Critical Care WAarticles

  How To Choose The Correct Size Of Suction Catheter Dr. Prashant Kumar Background: Suctioning of the artificial airway is a common procedure in everyday clinical practice. 1. Indication: Need to suction a tracheal/ tracheostomy tube should be assessed frequently as necessary by anyone providing care to the patient. The frequency of assessment may be as frequent as continuous in patients with very high secretions to as low as once in several days in dry-clean airways. No generalization can be made on this point.      The decision to suction a tracheal tube must be made on the basis of the clinical need to maintain the patency of the tracheobronchial tree. No routine suctioning should be performed based on timing alone. A tracheal tube should only be suctioned when clinically indicated by signs which could include:   i. visible, palpable or audible secretions (such as sputum, gastric or upper airway contents or blood)   ii. respiratory: desaturation, rising peak inspirat

  Try ACET + MPA combination for Extubation Failure after good Spontaneous Breathing Trial A 52M was admitted with h/o fall from height with D12 compression fracture and right side hemothorax. Plate fixation was done and hemothorax was drained. On day 5 he successfully passed spontaneous breathing trial on low FiO2 (25-30%). NIV was applied but it failed. He was re intubated and was started on Tab Acetazolamide 500 mg TDS and Tab Medroxyprogesterone 20 mg TDS. On the subsequent day the process was repeated and was extubated successfully.     What are the factors which predispose to reintubation after successful SBT and what are the best strategies to support this situation?     *Risk factors:* Old age Left ventricular dysfunction Anemia Positive fluids balance and transfusions given Renal dysfunction Fentanyl use (Cumulative dose) Prolonged mechanical ventilation Neurological impairment Airway edema (Cuff leak test < 110 ml) Low diastolic pressure

 ABC of Vitamin D in Critical Care == Vitamin D has multiple functions in the human body. In both general population and the critically ill vitamin deficiency is very common. Morality risk decrease as the level reaches towards the normal. It is clearly established that low vitamin D level is associated with increased ICU stay and mortality.  Supplementation of Vitamin D in short term is quite safe with mild hypercalcaemia if any in hypervitaminosis which remains quite harmless and needs no intervention. Antimicrobial and Immune-Modulatory Effects of Vitamin D Provide Promising Antibiotics Independent Approaches to Tackle Bacterial Infections. What is the recommendation for Vitamin D supplementation? The Recommended Daily Intake (RDI) of Vitamin D3 is 600IU for normal healthy persons. But at this rate it will take days to months to correct deficiency if any.   According to the ESPEN (2019) guidelines plasma level should be measure in all patients in critical illness. The reason for this