-extubation respiratory failure. Pooled analysis found that mortality rate at longest available follow-up [OR (95% CI) 0.84 (0.50, 1.42); p = 0.52] and reintubation rate [OR (95% CI) 0.75 (0.51, 1.09); p = 0.13] were similar between NIV and standard oxygen therapy. NIV did not decrease intubation rate when used as preventive modality [OR (95% CI) 0.65 (0.40, 1.06); p = 0.08]. Duration of ICU stay was also similar in the two groups [MD (95% CI) 0.46 (-0.43, 1.36) days; p = 0.3].

Conclusion: Post extubation NIV in non- surgical patients with acute respiratory failure does not provide any benefit over conventional oxygen therapy.

How To Cite This Article: Maitra S, Bhattacharjee S, Som A. Noninvasive Ventilation and Oxygen Therapy after Extubation in Patients with Acute Respiratory Failure: A Meta-analysis of Randomized Controlled Trials. Indian J Crit Care Med 2019;23(9):414-422.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5005/jp-journals-10071-23236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6775721PMC
September 2019

Comparison of long-, short-, and oblique-axis approaches for ultrasound-guided internal jugular vein cannulation: A network meta-analysis.

J Vasc Access 2020 Mar 18;21(2):204-209. Epub 2019 Aug 18.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, New Delhi, India.

Background: Comparison between various approaches of ultrasound (USG)-guided internal jugular vein cannulation, that is, short-axis out-of-plane approach, long-axis in-plane approach, and oblique-axis approach, is sparse. In this network meta-analysis of randomized controlled trials, all three approaches were evaluated to identify the best technique for USG-guided internal jugular vein cannulation.

Methods: Randomized controlled trials comparing short-axis out-of-plane approach, long-axis in-plane approach, and oblique-axis approach in any combination (i.e. comparison of any two or all three) for USG-guided internal jugular vein cannulation were included in this meta-analysis. Bayesian network meta-analysis was conducted with a non-informative prior effect size and heterogeneity, and all results were reported as posterior median odds ratio with 95% credible interval.

Results: Data of 658 patients from five randomized controlled trials were included in this meta-analysis. No difference was obtained in first attempt success rate of cannulation in three approaches (posterior median odds ratio between long-axis and short-axis view, oblique-axis and short-axis view, and long-axis and oblique-axis view were 0.67 (0.20, 2.08), 0.92 (0.09, 4.790), and 1.3420 (0.1680, 6.7820), respectively). No difference was seen in the incidence of carotid artery puncture and overall success rate of cannulation.

Conclusion: All three commonly used approaches for USG-guided internal jugular vein cannulation, that is, short axis, long axis, and oblique axis, are comparable in terms of clinical utility and safety. There is insufficient evidence to recommend one approach over another for this purpose.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/1129729819868927DOI Listing
March 2020

Distal radial arterial cannulation in adult patients: A retrospective cohort study.

Saudi J Anaesth 2019 Jan-Mar;13(1):60-62

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Purpose: Safety and feasibility of distal radial artery cannulation at the anatomic snuffbox in the perioperative settings in adult patients have been assessed in this study.

Methods: Adult patients undergoing elective surgery requiring arterial cannulation were recruited in this retrospective cohort study.

Results: Data of 55 patients have been reviewed here; among which in 21 patients, arterial puncture was performed ultrasound guidance and in 34 patients puncture was guided by the pulsation of the distal radial artery at the anatomical snuffbox. First attempt success rate of distal radial arterial cannulation was 76.3% (42 of 55 patients) and it was similar between ultrasound guided (USG) and palpation technique ( = 0.53, Chi-square test). Overall, cannulation success rate was 87.3% (48 of 55 patients) and it was also similar between USG and palpation technique ( = 0.79, Chi-square test).

Conclusion: Distal radial artery cannulation is technically feasible in patients undergoing elective surgery. However, further randomized controlled trials are required to establish its clinical utility and safety profile in comparison to conventional radial artery cannulation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/sja.SJA_700_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329248PMC
January 2019

Ultrasonography and Seldinger's technique: Using the best of both worlds for difficult radial artery cannulation!

