Indian Journal of Critical Care Medicine最新文献

Background and aims: Heating and humidification of ventilator gas are essential to ensure optimal ventilator support in critically ill children. Heat and moisture exchangers (HME) offer a simpler and more cost-effective method of humidification compared to active systems like heated humidifiers (HH). However, the efficacy and impact of HME on ventilator-related adverse events (VAEs) in children remain underexplored. This study aims to compare the incidence of VAEs in children managed with HME versus those using a HH during mechanical ventilation.

Patients and methods: This open-label randomized controlled trial was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital in South India from January 2022 to July 2023. Sixty children aged 2-15 years, who were expected to require mechanical ventilation for more than 48 hours, were enrolled. Patients were randomized into two groups after age-based stratification (2-5 years and 6-15 years). The intervention group received humidification via HME, while the control group received a HH. Patients were monitored until discharge, and daily assessments were performed to identify any VAEs for the first 7 days of mechanical ventilation.

Results: The primary outcome was the incidence of VAEs, expressed per 1,000 ventilator days. The HME group reported 28.36 VAEs per 1,000 ventilator days, while the HH group had 12.98 VAEs per 1,000 ventilator days. This difference was not statistically significant (p = 0.42). Other variables, including the average frequency of suctioning per day, total ventilator days, maximal peak inspiratory pressure, and mortality, were comparable between the groups.

Conclusion: This pilot randomized controlled trial did not find a statistically significant difference in the incidence of VAEs between use of HME and HHs in children. Given its simplicity and cost-effectiveness, HME may be cautiously considered for use in mechanically ventilated pediatric patients aged 2-15 years.

How to cite this article: Palanisamy S, Kodakkattil Sreevilasan S, Venkatesh L, Jose D, Gowtham BC, Parameswaran N. Effect of Heat and Moisture Exchanger vs Heated Humidifier on Ventilator-related Adverse Events in Children: A Pilot Randomized Controlled Trial. Indian J Crit Care Med 2025;29(9):746-752.

Background and aim: This study aims to compare the oxygenation saturation index (OSI), a noninvasive marker, with commonly used invasive markers of oxygenation [PaO₂, PaO₂ to FiO₂ (P/F) ratio, oxygenation index (OI)] in critically ill patients requiring invasive mechanical ventilatory support after 48 hours of admission in a surgical intensive care unit (ICU).

Patients and methods: A total of 91 intubated patients aged between 18 and 75 years admitted to the surgical ICU with preexisting or new onset respiratory failure were recruited as per predefined exclusion and inclusion criteria after being on the ventilator for 48 hours. Patients were enrolled in the study for 7 days or till extubation, tracheostomy, or death. The OSI was compared with other invasive and noninvasive markers to assess correlation.

Results: Strong correlation of OSI with P/F ratio, SpO₂/FiO₂ (S/F) ratio, and OI individually was noted up to 7 days post 48 hours of intubation in critically ill patients, while it correlated with SpO₂ on days 2, 3, 4, and 5 and PaO₂ on days 2, 4, and 5, respectively. Correlation after natural logarithmic transformation was strongest for OI (r = 0.833), followed by S/F ratio (r = 0.686), P/F ratio (r = 0.409), SpO₂ (r = 0.229), and weakest for PaO₂ (r = 0.045).

Conclusion: Oxygen saturation index is a valid noninvasive marker of oxygenation in critically ill intubated patients and correlates well with invasive markers of oxygenation.

How to cite this article: Koshy A, Kurian G, Jacob J, Vincent D, Rao SV, Subramani K, et al. Role of Oxygen Saturation Index as a Noninvasive Surrogate Marker of Oxygenation in Intubated Critically Ill Adult Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(9):765-770.