International Journal of Critical Illness and Injury Science最新文献

{"title":"What's new in critical illness and injury science? Emergency, critical, and operative care - A contemporary concept in junctional care and research, featuring the integration of operations, care, and compassion for seamless acute care delivery.","authors":"Sagar C Galwankar, Adriana L Facchiano, Thomas John Papadimos, Stanislaw P Stawicki, Bikram Kumar Gupta, Harman Singh Gill","doi":"10.4103/ijciis.ijciis_77_26","DOIUrl":"10.4103/ijciis.ijciis_77_26","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 3","pages":"81-84"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148896802","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adoption, perceived value, and barriers to generative artificial intelligence in emergency medicine: A cross-sectional survey of Latin American clinicians.","authors":"Amado Alejandro Baez, Claudia Acra, Brailin Difo","doi":"10.4103/ijciis.ijciis_43_26","DOIUrl":"10.4103/ijciis.ijciis_43_26","url":null,"abstract":"<p><strong>Background: </strong>Generative artificial intelligence (AI) tools are increasingly used by healthcare professionals, yet empirical data on adoption among Latin American emergency medicine clinicians remain limited.</p><p><strong>Methods: </strong>A voluntary, anonymous, cross-sectional online survey was administered to emergency medicine professionals across Latin America (April-October 2025). The Spanish-language instrument, pilot-tested before deployment, assessed AI familiarity, use patterns, perceived value, risks, governance, and training needs. Descriptive statistics and Chi-square tests were used for analysis.</p><p><strong>Results: </strong>A total of 123 respondents from 16 countries were analyzed. Most practiced in public or mixed healthcare settings (71.3%) and had over 10 years of experience (61.3%). Familiarity with generative AI was moderate to high (76.9%), and professional use was common (78.3%), with ChatGPT the dominant platform (81.0%). Adoption patterns were homogeneous across countries, with no significant associations between country of origin and familiarity, frequency of use, or platform preference. Primary applications included research and literature review (66.1%), medical education (59.1%), and clinical documentation (40.9%). Nearly half reported high perceived utility (49.6%), and 51.7% noted improvements in productivity. Major concerns included misinformation, erosion of clinical judgment (56.2% each), algorithmic bias (53.7%), and legal liability (46.3%). Institutional AI governance was nearly absent, with only 7.4% reporting existing policies. Despite this, 88.4% expressed interest in formal AI training and 65.6% supported integration into clinical guidelines.</p><p><strong>Conclusions: </strong>Latin American emergency clinicians are rapidly adopting generative AI with perceived benefits across multiple domains, but almost entirely without governance frameworks or structured training, highlighting an urgent need for regional policy and education infrastructure.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 3","pages":"92-99"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What's new in critical illness and injury science? When torsion does not declare itself: Lessons from an atypical adult presentation of acute scrotal pain.","authors":"Harman Singh Gill, Lucas Cavalier","doi":"10.4103/ijciis.ijciis_78_26","DOIUrl":"https://doi.org/10.4103/ijciis.ijciis_78_26","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 3","pages":"105-106"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective cohort study to estimate the safety of direct discharge to home from the intensive care unit.","authors":"Shikha Yadav, Ravi Prakash, Zia Arshad, Ram Gopal Maurya","doi":"10.4103/ijciis.ijciis_143_25","DOIUrl":"10.4103/ijciis.ijciis_143_25","url":null,"abstract":"<p><strong>Context: </strong>Traditionally, intensive care unit (ICU) discharge has followed a tiered approach of managing cases, i.e., patients are transferred to a general or parent surgical ward or high-dependency unit before being discharged to home. This practice assumes that some additional time is mandatory to observe patients who are recovering from the illness. With latest improvisations in postdischarge services for direct discharge to home (DDH), the balance is shifting in favor of DDH.</p><p><strong>Aims: </strong>To compare the clinical outcomes and safety of ICU patients discharged directly to home with those transferred to hospital wards before being discharged.</p><p><strong>Settings and design: </strong>Prospective cohort study done at a tertiary care hospital.</p><p><strong>Methods: </strong>According to patient's discharge or transfer to ward (TTW), they were grouped in either of the two: Group D: Direct discharge to home (DDH), Group W: TTW (minimum stay in ward 24 h). All patients were followed up to 3 months of discharge/transfer.</p><p><strong>Statistical analysis used: </strong>Continuous data of two independent groups were compared by independent Student's <i>t</i>-test, whereas categorical data by Chi-square (χ²) test were used. A two-tailed (α =2) <i>P</i> < 0.05 was considered statistically significant.</p><p><strong>Results: </strong>The results showed that ICU patient discharged directly to home had better post-ICU recovery for 90 days' follow-up.