Indian Journal of Critical Care Medicine最新文献

Aim: Acute circulatory failure is commonly encountered in critically ill patients, that requires fluid administration as the first line of treatment. However, only 50% of patients are fluid-responsive. Identification of fluid responders is essential to avoid the harmful effects of overzealous fluid therapy. Electrical cardiometry (EC) is a non-invasive bedside tool and has proven to be as good as transthoracic echocardiography (TTE) to track changes in cardiac output. We aimed to look for an agreement between EC and TTE for tracking changes in cardiac output in adult patients with acute circulatory failure before and after the passive leg-raising maneuver.

Materials and methods: Prospective comparative study, conducted at a Tertiary Care Teaching Hospital.

Results: We recruited 125 patients with acute circulatory failure and found 42.4% (53 out of 125) to be fluid-responsive. The Bland-Altman plot analysis showed a mean difference of 2.08 L/min between EC and TTE, with a precision of 3.8 L/min. The limits of agreement (defined as bias ± 1.96SD), were -1.7 L/min and 5.8 L/min, respectively. The percentage of error between EC and TTE was 56% with acceptable limits of 30%.

Conclusion: The percentage error beyond the acceptable limit suggests the non-interchangeability of the two techniques. More studies with larger sample sizes are required to establish the interchangeability of EC with TTE for tracking changes in cardiac output in critically ill patients with acute circulatory failure.

How to cite this article: Sharma S, Ramachandran R, Rewari V, Trikha A. Evaluation of Electrical Cardiometry to Assess Fluid Responsiveness in Patients with Acute Circulatory Failure: A Comparative Study with Transthoracic Echocardiography. Indian J Crit Care Med 2024;28(7):650-656.

This study investigated variability among four indicators for quantifying antimicrobial use in intensive care units (ICUs): defined daily doses (DDD), prescribed daily doses (PDD), duration of therapy (DOT), and length of therapy (LOT) and recommended the most clinically relevant approach. Retrospective data from patients who had received at least one antimicrobial was analyzed. Patients whose records were incomplete or expired were excluded. Duration of therapy (24433/1000 PDs) and LOTs (12832/1000 PDs) underestimated the overall consumption of antimicrobials compared with DDD of 28391/1000 PDs. Whereas PDD (46699/1000 PDs) overestimated it. Comparison analysis detected % differences of 13.94, 23.92, and 54.80% between DDD and DOT, DDD and PDD, and DDD and LOT, indicators respectively. Linear regression revealed stronger (r ² = 0.86), moderate (r ² = 0.50), and moderate (r ² =0.60) correlation between DDD and DOT, DDD and PDD and DDD and LOT indicators respectively. According to findings, combining DOT and DDD is a more practical method to quantify antimicrobial consumption in hospital ICUs.

How to cite this article: Deshwal PR, Tiwari P. Investigating the Variability among Indicators for Quantifying Antimicrobial Use in the Intensive Care Units: Analysis of Real-world Evidence. Indian J Crit Care Med 2024;28(7):662-676.

How to cite this article: Soni KD. Ultrasound-guided Arterial Cannulation: What are We Missing and Where are We Headed? Indian J Crit Care Med 2024;28(7):632-633.

Background: Suction-assisted laryngoscopy and airway decontamination (SALAD) is a new modality and training manikins are quite costly. Few modifications have been described with their pluses and minuses. We describe a low-cost simulator that replicates fluid contamination of the airway at various flow rates and allows the practice of SALAD in vitro.

Materials and methods: We modified a standard Laerdal airway management trainer with locally available equipment to simulate varying rates of continuous vomiting or hemorrhage into the airway during intubation. The effectiveness of our SALAD simulator was tested during an advanced airway workshop of the Airway Management Foundation (AMF). The workshop had a brief common presentation on the learning objective of the SALAD technique followed by a demonstration to small groups of 5-6 participants at one time with necessary instructions. This was followed by a hands-on practical learning session on the simulator.

Results: One hundred and five learners used the simulator including 15 faculties and 90 participants (48 on ICU and 42 on ENT workstations). At the end of the session, the workshop faculty and participants were asked to rate their level of confidence in managing similar situations in real practice on a four-point Likert scale. All 15 faculty members and 70 out of 90 participants felt very confident in managing similar situations in real practice. Fifteen participants felt fairly confident and 5 felt slightly confident.

Conclusion: In resource-limited settings, our low-cost SALAD simulator is a good educational tool for training airway managers in the skills of managing continuously and rapidly soiling airways.

