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Background Caudal block is usually performed after general anesthesia in children, which makes it hard to assess the success of the block. The aim of this study was to determine whether the surgical pleth index can serve as an objective tool for assessing nociception and the success of caudal block in anesthetized children. Methodology Sixty-two children aged 1–6 years, with American Society of Anesthesiologists Physical Status I and II, undergoing elective infraumbilical surgery, were included. All patients received general anesthesia with i-gel and caudal analgesia. The surgical pleth index, heart rate, and mean blood pressure were recorded throughout the procedure. Caudal block was assessed postoperatively with a gentle pinch. Results The patients were divided into Group S (caudal success) and Group F (caudal failure). In both groups, the SPI decreased after induction to nearly < 50. It continued to gradually decrease to ≈30 in Group S, whereas it increased sharply with incision in Group F to ≈76. After additional analgesia with fentanyl, the surgical pleth index decreased in Group F, but the mean surgical pleth index was significantly greater than in Group S ( p  < 0.01). The intergroup difference in surgical pleth index persisted throughout the procedure. A receiver operating curve showed that a surgical pleth index of 43.5 before incision has a sensitivity of 83.3% and a specificity of 67.9% for predicting successful caudal block. Heart rate and blood pressure increased significantly with incision in Group F, unlike in Group S. The intergroup difference in hemodynamics disappeared after additional analgesia. Conclusion A surgical pleth index of ≤ 43.5 (which may be rounded to 40) can serve as a nociceptive index to predict the success of a caudal block in children. IEC registration number IEC2 549/2023 dated 19th March 2024. Clinical trials registration (CTRI/2024/12/078281) dated 18th December 2024.

Introduction: There are few scores for mortality prediction in acute respiratory distress syndrome (ARDS) incorporating comprehensive ventilatory, acute physiological, organ dysfunction, oxygenation, and nutritional parameters. This study aims to determine the risk factors of ARDS mortality from the above-mentioned parameters at 48 h of invasive mechanical ventilation (IMV), which are feasible across most intensive care unit settings. Methods: Prospective, observational, single-center study with 150 patients with ARDS defined by Berlin definition, receiving IMV with lung protective strategy. Results: Our study had a mortality of 41.3% (62/150). We developed a 9-point novel prediction score, the driving pressure oxygenation and nutritional evaluation (DRONE) score comprising of driving pressure (DP), oxygenation accessed by the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO2/FiO2) ratio and nutritional evaluation using the modified nutrition risk in the critically ill (mNUTRIC) score. Each component of the DRONE score with the cutoff value to predict mortality was assigned a particular score (the lowest DP within 48 h in a patient being always ≥15 cmH2O a score of 2, the highest achievable PaO2/FiO2 <208 was assigned a score of 4 and the mNUTRIC score ≥4 was assigned a score of (3). We obtained the DRONE score ≥4, area under the curve 0.860 to predict mortality. Cox regression for the DRONE score >4 was highly associated with mortality (P < 0.001, hazard ratio 5.43, 95% confidence interval [2.94-10.047]). Internal validation was done by bootstrap analysis. The clinical utility of the DRONE score ≥4 was assessed by Kaplan-Meier curve which showed significance. Conclusions: The DRONE score ≥4 could be a reliable predictor of mortality at 48 h in ARDS patients receiving IMV.

Background and Aims: An electronic stethoscope with an inbuilt phonocardiogram is a potentially useful tool for paediatric cardiac evaluation in a resource-limited setting. We aimed to compare the acoustic and electronic stethoscopes with respect to the detection of murmurs as compared to the transthoracic echocardiogram (TTE). Methods: This was an observational study. Fifty children aged 0-12 years with congenital heart diseases (CHDs) and 50 without CHD scheduled for echocardiography were examined using both stethoscopes. The findings were corroborated with clinical findings and compared with the echocardiography report. Results: Among the 50 cases without CHD, no murmur was detected using either of the stethoscopes. This was in agreement with TTE findings. The calculated specificity of both stethoscopes was 100%. Amongst the 50 cases with CHD, the electronic stethoscope picked up murmurs in 32 cases and missed 18 cases. The acoustic stethoscope picked up murmurs in 29 cases and missed 21 cases. Thus, the sensitivity of electronic and acoustic stethoscopes as compared to TTE was calculated to be 64% and 58%, respectively. The positive predictive value of the electronic stethoscope as compared to TTE was 100% while the negative predictive value was 73%. The kappa statistic was 0.93 suggesting agreement in 93%. Mc-Nemar's test value was 0.24 suggesting that the electronic stethoscope did not offer any advantage over the acoustic stethoscope for the detection of CHD in children. Conclusion: A comparison of the electronic stethoscope with an acoustic stethoscope suggests that the rate of detection of CHD with both stethoscopes is similar and echocardiography remains the gold standard.

