Context:Correcting hypovolemia is extremely important. Central venous pressure measurement is often done to assess volume status. Measurement of inferior vena cava (IVC) is conventionally done in the subcostal view using ultrasonography. It may not be possible to obtain this view in all patients.Aims:We therefore evaluated the limits of agreement between the IVC diameter measurement and variation in subcostal and that by the lateral transhepatic view.Settings and Design:Prospective study in a tertiary care referral hospital intensive care unit.Subjects and Methods:After Institutional Ethics Committee approval and informed consent, we obtained 175 paired measurements of the IVC diameter and variation in both the views in adult mechanically ventilated patients. The measurements were carried out by experienced researchers. We then obtained the limits of agreement for minimum, maximum diameter, percentage variation of IVC in relation to respiration.Statistical Analysis Used:Bland–Altman's limits of agreement to get precision and bias.Results:The limits of agreement were wide for minimum and maximum IVC diameter with variation of as much as 4 mm in both directions. However, the limits of agreement were much narrower when the percentage variation in relation to respiration was plotted on the Bland–Altman plot.Conclusions:We conclude that when it is not possible to obtain the subcostal view, it is possible to use the lateral transhepatic view. However, using the percentage variation in IVC size is likely to be more reliable than the absolute diameter alone. It is possible to use both views interchangeably.

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Background and Aims:The transport of critically ill patients for procedures or imaging outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. The literature about benefits of and untoward events (UEs) during intrahospital transport of pediatric critically ill patient is scarce. We, therefore, audited the UEs during and benefits of intrahospital transport of critically ill pediatric patients in our ICU.Subjects and Methods:Eighty critically ill pediatric (<18 years) cancer patients, transported from the ICU for either diagnostic or therapeutic procedure over a period of 6 months, were included in the study. The data collected included the destination (computed tomography scan, intervention radiology, magnetic resonance imaging scan, and operation theater), accompanying medical personnel, UEs, and benefits obtained during transport.Results:Among eighty pediatric patients, the median age was 8 years (range 2–17 years). During the transport, four (5%) patients required endotracheal intubation, three (3.75%) patients required intercostal drain placement, and six (7.5%) patients required cardiopulmonary resuscitation. Accidental removal of central venous catheter was reported in three (3.75%) patients, drain came out in four (5%) patients, and three (3.75%) patients had accidental extubation. Transport indirectly led to a change in antibiotic therapy in 24 (30%) patients and directly helped in change of therapy in the form of interventions in 20 (25%) patients.Conclusion:Critically ill children can be transported safely with adequate pretransport preparations, which may help in avoiding major UEs and benefit the patient by change in the therapy.

Influenza A (H1N1) infection has a propensity to infect an immunocompromised host (ICH). These patients experience more severe manifestations and related complications with increased mortality. Influenza A (H1N1) infection in ICH differs from non-ICH in terms of clinical features, range of complications, radiological features, treatment response, and outcome. Radiology may show higher number of lesions but with no or minimal corresponding clinical manifestations. Coinfection with streptococci, staphylococci, and Aspergillus further increases mortality. Antiviral resistance compounds the overall picture despite optimal regimen. Use of steroids is detrimental. Extracorporeal membrane oxygenation (ECMO) is usually avoided in ICH. However, ICH groups with influenza A (H1N1) infection complicated by acute respiratory distress syndrome who have received ECMO have recorded mortality up to 61%. Nevertheless, evidence-based recommendation on use of ECMO in ICH is lacking. Annual inactivated influenza vaccine is recommended for most ICH groups with a few exceptions and for their close contacts. Hygiene measures greatly contribute to reducing disease burden. High index of suspicion for influenza A (H1N1) infection in ICH, early antiviral therapy, and treatment of coinfection is recommended. With the threat of transmission of resistant viral strains from ICH to the community, apart from treatment, preventive measures such as vaccination and hygienic practices have a significant role. Through this review, we have attempted to identify clinical and radiological peculiarities in ICH with influenza A (H1N1) infection, treatment guidelines, and prognostic factors. Influenza A (H1N1) infection in ICH may remain clinically silent or mild.

Background:The transport of critically ill patients for procedures or tests outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. Plenty of data is available on pre- and inter-hospital transport of patients; the data on intrahospital transport of patients are limited. We audited the complications and benefits of intrahospital transport of critically ill patients in our tertiary care center over 6 months.Materials and Methods:One hundred and twenty adult critically ill cancer patients transported from the ICU for either diagnostic or therapeutic procedure over 6 months were included. The data collected include the destination, the accompanying person, total time spent outside the ICU, and any adverse events and adverse change in vitals.Results:Among the 120 adult patients, 5 (4.1%) required endotracheal intubation, 5 (4.1%) required intercostal drain placement, and 20 (16.7%) required cardiopulmonary resuscitation (CPR). Dislodgement of central venous catheter occurred in 2 (1.6%) patients, drain came out in 3 (2.5%) patients, orogastric tube came out in 1 (0.8%) patient, 2 (1.6%) patients self-extubated, and in one patient, tracheostomy tube was dislodged. The adverse events were more in patients who spent more than 60 min outside the ICU, particularly requirement of CPR (18 [25%] vs. 2 [4.2%], ≤60 min vs. >60 min, respectively) with P < 0.05. Transport led to change in therapy in 32 (26.7%) patients.Conclusion:Transport in critically ill cancer patients is more hazardous and needs adequate pretransport preparations. Transport in spite being hazardous may lead to a beneficial change in therapy in a significant number of patients.