Publications by authors named "Rajnish Prasad"
Article Synopsis
- This study examines different patient phenotypes along the transition from preshock to cardiogenic shock (CS) to understand their prognostic implications and outcomes.* -
- It classifies nearly 2,500 admissions into four categories and finds that in-hospital mortality rates vary significantly, from 3.6% for isolated low cardiac output to 24.0% for SCAI stage C CS.* -
- Results indicate that patients in the earlier stages of shock can still experience a high risk of deteriorating, suggesting the need for improved definitions and severity assessments in CS.*
Objective: This study aimed to determine the factors associated with knowledge and practices related to menstrual hygiene management among adolescent girls in urban slums in Jaipur, India.
Material And Methods: A cross-sectional study among 417 adolescent girls was conducted. Descriptive statistics, Chi-square, and bivariate and multivariate logistic regression methods were used to analyze the data and determine the associated factors.
Article Synopsis
- Previous studies show variability in cardiac intensive care unit (CICU) length of stay (LOS), but lacked detailed risk assessments upon admission, prompting a new evaluation of LOS and its link to in-hospital mortality across different hospitals.
- Analysis of 22,862 admissions from 35 CICUs over five years revealed a median CICU LOS of 2.2 days, with longer stays associated with younger patients having more comorbidities and higher mortality rates across tertiles of LOS.
- The study concluded that significant differences in CICU LOS exist and that longer LOS correlates with increased risk of in-hospital mortality, suggesting improvements in CICU planning and resource use are necessary.
Interhospital Variation in Admissions Managed With Critical Care Therapies or Invasive Hemodynamic Monitoring in Tertiary Cardiac Intensive Care Units: An Analysis From the Critical Care Cardiology Trials Network Registry.
Circ Cardiovasc Qual Outcomes
January 2024
Article Synopsis
- * A study analyzed data from nearly 18,000 CICU admissions across 34 hospitals to assess the use of CCRx and its association with in-hospital survival, finding disparities in patient acuity and therapy utilization among hospitals.
- * The findings revealed that patients in hospitals with higher CCRx usage tended to have more severe conditions and higher comorbidity rates; however, adjusted mortality rates did not significantly differ based on CCRx levels, implying patient factors primarily influence therapy variations.
Prognostic significance of haemodynamic parameters in patients with cardiogenic shock.
Eur Heart J Acute Cardiovasc Care
October 2023
Article Synopsis
- Invasive haemodynamic assessment using a pulmonary artery catheter is important for managing patients with cardiogenic shock (CS) and understanding their prognosis.
- A study analyzed data from a multicenter registry involving patients with CS to find relationships between their haemodynamic parameters and outcomes like in-hospital mortality and end-organ dysfunction.
- Key findings indicated that lower mean arterial pressure, lower systolic blood pressure, and other specific haemodynamic metrics were linked to worse outcomes and higher serum lactate levels, suggesting severe circulatory issues.
Article Synopsis
- Cardiovascular and critical care societies recommend family engagement in clinical care, but the current practices in cardiac intensive care units (CICUs) are not well understood.
- A survey conducted among 39 CICUs in North America revealed that common family engagement practices include open visitation and structured care conferences, with a median engagement practice score of 5 out of 9.
- Although many CICUs implement family engagement practices, significant variability exists, highlighting the need for consistent strategies to enhance these practices across different units.
Article Synopsis
- The study investigates the varying use of pulmonary artery catheters (PACs) in cardiac intensive care units (CICUs) and their impact on patient outcomes, particularly in terms of in-hospital mortality among critically ill cardiac patients.
- Data was collected from a multicenter network involving over 13,000 CICU admissions between 2017 and 2021, focusing on factors like patient diagnosis, demographic information, and PAC usage.
- The findings revealed significant variation in PAC usage between different centers, with its use linked to lower mortality rates in shock patients, highlighting the need for more randomized trials to establish best practices for PAC application in cardiac care.
Clinician and Algorithmic Application of the 2019 and 2022 Society of Cardiovascular Angiography and Intervention Shock Stages in the Critical Care Cardiology Trials Network Registry.
