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4. Boosting Variational Inference With Locally Adaptive Step-Sizes

Author

Dresdner, Gideon, Shekhar, Saurav, Pedregosa, Fabian, Locatello, Francesco, and Rätsch, Gunnar

Subjects
Computer Science - Machine Learning, Statistics - Machine Learning
Abstract

Variational Inference makes a trade-off between the capacity of the variational family and the tractability of finding an approximate posterior distribution. Instead, Boosting Variational Inference allows practitioners to obtain increasingly good posterior approximations by spending more compute. The main obstacle to widespread adoption of Boosting Variational Inference is the amount of resources necessary to improve over a strong Variational Inference baseline. In our work, we trace this limitation back to the global curvature of the KL-divergence. We characterize how the global curvature impacts time and memory consumption, address the problem with the notion of local curvature, and provide a novel approximate backtracking algorithm for estimating local curvature. We give new theoretical convergence rates for our algorithms and provide experimental validation on synthetic and real-world datasets.

Published
2021

7. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Author

Rashidi, Mahboobeh, Hamid, Hytham K S, Saidahmed, Elfayadh, Karar, Ali Adil Ali, Mc Cree, Melanie, Adeola, Fowotade, Idowu, Olusola, Oladimeji, Motunrayo, Asiyanbi, Gabriel, Desalu, Ibironke, Olatosi, John O, Ugwu, Euphemia Mgbosoro, Yakubu, Saidu Yusuf, Misra, Krushna Chandra, Sheshala, Kaladhar, Mukherjee, Sudipta, Ghosh, Pralay, Chandran, Jagadish, Dsilva, Carol, Baby, Sailaja K, Renuka, M K, Patel, Mayur, Rathod, Darshana, Datta, Avijatri, Bose, Payel, Siddiqui, Suhail Sarwar, Ozair, Ahmad, Muzaffar, Syed Nabeel, Shekhar, Saurav, Singh, Ritu, Pahuja, Madhumati, Jain, Nikhilesh, Rubina, Noor Ahmedi, Vaidyanathan, R, Samdani, Pratit, Nimbolkar, Janardan, Sharma, Priya, Karmakar, Saurabh, Sharma, Ankur, Kothari, Nikhil, Baronia, Arvind, Gurjar, Mohan, Islam, Mohammad Motiul, Hasan, Rajib, Huq, Shihan Mahmud Redwanul, Rabbani, Raihan, Hewer, Tayne, Thompson, Patricia, Sligl, Wendy, Kutsogiannis, Demetrios J, McCoshen, Lorena, Baig, Nadia, Burma, Yaroslava, Sokhan, Anton, Renaud, Paul Jean, Humphreys, Miss Sally K, Tilley, Rebecca E, Patel, Jamie, Attwood, Ben, Chikungwa, Moses, Jackson, Matthew, Zaki, Ahmed, Banach, Dorota, Torre, Valentina Della, Marsden, Nicholas, Antrolikar, Supriya, Kannan, Santhana, Mckee, Rachel, Mcguigan, Peter, Baikady, R Rao, Jhanji, S, Black, E, Husain, A, Loftus, S, Tatham, Kate, Hall, Daniel, Longbottom, Rebecca, Baumer, Tom, Szakmany, Tamas, Roshdy, Ashraf, Sanderson, Amanda, Ritzema, Jenny, Keegan, Allison, Cerman, Jaroslav, Graham, Clive, Smith, Tim, Cole, Stephen, Cobb, Katherine, Parcell, Benjamin