J Anaesthesiol Clin Pharmacol 2018 Jul-Sep;34(3):420-421

Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/joacp.JOACP_15_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6194826PMC
November 2018

Recruitment maneuver does not provide any mortality benefit over lung protective strategy ventilation in adult patients with acute respiratory distress syndrome: a meta-analysis and systematic review of the randomized controlled trials.

J Intensive Care 2018 26;6:35. Epub 2018 Jun 26.

1Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, Room No. 5011, 5th Floor Teaching block, Ansari Nagar New Delhi, 110029 India.

Background: Clinical benefits of recruitment maneuver in ARDS patients are controversial. A number of previous studies showed possible benefits; a large recent study reported that recruitment maneuver and PEEP titration may even be harmful. This meta-analysis was designed to compare the clinical utility of recruitment maneuver with low tidal volume ventilation in adult patients with ARDS.

Methods: Randomized controlled trials comparing recruitment maneuver and lung protective ventilation strategy with lung protective strategy ventilation protocol alone in adult patients with ARDS has been included in this meta-analysis. PubMed and Cochrane Central Register of Controlled Trials were searched from inception to 10 November 2017 to identify potentially eligible trials. Pooled risk ratio (RR) and standardized mean difference (SMD) were calculated for binary and continuous variables respectively.

Results: Data of 2480 patients from 7 randomized controlled trials have been included in this meta-analysis and systemic review. Reported mortality at the longest available follow-up [RR (95% CI) 0.93 (0.80, 1.08);  = 0.33], ICU mortality [RR (95% CI) 0.91 (0.76, 1.10);  = 0.33] and in-hospital mortality [RR (95% CI) 0.95 (0.83, 1.08);  = 0.45] were similar between recruitment maneuver group and standard lung protective ventilation group. Duration of hospital stay [SMD (95% CI) 0.00 (- 0.09, 0.10);  = 0.92] and duration of ICU stays [SMD (95% CI) 0.05 (- 0.09, 0.19);  = 0.49] were also similar between recruitment maneuver group and standard lung protective ventilation group. Risk of barotrauma was also similar.

Conclusion: Use of recruitment maneuver along with co-interventions such as PEEP titration does not provide any benefit in terms of mortality, length of ICU, and hospital stay in ARDS patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s40560-018-0305-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6019312PMC
June 2018

Comparison between ultrasound guided technique and digital palpation technique for radial artery cannulation in adult patients: An updated meta-analysis of randomized controlled trials.

J Clin Anesth 2018 Jun 22;47:54-59. Epub 2018 Mar 22.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Study Objective: Possible advantages and risks associated with ultrasound guided radial artery cannulation in-comparison to digital palpation guided method in adult patients are not fully known. We have compared ultrasound guided radial artery cannulation with digital palpation technique in this meta-analysis.

Design: Meta-analysis of randomized controlled trials.

Setting: Trials conducted in operating room, emergency department, cardiac catheterization laboratory.

Patients: PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched (from 1946 to 20th November 2017) to identify prospective randomized controlled trials in adult patients.

Intervention: Two-dimensional ultrasound guided radial artery catheterization versus digital palpation guided radial artery cannulation.

Measurements: Overall cannulation success rate, first attempt success rate, time to cannulation and mean number of attempts to successful cannulation. Odds ratio (OR) and standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval (CI) were calculated for categorical and continuous variables respectively.

Results: Data of 1895 patients from 10 studies have been included in this meta- analysis. Overall cannulation success rate was similar between ultrasound guided technique and digital palpation [OR (95% CI) 2.01 (1.00, 4.06); p = 0.05]. Ultrasound guided radial artery cannulation is associated with higher first attempt success rate of radial artery cannulation in comparison to digital palpation [OR (95% CI) 2.76 (186, 4.10); p < 0.001]. No difference was seen in time to cannulate [SMD (95% CI) -0.31 (-0.65, 0.04); p = 0.30] and mean number of attempt [MD (95% CI) -0.65 (-1.32, 0.02); p = 0.06] between USG guided technique with palpation technique.

Conclusion: Radial artery cannulation by ultrasound guidance may increase the first attempt success rate but not the overall cannulation success when compared to digital palpation technique. However, results of this meta-analysis should be interpreted with caution due presence of heterogeneity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2018.03.019DOI Listing
June 2018

A comparison between video laryngoscopy and direct laryngoscopy for endotracheal intubation in the emergency department: A meta-analysis of randomized controlled trials.

