Indian Journal of Critical Care Medicine最新文献

How to cite this article: Datta PK, Sathe P, Bhattacharjee A, Kundu R. In Light of the LANDI-SEP Trial: New Evidence or Double Jeopardy? Indian J Crit Care Med 2025;29(1):84-85.

How to cite this article: Prakash J, Vaibhaw V, Saran K. Controlling Glycemic Variability in Non-diabetic Sepsis Patients: A Step toward Precision in Critical Care. Indian J Crit Care Med 2025;29(1):6-7.

How to cite this article: Kannamani B, Srinivasan S. Ultrasound in Shock: Is It the Elusive Magic Bullet? Indian J Crit Care Med 2024;28(12):1091-1092.

How to cite this article: Srinivasan A, Prusty BSK. Author Response-High Altitude Liver Failure: An Infrequent Trigger. Indian J Crit Care Med 2024;28(12):1181.

Purpose: This systematic review aimed to assess the accuracy of ultrasound in diagnosing shock types among intensive care patients.

Materials and methods: A comprehensive search of PubMed, Embase, Scopus, Cochrane Central Register, and Google Scholar was conducted for controlled trials published up to June 2023. Two intensivists independently screened articles for full-text reviews and abstracts, evaluating study quality using the QUADAS-2 tool. Prospective studies assessing ultrasound for diagnosing shock types in critically ill patients with undifferentiated shock were included.

Results: Among 7287 articles identified, four met the inclusion criteria for meta-analysis. Pooled positive likelihood ratios were 8.8 (95% CI: 2.4-32.37) for distributive shock and 137.56 (95% CI: 27.76-681.64) for obstructive shock. Summary receiver operating characteristic (SROC) curves showed an area under the curve (AUC) of 0.99 for cardiogenic and obstructive shock, 0.5 for hypovolemic and mixed shock, and 0.76 for distributive shock. Pooled negative likelihood ratios ranged from 0.05 (95% CI: 0.010 to 0.24) for cardiogenic shock to 0.22 (95% CI: 0.127-0.38) for mixed-etiology shock.

Conclusion: Ultrasound demonstrates high accuracy in diagnosing obstructive and cardiogenic shock among intensive care patients with undifferentiated shock. However, its utility for other shock types appears limited.

How to cite this article: Karigowda L, Gupta B, Elkady H, Deshpande K. Diagnostic Accuracy of Ultrasound in Intensive Care Patients with Undifferentiated Shock: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2024;28(12):1159-1169.

The synthetic antimicrobial agent Linezolid effectively penetrates many tissues and exhibits effectiveness against drug-resistant Gram-positive bacteria. This agent's pharmacokinetic qualities cast doubt on the need for intravenous treatment in cases of serious illness. For its time-dependent action to have an impact, serum levels must stay above the minimum inhibitory concentration throughout the dosage interval. According to our research, Linezolid infusions have been proposed to be given as continuous infusions to maintain adequate tissue and serum levels without trough concentration fluctuations. This will optimize the drug's effects and protect against toxicity and drug resistance. In critically ill individuals experiencing septic shock in the ICU, this study sought to validate the safety and efficacy of continuous Linezolid infusion in comparison to the conventional regimen. A prospective, randomized, controlled research involving 140 individuals suffering from septic shock who were older than 18 was carried out. Two groups of patients were randomly assigned. With an average treatment duration of 9.83 ± 2.537 in the intermittent infusion group and 7.39 ± 1.653 in the continuous infusion group, the first group obtained IV linezolid 600 mg twice daily as an intermittent infusion (II) over 60 minutes, whereas the second group obtained 300 mg IV as a loading dosage, and then continuous infusion of 900 mg/day in the first day and 1,200 mg/day in the subsequent days. There was a significantly high clinical cure and less ICU and hospital stay in the continuous infusion group (p < 0.001). Moreover, there was a lower incidence of developing thrombocytopenia in patients with renal impairment who got continuous infusion. Continuous infusion modality showed an advantage in terms of enhancing clinical efficacy in seriously ill cases with septic shock secondary to Gram-positive bacterial infection, especially in cases with renal impairment.

