Journal of Trauma Intensive Care STIC

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Volume 1, Number 1, January-June 2024
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EDITORIAL

Monica Kohli, Rajesh Raman

A New Era in Trauma Intensive Care

[Year:2024] [Month:January-June] [Volume:1] [Number:1] [Pages:2] [Pages No:1 - 2]

   DOI: 10.5005/jtric-11018-0001  |  Open Access |  How to cite  | 

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Original Article

P Jaideep, Rajni Gupta, Aparna Shukla

Effect of Epidural Dexmedetomidine and Fentanyl Infusion for Postoperative Analgesia in Patients Undergoing Upper Abdominal Surgeries: A Randomized, Double-blind Study

[Year:2024] [Month:January-June] [Volume:1] [Number:1] [Pages:5] [Pages No:3 - 7]

Keywords: Dexmedetomidine, Bupivacaine, Fentanyl, Epidural analgesia, Pain management, Local anesthetics, Postoperative pain

   DOI: 10.5005/jtric-11018-0006  |  Open Access |  How to cite  | 

Abstract

Background: Effective perioperative pain management is critical for patients undergoing major upper abdominal surgeries. Epidural analgesia, a cornerstone of regional anesthesia, is widely used to manage pain in these surgical cases. Fentanyl and dexmedetomidine are commonly used additives to local anesthetics for epidural analgesia. This trial aims to compare the two additives. Settings and design: The study was a double-blind, randomized controlled study conducted in a tertiary care hospital. Materials and methods: The trial included patients aged 18–65 of either gender who had planned upper abdominal surgery. The patients received an epidural infusion of 0.1% bupivacaine with either dexmedetomidine or fentanyl for postoperative analgesia. Outcome variables included static and dynamic pain on the visual analogue scale (VAS), analgesic consumption, and hemodynamic variables. Each group had 34 patients. Observations: The demographic variables were comparable between the groups. At various time points, the static and dynamic VAS score for pain were significantly lower in the dexmedetomidine group. The analgesic consumption was also lower in the dexmedetomidine group. Hemodynamic variables and complications were similar between the groups. Conclusion: Dexmedetomidine, as an adjuvant to epidural bupivacaine, is better than fentanyl in patients undergoing upper abdominal surgery.

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CASE REPORT

Muktesh Singh, Neelkamal Mishra, Mohd Kamil, Prabhat Mishra

Emerging Pathogens in Immunocompromised Hosts in ICU Settings: Ralstonia pickettii

[Year:2024] [Month:January-June] [Volume:1] [Number:1] [Pages:2] [Pages No:8 - 9]

Keywords: Case report, Critical care, Intensive care units, Opportunistic Infections, Ralstonia pickettii, Respiratory distress syndrome

   DOI: 10.5005/jtric-11018-0003  |  Open Access |  How to cite  | 

Abstract

Ralstonia pickettii, an oligotrophic betaproteobacteria is found in rivers, soils, lakes, and in biofilms in plastic water pipes. The objective of this case report was to describe a case of R. pickettii causing ventilator-associated pneumonia in an intensive care unit (ICU) setting, focusing on risk factors, antibiotic sensitivity patterns, clinical characteristics, management, and outcomes. A 45-year-old male patient presented to the Emergency Department with a complaint of neurotrauma after a road traffic accident. Decompressive craniectomy was done and the patient was shifted to ICU for postoperative care and mechanical ventilation, later patient was tracheostomized in view of prolonged mechanical ventilation, poor GCS, and for better tracheal toilet. Later patient developed pneumonia, and antimicrobial susceptibility testing showed the isolate R. pickettii, sensitive to levofloxacin and piperacillin/tazobactam. After five days of treatment, the patient was weaned from the ventilator.

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CASE REPORT

Pallavi, Mohd Kamil, Vipin Singh, Muktesh Singh

Psychiatric Symptoms due to Cobalt Toxicity: A Case Report

[Year:2024] [Month:January-June] [Volume:1] [Number:1] [Pages:2] [Pages No:10 - 11]

Keywords: Alloys, Case report, Chromium, Cobalt, Hallucinations, Intensive care units, Metal-on-metal joint prostheses

   DOI: 10.5005/jtric-11018-0007  |  Open Access |  How to cite  | 

Abstract

Cobalt is thought to cause a variety of symptoms in patients whose toxic amounts accumulate in the blood. Cobalt poisoning may be due to metal implants. A 50-year-old female had a fracture of the neck of the femur and underwent total hip arthroplasty under spinal anesthesia. On postoperative day 8, she became restless and hyperactive, persistently repeating words and actions and having visual hallucinations. Psychiatry opinion was taken, and intensive care units (ICUs)-induced psychosis could be ruled out. Meanwhile, her serum cobalt levels were sent, keeping in mind the differential diagnosis of cobalt-induced neuropsychiatric toxicity, and the levels were S. Cobalt – 10.88 µg/L. After discontinuing cobalt-containing medications, the patient gradually improved symptomatically over 2–4 days and was eventually discharged from the ICU.

