Indian Journal of Critical Care Medicine最新文献

Aim and background: Fluid resuscitation is the first-line treatment for patients with diabetic ketoacidosis (DKA). However, the optimal choice of resuscitative fluid remains controversial. This study aims to evaluate the impact of balanced electrolyte solution (BES) compared to 0.9% sodium chloride (NS) on various physiological and clinical outcomes in adult DKA patients.

Materials and methods: An extensive search of electronic databases, including Embase, PubMed, Cochrane Library, Web of Science, and Google Scholar, was conducted to select studies that directly compared BES and NS in adult DKA patients. This systematic review and meta-analysis included nine studies, comprising both randomized controlled trials and retrospective studies. Combined estimates were expressed as mean differences (MDs) with 95% confidence intervals (CIs). The primary outcomes were time to resolution of DKA and length of hospital stay. The secondary outcomes were post-resuscitation chloride and bicarbonate levels and adverse events.

Results: No significant difference was observed between BES and NS in the time to DKA resolution (MD: -1.63; 95% CI: -7.66-4.41; p = 0.60) or length of hospital stay (MD: -0.07; 95% CI: -0.44-0.31; p = 0.73). However, BES resulted in significantly higher post-resuscitation bicarbonate levels (MD: 1.63; 95% CI: 0.86-2.39; p < 0.001) and lower post-resuscitation chloride levels (MD: -2.37; 95% CI: -3.56 to -1.19; p < 0.001).

Conclusion: The use of BES is associated with improved post-resuscitation electrolyte balance and preventing hyperchloremic metabolic acidosis in DKA patients. While BES may offer some biochemical advantages, both BES and NS are safe for treating DKA.

How to cite this article: Gupta P, Nasa P, Shahabdeen SM. Effectiveness of Balanced Electrolyte Solution vs Normal Saline in the Resuscitation of Adult Patients with Diabetic Ketoacidosis: An Updated Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(1):65-74.

Background: Enhanced recovery is currently considered to be the treatment of various elective major surgeries. Enhanced recovery after surgery (ERAS) includes applying various perioperative measures, strategies, and active participation of patients in the recovery process.

Materials and methods: A quasi-experimental study was conducted in the surgical units of a hospital in Karnataka, India. Data were collected from patients undergoing elective abdominal surgery (n = 142). Psychological (anxiety) and physiological outcomes (vital capacity, pulse, respiration, and blood pressure) were assessed in experimental and treatment-as-usual groups on preoperative day 1 (2 days before surgery) and preoperative day 2 (1 day before surgery).

Results: The results showed a significant decrease in the state-anxiety scores in the experimental group than in the treatment-as-usual group (p < 0.05). Physiological outcomes such as pain, pulse, respiration, and blood pressure showed a significant decrease in the experimental group than the treatment-as-usual group (p < 0.05). Vital capacity was significantly increased in the experimental group and decreased in the treatment-as-usual group in the postoperative days (p < 0.05). A significant decrease in the length of postoperative stay was seen in the experimental group than in the treatment-as-usual group (p = 0.001). In the experimental group, there were less postoperative complications than in the treatment-as-usual group.

Conclusion: Enhanced recovery is considered to be the treatment for various elective major surgeries. It is an essential responsibility of healthcare professionals to improve postoperative outcomes by reducing complications and length of postoperative hospital stay.

How to cite this article: Barboza HR, Dsilva F, Lobo AS, Moosabba MS, Gurmitkal B. Enhanced Surgical Recovery Nursing Program: A Multidisciplinary Approach to Optimize Postoperative Patient Recovery. Indian J Crit Care Med 2025;29(1):21-26.

Background: Traumatic brain injury (TBI) in children can lead to grave consequences. The mechanism, mode, and management of pediatric neurotrauma are different from adult neurotrauma, and there is a growing demand to study the clinicoepidemiology of pediatric TBI.

Objective: To explore the clinicoepidemiological profile and outcome of pediatric neurotrauma.

Methods: This single-center retrospective study was conducted at a tertiary referral hospital in the PICU involving children (1 month to 18 years) sustaining TBI (2012-2022). Demographic, clinical, and laboratory details at the onset of admission were collected. Predictors of mortality were compared between survivors and non-survivors.

Results: Demographic, clinical, and laboratory data of 316 children with traumatic brain injuries at admission were collected and analyzed. The median (IQR) age was 72 months (36-132 months), with 68% of the cohort being male. The majority of the study population (49.1%) was under the age of 5 years. Injury from a fall was the most frequent mechanism of injury (53.5%), followed by road traffic accidents (5%). More than half of the study population suffered mild-TBI (55%). The overall mortality was 8.9% (28/316), and it was highest in the severe TBI group (31.6%) and under-5 years population (42.9%). Lower pediatric trauma score (PTS) (AOR: 0.52; 95% CI: 0.34-0.82) and polytrauma were significantly associated with mortality (AOR: 4.61; 95% CI: 1.02-20.86).

Conclusion: Traumatic brain injury is a significant concern in the pediatric population, particularly those under the age of 5 years. Lower PTS and polytrauma predicted poor outcome.

How to cite this article: Pujari CG, Lalitha AV, Raj JM, Ashwini A Meshram. Epidemiology of Neurotrauma in Pediatric Intensive Care Unit: A Single-center Experience of 10 Years. Indian J Crit Care Med 2025;29(1):59-64.

How to cite this article: Angadi VM, Kambagiri P, Jindal A. Critical Insights into Novel Immunomodulatory Therapy for Sepsis: Evaluating Promise Amidst Limitations. Indian J Crit Care Med 2025;29(1):90.

How to cite this article: Padyana M, Karanth S. Difficult Airway: Is this the Time to Focus on Point-of-care Ultrasonography? Indian J Crit Care Med 2025;29(1):1-2.

