Indian Journal of Anaesthesia

: 2020  |  Volume : 64  |  Issue : 13  |  Page : 41--47

KOPS Award Abstracts: Trauma And Critical


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 Abstract ID: ISAP095/R1 Comparative evaluation of central and peripheral venous catheters for initial venous access in icu patients

Khushboo Saini, P.K. Verma

VMMC and Safardung Hospital, New delhi

Background and Aims: Use of venous access is ubiquitous in health care. Peripheral venous catheters (PVC) are the most frequently used medical devices during hospital care while Central venous catheters (CVC) are common in the care of critically ill patients in intensive care unit (ICU). Hence this observational, comparative study was designed to compare complications associated with CVC and PVC in managing patients in ICU.

Methods: Patient admission in ICU was according to standard ICU admission guidelines. All adult patients admitted in ICU, were categorized according to the type of venous access present or initially put, into group with CVC (n=50) and PVC (n=50). These patients were observed until discharge or for 28 days (whichever is less) for occurrence of complications using radiological and microbiological guidance. These complications were categorized into major and minor complications which were further subcategorized into mechanical, infectious and thrombotic. Under mechanical- pneumothorax, arterial puncture, local haematoma, failure to insert CVC/PVC after several trials,subcutaneous diffusion.Under infectious- localized erythema, bacteremia, phlebitis and under thrombotic -vein thrombosis, were included.

Results: Demographic characters, duration of stay, SOFA2, APACHE scores were comparable. In our study, complications occurred in all of the patients in CVC group and 49 patients of PVC group. Major complications were present in 45 patients of CVC group and 48 patients of PVC group. Incidence of mechanical complications were significantly higher in PVCs as compared to CVC (76% in CVC vs 94% in PVC) (p<0.05). Total number of minor complications were significantly higher in CVCs as compared to PVCs (96% in CVC v/s 74% in PVCs) (p<0.05).

Conclusion: We conclude that number of complications in our study were comparable in both groups, although PVCs are associated with less number of life threatening complications and decreased morbidity.



Ricard Jd, Salomon L, Boyer A, Thiery G, Meybeck A, Roy C, et al. Central or peripheral catheters for initial venous access of ICU patients: a randomized controlled trial. Crit Care Med.2013;41(9):2108-15.Giuffrida DJ, Bryan-Brown CW, Lumb PD, Kwun KB, Rhoades HM. Central vs Peripheral venous catheters in critically ill patients. Chest. 1986;90(6):806-9.

 Abstract ID: ISAP495: Bon appetit to enterally fed diabetics! a novel use of gastric pocus in the icu to guide enteral nutrition

Bhaskar Murthy V, Sowmya M Jois, Rangalakshmi S

Rajarajeshwari Medical College and Hospital, Bangalore

Background and aims: Enteric tube feed intolerance is more common in critically ill patients. The traditional gastric juice withdrawal method to assess GRV (Gastric Residual Volume) is inaccurate as it depends on whether the tube is too shallow or deep in the stomach. Diabetic patients have decreased gastric motility and the chances of enteric tube feed intolerance is more. We compare ultrasound guided GRV and the GRV by gastric juice withdrawal method in critically ill diabetic patients. Aim was to compare GRV by USG and GRV by gastric juice withdrawal method and to record complications, number of days in ICU.

Methods: Study was conducted on 40 critically ill diabetic patients on enteral feeding, for 3 months. Before giving the enteral feed, antral cross sectional area (ACA = (AP×CC×3.142)/4) of the patient assessed by using 2 to 8Hz curvilinear probe in right lateral position (fig 1) and GRV was assessed using the formula

GRV: 27+14.6×Right lateral ACA -1.28 ×age

Then GRV by aspirating the gastric juice was noted and the feeds were withheld if GRV was more than 200ml. Complications and ICU stay were noted.

