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CO2 narcosis in a COVID-19 patient in prone position due to twisting of reservoir bag of a non-rebreathing mask: a case report

100%
Kumar N., Kumar A., Singh P. K., Kumar N., Kumar S.
Critical Care Innovations
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2020
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vol. 3
|
issue 4
30-34
EN
We know that oxygen therapy plays one of the important role for treating hypoxemia and it is widely used across a whole range of specialties and it involves administration of oxygen at concentrations greater than that in ambient air. We are reporting the first case of twisting of reservoir bag on using non-rebreathing face mask for providing supplemental oxygen in awake prone position in a 60 year old male tested COVID-19 positive. To prevent this twisting we recommend if a manufacturer do slight modification in making of these non-breathing face mask by adding a 1-2 cm L- shaped Plastic connector to the neck end of the oxygen reservoir bag. The sudden deflation of these reservoir bag not only increase the dead space, decrease alveolar ventilation but substantially compromised the gas exchange. So any twisting of these non-rebreathing face mask should be avoided. This twisting may compromise the patient condition due to rapid increase in PaCO2 and detrimental in patients with restrictive airway disease. On keeping the patient in prone position the twisting of the reservoir bag frequently occurs and this simple and useful modification may be beneficial for supplementation of oxygen therapy to COVID-19 patients requiring high fractional inspired oxygen concentration.
2
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Condensed water in the dryline water trap system of capnography as a potential source of infection: a case report.

81%
Kumar N., Kumar A., Kumar A., Das S.
Critical Care Innovations
|
2020
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vol. 3
|
issue 3
37-41
EN
Capnometry is the measurement of carbon dioxide (CO2) in a sample of gas. Capnography is continuous monitoring of the concentration or partial pressure of CO2 in respiratory gases. Here, we are reporting two cases of bacterial isolation from the water trap being used in the intensive care unit (ICU) and in one case was admitted to COVID ICU whose sample from the collected water trap was sterile. In all three of these patients a side stream capnography monitoring was being used. On close inspection of water trap chamber of capnograph we saw some collection of condensed water in all the three chambers. We sent the samples of all three patients for culture sensitivity out of which two was positive and one was sterile later on. The ICU- acquired infections are becoming a challenging health concern especially when caused by multi drug resistant pathogens and in current COVID 19 pandemic risks to health care worker are even more and it always warrants a close observation. In our case contamination of breathing systems may occurred because of compliance failure possibly due to improper inspection and functional testing of the sampling tube and exhaust tube which may lead to the reversal of the direction of flow through the sampling tube in a diverting respiratory gas monitor (RGM).
PL
Kapnometria to pomiar dwutlenku węgla (CO2) w próbce gazu. Kapnografia jest ciągłym monitorowaniem stężenia lub ciśnienia parcjalnego CO2 w gazach oddechowych. Autorzy zgłaszają dwa przypadki izolacji bakterii z pułapki wodnej stosowanej na oddziale intensywnej terapii (OIT) oraz jeden przypadek przyjęcia pacjenta na OIT, którego próbka z pobranej pułapki wodnej była sterylna. U wszystkich trzech z tych pacjentów w strumieniu bocznym stosowano monitoring kapnograficzny. Przy bliższej inspekcji komory pułapki wodnej kapnografu zauważono gromadzenie się skroplonej wody we wszystkich trzech komorach. Wysłano próbki wszystkich trzech pacjentów do oceny na posiew z czego dwa wyniki były pozytywne, a jeden był negatywny. Infekcje nabyte na OIT stają się wyzwaniem stanowiąc zagrożenie dla zdrowia, zwłaszcza spowodowane patogenami wielolekoopornymi i obecnym ryzykiem pandemii COVID 19 pracowników służby zdrowia, co zawsze wymaga uważnej obserwacji. W opisanym przypadku zanieczyszczenie układu wentylacyjnego mogło wystąpić z powodu braku właściwej inspekcji i testowania funkcjonalnego przewodu zasysającego i przewódu wydechowego, co może prowadzić do zmiany kierunku przepływu przez przewód zasysający do monitora gazów oddechowych (RGM).
3
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Acute naphthalene toxicity following ingestion of mothballs and ethyl alcohol: a case report

