Indian Journal of Critical Care Medicine最新文献

How to cite this article: Finsterer J, Scorza CA, Scorza FA, Fiorini AC. Risk Factors for Mortality after Out-of-hospital Resuscitation are More Diverse than Assumed. Indian J Crit Care Med 2025;29(1):92-93.

Aim and background: To assess the efficacy and safety of Ibutilide infusion for cardioversion of atrial fibrillation (AF) or flutter (AFL) to sinus rhythm.

Materials and methods: This open-label, multicenter phase IV study was conducted at six sites across India. The study enrolled 120 patients (108 with AF, 12 with AFL), each receiving up to two, 10-minute intravenous doses of 1.0 mg Ibutilide. The primary endpoints were the proportion of patients achieving cardioversion and the mean time taken to achieve cardioversion. Secondary endpoints included the proportion of patients maintaining sinus rhythm at 24 hours and the incidence of adverse events.

Results: The cardioversion rate at 4 hours post-Ibutilide infusion among 120 patients was 65.83% (n = 79), with an average conversion time of 35.12 ± 36.71 minutes. At 24 hours, 85 patients (70.8%) had successful cardioversion, with a mean time of 107.24 minutes. The majority of patients (71.76%) had achieved cardioversion within 30 minutes. Of the 85 patients who achieved successful conversion, 82 (68.3%) maintained sinus rhythm at 24 hours. A total of 66 patients (55%) achieved cardioversion with the first bolus whereas 19 (15.8%) needed a second bolus. Atrial fibrillation patients had a higher conversion rate (75%) compared to AFL patients (33%). A total of 10 adverse events were recorded in eight patients (6.67%), including nausea, headache, palpitations, and bradycardia. Three severe cardiac events, one case of ventricular tachycardia, and two of tachycardia necessitated discontinuation of Ibutilide. No fatalities or serious adverse events (SAE) were reported.

Conclusion: Ibutilide was found to be effective and well-tolerated for rapid restoration of sinus rhythm in patients with AF or AFL.

Clinical trial registry of india: CTRI/2018/01/011248.

How to cite this article: Dewan B, Navale S, Shinde S, Chaudhary J. Clinical Efficacy and Safety of Ibutilide in Cardioversion of Atrial Fibrillation or Flutter in Indian Patients: A Multicenter Study. Indian J Crit Care Med 2025;29(1):45-51.

How to cite this article: Hazra D, Al-Mandhari A. Author Response: Risk Factors for Mortality after Out-of-hospital Resuscitation are More Diverse than Assumed. Indian J Crit Care Med 2025;29(1):94.

Background: To evaluate the role of ultrasound (US) in the assessment of the airway and to determine whether US has the potential to serve as effective, noninvasive and less time-consuming method for the diagnosis of difficult intubation in ICU patients.

Patients and methods: This cross-sectional study was carried in 152 critically ill patients who underwent intubation in the ICU from December 2022 to April 2024. Prior to intubation thyromental height (TMH) and hyomental distance ratio (HMD-R) was measured using a scale and distance from skin to hyoid bone (SHB) and distance from skin to thyrohyoid membrane (STM) was measured using a US. Direct laryngoscopy was performed using a Macintosh blade, and the Cormack-Lehane (CL) grade was noted without external laryngeal manipulation. The laryngoscopy was classified as easy (CL Grade I and II) or difficult (CL Grade III and IV). The number of attempts at intubation, need for alternative difficult intubation approaches or inability to secure the airway was also noted.

Results: The incidence of difficult airway was 17.76%. The success rate for first-attempt intubation was 96.7%. Based on the receiver operating characteristic (ROC) curve analysis cut-off value of 1.97 cm [95% confidence interval (CI), 0.949-0.996, area under the curve (AUC), 0.972] for anterior soft tissue thickness from the skin to thyrohyoid membrane distinguished the difficult intubation group from the easy intubation group, with a sensitivity of 96.3% and specificity of 86.4%. For the hyoid bone level, a cut-off value of 0.905 cm (95% CI, 0.706-0.887, AUC, 0.797) had a sensitivity of 74.1% and specificity of 74.4%. Anterior soft tissue thickness from the skin to thyrohyoid membrane was a better predictor of a difficult airway. There was a significant correlation between clinical airway assessments and US airway assessments.

