Indian Journal of Critical Care Medicine最新文献

Background and aims: Infections remain a common cause of emergency department (ED) admissions in older adults, particularly in low and middle-income countries. This study investigates the clinical and microbiological spectrum and outcomes of infection-related emergencies in older adults in North India, comparing the youngest old (65-74 years), middle old (75-84 years), and oldest old (≥85 years) patients.

Patients and methods: This prospective observational study included older patients (≥65 years) with community-acquired infections admitted to the medical ED of a tertiary care academic hospital in North India from June 2023 to May 2024. Patients with hospital-acquired infections, including those that developed during prior admissions at referring hospitals, were excluded.

Results: We enrolled 300 patients (mean age 74.2 years, 51% males), including 164 youngest old, 92 middle old, and 44 oldest old. The most prevalent infections were pneumonia (39.3%), urinary tract infection (UTI) (13.3%), cholangitis (9.3%), and tuberculosis (7.7%). Microbiological confirmation was achieved in 37.3%, with frequent isolation of drug-resistant organisms such as Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, and Enterococcus faecium. The oldest old group presented more acutely with severe illness and had a higher incidence of pneumonia (56.8%), lower UTI rates (2.3%), and fewer microbiological diagnoses (13.6%). In-hospital mortality was 32.0%, highest in pneumonia (47.1%) and tuberculosis (47.8%), and lowest in UTI (14.7%). Baseline Acute Physiology and Chronic Health Evaluation (APACHE)-II score independently predicted mortality (OR 1.081, 95% CI: 1.013-1.153, p = 0.019).

Conclusion: Infection-related emergencies in older adults, especially the oldest old, pose diagnostic challenges and carry high mortality. Pneumonia is a major cause of ED admission and death among older adults in India.

How to cite this article: Kadar H, Erla SR, Angrup A, Bhatia M, Sharma N, Pannu AK. Infectious Disease Emergencies in Older Adults in India: A Prospective Observational Study Comparing Youngest Old, Middle Old, and Oldest Old Patients. Indian J Crit Care Med 2025;29(7):569-577.

Background and aim: Data on tracheostomy in children are scarce in India. Hence, our study aimed to determine the indications, timing, complications, and outcomes of tracheostomy in a pediatric intensive care unit (PICU).

Patients and methods: We carried out a single-center ambispective study in children aged 1 month to 12 years undergoing tracheostomy in the PICU from February 2019 to April 2024. Data on age, gender, indications, complications, outcome, and follow-up of post-tracheostomy patients were collected and analyzed.

Results: One hundred and thirty-six patients underwent tracheostomy. Neurological illness (57.4%) was the reason for admission in the majority of children. Prolonged ventilation was the most common indication for tracheostomy (50%). The median (IQR) duration of ventilation before tracheostomy was 21 (14-27) days. The mean (SD) duration of weaning to "T piece" was 9.3 (7.8) days. Forty-six children died in the hospital due to primary illness and 4 (2.9%) tracheostomy-related deaths. Complications were observed in 58 (42.6%) children. Tracheal aspirate growth was observed in 58 (42.6%). Mothers were the primary caregivers in 127 (93.4%). The median (IQR) duration of PICU stay was 28 (20-43.5) days. Forty-nine (36%) children were decannulated.

Conclusion: Tracheostomy is a safe procedure in the PICU, and the mortality is mainly due to underlying illness.

How to cite this article: Subramani S, Varadarajan P, Rangabashyam N, Jayaraman N, Balaji S, Rajajeyavel JM. Tracheostomy in Children: Experience from a Tertiary Care Center in South India. Indian J Crit Care Med 2025;29(7):592-596.

Background and aims: Currently, no validated scoring system exists to predict neurological outcomes in mechanically ventilated children. We aimed to develop and validate such a score in this population.

Patients and methods: We developed the NOPS-VC score, comprising eight items. Each parameter is rated on a Likert scale, where a minimum score of 1 indicates no significant risk, and a maximum score of 3 represents the highest risk for poor neurological outcomes. The face and content validity of the score were assessed using the content validity index (CVI) and content validity ratio. Neurological outcomes were determined at discharge and at 6 months of follow-up. Construct validity was assessed by correlating the NOPS-VC score with the Pediatric Cerebral Performance Category score, functional status scale (FSS), intelligence quotient (IQ), Vineland Adaptive Behavior Scale, gross motor function measure (GMFM), child behavior checklist, and pediatric quality of life inventory.

Results: Among 170 participants, 87 had good functional outcomes. The scale-level content validity index (S-CVI/UA) was 0.95, and S-CVI/Ave was 0.9, indicating excellent content validity. The one-factor model demonstrated a good fit, with all item loadings exceeding 0.7 [Tucker-Lewis index (TLI) = 0.95, comparative fit index (CFI) = 0.96, root mean squared error of approximation (RMSEA) = 0.067 (0.059-0.074)]. The area under the receiver operating characteristic (ROC) curve for the maximum and baseline NOPS-VC scores was 0.92 and 0.91, respectively. The optimal cutoff value for both scores was 18, with sensitivity/specificity of 82/97% for the maximum score and 80/97% for the baseline score. Construct validity showed strong correlations (r ≥ 0.70) with all parameters.

Conclusion: The NOPS-VC score, when applied at the initiation of mechanical ventilation in critically ill children, demonstrates strong validity in predicting neurological outcomes at 6 months, with an optimal cutoff value of 18.

How to cite this article: Tomar A, Panda PK, Elwadhi A, Tiwari LK, Sharawat IK. Development and Validation of a Neurological Outcome Prediction Score for Children Requiring Mechanical Ventilation: The NOPS-VC Score. Indian J Crit Care Med 2025;29(7):578-585.