J, Angell, Hollie, Hugill, Keith, Franke, Uwe, Arias, Sonia Sousa, Templeton, Maie, Lennard, James, Macfie, Caroline, Johnson, Aimee, Dolan, Rachael, Yonan, Aimee, Soltan, Marina, Bajaj, Manan, Goyal, Shraddha, Mulhi, Randeep, Torlinski, Tomasz, Khade, Reena, Tinaslanidis, George, Zormpa, Artemis, Raj, Ashok, Kent, Melanie, Cowton, Amanda, Faulkner, Maria, Tizard, Kate, Rojo, Roceld, Antcliffe, David, Ercole, Ari, Morris, Andrew Conway, Routledge, Matthew, Aktas, Sabahat Cagan, Batirel, Ayse, Akyol, Ahmet, Goksu, Senay, Ersoy, Yasemin, Bayindir, Yasar, Altin, Nilgün, Gürbüz, Yunus, Erdoğan, Cem, Ozgen, Cansu, Sungurtekin, Hulya, Evik, Guliz, Ersoz, Gulden, Guzeldag, Seda, Bilir, Yeliz, Saracoglu, Kemal Tolga, Eroglu, Ahmet, Aksoy, Firdevs, Koksal, Iftihar, Karaali, Ridvan, Saltoglu, Nese, Cakmak, Rumeysa, Tunay, Burcu, Yilmaz, Mesut, Akdogan, Ozlem O, Baykam, Nurcan N, Çolak, Onur, Agalar, Canan, Sari, Ali, Gundogan, KÜRŞAT, Akbas, Türkay, Çolak, Sait, Demiray, Emine Kubra Dindar, Erol, Çiğdem, Ozturk, Barcin, Telli, Murat, Kurt, Ibrahim, Kalem, Ayşe Kaya, Kayaaslan, Bircan, Talan, Leyla, Altintas, Neriman Defne, Ceyhun, Solakoğlu, Mehtap, Selcuk, Kusoglu, Hulya, Kocagoz, Sesin, Timuroglu, Arif, Aslan, Abdullah Tarik, Akova, Murat, Abed-Maillard, S, Pagani, Jl, Jakob, Stephan, Prazak, Josef, De Geer, Lina, Åkerlund, Joyce, Edin, Alicia, Haney, Michael, Svensson, Carl Johan, Spahic, Dzana, Sjövall, Fredrik, Gallego, Alberto Orejas, Blasco-Navalpotro, Miguel Angel, Novo, Mariana, Ayestaran, J Ignacio, De La Rica, Alejandro Suarez, Maseda, Emilio, Rodriguez, Dra M, Asensio, Dra Mj, Prieto, Emilio Garcia, Espina, Lorena Forcelledo, Salgado, Dra Maria, Ubeda, Alejandro, Gomà, Gemma, Santos, Emilio Diaz, Quesada, María Dolores, Raguer, Laura, Roig, Regina, Catalan, Beatriz, Armestar, Fernando, Bermudez, Rosana Munoz, Arnillas, Maria Pilar Gracia, Amerigo, Joaquin Amador, Flores, Matias, Vera, Paula, Casares, Vanessa, Martinez, Maria, Rocca, Ricard Ferrer, Furman, Mikhail, Belskiy, Vladislav, Chukina, Maria, Vistovskaya, Natala, Eremenko, Aleksandr, Gaigolnik, Denis, Tribulev, Maksim, Zubareva, Nadezhda, Magomedov, Marat, Meleshkina, Yulia, Anderzhanova, Anastasia, Gritsan, Alexey, Lungu, Olguta, Grigoras, Ioana, Marcu, Alexandra, Popescu, Mihai, Tomescu, Dana, Predoi, Cornelia Elena, Filipescu, Daniela Carmen, Cobilinschi, Cristian, Grintescu, Ioana Marina, Bubenek-Turconi, Serban, Valeanu, Liana, Mendes, António Carvalho, Pereira, Énio, Moura, José Pedro, Nunes, Cristina, Pascoalinho, Dulce, Queiró, Joana, Ledo, Sara, da Costa, Tito, Molinos, Elena, Cunha, Rui Pedro, Costa, Vasco, Duarte, Tiago, Botelho, Isabel, de Figueiredo, António Manuel Pereira, Teresa, Ana, Krystopchuk, Andriy, Pinto, Ana Rios, Marques, Ana Josefina