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Background and Aims: Anaesthetic agents can affect the neuroendocrine response to surgical stress. Along with affecting other parameters, this can affect blood glucose levels. This study aimed to compare the effect of sevoflurane and desflurane on hourly intraoperative blood glucose levels in non-diabetic patients undergoing intracranial surgery. Methods: A total of 70 adults (18-65 years) of American Society of Anesthesiologists physical status I and II undergoing elective intracranial surgery for supratentorial and infratentorial lesions were enroled. Patients were randomised to receive either sevoflurane or desflurane as the maintenance anaesthetic agent. The blood glucose level was measured hourly after induction until the completion of surgery. Parametric tests, non-parametric tests, Friedman test, generalised estimating equations, Chi-square test, and Fisher's exact test were used to analyse the data. Results: In the sevoflurane group, the mean (standard deviation) blood glucose (mg/dL) increased from 93.34 (9.33) at the baseline to a maximum of 102.00 (8.61) at the 9 hours timepoint. This change was statistically significant (P < 0.001). In the desflurane group, the mean blood sugar (mg/dL) increased from 89.34 (9.85) at the baseline to a maximum of 92.37 (9.92) at the 4 hours timepoint and then decreased to 88.50 (0.71) at 9 hours timepoint. Conclusion: Desflurane caused an initial rise followed by a decline, whereas a gradual increase in intraoperative blood glucose level was seen with sevoflurane use in non-diabetic adult patients undergoing elective neurosurgery. The intraoperative change in blood sugar was statistically significant but was within the normal clinical range.

Background Catheter-associated urinary tract infections (CAUTIs) are a major healthcare-associated infection (HAI) in trauma care settings, contributing to morbidity, mortality and antimicrobial resistance. In this study we characterize the epidemiology, microbiological profile, antimicrobial resistance patterns, and clinical outcomes of CAUTIs and non-CAUTI urinary tract infections (UTIs) at a Level 1 Trauma Centre in India from 2017 to 2024, using a modified CDC-NHSN definition and digital surveillance. Methods A retrospective analysis of 723 UTI events was conducted using Centers for Disease Control and Prevention’s National Healthcare Safety Network (CDC-NHSN) definitions, modified to include Candida spp. at ≥ 10 5 CFU/mL. Surveillance was performed by dedicated Hospital Infection Control Nurses (HICNs) using a digital system. Microbiological identification and antimicrobial susceptibility testing (AST) were conducted via the conventional manual methods and automated systems. Results of 723 UTI events, 608 (84.0%) were CAUTIs. The cohort had a median age of 34 years (IQR:22–45) and was 76% male. Pseudomonas aeruginosa (18%), Klebsiella pneumoniae (17.9%), and Escherichia coli (15%) were predominant pathogens. Antimicrobial resistance was high, with 100% resistance to ceftazidime in Acinetobacter baumannii and 93.6–94.1% resistance to ciprofloxacin in Klebsiella spp. and Enterococcus spp. Mortality was 25.5% (28.2% in CAUTI, 12.9% in non-CAUTI). Conclusion This large-scale, trauma specific study with modified fungal criteria and digital surveillance highlights the importance of CAUTI burden and the high resistance in pathogens causing this infection. Clinical trial number Not applicable.

Background: Radiocontrast administration during interventional neuroradiology (INR) procedures for aneurysmal subarachnoid haemorrhage (aSAH) can add to renal insult. Serum creatinine (sCr) is a conventional marker of acute kidney injury (AKI). Serum neutrophil gelatinase-associated lipocalin (sNGAL) is a novel marker which is increasingly used to predict renal injury in susceptible patients. Objectives: The primary aim of this study was to evaluate correlation between serum neutrophil gelatinase-associated lipocalin (NGAL) and sCr in aSAH patients undergoing therapeutic or diagnostic INR procedures. The secondary aim was to find the incidence of contrast-induced AKI and hemodynamic complications during the study period. Material and Methods: All consenting aSAH patients (18-60 years, Modified Hunt and Hess grade 1-4) posted for INR procedures during the study time were included. Patients with history of chronic renal disease, recent contrast exposure, or renal insufficiency were excluded. Blood samples for sCr and sNGAL were obtained preprocedure and then at 1, 6, 24, and 48 h after contrast administration. Hourly urine output was noted. AKI was defined by KDIGO guidelines. Statistical Analysis Used: Repeated measurement analysis of variance, Posthoc Bonferroni test and Pearson correlation coefficient test. Results: Fifty patients, mean age 47.34 ± 9.31 years, were enrolled for the study. Majority (48; 96%) were Hunt and Hess (H and H) grade I-III. The mean volume of contrast administered was 123.2 ± 53.08 mL. The mean sNGAL and sCr values at pre-op, 1, 6, 24, and 48 h were 124.99 ± 64.58, 148.40 ± 77.90, 147.33 ± 76.00, 125.49 ± 64.44, and 116.38 ± 61.79 ng/mL and 0.629 ± 0.23, 0.624 ± 0.22, 0.612 ± 0.21, 0.632 ± 0.19, and 0.577 ± 0.22 mg/dL, respectively. There was a correlation in sCr and sNGAL value (P < 0.001) at all study time points. However, no specific pattern was seen. No patient developed any AKI or hemodynamic complications in first 48 h. Conclusions: There is a correlation between serum NGAL and sCr at individual time points. NGAL may represent a sensitive early biomarker of renal impairment after INR Procedures. There was no incidence of AKI after contrast administration in aSAH patients without predisposing renal risk factors.

