Review of code blue system and audit

Background: Code Blue systems are communication systems that ensure the most rapid and effective resuscitation of a patient in respiratory or cardiac arrest. Code blue was established in Bharati Hospital and Research Centre in Sept 2011 in order to reduce morbidity and mortality in wards. The aim of the study was to evaluate the current code blue system and suggest possible interventions to strengthen the system.Methods: It was retrospective observational descriptive study. The study population included all consecutive patients above the age of 18 years for whom code blue had been activated. Data was collected using code blue audit forms. The data was analysed using SPSS (Statistical Package for social sciences) software.Results: A total of 260 calls were made using the blue code system between September 2011 to December 2012. The most common place for blue code activation was casualty. The wards were next, followed by dialysis unit and OPD. The indications for code blue team activation were cardio-respiratory arrest (CRA) (88 patients, 33.84%), change in mental status (52 patients, 20%), road traffic accidents RTA (21, 8.07%), convulsions (29 patients 11.15%), chest pain (19 patients, 8.46%), breathlessness (18 patients,6.92%) and worry of staff about the patient (17 patients, 6.53%), presyncope (10 patients, 3.84%), and others (6 patients, 2.30%). The average response time was 1.58±0.96 minutes in our study. Survival rate was more in medical emergency group 46.15% than in CRA group 31.61%. Initial success rate was 35.2% and a final success rate was 34.6%.Conclusions: Establishment of code blue team in the hospital enabled us to provide timely resuscitation for patients who had “out of ICU” CRA. Further study is needed to establish the overall effectiveness and the optimal implementation of code blue teams. The increasing use of an existing service to review patients meeting blue code criteria requires repeated education and a periodic assessment of site-specific obstacles to utilization

Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India

Background This study aimed to determine the predictive power of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in determining outcomes for traumatic brain injury (TBI) patients. The Glasgow Outcome Scale (GOS) was used to evaluate patients at 1 month and 6 months after the injury. Methods We conducted a 15-month prospective observational study. It included 50 TBI patients admitted to the ICU who met our inclusion criteria. We used Pearson's correlation coefficient to relate coma scales and outcome measures. The predictive value of these scales was determined using the receiver operating characteristic (ROC) curve, calculating the area under the curve with a 99% confidence interval. All hypotheses were two-tailed, and significance was defined as P<0.01. Results In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively. Conclusions The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome

The utility of a modified technique for lower respiratory tract sampling in COVID-19 ICU and review of diagnostic approaches in suspected ventilator associated pneumonia

INTRODUCTION: Lower respiratory tract (LRT) sampling is an aerosol generating procedure. In COVID 19 pandemic, guidelines have advocated caution against all aerosol generating procedures. However, microbial cultures on tracheobronchial aspirates are important to guide antibiotic usage in ventilator-associated pneumonia (VAP). MATERIAL AND METHODS: In our tertiary care COVID-19 intensive care unit (ICU), a protocol was set for using closed suction system for timely LRT sampling in VAP and to reduce the risk of exposure to respiratory secretions. Timing of sample collection was as per intensivist discretion following CDC VAP definition. This prospective study was conducted between June to November 2020, to assess the utility of this technique in diagnosis of suspected VAP. Microbiological and clinico-radiological parameters were documented. Heavy growth (>105 cfu/mL) on semiquantitative culture was taken as significant. RESULTS: Total 69 samples generated from 63 patients were analyzed. Mean age 54.48 years and 77.78% of patients had one or more comorbidities. Average duration of invasive ventilation prior to the first culture was 7.14 ± 4.36 days. Progressive radiological worsening at the time of sample collection was in 92.75% (64 of 69 episodes). Microbiological diagnosis of VAP was confirmed in 76.81%. Culture reports guided antibiotic change. Insignificant culture growth in 13.06%. The positivity rate for early and late (>4days) samples were 69.56% and 80.43% respectively. 95% of culture isolates were Gram negative microorganisms. Most common being Acinetobacter baumannii (41.67%) and Klebsiella pneumoniae (31.66%) in both early and late VAP. Around 85% were multidrug resistant organisms. There were no significant adverse events related to sampling technique. CONCLUSIONS: Lower respiratory tract sampling using closed suction system is easy to execute and minimizes procedure related risk to both patient and health care workers in COVID-19 ICU. Gram negative MDR pathogens are prevalent in both early and late VAP. Need further comparative study to understand effectiveness of this technique against other conventional techniques in VAP diagnosis