Acinetobacter baumannii is an important cause of nosocomial ventriculitis associated with external ventricular device (EVD). It is frequently multidrug resistant (MDR), carries a poor outcome, and is difficult to treat. We report a case of MDR Acinetobacter ventriculitis treated with intravenous and intraventricular colistin together with intravenous tigecycline. The patient developed nephrotoxicity and poor neurological outcome despite microbiological cure. Careful implementation of bundle of measures to minimize EVD-associated ventriculitis is valuable.

Olanzapine is an atypical antipsychotic drug that is being increasingly used as an intentional overdose. It usually presents with reduced and fluctuating level of consciousness and coma. It may rarely present with muscle toxicity by binding to HT2A receptor in skeletal muscle and increasing its permeability. We report a case of such poisoning which had no obvious symptoms but was brought to emergency due to overdose and was found to have acute muscle toxicity as evidenced by raised creatine phosphokinase (CPK) levels. From this, we also want to emphasize that CPK levels should be checked in all the patient's prescribed olanzapine to look for muscle toxicity.

Background: Arterial blood gas is required for extubation decision after spontaneous breathing trial in most of intensive care unit. This study was conducted to assess the influence of arterial blood gas for extubation after successful spontaneous breathing trial in intensive care unit patients planned for extubation.Methods: It was prospective observation study conducted in all patients of age greater than eighteen year admitted in intensive care unit of tertiary care hospital for one year. It was done in 108 patients who were planned for extubation. Patients were assessed by intensivist clinically and decided whether a patient can be extubated on clinical grounds. Spontaneous breathing trial was done for 2 hours by t-piece in patients who met clinical and objective criteria. Arterial blood gas was done in all patients who successfully completed spontaneous breathing trial. Patients with successful spontaneous breathing trial, acceptable arterial blood gas were extubated. Independent Student’s t test and paired t test was used for data analysis. Results: Out of 108 patients who passed the spontaneous breathing trial, 96(88.88%) patients had acceptable arterial blood gas and were extubated and 12(11.11%) patients did not have acceptable arterial blood gas level and were chosen to have other mode of weaning.Conclusions: This study demonstrates that arterial blood gas level has changed decision for extubation after successful spontaneous breathing trial. Further, arterial blood gas might help in identification of patients who can undergo extubation failure when rapid shallow breathing index failed to predict outcome of extubation. Keywords: Arterial blood gas; extubation; spontaneous breathing trial; weaning

Background: High mortality and morbidity in neurological patients are found due to lack of closed ICU (Intensive Care Unit), neurointensivist, and training in neurocritical care in most of the developing countries. Therefore, this study was conducted to evaluate the outcome of the neurological patient managed by neurointensivist in a semi-closed ICU. Materials and methods: It was a prospective, descriptive observational cross-sectional study in a level three Neuro-intensive care unit of a tertiary care hospital of Eastern Nepal, for one year in 191 patients. All patients above 18 years admitted to the Neuro-intensive care unit were included in this study. Demographic data was collected for all patients at the time of presentation to the ICU. The outcome of the patient was defined as transferred to Neuro-Ward, leave against medical advice (LAMA), do not resuscitate (DNR) and death. Statistical analysis was done by using SPSS. The result was presented as frequency and percentage. Results: Out of 191 patients, Males (71.7%) was more common than females (28.2%). There were 107 (56%) patients were admitted after 24 hours of injury or illness. 28.2% of patients had a hemorrhagic stroke and was the most common diagnosis for admission in the ICU. This study showed that 58(82.72%) patients survived and were discharged, 23(12%) expired, 7(3.66%) went in LAMA) and 3(1.57%) gave do not resuscitate orders (DNR). Mean days on a mechanical ventilator was 3.17 ± 2.12 days. Mortality in the intubated patient was 19%. Conclusion: A semi-closed Neuro-intensive care unit that includes full-time neurointensivist may have a better outcome than the open ICU.

Background: The critical value can occur while performing panels of tests at laboratory by different chemistry or blood analysers with varieties of principles. The main objective of the study was to study the process of critical result reporting and to know the way of communication and documentation done for critical value in the laboratory, ICUs and the wards.Materials and Methods: This study was prospective and non-experimental was conducted at B&C Medical College and Teaching Hospital from 14.04.2018 to 14.05.2018. Total 60 critical values samples were included. The data was collected by means of observing the critical values of inpatient and the process of reporting from the laboratory to the respective wards and ICUs.Results: Out of 60 samples included in our study, there was 100% communication to concerned treating units. For the confirmation of critical value repeat test was done in 68% of cases. In 75% of cases clinicians did follow up. Recording of a critical report in lab was done in 96% of cases and almost all of the critical values 98% were immediately reported to the respective wards by technical staffs. There was no communication in 1.6% of cases to treating units by technical staff. Majority 78% of critical values were communicated by respective wards and ICUs nurses to concerned doctors.Conclusion: Critical value can occur while performing panels of tests at laboratory and reporting such values to treating clinicians or respective wards or ICUs could help heath care providers for effective treatment of the patients and their adequate care.