Indian Journal of Critical Care Medicine最新文献

Aim: Mechanical power (MP) has been proposed as a predictor of acute respiratory distress syndrome (ARDS) mortality, but evidence remains conflicting. We aimed to study its prognostic utility in predicting mortality in ARDS.

Patients and methods: This was a single-center prospective observational study including 137 ARDS patients. The organ dysfunction scores, MP and its components (elastic static, elastic dynamic, and resistive power), driving pressure (DP), severity of acute kidney injury (AKI), lung ultrasound scores, pulmonary artery hypertension, days of intensive care unit (ICU) stay, and mortality outcomes were noted.

Results: Out of 137 ARDS patients, there were 73 (53.3%) non-survivors. Mechanical power was significantly higher with median [interquartile range (IQR)] 29 (24.55-32) J/min in the mortality group and 24 (20-28.75) J/min in the survival group (p-value < 0.001, Mann-Whitney U-test). However, MP was not an independent predictor of mortality. Driving pressure is an independent predictor of mortality with DP >16 cm H₂O, hazard ratio (HR) for mortality 2.925 [(95% confidence interval (CI) 1.778-4.810), Cox-proportional hazard p-value < 0.001]. Out of the three components of MP, dynamic elastic power component is the main contributor to high MP (=29 J/min).

Conclusion: Although MP is significantly higher in ARDS non-survivors as compared to survivors, adjustments for confounders showed that it is not an independent predictor of mortality. Driving pressure is an independent predictor of mortality. Elastic dynamic power is the most important component of high MP.

How to cite this article: Medhi PP, Chaudhuri S, Parampalli V, Devadiga S, Mareguddi AB, Karanth S, et al. Mechanical Power and its Components vs Driving Pressure for Predicting Mortality in Acute Respiratory Distress Syndrome: A Prospective Observational Study. Indian J Crit Care Med 2025;29(10):815-822.

How to cite this article: Prakash J, Saran K, Choudhuri B. Early Vasopressin in Septic Shock-Promise, Paradox, and the Pursuit of Precision. Indian J Crit Care Med 2025;29(10):799-801.

Aim: To investigate how well trigger tools function while evaluating adverse drug reactions (ADRs) among patients in emergency intensive care units (EICUs) and to assess the sensitivity of the Institute for Healthcare Improvement: Global Trigger Tool (IHI: GTT) for reporting adverse drug events among patients admitted to EICUs.

Methods: A prospective, continuous, single-center research study was conducted for 9 months in the Department of Accident and Emergency Medicine. Triggers were defined based on the IHI GTT and Menat trigger tool. Each flagged case was reviewed for 15 minutes, which provides an equitable balance between efficiency and thoroughness to confirm the presence of an ADR. Performance metrics were calculated and analyzed.

Results: Three hundred medical records were collected, and 167 cases were randomly analyzed using 87 triggers. The prevalence of ADRs was 28%. The trigger tools showed 83.8% sensitivity and 48.7% specificity. The results indicated that the negative predictive value was 92.3%, while the positive predictive value was 72.9%.

Conclusion: Trigger tools are a useful way to identify ADRs, even though issues with specificity and false positives still exist. Further improvements in technology and ongoing development will probably make these instruments even more effective and efficient in the dynamic environment of EICUs.

How to cite this article: Prakash N, Kumar AP, Ramesh AC, Boopathi D, Deepalaksmi M. Performance of Trigger Tools in Identifying Adverse Drug Events in Emergency Intensive Care Unit: A Prospective Observational Study. Indian J Crit Care Med 2025;29(10):861-864.

How to cite this article: Zarrouk S, Finsterer J. Due to Limitations in the Feasibility of the Perme Score, it should not be Used to Classify Muscle Weakness in Intensive Care Unit Patients. Indian J Crit Care Med 2025;29(10):882-883.

How to cite this article: Kotal S, Chatterjee S, Pain S, Kundu AK. Author Response: Comment on "A Prospective Study to Assess the Profile and Outcome of Acute Paraquat Poisoning in a Tertiary Care Hospital of West Bengal". Indian J Crit Care Med 2025;29(10):888.

How to cite this article: Finsterer J. A Neurological Outcome Score for Ventilated Pediatric Intensive Care Unit Patients Should Only Include Neurological, Objective Outcome Parameters. Indian J Crit Care Med 2025;29(10):876-877.

Background and aims: Postcardiac arrest shock in pediatric patients poses significant clinical challenges due to high morbidity and mortality rates. Despite advancements in resuscitation techniques, managing postcardiac arrest syndrome remains complex. Traditionally, epinephrine has been used for postresuscitation shock, but recent studies suggest potential adverse effects. Norepinephrine, commonly used in adults, may offer advantages but lacks sufficient evidence in pediatric populations. This study aims to compare the efficacy and safety of norepinephrine vs epinephrine in children experiencing postcardiac arrest shock.

