Aims:This study aims to study the incidence, microbiological and antibiotic sensitivity and resistance profile and impact on intensive care units (ICUs) stay and mortality of nosocomial infections in patients admitted to surgical ICU of our hospital.Methods:A retrospective analysis of all patients admitted, over the course of 1 year, in the surgical ICU was undertaken. All patients who developed nosocomial infections were included in the study. Incidence, sites, common organisms of nosocomial infection were identified. The antibiotic sensitivity pattern of the microorganisms which were cultured was identified. This group of patients with nosocomial infections was matched with group of patients without nosocomial infections with respect to age, gender, and clinical diagnosis and the impact of nosocomial infections on ICU stay, and mortality was studied.Results:Of 1051 patients admitted to the ICU during the study, 350 patients developed nosocomial infections and were included in the study group. Of the remaining patients, 350 patients matching the patients in the study group were included in the control group. The prevalence of nosocomial infections in our study was 33.30%. Skin and soft tissue infections (36.30%), including postoperative wound infections were the most common nosocomial infection, followed by respiratory infections (24.46%) and genitourinary infections (23.40%). The most common organisms causing nosocomial infections were Escherichia coli (26.59%) and Acinetobacter species (18.08%). About 40% of all Gram-negative organisms isolated were multidrug resistant. The average length of stay in ICU was 14.4 days for patients with nosocomial infections and 5.4 days (P < 0.05) for matched patients without nosocomial infections. The mortality in patients with nosocomial infections was 25.14% while that in patients without nosocomial infections was 10.57% (P < 0.05). Overall ICU mortality was 14.27%.Conclusions:Nosocomial infections in surgical ICU patients significantly increase ICU length of stay and mortality.

Insertion of central venous catheter (CVC) is the most common procedure to be performed in Intensive Care Units. Addition of ultrasonographic guidance to this procedure, which was initially performed blindly, has improved safety of this procedure. Confirmation of endovenous placement of CVC though, is tricky, as methods for confirmation are either operator dependent, time-consuming or not available at bedside. Prospective observational study was carried out to study feasibility of use of sonobubble test to confirm the presence of CVC within central vein. After insertion of CVC in the internal jugular, subclavian or axillary vein, a 10 ml bolus of shaken saline microbubble is injected through port of CVC, and opacification of right atrium is observed in xiphoid view on ultrasonography. The Sonobubble test was helpful for dynamic confirmation of endovenous placement of CVC and prevented complications such as arterial puncture and cannulation. We recommend its use following CVC insertion.

Multiple system atrophy (MSA) is a rare adult-onset neurodegenerative disease. Symptoms vary from autonomic dysfunction to Parkinsonism and cerebellar ataxia, in any combination. MSA affects many organ systems with many possible complications and makes perioperative management of a patient with this condition very challenging. Successful management of a patient with MSA posted for laparoscopic nephrectomy under general anaesthesia is reported.

Hydrogen peroxide (H2O2) irrigation is commonly utilised in neurosurgical and non-neurosurgical procedures for its bactericidal and haemostatic effects. Tension pneumocephalus and venous air embolism are potentially disastrous neurological complications mostly seen after intracranial surgery in sitting position and trauma. We present a case of oxygen embolus and tension pneumocephalus after H2O2 irrigation during craniotomy in supine position.

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