Background: Glucose variability is an indicator and independent predictors of mortality and severity of sepsis in critically septic patients of intensive care unit. Objectives: This study evaluated the relationship of glucose variability in critically ill septic patients in relation with serum lactate. Method: It is a prospective observational study was conducted in the Intensive Care Unit (ICU) in Department of Anesthesia, Pain, Palliative Care and Intensive Care, Dhaka Medical College hospital, Dhaka over a period of one year in between 1st January- 31st December, 2015. Total 51 septic adult patients were included in the study according to the selection criteria. In this study, 8 consecutive capillary blood samples were taken with a periodic interval of 3 hours starting from admission. Mean and standard deviation (SD) blood glucose were computed to see the glucose variability and agreement done with serum lactate and severity of sepsis. All collected data were registered documented and analyzed in the statistical program Statistical Package for Social Science (SPSS) version 20.0. Result: Among total 51 patients, 52.9% study cases were of 4th decade with a mean age of 46±12 years had a mild female predominance. Glycemic variability was taken as >2SD. High glycemic variability observed in 70.6% cases. Good agreement observed in glucose variability with serum lactate by Kappa Statistics. Conclusion: Glucose variability shows the prediction of sepsis and it could be used as a useful alternative tool to predict sepsis and severity of sepsis. Bangladesh Crit Care J March 2022; 10 (1): 10-14

Tracheostomy is a life saving and important surgical procedure throughout the world from long since. Minimum number of study were conducted on tracheostomy in our setting. Based on number, probably Dhaka Medical College Hospital is one of the top institute in the world, where highest number of tracheostomy is being operated (3-10 per day). So, our purpose of this study is to describe our own experiences, regarding indication, complication , decanulation, morbidity and mortality following tracheostomy and to compare the results with the institutes of other countries of the world. Methods It is a prospective observational study, conducted at Dhaka Medical College Hospital from July 2014 to June 2019. Data were collected from the Registers of emergency and elective operation theatre, indoor, intensive care unit (ICU) and medical record room (where file of all patients are being kept for long time). SPSS software was used for data processing and analysis. Prior to the study ethical approval was obtained from Ethical review committee. Results Total 257 patients were selected for the study. Among them 210 (81.71%) were male and 47 (18.29%) were female. Most of the patients were elderly, above sixty years. Commonest indication for tracheostomy were upper airway obstruction due to laryngeal or other head neck cancer in 70.04% of patients. Next important indication was upper airway obstruction due to trauma in 24.9% cases. Most of the time (82.88%) we had to perform Emergency tracheostomy. Longitudinal or

Background: Sepsis is one of the leading causes of admission in ICU with high mortality and morbidity.Intensivists face challenges to manage sepsis in their practices particularly in a limited resource setting.The diagnosis of sepsis and its evaluation of severity are not easy because of its complex pathophysiologyand variable nature of presentation. So, researchers identified biomarkers including troponin I for potentialuse in sepsis. Of them troponin I is a useful biomarker with prognostic significance. Materials and methods: This prospective observational study was conducted among purposively selected110 patients diagnosed as sepsis at intensive care unit (ICU) in Dhaka Medical College & Hospital. Afterfulfilling the inclusion and exclusion criteria, ECG was done to exclude MI. Then troponin I was measuredwith a cut of value of 0.6 ng/ml. the patients were followed up for a period upto 30 days. Statisticalassociations between categorical variables were tested using chi-square test and mean difference ofcontinuous variables by independent t-test. Correlation between troponin I value length of ICU stays andventilator days were calculated. Results:Among 110 patients diagnosed as sepsis 56.4% had normal troponin I and 43.6% had elevatedtroponin I. Distribution of elevated troponin I was higher among male patients (77.1% vs 64.5%) thanfemale. Mean duration of ICU stay was prolonged in elevated troponin I group as like ventilator support.Positive relationship was found between troponin level I and duration of ventilator support as well aslength of ICU stay (r=0.225, 0.279). There was significantly increased mortality rate in elevated troponingroup of patients compared to normal troponin group (72.9% vs 35.5%) in sepsis patients (p<0.001) followedby in severe sepsis 67.5% vs 35.48% (p=0.001) and 92.9% vs 57.1%) in septic shock (p<0.029). Conclusion: This study showed that mortality and morbidity increases when troponin I value elevatedin sepsis. JBSA 2018; 31(1): 12-19

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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 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 (RSBI) was measured by the ratio of respiratory frequency (f) to average exhaled tidal volume (EVT). When rapid shallow breathing index was 105 breath/min/L or less and more than 105 breath/min/L were taken as low and high RSBI respectively. Result: A total number of 117 patients were recruited for this study after fulfilling the inclusion and exclusion criteria of which 92 patients were in low RSBI group and the rest 25 patients were in high RSBI group. The mean age was found 31.8±12.8 years in low RSBI group and 35.9±13.2 years in high RSBI group (p>0.05). It was observed that male was found 57(62.0%) in low RSBI group and 13(52.0%) in high RSBI group (p>0.05). It was observed that 14(15.2%) patients had laparotomy in low RSBI group and 4(16.0%) in high RSBI group (p>0.05). Surgical patients was found 27(29.3%) in low RSBI group and 11(44.0%) in high RSBI group (p>0.05). Conclusion: In conclusion there is no statistical significant relationship of age, gender and clinical diseases of the patients with low and high rapid shallow breathing index who are under mechanical ventilation at intensive care unit. Journal of National Institute of Neurosciences Bangladesh, July 2021, Vol. 7, No. 2, pp. 92-96