Indian Journal of Critical Care Medicine最新文献

Background and aims: We performed this systematic review and meta-analysis to study the timing of vasopressin initiation and its association with patient-centered outcomes in adult patients with septic shock.

Data sources and study selection: We searched Embase, PubMed, and Web of Science for eligible prospective, retrospective studies, and Randomized controlled trials (RCTs) from January 2013 to December 2024 in adult patients with septic shock that compared an early (<6 hours) vs late strategy (>6 hours) of vasopressin initiation. Our primary outcome was short-term mortality, while other secondary outcomes included hospital and ICU mortality, incidence of renal replacement therapy (RRT), occurrence of new-onset arrhythmias (NOA), and ICU and hospital length of stay (LOS).

Results: Seven studies with a total of 3,993 patients were included in the systematic review and meta-analysis. Early initiation of vasopressin was associated with a lower short-term mortality [relative risk (RR) 0.84, 95% CI: 0.71-0.99; p = 0.033, I ² = 30.2%], which was the primary outcome of our study. Early vasopressin initiation was associated with a decrease in hospital mortality (RR 0.83, 95% CI: 0.76-0.92; p = 0.0003, I ² = 17.9%), decreased requirement of RRT (RR 0.78, 95% CI: 0.61-0.99, p = 0.043, I ² = 31%), decreased ICU mortality (RR 0.86, 95% CI: 0.78-0.95; p = 0.003, I ² = 0%) and hospital LOS) [mean difference (MD) -1.83 (-3.41 to -0.25) days, p = 0.02]. There was no difference in new-onset arrhythmia or length of ICU stay between the two groups.

Conclusion: We report a significant advantage of initiating vasopressin within six hours for patients experiencing septic shock. However, the studies contributing to this meta-analysis are characterized as being at high risk of bias.

How to cite this article: Bhattacharjee A, Datta PK, Kumar V, Ravikumar RH, Sathe P, Kundu R. Timing of Vasopressin Initiation in Patients with Septic Shock: An Updated Systematic Review and Meta-analysis with Trial Sequential Analysis. Indian J Crit Care Med 2025;29(10):839-850.

How to cite this article: Venkatesan DK, Kambagiri P. Tracheostomy in Children: A Call for Deeper Reflection. Indian J Crit Care Med 2025;29(10):880.

Sepsis is associated with significant morbidity and mortality in critical care units, for which there is no effective therapy at present. The failure of corticosteroids and cytokine-targeted therapies suggests that an out-of-the-box approach is needed to understand their pathobiology and develop effective therapy. Essential fatty acids (EFAs) and their metabolites have both pro- and anti-inflammatory actions, regulate the production and actions of cytokines, and modulate immune response. Patients with sepsis have significantly lower concentrations of gamma-linolenic acid (GLA), dihomo-GLA (DGLA), arachidonic acid (AA) of the n-6 series, and alpha-linolenic acid (ALA) and eicosapentaenoic acid (EPA) of the n-3 series that are derived from EFAs in their plasma phospholipid fraction. Corticosteroids inhibit the metabolism of EFAs to their long-chain metabolites in addition to suppressing the formation of eicosanoids from DGLA, AA, EPA, and DHA. Interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) inhibit the activities of desaturases and thus decrease the formation of GLA and AA from LA and EPA and DHA from ALA. Thus, corticosteroids and cytokines interfere with EFA metabolism, which may explain their ineffectiveness in sepsis. It is suggested that sepsis is an EFAs deficiency state that leads to dysregulated inflammation and immune response and failure of resolution of inflammation and wound healing. It is proposed that restoring EFAs and their metabolism to normal can prevent and manage sepsis and other similar inflammatory disorders/diseases.

How to cite this article: Das UN. Is Sepsis an Essential Fatty Acids Deficiency State? Indian J Crit Care Med 2025;29(10):802-806.

How to cite this article: Kumar M, Sundarsingh V. Pitfalls in the Diagnosis of Acute Kidney Injury and Hepatorenal Syndrome in Cirrhosis. Indian J Crit Care Med 2025;29(10):874.

How to cite this article: Singh NP, Kothekar AT. From Radiation to Resonance: Ultrasound vs Traditional Imaging in Intensive Care Unit Lung Pathologies. Indian J Crit Care Med 2025;29(10):797-798.

How to cite this article: Yadav S, Ekka M, Vinayak MS. Author Response: Pitfalls in the Diagnosis of Acute Kidney Injury and Hepatorenal Syndrome in Cirrhosis. Indian J Crit Care Med 2025;29(10):875.

Aims and background: Myroides spp. is an environmental pathogen and causes disease in immunocompromised patients. In this study, we report an outbreak of urinary tract infections (UTIs) caused by Myroides odoratimimus (M. odoratimimus) in a university hospital in Turkey.

Methods: A total of 25 M. odoratimimus strains isolated from the clinical samples of 20 patients in our intensive care units and clinics were included in the study. Phenotypic and genotypic identification of isolates was performed using conventional methods, VITEK®-2 automated identification system, Matrix Assisted Laser Desorption/Ionization-Time of Flight Mass Spectrometry, and 16S-RNA Microbial Diagnosis methods. In addition, the repetitive extragenic palindromic (REP) elements polymerase chain reaction (PCR) assay method was applied for molecular epidemiological analysis.

Results: All cases were diagnosed with nosocomial UTI, except for one case diagnosed with nosocomial bacteremia. One of the M. odoratimimus isolates was sensitive to piperacillin/tazobactam (MIC: ≤4 µg/mL), and one isolate was moderately sensitive to cefepime (MIC: 16 µg/mL). Other all M. odoratimimus isolates were resistant to the tested antibiotics beta-lactams, monobactams, carbapenems, aminoglycosides, fluoroquinolones, and sulphonamides. When 10 isolates were evaluated with the REP PCR method, DNA fingerprint similarities were visually determined, and there was a similar DNA pattern among them. The source of Myroides infection could not be identified from the environmental samples.

Conclusions: The increasing population of immunosuppressed patients suggests that M. odoratimimus and other opportunistic multi-drug resistant pathogens with resistance to broad-spectrum antibiotics may be encountered more frequently in critical units in future.In order to choose the optimal antibiotic regimen, awareness and an index of suspicion regarding this atypical pathogen are important for rapid identification and appropriate susceptibility testing.

Clinical significance: It has been observed that the pathogenicity of M. odoratimimus bacteria has increased recently, and it can not only cause UTIs but more serious manifestations such as sepsis with bacteremia, which can be life-threatening.

How to cite this article: Savci U, Eser B, Sungur M, Yildiz SS, Akdogan O, Caliskan S, et al. A New Emerging Threat in Critical Care: Myroides odoratimimus Outbreak in a Tertiary Hospital. Indian J Crit Care Med 2025;29(10):829-838.

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.