Indian Journal of Critical Care Medicine最新文献

Background and aims: Intensive care unit-acquired weakness (ICUAW) is a common complication in critically ill patients on prolonged mechanical ventilation (MV), impairing recovery and prolonging intensive care unit (ICU) stays. Standard diagnostic tools like the handgrip strength test (HGST) require patient cooperation and may be limited in critical settings. This study evaluated whether the Perme ICU Mobility Score, a multidimensional functional assessment, is associated with ICUAW and can serve as a screening tool using HGST as the diagnostic reference.

Patients and methods: We conducted a prospective observational study in a Brazilian tertiary ICU from May 2021 to October 2023. We assessed adults (≥18 years) undergoing MV for ≥7 days who were clinically stable (pressure support 7 cm H₂O, PEEP 5 cm H₂O, RASS -1 to +1). ICUAW was defined using sex-specific HGST cutoffs (<11 kg men, <7 kg women). Logistic regression, least absolute shrinkage and selection operator (LASSO), and Random Forest models assessed the association between ICUAW and Perme Score. ROC curves and the Youden index determined the optimal cutoff.

Results: Among 97 patients, ICUAW was identified in 78.4%. Lower Perme Scores were significantly associated with ICUAW (p < 0.001). A cutoff ≤9 showed 76.3% sensitivity, 71.4% specificity, and OR = 8.06 (95% CI: 2.72-23.8). In multivariate analysis, the Perme Score (OR = 0.86; p = 0.0004) and SAPS 3 remained independent predictors. Machine learning models confirmed Perme Score as the most significant variable.

Conclusions: The Perme Score is a feasible, complementary screening tool for ICUAW. A cutoff ≤9 supports early functional risk stratification but should be interpreted alongside clinical context due to limited specificity and negative predictive value (NPV).

How to cite this article: Delazari LEB, Ratti LSR, da Silva AC, Sibinelli M, Heidemann AM, Montedioca HLM, et al. Perme Score and Machine Learning for Detecting ICU-acquired Weakness: A Prospective Observational Cohort Study. Indian J Crit Care Med 2025;29(7):562-568.

Background and aims: Hypertriglyceridemia is the third most common cause of acute pancreatitis (AP). However, the evidence on the management of hypertriglyceridemia-induced AP is lacking. We undertook a systematic review of all published case reports and series to evaluate the clinical characteristics of hypertriglyceridemia-induced AP patients in whom plasmapheresis was used, and the effect of plasmapheresis on plasma triglycerides levels and procedure-related safety.

Materials and methods: A systematic literature search was performed for case reports and series published between January 1, 1975 and April 30, 2023 in PubMed, Science Direct, Embase and Google Scholar databases using keywords "hypertriglyceridemia" AND "pancreatitis" AND "plasmapheresis" OR "plasma exchange." The inclusion criteria were (1) hypertriglyceridemia-induced AP and (2) use of plasmapheresis to manage AP.

Results: Seventy-one studies involving 91 unique patients were included in this meta-summary. Nearly three-fourth had severe AP and one-fifth with recurrent pancreatitis. A previous history of hypertriglyceridemia and diabetes was known in 52.7% of the patients, and alcohol abuse in 17.6%. The majority of the patients were young males, with 15 pregnant females. A median of two sessions with a plasma exchange volume of 3 L significantly reduced serum triglycerides in patients with hypertriglyceridemia. Most (96.7%) of the patients recovered with a median hospital and intensive care unit length of stay (LOS) of 11 and 5 days, respectively.

Conclusion: Plasmapheresis is an effective therapeutic procedure that can significantly reduce triglycerides levels in hypertriglyceridemia-induced AP. The procedure is reasonably safe, including in patients with severe AP and pregnancy. Future prospective randomized studies are required to evaluate the impact of plasmapheresis on patient-centered outcomes compared with pharmacological management of AP.

How to cite this article: Nasa P, Jain R, Singh O, Juneja D. Plasmapheresis for Hypertriglyceridemia-induced Acute Pancreatitis: A Systematic Review and Meta-summary of Case Reports. Indian J Crit Care Med 2025;29(7):604-611.

Background and aims: Enterococci, particularly vancomycin-resistant Enterococci (VRE), pose a significant clinical challenge due to rising pathogenicity and antimicrobial resistance. This study aims to examine the prevalence of Enterococcal bacteremia and their antibiotic susceptibility pattern in a Tertiary Care Hospital in Western India. The study also highlights clinical implications of resistance patterns, emphasizing therapeutic challenges and the need for targeted antimicrobial stewardship to guide effective treatment of Enterococcal infections.

