Indian Journal of Critical Care Medicine最新文献

How to cite this article: Mehta KN, Otiya DM. Lung Ultrasound in the ICU: Strengths, Limitations, and the Continued Role of Computed Tomography. Indian J Crit Care Med 2025;29(12):1054-1055.

How to cite this article: Al Tayar AS, Salem HA, Nasa P. Author Response: Lung Ultrasound in the Intensive Care Unit: Strengths, Limitations, and the Continued Role of Computed Tomography. Indian J Crit Care Med 2025;29(12):1056-1057.

Background and aims: Trauma continues to represent a major global contributor to morbidity and mortality, with individuals sustaining polytrauma particularly vulnerable to developing systemic inflammatory response syndrome (SIRS) and sepsis. This study aims to evaluate the C-reactive protein (CRP) to albumin ratio (CAR) in predicting the postoperative SIRS and sepsis occurrence among polytrauma cases admitted to intensive care units (ICUs).

Patients and methods: This prospective observational study involved 100 polytrauma cases admitted to Ain Shams University Hospital ICUs. C-reactive protein and albumin levels were measured upon ICU admission and on postoperative days 1, 3, and 5. The CAR was calculated, and its association with SIRS and sepsis was assessed.

Results: Systemic inflammatory response syndrome developed in 35% and sepsis in 28% of patients. C-reactive protein/albumin ratio (CAR) was significantly higher in SIRS-positive patients at Day-1 (median 9.7 vs 8.0, p < 0.001), Day-3 (17.5 vs 11.9, p < 0.001), and Day-5 (28.9 vs 13.8, p < 0.001). C-reactive protein/albumin ratio (CAR) also differentiated sepsis-positive patients at Day-3 (17.7 vs 12.1, p < 0.001) and Day-5 (29.0 vs 14.0, p < 0.001). Receiver-operating characteristic (ROC) analysis showed that CAR at Day-5 had an area under the curve (AUC) of 0.989 for SIRS (sensitivity: 91.4%, specificity: 98.5%) and 0.934 for sepsis (sensitivity: 89.3%, specificity: 88.9%).

Conclusion: Progressive elevation of CAR is a reliable early predictor of postoperative SIRS and sepsis in polytrauma patients, peaking on Day-5.

Clinical significance: Early detection of postoperative sepsis in polytrauma patients by a simple, inexpensive screening tool allows risk stratification and timely intervention of this high-risk group, improving clinical outcomes.

How to cite this article: Salem AS, Zaghloul MA, Boctor AM, Abd Elfattah MM, Shehata OM. C-reactive Protein/Albumin Ratio as a Predictive Inflammatory Marker for Postoperative Systemic Inflammatory Response Syndrome and/or Sepsis in Polytraumatized Patients in ICU. Indian J Crit Care Med 2025;29(12):1002-1009.

How to cite this article: Nimavat BD, Zirpe KG. Old Wine in a New Bottle: Vasograde Scale and Biomarkers, Composite Model in Subarachnoid Hemorrhage. Indian J Crit Care Med 2025;29(12):979-982.

Background and aims: Existing clinical prediction tools for delayed cerebral ischemia (DCI) in aneurysmal subarachnoid hemorrhage (aSAH) patients do not integrate systemic inflammatory status, which is increasingly recognized as a contributor to DCI. We evaluated whether adding inflammatory indices, Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI), to existing tools improves DCI prediction.

Patients and methods: This retrospective observational study included 624 adult patients with aSAH who underwent clipping or coiling over a 2-year period. Patients were stratified into DCI and non-DCI groups. Multivariable logistic regression identified independent predictors of DCI, which were used to construct a bedside score (VASS-DCI) based on adjusted odds ratios. Receiver operating characteristic (ROC) analysis, DeLong's test, and decision curve analysis (DCA) were used to assess model performance and clinical utility.

Results: A total of 179 patients (28.7%) developed DCI. Increasing age, VASOGRADE (yellow/red), SII ≥ 2,056,309, and SIRI ≥ 5,568 were independent predictors of DCI. A multivariable model developed using these variables significantly outperformed the VASOGRADE score (AUC 0.774 vs 0.637; p < 0.0001). DCA demonstrated a higher net clinical benefit of the full model across a threshold probability range of 10-55% compared to VASOGRADE. A clinical risk score, the VASS-DCI (range 0-6), was developed using these predictors. The score stratified patients into low (0-2), moderate (3-4), and high-risk (5-6) groups, with corresponding DCI incidences of 11.8, 48.8, and 64.3%, respectively.

Conclusion: The VASS-DCI score integrates inflammatory, clinical, and radiological parameters into a practical bedside tool for early prediction of DCI in aSAH patients.

