How to cite this article: Chaudhuri S, Rao S, Parampalli V. Author Response: Mechanical Power and Driving Pressure in Acute Respiratory Distress Syndrome: Clarifying Overlap Context and Clinical Meaning. Indian J Crit Care Med 2025;29(11):976-977.
How to cite this article: Chaudhuri S, Rao S, Parampalli V. Author Response: Mechanical Power and Driving Pressure in Acute Respiratory Distress Syndrome: Clarifying Overlap Context and Clinical Meaning. Indian J Crit Care Med 2025;29(11):976-977.
Aims and background: Sepsis-associated liver dysfunction (SALD) represents a prevalent and critical complication frequently observed in patients with sepsis. The association between the initial aspartate aminotransferase (AST)-to-platelet (PLT) ratio index (APRI) and SALD is unclear in adult patients diagnosed with sepsis.
Patients and methods: We retrospectively analyzed data from the Medical Information Mart for Intensive Care-IV database. Sepsis-associated liver dysfunction was defined as an elevated serum aminotransaminase (>800 IU/L) or total bilirubin (>2 mg/dL) level. Multivariate and smoothing curve analyses were performed to investigate the relationship between the APRI [APRI = (AST (IU/L)/upper limits of normal)/PLT (k/uL)×100] and SALD. Subgroup analysis was additionally conducted to assess the robustness of the finding. Receiver operating characteristic (ROC) curve was performed to evaluate the discriminatory ability of SALD. External validation was performed using our own dataset.
Results: Overall, 6,334 sepsis patients (SALD, n = 985; no-SALD, n = 5,349) were included. Initial APRI was positively associated with SALD occurrence after controlling for potential confounding variables [odds ratio (OR) = 1.17; 95% confidence interval (CI): 1.15-1.20; p < 0.001]. A nonlinear dose-dependent relationship was found between initial APRI and SALD (p < 0.001). Subgroup analysis revealed no significant interaction between initial APRI and each subgroup divided by age, sex, albumin level, and Sequential Organ Failure Assessment score (p > 0.05). The area under the curve (AUC) for APRI was 0.769 (95% CI: 0.752-0.786), and the optimal cutoff was 0.95. External validation also exhibited good consistency (AUC: 0.761; 95% CI: 0.680-0.842).
Conclusion: A high initial APRI was linked to an elevated risk of developing SALD in adult patients with sepsis, as shown by the non-linear dose-dependent relationship.
Clinical significance: Initial APRI is an easy and accessible tool that can be adopted for timely detection of the risk of SALD and prompt initiation of interventions for adult patients with sepsis.
How to cite this article: Zhang B, Li X, Qin Z, Dong D, Yu W. Initial Aspartate Aminotransferase-to-platelet Ratio Index is Associated with Sepsis-associated Liver Dysfunction in Adult Patients with Sepsis: A Retrospective Cohort Study. Indian J Crit Care Med 2025;29(11):916-924.
Background and aims: It is unclear if maternal and fetal outcomes of pregnant women admitted to the intensive care unit (ICU) with A/H1N1pdm and SARS-CoV-2 infection are different.
Patients and methods: This retrospective study (2007-2022) included pregnant women admitted to the ICU with real-time reverse transcription polymerase chain reaction-confirmed A/H1N1pdm or SARS-CoV-2 pneumonia; non-viral pneumonia and incomplete records were excluded. The primary outcome was maternal mortality. Secondary outcomes included need for organ support, duration of ventilation, hospital stay, and fetal outcome. Predictors of maternal mortality were explored using multivariate logistic regression.
