Indian Journal of Critical Care Medicine最新文献

Background and aims: A severity-matched case-control study was done to analyze the efficacy of thromboelastography (TEG) in diagnosing and categorizing sepsis-induced coagulopathy (SIC) by addressing the second pillar of patient blood management, i.e., minimizing bleeding and blood loss.

Patients and methods: Sepsis-induced coagulopathy managed with TEG data was collected from 2020 to 2021, and severity-matched retrospective data where SIC managed with conventional tests was collected from 2018 to 2019, which comprised the control group. Age > 18 years, SIC requiring critical care admission were the inclusion criteria. The Sequential Organ Failure Assessment (SOFA) scoring system was used for severity matching. Coagulopathy was defined as an abnormal coagulation screen or TEG parameters.

Results: A total of 125 patients were included in the TEG-based management, and 118 in the control group. Out of 125, TEG-based diagnosis showed normal, hypo, and hypercoagulable status in 26, 66, and 33 patients, respectively. Hypocoagulable picture was more predominant with an increase in the SOFA score. Severity-matched control group analysis showed that individualized hemostasis management with TEG resulted in a 58% reduction in mortality rate (from 91.67% to 38.4%, p ≤ 0.0001). A hypocoagulable TEG had a higher risk of mortality (OR = 1.89, CI = 0.909-3.963). Kaplan-Meier survival analysis showed that individualized management of SIC had a favorable outcome using TEG-based data (Log rank 12.4, p < 0.001).

Conclusion: Patient blood management in SIC with TEG differentiates hypercoagulable from hypocoagulable patients, thus providing clarity in clinical decision-making to improve patient survival.

How to cite this article: Vaidya A, Mohan G, Rao S, Shastry S. Categorizing Sepsis-induced Coagulopathy Using Thromboelastography: An Approach to Address the Second Pillar of Patient Blood Management. Indian J Crit Care Med 2026;30(2):122-127.

Background and aims: In India, where cancer incidence is rising, and healthcare infrastructure in tertiary care centers is strained, the outcomes of cancer patients requiring intensive care unit (ICU) care remain poorly understood. We aim to describe demographic, clinical, and survival data and to identify factors associated with mortality in non-elective medical admissions of critically ill cancer patients to ICU in a tertiary care hospital.

Patients and methods: Retrospective observational study of non-elective medical admissions of critically ill adult cancer patients to the ICU with a diagnosis of solid organ or hematological malignancies between 1st January 2018 and 31st December 2022. Data regarding patient and neoplasm characteristics, ICU admission features, and outcomes were collected from medical records and ICU charts.

Results: A total of 204 non-elective medical admissions of critically ill cancer patients to the ICU were analyzed. Hematological malignancies were documented in 53.9% patients. The main causes of admission to the ICU were febrile neutropenia (34.3%), respiratory failure (31.8%), sepsis (9.8%), and shock (7.8%). The mean length of ICU stay was 5.62 ± 5.67 days. Intensive care unit mortality was 52.94%. The most common cause of mortality was septic shock (53.7%). The need for invasive mechanical ventilation (IMV) [adjusted odds ratio (OR) 0.113; 95% confidence interval (CI) 15.98 (4.22-60.56), p < 0.001], use of vasopressors (adjusted OR 12.59; 95% CI: 3.45-45.94, p < 0.001), need for dialysis (adjusted OR 17.99; 95% CI: 1.97-164.45, p = 0.01), and tracheostomy (adjusted OR 0.15; 95% CI: 0.03-0.7, p = 0.016), were independent risk factors associated with higher ICU mortality.

Conclusion: An increasing number of cancer patients require intensive care, and our study suggests that many of these patients have a reasonable chance of surviving their ICU stay. The in-ICU mortality of 52.94% was observed at our tertiary care center in India. Independent predictors of mortality included age, type of malignancy, treatment intent, need for early IMV, vasopressors, and dialysis in the ICU.

How to cite this article: Sandill S, Mishra S, Garg R, Gupta N, Bharti SJ, Kumar V, et al. Outcomes of Cancer Patients Requiring Non-elective Medical Admission to the Intensive Care Unit of a Tertiary Care Center in India: A 5-year Retrospective Study. Indian J Crit Care Med 2026;30(1):13-18.

Background and aim: Intracranial pressure (ICP) monitoring is essential to manage patients with acute neurological emergencies to improve outcomes. Non-invasive modes of monitoring are preferred over invasive as they are associated with fewer complications. Our study aimed to compare optic nerve sheath diameter (ONSD) measurement using ultrasonography (USG) and computed tomography (CT) in patients with raised ICP.