Pinheiro, Alves, Madalena, Guimarães, Nádia, Pereira, Tiago, Cartoze, Nuno, Bisanti, Alessandra, Martin-Loeches, Ignacio, Pietraszek-Grzywaczewska, Iwona, Peichota, Mariusz, Broda, Hanna, Nowakowski, Tomasz, Wasowska, Dominika, Walczak-Wieteska, Paulina, Kotkowska, Anna, Bojko, Jozef, Szczesniak, Anna, Komorowska, Irmina Kaptur, Tamowicz, Barbara, Mikstacki, Adam, Rizzo, Anna Chiara, Cotoia, Antonella, Fiorelli, Silvia, Rocco, Monica, Covotta, Marco, Pelagalli, Lorella, Di Guardo, Andrea, Bellina, Davide, Ippolito, Mariachiara, Cortegiani, Andrea, Battaglini, Denise, Pelosi, Paolo, Schlevenin, Maria Grazia, Zuccaro, Francesco, Lodi, Giovanni, Daroui, Ivan, Mirabella, Michele, Porcile, Elisa, Gratarola, Angelo, Giacobbe, Daniele Roberto, Di Gravio, Valentina, Vargas, Joel, Carelli, Simone, Montini, Luca Maria, De Pascale, Gennaro, Sales, Gabriele, Montrucchio, Giorgia, Papathanakos, Georgios, Kouroulas, Vasilios, Retselas, Ioannis, Theodorou, Vasiliki, Marouli, Diamantina, Malliotakis, Polychronis, Almiroudi, Mariota Panagiota, Dimopoulos, Georges, Ali, Fadi, Papageorgiou, Eirini, Athanasa, Zoi, Sakagianni, Aikaterini, Chantziara, Vasiliki, Efthymiou, Anna, Georgopoulou, Maria, Chatzis, Marinos, Sakkalis, Anastasios, Nikolaou, Charikleia, Kogkopoulos, Evangelos, Oikonomou, Marina, Kampolis, C, Papanikolaou, M, Marmanidou, Kyriaki, Paskalis, Harry, Karaiskos, Ilias, Moldovan, Leora, Matei, Mariana Kristina, Koutsoukou, Vasiliki, Romanou, Vasiliki, Vasileiou, Maria, Renta, Foteini, Papoti, Sofia, Iasonidou, Cristina, Kaimakamis, Evangelos, Soulountsi, Vasiliki, Fildisis, Georgios, Psallida, Vasiliki, Smyrniotis, Dimitrios, Arvaniti, Kostoula, Temirov, Talgat, Merenkov, Yevgeniy, Babashev, Baurzhan, Kaligozhin, Zhannur, Bazhykayeva, Yelena, Mugazov, Miras, Ymbetzhanov, Yerlan, Viderman, Dmitriy, Metz, Carlos, Lepper, Philippe, Wempe, Carola, Gottschalk, Antje, Schmidt, Karsten, Dubler, Simon, Pasieka, Bastian, Petros, Sirak, Thomas-Rueddel, Daniel, Bloos, Frank, Hoheisen, Sandra, Bracht, Hendrik, Klouche, Kada, Imzi, Nadia, Dahyot-Fizelier, Claire, Fartoukh, Muriel, Voiriot, Guillaume, Aparicio, Christelle, Siami, Shidasp, Le Guennec, Loïc, Demeret, Sophie, Silva, Stein, Sarton, Benjamine, Roger, Claire, Lefrant, Jean-Yves, Larcher, Romaric, Badre, Gaëtan, Kalfon, Pierre, Razazi, Keyvan, Dessap, Armand Mekonted, Baudry, Thomas, Argaud, Laurent, Smonig, Roland, Louis, Guillaume, Bourenne, Jérémy, Gainnier, Marc, Barbier, François, Djanikian, Flora, Perrigault, Pierre-François, Foucrier, Arnaud, Janny, Sylvie, Weiss, Emmanuel, Bruel, Cédric, Tran, Marc, Philippart, François, Paulet, Rémi, Thyrault, Martial, Duprey, Matthieu, Garcon, Pierre, Mira, Jean-Paul, Le Souhaitier, Mathieu, Bortolotti, Perrine, Kipnis, Eric, Duburcq, Thibault, Coupez, Elisabeth, Souweine, Bertrand, Nica, Alexandru, Alfandari, Serge, Leroy, Olivier, Rosman, Jérémy, Mateu, Philippe, Escudier, Etienne, Guesdon, Charlotte, Massri, Alexandre, Beuzelin, M, Marchalot, A, Le