J Clin Anesth 2018 Jun 14;47:21-26. Epub 2018 Mar 14.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Study Objectives: Direct laryngoscopy is the most commonly used modality for endotracheal intubation in the emergency department. Video laryngoscopy may improve glottic view during laryngoscopy and intubation success rate in such patients. This meta-analysis has been designed to compare clinical efficacy of video laryngoscopy with direct laryngoscopy for endotracheal intubation in the emergency department.

Design: Meta-analysis of randomized controlled trial.

Setting: Randomized controlled trials comparing video laryngoscopy and direct laryngoscopy for endotracheal intubation in adult patients in emergency department. PubMed (1946 to 20th October 2017) and The Cochrane Library databases (CENTRAL) were searched for potentially eligible trials on 20th October 2017.

Patients: Adult patients presenting in the emergency department.

Interventions: Video laryngoscopy & direct laryngoscopy for intubation in emergency department.

Measurement: Primary outcome was 'first intubation success rate' and secondary outcomes were overall intubation success rate, in-hospital mortality and oesophageal intubation rate.

Main Results: Data of 1250 patients from 5 randomized controlled trials have been included in this study. Video laryngoscopy offers no advantage over direct laryngoscopy in terms of first intubation success rate (odds ratio 1.28, 95% CI 0.70, 2.36; p = 0.42), overall intubation success rate (OR 1.26, 95% CI 0.53, 3.01; p = 0.6) or in-hospital mortality (OR 1.25, 95% CI 0.8, 1.95; p = 0.32). However, oesophageal intubation rate is lower with the use of video laryngoscopy (OR 0.09, 95% CI 0.01, 0.7; p = 0.02).

Conclusion: Use of video laryngoscopy for emergency endotracheal intubation in adult patients is associated with reduced oesophageal intubation over direct laryngoscopy. However, no benefit was found in terms of overall intubation success.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2018.03.006DOI Listing
June 2018

Comparison of LMA Supreme™ with i-gel™ and LMA ProSeal™ in children for airway management during general anaesthesia: A meta-analysis of randomized controlled trials.

J Clin Anesth 2017 Sep 1;41:5-10. Epub 2017 Jun 1.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Study Objective: A few randomized trials have compared LMA Supreme™ with LMA ProSeal™ and i-gel™ in children but their conclusions varied widely. This systematic review and meta analysis has compared the former device with the latter two devices.

Design: Meta-analysis and systematic review using the Mantel-Haenszel method and pooled mean difference using inverse variance method.

Setting: Meta-analysis of published prospective randomized controlled trials.

Patients: Paediatric patients undergoing surgery under general anaesthesia.

Intervention: LMA Supreme™ with LMA ProSeal™ or i-gel™ as airway management device.

Results: Electronic database searching revealed four randomized trials where LMA Supreme™ has been compared with LMA ProSeal™ and three trials where a comparison was made between LMA Supreme™ and i-gel™ in paediatric population. LMA Supreme™ provided similar oropharyngeal leak pressure when compared to LMA ProSeal™ [mean difference (95% CI) 1.57 (-1.33, 4.47)cm HO; p=0.29] and i-gel™ [mean difference (95% CI) 1.18 (-2.11, 4.47)cm HO; p=0.48]. First insertion success rate is also similar when LMA Supreme™ is compared to LMA ProSeal™ [RR (95% CI) 1.03 (0.97, 1.1); p=0.74] and i-gel™ [RR (95% CI) 0.99 (0.95, 1.03); p=0.51]. Device insertion is significantly faster with LMA Supreme™ than i-gel™ [mean difference (95% CI) 1.87 (0.93, 2.81) s; p<0.0001].

Conclusion: We suggest that LMA Supreme™ may be an alternative to LMA ProSeal™ and i-gel™ in children for airway management during general anaesthesia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2017.04.019DOI Listing
September 2017

Levosimendan does not provide mortality benefit over dobutamine in adult patients with septic shock: A meta-analysis of randomized controlled trials.

J Clin Anesth 2017 Jun 30;39:67-72. Epub 2017 Mar 30.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Objectives: Despite of advancement in intensive care medicine, sepsis and septic shock carry a high mortality. Levosimendan, an inodilator, may be promising for septic shock patients with myocardial dysfunction; however, firm evidence is lacking. In this meta- analysis of randomized controlled trials, levosimendan has been compared with dobutamine in adult patients with sepsis and septic shock.

