International Journal of Critical Illness and Injury Science最新文献

Background: Effective and timely weaning is essential for improving the outcome of intensive care unit (ICU) patients. This study was conducted to determine whether diaphragmatic thickness fraction measured by ultrasound provides any additional benefit when combined with clinical parameters for successful weaning.

Methods: This prospective observational study was conducted on 100 mechanically ventilated patients in the ICU. When the criteria for weaning were satisfactorily fulfilled, a spontaneous breathing trial was administered. Rapid Shallow Breathing Index (RSBI) and bedside ultrasound to measure diaphragmatic thickness fraction (DTF) were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RSBI and DTF were calculated utilizing a cutoff value of RSBI <82 and a DTF cutoff of >37%. The predictability of weaning success was evaluated by the area under the receiver operating characteristic curve (AUROC).

Results: Of the 100 patients observed, 68 patients had weaning success while 32 patients experienced weaning failure. The sensitivity, specificity, PPV, and NPV of RSBI were greater compared to DTF (88.23%, 96.87%, 98.36%, and 79.48% vs. 88.23%, 84.37%, 92.30%, and 77.14% respectively). The AUROC values for RSBI, DTF, and their combination were 0.86, 0.78, and 0.90, respectively. The Pearson correlation coefficient of RSBI with DTF was found to be -0.475.

Conclusion: RSBI proved to be a highly reliable predictor of successful weaning, demonstrating superior diagnostic accuracy. The combination of RSBI and DTF improved the diagnostic validity profile, suggesting that integration of diaphragmatic ultrasound with conventional clinical indices enhances the reliability of weaning assessment.

Background: Lumbar spine surgeries are associated with severe postoperative pain due to the extensive handling of tissue and bone. Multimodal analgesia is the preferred choice but is associated with systemic side effects. Atomized drugs at the local surgical site may be a more attractive option than the intravenous route. In this study, we compare the atomized form of ketamine and dexmedetomidine at the surgical site for postoperative pain relief in lumbar spine surgeries.

Methods: After approval from institutional ethics committee and the Clinical Trial Registry - India, 45 patients of age group between 18 and 60 years, scheduled for lumbar spine surgery under general anesthesia were divided into three equal groups: Group D: Received dexmedetomidine 1 µ/kg, Group K: Received Ketamine 1 mg/kg and Group N: Received 20 ml of normal saline. Drugs were diluted in 20 mL of normal saline and applied over the surgical site at the end of the surgery, before closure, in the form of fine droplets using an atomizer device. Our primary outcome was the postoperative analgesia measured by the Visual Analog Scale.

Results: Duration of postoperative analgesia was significantly higher in the ketamine group, 240 min (interquartile range [IQR]: 120-360) than the dexmedetomidine group, 120 min (IQR: 120-240) determined by the Kruskal-Wallis test (P < 0.001).

Conclusion: Atomized ketamine and dexmedetomidine at the surgical site during closure in lumbar spine fixation surgery is an attractive choice for postoperative pain relief without any systemic side effects.

Background: Endotracheal intubation (ETI) is a commonly performed emergency procedure used to secure the airways in critically ill patients. Despite its importance, ETI presents significant risks to patients with difficult airways. The availability of different types of laryngoscopes, most notably video laryngoscopes and direct laryngoscopes (DLs), has contributed to improved intubation success rates and reduced complications. While numerous studies have compared video laryngoscopes and DLs, there remains a limited synthesis of evidence evaluating the full range of all laryngoscopes across different patient population and clinical settings.

Methods: A narrative synthesis approach was employed in this review. Relevant articles were obtained from multiple databases, including PubMed (MEDLINE), CINAHL, and PsycINFO. Articles published up to June 23, 2025, were considered for inclusion. The methodological rigor and reporting quality of each article were appraised. The screening and exclusion process were documented using the PRISMA flow diagram. Titles, abstracts, full texts, and reference lists of all retrieved articles were thoroughly reviewed to identify potentially relevant publications.

Results: Video laryngoscopes, particularly the McGrath, GlideScope, and C-MAC D-Blade, demonstrated superior performance compared to laryngoscopes. There was better first-pass success, better view of the larynx, less need for external adjusting maneuvers, and shorter time to intubation. Other devices such as Airtraq and Bonfils fiberscope have good results in some clinical settings, but are useful only where there is high operator dependence and have a more difficult learning curve.

Conclusion: Video laryngoscopes have proven to be better than DLs in managing adult patients with difficult airways due to the advantages of the success rate, visualization of the glottis, and efficiency of the procedure. However, methodological heterogeneity and an absence of consistently high quality in clinical trial data lead to inadequate evidence for recommending one specific laryngoscope as being better for all difficult airway scenarios. Further well-designed high-quality clinical studies are required to determine the most effective laryngoscope for intubating adults with difficult airways across diverse clinical settings.

