Browsing by Author "Kafle, Raju"
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Publication Nepal Paediatric Society Clinical Guidance for Management of Sepsis and Septic Shock in the Paediatric Intensive Care Units in Nepal(Nepal Paediatric Society (JNPS), 2021) Basnet, Sangita; Shrestha, Dhruba; Amatya, Puja; Sharma, Arun; Bajracharya, Binod Lal; Shrestha, Anil; Shrestha, Sudeep; Rajchal, Pramila; Kafle, Raju; Shrestha, Devendra; Puri, Sangeeta; Bhatta, Anwesh; Pathak, Om Krishna; Shrestha, ShrijanaAbstract: Justification: Sepsis is a major cause of morbidity and mortality in Nepal. There is a lack of standardisation in the management of severe sepsis and septic shock. Additionally, international guidelines may not be completely applicable to resource limited countries like Nepal. Objective: Create a collaborative standardised protocol for management of severe sepsis and septic shock for Nepal based on evidence and local resources. Process / Methods: Paediatricians representing various paediatric intensive care units all over Nepal gathered to discuss clinical practice and delivery of care of sepsis and septic shock under the aegis of Nepal Paediatric Society. After three meetings and several iterations a standardised protocol and algorithm was developed by modifying the existing Surviving Sepsis Guidelines to suit local experience and resources. Recommendations: Paediatric sepsis and septic shock definitions and management in the early hours of presentation are outlined in text and flow diagram format to simplify and standardise delivery of care to children in the paediatric intensive care setting. These are guidelines and may need to be modified as necessary depending on the resources availability and lack thereof. It is recommended to analyse data moving forward and revise every few years in the advent of additional data.Publication Utility of Sequential Organ Failure Assessment Score in Prognosticating sick Children in Paediatric Intensive care Unit(Nepal Paediatric Society (JNPS), 2022) Kafle, Raju; Sanjeev, Shah; Kumar, Gupta BinodAbstract: Introduction: There are number of scoring systems to assess the morbidity and mortality of sick children in intensive care unit. Out of these scoring systems our study was designed to look for the utility of Sequential Organ Failure Assessment (SOFA) score which is less time consuming and simple to apply as a predictor of mortality in sick children admitted in Paediatric Intensive Care Unit (PICU). Methods: This was a prospective observational study done in PICU of Universal College of Medical Sciences, Bhairahawa, Nepal. Recruited patients were all critically sick children above one year who stayed in hospital above 72 hours and underwent all necessary evaluation, and were followed up until they were discharged or deceased. Initial SOFA score was calculated within 24 hours of admission (SOFA T0) and again calculated after 72 hours (SOFA T72). Delta SOFA score was calculated as the change in SOFA scores over 72 hours (SOFA T0 - SOFA T72). The primary outcome was in-hospital mortality. Results: When compared to outcome, the non survivors had high mean initial SOFA (T0) 11.51 ± ences ec ing 3.001 (P < 0.001), mean SOFA after 72 hours (T72) was 15.51 ± 4.026 (P < 0.001) and mean delta SOFA (T0-T72) was 4.58 ± 2.59 (P = 0.166) as compared to survivors. Delta SOFA was not significantly associated with outcome (P = 0.166). The initial SOFA score T0 > / = 11 predicted a mortality of 70.90% and SOFA T72 score of >/=15 predicted a mortality of 81.60% but delta sofa >/= 4 predicts a mortality of only 43.60%. Area under receiver operating characteristic (ROC) curve for SOFA TO was 0.769, for SOFA T72 was 0.890 and for delta SOFA was 0.604 and thus, showing excellent discriminative power for SOFA 72 for predicting mortality. Conclusions: The SOFA score demonstrated fair to good accuracy for predicting mortality when applied to sick children > 1 year admitted in PICU. Our study showed both initial SOFA T0 and SOFA at 72 hours predict mortality with good accuracy but SOFA at 72 hours is a better predictor of mortality as compared to initial and delta SOFA scores.