Patients and methods: This is a retrospective observational study conducted in a Tertiary Care Teaching University Hospital. All blood cultures received in the laboratory from October 2022 to September 2023 were included in the study. They were processed using the automated BD BACTEC system and species identification and antibiotic susceptibility testing (AST) were performed using the VITEK 2 Compact system, following Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: From 10,449 blood cultures received during the study period, 13.18% showed bacterial growth. Of these, 30.33% were gram-positive, with Enterococcus spp. constituting 30.14%. Enterococcus faecium was most prevalent (85.71%), and VRE prevalence was 8.73%. All VRE isolates were resistant to benzylpenicillin and fluoroquinolones, with 80% additionally resistant to linezolid. VanA phenotype was present in all isolates. A total of 100% susceptibility was observed for daptomycin and tigecycline.

Conclusion: Findings of this study underscore the urgent need for stringent infection control measures and prudent antibiotic stewardship to effectively manage and prevent VRE infections.

How to cite this article: Rajni E, Jorwal A, Goyal K, Grag VK. An Overview of Enterococcal Bacteremia with Potential Therapeutic Options. Indian J Crit Care Med 2025;29(7):612-614.

Background and aims: Acute respiratory distress syndrome (ARDS) is a syndrome that incorporates a wide group of patients with sign and symptoms of acute hypoxemic respiratory failure. Various studies describing hypo- and hyperinflammatory subphenotypes among ARDS cohorts have been performed. The objective of this systematic review and meta-analysis was to examine how biomarker-based subphenotypes of ARDS impact mortality.

Methods: Medline, Cochrane Library, KoreaMed, LILACS, TRIP Database, and World Health Organization Clinical Trial Registry were searched for studies on subphenotyping of ARDS on the basis of inflammatory biomarkers that reported mortality. Pooled relative risk (RR) of mortality and mean difference (MD) of ventilator-free days (VFDs) were calculated. Grading of recommendations, assessment, development, and evaluations (GRADE) approach for prognostic outcomes was used to assess the certainty of evidence.

Results: A total of 12 studies comprising 6,643 patients were included in the review. Pooled analysis demonstrated that hyperinflammatory subphenotype ARDS may be associated with a higher risk of dying as compared with hypoinflammatory subphenotype ARDS (RR 2.50, 95% confidence interval (CI) 1.77-2.86). Hyperinflammatory ARDS may be associated with fewer VFDs compared with hypoinflammatory ARDS (MD: 15.90 days, 95% CI 2.23-29.57 days fewer). These findings, although based on low certainty evidence, were robust to multiple sensitivity analyses.

Conclusion: The review demonstrates that hyperinflammatory subphenotype of ARDS may be associated with increased mortality and decreased VFDs. This may help patients and clinicians to know clinical outcome of patient with ARDS.

How to cite this article: Das SK, Choupoo NS, Rochwerg B, Goswami D, Ray S, Gupta A, et al. The Impact of Inflammatory Biomarker Subphenotypes on Acute Respiratory Distress Syndrome Prognosis: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(7):597-603.

Background and aims: Adenoviral pneumonia is a significant cause of morbidity and mortality among children. There is limited data about the clinical profile, intensive care needs, and outcomes of children with adenoviral pneumonia from resource-limited settings.

Patients and methods: This retrospective study was conducted in the pediatric emergency room (PER) and pediatric intensive care unit (PICU) of a tertiary care hospital in North India over a period of a period of 2 years (July 2022 to June 2024). The data collection included demographic and clinical features, laboratory investigations, complications, treatment, intensive care needs, and outcomes.

Results: Eighty-five children were enrolled, majority were <1 year of age and males (71.7% each). All presented with fever and respiratory symptoms. The common complications were acute respiratory distress syndrome (ARDS) (47%), multiple organ dysfunction syndrome (MODS) (26%), shock (25%), and encephalopathy (25%). PICU admission was needed in 46% of children. The intensive care needs included invasive mechanical ventilation (48%), CPAP (39%), HFNC (9%), vasoactive drugs (25%), IVIG (8%), RRT (6%), and cidofovir (5%). The duration of ER, PICU, and hospital stay was 48 (24-96) hours, 7 (4-14) days, and 9 (5-18) days, respectively. The mortality rate was 22%. On multivariate analysis, the independent predictors of mortality were low admission pH, myocardial dysfunction, acute kidney (AKI), ARDS, shock, encephalopathy, MODS, and healthcare-associated infection (HCAI).

Conclusion: Infants constituted the largest group of patients requiring admission for adenoviral infection to pediatric emergency in a tertiary care center. Common complications were ARDS, shock, MODS, and encephalopathy. Nearly half required PICU admission for organ support. The mortality rate was 22%; and low admission pH, myocardial dysfunction, AKI, ARDS, shock, encephalopathy, MODS, and HCAI were independent predictors of mortality.

How to cite this article: Vyasam S, Jayaram J, Sarkar S, Angurana SK, Raj S, Bora I, et al. Clinical Profile, Intensive Care Needs, and Outcome of Children with Adenoviral Pneumonia: A Retrospective Study from a Tertiary Care Hospital in North India. Indian J Crit Care Med 2025;29(7):586-591.