Results: Fifty-six women (A/H1N1pdm = 42, SARS-CoV-2 = 14) were admitted to the ICU at a median (interquartile) gestational age of 32.3 (27.3-36) weeks. Gestational diabetes (p = 0.02), hypothyroidism (p = 0.04), hypertension (p = 0.09), and infertility treatment (p = 0.09) were more frequent among SARS-CoV-2 infected women. Time from symptom onset to ICU admission was 4 (3-5) days. Although APACHE-II scores were similar in both groups, a higher proportion of patients with A/H1N1pdm had tachycardia (87.8% vs 21.4%, p = 0.001), and their median oxygen saturation at admission was lower (89% vs 94%, p = 0.02). Ventilatory support (non-invasive and/or invasive support) was required in all A/H1N1pdm patients and 78.6% with SARS-CoV-2 (p = 0.013). Ventilation duration was 12 days (4-18) for SARS-CoV-2 and 4 days (2-7) for A/H1N1pdm (p < 0.001). The frequency of cardiac and renal dysfunction was similar in both groups. Maternal mortality was 21.4% in A/H1N1pdm and 28.6% in SARS-CoV-2; fetal loss was 16.7% and 26.3%, respectively. Four neonatal deaths occurred. Delayed hospital presentation independently predicted maternal mortality (OR: 1.8; 95% CI: 1.07-3.06).
Conclusion: Respiratory failure due to A/H1N1pdm and SARS-CoV-2 infections in pregnancy is associated with high maternal mortality and fetal loss. Delayed presentation is independently associated with maternal death.
How to cite this article: Thomas VV, Nakkeeran G, Jacob KR, Chacko B, Moorthy M, Gowri M, et al. Maternal and Fetal Outcomes in Pregnant Women Admitted to the Intensive Care Unit with A/H1N1pdm or SARS-CoV-2 Infection: A Retrospective Study. Indian J Crit Care Med 2025;29(11):907-915.
Background and aims: Medication errors (MEs) are among the most common preventable errors that affect patient care. Despite a growing body of research on MEs in India, no comprehensive systematic literature review (SLR) has been conducted on their epidemiology. This SLR aims to identify and critically assess the incidence rates, frequency, and severity of MEs across various hospitals in India.
Methods: This SLR was conducted in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. It included studies (January 2014-April 2025) from electronic databases such as Medline, Cochrane, ScienceDirect, and Google Scholar. The inclusion criteria focused on studies reporting MEs in hospitalized patients in India. The quality of the studies was assessed using a validated quality appraisal tool.
Results: A total of 40 studies were included in the analysis, wherein 31 studies (77.5%) were rated as moderate, 5 (12.5%) as low, and 4 (10%) as high quality. The median incidence rate of MEs was 34.11% (95% CI: 20.45-54.56) in 10 studies, with rates ranging from 6.11% to 43.60% in ICU patients. Medication error frequency rate was 26.74% (95% CI: 17.69-35.80), reported in 28 studies. Most MEs were less severe; however, 8.9% of MEs required monitoring, 2.2% caused temporary harm, necessitating intervention, and 0.1-1.2% of MEs caused prolonged hospitalization.
Conclusions: The SLR emphasizes the significant challenges MEs pose to patient safety in Indian hospitals. The findings underscore the critical need for targeted interventions to mitigate MEs, particularly in severe categories.
How to cite this article: Govil D, Khan RA, Agarwal A, Ghosh P. Epidemiology of Medication Errors in Indian Hospital Settings: A Systematic Literature Review. Indian J Crit Care Med 2025;29(11):954-966.
How to cite this article: Vijayasimha M. Bias-aware Oxygen Saturation Index in Critical Care: A Standards-first Framework to Make a Useful Tool Truly Fair. Indian J Crit Care Med 2025;29(11):970-971.
Aim and background: Acute respiratory distress syndrome (ARDS) is a life-threatening condition with a high mortality rate despite advances in supportive care. Aviptadil, a synthetic analogue of vasoactive intestinal peptide (VIP), exhibits anti-inflammatory potential and cytoprotective effects that may improve pulmonary function. However, its role in improving survival among ARDS patients remains uncertain. This systematic review and meta-analysis aimed to evaluate the effectiveness of aviptadil in improving survival and oxygenation outcomes in ARDS.