Design: Meta-analysis of randomized controlled trial.

Setting: Intensive-care unit.

Participants: Adult septic shock patients.

Intervention: Adult septic shock patients received dobutamine or levosimendan.

Main Outcome Measure: Mortality at longest follow-up, blood lactate level, cardiac index and noradrenaline requirement.

Results: Data from 7 randomized trials have been included in this meta-analysis. Levosimendan has no benefit in terms of mortality at longest follow up in comparison to dobutamine (Odds ratio 0.77, 95% CI 0.45, 132; p=0.34) and length of ICU stay (MD -4.7days, 95% CI -10.3, 0.9days, p=0.10). Patients received levosimendan had less blood lactate level (standardized mean difference -0.95; 95% CI -1.64, -0.27; p=0.006) and higher cardiac index (mean difference 0.44; 95% CI 0.17, 0.71; p=0.001). Noradrenaline requirements are similar in both the groups.

Conclusion: There is no evidence that levosimendan is superior to dobutamine in adult patients with sepsis and septic shock. Further large randomized trials are necessary in this area.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2017.03.011DOI Listing
June 2017

In response to: Comparison of paravertebral and interpleural block in patients undergoing modified radical mastectomy.

J Anaesthesiol Clin Pharmacol 2017 Jan-Mar;33(1):131-132

Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0970-9185.168161DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5374820PMC
April 2017

[Perioperative gabapentin and pregabalin in cardiac surgery: a systematic review and meta-analysis].

Rev Bras Anestesiol 2017 May - Jun;67(3):294-304. Epub 2017 Mar 1.

All India Institute of Medical Sciences, Department of Anaesthesiology & Intensive Care, New Delhi, Índia. Electronic address:

Objectives: Sternotomy for cardiac surgeries causes significant postoperative pain and when not properly managed may cause significant morbidity. As neuropathic pain is a significant component here, gabapentin and pregabalin may be effective in these patients and may reduce postoperative opioid consumption. The purpose of this systematic review was to find out efficacy of gabapentin and pregabalin in acute postoperative pain after cardiac surgery.

Methods: Published prospective human randomized clinical trials, which compared preoperative and/or postoperative gabapentin/pregabalin with placebo or no treatment for postoperative pain management after cardiac surgery has been included in this review.

Results: Four RCTs each for gabapentin and pregabalin have been included in this systematic review. Three gabapentin and two pregabalin studies reported decrease in opioid consumption in cardiac surgical patients while one gabapentin and two pregabalin studies did not. Three RCTs each for gabapentin and pregabalin reported lower pain scores both during activity and rest. The drugs are not associated with any significant complications.

Conclusion: Despite lower pain scores in the postoperative period, there is insufficient evidence to recommend routine use of gabapentin and pregabalin to reduce opioid consumption in the cardiac surgical patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.bjan.2016.07.005DOI Listing
April 2019

Combination of 5-HT3 Antagonist and Dexamethasone Is Superior to 5-HT3 Antagonist Alone for PONV Prophylaxis After Laparoscopic Surgeries: A Meta-analysis.

Anesth Analg 2016 12;123(6):1418-1426

From the Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, 110029, India.

Introduction: 5-Hydroxytryptamine type 3 (5-HT3) receptor antagonists are the most commonly used drugs for postoperative nausea vomiting (PONV) prophylaxis. Dexamethasone is another antiemetic with proven efficacy in reducing PONV. The aim of this study was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to compare the combination of dexamethasone and 5-HT3 antagonist versus a 5-HT3 antagonist alone as prophylaxis of PONV in laparoscopic surgical patients.

Methods: PubMed, PubMed Central, and CENTRAL databases were searched to identify those randomized trials that compared a 5-HT3 antagonist with the 5-HT3 antagonist and dexamethasone combination for PONV prophylaxis after laparoscopic surgeries.