Circ Heart Fail
January 2023
Article Synopsis
- The study examines how effectively the 2019 SCAI shock stages predict mortality risk in cardiogenic shock patients, noting differences between clinician assessments and algorithmic applications.
- Researchers analyzed data from 9612 cardiac ICU admissions, determining that both clinician and algorithm-based methods reveal a clear gradient in mortality risk, with clinicians identifying higher risk patients.
- An updated algorithm using the 2022 SCAI criteria and a vasoactive-inotropic score enhances risk prediction, aligning more closely with clinician assessments compared to previous methods.
Background: The efficacy and safety of prophylactic full-dose anticoagulation and antiplatelet therapy in critically ill COVID-19 patients remain uncertain.
Methods: COVID-PACT (Prevention of Arteriovenous Thrombotic Events in Critically-ill COVID-19 Patients Trial) was a multicenter, 2×2 factorial, open-label, randomized-controlled trial with blinded end point adjudication in intensive care unit-level patients with COVID-19. Patients were randomly assigned to a strategy of full-dose anticoagulation or standard-dose prophylactic anticoagulation.
Critical Care Cardiology Trials Network (CCCTN): a cohort profile.
Eur Heart J Qual Care Clin Outcomes
October 2022
Aims: The aims of the Critical Care Cardiology Trials Network (CCCTN) are to develop a registry to investigate the epidemiology of cardiac critical illness and to establish a multicentre research network to conduct randomised clinical trials (RCTs) in patients with cardiac critical illness.
Methods And Results: The CCCTN was founded in 2017 with 16 centres and has grown to a research network of over 40 academic and clinical centres in the United States and Canada. Each centre enters data for consecutive cardiac intensive care unit (CICU) admissions for at least 2 months of each calendar year.
Background: Vasopressors and inotropes are the primary pharmacologic agents in the management of cardiogenic shock. Increased use of these agents in the setting of cardiogenic shock treated with the Impella is associated with increased mortality. This study evaluates the use of vasopressors and inotropes as predictors of mortality in patients treated with the Impella for acute cardiogenic shock.
View Article and Find Full Text PDFObjectives: The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) epidemic is characterized by a global sense of uncertainty, partly driven by the paucity of real-life clinical data. This study assessed whether admission patient characteristics were associated with need for intensive care unit (ICU) care.
Methods: The observational study included consecutive patients admitted to a large community teaching hospital with a diagnosis of SARS-CoV-2 between March 6, 2020 and March 31, 2020.
The Impella (Abiomed, Danvers, Massachusetts) device is increasingly used for mechanical circulatory support (MCS) to treat acute severe cardiogenic shock (CS). Initial and continued determination of the appropriate degree of MCS is challenging. This study evaluates predictors of mortality in patients treated with the Impella for acute severe CS and outcomes associated with prolonged Impella use.
View Article and Find Full Text PDFRecent recommendations from the Centers for Disease Control (CDC) to use alcohol-based substances for hand hygiene and skin antisepsis could introduce new fire hazards in the operating room (OR). This potential for an increase in the number of fires in the hospital setting with wide spread use of alcohol-based agents warrants heightened awareness of the risks and implementation of safety measures when using these agents. Here, we report a patient who, during a tracheostomy, sustained severe burns resulting from a fire in the OR.
View Article and Find Full Text PDFMultiple strategies and testing modalities are available to evaluate patients presenting to the emergency department with cardiac complaints. Many provide anatomic and prognostic information about coronary stenosis and long-term out-comes. Although nuclear and stress echo imaging have the ability to predict outcomes in patients in the emergency department population, the newer modalities of cardiac imaging (EBCT, MDCT,and CMR) continue to show promising results and may soon be incorporated into emergency department chest pain centers.
View Article and Find Full Text PDFObjective: The purpose of our study was to determine whether MDCT can provide a comprehensive assessment of cardiac and noncardiac causes of chest pain in stable emergency department patients.
Subjects And Methods: Patients with chest pain who presented to the emergency department without definitive findings of acute myocardial infarction based on history, physical examination, and ECG were recruited immediately after the initial clinical assessment. For each patient, the emergency department physician was asked whether a CT scan would normally have been ordered on clinical grounds (e.