How to cite this article: Albadry AM, Zakaria HY, Elhefny MM, Elsherif IM. Efficacy and Safety of Continuous vs Intermittent Linezolid Infusion in Critically Ill Patients with Septic Shock. Indian J Crit Care Med 2024;28(12):1118-1121.

Aims and background: Glucocorticoids, vitamin C and thiamine have important biological effects in patients with sepsis and septic shock. Multiple studies have demonstrated the beneficial role of a combination therapy of vitamin C, hydrocortisone and thiamine in patients with sepsis and septic shock in terms of mortality reduction, and increase in the number of days free of ventilators and vasopressors.

Materials and methods: Patients who had septic shock were assessed for eligibility after intensive care unit (ICU) admission. After randomization, the treatment group received a combination of vitamin C, thiamine and hydrocortisone for a duration of 96 hours (16 doses) and the control group received hydrocortisone for a duration till the patient was on vasopressors. The primary outcome assessed was ICU mortality, and the key secondary outcome was the duration free of vasopressor administration at the end of 7 days.

Results: A total of 86 patients were included in the study. Seventy percent of patients in the control group and 58 percent in the intervention group died during ICU stay. None of the primary and secondary outcomes were statistically significant.

Conclusion: The use of a combination of vitamin C, hydrocortisone and thiamine has no added benefits over the use of hydrocortisone alone in patients with septic shock.

Clinical significance: The results of this clinical trial shows that the use of a combination of vitamin C, hydrocortisone and thiamine in patients with septic shock is not useful and should not be a routine practice in critically ill septic patients.

How to cite this article: Sharma S, Paneru HR, Shrestha GS, Shrestha PS, Acharya SP. Evaluation of the Effects of a Combination of Vitamin C, Thiamine and Hydrocortisone vs Hydrocortisone Alone on ICU Outcome in Patients with Septic Shock: A Randomized Controlled Trial. Indian J Crit Care Med 2024;28(12):1147-1152.

Introduction and aims: Urine output (UO) in response to furosemide stress test (FST) can predict the progression of acute kidney injury (AKI). This study aimed to assess if changes in UO, urine spot sodium (USS), urine spot sodium creatinine ratio (USSCR) and changes in these parameters over 6 hours could differentiate between progressive and non-progressive AKI.

Materials and methods: Fifty critically ill adults with AKI in acute kidney injury network (AKIN) stages I and II with volume overload were included in this prospective study. The FST was performed with 1 mg/kg intravenous bolus. Hourly UO, USS, USSCR, maximum USS difference (USSDMAX), and maximum USSCR difference (USSCRDMAX) were documented. Any progression of AKI was noted till day 3.

Results: A total of 50 patients were recruited and n = 10 had progressive AKI (PAKI) and n = 40 had non-progressive AKI (NPAKI). Urine output at 1 and 2 h were significantly less in PAKI group. USS0, USS2, USS6, and USSDMAX were comparable between the groups. USSCR0 and USSCR6 were comparable between the groups whereas USSCR2 and USSCRDMAX were significantly less in PAKI group. USSDMAX did not correlate with UO1 (correlation coefficient 0.2, p = 0.16). However, USSCRDMAX showed a poor but significant correlation with UO1 (correlation coefficient 0.3, p = 0.03).

Conclusion: To conclude, hourly UO in the first two hours and maximum change in USSCR within 6 hours following the FST may have an important role in early differentiation of progressive AKI in critically ill patients.

How to cite this article: Suhas P, Anand RK, Baidya DK, Dehran M. Role of Spot Urine Sodium in Furosemide Stress Test in Volume-overloaded Critically Ill Patients with Acute Kidney Injury. Indian J Crit Care Med 2024;28(12):1107-1111.

How to cite this article: Kannan S. Letter to the Editor: In Response to the Retraction Notice of an Article. Indian J Crit Care Med 2024;28(12):1184.

How to cite this article: Chatterjee R, Gupta L. The Reality of Evaluating Urine Spot Sodium and Urine Spot Sodium Creatinine Ratio in Furosemide Stress Test as a New Biomarker in Diagnosing Progressive AKI in Critically Ill. Indian J Crit Care Med 2024;28(12):1089-1090.