Results: Data from 17 RCTs that evaluated 1402 patients were included. Results from our meta-analysis show that the combination of dexamethasone and a 5-HT3 receptor antagonist is more effective in preventing PONV than the 5-HT3 antagonist alone (odds ratio 0.38, 95% confidence interval [CI] 0.27-0.54; number needed to treat = 6.6), with no statistical heterogeneity (I = 0) among studies. The need for rescue antiemetic is also decreased in patients receiving the combination (odds ratio 0.21, 99% CI 0.10-0.46; number needed to treat = 6), although data are insufficient to detect any significant difference in incidence of adverse effects. In addition, patients in the combination group complained of less pain after 24 hours (Weighted Mean Difference -0.67, 99% CI -1.27 to -0.08).

Conclusion: Combination of a 5-HT3 receptor antagonist and dexamethasone is significantly more effective than 5-HT3 antagonist alone in preventing PONV after laparoscopic surgeries, with possible improvement in postoperative analgesia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1213/ANE.0000000000001617DOI Listing
December 2016

Goal directed fluid therapy decreases postoperative morbidity but not mortality in major non-cardiac surgery: a meta-analysis and trial sequential analysis of randomized controlled trials.

J Anesth 2017 02 13;31(1):66-81. Epub 2016 Oct 13.

Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, 110029, India.

Background And Aims: Optimum perioperative fluid administration may improve postoperative outcome after major surgery. This meta-analysis and systematic review has been aimed to determine the effect of dynamic goal directed fluid therapy (GDFT) on postoperative morbidity and mortality in non-cardiac surgical patients.

Material And Methods: Meta-analysis of published prospective randomized controlled trials where GDFT based on non-invasive flow based hemodynamic measurement has been compared with a standard care. Data from 41 prospective randomized trials have been included in this study.

Results: Use of GDFT in major surgical patients does not decrease postoperative hospital/30-day mortality (OR 0.70, 95 % CI 0.46-1.08, p = 0.11) length of post-operative hospital stay (SMD -0.14; 95 % CI -0.28, 0.00; p = 0.05) and length of ICU stay (SMD -0.12; 95 % CI -0.28, 0.04; p = 0.14). However, number of patients having at least one postoperative complication is significantly lower with use of GDFT (OR 0.57; 95 % CI 0.43, 0.75; p < 0.0001). Abdominal complications (p = 0.008), wound infection (p = 0.002) and postoperative hypotension (p = 0.04) are also decreased with used of GDFT as opposed to a standard care. Though patients who received GDFT were infused more colloid (p < 0.0001), there is no increased risk of heart failure or pulmonary edema and renal failure.

Conclusion: GDFT in major non- cardiac surgical patients has questionable benefit over a standard care in terms of postoperative mortality, length of hospital stay and length of ICU stay. However, incidence of all complications including wound infection, abdominal complications and postoperative hypotension is reduced.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00540-016-2261-7DOI Listing
February 2017

Reexpansion pulmonary edema after hepatic hydatid cyst excision.

J Clin Anesth 2016 Nov 2;34:310-1. Epub 2016 Jun 2.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2016.05.003DOI Listing
November 2016

Stuck stylet situation: a rare manufacturing defect of spinal needle.

J Clin Anesth 2016 Nov 2;34:70-1. Epub 2016 May 2.

Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2016.03.043DOI Listing
November 2016

Perioperative implication of sudden manifestation of carcinoid tumor masquerading as insulinoma.

J Anaesthesiol Clin Pharmacol 2016 Jul-Sep;32(3):416-7

Department of Urology, All India Institute of Medical Sciences, New Delhi, India.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0970-9185.173370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5009871PMC
September 2016

Laryngeal mask airway ProSeal provides higher oropharyngeal leak pressure than i-gel in adult patients under general anesthesia: a meta-analysis.

J Clin Anesth 2016 Sep 18;33:298-305. Epub 2016 May 18.

Department of Anaesthesiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address:

Study Objective: i-gel is a single-use supraglottic airway device that has a gastric drain tube similar to laryngeal mask airway (LMA) ProSeal. Randomized trials, when compared i-gel with LMA ProSeal, reported a differing results. Primary objective of this study is to compare LMA ProSeal and i-gel in terms of oropharyngeal leak pressure.

Design: Meta-analysis of randomized controlled trials where i-gel has been compared to LMA ProSeal in adult airway management during general anesthesia.

Setting: Teaching institutions.