Conclusion: Point-of-care US can serve as an independent tool for assessing the airway in intensive care unit (ICU) patients, with anterior soft tissue thickness from skin to thyrohyoid membrane being a superior predictor. Combined models of sonographic and clinical tests could enhance the diagnostic value for identifying difficult intubation cases in ICU patients.

How to cite this article: Mallick S, Das S, Pradhan S, Kar S. Evaluation of Point-of-care Ultrasound of Airway to Predict Difficult Laryngoscopy and Intubation in Intensive Care Unit Patients. Indian J Crit Care Med 2025;29(1):14-20.

How to cite this article Ghosh S. Intravenous Fluid Prescription in Diabetic Ketoacidosis: Where is the Evidence? Indian J Crit Care Med 2025;29(1):10-11.

How to cite this article: Tyagi N. Nurse-led Enhanced Recovery after Surgery Programs: Potential Solution to Shorten Postoperative Recovery. Indian J Crit Care Med 2025;29(1):3-5.

How to cite this article: Ghosh I, Sangha SS, Pandey G, Srivastava A. Author Response: Insights into Immunomodulatory Therapy for Sepsis. Indian J Crit Care Med 2025;29(1):91.

Background: Carbapenem-resistant Enterobacterales (CRE) infections pose a significant global public health threat. We aimed to assess the risk variables, clinical characteristics, and outcomes of CRE-caused infections in criticalcare patients.

Patients and methods: This prospective study enrolled 181 adult patients infected with Enterobacterales in the intensive care unit (ICU). Patients underwent clinical assessment and monitoring throughout their ICU stay. Carbapenem resistance was identified through antibiotic susceptibility testing and multiplex molecular detection of carbapenemase-encoding genes.

Results: The mean age of patients was 67.99 ± 12.89 years, with 71.3% being males. Of 181 patients, 111 (61.3%) were found to have CRE infections, including 39 Klebsiella pneumoniae and 31 Escherichia coli isolates. The CRE isolates showed the predominance of the OXA-48 (74.8%), followed by the NewDelhi Metallobetalactamase (NDM) carbapenemase genes (20.7%). The risk factors associated with CRE infection included high sequential organ failure assessment (SOFA) score, prolonged length of stay (LOS) in ICU, prior use of broad-spectrum antimicrobials, hemodialysis, plasma exchange, and prolonged mechanical ventilation. Carbapenem-resistant Enterobacterales infections significantly required longer LOS, more need for mechanical ventilation, and exhibited lower rates of bacterial elimination than carbapenem-susceptible Enterobacterales (CSE) infections. The type of resistance gene did not significantly influence the mortality rate among CRE patients. The successful treatment of OXA-48-positive CRE showed a strong correlation with tigecycline and colistin antibiotics.

Conclusion: Carbapenem-resistant Enterobacterales infection in ICU patients was associated with adverse outcomes. Identification of high-risk patients is essential for early diagnosis and appropriate management. Therefore, it is crucial to improve infection control methods and implement antimicrobial stewardship to avoid spreading infections.

How to cite this article: Shoala ARK, Nassar Y, El-Kholy AA, Soliman NS, Abdel-Fattah A, El-Ghawaby H. Clinical Predispositions, Features, and Outcomes of Infections with Carbapenem-resistant Enterobacterales among Critical Care Patients. Indian J Crit Care Med 2025;29(1):36-44.

How to cite this article: Finsterer J, Marques JG. Continuous Infusion of Propofol or Dexmedetomidine should not be the First Choice to Prevent Postoperative Delirium after Hip Fracture. Indian J Crit Care Med 2025;29(1):86-87.

How to cite this article: Ekkapat G, Chokengarmwong N. Author Response: Continuous Infusion of Propofol or Dexmedetomidine should not be the First Choice to Prevent Postoperative Delirium in Patients after Hip Fracture. Indian J Crit Care Med 2025;29(1):88-89.