81%
Roshan N. K., Vishwas K., Kumar N.
Critical Care Innovations
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2023
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vol. 6
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issue 1
29-35
EN
Naphthalene poisoning is an uncommon poisoning due to its pungent smell, taste, insolubility in water, and poor absorption from the gut following exposure to naphthalene-containing compounds such as mothballs. Paradichlorobenzene has been reported to dissolve more quickly in alcohol. Within a period of 48-96 hours following naphthalene mothball exposure patient presents with acute onset of non-bloody bilious vomiting, dark brown urine and watery diarrhoea. We present a diagnostic and therapeutic challenge while treating a 27 years old male admitted to the intensive care unit with features of acute naphthalene-toxicity, methemoglobinemia and acute kidney injury following accidental ingestion of mothballs and ethyl alcohol. His vital signs at the time of intensive care unit admission included fever, tachycardia, and hypotension, and his laboratory workup demonstrates hyperbilirubinemia with indirect predominance, hemolytic anaemia, methemoglobinemia, and renal dysfunction. Treatment options include supportive care, red cell transfusion, ascorbic acid, methylene blue, and N-acetylcysteine. The importance of obtaining a careful history and clinical findings is of paramount importance, especially in making the right diagnosis and a successful outcome largely depends on it.
4
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Acute hypersensitivity reaction following intravenous ferric carboxymaltose injection for iron deficiency anaemia: a case report

72%
Kumar N., Gautam P. B., Ahmad S., Qutub D., Prasad I.
Critical Care Innovations
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2023
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vol. 6
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issue 1
41-45
EN
Ferric carboxymaltose (FCM) is a non-dextran iron preparation used for intravenous treatment of iron deficiency anaemia (IDA) in adult patients with intolerance or poor response to oral iron therapy. Acute hypersensitivity reactions (HSRs) during iron infusions are very rare but can be life-threatening even after receiving a prior test dose. Here, we report a case of 42 years old female patient who underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. On the next postoperative day she received an injection of ferric carboxy maltose. She was diagnosed with IDA. She presented with the picture of an adverse drug reaction due to injection FCM. She was managed with oxygen, vasopressors, antihistaminics, intravenous fluids and, corticosteroids. She recovered well within 24 hours of intensive care unit admission following this adverse drug reaction. So, careful and precise observation is required in management of adverse reaction following ferric carboxymaltose and prompt recognition and treatment based on severity is warranted.
5
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Prolonged use of non-invasive ventilation in patients with COVID 19: a case report

72%
Singh K., Kumar A., Kumar N., Kumar A., SK A.
Critical Care Innovations
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2021
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vol. 4
|
issue 1
44-47
XX
One of the most commonly affected organ systems by SARS-CoV-2 virus is the respiratory system. Major challenge with coronavirus disease is managing the pulmonary complications. Role of non-invasive ventilation in patients of coronavirus disease 2019 (COVID 19) has been questioned in spite of evidence showing its use in acute hypoxemic respiratory failure. Patient selection is very important when using non-invasive ventilation for management of respiratory failure due to COVID 19. Here we report a case of COVID 19 with respiratory failure that was managed successfully with prolonged use of non-invasive ventilation.
6
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Monitoring and evaluation of muscle atrophy: a much needed step in critically ill COVID-19 patients

62%
Kumar A., Kumar A., Kumar N., Kumar A., Sinha C., Kumari P., Singh V.
Critical Care Innovations
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2021
|
vol. 4
|
issue 1
30-43
XX
INTRODUCTION: Elderly COVID-19 patients admitted to the intensive care unit (ICU) are at high risk of an inflammatory syndrome, hypercatabolic reaction, malnutrition, and physical immobilization. This may result in loss of muscle mass and pulmonary infection leading to prolonged ventilatory support. Factors responsible for muscle mass loss in ICU are (1) microcirculatory disturbances, (2) presence of systemic inflammatory response syndrome (SIRS), (3) sepsis (4) drugs (corticoids, neuromuscular blockers) having inhibitory activity on the nervous system, neuromuscular junction and muscle itself. Mechanism of muscle atrophy in critically ill elderly patients include an imbalance between protein synthesis and degradation. Interventions to manage muscle atrophy for the patients admitted to ICU is also extrapolated to mechanically ventilated COVID-ARDS patients. PURPOSE: Early recognition of factors contributing to intensive care unit acquired weakness (ICUAW) in COVID-19 patients, inflammation, high catabolic phase, steroid use, and paralysis. The potential interventions to target these specific mechanisms and ameliorate muscle dysfunction in COVID-19 patients. CONCLUSIONS:Intensive care unit acquired weakness (ICUAW) in critically ill COVID-19 patients is due to severity of illness, co-morbidities, muscle unloading, or ICU treatments, a systemic reaction circulating within the body, or combinations therein. Furthermore, the availability of a culture model of ICUAW could facilitate in expediting the diagnosis of ICUAW and fast track the discovery of putative treatments. We recommend NIV or HFNC ventilation or early weaning from invasive mechanical ventilation in critically ill COVID-19 elderly patients.
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