Measurements: PubMed, PubMed Central, and Cochrane databases were searched with search words "i-gel," "i-gel laryngeal mask airway," "i-gel ProSeal," and "i-gel LMA ProSeal" to find out the randomized controlled trials that compared i-gel with LMA ProSeal in terms of safety and efficacy. A total of 10 prospective randomized trials have been included in this meta-analysis.

Main Results: LMA ProSeal provides higher oropharyngeal leak pressure than i-gel (mean difference, 3.37 cm H2O; 95% confidence interval, 1.80-4.95 cm H2O; P< .0001). Time to insert the device, first insertion success rate, and ease of gastric tube insertion are similar with both the devices, but i-gel may be easier to insert. Although the reported complications are not frequent and not very serious, a significantly higher blood staining on the mask has been noted with LMA ProSeal (odds ratio, 0.27; 95% confidence interval, 0.13-0.56; P= .0004).

Conclusion: LMA ProSeal may still remain the supraglottic device of choice over i-gel in adult patients during general anesthesia as it provided better seal against leak pressure with comparable device insertion characteristics.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2016.04.020DOI Listing
September 2016

Therapeutic hypothermia after cardiac arrest is not associated with favorable neurological outcome: a meta-analysis.

J Clin Anesth 2016 Sep 5;33:225-32. Epub 2016 May 5.

Senior Resident, Department of Anaesthesiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi -110029, India. Electronic address:

Background: Cardiac arrest is associated with very high mortality and causes neurological dysfunction in the survivors. Therapeutic hypothermia is one of the recommended modality in the postarrest management. However, recent findings question its benefit in postarrest management. This meta-analysis has been conceptualized to quantify clinical benefit of therapeutic hypothermia in post-cardiac arrest patients.

Methods: Prospective, randomized, and quasi-randomized controlled trials comparing the efficacy of therapeutic hypothermia in post-cardiac arrest adult population with a post-cardiac arrest management protocol that does not include therapeutic hypothermia were included in this meta-analysis. Two authors independently searched PubMed, PubMed Central, Scopus, and Central Register of Clinical Trials of the Cochrane Collaboration for potentially eligible trials.

Results: Data of 1399 patients from 6 controlled trials have been included in this systematic review and meta-analysis. Therapeutic hypothermia does not provide any benefit in favorable neurological outcome (P=.06; odds ratio, 1.80; 95% confidence interval [CI], 0.97-3.35; n=1384), in survival at hospital discharge (P=.58; odds ratio, 1.16; 95% CI, 0.69-1.96; n=1399), and in long-term survival (P=.36; odds ratio, 1.32; 95% CI, 0.73-2.39; n=1292). Therapeutic hypothermia also increases incidence of pneumonia (P=.02; odds ratio, 1.30; 95% CI, 1.04-1.64; n=1204; number needed to harm, 15).

Conclusion: Therapeutic hypothermia in the post-cardiac arrest management protocol does not provide any benefit in favorable neurological outcome, survival to hospital discharge, and long term survival. Incidence of pneumonia may be increased with the use of therapeutic hypothermia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jclinane.2016.03.001DOI Listing
September 2016

Comparison of high-flow nasal oxygen therapy with conventional oxygen therapy and noninvasive ventilation in adult patients with acute hypoxemic respiratory failure: A meta-analysis and systematic review.

J Crit Care 2016 10 25;35:138-44. Epub 2016 May 25.

Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Purpose: The role of high-flow nasal oxygen (HFNO) therapy in adult patients with acute hypoxemic respiratory failure is controversial.

Methods: This meta-analysis of prospective randomized controlled trials (RCTs) has been designed to compare HFNO with noninvasive ventilation (NIV) and conventional oxygen therapy in such patients.

Results: Initial database searching revealed 336 RCTs, of which 7 were included in this meta-analysis. Five RCTs compared HFNO with standard oxygen therapy, one compared HFNO with NIV, and one compared all three. HFNO did not decrease the requirement of higher respiratory support compared with control group. HFNO was associated with improved respiratory rate and dyspnea score, and better comfort in 3 RCTs, whereas other studies did not find any difference.

Conclusion: High-flow nasal oxygen does not offer any benefit over NIV or conventional oxygen therapy in terms of requirement of higher respiratory support.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcrc.2016.05.013DOI Listing
October 2016
-->