Background/Objectives: Effective communication between healthcare professionals and patient caregivers is paramount in the surgical waiting area, particularly during periods of heightened stress and emotional vulnerability. Globally, communication practices exhibit considerable variability, from traditional face-to-face interactions to integrating advanced digital technologies. Despite innovations, a comprehensive understanding of the impact of diverse communication strategies on patient caregiver satisfaction remains underdeveloped. This scoping review was designed to systematically map the existing literature on healthcare communication practices and identify strategies that may influence satisfaction among patient caregivers. Methods: A thorough search of multiple databases—Scopus, PubMed, CINAHL, Embase, ProQuest, Web of Science, the Cochrane Library, and clinical trial registries—was conducted. Only studies published in English or those for which an English full text was accessible were included. Eligible studies were those undertaken in hospital settings, including operating theaters, surgical units, surgical waiting areas, postoperative intensive care units, emergency departments, and other clinical areas focusing on patient caregivers. The review adhered to the methodological framework recommended by the Joanna Briggs Institute for scoping reviews and was reported following the most recent PRISMA-ScR guidelines. Results: Ultimately, five studies met the inclusion criteria. The selection process involved a structured search utilizing Medical Subject Headings (MeSH), keywords, and index terms, supplemented by manual reference list screening. Initial screening was performed based on titles and abstracts, followed by full-text evaluation using a standardized selection form. Data extraction focused on the communication methods, study designs, and outcomes related to patient caregiver satisfaction. The findings are synthesized narratively and presented through tables and figures, offering a comprehensive overview of global communication practices and their influence on patient caregiver satisfaction in surgical environments. Across the five included studies, digital communication interventions such as SMS, mobile apps, or video updates reported improved patient caregiver satisfaction (e.g., 70.8% in Canada and 97% in Switzerland) and also reduced patient caregiver anxiety (e.g., STAI score ≥ 44) in 74.2% of Ethiopian patient caregivers. Worldwide evidence highlights the practical importance of tailored digital communication practices to support providing timely and accessible information to patient caregivers, while also revealing gaps linked to insurance status, digital literacy, and various communication approaches in healthcare systems. Conclusions: The five studies included showed considerable variation in communication practices across surgical settings. The main findings reveal that structured, timely, and transparent communication, mainly via digital tools such as SMS updates and mobile applications, enhanced patient caregiver satisfaction and alleviated their emotional distress too. Nevertheless, gaps were identified in postoperative communication, and challenges, such as technological accessibility, digital literacy skills of patient caregivers, and inconsistent methods for measuring satisfaction outcomes, were noted across studies. This scoping review identified the different types of healthcare communication practices adopted globally in surgical care settings and also demonstrated their influence on patient caregiver satisfaction. Traditional and digital communication practices both have their significant impact on patient caregiver experiences in surgical healthcare settings, focusing more on timely and consistent real-time updates and culturally sensitive information. Addressing the existing communication gaps and having tailored communication approaches to specific contexts may lead to improved patient caregiver support and surgical outcomes.

Introduction: Off-pump coronary artery bypass (OPCAB) surgery is associated with evasion of complications of cardiac bypass. The incidence of postoperative atrial fibrillation (POAF) may also be reduced because of less ischemia and inflammation. Aim: Prospective evaluation of utility of CHA2DS2-VASc score in the prediction of POAF after OPCAB surgery. Methodology: In this prospective, observational study, 99 patients who underwent elective isolated OPCAB surgery were included. Patients with pacemaker in situ, receiving antiarrhythmic drugs preoperatively, and preexisting atrial fibrillation were excluded. A detailed history taking and physical examination were done preoperatively and the CHA2DS2-VASc scores were calculated for each patient. They received a standard anesthetic including midazolam, fentanyl, propofol, vecuronium, and isoflurane. The number of grafts, inotrope usage, and blood product transfusion in the perioperative period were noted. Patients were followed up for 5 days after surgery for development of new onset POAF requiring treatment. Results: About 20 of the 99 patients developed POAF. POAF occurred most commonly on postoperative day 2. They were older, more likely diabetic, had preoperative diastolic dysfunction, and received blood products perioperatively. POAF group had higher mean CHA2DS2-VASc score (3.6 ± 0.821 vs. 2.11 ± 1.35) and had longer hospital stay (16.85 ± 8.61 vs. 12.6 ± 4.05 days) than no POAF group. The cutoff for CHA2DS2-VASc score was 3, which showed 90% sensitivity, 77.22% specificity, 50% positive predictive value, and 96.63% negative predictive value. Conclusions: CHA2DS2-VASc score is useful in predicting POAF after OPCAB surgery. Higher the CHA2DS2-VASc score, greater is the possibility of development of POAF.

