Indian Journal of Critical Care Medicine最新文献

Background and aims: Frailty is a multifaceted condition characterized by diminished physiological reserves, reduced resilience, and heightened vulnerability to stressors. Its prevalence among critically ill patients, particularly those with cancer, poses unique challenges due to pre-existing impairments and comorbidities. This study aims to evaluate the prevalence of frailty in critically ill cancer patients, identify associated risk factors, and assess its impact on acute clinical outcomes and 90 days postdischarge health-related quality of life (HRQOL).

Patients and methods: A prospective, single-center cohort study was conducted between October 2021 and September 2022, enrolling critically ill cancer patients admitted to the intensive care unit (ICU). Frailty was assessed using the clinical frailty scale (CFS) within 48 hours of ICU admission. Data on demographics, illness severity [acute physiology and chronic health evaluation II (APACHE II) score], nutritional status, and clinical outcomes were collected. Ninety days postdischarge HRQOL was evaluated using the EuroQol 5-dimension 5-level (EQ-5D-5L) questionnaire.

Results: All 627 enrolled patients were identified as frail, with 79.7% categorized as having mild frailty. Age (p = 0.006) and higher Charlson comorbidity index (CCI) scores (p < 0.001) were significant risk factors for frailty. Frailty severity was significantly associated with a prolonged requirement for vasoactive support, invasive ventilation, ICU and hospital stay, ICU readmission, delayed mobilization, and increased mortality (p < 0.05). Ninety days postdischarge, patients with higher frailty grades reported worsened mobility, self-care, usual activities, pain/discomfort, and lower subjective health scores (p < 0.05).

Conclusion: Frailty is highly prevalent among critically ill cancer patients. Increasing frailty adversely impacts clinical outcomes and postdischarge HRQOL. Tailored interventions are essential to address the complex needs of this vulnerable population.

How to cite this article: Sundaramurthy SK, Murali Rajagopalan TS, Balakrishnan P, Ramakrishnan N, Dominic Savio R. Frailty in Critically Ill Cancer Patients in a Lower-middle Income Country-Prevalence, Risk Factors, and Impact on Acute Clinical Outcomes and Postdischarge Health-related Quality of Life: A Single Center Study. Indian J Crit Care Med 2026;30(1):19-26.

Background and aims: The pCO₂ gap, calculated by the difference between central venous and arterial partial pressure of carbon dioxide, has been evaluated as a global index of tissue perfusion. We aimed to evaluate whether the pCO₂ gap could be used to identify patients in the immediate postoperative period following high-risk major abdominal surgery to predict the occurrence of postoperative complications.

Patients and methods: A prospective observational study included all postoperative high-risk adult surgical patients admitted to the intensive care unit (ICU) after major abdominal surgery. The pCO₂ gap, central venous oxygen saturation (ScvO₂), lactate levels, and postoperative complications were recorded at ICU admission, and after 12-24 hours.

Results: Sixty-three patients undergoing major abdominal surgery were included in the study. The mean age of the study population was 53 ± 20 years. The patients who had persistently high pCO₂ gap >6 mm Hg at 24 hours postoperatively had a higher incidence of complications (n = 19.31%) compared to the group of patients with pCO₂ gap <6 mm Hg (n = 41.68%). The mean pCO₂ gap in the postoperative period at 24 hours was higher in patients with complications than those without complications (7.30 ± 0.60 vs 4.24 ± 1.30 mm Hg). Higher pCO₂ gap and higher sequential organ failure assessment (SOFA) score were independently associated with postoperative complications. The pCO₂ gap at ICU admission had a higher sensitivity and specificity than ScvO₂ and lactate for differentiating between patients who did and who did not develop complications.

Conclusion: High pCO₂ gap (>6 mm Hg) can be used as a complementary tool to predict postoperative complications in high-risk patients following major abdominal surgery.

How to cite this article: Kaur A, Paul G, Gautam PL, Sama A, Singh VP. Central Venous-arterial Carbon Dioxide Difference (pCO₂ gap) as a Guide to Predict Complications in Postoperative High-risk Surgical Patients: A Prospective Observational Study. Indian J Crit Care Med 2026;30(1):62-67.

