Indian Journal of Critical Care Medicine最新文献

Background and aims: Ventilator-associated pneumonia (VAP) is a common intensive care unit (ICU) complication linked to increased morbidity and delayed diagnosis. Lung ultrasound (LUS) is a bedside, radiation-free tool with potential for early detection and monitoring. This study aimed to evaluate the diagnostic accuracy of LUS compared to expert panel adjudication and assess its role in monitoring treatment response.

Patients and methods: In this prospective observational study conducted in a tertiary ICU, 206 adult patients ventilated for >48 hours underwent serial LUS starting 48 hours post-intubation. Lung ultrasound findings were compared with Clinical Pulmonary Infection Score (CPIS) and expert panel diagnosis (gold standard). Aeration scores were assessed; patients with a Δ score >2 between day 1 and day 5 of antibiotic therapy were considered responders.

Results: Of the 206 patients, 73 developed VAP as confirmed by the expert panel. Lung ultrasound detected VAP significantly earlier than expert adjudication (median 150 vs 178.5 hours; p < 0.001), with 80.7% of cases diagnosed earlier by LUS. Lung ultrasound showed 91.78% sensitivity, 87.97% specificity, 80.7% positive predictive value (PPV), and 95.1% negative predictive value (NPV). Among 64 patients eligible for aeration score analysis, responders (n = 24) showed a non-significant trend toward higher 28-day survival (75 vs 52.5%, p = 0.074). Intensive care unit stay and ventilator duration were comparable between groups.

Conclusion: Lung ultrasound demonstrates high diagnostic accuracy and enables earlier VAP detection compared to clinical scores. It effectively tracks disease progression and treatment response through serial aeration scores. Incorporating LUS into routine ICU care may enhance diagnostic timeliness and support individualized treatment strategies.

Trial registration: The study was approved by the Institutional Ethics Committee of the IMS and SUM Hospital (Ref. no/ECR/627/Inst/OR/2014) and was registered with the Clinical Trials Registry of India (CTRI) under the registration number CTRI/2022/10/046326.

How to cite this article: Roy C, Choudhury S, Chhotray P, Patra ESK, Panda S, Mishra SB. Utility of Lung Ultrasonography for Early Diagnosis and Monitoring of Ventilator-associated Pneumonia in Mechanically Ventilated Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(9):753-759.

Background and aims: Pressure injury (PI) is a common problem among patients admitted to intensive care units (ICUs). Sacral PI, a specific type of PI, leads to serious complications, thereby reducing the quality of life, increasing morbidity, mortality, and financial cost on patients and the healthcare system. This study aimed determine the efficacy of prophylactic sacral dressings (PSD) in reducing PI among ICU patients.

Methods: PRISMA guidelines were followed. Relevant studies were electronically searched from databases, including PubMed, Scopus, and through supplementary sources such as the Wiley Online Library and Google Scholar. Three reviewers extracted the studies and performed quality assessment of the selected studies. Disagreements were resolved by consultation with the fourth reviewer.

Results: A total of seven randomized controlled trials (RCTs), involving 3,735 patients, were included. Among them, 2,144 received PSD and 1,591 received standard care. The risk of bias in the included studies was low and considered acceptable. The pooled odds ratio (95% CI) for our binary outcomes was calculated. A significant decrease in sacral PI rate (p < 0.001) and ≥ stage II PI was observed in the PSD group (p < 0.006). Visual assessment of the funnel plot revealed no presence of publication bias.

Conclusion: The use of PSD led to a notable decrease in sacral PI rate, including ≥ stage II sacral PI among the ICU patients. Further studies with larger sample sizes and specific ICU populations are recommended to confirm these findings.

How to cite this article: Bhutia SY, Saini SK, Jat MS, Balai MK. Prophylactic Sacral Dressing in Prevention of Pressure Injury among ICU Patients: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(9):771-778.

Background and aims: Pediatric guidelines recommend initial resuscitation of septic shock using either epinephrine or norepinephrine as first-line support. However, there are no trials comparing these two agents. The primary aim of this randomized controlled trial was to test the feasibility of a study protocol, specifically in terms of recruitment rates and protocol adherence, comparing epinephrine and norepinephrine as first-line vasoactive agents in pediatric septic shock.

Patients and methods: A double-blinded, randomized controlled single-center study was conducted in the Emergency Medicine Department (ED) and pediatric intensive care unit (PICU) at a tertiary referral hospital in India. Thirty children aged between 1 month and 17 years with suspected septic shock, in whom signs of shock persisted after the initial fluid bolus, were recruited.

Participants were randomized: 1:1 to receive either epinephrine or norepinephrine (each 15), initiated at 0.05-0.1 µg/kg/min. Feasibility outcomes were recruitment rates, randomization to study-drug initiation time, and adherence to protocol. Exploratory clinical outcomes included proportion of shock resolution, adverse events, and hospital mortality.

