Indian Journal of Critical Care Medicine最新文献

Background: To estimate a correlation between change in lung ultrasound aeration score (LUSS) and mortality in patients with ventilator-associated pneumonia.

Materials and methods: We conducted a prospective observational study in which lung ultrasound, the partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO₂/FiO₂ ratio), and static lung compliance were performed for five consecutive days since the diagnosis of ventilator-associated pneumonia (day 1-5) in a 20-bed multidisciplinary intensive care unit in at a tertiary care academic institute in Northern India. A hundred and seventeen ventilated patients were studied for the first 5 days after ventilator-associated pneumonia (VAP) development. Lung ultrasounds were performed with an ultrasonography machine using a round-tipped probe of 2-5 MHz at six different areas of each hemithorax, which includes superior and inferior in anterior, lateral, and posterior lung fields. Patients with a decreased LUSS of 2 were labeled as responders. A decrease of LUSS of less than 2 or an increase of LUSS were leveled as nonresponders.

Results: The correlation between the change in LUSS between days 1 and 5 was significant with 28-day mortality (26.3% in responders vs 87.8% nonresponses with p < 0.001).

Conclusion: The responders to treatment for VAP described by LUSS had lower mortality than non-responders.

How to cite this article: Panda S, Agarwal A, Mishra SB, Jain G, Talawar P. Lung Ultrasound Score as a Predictor of Clinical Severity and Prognosis in Patients of Ventilator-associated Pneumonia. Indian J Crit Care Med 2024;28(11):1009-1014.

Background: Out-of-hospital cardiac arrest (OHCA) is a significant global health challenge with high incidence and low survival rates; this study aimed to predict mortality in these patients.

Methods: This 5-year retrospective chart review, conducted at the emergency departments (EDs) of two tertiary hospitals, systematically categorized, coded, and analyzed variables to assess mortality risk in OHCA patients.

Results: Of the 822 (36.5%) patients who met the inclusion criteria, the mean age was 60.2 years (SD ± 17.6), with 65.7% being male. Cardiopulmonary resuscitation (CPR) was attempted on 586 patients, with 178 (30.4%) achieving return of spontaneous circulation (ROSC) in the ED. Significant risk factors for mortality included hypertension (p = 0.01), diabetes mellitus (p = 0.05), respiratory illnesses (p = 0.04), and having three or more comorbidities (p = 0.01). Manifestations in previous ED visits (<180 days), such as cardiac complaints (p = 0.05) and dyspnea due to fluid overload (p = 0.02), were significant. Among the cohort, 76.4% visited the ED (<180 days) and had a mortality rate of 95.7%, compared to 78.4% for those who did not visit. Asystole and pulseless electrical activity (PEA) were significant factors for the nonachievement of ROSC (p < 0.001 vs p = 0.032) and mortality (p < 0.001 vs p = 0.03). Overall, 49 patients (8.4%) survived to hospital discharge.

Conclusion: Elderly males with hypertension, diabetes, respiratory ailments, and multiple comorbidities constituted a significant risk group. Factors such as prior episodes of chest pain and fluid overload were associated with higher mortality. Patients with asystole and PEA had low survival rates.

How to cite this article: Al-Habsi T, Al-Mandhari A, Hazra D, Al-Badri M, Al Harthi K, Al-Obaidani T, et al. Predictors of Mortality in Out-of-hospital Cardiac Arrest (OHCA) Patients: A Retrospective Cross-sectional Study from the Sultanate of Oman. Indian J Crit Care Med 2024;28(11):1056-1062.

In the intensive care unit (ICU), relentless demands of immediate action, reliance on high-tech equipment, and weight of an overwhelming workload can obscure the patient's humanity. The impact of this dehumanization and humanization may be significant, hence the study aimed to understand experiences of ICU patients and their families and seek to understand the outcomes of such encounters during the course of ICU care. The study was based on inductive-grounded theory approach. After taking informed consent, the investigators invited the participants for the interview, in the vernacular language that was audio recorded and field notes were taken. Under the two main dimensions of humanization and dehumanization, the data yielded four main themes and eight sub-themes. The themes were communication, infrastructure, experience of care and patient autonomy. The dehumanizing behaviors contributed to patients feeling disregarded and undermined their sense of dignity and worth. To our understanding, this is the foremost barrier to a heathy patient-physician relationship. However, by prioritizing humanization in the ICU, healthcare professionals can create a more compassionate and supportive environment. Hence, it is essential to implement strategies that improve patient and family support in the ICU, such as providing regular updates on the patient's condition, offering emotional support through counseling services, and involving families in the care decision-making process. These measures can help alleviate the vulnerability experienced by patients and their families during such challenging times.

