19 research outputs found
A BIO-ELECTRICAL MODEL FOR PHYSIOLOGICAL EVALUATION OF NADI PARIKSHA (AYURVEDIC PULSE DIAGNOSIS)
Physiology of the traditional Ayurvedic diagnostic technique of Nadipariksha has always been a matter of controversy. This diagnostic skill is based on a fine tactile sensitivity of the physician to distinguish varied intensities of mechanical vibrations elicited by radial artery pulsation, normally perceived as Pulse Pattern Variability (PPV). Ancient exponents of Yoga and Ayurveda define Nadi as the channel of Prana which is known as the very basis of bio-energy dynamics of the body. To the modern physician Nadipariksha indicates an assessment of cardiac function which is an important aspect of vascular physiology. The above concept has been re-examined in this article, in the light of whole body bio-electrical activity pattern. The study suggests Nadi as the Energy Pulsating Pathway (EPP) encompassing cells Pulsating Bio-Electrical Response (PBER). The observed varying intensities of PPV in Nadipariksha are proposed to be due to collision of weak threshold PBER with the mechanical vibration of pulsating radial artery. The underlying mechanism of Nadipariksha has been proposed to be associated with energy dynamics of bio-electrical waveform activity at the cellular level. This approach points at its possible implications in developing a more objective diagnostic method in assessing psycho-physiological abnormalities of a patient without having to depend on the subjective diagnostic judgment of a physician. Further, this study hints at the possible experimental evidence towards a physiological evaluation of Nadipariksha through the measures of bio-impedance, bio-reactance and bio-phase angle
Operationalizing Appropriate Sepsis Definitions in Children Worldwide: Considerations for the Pediatric Sepsis Definition Taskforce
Sepsis is a leading cause of global mortality in children, yet definitions for pediatric sepsis are outdated and lack global applicability and validity. In adults, the Sepsis-3 Definition Taskforce queried databases from high-income countries to develop and validate the criteria. The merit of this definition has been widely acknowledged; however, important considerations about less-resourced and more diverse settings pose challenges to its use globally. To improve applicability and relevance globally, the Pediatric Sepsis Definition Taskforce sought to develop a conceptual framework and rationale of the critical aspects and context-specific factors that must be considered for the optimal operationalization of future pediatric sepsis definitions. It is important to address challenges in developing a set of pediatric sepsis criteria which capture manifestations of illnesses with vastly different etiologies and underlying mechanisms. Ideal criteria need to be unambiguous, and capable of adapting to the different contexts in which children with suspected infections are present around the globe. Additionally, criteria need to facilitate early recognition and timely escalation of treatment to prevent progression and limit life-threatening organ dysfunction. To address these challenges, locally adaptable solutions are required, which permit individualized care based on available resources and the pretest probability of sepsis. This should facilitate affordable diagnostics which support risk stratification and prediction of likely treatment responses, and solutions for locally relevant outcome measures. For this purpose, global collaborative databases need to be established, using minimum variable datasets from routinely collected data. In summary, a "Think globally, act locally" approach is required
International Consensus Criteria for Pediatric Sepsis and Septic Shock.
ImportanceSepsis is a leading cause of death among children worldwide. Current pediatric-specific criteria for sepsis were published in 2005 based on expert opinion. In 2016, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as life-threatening organ dysfunction caused by a dysregulated host response to infection, but it excluded children.ObjectiveTo update and evaluate criteria for sepsis and septic shock in children.Evidence reviewThe Society of Critical Care Medicine (SCCM) convened a task force of 35 pediatric experts in critical care, emergency medicine, infectious diseases, general pediatrics, nursing, public health, and neonatology from 6 continents. Using evidence from an international survey, systematic review and meta-analysis, and a new organ dysfunction score developed based on more than 3 million electronic health record encounters from 10 sites on 4 continents, a modified Delphi consensus process was employed to develop criteria.FindingsBased on survey data, most pediatric clinicians used sepsis to refer to infection with life-threatening organ dysfunction, which differed from prior pediatric sepsis criteria that used systemic inflammatory response syndrome (SIRS) criteria, which have poor predictive properties, and included the redundant term, severe sepsis. The SCCM task force recommends that sepsis in children be identified by a Phoenix Sepsis Score of at least 2 points in children with suspected infection, which indicates potentially life-threatening dysfunction of the respiratory, cardiovascular, coagulation, and/or neurological systems. Children with a Phoenix Sepsis Score of at least 2 points had in-hospital mortality of 7.1% in higher-resource settings and 28.5% in lower-resource settings, more than 8 times that of children with suspected infection not meeting these criteria. Mortality was higher in children who had organ dysfunction in at least 1 of 4-respiratory, cardiovascular, coagulation, and/or neurological-organ systems that was not the primary site of infection. Septic shock was defined as children with sepsis who had cardiovascular dysfunction, indicated by at least 1 cardiovascular point in the Phoenix Sepsis Score, which included severe hypotension for age, blood lactate exceeding 5 mmol/L, or need for vasoactive medication. Children with septic shock had an in-hospital mortality rate of 10.8% and 33.5% in higher- and lower-resource settings, respectively.Conclusions and relevanceThe Phoenix sepsis criteria for sepsis and septic shock in children were derived and validated by the international SCCM Pediatric Sepsis Definition Task Force using a large international database and survey, systematic review and meta-analysis, and modified Delphi consensus approach. A Phoenix Sepsis Score of at least 2 identified potentially life-threatening organ dysfunction in children younger than 18 years with infection, and its use has the potential to improve clinical care, epidemiological assessment, and research in pediatric sepsis and septic shock around the world
GAP between knowledge and skills for the implementation of the ACCM/PALS septic shock guidelines in India: Is the bridge too far?