Results: GRV by the ultrasound method was found to be 29.6 +/- 13.79 ml (Mean +/- SD) compared to traditional gastric juice withdrawal method i.e. 8+/- 3.70 ml (P< 0.0001). Duration of ICU stay was 5.8+/-1.6 days. Regurgitation was present in 1 patient

Conclusion: POCUS in critically ill diabetics, guides enteral feeding better than traditional gastric juice withdrawal method and prevent the complications such as aspiration, thereby decreases ICU stay.

{Figure 1}


Liu Y, Gao YK, Yao L, Li L. Modified B-ultrasound method for measurement of antral section only to assess gastric function and guide enteral nutrition in critically ill patients. World journal of gastroenterology. 2017 Jul 28; 23(28):5229.Sharma V, Gudivada D, Gueret R, Bailitz J. Ultrasound-Assessed Gastric Antral Area Correlates with Aspirated Tube Feed Volume in Enterally Fed Critically Ill Patients. Nutrition in Clinical Practice. 2017 Apr; 32(2):206-11.

 Abstract ID: ISAP160: Comparison of conventional central venous pressure with peripheral venous pressure and external jugular venous pressure in patients with sepsis”

Sreenidi R, Suresh Kumar N

Sri Devaraj Urs Medical College, Kolar

Background and aims: Central venous pressures along with other dynamic and static variables are used to guide fluid therapy in patients with sepsis admitted to ICU. However, insertion of central venous catheter is associated with serious complications. We, therefore measured external jugular venous pressure (EJVP), peripheral venous pressure (PVP) and correlated with central venous pressure (CVP) measured by conventional technique and thus technical difficulty and complications can be avoided. The aim was to evaluate the correlation between conventional CVP with EJVP and PVP values in patients with sepsis.

Methods: Prospective observational study done on 54 patients admitted with sepsis requiring fluid resuscitation. CVP, EJVP and PVP measurements were taken using a water column manometer in cmH2O. All the three venous pressures are repeated 3 times following every fluid challenge of 250ml

Results: Descriptive and inferential statistical analysis has been carried out in the present study. The observations were analyzed by dividing the patients into 2 groups on the basis of CVP measurements. GROUP A (CVP ≤ 10)- Mean difference between CVP with PVP and EJVP is >2cmH20 and p value is insignificant. GROUP B (CVP >10)- Mean difference between CVP with PVP and EJVP is <2cmH2O and p value (p<0.001) is strongly significant.

Correlation between CVP - EJVP, CVP - PVP in GROUP A and GROUP B


Conclusion: The present study concludes that, there is definite correlation between CVP, EJVP and PVP in a given patient. Further concludes the difference between CVP and EJVP/PVP was minimum (<2cmH2O) when the CVP was>10cmH2O.


Kumar D, Ahmed SM, Ali S, Ray U, Varshney A, Doley K. Correlation between central venous pressure and peripheral venous pressure with passive leg raise in patients on mechanical ventilation. Indian J Crit Care Med.2015;19:648-54Leonard AD, Allsager CM, Parker JL, Swami A, Thompson JP. Comparison of central venous and external jugular venous pressures during repair of proximal femoral fracture. Br JAnaesth. 2008; 101: 166–70

 Abstract ID: ISAP215: Comparison of suction above cuff and standard endotracheal tubes in icu patients for the incidence of ventilator-associated pneumonia: A randomized controlled study.

Shweta Kumari, K.H Raghwendra, Sanjeev Kumar

Indira Gandhi Institute of Medical Sciences, Patna, Bihar

Background and aims: Ventilator associated pneumonia (VAP) is defined as a hospital acquired pneumonia that develops within 48 to 72 hours after endotracheal intubation. The accumulation of subglottic secretions above the endotracheal tube cuff increase the risk of VAP, as these secretions may leak around the cuff of ETT resulting aspiration and an increase risk of infections. This study we compared the incidence of VAP with suction above cuff and standard ETT in ICU patients and its impact on clinical outcome.