Methodology: This single-center, double blind, randomized controlled trial (RCT) will be conducted at a tertiary care hospital in India. It will include children aged 1 month to 18 years who experience cardiac arrest from noncardiac causes, achieve return of spontaneous circulation (ROSC), and develop postresuscitation shock. Patients with known cardiac diseases will be excluded. Participants will be randomized to receive either norepinephrine or epinephrine infusions. The primary outcome is in-hospital mortality. Secondary outcomes include duration of vasopressor use, mean arterial pressure (MAP) response, neurological outcomes [cerebral performance category (CPC) scale], and incidence of arrhythmias.

Results: For analysis, categorical variables will be compared using the Chi-square test or Fisher's exact test, while continuous variables will be analyzed using either the independent Student's t-test or the Mann-Whitney U test, as appropriate.

Conclusion: This study will provide critical evidence on the comparative efficacy and safety of norepinephrine and epinephrine in pediatric postcardiac arrest shock, addressing a significant knowledge gap in pediatric critical care.

Trial registration number: Clinical-Trials-Registry-India, Ref. No. CTRI/2025/03/081706 dated 5th March, 2025. https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTE0NzM0&Enc=&userName=.

How to cite this article: Prasad A, Ghorui A, Kumar P, Halder P. Comparison of the Efficacy of Epinephrine vs Norepinephrine in Clinical Outcomes among Children with Postcardiac Arrest Shock: A Hospital-based, Double Blind, Randomized Controlled Trial. Indian J Crit Care Med 2025;29(10):868-873.

Background and aims: Artificial intelligence (AI) has proven to be a highly useful tool in the clinical setting, especially in the Intensive Care Unit (ICU). The use of various AI-mediated instruments to guide medical treatments and even support surgical procedures has been previously described, but there is still no aggregated evidence on its usefulness in assisting the physical rehabilitation process of critically ill patients, understanding that this is extremely important to prevent the development of muscle weakness in the ICU. This review, therefore, aimed to describe the usefulness of AI in supporting the physical rehabilitation of patients admitted to the ICU.

Materials and methods: This scoping review was conducted following the Joanna Briggs Institute (JBI) methodology, originally developed by Arksey and O'Malley. A structured search strategy based on a Population, Concept, and Context (PCC) framework was used to search PubMed, Web of Science, Scopus, and the Virtual Health Library (VHL) databases.

Results: The initial search yielded 116 articles. After removing duplicates and applying exclusion criteria during title and abstract screening, eight studies were included in the final analysis. Identified tools included noninvasive mobility sensors, robotic assistance systems, machine learning algorithms, and software to support musculoskeletal ultrasound assessment.

Conclusion: Artificial intelligence is emerging as a key tool for ICU rehabilitation, offering objective data, enhancing patient monitoring, and streamlining assessment processes.

How to cite this article: Payán-Salcedo HA, Castro Aguilera AM, Salinas Batioja MF, Castillo Diaz LM. Application of Artificial Intelligence in Physical Rehabilitation of Patients Admitted to the Intensive Care Unit: A Scoping Review. Indian J Crit Care Med 2025;29(10):851-860.

Background and aims: Postoperative nursing care plays a crucial role in improving outcomes and enhancing the recovery of patients undergoing abdominal surgery. Enhanced recovery after surgery (ERAS) protocols have been shown to significantly reduce postoperative complications and length of hospital stay by promoting early mobilization and faster recovery. The aim of the study was to evaluate the effects of early postoperative feeding and mobilization on the length of postoperative hospital stay and complications among patients.

Patients and methods: A quantitative approach with a quasi-experimental pretest-posttest control group design was used in the study. The lower extremity exercises and oral feeding were initiated as early as possible, as tolerated by the patient, in the experimental group. Passage of the first flatus and return of bowel function are considered to initiate the feed following surgery among patients in the treatment-as-usual group.

Results: In the present study, 53.6% of the study participants in the experimental group and 29.6% in the treatment-as-usual group were nil per oral (NPO) for 1 hour in the postoperative phase. By 24 hours postoperatively, most patients had initiated oral feeding (86% in the experimental and 77.5% in the treatment-as-usual groups). Delayed feeding was uncommon in the experimental group, with only a few patients remaining NPO for 2-5 days (14%). In contrast, a higher proportion in the treatment-as-usual group remained NPO beyond 2 days (16.9%), with some as late as 9 days (1.4%). Patients in the experimental group had a significantly shorter length of stay in the recovery unit and also in the postoperative ward compared to those who received standard treatment. Immediate postoperative complications occurred in 8.4% of the experimental group and 26.6% of the treatment-as-usual group, which were assessed using a checklist prepared by the investigators.

Conclusion: Implementation of evidence-based nursing interventions during the postoperative phase achieves significant improvements in patient outcomes. This underscores the importance of integrating current research and best practices into routine patient care to enhance recovery and also reduce the burden on the health care system.

How to cite this article: Barboza HR, Moosabba MS, Lobo AS. Enhanced Surgical Recovery Nursing Program: A Focus on Initiation of Early Feeding and Mobilization Following Elective Abdominal Surgery. Indian J Crit Care Med 2025;29(10):823-828.