Background: Extracorporeal treatment (ECTR) have been employed for poison elimination dating back to as early as the 1960s, but during the current day and time, the indications for ECTR are mostly arbitrary and are considered when other treatments of poison elimination or reduction below toxic levels are not available. It is invaluable, especially when the toxins or poison are amendable to removal by ECTR, especially in a setting of clinical deterioration, the unavailability of specific antidotes, or when other treatment modalities are cost prohibitive in a tertiary setting with ECTR facilities.

Objective: To reiterate the efficacy of extracorporeal therapy techniques in poisoning focusing on the indications, available modalities, and outcomes.

Methods: Three clinical cases of acute poisoning with phenobarbitone, copper sulfate, and snake envenomation, effectively managed by ECTR, in detail were reviewed. A literature review on ECTR in poisoning was also conducted to summarize the principles.

Results: All three patients were managed with appropriate ECTR modalities. Therapeutic plasma exchange was used to treat snakebite-induced thrombotic microangiopathy, hemodialysis was used to treat phenobarbital toxicity, and plasma exchange was used effectively for copper sulfate poisoning. ECTR was initiated early, which resulted in clinical improvement and recovery in all cases.

Conclusion: HD remains a pivotal treatment option for the management of severe poisonings. Nevertheless, given the rare possibility of an encounter with cases necessitating treatment with extracorporeal therapies and the lack of recommendations and guidelines to standardize the practice, the evidence supporting the application of ECTR still remains limited and needs to be studied further for high-quality evidence.

Boerhaave's syndrome (BS), or spontaneous esophageal perforation, is a rare and life-threatening condition. Despite advancements in medical and surgical management, BS carries a high mortality rate, up to 50%, and presents significant diagnostic and therapeutic challenges. Management options include both surgical and nonoperative approaches, with the Pittsburgh score providing a useful tool for predicting outcomes and guiding treatment. Complications such as mediastinitis and sepsis are common. This review explores the demographics, risk factors, clinical presentation, diagnostic modalities, and management strategies for BS. Furthermore, it stresses the importance of early diagnosis and individualized treatment to improve the outcomes in patients with BS.

Artificial intelligence (AI) refers to machines capable of imitating human cognition, with abilities to learn, apply logic and reasoning, and adapt to new information. The scope of AI in medicine ranges from prehospital triage to assisting in diagnosis and prognosticating patients. AI has shown incredible potential in pediatric emergency department by focusing on the development of clinical prediction models, triage systems, and diagnostic aids, contributing to higher accuracy and efficiency in patient management, along with hospital management, medical education, and training. Our review article discusses the current applications of AI in pediatric emergency and explores the barriers to AI in health care and ways to circumnavigate them moving forward. We aim to offer an insight into this less-explored world where technology meets the unpredictable and fast-paced environment of pediatric emergency medicine, building a future with a promise of innovation and redefining standards of care.

Introduction: Stroke is a leading cause of mortality and disability in India, and the hospital and intensive care unit (ICU) beds are limited. This randomized controlled trial (RCT) aimed to assess the effectiveness of early tracheostomy (ET) in reducing 30-day mortality in stroke patients, and secondary objectives included evaluating rates of ventilator-associated pneumonia (VAP) and length of ICU stay compared to late tracheostomy (LT).

Methods: This open-label RCT was conducted over 18 months at a tertiary care hospital in north India, involving 60 patients (30 in each group). Eligible participants were adults (≥18 years) with nontraumatic stroke (acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and vasculitic infarcts) requiring prolonged intubation (stroke-related early tracheostomy score ≥8). Exclusions included preexisting pneumonia, high oxygen needs, pregnancy, and those on ventilation for over 4 days. Patients were assigned to ET (day 4) or LT (day 10), with demographics and clinical characteristics recorded. Mortality was assessed on day 30 postintubation and data for secondary outcomes were collected every other day.

Results: Sixty-four patients were randomized, 30 to the ET group, and 34 to the LT group, with a mean age of 55.48 (±15.94) years. Mortality within 30 days was 50% in both groups. VAP rates were 43.3% in the ET group and 50% in the LT group (P = 0.605). The mean ICU length of stay was 12.07 days for ET and 18.43 days for LT (P = 0.0001).

Conclusion: The RCT found no significant differences in mortality or VAP rates but noted reduced ICU hospital stays for the ET group, suggesting benefits for severe stroke patients.