Methodology: A comprehensive search was conducted across six databases-PubMed, Scopus, Embase, Google Scholar, Cochrane Library, and Web of Science-up to October 2025. Two investigators independently screened eligible studies. Descriptive synthesis and meta-analysis were performed using a random-effects model. The risk of bias (RoB) was assessed with the RoB 2 tool for randomized controlled trials (RCTs) and the Joanna Briggs Institute (JBI) tool for case series.
Results: The systematic review included nine studies (two RCTs and seven case series) with a total of 665 patients, 361 of whom received aviptadil. Meta-analysis of the two RCTs yielded a pooled prevalence of survival of 0.71 [95% confidence interval (CI): 0.53-0.87]. The survival odds ratio (OR) comparing aviptadil to placebo was 1.01 (95% CI: 0.72-1.42, p = 0.93), indicating no significant benefit. Across the case series, 48 of 54 patients (88.9%) survived following aviptadil therapy, demonstrating consistent improvements in oxygenation and reductions in inflammatory markers.
Conclusion: Aviptadil may have a physiological role in improving oxygenation and reducing inflammation in ARDS; however, current evidence does not indicate a significant survival benefit. Larger, well-designed RCTs are needed to clarify its therapeutic potential.
How to cite this article: Udupa AA, Todur P, Chaudhuri S, Gupta N, Bhat VR, Nagendra D, et al. Aviptadil Therapy in Acute Respiratory Distress Syndrome Patients: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(11):942-953.
How to cite this article: Kumar N. Medication Errors in Critical Care. Indian J Crit Care Med 2025;29(11):899-901.
How to cite this article: Palanisamy S, Parameswaran N. Tools for Monitoring Respiratory Distress in Heated Humidified High-flow Nasal Cannula in Children: How do We Score the Scores? Indian J Crit Care Med 2025;29(11):897-898.
Background and aims: Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is a life-saving treatment for patients with severe respiratory failure. However, predicting the survival chances of these patients remains difficult. Two commonly used scoring systems, the respiratory ECMO survival prediction (RESP) and Acute Physiology and Chronic Health Evaluation II (APACHE II) score, help in estimating the risk of mortality. This study aimed to compare how well these two scoring systems predict mortality in VV-ECMO patients.
Patients and methods: This was a retrospective study involving patients who received VV-ECMO from 2015 to 2022. We looked at factors like patient age, existing health conditions, the duration of extracorporeal membrane oxygenation (ECMO) treatment, and whether they survived or not. We also compared the actual mortality rate with the predictions made by the RESP and APACHE II scores, using the area under the curve (AUC) to evaluate how accurate each system was.
Results: Out of all the patients, the actual mortality rate was 41.4%. The RESP score predicted a mortality rate of 51.1%, while APACHE II predicted 48.1%. Acute Physiology and Chronic Health Evaluation II (APACHE II) proved to be a better predictor (AUC = 0.722) compared to RESP (AUC = 0.649). Sepsis and difficulty in weaning off ECMO were strongly associated with higher mortality rates, while factors like age, comorbidities, and complications like bleeding or stroke didn't seem to have much of an impact.
Conclusion: Our study found that APACHE II is a more reliable tool than RESP when it comes to predicting mortality in VV-ECMO patients. It can help doctors make more informed decisions about patient care and predict mortality.
How to cite this article: Prasad J, Maqbool K, Chauhan M, Dewan S. Which Score Works Better? Comparing Respiratory Extra-Corporeal Membrane Oxygenation Survival Prediction and Acute Physiology and Chronic Health Evaluation II in Predicting Mortality for Veno-venous Extracorporeal Membrane Oxygenation Patients. Indian J Crit Care Med 2025;29(11):930-935.
How to cite this article: Koshy A, Kurian GP, Jacob JM, Vincent D, Rao SV, Kandasamy S, et al. Author Response: Bias-aware Oxygen Saturation Index in Critical Care: A Standards-first Framework to Make a Useful Tool Truly Fair. Indian J Crit Care Med 2025;29(11):972-973.
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