Results: Of 44 screened patients, 10 met exclusion criteria and 4 declined consents, with a recruitment rate of 3.2 patients/month. The median time to vasoactive initiation after randomization was 12 minutes (IQR 8-15). The median time for shock resolution was 31 hours (IQR 10.8-51.2) and 14 hours (IQR 11.5-16.5) in the epinephrine and norepinephrine groups, respectively. Adverse events meeting pre-determined stopping criteria occurred in 7/16 and 1/15 in the epinephrine and norepinephrine groups, respectively. One patient in each group died.

Conclusions: A protocol randomizing children with septic shock to epinephrine vs norepinephrine was feasible in terms of protocol adherence and recruitment rates. These findings can inform the design of a definitive multicenter trial powered for patient-centered endpoints.

How to cite this article: Nataraj R, Dalal P, Vijayaraghavan BKT, Venkatachalam P, Kumar V, Lakshmanan L, et al. Epinephrine vs Norepinephrine as the Initial Vasoactive Agent in Pediatric Septic Shock: A Feasibility Randomized Controlled Trial for Recruitment Rates and Protocol Adherence, the Epinephrine vs Norepinephrine in Pediatric Septic Shock Trial. Indian J Crit Care Med 2025;29(9):737-745.

Background and aims: In critically ill patients with acute respiratory distress syndrome (ARDS), especially during the COVID-19 pandemic, prolonged prone positioning complicated conventional monitoring. Transthoracic echocardiography (TTE) was often unfeasible, highlighting the need for alternative methods. Transesophageal ultrasound (TEUS) allows bedside, multiorgan assessment but has been underutilized in prone patients. To evaluate the feasibility and clinical utility of TEUS for multisystem monitoring in patients with moderate to severe ARDS in the prone position.

Patients and methods: This retrospective observational study was conducted in two ICUs in Argentina from October 2020 to October 2022. Adult patients with COVID-19-related ARDS who underwent TEUS while ventilated in the prone position were included. Certified intensivists performed standardized TEUS protocols to assess cardiac function, pulmonary status, and venous congestion using the venous excess ultrasound (VExUS) score.

Results: Transesophageal ultrasound was performed in 109 patients. Assessment of left and right ventricular function, diastolic parameters, and lung patterns was feasible in nearly all cases. Right ventricular dysfunction was present in 36.7%, and VExUS-related congestion markers (portal pulsatility, hepatic/intrarenal vein changes) were frequent. Lung ultrasound via TEUS identified interstitial-alveolar patterns in 98.2%. Transesophageal ultrasound findings guided fluid and ventilatory management.

Conclusion: Transesophageal ultrasound is a feasible, safe, and clinically valuable tool for comprehensive, real-time multisystem monitoring in prone, mechanically ventilated ARDS patients. It enables informed decision-making without patient repositioning, especially when other imaging is limited. Broader adoption in ICU practice could improve care, highlighting the need for training programs in critical care TEUS.

How to cite this article: Isa M, Sosa FA, Bertorello-Andrade L, Roberti JE, Fernández J, Tort B, et al. Multiorgan Assessment with Transesophageal Ultrasound in Prone Ventilation Patients with Acute Respiratory Distress Syndrome: An Observational Study in Argentina. Indian J Crit Care Med 2025;29(9):731-736.

Background and aims: The Cornell Assessment of Pediatric Delirium (CAPD)-revised is a validated tool for detecting delirium in critically ill children. This study aimed to determine the prevalence of delirium and associated risk factors in a pediatric intensive care population using CAPD.

Materials and methods: A descriptive cross-sectional study was conducted among 201 critically ill children aged 1 month-14 years admitted to a tertiary care hospital in Karachi, Pakistan, from August 2021 to February 2022. Delirium was assessed twice daily for three consecutive days using CAPD. A score of ≥9 was considered diagnostic.

Results: Delirium was identified in 24.9% of patients (n = 50/201). The mean age was 5.14 ± 4.03 years, with 61.7% male (n = 124/201). Significant risk factors included comorbidities (n = 34/201, OR = 3.45, 95% CI: 1.78-6.70, p = 0.0005), developmental delay (n = 3/201, OR = 5.12, 95% CI: 1.34-19.54, p = 0.015), benzodiazepine use (n = 45/201, OR = 2.89, 95% CI: 1.52-5.50, p = 0.001), antiepileptic use (n = 38/201, OR = 2.67, 95% CI: 1.38-5.17, p = 0.004), high-flow oxygen (n = 60/201, OR = 2.31, 95% CI: 1.20-4.45, p = 0.012), and mechanical ventilation (n = 55/201, OR = 3.12, 95% CI: 1.62-6.01, p = 0.001).

Conclusion: Delirium affected nearly one-quarter of critically ill children, with comorbidities, developmental delay, use of sedatives, and advanced respiratory as key risk factors. Cornell Assessment of Pediatric Delirium is a valuable tool for routine screening to enable early recognition and management of pediatric delirium. More multicenter studies are recommended for further validation.

How to cite this article: Nashit M, Ul Haque A, Mirza S, Habib I, Shahid S, Ahmed AR, et al. Prevalence and Risk Factors of Pediatric Delirium in Critically Ill Children: A Study Using Cornell Assessment of Pediatric Delirium Tool at a Tertiary Care Hospital. Indian J Crit Care Med 2025;29(9):760-764.