How to cite this article: Sharma P, Muthuchellappan R, Francis T, Sharma P, Mallesha HS, Nagaraja S. A Composite Model - "VASS-DCI" - for Delayed Cerebral Ischemia Following Aneurysmal Subarachnoid Hemorrhage: Role of VASOGRADE and Inflammatory Biomarkers. Indian J Crit Care Med 2025;29(12):988-995.

How to cite this article: Bhattacharjee A, Datta PK, Ravikumar RH, Sathe P, Kumar V, Kundu R. Author Response: Timing Matters: Caution and Opportunity in Early Vasopressin for Septic Shock. Indian J Crit Care Med 2025;29(12):1059-1060.

Background and aims: Personalized parenteral nutrition (PPN) is a customized strategy to address the individual metabolic and nutritional requirements of the critically ill patients, especially in cases where enteral nutrition (EN) is not possible. However, available evidence regarding its effectiveness and safety is still inconclusive. This systematic review and meta-analysis aim to evaluate the impact of PPN on the clinical outcome of critically ill patients, including its effect on their length of stay in the intensive care unit (ICU), morbidity, and mortality.

Methodology: A systematic literature search was conducted in PubMed, EMBASE, and Cochrane databases. Information pertinent to the question was retrieved from the selected studies by using a structured data extraction form. Included studies were those that had assessed the impact on clinical outcomes of PPN in critically ill patients. Data were synthesized using a random-effects meta-analysis model. An odds ratio (OR) with 95% confidence intervals (CIs) was used as the pooled effect size.

Results: The meta-analysis included seven studies. The clinical risk was significantly higher in PPN with an OR of 1.24 (95% CI: 1.10-1.39; p < 0.01). Although there were some studies that showed an improvement in nutritional markers and decreased inflammation, the overall impact on mortality and the length of stay in the ICU was inconsistent with considerable clinical and methodological heterogeneity (I² = 81%).

Conclusion: Personalized parenteral nutrition has demonstrated improved benefits in tailored nutritional support for critically ill patients. The evidence, however, has shown mixed clinical outcomes, and its effect on mortality and morbidity has been inconclusive. Future research is needed to optimize the composition of PPN formulations and evaluate the long-term effects of this intervention.

How to cite this article: Gatar O, Arishi AA, Sultan MA, Gatar MM. Impact of Personalized Parenteral Nutrition on Inflammatory Markers and Clinical Outcomes in Critically Ill Patients: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(12):1040-1049.

Background: In emergency department (ED) settings, accurate and timely measurement of biochemical parameters like sodium, potassium, hemoglobin (Hb), and glucose is critical for initiating appropriate interventions. These parameters can be measured by a hospital laboratory autoanalyzer (HLA) or a blood gas analyzer (BGA). Although BGAs, as compared to HLAs, are able to deliver rapid results at the point of care, their accuracy has been a subject of debate. Therefore, this study was designed to compare them and determine their interchangeability.

Patients and methods: A prospective, cross-sectional study was conducted in 1,000 adult patients in the Emergency Medicine Department. Both arterial sampling for blood gas analysis and venous sampling for laboratory analysis were taken simultaneously. The reliability between two measurements was evaluated using the intraclass correlation coefficient (ICC), and agreement was assessed using Bland-Altman analysis with 95% limits of agreement (LOA).

Results: The intraclass correlation coefficient indicated good to excellent reliability for all parameters: Sodium (ICC = 0.946, 95% CI: 0.790-0.976), potassium (ICC = 0.907, 95% CI: 0.769-0.951), Hb (ICC = 0.947, 95% CI: 0.938-0.953), and glucose (ICC = 0.967, 95% CI: 0.962-0.971). The Bland-Altman plot showed moderate to high agreement for sodium, potassium, and Hb levels, and the mean bias was within acceptable limits. Despite the excellent ICC and high correlation for glucose, the Bland-Altman analysis revealed a substantial bias (+6.19 mg/dL) and very wide LOA (-67.69 to +80.07 mg/dL), indicating poor agreement.

Conclusion: We advocate the use of BGA for sodium, potassium, and Hb measurement in emergency settings for quick decision-making. However, glucose measurements from BGA require careful interpretation and should be supplemented with laboratory testing.

How to cite this article: Mittal G, Gupta K, Kaushal A, Chauhan R, Sharma N, Singh K, et al. Comparison of Sodium, Potassium, Hemoglobin, and Glucose Levels by Blood Gas Analyzer and Hospital Laboratory Autoanalyzer in Emergency Department Settings: A Cross-sectional Study. Indian J Crit Care Med 2025;29(12):1020-1025.

How to cite this article: Chanchalani G. Aviptadil in Aviptadil in Acute Respiratory Distress Syndrome-Promise or Mirage? Indian J Crit Care Med 2025;29(11):895-896.

How to cite this article: Prakash J, Choudhuri B. Mechanical Power and Driving Pressure in ARDS: Clarifying Overlap Context and Clinical Meaning. Indian J Crit Care Med 2025;29(11):974-975.