Purpose: Evaluation of the effectiveness of the feeding protocol in improving feeding interruption (FI) and clinical outcome in critically ill patients. Materials and methods: This was a single-center, retrospective, and prospective cohort study design evaluating the nutritional characteristics and adequacy, and the causes and clinical outcomes of FI, pre- and post-feeding protocol implementation. The risk factor for ICU mortality was also identified. Results: In total, 430 patients were included, 217 in the pre-protocol group and 213 in the post-protocol group. After protocol implementation, energy and protein intake significantly improved, and the total target nutrition was achieved. The post-protocol group was prescribed a more energy-dense formula (29.0% vs. 55.4%, p < 0.001), a protein supplement (27.6% vs. 56.3%, p < 0.001), and a prokinetic agent (38.7% vs. 48.8%, p = 0.03). There was no difference in the duration of feeding interruption (28 h vs. 30 h, p = 0.60). Implementation of feeding protocol did not affect ICU mortality (OR 0.508, CI 0.250–1.032, p = 0.06). The mortality predictors were SOFA score, underweight, and illness-related FI episode. Conclusion: Implementation of the feeding protocol improved feeding strategies and overall nutritional intake; however, it did not improve FI. Illness-related FI was associated with a reduction in survival of critically ill patients.

Excessive antibiotic consumption is still common among critically ill patients admitted to intensive care units (ICU), especially during the coronavirus disease 2019 (COVID-19) period. Moreover, information regarding antimicrobial consumption among ICUs in South-East Asia remains scarce and limited. This study aims to determine antibiotics utilization in ICUs by measuring antibiotics consumption over the past six years (2016–2021) and specifically evaluating carbapenems prescribed in a COVID-19 ICU and a general intensive care unit (GICU) during the second year of the COVID-19 pandemic. (2) Methods: This is a retrospective cross-sectional observational analysis of antibiotics consumption and carbapenems prescriptions. Antibiotic utilization data were estimated using the WHO Defined Daily Doses (DDD). Carbapenems prescription information was extracted from the audits conducted by ward pharmacists. Patients who were prescribed carbapenems during their admission to COVID-19 ICU and GICU were included. Patients who passed away before being reviewed by the pharmacists were excluded. (3) Results: In general, antibiotics consumption increased markedly in the year 2021 when compared to previous years. Majority of carbapenems were prescribed empirically (86.8%). Comparing COVID-19 ICU and GICU, the reasons for empirical carbapenems therapy in COVID-19 ICU was predominantly for therapy escalation (64.7% COVID-19 ICU vs. 34% GICU, p < 0.001), whereas empirical prescription in GICU was for coverage of extended-spectrum beta-lactamases (ESBL) gram-negative bacteria (GNB) (45.3% GICU vs. 22.4% COVID-19 ICU, p = 0.005). Despite microbiological evidence, the empirical carbapenems were continued for a median (interquartile range (IQR)) of seven (5–8) days. This implies the need for a rapid diagnostic assay on direct specimens, together with comprehensive antimicrobial stewardship (AMS) discourse with intensivists to address this issue.

Background: A feeding tube (FT) is routinely placed in critically ill patients, and its correct placement is confirmed with a chest X-ray (CXR), which is considered the gold standard. This study evaluated the diagnostic accuracy of ultrasonography (USG) in verifying FT placement compared to a CXR in an intensive care unit (ICU). Method: This was a prospective single-blind study conducted on patients admitted to the ICU of a tertiary hospital in Malaysia. The FT placements were verified through a fogging test and USG at the neck and subxiphoid points. The results of confirmation of FT placement through USG were compared with those obtained using CXRs. Results: A total of 80 patients were included in this study. The FT positions were accurately confirmed by overall USG assessments in 71 patients. The percentage of FT placements correctly identified by neck USG was 97.5%, while the percentage of those identified by epigastric USG was 75%. The corresponding patients’ CXRs confirmed correct FT placement in 76 patients. The overall USG assessment had a sensitivity of 92.11% and specificity of 75%, a positive predictive value of 98.59%, and a negative predictive value of 33.33%. The USG findings also showed a significant association between FT size and BMI. FTs with a size of 14Fr were better visualized (p = 0.008), and negative USG findings had a significantly higher BMI (p < 0.001). Conclusion: USG is a simple, safe, and reliable bedside assessment that offers relatively high sensitivity in confirming correct FT placement in critically ill patients.