Methods: After ethical approval and CTRI registration (CTRI/2018/01/011507) 60 ICU patients from age 18 to 65 years, requiring endotracheal intubation and mechanical ventilation for the management in ICU and anticipated to remain on ETT for >48 hrs will be randomised into 2 groups:

GROUP-A- Suction above cuff

GROUP-B-Standard ETT

All VAP preventive measure were similar between two groups except for the difference in the type of tube.

Results: The data of 60 patients were analysed.The incidence of clinical VAP in standard ETT group(30%) as compared to suction above cuff(13.3%). The incidence of microbiological VAP was higher in standard ETT group (52%) as compared to suction above cuff group but not statistically significant (p >0.05). There was no difference between the two groups in outcome such as duration of intubation and mechanical ventilation.

Conclusion: There was no significant difference in the incidence of clinical and microbiological VAP was seen between 2 groups when other strategies for VAP prevention were similar. Other outcome were similar with use of either tube for intubation.


Jena S, Kamath S, Masapu D, et al. Comparison of suction above cuff and standard endotracheal tubes in neurological patients for the incidence of ventilator-associated pneumonia and in-hospital outcome: A randomized controlled pilot study. Indian J Crit Care Med. 2016;20(5):261–266.Kasuya Y, Hargett JL, Lenhardt R, Heine MF, Doufas AG, Remmel KS, et al. Ventilator-associated pneumonia in critically ill stroke patients: Frequency, risk factors, and outcomes. J Crit Care. 2011;26:273–9. [

 Abstract ID: ISAP284: Comparison Of Diagnostic & Prognostic Value Among Presepsin (S Cd14-St), Procalcitonin And Il-6 In Sepsis

Kshitij Pandey, Yogendra Pratap Singh, Deepak Malviya, Virendra Kumar

Dr Ram Manohar Lohiya Institute Medical Sciences, Lucknow

Background and Aims: Sepsis carries significant morbidity and mortality worldwide. Early diagnosis and management is still recommended as the best method of choice to prevent sepsis and septic shock. Sepsis should be diagnosed early by high sensitivity and specificity sepsis biomarkers and treated early by antibiotics. This study was done to investigate the clinical value of Presepsin in early diagnosis, risk stratification and prognostic evaluation of sepsis in a patient with sepsis/septic shock admitted in ICU and to compare it with the diagnostic and prognostic value of procalcitonin (PCT), IL-6 and hsCRP. Primary aim was to comparatively evaluate diagnostic, short term & long term prognostic utility of presepsin, PCT & IL-6 with SOFA score. Correlation of sequential trend of presepsin, PCT & IL-6 with SOFA score were secondary objectives

Methods: 30 patients included in the study & they were divided into two groups Sepsis(S) and Septic shock (SS) of adult patients >18 yrs were admitted with expected length of stay in ICU over 3 days. Blood samples for routine lab investigations and biomarkers like Presepsin(sCD14-ST), Procalcitonin (PCT), Interleukin-6 (IL-6) and highly sensitive C-reactive. protein (hsCRP) measurements were taken at the time of admission in ICU before administration of first dose of antibiotics at D1 and at D2 and further at the interval of 24 hours up to 3 days of ICU treatment. The sequential organ failure assessment (SOFA) score was determined on D1 through D3.

Results: Sensitivity & specificity of PCT were 66.7% & 50 % VS IL-6 61.1% & 66.7%, hsCRP 50% & 75% and Presepsin 44.4% & 50%.

Conclusion: Presepsin have limited diagnostic value while PCT and hsCRP unable to differentiate between sepsis and septic shock. IL-6 also have some prognostic value but it is statistically found to be insignificant. Prognostic value of PCT in predicting mortality is better than IL-6 and much better amongst hsCRP and Presepsin.


Behnes M, Bertsch T, Lepiorz D, Lang S, Trinkmann F, Brueckmann M, et al. Diagnostic and prognostic utility of soluble CD 14 subtype (presepsin) for severe sepsis and septic shock during the first week of intensive care treatment. Crit Care 2014; 18: 507Song M, Kellum J. Interleukin-6. Critical Care Medicine 2005; 33(12): S463-5.