Background and aims: In-hospital cardiac arrest (IHCA) remains a major cause of mortality among hospitalized patients globally. This prospective, multicenter, observational study assessed the associations of a tele-intensive care unit (Tele-ICU) hemodynamic surveillance program and clinical outcomes in adult inpatients monitored across three tertiary-care hospitals in India.

Patients and methods: From September 2024 to August 2025, 5,253 adult inpatients in ICUs, general wards, and Emergency Departments (EDs) were continuously monitored by a centralized Tele-ICU hub. Pre-specified thresholds for hemodynamic parameters generated real-time alerts, which were verified and adjudicated by Tele-ICU intensivists according to a standardized protocol. Outcomes, interventions, and mortality were analyzed using full multivariable logistic regression, with clearly defined denominators and clustering by site to account for within-site addressed.

Results: A total of 2,278 patients (43.3%) experienced clinically significant hemodynamic alerts. The system's alerting and verification protocol demonstrated a sensitivity of 79.2% and specificity of 80.1%, with consistent performance across sites and locations. Median acute physiology and chronic health evaluation (APACHE) II score was 16 [interquartile range (IQR) = 12-22]. Patients experiencing verified alerts had a mortality rate of 12% (n = 273), which is lower than the APACHE-predicted rate of 24.5% (risk-adjusted mortality ratio = 0.69; calibration plot provided). Multivariable logistic regression, including age, sex, APACHE II, diagnosis group, comorbidities, admission location, and time to intervention, showed that early intervention ≤15 minutes after alert was associated with lower odds of in-hospital mortality [adjusted odds ratio (aOR) 0.65, 95% CI: 0.52-0.81, p < 0.001; C-statistic 0.83].

Conclusion and clinical significance: The early recognition and verification of hemodynamic alerts in Tele-ICU were associated with improved clinical outcomes and a lower risk-adjusted mortality.

How to cite this article: Dharanindra M, Potineni RB, Rayana S, Thommandru S, Shaik J, Jampala K, et al. Tele-Intensive Care Unit-associated Early Recognition of In-hospital Hemodynamic Events and Clinical Outcomes: A Multicenter Observational Study. Indian J Crit Care Med 2026;30(1):40-49.

Background: A Code Blue in a hospital means that there is a critical medical emergency that requires immediate resuscitation, usually because of cardiac or respiratory arrest. When activated, a specific Code Blue team rapidly takes action to implement life-saving measures. Timely post-Code Blue debriefings are important for team learning, clinical outcomes, and the emotional support of healthcare workers. Debriefing is often ignored due to various problems.

Aims: To determine what hinders healthcare professionals (HCPs) from conducting post-Code Blue debriefing, examine factors facilitating debriefing, and assess the association between the perceived barriers and the demographic characteristics of HCPs.

Patients and methods: A cross-sectional study involved the Code Blue teams from two tertiary hospitals in Taif City. A survey questionnaire was utilized to assess perceived barriers and facilitators that could enhance post-Code Blue debriefing. Multiple linear regression, the Kruskal-Wallis test, Spearman's correlation, and descriptive statistics were used.

Results: Three primary obstacles to successful debriefing emerged: Leadership, communication, and psychological/emotional. Most barriers pertained to leadership, such as work (mean = 3.65), inadequate resources, and lack of debriefing guidelines and effective training. Ongoing leadership support (mean = 3.75), structured protocol, and allocated time were the most effective facilitators for debriefing. Compared to their older colleagues, younger practitioners reported significantly more communication-related barriers (p = 0.037), indicating that experience may affect post-event discussions. Leadership and psychological barriers were also found to be moderately positively correlated.

Conclusion: Healthcare professionals acknowledge the crucial role of post-Code Blue discussions; however, leadership, emotional, and interpersonal barriers hinder debriefing conductions. Leadership involvement, design of debriefing guidelines, and emotional safety may encourage the regular conduct of debriefing sessions.

How to cite this article: AbdElbagy A. Enhancing Post-Code Blue Debriefing through Identification and Overcoming Barriers Encountered by Healthcare Practitioners. Indian J Crit Care Med 2025;29(12):1026-1031.

How to cite this article: Vijayasimha M, Jayarajan D, Mir ZR. From Narrative to Navigation-A Translational Roadmap for AI-enabled Early Sepsis Prediction: Comment on Shanmugam et al. Indian J Crit Care Med 2025;29(12):1050-1051.