</p><p><strong>Conclusions: </strong>ICU patients discharged directly to home have significantly better clinical outcomes and safety, when applied to carefully selected ICU patients compared to those transferred to hospital wards before being discharged.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 3","pages":"100-104"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glasgow-Blatchford score for early risk stratification in upper gastrointestinal bleeding: Predicting blood transfusion and early endoscopy.","authors":"Manna Maria Theresa, Prannoy George Mathen, Kathyayini Vijayalakshmi Revivarman, Sabarish B Nair, T P Sreekrishnan, Bharath Prasad Sivaprasad","doi":"10.4103/ijciis.ijciis_3_26","DOIUrl":"10.4103/ijciis.ijciis_3_26","url":null,"abstract":"<p><strong>Background: </strong>Upper gastrointestinal bleeding (UGIB) remains a common medical emergency associated with significant morbidity and mortality. Early risk stratification is essential to identify patients who require urgent intervention. The Glasgow-Blatchford Score (GBS) is widely used to assess UGIB severity at presentation; however, data regarding its performance in the Indian population are limited. This study aimed to evaluate the ability of the GBS to predict the need for blood transfusion and early endoscopy among patients presenting with UGIB.</p><p><strong>Methods: </strong>A retrospective observational study was conducted at a tertiary care hospital in South India over a period of 2.5 years. Medical records of adult patients (18-80 years) presenting to the emergency department with clinical features of UGIB were reviewed. Demographic, clinical, and laboratory parameters required for calculating the GBS were collected. Statistical analysis included independent <i>t</i>-tests and Chi-square tests to evaluate associations between GBS and clinical outcomes. Receiver operating characteristic (ROC) curve analysis was performed to determine optimal cutoff values for predicting blood transfusion and early endoscopy.</p><p><strong>Results: </strong>A total of 100 patients were included, with a mean age of 59 ± 12 years, and 78% were male. Chronic liver disease was present in 61% of the cohort. Patients requiring blood transfusion had significantly higher GBS values compared with those who did not (<i>P</i> = 0.006). ROC analysis showed moderate predictive ability for blood transfusion (area under the curve [AUC] 67.8%) with an optimal cutoff score of 8 (sensitivity 86% and specificity 46%). For early endoscopy, the AUC was 71.8%, with a cutoff score of 9 (sensitivity: 80.6% and specificity: 54%).</p><p><strong>Conclusion: </strong>The GBS demonstrated significant predictive value for identifying patients with UGIB who are likely to require blood transfusion and early endoscopic evaluation. Incorporation of GBS into emergency department triage protocols may facilitate timely risk stratification and support evidence-based management of UGIB.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 3","pages":"85-91"},"PeriodicalIF":0.0,"publicationDate":"2026-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13544648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148897327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward an \"accordion intensive care unit\" model: A flexible, patient-centered approach to critical-care capacity.","authors":"Kais Regaieg, Sabrina Chaouch, Ilef Alila, Toboure Zanze","doi":"10.4103/ijciis.ijciis_138_25","DOIUrl":"10.4103/ijciis.ijciis_138_25","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 2","pages":"79-80"},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the role of high-dose intravenous thiamine supplementation for lactate clearance in patients with cirrhosis and sepsis.","authors":"Radiya Ali, Angel Yazdi, Keegan Collins, Danielle Guffey, Tianshi David Wu, Rebecca Kessinger, Ali Omranian, Meghna Vallabh","doi":"10.4103/ijciis.ijciis_124_25","DOIUrl":"10.4103/ijciis.ijciis_124_25","url":null,"abstract":"<p><strong>Background: </strong>Thiamine is a vitamin that plays a role in lactate clearance. Patients with sepsis may present with elevated lactate, and also in cirrhosis, as lactate is hepatically metabolized. Prior studies showed mixed results regarding the role of thiamine for lactate clearance with limited inclusion of cirrhosis patients. The purpose of this study was to determine the association of high-dose intravenous thiamine on time to lactate clearance among patients with cirrhosis and sepsis.</p><p><strong>Methods: </strong>We performed a single-center retrospective cohort study of critically ill patients with cirrhosis with a diagnosis of sepsis with lactate >4 mmol/L between January 1, 2020, and December 31, 2024. Patients who received ≥400 mg were classified as receiving high-dose thiamine. Fine-Gray competing risks models adjusted for demographic, comorbidity, and illness severity variables estimated the association of receiving high-dose thiamine with time to lactate clearance, defined as a lactate <3 mmol/L. Additional secondary outcomes included intensive care unit and in-hospital mortality.</p><p><strong>Results: </strong>A total of 136 patients were identified and included in the analysis. Median age was 58.4, and 54% were male. Thirty-three patients received high-dose thiamine. Patients had similar baseline characteristics, including on indicators of illness severity, cirrhosis severity, and use of vasopressors. In both unadjusted and adjusted models, the receipt of high-dose thiamine was not associated with differences in time to lactate clearance or mortality.