 Abstract ID: ISAP353: Comparison of posterior tracheal wall injury in ultrasound and fiber optic guided percutaneous tracheostomy.

Avishek Chakma, Abu Nadeem, Prof. Syed Moeid Ahmed, Muazzam Hasan

Jawaharlal Nehru Medical College, Aligarh

Background and aims: Percutaneous tracheostomy (PCT) may be performed under ultrasonography (US) guidance or fiberoptic (FOB) guidance. Very few studies have compared US and FOB guided PCT technique related posterior tracheal injury. Hence,aim of our study is to compare incidence of posterior tracheal injury in both techniques using Griggs method.

Methods:30 ICU patients expected to be on prolong mechanical ventilation were randomly categorised into two equal group viz.,US-PCT and FOB-PCT. Parameters recorded were Number of times posterior tracheal wall hit by introducing needle and Howard Kelly forcep, no of needle puncture attempt, puncture site in relation to carina, total duration of each procedure. In US-PCT, a third physician who is not part of the study observed posterior wall hit with fiber optic.

Results: In US-PCT group, number of times posterior tracheal wall was hit: once in 5 cases, twice in 4 cases, thrice in 3 cases and none in 3 cases whereas in FOB-PCT group,it was nil. In FOB-group, puncture site was at 12-o'clock in 13 cases and in 2 cases, at 11-o'clock. In US-group, site was between 9 and 12-o'clock in 11 cases and at 12-o'clock in 4 cases.

The mean number of needle puncture in FOB-group is 1 and in US-group 2.13. Mean duration in FOB-PCT was 17.2 minutes vs 14 minutes in US-PCT group.


Conclusion: USG-PCT has advantage of shorter duration, being informative with regard to neck anatomy and vascularity but number of needle puncture attempt is more, not in central and it cannot visualize tip of introducing needle or grigg's forcep,hence resulted in support of routine use of fibreoptic during PCT to enhance its reliability.


Sarıtaş, A., & Kurnaz, M. M. (2019). Comparison of Bronchoscopy-Guided and Real-Time Ultrasound-Guided Percutaneous Dilatational Tracheostomy: Safety, Complications, and Effectiveness in Critically Ill Patients. Journal of Intensive Care Medicine, 34(3), 191–196.Ravi PR, Vijay MN. Real time ultrasound-guided percutaneous tracheostomy: is it a better option than bronchoscopic guided percutaneous tracheostomy?Med J Armed Forces India. 2015;71(2):158-164.

 Abstract ID: ISAP443: Comparison of clinical outcome of lung recruitment by peep/fio2 incremental method and by using ultrasonography

Madhuresh Samadder, Apurva Agarwal, Anil Kumar Verma, Satyendra Gehlot

G.S.V.M Medical College, Kanpur

Background and aims: This study aimed to compare best positive end expiratory pressure (PEEP)&oxygenation status in acute respiratory distress syndrome (ARDS)by 2 methods

1) PEEP/FIO2 incremental method & 2) lung ultrasound (LUS).

Methods: This is a randomised control study comprising of 40 patients with moderate to severe ARDS (Berlin criteria) requiring mechanical ventilation. All patients were ventilated according to ARDS net protocol (lung protective ventilation). They were randomly divided into 2groups GROUP.I(n=20) GROUP.U(n=20)

GROUP.I were ventilated by higher PEEP/FIO2 incremental method


GROUP.U LUS perfomed by 2-4MHz probe in 6zones of hemithorax i.e upper&lower part of anterior,lateral&posterior regions of both sides.each zone scored according to :-



End point of peep titration-PaO2>55mmHg for that ABG were performed every 30mins for6hours.

Parameters studied were:HR, BP, SPO2, ABG, PLATEAU PRESSURE. Data analysed using SPSS software& result were considered significant when p<0.05.