Meur, Anthony, Auchabie, Johann, Castanera, Jérémy, Dulac, Thierry, Montravers, P, Zappela, N, Patrier, Juliette, Timsit, Jean-François, Arbelot, Charlotte, Leone, Marc, Lasic, Hrvoje, Nikolic, Mario, Sakan, Sanja, Persec, Jasminka, Brajkovic, Ana Vujaklija, Radonic, Radovan, Filipovic-Grcic, Ina, Custovic, Aida, Zlojutro, Biljana, Kovacevic, Pedja, Opdenacker, Godelive, De Waele, Elisabeth, Wittebole, Xavier, Serck, Nicolas, De Schryver, Nicolas, Misset, Benoît, Layos, Nathalie, Noel, Cindérella, Biston, Patrick, Haentjens, Lionel, Henin, Pierre, Mesland, Jean-Baptiste, Vanderhaeghen, Sofie F M, Bourgeois, Marc, Denys, Wouter, Hollevoet, Isabelle, De Waele, Jan, De Bus, Liesbet, Tomas, Ernesto Deloya, Perez-Nieto, Orlando R, Tejeda-Huezo, Brigitte, Sánchez-Hurtado, Luis, Ñamendys-Silva, Silvio A, Davalos-Alvarez, Adrian, Dominguez-Cherit, Jose G, Lomeli-Teran, Manuel, Villafuerte, Missael Vladimir Espinoza, Herrera, Mara Ocotlan Gonzalez, Aguilar, Candy Garcia, Leal, Jesús Nicolás Pantoja, Castillo, Roberto Alejandro, Hermosillo, Mariana, Romero-Gonzalez, Juan P, Reyes, Luis Felipe, Montefiore, Pablo, Nuccetelli, Yanina, Alonzo, Microbiologa Irene, Aparicio, Dra Marta, Segura, Matías, Fernández, Rubén, Lopez, Patricia Mabel, Acevedo, José Oscar, Morvillo, Lic Natalia, Centeno, Pablo, Sellami, Walid, Turki, Olfa, Bouaziz, Mounir, Bakr, Lubna, Al-Jadaan, Mohammad, Abu-Sayf, Natalia, Chaaban, Mohammad Karam, Aljabbary, Ahmed, Awad, Maher, Almekhlafi, Ghaleb A, Elrabi, Omar, Sallam, Hend, Nissar, Shaikh, Lance, Marcus, Karic, Edin, Elbuzidi, Abdurahaman, Hssain, Ali Ait, Jayyab, Mustafa Abu, Amro, Sarah, Belkhadir, Z, Ghannam, A, Hachimi, Abdelhamid, Younes, Oujidi, Housni, Brahim, Zeggwagh, Amine Ali, Dendane, Tarek, Wajdi, Maazouzi Ahmed, Mouhssine, Doumiri, Kanjaa, Nabil, Boukatta, Brahim, Seddiki, Rachid, Serghini, Issam, Hasan, Rabab Shaban Ben, Hasan, Hayat Ben, Jobran, Rania, Hdada, Aisha Khaled, Abousnina, Fathi A, Abdulwahed, Eman, Taher, Ahmed Sa, Bouhuwaish, Ahmad, Bilkhayr, Hala, Almiqlash, Bushray, Homaidan, Ahmed Gaber Sadik, AliAli, Almajdoub Mohammed, Aqeelah, Ahmed, Gamra, Marwa, Buimsaedah, Ahmad, Fares, Aya, Ibrahim, Rebecca, Abilama, Fayez, Diab, Adei, Harara, Belal, Levin, Phillip, Belman, Daniel, Rigler, Merav, Kagan, Ilya, Singer, Pierre, Ahmed, Abdullah Khudhur, Tabatabaei, Seyed Mohammad Nasirodin, Tajvidi, Ramin, Masjedi, Mansoor, Sarshad, Hakimeh, Sabetian, Golnar, Dabiri, Gholamreza, Aalinezhad, Fatemeh, Mahmoodpoor, Ata, Zargar, Mohammad Amin, Kiani, Arash, Amiri, Fereshteh, Javaherforoosh, Fatemeh, Baghbanian, Reza, Soltani, Farhad, Savaie, Mohsen, Ahmadi, Fatemeh, Kashipazha, Davood, Mehraban, Zahra, Borsi, Seyed Hamid, Ouhadian, Maryam, Zand, Farid, Hemead, Hanan M, Awad, Ahmed K, Elbadawy, Merihan A, Elsayed, Ahmed, Elmandouh, Omar, Aldhalia, Amer, Saber, Ahmed, Elbahnasawy, Mohamed, Mostafa, Tarek, Osman, Nermin, Barsoum, Mina, Elhadidy, Amr, Alsisi, Adel, Houfi, Ashraf