Indian Journal of Critical Care Medicine最新文献

Background: A Code Blue in a hospital means that there is a critical medical emergency that requires immediate resuscitation, usually because of cardiac or respiratory arrest. When activated, a specific Code Blue team rapidly takes action to implement life-saving measures. Timely post-Code Blue debriefings are important for team learning, clinical outcomes, and the emotional support of healthcare workers. Debriefing is often ignored due to various problems.

Aims: To determine what hinders healthcare professionals (HCPs) from conducting post-Code Blue debriefing, examine factors facilitating debriefing, and assess the association between the perceived barriers and the demographic characteristics of HCPs.

Patients and methods: A cross-sectional study involved the Code Blue teams from two tertiary hospitals in Taif City. A survey questionnaire was utilized to assess perceived barriers and facilitators that could enhance post-Code Blue debriefing. Multiple linear regression, the Kruskal-Wallis test, Spearman's correlation, and descriptive statistics were used.

Results: Three primary obstacles to successful debriefing emerged: Leadership, communication, and psychological/emotional. Most barriers pertained to leadership, such as work (mean = 3.65), inadequate resources, and lack of debriefing guidelines and effective training. Ongoing leadership support (mean = 3.75), structured protocol, and allocated time were the most effective facilitators for debriefing. Compared to their older colleagues, younger practitioners reported significantly more communication-related barriers (p = 0.037), indicating that experience may affect post-event discussions. Leadership and psychological barriers were also found to be moderately positively correlated.

Conclusion: Healthcare professionals acknowledge the crucial role of post-Code Blue discussions; however, leadership, emotional, and interpersonal barriers hinder debriefing conductions. Leadership involvement, design of debriefing guidelines, and emotional safety may encourage the regular conduct of debriefing sessions.

How to cite this article: AbdElbagy A. Enhancing Post-Code Blue Debriefing through Identification and Overcoming Barriers Encountered by Healthcare Practitioners. Indian J Crit Care Med 2025;29(12):1026-1031.

How to cite this article: Vijayasimha M, Jayarajan D, Mir ZR. From Narrative to Navigation-A Translational Roadmap for AI-enabled Early Sepsis Prediction: Comment on Shanmugam et al. Indian J Crit Care Med 2025;29(12):1050-1051.

Background and aim: Sepsis is a major health problem that causes the death of the majority of those affected. Early determination of mortality is essential to provide timely and adequate interventions. We investigated the efficacy of various prognostic indicators for the prediction of mortality in intensive care unit (ICU) sepsis patients.

Patients and methods: Sepsis patients admitted to the ICU of our hospital between March 15, 2023 and January 01, 2024, were included in this study. These were divided into two groups: Survivors and nonsurvivors. Demographic, clinical, and laboratory data of the groups were compared and their efficacy in predicting mortality was investigated.

Results: Of the 115 patients in our study, 58 (50.4%) were in the nonsurvivor group and 57 (49.6%) were in the survivor group. Among the 16 different prognostic indicators investigated, the prognostic nutritional index (PNI) was found to have the highest diagnostic power (AUC = 0.704, 95% CI: 0.612-0.786; p < 0.0001) followed by the urea-albumin ratio (UAR) (AUC = 0.690, 95% CI: 0.597-0.773; p < 0.001). Multiple logistic regression analysis showed that the area under the curve (AUC) increased significantly in the model using PNI and UAR values together (AUC = 0.742, 95% CI: 0.653-0.819; p < 0.0001).

Conclusion: Our study showed that PNI and UAR indicators, when used together, may be a useful tool in the assessment of mortality risk in ICU sepsis patients.

How to cite this article: Damarsoy T, Gozdas HT, Yildiz I, Demirhan A. Prognostic Nutritional Index and Urea-albumin Ratio: Novel Mortality Predictors for Critically Ill Sepsis Patients*. Indian J Crit Care Med 2025;29(12):996-1001.

Background and aim: Nicotinamide phosphoribosyl transferase (NAMPT) is an upstream cytozyme (cytokine plus enzyme) with unique features, having intracellular NAMPT (iNAMPT) and extracellular NAMPT (eNAMPT) components. Genetic associations and therapeutic inhibition highlight its potential as both a biomarker and therapeutic target. We aimed to study the utility of eNAMPT as a predictor of severe organ dysfunction and its association with mortality in acute respiratory distress syndrome (ARDS).

Patients and methods: This is a single-center, prospective observational study involving 90 patients with ARDS. We noted plasma eNAMPT levels, oxygenation levels, inflammatory markers, lung ultrasound scores, driving pressures, and echocardiography parameters. Severity of organ dysfunction and ICU mortality were the outcomes.

Results: Plasma eNAMPT was found to be a predictor of severe organ dysfunction in ARDS [adjusted OR: 1.343, 95% CI (1.105-1.634), p-value 0.003]. The cut-off eNAMPT level of ≥ 4.38 ng/mL was used to predict early severe organ dysfunction, with an AUC of 0.752, 95% CI (0.647-0.857), p-value < 0.001, sensitivity of 71.4%, and specificity of 79.2%. Plasma eNAMPT was significantly higher in non-survivors [4.53 (4-9.98) ng/mL] as compared to survivors [3.76 (3.40-4.29) ng/mL] (p-value < 0.001). eNAMPT level ≥4.175 ng/mL was associated with higher mortality (hazard ratio: 3.82; 95% CI: 2.010-7.276, p-value < 0.001) and a shorter median survival time [5 days vs. 16 days (Log-rank (Mantel-Cox) p-value < 0.001].