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CASE SERIES

Muthu Nagarathinam, Swati Srivastava, Pallavi

Clinical Challenges and Treatment Strategies for Rare ICU Pathogens: A Case Series

[Year:2024] [Month:January-June] [Volume:1] [Number:1] [Pages:3] [Pages No:12 - 14]

Keywords: Antimicrobial drug resistance, Intensive care units, Multi-drug resistance, Opportunistic infections, Sepsis

   DOI: 10.5005/jtric-11018-0002  |  Open Access |  How to cite  | 

Abstract

The emergence of rare bacterial strains in intensive care units (ICUs) presents numerous challenges for treatment and infection control. This case series describes the detection and management of three uncommon bacteria Pluralibacter gergoviae, Stenotrophomonas maltophilia, and Elizabethkingia anopheles in ICU patients. The clinical implications and antibiotic susceptibilities of these pathogens are critical for effective management and infection control within healthcare settings. These cases highlight the opportunistic nature and antibiotic resistance patterns of P. gergoviae, S. maltophilia, and E. anophelis, underscoring the need for vigilance in diagnosis and treatment. This series underscores the significant clinical impact of rare bacterial strains in ICU settings, particularly in immunocompromised patients. Prompt identification and appropriate antibiotic therapy are crucial to ensure a favorable outcome.

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CASE SERIES

Rati Prabha, Farhan Zahir Shaikh, Apoorva Gupta, Shreya Rastogi

I-gel Plus as a Rescue Device after Failure to Manage Airway: A Case Series

[Year:2024] [Month:January-June] [Volume:1] [Number:1] [Pages:2] [Pages No:15 - 16]

Keywords: Airway extubation, Airway management, General anesthesia, Intensive care unit, Perioperative period, Thoracic surgery

   DOI: 10.5005/jtric-11018-0005  |  Open Access |  How to cite  | 

Abstract

In anesthesiology, airway management during the perioperative period is crucial for patient safety. While endotracheal intubation has traditionally been a standard practice, supraglottic airway devices (SADs) have significantly expanded the options available to anesthesiologists. Supraglottic airway devices offer a balance between effectiveness, ease of use, and potential advantages over endotracheal tubes. They are useful in various circumstances. The i-gel Plus is a modification of the widely used i-gel. This case series describes three cases where the i-gel Plus was used for airway management when other methods failed. These cases highlight the effectiveness of the i-gel Plus in challenging airway management scenarios, emphasizing its potential as a reliable tool in the anesthesiologist's arsenal. The current evidence on the i-gel Plus, including studies on cadavers and large patient cohorts, suggests high success rates and ease of use. However, further research is needed to validate its benefits across diverse clinical situations.

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REVIEW ARTICLE

Zia Arshad

Trauma Care: Role of Trauma Intensivist

[Year:2024] [Month:January-June] [Volume:1] [Number:1] [Pages:3] [Pages No:17 - 19]

Keywords: Acidosis, Coagulopathy, Hypothermia, Intensive care unit, Resuscitation, Trauma

   DOI: 10.5005/jtric-11018-0004  |  Open Access |  How to cite  | 

Abstract

Trauma is a major health issue all over the world and is associated with a high rate of death and disability in both developed and developing countries. There has been a dramatic change in the management of trauma patients in the last two decades. The term damage control resuscitation and damage control surgery came into light during the last 20 years. Physician involvement is increased in trauma victims’ care as the physiological derangements, maintenance of hemodynamics, and infection control are equally catastrophic for the patient, so the focus is shifted to the intensive care unit (ICU) from the operating room (OR). The objective of this article is to emphasize the role and importance of trauma intensivists in the management of polytrauma patients. Trauma intensive care is a new horizon for anesthesiologists who can manage trauma in association with a trauma surgeon, and their role will increase day by day with the advancement of imaging techniques and interventional radiology. To summarize, the duties and responsibilities of a trauma intensivist start with pre-hospital care and transport to damage control resuscitation with ABC care, maintaining hemodynamic, inter-hospital transport, preparing for damage control surgery, postoperative resuscitation, respiratory support, pain management, follow-up, and rehabilitation.

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