How to cite this article: Paul G, Mahajan RK, Gautam PL, Kaur G, Paul SS, Paul B. Voices from the ICU: Perspectives on Humanization in Critical Care Settings. Indian J Crit Care Med 2024;28(10):923-929.

Background: The present study examined the duration of bronchodilation induced by nebulized glycopyrronium bromide (GB) and compared its effectiveness and incidence of any side effects with the combination of salbutamol and ipratropium bromide (SI) in critically ill mechanically ventilated chronic obstructive pulmonary disease (COPD) patients.

Patients and methods: This prospective, observational study was conducted in mechanically ventilated adult patients of COPD (18-75 years). Data of two groups of patients were collected for 12 hours each for three consecutive days after the nebulization - Group I: those who received 25 µg of GB, and Group II: those who received 1.25 mg of levo-salbutamol and 500 µg of ipratropium by nebulization.

Results: A significantly higher number of patients in group II had copious secretions. The mean static compliance was comparable at all time intervals, whereas the mean airway pressure was significantly lower in group II from 15 minutes to 4 hours post-nebulization. In group I, the onset of bronchodilation was 30 minutes on days 1 and 3, and 60 minutes on day 2, whereas, in group II, it was 60 minutes on days 1 and 2 and 30 minutes on day 3. In group I, bronchodilation was 10 hours on day 1 and 12 hours each on days 2 and 3, whereas in group II, bronchodilation was 4 hours on day 1 and 6 hours each on day 2 and 3.

Conclusion: Compared with SI, GB nebulization resulted in lesser respiratory secretions, a longer duration of action in terms of lowered airway resistance, and no adverse effects like hypertension, tachycardia, or desiccation of respiratory secretions.

How to cite this article: Priya P, Nath SS, Kumar V, Kumar S. Comparison of Nebulized Glycopyrronium with a Combination of Salbutamol and Ipratropium on Ventilatory Parameters in Critically Ill Mechanically Ventilated Patients of Chronic Obstructive Pulmonary Disease: An Observational Study. Indian J Crit Care Med 2024;28(10):963-969.

How to cite this article: Pandya ST. COVID-19 in Pregnancy: Do Parturients Carry a High Risk of Adverse Maternal and Neonatal Outcomes? Indian J Crit Care Med 2024;28(10):897-898.

Background and objectives: Several respiratory complications have been described after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC).

Materials and methods: Patients admitted to intensive care unit (ICU) after CRS and HIPEC during 10 years.

Data recorded were: Demographic characteristics; severity of illness; complete blood sample; chest radiographs; type of cancer and extension; HIPEC drug and temperature; ICU and hospital stay; and mortality.

Results: Of the 124 patients included, 67 patients (54.0%) presented respiratory complications: 56 (83.6%) acute respiratory failure, 25 (37.3%) pleural effusion, 13 (19.4%) atelectasis, and 3 (4.5%) other; only 1 (3.0%) developed pneumonia. They had higher severity scores at ICU admission. 1 patient required initiation of invasive mechanical ventilation during ICU admission due to pneumonia, and 1 patient needed placement of a pleural chest tube due to symptomatic pleural effusion.Only the need for a high fluid balance during surgery was correlated to the development of respiratory complications on multivariate analysis.Median ICU stay was 5 (4.0-5.0) days. ICU mortality was 0.8.0%.

Conclusion: In our study, 54% of patients treated with CRS and HIPEC developed respiratory complications during the postoperative period. However, the majority of these complications were not severe and did not significantly impact mortality rates or hospital stays.

How to cite this article: Pintado MC, Oñoro A, Beltran D, Nevado E. Respiratory Complications in the Immediate Postoperative Period after Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy Nowadays: An Observational Study. Indian J Crit Care Med 2024;28(10):952-957.

Background: The confusion assessment method for the intensive care unit (CAM-ICU) is a bedside tool to diagnose delirium in critically ill patients. This study aims to determine the reliability and validity of the Hindi version of CAM-ICU against the Diagnostic and Statistical Manual (DSM), fourth edition text revision (DSM-IV-TR), and DSM, fifth edition (DSM-5) criteria for diagnosis of delirium.

