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Anaesthesia

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ICU Management

Question
93 out of 100
 

Which of the following is not true in regard to management of ICU patients? (AIIMS Nov 2011)



A Low tidal volume used to prevent acute lung injury

B Proper monitoring is done by 24hr urine output, heart n respiratory rate

C Strict management of hyperglycemia decreases mortality

D Use of Drotrecogin-alpha is strictly limited to severe sepsis

Ans. D

Use of Drotrecogin-alpha is strictly limited to severe sepsis

a. Drotrecogin alfa (activated) (Xigris, marketed by Eli Lilly and Company) is a recombinant form of human activated protein C that has anti-thrombotic, anti-inflammatory, and profibrinolytic properties.

b. Drotrecogin alpha (activated) belongs to the class of serine proteases.

c. Drotrecogin alfa has not been found to improve outcomes in people with severe sepsis. The ethicalness of the marketing campaign for its use in severe sepsis has been questioned.

d. Drotrecogin alfa does not improve mortality in severe sepsis or septic shock but does increase bleeding risks therefore a 2011 Cochrane review recommended that clinicians and policy makers not recommend its use

e. Therefore, Eli Lilly & Co. withdrew Xigris from the market after this study showing no efficacy for the treatment of sepsis

f. All other 3 options mentioned are proven mechanism to decrease mortality and morbidity in ICU settings

g. Barotrauma was once the most frequent and easily recognized complication of mechanical ventilation. barotrauma represents only one of the mechanisms underlying ventilator-induced lung injury (VILI).

h. Improved understanding of the mechanisms underlying VILI and barotrauma makes it imperative for physicians adjust ventilator settings to prevent alveolar overdistention.

i. Although ventilation with low tidal volume is effective, clinicians have been slow to adopt this approach. The tidal volume used for mechanically ventilated patients had decreased over time, and current practice involves tidal volumes that are lower than those used in the past.

j. Limiting plateau pressures to less than 30 cm water may be another effective approach for all patients. With volume ventilators, this is best accomplished with low tidal volumes.

k. Hyperglycemia has been found associated with increased mortality in patients in intensive care units, with the rates the highest in patients without diagnosed diabetes and in those admitted with cardiovacular disorders, such as myocardial infarction, unstable angina and stroke, according to a study presented at the American Diabetes Association 66th Annual Scientific Sessions in Washington.

ICU Management Flashcard List

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