El, Nadeem, Rashid, Chiewroongroj, Supattra, Apichatbutr, Yutthana, Wongsurakiat, Phunsup, Ku, Shih-Chi, Kuo, Li-Kuo, Hu, Ting-Yu, Cia, Cong-Tat, Chou, Nai-Kuan, Yeh, Yu Chang, Ng, Louis Xiang Long, Ng, Kangqi, Quah, Jessica Lishan, Lim, Jia Yan, Ong, Caroline Yu Ming, Li, Andrew Yunkai, Goh, Ken Junyang, Kwa, Andrea Lay Hoon, Lie, Sui An, Ng, Shin Yi, Goh, Qing Yuan, Lim, Sung Yoon, Park, Seung Yong, Park, Sunghoon, Lee, Sang-Min, Jeon, Kyeongman, Ali, Saedah, Mazlan, Mohd Zulfakar, Azman, Abd Hamid, Tong, Lee Kok, Noor, Zuraini Md, Rahman, Hamizah Bt Abdul, Fong, Kean Khang, Wong, Siong Ling Danny, Liew, Mun Thing, Visvalingam, Sheshendrasurian, Pheng, Lee See, Jamaluddin, Muhamad Fadhil Hadi, Hasan, M Shahnaz, Takaki, Shunsuke, Kato, Hideaki, Atobe, Kaori, Saito, Hiroki, Rinka, Hiroshi, Omori, Koichiro, Fujitani, Shigeki, Yoshida, Hideki, Nagashima, Michio, Mishima, Yuka, Shigemitsu, Hidenobu, Kuriyama, Akira, Matsuyoshi, Takeo, Makino, Jun, Hosokawa, Koji, Hashimoto, Satoru, Yamasaki, Masaki, Karumai, Toshiyuki, Hayashi, Yoshiro, Geng, Nan, Peije, Li, Weifeng, Xie, Ye, Ling, Qin, Bingyu, Wang, Yan, Yan, Jing, Huang, Min, Zhou, Suming, Hu, Chungfang, Ye, Jilu, Zhang, Min, Yin, Yongjie, Wang, Jinfeng, Wang, Ruilan, Yin, Chengfen, Xu, Lei, Mingmin, Chen, Wusi, Qiu, Zhao, Juan, Zhao, Peng, Wang, Hao, Chen, Xiaomei, Luo, Jili, Qian, Chuanyun, Zhen, Wang, Wei-Hua, Lu, Jianfeng, Xie, Haibo, Qiu, Sridharan, Dhadappa Damodar, Sudhirchandra, Shah, Moorthi, P Dhakshina, Mon, Tomas, Walid, Haji Adi Muhamad Ibnu, Tabah, Alexis, Buetti, Niccolò, Staiquly, Quentin, Ruckly, Stéphane, Conway Morris, Andrew, Bassetti, Matteo, Lipman, Jeffrey, Ferrer, Ricard, Qiu, Haibo, Paiva, José-Artur, Povoa, Pedro, Abidi, Khalid, Elhadi, Muhammed, Pollock, Hamish, Margetts, Ben, Young, Meredith, Bhadange, Neeraj, Tyler, Steven, Ledtischke, Anne, Finnis, Mackenzie, Dwivedi, Jyotsna, Saxena, Manoj, Biradar, Vishwanath, Soar, Natalie, Sarode, Vineet, Brewster, David, Regli, Adrian, Weeda, Elizabeth, Ahmed, Samiul, Fourie, Cheryl, Laupland, Kevin, Ramanan, Mahesh, Walsham, James, Meyer, Jason, Litton, Edward, Palermo, Anna Maria, Yap, Timothy, Eroglu, Ege, Attokaran, Antony George, Jaramillo, C'havala, Nafees, Khalid Mahmood Khan, Rashid, Nurhikmahtul Aqilah Haji Abd, Tabah, Alexi, Buetti, Niccolò, Staiquly, Quentin, Ruckly, Stéphane, Akova, Murat, Aslan, Abdullah Tarik, Leone, Marc, Conway Morris, Andrew, Bassetti, Matteo, Arvaniti, Kostoula, Lipman, Jeffrey, Ferrer, Ricard, Qiu, Haibo, Paiva, José-Artur, Povoa, Pedro, De Bus, Liesbet, De Waele, Jan, Zand, Farid, Gurjar, Mohan, Alsisi, Adel, Abidi, Khalid, Bracht, Hendrik, Hayashi, Yoshiro, Jeon, Kyeongman, Elhadi, Muhammed, Barbier, Françoi, Timsit, Jean-Françoi, EUROBACT-2 Study Group, ESICM, ESCMID ESGCIP and the OUTCOMEREA Network including, Andrea Cortegiani, and Mariachiara Ippolito