How to cite this article: Kumar R, Kumar R. An Indigenous Suction-assisted Laryngoscopy and Airway Decontamination Simulation System. Indian J Crit Care Med 2024;28(7):702-705.

Background: Nontraumatic brain injury encompasses various pathological processes and medical conditions that result in brain dysfunction and neurological impairment without direct physical trauma. The study aimed to assess the efficacy of intravenous administration of 20% mannitol and 3% hypertonic saline to reduce intracranial pressure in nontraumatic brain injury.

Materials and methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed for study selection and data extraction. The search was conducted in the PubMed, Embase, and Scopus databases, including articles published in English from January 2003 to December 2023. Our study included randomized controlled trials, comparative studies, prospective analyses, and retrospective cohort studies. We extracted data on baseline characteristics of patients, intervention details, major outcomes, and complications. Quality assessment was performed using the Jadad scale and the Robvis assessment tool for risk of bias.

Results: A total of 14 studies involving 1,536 patients were included in the analysis. Seven studies reported hypertonic saline as more effective in reducing intracranial pressure, while three studies found similar effectiveness for both interventions. Adverse events were reported in only three studies. The studies that reported complication rates ranged from 21 to 79%. A meta-analysis was conducted on five studies, showing varying rates of adverse events associated with mannitol and hypertonic saline.

Conclusion: Both hypertonic saline solution and mannitol have been explored as treatment options for decreasing intracranial pressure in nontraumatic brain injuries. While some studies indicate the superiority of hypertonic saline, others report similar effectiveness between the two interventions.

How to cite this article: Choudhury A, Ravikant, Bairwa M, Jithesh G, Kumar S, Kumar N. Efficacy of Intravenous 20% Mannitol vs 3% Hypertonic Saline in Reducing Intracranial Pressure in Nontraumatic Brain Injury: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2024;28(7):686-695.

Background: The OI was originally evaluated as a prognostic tool for acute hypoxemic respiratory failure in children and was an independent predictor for mortality in adult patients with acute respiratory distress syndrome (ARDS).

Methods: Oxygenation index and OSI of 201 adult patients undergoing emergency surgery were evaluated at different time points. The primary objective of this study was to find the correlation between OI and OSI. The secondary objectives were to find the prognostic utility of OI and OSI for postoperative mechanical ventilation and mortality.

Results: Significant statistical correlation was found between OI and OSI both at the beginning (r ² = 0.61; p < 0.001) and immediately after surgery (r ² = 0.47; p < 0.001). Oxygen saturation index at the beginning [area under the receiver operating characteristics curve (AUROC) (95% CI) 0.76 (0.62-0.89); best cutoff 3.9, sensitivity 64% and specificity 45%] and immediately after surgery [AUROC (95% CI) 0.82 (0.72-0.92); best cutoff 3.57, sensitivity 79%, and specificity 62%] were reasonable predictors of the requirement of invasive ventilatory support. Exploratory analysis reported that older age (p = 0.02), higher total leukocyte count (p = 0.002), higher arterial lactate (p = 0.02), and higher driving pressure (p < 0.001) were independently associated with hospital mortality.

Conclusion: In adult patients undergoing emergency laparotomy under general anesthesia, OI and OSI were found to be correlated. Both metrics demonstrated reasonable accuracy in predicting the need for invasive ventilatory support beyond 24 hours and hospital mortality.

How to cite this article: Thakuria R, Ernest EE, Chowdhury AR, Pangasa N, Kayina CA, Bhattacharjee S, et al. Oxygenation Index and Oxygen Saturation Index for Predicting Postoperative Outcome in Patients Undergoing Emergency Surgery: A Prospective Cohort Study. Indian J Crit Care Med 2024;28(7):645-649.

How to cite this article: Tiwari AM, Zirpe KG, Kulkarni AP. Author Response: The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (PCO₂ Gap) During Resuscitation Affects ICU Outcomes: A Prospective Observational Study. Indian J Crit Care Med 2024;28(7):710.

How to cite this article: Bhosale SJ, Joshi M, Dhakane P, Rane AD, Kulkarni AP. Transient STEMI: Not to be Considered a Lesser Evil. Indian J Crit Care Med 2024;28(7):711-712.

How to cite this article: Sinha S. Interleukin-6 in Sepsis-Promising but Yet to Be Proven. Indian J Crit Care Med 2024;28(7):629-631.

How to cite this article: Sundarsingh V, Kumar M, Rodrigues PR. The Evolution of Central Venous-to-arterial Carbon Dioxide Difference (pCO₂ Gap) during Resuscitation Affects ICU Outcomes: A Prospective Observational Study. Indian J Crit Care Med 2024;28(7):709.