Browsing by Author "Acharya, Subhash Prasad"
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Publication A Seven-Year Audit of Intensive Care Unit Admissions and Outcome in a Tertiary Care Hospital in Nepal(Institute of Medicine, Tribhuvan University, 2025) Sharma, Sachit; Shrestha, Gentle Sunder; Shrestha, Pramesh Sundar; Paneru, Hem Raj; Pathak, Sunil; Rijal, Divas; Acharya, Subhash PrasadAbstract: Introduction An audit is used to assess if a particular aspect of health care is in accordance with the standard practice and aims to achieve improvement in quality for the benefit of the patient. The current study is a retrospective descriptive observational audit which intends to study the patient profile and outcome of patients admitted to a level III ICU of a tertiary care hospital in Nepal over a duration of seven years. Methods A retrospective descriptive observational audit was conducted in the Tribhuvan University Teaching Hospital (TUTH) ICU from 1st Baisakh, 2074 to 31st Chaitra, 2080. Data on patient profile and outcome were recorded and statistical analysis was performed. Results A total of 6,233 patients were admitted, with 53.9% male patients over a duration of 7 years in TUTH ICU. Medical admissions accounted for 51.67% and surgical admissions 48.33%. Overall, the maximum number of cases were admitted under neurosurgical speciality. Of all patients, 64.7% improved and were shifted out of ICU while mortality was 27.4%. An average sequential organ failure assessment (SOFA) score was 6.7 during the study period. Conclusion The major finding of the study was a progressive decline in average SOFA score, average length of ICU stay and average length of Mechanical Ventilation over the last 3 years. The highest number of admission was in neurosurgery and respiratory medicine over the duration of seven years.Publication Clinical Characteristics and Outcomes of Patients Managed with Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: A Retrospective Observational Study(Nepal Medical Association, 2025) Pradhan, Utsav; Karki, Bipin; Paneru, Hem Raj; Shrestha, Pramesh Sunder; Shrestha, Gentle Sunder; Acharya, Subhash PrasadAbstract Introduction: Percutaneous dilatational tracheostomy has emerged as a preferred minimally invasive alternative to surgical tracheostomy for critically ill patients requiring prolonged mechanical ventilation, though comprehensive data from Nepal remains limited. This study aimed to evaluate the practice of percutaneous dilatational tracheostomy and analyze clinical outcomes in a tertiary level ICU in Nepal. Methods: A retrospective observational study was conducted at Level III ICUs Nepal from April 14, 2021 to April 12, 2024. All patients aged 18 and older who underwent percutaneous dilatational tracheostomy during ICU stay in the study duration were included. Ethical approval for the study was obtained from the institutional review committee [Ref. 583. (6-11) E2]. Data on clinical characteristics, procedural techniques, complications, and outcomes were collected from electronic records and individual file records from hospital record department. Results: The study population comprised predominantly males 53 (63.86%) with a median age of 49 (IQR: 30-62) years. Neurological disorders, particularly intracranial haemorrhage, were the most common admission diagnosis 53 (63.86%). The mean duration from mechanical ventilation to PDT was 16 (IQR: 11-20) days and the main indication was prolonged mechanical ventilation 62 (74.7%). Grigg’s guidewire dilator forceps technique was used 77 (92.77%) of the time. Immediate complications occurred in 12 (14.46%) of cases. The hospital survival rate was 42 (50.6%) with 69 % of survivors achieving decannulation before discharge. Conclusions:Percutaneous dilatational tracheostomy safe bedside procedure for critically ill patients needing prolonged ventilation, with only minor, non-life-threatening complications observed in our tertiary care setting.Publication Recurrent Ischemic Stroke in a Patient with Atrial Myxoma: A Case Report(Nepal Medical Association, 2022) Shrestha, Gentle Sunder; Rimal, Ankit; Shrestha, Shubha Kalyan; Shrestha, Pramesh Sunder; Acharya, Subhash PrasadAbstract Cardiac myxoma is an infrequent but curable cause of ischemic stroke. There are no guidelines addressing the timing of surgery to excise the tumour or for the use of thrombolysis or thrombectomy. We present a case with an ischemic stroke which was diagnosed to have atrial myxoma. She was planned for surgical excision of the tumour but suffered from a second ischemic stroke while awaiting surgery. This article aims to highlight vital aspects of this rare phenomenon and discuss the prospects of the timing of surgery and neurosurgical intervention. The importance of a proper cardiac evaluation in all cases of stroke is highlighted.Publication Ultrasound versus Chest X-ray for Confirmation of Central Venous Catheter Tip Position: A comparative study(Institute of Medicine, Tribhuvan University, 2025) Mandal, Lokendra Narayan; Bhattarai, Amit Sharma; Parajuli, Bashu Dev; Acharya, Subhash Prasad; Shrestha, AnilAbstract: Introduction Malposition of central venous catheter (CVC) tip is common after central vein cannulation. Chest radiography is the standard method for confirmation, but ultrasound is gaining popularity for bedside localization, placement confirmation, and complication detection. CVC insertion is frequently performed for various medical purposes. While both chest radiography and ultrasound are used to confirm tip position, ultrasound is radiation-free and faster. Real-time ultrasound during insertion reduces attemptsto catheterisation and complications like pneumothorax. However, radiographic confirmation remains the gold standard. This study aimed to evaluate the accuracy and speed of ultrasound compared to chest X-ray for confirming CVC tip position. Methods A total of 109 patients (aged 15–65 years) who underwent CVC insertion via the right internal jugular vein were enrolled. Written informed consent was obtained from patients or family members. Sonographic confirmation was done using a bubble study, while chest X-ray was used for radiographic confirmation. Sensitivity, specificity, predictive values, interrater reliability, and percent agreement between the two methods were assessed. The mean confirmation times were also compared. Results Ultrasound showed 91.6% sensitivity, 96.91% specificity, 78.57% positive predictive value, and 98.95% negative predictive value. Interrater reliability (k = 0.82) and percent agreement (96.3%) were high. Ultrasound confirmed placement 88.29 minutes earlier than chest X-ray. Conclusion Ultrasound confirmation using a saline flush method is accurate and significantly faster than chest radiography for CVC tip verification.