Subjects
antibiotic resistance, bloodstream infection, hospital-acquired, bacteremia, Critical Care and Intensive Care Medicine
Abstract

Purpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods: We carried out a prospective international cohort study of adult patients (≥ 18years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) waspresent in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alivefrom hospital by day-28. Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes.

Published
2023

11. Hyperglycemia risk evaluation of hydrocortisone intermittent boluses versus continuous infusion in septic shock: A prospective randomized trial.

Author

Ram, Ganesh, Shekhar, Saurav, Singh, Raj, Anand, Ravi, De, Ranjeet, and Kumar, Nitin

Subjects
*SEPTIC shock, *HYDROCORTISONE, *RISK assessment, *HYPERGLYCEMIA, *BLOOD sugar
Abstract

Background: Hydrocortisone showed an important role in reversal of shock when added to standard therapy in managing septic shock. Hyperglycemia is one of the most common side effects associated with corticosteroid treatment. Aims: This study aimed to evaluate the risk of hyperglycemia of intermittent hydrocortisone boluses versus continuous infusion in septic shock patients. Settings and Design: This was a prospective randomized controlled study conducted in a tertiary care teaching hospital. Materials and Methods: One hundred and forty patients with septic shock and who received noradrenaline were enrolled in this randomized study. Group 1 was intermittent bolus hydrocortisone group (n = 70) and Group 2 was continuous infusion group (n = 70). All patients who were admitted with septic shock and who received noradrenaline and hydrocortisone were included in the study. Those patients who had exceeded 200 mg per day of hydrocortisone were excluded from the study. The primary outcome of the study was mean blood glucose. Statistical Analysis Used: Qualitative variables were compared between the two groups with the Chi-square of the Fisher's exact test and continuous variables were compared using the Student's t-test or the Wilcoxon rank-sum test. Results: Out of 112 patients, 54 patients received hydrocortisone as intermittent boluses (48.2%), and 58 patients (51.8%) received continuous infusion. For the primary outcome, no statistically or clinically significant difference was found in the blood glucose estimated marginal mean: 154.44 mg.dL−1 (95% confidence interval [CI]: 144.18–166.88) in the bolus group and 160.2 mg.dL−1 (95% CI: 143.82–176.76) in the infusion group with a mean difference of 05.76 mg.dL−1 (95% CI: −13.86–25.38). For the secondary outcomes of the study, no difference was found between the two groups in hyperglycemic or hypoglycemic events, mortality, length of stay in intensive care unit, and reversal of shock. Conclusions: The risk of hyperglycemia is almost equal in both intermittent and continuous infusions of hydrocortisone in septic shock patients. [ABSTRACT FROM AUTHOR]

Published
2022
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12. Early versus late tracheostomy in patients with acute brain injury: Importance of SET score.

