Pakistan Journal of Intensive Care Medicine

INHALED ANTIBIOTICS FOR TREATING PNEUMONIA IN INVASIVELY VENTILATED PATIENTS IN THE INTENSIVE CARE UNIT

BA ABDELRAHMAN — 2024-11-30

Pneumonia in invasively ventilated patients is a significant concern in the intensive care unit (ICU), often associated with increased morbidity, prolonged hospital stays, and high mortality rates. The emergence of multidrug-resistant (MDR) pathogens further complicates management. Inhaled antibiotics (IABs) have gained attention as an adjunctive or alternative treatment modality to systemic antibiotics, offering direct drug delivery to the lungs with potentially enhanced efficacy and reduced systemic toxicity. This review explores the role of inhaled antibiotics in treating pneumonia in invasively ventilated patients, focusing on pharmacological considerations, clinical efficacy, safety profiles, and limitations. Relevant evidence is derived from databases such as PubMed, Scopus, Web of Science, and Google Scholar, incorporating the latest studies and clinical trials to provide a comprehensive understanding.

CLINICAL SPECTRUM AND OUTCOME OF PATIENTS ADMITTED IN PEDIATRIC INTENSIVE CARE UNIT OF A TERTIARY HOSPITAL

A REHMAN — 2024-12-30

Background: Pediatric Intensive Care Units (PICUs) are crucial for managing critically ill children, yet limited data exist regarding the clinical spectrum and outcomes of patients admitted to PICUs in developing countries, particularly in Pakistan. Objective: To assess the clinical spectrum, outcomes, and burden of pediatric patients admitted to the PICU. Study Design: A cross-sectional study. Setting: The study was conducted at the PICU of The Children’s Hospital, Lahore. Duration of Study: January to December 2023. Material and Methods: A total of 884 patients admitted to the PICU during the study period were included. Patient data, including demographics, diagnoses, clinical interventions, and outcomes, were recorded over one year and analyzed using SPSS version 26. Descriptive statistics were employed, and associations were identified using the Chi-square test, with statistical significance set at p < 0.05. Results: The mean age of patients was 6.7 years, with 58.8% being male. The most common diagnoses included pneumonia (22.3%), diabetic ketoacidosis (21.9%), and Guillain-Barré syndrome (15.6%). Mechanical ventilation was required in 54.1% of cases. The overall mortality rate was 14.4%, with pneumonia accounting for 44% of deaths. Significant predictors of mortality included sepsis (p = 0.000) and mechanical ventilation (p = 0.000). Mortality was notably higher among patients under 1 year of age (p = 0.000). Conclusion: This study underscores the significant burden of respiratory illnesses, diabetic ketoacidosis, and sepsis in the PICU, along with high mortality rates. Enhancing early interventions, optimizing resource allocation, and implementing targeted care protocols are essential to improving outcomes in critically ill pediatric populations in resource-limited settings.

CLINICAL EFFICACY OF DEXAMETHASONE VERSUS HYDROCORTISONE IN ACUTE EXACERBATION OF ASTHMA IN CHILDREN

R IMTIAZ — 2024-12-29

Background: Asthma is a prevalent chronic respiratory condition among children worldwide, significantly impacting their health, quality of life, and healthcare systems. Acute exacerbations of asthma require prompt and effective management to reduce morbidity. Objective: To compare the clinical efficacy and safety of dexamethasone versus hydrocortisone in children with acute asthma exacerbations. Study Design: Randomized controlled trial. Setting: Emergency Pediatric Medicine Department and General Medical Ward of the Children's Hospital, Lahore. Duration of Study: November 2023 to April 2024. Methods: Children aged 6–15 years presenting with acute asthma exacerbations were enrolled and randomly assigned to receive either dexamethasone or hydrocortisone. Baseline characteristics, including age, gender, weight, respiratory rate, oxygen saturation, asthma history duration, and initial FEV1, were recorded. The primary outcomes assessed included changes in respiratory parameters, duration of respiratory support, and length of hospital stay. Results: The study included 110 participants, with 55 patients in each group. The mean age was 9.5±3.45 years in the dexamethasone group and 9.4±2.91 years in the hydrocortisone group. Both groups showed comparable gender distribution (60% male and 58% male, respectively) and baseline characteristics. The mean respiratory rate was 32±4.2 bpm in the dexamethasone group versus 31±4.1 bpm in the hydrocortisone group, while oxygen saturation was 94±2% versus 93±2.4%, respectively. The mean hospital stay was shorter in the dexamethasone group (3.1±0.9 days) compared to the hydrocortisone group (3.6±1.1 days). Dexamethasone demonstrated faster improvement in respiratory parameters and earlier cessation of respiratory support. Conclusion: Dexamethasone is a more effective and convenient option than hydrocortisone for managing acute asthma exacerbations in children, offering faster clinical improvement and shorter hospital stays.

COMPLETE REVERSAL OF TRANS-TENTORIAL AND SUB-FALCINE BRAIN HERNIATION WITH CRANIECTOMY: A SUCCESSFUL CASE REPORT

R PERVAIZ — 2024-07-05

Introduction: Brain herniation, or brain code, is a critical condition caused by elevated intracranial pressure, leading to abnormal brain tissue protrusion. Chronic herniations may be linked to developmental defects and remain asymptomatic, while acute herniations are life-threatening, especially after neurosurgery. Case Presentation: A 25-year-old female with Glioblastoma multiforme presented with facial weakness. Initially suspected as Bell’s Palsy, her condition rapidly worsened, leading to coma and signs of raised intracranial pressure. A CT scan revealed a brain tumor with associated edema, hemorrhage, and multiple herniations. Emergency craniectomy and subsequent medical management showed initial improvement, but she later developed ischemia and infarction, resulting in her death. Discussion: Timely diagnosis and intervention are crucial in managing brain herniation. Clinical signs and cranial nerve assessments are vital for diagnosis. Management focuses on reducing intracranial pressure through medical and surgical means. Early intervention is key to better outcomes, though the prognosis can be poor due to underlying conditions like Glioblastoma multiforme. Conclusion: Effective management of brain herniation requires timely surgical and medical intervention. This case illustrates the rapid progression and complexity of brain herniation, emphasizing the importance of early and comprehensive treatment.