Browsing by Author "Pradhan, Saurabh"
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Publication Characteristics and Outcomes of COVID-19 Patients Admitted to Adult Intensive Care Unit: A Single-Center Observational Study from the Second Wave in Nepal(Institute of Medicine, 2021) Pradhan, Saurabh; Upreti, Anup R; Upadhyaya, Sarobar; Oli, Manish; Shrestha, Asim; Shrestha, YashaswiABSTRACT Introduction: There is inadequate data of critically ill COVID-19 caused by the delta variant. So, we sought to investigate the characteristics and outcomes during the second wave in Nepal. Methods: COVID-19 patients admitted to adult ICU of a single institution from April to August 2021 were included. Clinical, laboratory and radiological findings were collected. In-hospital mortality, length of ICU stay, duration of mechanical ventilation (MV) and complications during ICU stay were obtained. Results: Total 136 patients were included with a mean age of 56.24 (± 15.81) years and 52.2% males. Fifty-five percent had comorbidities. Mean fraction of inspired oxygen required was 0.8 and sequential organ failure assessment score on admission was 4.09. C-reactive protein (CRP), lactate dehydrogenase and ferritin levels were elevated to 62.5mg/L, 515 U/L and 472ng/mL respectively. The computed tomography score was 20. Thirty four (25%) required MV; 70 (52%) were managed with non-invasive ventilation; 41 (30.14%) required vasopressors; 4 (2.9%) required renal replacement therapy. In-hospital mortality was 43.4%. The median length of ICU stay and duration of MV were 6 and 3.5 days respectively. Hospital acquired infection was the commonest complication. Age (OR 1.126 (95% CI 1037-1.223, p value 0.005)) and CRP on admission (OR 1.023 (95% CI 1.000-1.047, p value 0.050) were found to be predictors of mortality. Conclusion: In this single center study from the second wave of the pandemic, majority of critically ill COVID-19 patients were elderly with co-existing illnesses. In-hospital mortality was high. Age and CRP on admission were found to be independently associated with poor outcome. Keywords: Characteristics, COVID-19, critical care, Nepal, outcomesPublication Separate Consent for Anesthetic Practice: Need of the Moment(Institute of Medicine, 2020) Shrestha, Anil; Shrestha, Gentle S; Pradhan, Saurabh; Joshi, PankajABSTRACT Decades of refinement and modifications have led the modern anaesthetic practice to be conducted so smoothly and safely, that sometimes we take for granted the enormous amount of risks involved with it. Furthermore, with the evolution of monitoring techniques, and discovery of safer drugs, anesthesia has facilitated the conduction of complex surgeries on sicker patients, and older patients. The expansion to critical care and pain management services has added another dimension to this field, with anesthesiologists not just working as facilitators for another procedure, but acting as primary physicians. Anesthesiologists are among the few clinicians, who are involved in patient morbidity and mortality in their daily routine. With the ever-changing ethical and legal background, the significance of obtaining a separate consent for anesthesia needs to be timely evaluated. In this review, we have discussed the significance of a separate consent for anesthesia and highlight its various aspects. Keywords: Anesthetic practice, separate consent