</p><p><strong>Conclusions: </strong>Thiamine use in patients with cirrhosis who experienced sepsis did not result in improved lactate clearance compared to those who did not receive high-dose thiamine. These data do not support empiric high-dose thiamine to aid lactate clearance in this population.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 2","pages":"53-56"},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of the incidence of acute kidney injury in patients with acute pancreatitis managed with or without thoracic epidural analgesia: A prospective randomized controlled trial.","authors":"Soumyasri Ambli, Bikram Kumar Gupta, Arun Raj Pandey, Yashpal Singh, Pushkar Ranjan, Vanita Ramesh Mhaske","doi":"10.4103/ijciis.ijciis_4_26","DOIUrl":"10.4103/ijciis.ijciis_4_26","url":null,"abstract":"<p><strong>Background: </strong>Acute pancreatitis (AP) is frequently complicated by acute kidney injury (AKI), contributing to increased morbidity and mortality. Thoracic epidural analgesia (TEA) may improve splanchnic perfusion, attenuate inflammation, and reduce renal dysfunction.</p><p><strong>Methods: </strong>In this prospective randomized controlled trial, 88 adults with AP were enrolled; 8 were lost to follow-up. Eighty patients were analyzed and randomized to a TEA group (<i>n</i> = 40) or a control group (<i>n</i> = 40). The TEA group received epidural analgesia in addition to standard care. Renal and metabolic parameters, including urine output, serum urea, creatinine, electrolytes, lactate, bicarbonate, and base excess, were monitored. AKI was defined and staged using KDIGO criteria. Statistical analysis was performed using independent <i>t</i>-tests and Chi-square tests, with <i>P</i> < 0.05 considered significant.</p><p><strong>Results: </strong>Baseline characteristics were comparable between groups. Transient hypotension occurred in nine TEA patients and was managed conservatively; no major complications were observed. Postintervention urine output was significantly higher (<i>P</i> = 0.034) and serum urea significantly lower (<i>P</i> = 0.016) in the TEA group. Lactate levels were lower (<i>P</i> = 0.011), bicarbonate levels higher (<i>P</i> = 0.026), and base excess less negative (<i>P</i> = 0.033), indicating improved perfusion and metabolic status. AKI occurred in 7/40 patients in the TEA group and 12/40 in controls, a nonsignificant difference (<i>P</i> = 0.14). However, AKI severity was lower in the TEA group.</p><p><strong>Conclusion: </strong>TEA was associated with improved renal and metabolic parameters and a trend toward reduced AKI incidence and severity in AP, without major adverse effects. Larger multicenter studies are needed for confirmation.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 2","pages":"48-52"},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic accuracy of mid-regional proadrenomedullin in patients with sepsis - A longitudinal observational study.","authors":"Akshita Makkar, H L Khushboo, Mukesh Bairwa, Ashish Sharma, Bela Goyal, Ravi Kant","doi":"10.4103/ijciis.ijciis_142_25","DOIUrl":"10.4103/ijciis.ijciis_142_25","url":null,"abstract":"<p><strong>Background: </strong>Prognostication in sepsis remains challenging as conventional scores and biomarkers, including procalcitonin (PCT) and lactate, show limited predictive strength when used alone. This study evaluated the ability of mid-regional proadrenomedullin (MR-proADM) to predict 14-day mortality in patients with sepsis, intending to improve early risk stratification.</p><p><strong>Methods: </strong>A prospective observational study was conducted at a tertiary hospital in North India over 18 months. One hundred and twenty patients admitted to the intensive care unit (ICU) and ward with sepsis were enrolled. On admission, serum MR-proADM, PCT, and lactate were measured, and Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated. Prognostic accuracy was determined using the receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>The mean age of the participants was 45.9 ± 16.1 years, with 54.2% male. Nonsurvivors (<i>n</i> = 56) required ICU care more frequently (69.6%) and ventilator support (55.4%). MR-proADM levels were significantly higher in nonsurvivors (2.48 ± 1.93 nmol/L) than survivors (1.43 ± 0.78 nmol/L, <i>P</i> < 0.001). MR-proADM achieved an area under ROC of 0.767, which was comparable to SOFA (0.712), lower than lactate (0.807), and superior to PCT (0.693) and APACHE II (0.699). MR-proADM >5.75 nmol/L was uniformly associated with mortality.</p><p><strong>Conclusion: </strong>MR-proADM is a reliable adjunctive prognostic biomarker for sepsis and may enhance early risk stratification when used alongside established scores and biomarkers.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 2","pages":"41-47"},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Back to basics in critical care: Can hematological ratios refine sepsis risk stratification?","authors":"Bikram Kumar Gupta, Jay Prakash, Alexandra Ortego","doi":"10.4103/ijciis.ijciis_42_26","DOIUrl":"10.4103/ijciis.ijciis_42_26","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 2","pages":"33-35"},"PeriodicalIF":0.0,"publicationDate":"2026-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}