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3 "Lakshmi Ramamoorthy"
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Original Articles
Nursing
Minimizing discard volume to 2 ml before blood sampling from a central venous catheter: a prospective observational study in India
Abinaya Pushparaj, Lakshmi Ramamoorthy, Manu Ayyan S, Rajeswari Murugesan, Hmar Thiak Lalthanthuami
Acute Crit Care. 2026;41(1):174-182.   Published online February 9, 2026
DOI: https://doi.org/10.4266/acc.000792
  • 2,086 View
  • 56 Download
AbstractAbstract PDF
Background
Central venous catheters (CVCs) are essential for the treatment of critically ill patients. The practice of discarding varying volumes of blood before sampling from CVCs is widely adopted globally. However, there is no established consensus regarding the appropriate volume of blood to discard before sampling. Therefore, this study aims to compare serum electrolyte levels and hemogram measurements obtained via direct venous puncture with those derived from the proximal lumen of the CVC using a discard volume of 2 ml. Methods: Using a prospective observational study design, 105 patients from intensive care units of a tertiary care center were selected through a convenience sampling method. The parameters analyzed included serum electrolytes (sodium, potassium, and calcium) and complete blood counts (hemograms). Intraclass correlation and Bland-Altman plot analysis were employed to assess agreement between the two sampling methods. Results: The study showed high agreement between the two methods, with a P-value of <0.001, except for white blood cell. The presence of acidosis as a clinical confounder was the primary reason for the differences in agreement for potassium (P=0.018), hematocrit (P=0.006), mean corpuscular volume (P=0.041), mean corpuscular hemoglobin (P=0.034), mean corpuscular hemoglobin concentration (P=0.031), neutrophil (P=0.045), and eosinophil (P=0.553). Conclusions: This study suggests that discarding 2 ml of blood, rather than 3 ml or more, before routine sampling from CVCs is sufficient and may help to reduce iatrogenic blood loss in critically ill patients.
Nursing
Effect of fourth hourly oropharyngeal suctioning on ventilator-associated events in patients requiring mechanical ventilation in intensive care units of a tertiary care center in South India: a randomized controlled trial
Khanjana Borah, Lakshmi Ramamoorthy, Muthapillai Senthilnathan, Rajeswari Murugesan, Hmar Thiak Lalthanthuami, Rani Subramaniyan
Acute Crit Care. 2023;38(4):460-468.   Published online November 24, 2023
DOI: https://doi.org/10.4266/acc.2022.01501
  • 7,384 View
  • 314 Download
AbstractAbstract PDF
Background
Mechanical ventilation (MV) is a necessary life-saving measure for critically ill patients. Ventilator-associated events (VAEs) are potentially avoidable complications associated with MV that can double the rate of death. Oral care and oropharyngeal suctioning, although neglected procedures, play a vital role in the prevention of VAE.
Methods
A randomized controlled trial was conducted in the intensive care units to compare the effect of fourth hourly oropharyngeal suctioning with the standard oral care protocol on VAE among patients on MV. One hundred twenty mechanically ventilated patients who were freshly intubated and expected to be on ventilator support for the next 72 hours were randomly allocated to the control or intervention groups. The intervention was fourth hourly oropharyngeal suctioning along with the standard oral care procedure. The control group received standard oral care (i.e., thrice a day) and on-demand oral suctioning. On the 3rd and 7th days following the intervention, endotracheal aspirates were sent to rule out ventilator-associated pneumonia.
Results
Both groups were homogenous at baseline with respect to their clinical characteristics. The intervention group had fewer VAEs (56.7%) than the control group (78.3%) which was significant at P<0.01. A significant reduction in the status of “positive culture” on ET aspirate also been observed following the 3rd day of the intervention (P<0.001).
Conclusions
One of the most basic preventive strategies is providing oral care. Oropharyngeal suctioning is also an important component of oral care that prevents microaspiration. Hence, fourth-hourly oropharyngeal suctioning with standard oral care significantly reduces the incidence of VAE.
Pulmonary
Under or overpressure: an audit of endotracheal cuff pressure monitoring at the tertiary care center
Biju Viswambharan, Manjini Jeyaram Kumari, Gopala Krishnan, Lakshmi Ramamoorthy
Acute Crit Care. 2021;36(4):374-379.   Published online November 26, 2021
DOI: https://doi.org/10.4266/acc.2021.00024
  • 15,497 View
  • 275 Download
  • 3 Web of Science
  • 4 Crossref
AbstractAbstract PDF
Background
Mechanical ventilation is a lifesaving intervention for critically ill patients but can produce the major complication of ventilator-associated pneumonia (VAP). Inappropriately inflated endotracheal tubes cause potential harm due to high or low pressure; this can be prevented through monitoring protocols.
Methods
A cross-sectional study of 348 cuff pressure readings was performed with intubated and mechanically ventilated patients to evaluate the exact proportion of patients in intensive care units (ICUs) where the cuff pressure is optimal and to identify the ICUs where device-based monitoring is available to produce a lower proportion of sub-optimal cuff pressure cases. Every three days, cuff pressure was assessed with a handheld cuff pressure manometer. The corresponding VAP rates of those ICUs were obtained from the hospital infection control department.
Results
Cuff pressure of 40.2% was the lower cutoff for the high category, that of optimal was 35.3%, and the highest cutoff of sub-optimal was 24.4%. This study also showed ICUs that had cuff pressure monitoring devices and protocols. Active measurement protocols had a higher proportion of optimal cuff pressure (58.5%) and a lower proportion of sub-optimal and high cuff pressure (19.5% and 22.0%) compared to ICUs with no device-based monitoring protocols. Furthermore, the VAP rate of ICUs exhibited a weak positive correlation with sub-optimal cuff pressure.
Conclusions
Device-based cuff pressure monitoring is essential in maintaining adequate cuff pressure but often is inadequate, resulting in high readings. Therefore, this study suggests that device-based cuff pressure monitoring be practiced.

Citations

Citations to this article as recorded by  
  • Assessment of pressure–volume loop, inflation to precise pressure, minimum occlusive volume, and manual palpation techniques for inflation of endotracheal tube cuff: A randomised clinical study
    Soumya Murmu, Jyoti Sharma, Mayank Gupta, Ruhi Sharma, Anju Grewal, Dinesh Kumar Singh
    Indian Journal of Anaesthesia.2025; 69(11): 1221.     CrossRef
  • Pressure changes in the endotracheal tube cuff in otorhinolaryngologic surgery: a prospective observational study
    Sujung Park, Young In Kwon, Hyun Joo Kim
    Frontiers in Medicine.2023;[Epub]     CrossRef
  • Correlación entre la presión del manguito del tubo endotraqueal y los síntomas laringotraqueales en postoperatorio
    Wedley Peñaloza, Reyes Cruz Manuel Reyes , Evelin Núñez Wong
    Gaceta Médica de la Junta de Beneficencia de Guayaquil.2023; 1(1): 13.     CrossRef
  • Efficacy of using an intravenous catheter to repair damaged expansion lines of endotracheal tubes and laryngeal masks
    Tingting Wang, Jiang Wang, Yao Lu, Xuesheng Liu, Shangui Chen
    BMC Anesthesiology.2022;[Epub]     CrossRef
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