Conclusion: Plasma eNAMPT (≥4.38 ng/mL) predicts early severe organ dysfunction in ARDS patients. It is also associated with mortality and a shorter median survival time.

How to cite this article: Rao S, Srinivas T, Parampalli V, Todur P, Udupa AA, Rao S, et al. Utility of Extracellular Nicotinamide Phosphoribosyl Transferase as a Novel Biomarker in Predicting Early Severe Organ Dysfunction and Mortality in Acute Respiratory Distress Syndrome: A Prospective Observational Study. Indian J Crit Care Med 2025;29(12):1010-1019.

How to cite this article: Shanmugam H, Airen L, Rawat S. Author Response: From Narrative to Navigation: A Translational Roadmap for AI-enabled Early Sepsis Prediction-Comment on Shanmugam et al. Indian J Crit Care Med 2025;29(12):1052-1053.

How to cite this article: Ghatak T, Mani UA. The Sci-Hub Ban in India: When Copyright Collides with Clinical Reality. Indian J Crit Care Med 2025;29(12):986-987.

Background: NETosis is a unique form of cell death leading to the formation of neutrophil extracellular traps (NETs), which may be responsible for many of the serious complications of COVID-19, such as acute respiratory distress syndrome (ARDS), cytokine storm, thromboembolic complications, acute organ dysfunction, and multiorgan failure.

Aims: The aim was to assess the relationship between markers of NETosis [citrullinated histones (Cit-H3), myeloperoxidase (MPO), and elastase] and COVID-19, as well as its severity.

Patients and methods: Ninety-nine hospitalized adult patients aged 18 years or older with COVID-19 and 30 controls were prospectively enrolled. Serum levels of Cit-H3, MPO, and elastase were measured at the time of admission, and their levels were compared between the clinical categories of COVID-19 (non-severe, severe, and critical). The correlation between markers of NETosis and the PO₂/FiO₂ ratio was also determined.

Results: Among the NETs markers, Cit-H3 and elastase levels significantly increased in the COVID-19 patients compared to the control. In the comparison of COVID-19 categories, only Cit-H3 significantly increased in severe categories compared to the non-severe group. Citrullinated histones showed fair diagnostic ability for the prediction of the severity, with a sensitivity and specificity of approximately 74 and 64%, respectively, at a cut-off of 34 ng/mL. Elastase was found to have a weak negative correlation, while Cit-H3 had a moderate negative correlation with the PO₂/FiO₂ ratio.

Conclusions: Citrullinated histones, along with C-reactive protein (CRP), are independently associated with COVID-19 severity. These findings support the relevance of NETosis-related biomarkers in disease progression and may inform future research on targeted monitoring strategies.

Clinical trial registration no: Clinical trial registry of India (CTRI/2020/10/028488).

How to cite this article: Kumar A, Kumar N, Banerjee A, Kumar A, Kumar A, Sinha C. Relationship of Circulatory Markers of NETosis with COVID-19 Severity: A Prospective Cohort Study. Indian J Crit Care Med 2025;29(12):1032-1039.

How to cite this article: Scorza CA, Scorza FA, Finsterer J. Diagnose Pediatric Delirium Preferentially by Psychiatric Examination, as CAPD Has Low Specificity. Indian J Crit Care Med 2025;29(12):1061-1062.

Point‑of‑care ultrasound (PoCUS) has transformed bedside diagnostics in critical care, yet its educational framework remains fragmented. Despite decades of use, training often relies on short workshops or ad hoc mentorship, leaving many trainees with suboptimal image-acquisition skills and/or interpretive competence. This commentary highlights barriers to effective PoCUS education, illustrated through clinical cases where misinterpretation posed significant risks. We identify systemic challenges including inconsistent curricula, poorly defined competencies, reliance on arbitrary scan numbers, and limited supervision. Accreditation processes remain variable, with guidelines offering aspirational statements but little implementation detail. Medicolegal concerns further underscore the need for structured training. We propose a way forward through longitudinal, competency‑based programs anchored in educational milestones, validated assessment tools, and quality assurance mechanisms. Global collaboration and standardized frameworks are essential to harmonize training and ensure safe practice. Addressing these gaps will strengthen PoCUS education and safeguard patient outcomes.

How to cite this article: Rajamani A, McLean A, Pichamuthu K, Huang S. Point-of-care, Point-of-concern? A Commentary on What Ails Point-of-care Ultrasound Education. Indian J Crit Care Med 2025;29(12):983-985.

How to cite this article: Karim HMR, Khandelwal A, Atlapure B, Aspari A. Timing Matters: Caution and Opportunity in Early Vasopressin for Septic Shock. Indian J Crit Care Med 2025;29(12):1058.