Objective: To determine whether physicians were aware of and had the
skills to implement the American College of Critical Care
Medicine/Pediatric Advanced Life Support Course septic shock protocol.
Design: A cross-sectional questionnaire survey. Setting: Four academic
institutions in Chennai, Manipal, Mangalore, and Trivandrum - cities
representing the three southern states of Tamil Nadu, Karnataka, and
Kerala, respectively, between February and April 2006. Interventions:
Pre and post lecture questions. They were evaluated using 11 questions
testing knowledge and 10 questions testing their comfort level in
performing interventions related to the initial resuscitation in septic
shock. Measurement and Main Result: The ACCM/PALS sepsis guidelines
were taught during the PALS course conducted in the four academic
institutions. A total of 118 delegates participated, of whom 114 (97%)
were pediatricians and four (3%) were anaesthetists. The overall mean
number of correct responses for the 11 questions testing knowledge
before and after the lecture was 2.1 and 4.07, respectively
P=0.001(paired t test). Although, 42% of the respondents (n=50) were
aware of the ACCM guidelines, 88% (n=104) did not adhere to it in their
practice. A total of 86% (n=101) and 66% (n=78) did not feel
comfortable titrating inotropes or intubating in the ED; 78% (n=92) and
67% (n=78), respectively felt that central venous access (CVA) and
arterial pressure (AP) monitoring were unimportant in the management of
fluid refractory shock. Of the physicians, 20% (n=24) had never
intubated a patient, 78% (n=92) had not introduced a central venous
catheter, and 76% (n=90) had never introduced an intra-arterial
catheter. Conclusions: In view of the lack of skills and suboptimal
knowledge, the ACCM/PALS sepsis guidelines may be inappropriate in its
current format in the Indian setting. More emphasis needs to be placed
on educating community pediatricians with a simpler clinical protocol,
which has the potential to save many more children
Factors to be Considered in Advancing Pediatric Critical Care Across the World
This article reviews the many factors that have to be taken into account as we consider the advancement of pediatric critical care (PCC) in multiple settings across the world. The extent of PCC and the range of patients who are cared for in this environment are considered. Along with a review of the ongoing treatment and technology advances in the PCC setting, the structures and systems required to support these services are also considered. Finally the question of how PCC can be made sustainable in a volatile world with the impacts of global crises such as climate change is addressed
Pediatric Sepsis Guidelines: Summary for resource-limited countries
Justification: Pediatric sepsis is a commonly encountered global issue.
Existing guidelines for sepsis seem to be applicable to the developed
countries, and only few articles are published regarding application of
these guidelines in the developing countries, especially in
resource-limited countries such as India and Africa. Process: An
expert representative panel drawn from all over India, under aegis of
Intensive Care Chapter of Indian Academy of Pediatrics (IAP) met to
discuss and draw guidelines for clinical practice and feasibility of
delivery of care in the early hours in pediatric patient with sepsis,
keeping in view unique patient population and limited availability of
equipment and resources. Discussion included issues such as sepsis
definitions, rapid cardiopulmonary assessment, feasibility of early
aggressive fluid therapy, inotropic support, corticosteriod therapy,
early endotracheal intubation and use of positive end expiratory
pressure/mechanical ventilation, initial empirical antibiotic therapy,
glycemic control, and role of immunoglobulin, blood, and blood
products. Objective: To achieve a reasonable evidence-based consensus
on the basis of published literature and expert opinion to formulating
clinical practice guidelines applicable to resource-limited countries
such as India. Recommendations: Pediatric sepsis guidelines are
presented in text and flow chart format keeping resource limitations in
mind for countries such as India and Africa. Levels of evidence are
indicated wherever applicable. It is anticipated that once the
guidelines are used and outcomes data evaluated, further modifications
will be necessary. It is planned to periodically review and revise
these guidelines every 3-5 years as new body of evidence accumulates