How to cite this article: Baalaaji M. Pediatric Neurotrauma: Closing the Gaps. Indian J Crit Care Med 2025;29(1):8-9.

Introduction: Delirium is a syndrome commonly seen in intensive care unit (ICU) patients. It is characterized by acute changes in mental status, inattention, disorganized thinking, and altered level of consciousness. Due to its higher prevalence in mechanically ventilated ICU patients, it is crucial to recognize it early and implement standardized evidence-based protocols for preventing it in regular practice.

Objectives: To identify the benefits and effectiveness of nonpharmacological interventions for preventing delirium among critically ill patients admitted to the ICU.

Methods: The preferred reporting items for systematic reviews and meta-analyses statement guidelines were followed. Two independent authors searched electronic and grey literature for systematic review and meta-analysis in the following databases: PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar.

Results: This umbrella review included 12 studies on delirium prevention interventions, excluding reviews, abstracts, case studies, and pharmacological interventions. Our finding shows that multicomponent strategies are the most promising intervention for preventing delirium. Inclusion of family participation is the most vital part, with flexible visitation to be included in delirium care protocols. Multidisciplinary approaches raise workloads among healthcare professionals through increased coordination, assessments, and documentation.

Conclusions: Multicomponent interventions are regarded as the most effective among all nonpharmacological interventions for reducing and preventing delirium.

Highlights: Delirium syndrome is preventable among mechanically ventilated patients. The study aims to identify the benefits and effectiveness of nonpharmacological interventions for preventing delirium among critically ill patients admitted to the ICU.

How to cite this article: Sonia M, Kaur S, Kothari N. Prevention of Delirium in the Intensive Care Unit through Nonpharmacological Interventions: An Umbrella Review. Indian J Crit Care Med 2025;29(1):75-83.

How to cite this article: Prayag S. ARDS Ventilation, The Man Behind the Evolution. Indian J Crit Care Med 2025;29(1):12-13.

Background: Glycemic variability (GV) is the third domain of sepsis-induced dysglycemia, after hyperglycemia and hypoglycemia, potentially leading to adverse outcomes. This study analyzed the association of GV with in-hospital mortality and length of stay (LOS) in non-diabetic sepsis patients.

Materials and methods: In this prospective observational study, non-diabetic sepsis patients were followed till day 14 of hospital stay, and blood glucose levels were assessed by finger-prick method (seven times per day) daily; clinico-laboratory and GV parameters [standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE)] were assessed on days 1, 3, 5, 7, 10, and 14 of admission.

Results: Two hundred thirteen patients were screened and 80 (mean age 45.6 ± 15.37 years; 50% men) were included in the final analysis. Patients with in-hospital mortality had significantly higher GV when compared to patients without in-hospital mortality [SD: 37.57 vs 25.21, adjusted odds ratio (aOR) 1.13, 95% confidence interval (CI) 1.02-1.24, p = 0.013; CV: 24.91 vs 16.88, aOR 1.19, 95% CI: 1.03-1.38, p = 0.016; MAGE: 73.13 vs 48.03, aOR 1.05, 95% CI: 1.01-1.11, p = 0.014], independent of illness severity (APACHE II), mean blood glucose and hypoglycemia on multivariate regression analysis. There was no significant correlation between GV and LOS. Multivariate analysis showed a significant independent association between CV and ventilator requirement (aOR 1.15, 95% CI: 1.03-1.29, p = 0.017) and between SD and need for renal replacement therapy (aOR 1.04, 95% CI: 1-1.09, p = 0.044).

Conclusion: This study demonstrated that GV is independently associated with increased in-hospital mortality in non-diabetic sepsis patients. Further studies are required to investigate whether targeting lower GV in septic patients would translate to better outcomes.

Clinical significance: Glycemic variability in sepsis is controversial, with discordant results and a paucity of studies on the Indian population in the literature. Despite blood sugar monitoring being routinely done in sepsis patients, GV is rarely measured and the results of our study indicate that it may be worthwhile to estimate GV in sepsis. This may aid in identifying a subset of patients with increased mortality risk, who may benefit from intensive glucose monitoring and modification of insulin regimen.

How to cite this article: Prakash P, Sethi P, Vikram N, Khan M, Gupta Y, Jadon RS, et al. Association of Glycemic Variability with Outcomes in Non-diabetic Sepsis Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(1):27-35.

Aim and background: Hyperglycemia is a serious condition and associated with an increased risk of complications and mortality in both critically ill and non-critically ill people. Improvement in the glycemic level reduces the length of hospital stay, systemic infections and short- and long-term mortality. The aim was to test the effectiveness of insulin degludec vs insulin glargine and regular insulin in controlling blood sugar in patients with critical hyperglycemia.

Materials and methods: Using random control trial, the patients were randomly divided into three equal groups-group R, group G and group D. Each group included 30 patients. Group G was managed using regular insulin together with an insulin glargine. Group D was managed using regular insulin together with an insulin degludec. However, group R was managed using only regular insulin.

Results: The incidence of hypoglycemia was statistically more significant in the group of regular insulin than in groups G and group D with a p-value 0.0069. There was no statistically significant difference between the three groups regarding the frequency of hypoglycemia.

Conclusion: Ultra-long-acting insulin can effectively control random blood sugar (RBS) with a decrease in the total dose of insulin used. It is recommended that using insulin degludec is a safe and effective alternative to regular insulin for glycemic control in critically ill patients.

How to cite this article: El Sherif IM, Haggag AM, Abbas MH, Kamel WY. Insulin Degludec vs Insulin Glargine for Glycemic Control in Critical Illness Hyperglycemia. Indian J Crit Care Med 2025;29(1):52-58.