Introduction:This study was aimed to examine the impact of cumulative fluid balance on extubation failure following planned extubation.Methods:Consecutive adult patients (≥16 years) admitted in a general intensive care unit (ICU), between January 1, 2016, and December 31, 2017, mechanically ventilated for at least 24 h and extubated following successful spontaneous breathing trial, were prospectively evaluated.Results:The cumulative fluid balance at extubation was significantly higher in the extubation failure group (median 4336.5 ml vs. 2752 ml, P = 0.036). The area under the receiver operating characteristic curve for cumulative balance to predict extubation failure was 0.6 (95% confidence interval [CI]: 0.504–0.697) with optimal cutoff value of 3490 ml (sensitivity and specificity of 60% and 59.5%, respectively). Other risk factors for extubation failure identified by univariate analysis were the duration of mechanical ventilation at extubation, chronic kidney or neurological disease, heart rate, and respiratory rate. In multiple regression model, the cumulative fluid balance >3490 ml retained its predictive potential for extubation failure (odds ratio = 2.191, 95% CI = 1.015–4.730).Conclusions:Our result validates the association between higher cumulative fluid balance and extubation failure in an Indian ICU. A future randomized control trial may examine any role of therapeutic diuresis/ultrafiltration in preventing failed extubation in patients who fulfill the readiness to wean criteria with cumulative net fluid balance ≥3490 ml.

No abstract

Abdominal compartment syndrome (ACS) is an uncommon complication of dengue haemorrhagic fever (DHF), described so far only in association with fluid refractory shock and high-volume resuscitation. We describe an unusual case of ACS in a patient of DHF where raised intra-abdominal pressure was due to spontaneous rectus sheath haematoma causing external compression. Early recognition of the haematoma, constant vigilance and timely decision for surgical intervention could salvage the patient with complete recovery of organ function.

No abstract

A bstract Introduction This study aimed to address the issue of antibiotic prescription processes in an Indian Intensive care unit (ICUs). Materials and methods In a prospective longitudinal study, all adult patients admitted in the ICU for 24 hours or above between 01 June 2020 and 31 July 2021 were screened for any new antibiotic prescription throughout their ICU stay. All new antibiotic prescriptions were assessed for baseline variables at prescription, any modifications during the course, and the outcome of antibiotic prescription. Results A total of 1014 patients fulfilled entry criteria; 59.2 and 7.2% of days they were on a therapeutic and prophylactic antibiotic(s). Patients, who were prescribed therapeutic antibiotic(s), had worse ICU outcomes. A total of 49.5% of patients (502 of 1,014) received a total of 552 new antibiotic prescriptions during their ICU stay. About 92.13% of these prescriptions were empirical and blood or other specimens were sent for culture in 78.81 and 60.04% of instances. A total of 31.7% of episodes were microbiologically proven and were more likely to be prescribed by an ICU consultant. A total of 169 modifications were done in 142 prescription episodes; 73 of them after sensitivity results. Thus, the overall rate of de-escalation was 13.95%. Apart from the negative culture result (36.05%), an important reason for a relatively low rate of de-escalation was the absence of sampling (12.32%). Longer ICU stay before antibiotic prescription, underlying chronic liver disease (CLD), worse organ dysfunction, and septic shock were independently associated with unfavorable treatment outcomes. No such independent association was observed between antibiotic appropriateness and patient outcome. Conclusion Future antibiotic stewardship strategies should address issues of high empirical prescription and poor microbiological sampling hindering the de-escalation process. How to cite this article Ghosh S, Salhotra R, Singh A, Lyall A, Arora G, Kumar N, et al . New Antibiotic Prescription Pattern in Critically Ill Patients (“Ant-critic”): Prospective Observational Study from an Indian Intensive Care Unit. Indian J Crit Care Med 2022;26(12):1275–1284.