Author

Shekhar, Saurav, Singh, Raj, De, Ranjeet, Singh, Ritu, Akhileshwar, and Kumar, Nitin

Subjects
*BRAIN injuries, *TRACHEOTOMY, *INTENSIVE care units, *VENTILATOR-associated pneumonia
Abstract

Introduction: Patients with acute brain injury presents are unique subset of neurocritical care patients with its long-term functional prognosis difficult to determine. They often have long intensive care unit (ICU) stay and presents as challenge to decide when to transfer out of ICU. This prospective study aims to assess the benefits of early tracheostomy in terms of ICU-length of stay (ICU-LOS), number of days on ventilator (ventilator days), incidence of ventilator-associated pneumonia (VAP), and mortality rates. Materials and Methods: After institutional ethical clearance, 80 patients were randomized into two groups: Group A, early tracheostomy group (tracheostomy within 3 days of intubation) and Group B, standard of care group (tracheostomy after 10 days of intubation: late tracheostomy). A cutoff of 10 in the SET score was used in predicting need of early tracheostomy; both groups were compared with respect to ICU-LOS, number of ventilator days (ventilation time), need of analgesia and sedation, incidence of VAP, and mortality data. Results: Both the groups were comparable in terms of demographic profile and various disease severity scores. ICU-LOS was 14.9 ± 3.6 days in Group A and 17.2 ± 4.6 in Group B. The number of days on ventilator and incidence of VAP was significantly lower in Group A as compared to Group B. There was significantly lower mortality in Group A subset of patients in ICU. Conclusion: SET score is a simple and reliable score with fair accuracy and high sensitivity and specificity in predicting need of tracheostomy in neurocritical patients. A cutoff of 10 in the score can be reliably used in predicting need of early tracheostomy as in few other studies. Early tracheostomy is clearly advantageous in neurocritical patients, but has no advantage in terms of long-term mortality rates. [ABSTRACT FROM AUTHOR]

Published
2022
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13. Comparison of oral versus intramuscular clonidine for the prolongation of bupivacaine spinal anesthesia in patients undergoing lower abdominal and lower limb surgeries.

Author

Singh, Raj, Shekhar, Saurav, De, Ranjeet, Singh, Siddharth, Singh, Ritu, and Singh, Akrity

Subjects
*SPINAL anesthesia, *BRACHIAL plexus block, *CLONIDINE, *BUPIVACAINE, *LOCAL anesthetics
Abstract