Patients and methods: After ethical committee approval and applying inclusion criteria, 140 patients were included in the study. Optic nerve sheath diameter was measured using ultrasound by the physician on admission into the critical care unit before initiation of anti-edema measures in whom ICP rise was suspected. It was compared with ONSD measurement obtained via CT using electronic calipers by a neuroradiologist. Evidence of ICP rise was identified using CT scan findings. Optic nerve sheath diameter measurements were taken twice in both the right and left eye each using ultrasound and CT scan to overcome inter-observer variability.

Results: A total of 150 patients were screened and 10 were excluded as they met exclusion criteria. The mean age (years) of the participants was 55.27 ± 14.90. The mean (SD) of ONSD (mm) (USG) was 4.97 (0.74). The mean (SD) of ONSD (mm) (CT) was 5.07 (0.71). Based on CT findings, 65.7% of the participants had evidence of raised ICP. At a cut-off of ONSD (mm) (CT) ≥5, it predicts raised ICP with a sensitivity of 56% and a specificity of 73%. At a cut-off of ONSD (mm) (USG) ≥4.825, it predicts raised ICP with a sensitivity of 74% and a specificity of 56%. There was no significant difference in the diagnostic performance of ONSD (mm) (CT) and ONSD (mm) (USG) in the receiver operator curve.

Conclusion: Ultrasonography-guided ONSD measurement is comparable with CT-guided ONSD measurement in patients with raised ICP in patients with acute neurological emergencies. Non-invasive intracranial pressure monitoring can be reliably utilized to manage acute neurological emergencies.

How to cite this article: Parameswaran P, Venkatachalam B, Selvi T, Selvaraj N, Ravi S. A Prospective Comparative Study of Optic Nerve Sheath Diameter Measurement by Ultrasonography vs Computed Tomography Scan for the Detection of Elevated Intracranial Pressure in Patients with Acute Neurological Emergencies. Indian J Crit Care Med 2026;30(1):50-55.

Background and aims: Sepsis remains a leading cause of pediatric in-hospital mortality, particularly in resource-limited settings. The Pediatric Sequential Organ Failure Assessment (p-SOFA) score is widely used to guide prognostication, but its performance in children is suboptimal. The Phoenix Sepsis Score (PSS), developed specifically for pediatric patients, may offer improved predictive accuracy, yet validation data from Eastern India are lacking. We aimed to evaluate and compare the predictive performance of the PSS and p-SOFA scores for in-hospital mortality among children with sepsis admitted to a resource-limited pediatric intensive care unit (PICU) in Eastern India.

Patients and methods: This prospective analytical study enrolled children aged 1 month to 15 years with suspected or confirmed sepsis over 18 months. The PSS and p-SOFA scores were recorded on day 1 and day 3. Predictive performance for in-hospital mortality was assessed using the areas under the receiver-operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), sensitivity, specificity, positive predictive value, and negative predictive value. Multivariable logistic regression was used to estimate adjusted odds ratios (aOR) for mortality.

Results: Among 105 included children, 21 (20%) died during hospital stay. Non-survivors had significantly higher PSS and p-SOFA scores on both day 1 and day 3 (p < 0.001). On day 3, the PSS showed superior predictive performance (AUROC 0.910; AUPRC 0.678) compared to p-SOFA (AUROC 0.861; AUPRC 0.595). A PSS ≥5 on day 3 was associated with 96% sensitivity and significantly increased odds of in-hospital mortality (aOR 40.0, 95% CI: 35.1-47.5).

Conclusion: Both scores are effective for mortality prediction, but the PSS demonstrated superior sensitivity, ease of use, and robustness in resource-limited environments. The PSS may serve as a more practical tool for early prognostication in pediatric sepsis.

How to cite this article: Kumar R, Ghosh A, Annigeri S, Prakash J, Jana D. Utility of Phoenix Sepsis Score for Predicting Mortality in Pediatric Sepsis: A Prospective Analytical Study from a Resource-limited Pediatric Intensive Care Unit in Eastern India. Indian J Crit Care Med 2026;30(1):27-34.