Results: Demographic & anthropometric characters were matched in all patients. Best PEEP &oxygenation were significantly better in groupU. Time taken to achieve LUS score>+8 had strong correlation with time taken to attain best PEEP & target PaO2(r>0.6).


Conclusions: LUS scoring guided PEEP determination is faster&better method than PEEP/FIO2 incremental method giving real time image of lung recruitment in heterogenous lung of ARDS.


Tang KQ1, Yang SL, Zhang B, Liu HX, Ye DY, Zhang HZ, Ma S. Ultrasonic monitoring in the assessment of pulmonary recruitment and the best positive end-expiratory pressure. Medicine (Baltimore) 2017 Sep;96(39):e8168. doi: 10.1097/MD.0000000000008168.Walkey AJ, Del Sorbo L, Hodgson CL, Adhikari N KJ , Wunsch H, Meade M O et al. Higher PEEP versus Lower PEEP Strategies for Patients with Acute Respiratory Distress Syndrome A Systematic Review and Meta-Analysis. Ann Am Thorac Soc. 2017 Oct;14(Supplement_4):S297-S303.

 Abstract ID: ISAP686: Comparison of the characteristics and hemodynamic effects of infraclavicular subclavian central venous catheterisation done under spontaneous respiration versus mechanical ventilation

Mohammed Afsal P, Vijay Kumar Nagpal

PGIMER, Dr RML Hospital. New Delhi

Background and aims: Subclavian central venous catheterisation is used in anaesthesia practice for CVP monitoring, drug administration and rapid infusion of fluids. The effects of ventilation on the central venous cannulation is not clearly known. Hence we compared the characteristics and hemodynamic effects of subclavian venous catheterisation done under spontaneous respiration and mechanical ventilation.

Methods: A prospective randomised cross-sectional study was undertaken in 100 patients requiring subclavian venous catheterisation. They were randomised by computer generated random number table to receive the venous cannulation either during spontaneous or mechanical ventilation. The characteristics i.e success or failure, successful cannulation in first attempt, number of attempts, time taken; and hemodynamic effects i.e heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were measured in patients with spontaneous respiration and with mechanical ventilation. Hemodynamic variables were measured every 2 minutes till successful catheterisation and till 10 minutes after successful catheterisation.

Results: The demographic variables were comparable in both the groups. Failure to cannulate occurred in total of 8 patients and were comparable among the groups. Successful catheterisation in first attempt was possible in 66% patients breathing spontaneously versus 72% in mechanically ventilated patients (p=0.517). Time to successful catheterisation were also comparable between groups (145.42 ± 56.54 sec vs 133.38 ± 36.78 sec, p = 0.582). Heart rate variability >20% of baseline occurred in 22% vs 4% in spontaneously breathing and mechanically ventilated patients (p = 0.015). The systolic, diastolic and MAP were comparable between the groups

Conclusion: The infraclavicular subclavian venous catheterisation done under spontaneous respiration may result in significant heart rate variability.


Fragou M, Gravvanis A, Dimitriou V, Papalois A, Kouraklis G, Karabinis A, et al. Real-time ultrasound-guided subclavian vein cannulation versus the landmark method in critical care patients: a prospective randomized study. Crit Care Med. 2011;39(7):1607-12.Kim E, Kim HJ, Hong DM, Park HP, Bahk JH. Influence of mechanical ventilation on the incidence of pneumothorax during infraclavicular subclavian vein catheterization: a prospective randomized noninferiority trial. Anesth Analg. 2016;123(3):636-40.

 Abstract ID: ISAP 484: Prognostic value of procalcitonin as a marker for sepsis in post liver transplantation patients.

Pravin Sankar P R, Navaneethan S, Kumaresan C, Vaishali K

Manipal Hospitals, Bangalore

Background and aims: Procalcitonin, an acute phase protein, composed of 116 amino acids, and is the precursor of calcitonin, a widely accepted marker for sepsis. Systemic inflammation and sepsis in post liver transplantation,1, 2 is a dreaded complication with increased morbidity and mortality. The clinical signs of inflammation or sepsis and routine blood investigations, like C reactive protein and total leukocyte count, are erroneously elevated or low in these patients with immunosuppression. Early diagnosis and treatment of inflammation and sepsis becomes mandatory to minimize complications and graft loss.