Background and Objectives: Shivering is a common complication of subarachnoid block (SAB). Magnesium sulphate has been proven to be effective in preventing shivering. The aim of this study was to compare the effectiveness and adverse effects in hemodynamic parameters between 50 mg/kg and 30 mg/kg of intravenous magnesium sulphate for prevention of shivering post-subarachnoid block. Materials and Methods: Eighty-six patients scheduled for surgery under SAB, aged between 18 to 65 years old with American Society of Anesthesiologists physical status I and II were randomised into two groups. Group A received a bolus of 50 mg/kg, while Group B received 30 mg/kg of intravenous magnesium sulphate, given over a 20 min duration following SAB. Shivering grade was recorded intraoperatively according to the Crossley and Mahajan shivering scale. Mean arterial pressure (MAP), heart rate, tympanic temperature, oxygen saturation and the use of vasopressors were recorded. Results: Forty-five percent of patients in Group A and 20% of patients in Group B did not exhibit shivering (p-value < 0.01). High-grade shivering was observed in 12.5% in Group A and 40% in Group B, respectively (p-value 0.02). The MAP trend was lower in Group B (p-value < 0.01), but the incidence of hypotension was not significant in both groups. The use of vasopressors was also similar between groups. Group B showed a lower oxygen saturation trend (p-value 0.04). The trends of heart rate and tympanic temperature were not significant in both groups. No patients had episodes of bradycardia or oxygen desaturation. Conclusions: In this study, intravenous magnesium sulphate 50 mg/kg is the lowest effective dose for prevention and treatment of high-grade shivering post-SAB without significant hemodynamic adverse events.

Background: Current fasting guidelines are often exceeded in clinical practice, resulting in stressful events during anaesthesia in children. This prospective study compares residual gastric volume after 1 versus 2 h of clear fluid ingestion in fasted children. METHODS: A total of 106 patients were enrolled in the study. Ultrasonography (USG) of gastric antrum (GA) was performed in the supine and right lateral decubitus (RLD) positions. All children fasted from solid food for 6 h. Blackcurrant flavoured drink (3 mL/kg) was given following the measurement of baseline (T₀) USG of GA, with follow-ups after 1 (T₁) and 2 (T₂) hours post-ingestion. Residual gastric volume (RGV) was calculated from the cross-sectional area of GA using a standard formula. Parental satisfaction with their children’s behaviour concerning fasting time was recorded. Results: RGV was significantly higher at T₁ compared to T₂ (p < 0.001). No significant difference was seen between T₀ and T₂ (p = 0.30). Parental satisfaction was similar at T₁ and T₂ (p = 0.158). Conclusions: The RGV in paediatric patients after 1 h of clear fluid ingestion was significantly higher than after 2 h of ingestion. There was no difference observed in parental satisfaction concerning the two intervals of fluid fasting. RLD and supine positions can be used reliably to measure the RGV in children.

Optimal conditions during supraglottic airway placement are important to prevent adverse events associated with inadequate depth of anaesthesia. This study compared propofol co-induction with ketamine or midazolam during ProSeal TM Laryngeal Mask Airway (PLMA) insertion. Materials and Methods: A total of 118 ASA I or II patients aged between 18 to 60 years requiring PLMA insertion for surgery were recruited into this prospective, randomised and double blind study. Patients were grouped into propofol (2mg/kg) co-induction with either ketamine (0.5mg/kg) or midazolam (0.03mg/kg). During PLMA insertion, the degree of mouth opening, ease of insertion, swallowing, coughing or gagging, movement and laryngospasm were scored and haemodynamic changes were recorded. Overall insertion conditions were further graded into excellent, good, poor or unacceptable. Results: The ketamine-propofol group had significantly better mouth opening (p=0.01) and shorter duration of apnoea (p<0.001). Other conditions during PLMA insertion and the overall grading were comparable between groups. Haemodynamic parameters were comparable to baseline within each group. However, the ketamine-propofol group had more stable blood pressure readings and maintained a higher heart rate (p<0.05) compared to the midazolampropofol group. Conclusion: Propofol co-induction with either ketamine or midazolam conferred comparable PLMA placement conditions.