Critically ill patients have a physiologically difficult airway (PDA), wherein tracheal intubation (TI) and transition to positive pressure ventilation may lead to cardiorespiratory and other complications. Medications administered during the management of a PDA, have an impact on peri-intubation hemodynamics, and may influence patient outcomes. Appropriately choosing, and dosing medications, such as anesthetic induction agents, neuromuscular blocking agents (NMBAs) etc. are thus important considerations that clinicians should be aware of. However, despite significant awareness, and research in this area, there remains ambiguity in the choice of such drugs. This review provides an update on the pharmacology of airway management in patients with a PDA, discussing medications administration strategies widely used in this patient population. We review the current evidence related to the use of anesthetic induction agents, neuromuscular blocking agents, vasopressors, inotropes, and adjunctive agents and provide updated guidance on appropriate medication selection in the context of airway management in patients with a PDA.

How to cite this article: Karamchandani K, Khawaja A, Chaney W, Bangalore R, Myatra SN. The Pharmacology of Physiologically Difficult Airway Management and Impact on Hemodynamics: A Review. Indian J Crit Care Med 2026;30(1):68-76.

Background and aim: Length-based tapes are extremely useful in critically sick children to estimate weight, emergency drug dosages, size of the equipment, and dose of defibrillation/cardioversion. The Indian Academy of Pediatrics (IAP), Advanced Life Support (ALS), and Basic Life Support (BLS) group felt the need to develop an indigenous tape for Indian children. A color-coded length-based tape [Indian Children Length-based Tape (InChiTape)] was planned to develop and later validate it.

Patients and methods: The population included children admitted to the emergency in the age range of 1 month-12 years and weight range of 2.5-40 kg. A color-coded length-based tape was developed using the World Health Organization (WHO) weight-for-length/height charts for boys (≤5 years) and the IAP weight-for-length/height charts for boys (>5 years). The median weights/lengths, corresponding +2SD and -2SD lengths, were marked on the charts for boys starting from 2.5 kg onward.

Results: Fourteen centers from all zones of India pooled the data of 1,595 children. The majority of children were in the age range of 1-3.9 years (30%) and weight range of 5-9.9 and 10-14.9 kg (24.9 and 24.4%, respectively). The actual weight of children corresponded to the correct weight range/band on the InChiTape in 69.1% (n = 1,102) children, ranging from 56.6 to 78.4% in different age-groups and 55.5 to 76.3% in different weight ranges. There was a good correlation between actual weight and the average of respective weight range/band on the InChiTape (Pearson correlation of 0.95, p < 0.001).

Conclusion: The InChiTape is a rapid, reliable, and accurate method of estimating the weight of Indian children weighing 2.5-40 kg in an emergency.

How to cite this article: Angurana SK, Gupta S, Tiwari L, Shamarao S, Khera D, Sarkar M, et al. Development and Validation of Indian Children Length-based Tape (InChiTape) for Use in Critically Sick Children. Indian J Crit Care Med 2026;30(1):35-39.

Background and aims: Recent sepsis guidelines recognize myocardial dysfunction as a major contributor to the pathophysiology of septic shock. Sepsis-induced cardiomyopathy (SIC) is typically characterized by acute onset and potential reversibility. The present study aimed to determine the incidence, spectrum, and prognostic significance of myocardial dysfunction in patients with septic shock.

Patients and methods: We included patients aged 18 years or older diagnosed with septic shock. We excluded those having an improper window for transthoracic echocardiography, known cardiac diseases, pregnancy, or postcardiac arrest status. Eligible patients underwent transthoracic echocardiography within the first 24 hours of intensive care unit (ICU) admission. Echocardiography was used to assess systolic and diastolic function of both ventricles based on the criteria recommended by the American Society of Echocardiography (ASE). For patients with abnormal findings, a follow-up echocardiogram was conducted on day 7 to assess the reversibility of myocardial dysfunction.

Results: Myocardial dysfunction was identified in 39 of 71 patients, yielding an incidence of 54.9% (95% CI: 42.6-66.7). Mortality was significantly higher among patients with SIC, with 29 out of 39 succumbing to the condition. Sepsis-induced cardiomyopathy was characterized by various patterns, including left ventricular (LV) systolic dysfunction, LV diastolic dysfunction, and right ventricular (RV) dysfunction, with LV diastolic dysfunction being the most prevalent. Multivariable regression analysis, adjusting for potential confounders, demonstrated that the presence of SIC was an independent predictor of mortality.

Conclusion: Sepsis-induced cardiomyopathy was present in over half of the patients with septic shock, with diastolic dysfunction being the predominant subtype. Sepsis-induced cardiomyopathy was associated with increased mortality.

How to cite this article: Nadaf ZM, Ravikumar RH, Anand RK, Ramachandran R, Trikha A, Wig N, et al. Incidence and Prognostic Impact of Myocardial Dysfunction in Septic Shock: An Observational Cohort Study. Indian J Crit Care Med 2026;30(1):56-61.