Introduction: Nutritional risk in the Critically Ill (NUTRIC) score is a predictor of adverse outcomes in the critically ill, and its utility in a specific population of critically ill has been recommended. We aimed to study the utility of modified NUTRIC (mNUTRIC) score as a mortality predictor in acute febrile illness (AFI)-induced acute respiratory distress syndrome (ARDS) and all-cause ARDS patients. Methods: We recorded data from two prospective observational ARDS studies conducted at a single-center tertiary care hospital to evaluate the utility of the mNUTRIC score as an independent mortality predictor in all-cause ARDS and AFI-ARDS. A total of 216 all-cause ARDS patients were included, of which 73 were AFI-ARDS and 143 were non-AFI ARDS. Results: Mortality of AFI-ARDS was 16/73 (21.9%) compared to 62/143 (43.35%) in non-AFI ARDS (P = 0.002). There were no significant differences in severity of ARDS in AFI-ARDS and non-AFI ARDS groups (P = 0.504). The mNUTRIC score was found to be an independent predictor of mortality in all-cause ARDS patients (n = 216) and AFI-ARDS patients (n = 73) after Cox regression multivariable analysis. In all-cause ARDS, the mNUTRIC score had an area under the curve (AUC) of 0.778, cutoff ≥4, 82.1% sensitivity, and 65.9% specificity as a predictor of mortality. In AFI-ARDS, the mNUTRIC score had an AUC of 0.769, cutoff ≥4, 81.3% sensitivity, 66.67% specificity, and P = 0.001 as a predictor of mortality. Conclusion: The mNUTRIC score is an independent mortality predictor for all-cause ARDS and AFI-ARDS patients. AFI-ARDS has significantly lesser mortality than non-AFI ARDS.

There are few scores for mortality prediction in acute respiratory distress syndrome (ARDS) incorporating comprehensive ventilatory, acute physiological, organ dysfunction, oxygenation, and nutritional parameters. This study aims to determine the risk factors of ARDS mortality from the above-mentioned parameters at 48 h of invasive mechanical ventilation (IMV), which are feasible across most intensive care unit settings. Our study had a mortality of 41.3 (62/150). We developed a 9-point novel prediction score, the driving pressure oxygenation and nutritional evaluation (DRONE) score comprising of driving pressure (DP), oxygenation accessed by the ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen (PaO[sub.2]/FiO[sub.2]) ratio and nutritional evaluation using the modified nutrition risk in the critically ill (mNUTRIC) score. Each component of the DRONE score with the cutoff value to predict mortality was assigned a particular score (the lowest DP within 48 h in a patient being always ≥15 cmH[sub.2]O a score of 2, the highest achievable PaO[sub.2]/FiO[sub.2] 4 was highly associated with mortality (P < 0.001, hazard ratio 5.43, 95 confidence interval [2.94-10.047]). Internal validation was done by bootstrap analysis. The clinical utility of the DRONE score ≥4 was assessed by Kaplan-Meier curve which showed significance. The DRONE score ≥4 could be a reliable predictor of mortality at 48 h in ARDS patients receiving IMV.

Iatrogenic tracheobronchial injury is rare. Limited data is available on such injuries in infants and management of these is challenging. We present a 7-month-old male infant who was diagnosed with oesophageal stricture, and was planned for thoracoscopic repair of the same. Anaesthetic management with a single lumen tracheal tube ensued. However, an intraoperative loss of capnogram and desaturation led to the diagnosis of iatrogenic tracheobronchial injury. After unsuccessful pursuits with a Fogarty catheter through the tracheobronchial tear and through the right bronchus for lung isolation, blind left endobronchial intubation with a smaller tube and one lung ventilation was successful. The rent was repaired by an open procedure, and oesophageal surgery completed. However, the child succumbed and died of multiorgan failure 3 days later.