Background: Spinal subarachnoid block (SAB) is the first choice anesthesia in lower abdominal and lower limb surgeries. It produces a varying degree of sensory analgesia, motor blockade, and sympathetic blockade depending on the dose, concentration, and volume of the local anesthetic given. This study was undertaken to assess the degree of sensory and motor block with 150 μg of oral versus intramuscular clonidine as an adjuvant to bupivacaine for spinal anesthesia. Aims and Objective: To compare the efficacy of oral versus intramuscular clonidine as an adjuvant to bupivacaine for the prolongation of sensory and motor block in patients undergoing lower abdominal and lower limb surgeries under SAB. Materials and Methods: After institutional ethical clearance, 90 patients were randomized into three groups scheduled for lower abdominal and lower limb surgeries under spinal anesthesia. • Group O: Bupivacaine 0.5% (heavy) 3.0 mL and oral clonidine 150 μg 1 h before spinal anesthesia. • Group I: Bupivacaine 0.5% (heavy) 3.0 mL and intramuscular clonidine 150 μg 1 h before spinal anesthesia. • Group C: Control group – 3 mL bupivacaine 0.5% (heavy) alone. Result: The onset of sensory block in Group O was 4.9 ± 0.52 min, whereas in Group I, it was 4.6 ± 0.42 min than Group C (5.1 ± 0.60). Onset of motor block was also significantly lower in Group O and Group I (3.9 ± 0.53 and 3.7 ± 0.42 min) than in Group C (4.4 ± 0.6 min) which was a control group. There was also a significant difference in the duration of the sensory block between Group O (206.4 ± 9.2 min), Group I (219 ± 8.6 min), and Group C (184.3 ± 9.1 min). The duration of motor block was significantly higher in Group O (183.6 ± 8.2 min) and Group I (197.8 ± 9.6 min) when compared to Group C (162.8 ± 8.9 min). The timing of rescue analgesia in Group O was 222.4 ± 11.7 min, whereas in Group I, it was 243.46 ± 10.9. Conclusion: On the basis of finding of our study, we conclude that the use of clonidine as a premedication at a dose of 150 μg significantly increased the duration of sensory block, motor block, and duration of analgesia and shortened the time of onset of sensory and motor blockade. [ABSTRACT FROM AUTHOR]

Published
2022
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14. Would “suction above cuff” be a better option than the “standard” endotracheal tube for the prevention of ventilator-associated pneumonia: A randomized study in postoperative neurological patients.

Author

Shekhar, Saurav and Kumar, Priyesh

Subjects
*ENDOTRACHEAL tubes, *PNEUMONIA, *POSTOPERATIVE care
Abstract

Context: Ventilator associated pneumonia is one the most common nosocomial infection encountered in the ICU patients. Despite of the implementation of the VAP prevention bundle, the incidence remains high. This can be attributed to the peritubal leak and the aspiration of the oropharyngeal secretions. The secretions further forms a nidus for the growth of organisms in the lower respiratory tract. In this study, a specialised tube, named 'suction above cuff endotracheal tube' is used, which has an additional suction port opening above the cuff. This is to facilitate timely aspiration of the secretion which pent-up above the cuff and gradually trickles down the trachea resulting in pneumonia. Aim: to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurological post-operative patients and its impact on clinical outcome. Settings and Design: 60 patients of post-operative neurological cases aged ≥ 18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT. Results: In this study involving neurological population, there was no significant difference in incidence of clinical and microbiological VAP between SETT and SACETT group, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation. [ABSTRACT FROM AUTHOR]

Published
2018
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15. Would "Suction above Cuff" be a Better Option than the "Standard" Endotracheal Tube for the Prevention of Ventilator-Associated Pneumonia: A Randomized Study in Postoperative Neurological Patients.

Author

Gunjan, Ankesh, Shekhar S, Akhileshwar, and Kumar P

Abstract

Context: Ventilator associated pneumonia is one the most common nosocomial infection encountered in the ICU patients. Despite of the implementation of the VAP prevention bundle, the incidence remains high. This can be attributed to the peritubal leak and the aspiration of the oropharyngeal secretions. The secretions further forms a nidus for the growth of organisms in the lower respiratory tract. In this study, a specialised tube, named 'suction above cuff endotracheal tube' is used, which has an additional suction port opening above the cuff. This is to facilitate timely aspiration of the secretion which pent-up above the cuff and gradually trickles down the trachea resulting in pneumonia., Aim: to compare the incidence of VAP with standard endotracheal tube (SETT) and suction above cuff endotracheal tube (SACETT) in neurological post-operative patients and its impact on clinical outcome., Settings and Design: 60 patients of post-operative neurological cases aged ≥ 18 years and requiring intubation and/or ventilation and anticipated to remain on ETT for ≥48 h were randomized to receive either SETT or SACETT., Results: In this study involving neurological population, there was no significant difference in incidence of clinical and microbiological VAP between SETT and SACETT group, when other strategies for VAP prevention were similar. Other outcomes were similar with use of either tube for intubation., Competing Interests: There are no conflicts of interest.

Published
2018
Full Text
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