Methods: We retrospectively, analyzed 60 patients undergoing liver transplantation. The procalcitonin, C-reactive protein, total leucocyte count, chest radiographs for evidence of pneumonia and surgical site infection were noted for initial 7 days postoperatively. Univariate linear regression analysis for correlation and the students paired t-test for continuous variables and Pearson's test for categorical variables were done.

{Figure 2}

Results: The procalcitonin levels were significantly higher on all days postoperatively. The peak procalcitonin level was seen on day 1 and day 2, and showed a gradual downward trend, but was still positive for sepsis on day 7 with significant p-values (0.0001). The clinical signs and total leukocyte count were not consistent with sepsis.

Conclusion: Absolute value of procalcitonin is not a marker of sepsis in liver transplant patients in the initial postoperative period.


Aristotelis Perrakis, Falk Stirkat, Roland S. Croner, Nikolaos Vassos, Dimitrios Raptis, Süleyman Yedibela, Werner Hohenberger, and Volker Müller. Prognostic and diagnostic value of procalcitonin in the post-transplant setting after liver transplantation. Arch Med Sci. 2016 Apr 1; 12(2): 372–379.Maartje A. J. van den Broek, Steven W. M. Olde Damink, Bjorn Winkens, Christoph E. Broelsch, Massimo Malago, Andreas Paul, and Fuat H. Saner. Procalcitonin as a Prognostic Marker for Infectious Complications in Liver Transplant Recipients in an Intensive Care Unit. LIVER TRANSPLANTATION 16:402-410, 2010.

 Abstract ID: ISAP590: The efficacy of different arterial wave form derived variables {pulse pressure variation (ppv), stroke volume variation (svv), systolic pressure variation (spv)} for fluid responsiveness in hemodynamically unstable mechanically ventilated critically ill patients

Ujjawal Prakash, Deepak Malviya, Soumya Sankar Nath, Nitish Kumar

dr. R.M.L.I.M.S, Lucknow

Background & aims: Worldwide, more than 15 million patients are admitted to ICUs annually in which circulatory insufficiency is commonly encountered. Accurate prediction of fluid responsiveness remains one of the most difficult task at the bed side to assess whether the volume expansion will help or not. This study was to compare the efficacy of different arterial waveform derived variables for fluid responsiveness in hemodynamically unstable mechanically ventilated critically ill patients in Indian Scenario. Aim is to predict fluid responsiveness and compare dynamic changes in different arterial waveform derived variables like SSV, PPV and SPV in mechanically ventilated critically ill patients in an ICU setup.

Methods: 50 Patients were selected after evaluation. Spontaneous effort were masked using sedation. Three sets of measurements were recorded: The 1st set-at the baseline(0 minutes), 2nd after fluid challenge {10ml/kg body weight of crystalloids over 30 minutes} i.e 30 minutes and 3rd at 60 minutes. HR, CVP, MAP,CI, SVV, PPV and SPV were measured and used to classify patients as responders {cardiac Index increase of > 10%} and non-responders {increase of < 10%}.


Results: SVV and PPV are both significant at 30 minutes of fluid challenge and non-significant at 60 minutes.

Conclusion: The initial assessment for fluid responsiveness in critically ill mechanically ventilated hemodynamically unstable patients should be based on SVV and PPV to prevent the complications of fluid overload and their consequences in critically ill patients.


Pinsky MR, “Hemodynamic evaluation and monitoring in the icu,” Chest 2007; 132( 6): 2020–9.Perner A, Faber T. Stroke volume variation does not predict fluid responsiveness in patients with septic shock on pressure support ventilation. Acta Anaesthesiol Scand. 2006; 50: 1068–73.