Methods: Seventy-five Hindi-speaking consenting patients ≥18-year-old with Richmond Agitation Sedation Scale ≥-3 and an anticipated ICU stay > 48 hours were included. Patients with known severe mental illnesses, visual/hearing loss, neurological injury, burns, drug overdose, and Glasgow Coma Scale <9 at the time of screening were excluded. After 48 hours of ICU stay and ensuring at least 2 hours of sedative interruption, within a 4-hour period, two examiners independently assessed delirium using the Hindi version of the scale and an experienced psychiatrist assessed the patients independently and applied the DSM-IV-TR and DSM-5 criteria for diagnosing delirium. Time taken for CAM-ICU assessment, inter-observer reliability, sensitivity, specificity, and positive and negative predictive values were calculated.

Results: The Cohen's κ value was 0.944 (p < 0.001). The Cronbach's α for observer 1 and observer 2 was 0.961 and 0.968, respectively. The sensitivity and negative predictive value of the tool was 100% with both DSM-IV-TR and DSM-5. The specificity was 90.2% and 92% and the positive predictive value was 82.8 and 86.2% with DSM-IV-TR and DSM-5, respectively.

Conclusions: The Hindi version of CAM-ICU is a reliable and valid tool for the diagnosis of delirium in an ICU setting.

Trial registration: The study was registered with the Clinical Trials Registry, India (CTRI) as per the research guidelines laid down by the Indian Council of Medical Research before enrolling the participants. (CTRI number- CTRI/2021/01/030471). The registration date was 14th January 2021. URL of registry is http://ctri.nic.in.

Highlights: Delirium in the ICU is often undiagnosed due to unfamiliarity, lack of understanding of symptoms, non-availability of psychiatric consultation, and validated diagnostic tools in the native language of the patient. This study aims to find the reliability and validity of the Hindi version of CAM-ICU.

How to cite this article: Salhotra R, Bose A, Srivastava S, Mohta M, Pandarinathan K, Rautela RS. Reliability and Validity of Hindi Version of the Confusion Assessment Method for Intensive Care Unit (CAM-ICU) for Diagnosis of Delirium: A Cohort Study. Indian J Crit Care Med 2024;28(10):958-962.

How to cite this article: Mishra S. Revisiting ARDS Classification: Are We There Yet? Indian J Crit Care Med 2024;28(10):899-900.

How to cite this article: Pande R, Pandey M. The Sepsis Score Dilemma: Balancing Precision and Utility. Indian J Crit Care Med 2024;28(10):906-907.

Background: Acute kidney injury (AKI) is a hidden complication among children within pediatric intensive care units (PICU).

Aim: To evaluate the early predictive and diagnostic value of Urinary [TIMP-2][IGFBP7] to detect AKI in PICU patients.

Methods: A case-control study was conducted on 112 children (72 admitted to PICU and 40 healthy controls) Urinary [TIMP-2][IGFBP7] was measured within 24 hours of PICU admission.

Results: Acute kidney injury developed in 52 (72.2%) out of 72 critically ill patients. The AKI group had significantly higher serum creatinine, CRP, and pediatric sequential organ failure assessment score (pSOFA) score (p = 0.001, 0.01, and 0.001, respectively) and significantly lower estimated creatinine clearance (eCCl) (p = 0.001). Urinary [TIMP-2][IGFBP7] was significantly higher in the AKI group as compared with the non-AKI group (p = 0.007). The duration of the PICU stay was 1.8-fold higher in the AKI group (p = 0.004). At the time of study enrollment, 7 (13.5%) patients had normal initial eCCl. 26 patients (50.0%) fulfilled the "Risk," 18 patients (34.6%) the "Injury," 1 patient (1.9%) the "Failure" and 0 patient (0%) the "Loss" criteria. Nine (17%) patients progressed to the next higher pediatrics risk, injury, failure, loss, end-stage renal disease (pRIFLE) stage. Urinary [TIMP-2][IGFBP7] was significantly higher in the "Failure" stage followed by "Injury," stage then the "Risk," stage (p = 0.001). Hypovolemia/dehydration had the highest [TIMP-2][IGFBP7] values followed by sepsis. Urinary [TIMP-2][IGFBP7] was significantly increased in mechanically ventilated and patients who received inotropic medications.

Conclusions: [TIMP-2]·[IGFBP7] was higher in AKI patients compared with non-AKI ones especially cases with hypovolemia and sepsis. It may predict severe morbidity and mortality because its higher levels in mechanically ventilated children and those on positive inotropic support.

How to cite this article: Ismail M, Abdelhamid N, Hasanin HM, Hamed HM, Motawie A, Kamel S, et al. Early Diagnostic and Prognostic Value of the Urinary TIMP-2 and IGFBP-7 in Acute Kidney Injury in Critically Ill Children. Indian J Crit Care Med 2024;28(10):970-976.