Introduction: Catheter-associated urinary tract infections (CAUTIs) are one of the most common device-associated infections acquired in a hospital. Trauma patients are highly susceptible to CAUTI, as catheterization is a lifesaving measure often required for their management. This study focuses on the profile of CAUTI, the organism profile with antibiotic susceptibility patterns, and the clinical outcomes in the ICUs of a trauma care center. Methodology: A retrospective analysis of prospective surveillance data of patients in ICUs was done over a period of ten years (2010-2019) in a level 1 trauma center. A modified NHSN definition of CAUTI was used. Microbiological processing and antibiotic susceptibility profile was done based on standard guidelines. Clinical outcomes were considered for analysis. Results: A total of 10,732 patients were included in the study, accounting for 98,131 patient days and 78,126 urinary catheter days (UCD). Among 546 patients, 577 episodes of CAUTI were recorded, giving a CAUTI rate of 7.4/1,000 catheter days. The average length of stay (LOS) of patients was 19.9 days. There was a significant relationship between UCD and the development of CAUTI. Orthopedic and spinal injuries (91%) accounted for the maximum device utilization ratio, followed by polytrauma (90%), miscellaneous injuries (88%), and head injuries (69%). CAUTI episodes were the highest in head injury patients. Gram-negative organisms (53.4%) dominated the pathogen profile. The crude mortality was 25.1%. Conclusions: Surveillance of CAUTI with analysis of the organisms and the antibiotic susceptibility trend will help improve infection prevention practices and antibiotic stewardship programs in local hospital settings.

Background: In traumatic brain injuries (TBI), cerebral microdialysis (CMD)-derived parameters, especially the lactate to pyruvate ratio (LP ratio), have been utilized for cerebral perfusion optimization. The objectives were to identify cerebral ischemia as measured by CMD in TBI patients requiring decompressive craniectomy and to observe the correlation between cerebral perfusion pressure (CPP), intracranial pressure (ICP), and CMD variables in these patients. Our secondary aim was to observe the effect of CPP augmentation on ischemia biomarkers. Methods: After the Institute Ethics Committee approvals, seven adult patients requiring decompressive craniectomy following TBI were enrolled and CMD data were obtained prospectively for 72 h. CPP was augmented by 20% with noradrenaline infusion if LP ratio >40. Correlations were done with bootstrapping (n = 500) to obtain the confidence intervals (CI) due to the small sample size. Results: One patient had cerebral ischemia (median LP ratio of 265.5 and median pyruvate of 38 μmol/L), while another patient had non-ischemic mitochondrial dysfunction (median LP ratio 40.7 and median pyruvate 278.5). The coefficients of correlation between the LP ratio with CPP and ICP were r = −0.05 (CI = −0.14-0.03) and r = 0.09 (CI = −0.03-0.24), respectively. The coefficient of correlation between cerebral and blood glucose was r = 0.38, (CI − 0.35-0.14). Only two patients needed CPP augmentation, however, postaugmentation cerebral biochemistry did not change appreciably. Conclusion: CMD can identify cerebral ischemia, however, no correlations were observed between the LP ratio and CPP or ICP. CPP augmentation did not improve cerebral biochemistry. More studies are required to understand and treat cerebral metabolism in TBI.

Study designDescriptive retrospective.ObjectivesTo evaluate the burden of respiratory morbidity in terms of ventilator dependence (VD) days and length of stay in neurotrauma ICU (NICU) and hospital, and to determine mortality in patients with traumatic cervical spinal cord injury (CSCI) in a low middle-income country (LMIC).SettingJai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India.MethodsA total of 135 patients admitted with CSCI in the NICU between January 2017 to December 2018 were screened. Information regarding age, gender, American Spinal Injury Association (ASIA) impairment scale (AIS), level of injury, duration of VD, length of NICU, hospital stay, and outcome in terms of mortality or discharge from the hospital were obtained from the medical records.ResultsA total of 106 CSCI patients were analyzed. The mean (SD) age of patients was 40 (±16) years and male: female ratio was 5:1. The duration of VD, duration of NICU, and hospital stay was a median of 8 days (IQR 1127), 6 days (IQR 1118), and 15 days (IQR 3127) respectively. Mortality was 19% (20/106). The mortality was significantly associated with poorer AIS score, VD, and duration of ICU and hospital stay. All patients were discharged to home only after they became ventilator-free.ConclusionsThe ventilator burden, hospital stay, and mortality are high in patients with CSCI in LMICs. Poor AIS scores, prolonged VD, ICU and hospital stay are associated with mortality. There is a need for comprehensive CSCI rehabilitation programs in LMICs to improve outcome.