International Journal of Critical Illness and Injury Science最新文献

{"title":"Circulating metabolome as key biomarkers for ventilator-associated pneumonia: Case-Control study in a tertiary care hospital of North India.","authors":"Ajay Kumar Gautam, Rahul Yadav, Bikram Kumar Gupta, Nidhi Tiwari, Chandan Singh","doi":"10.4103/ijciis.ijciis_129_25","DOIUrl":"10.4103/ijciis.ijciis_129_25","url":null,"abstract":"<p><strong>Introduction: </strong>Ventilator-associated pneumonia (VAP) is a microbial infection that develops in the lungs when a patient has been intubated for mechanical ventilation for more than 48 h. Diagnosis of VAP remains a challenge despite clinical advances. NMR-based metabolomics might play a pivotal role in overcoming the diagnostic complexity of VAP by investigating biomarkers.</p><p><strong>Materials and methods: </strong>This case-control study was conducted in 2024-2025 at Sir Sunder Lal Hospital, Varanasi. The participated patients had an intubation period of more than 48 h; a total of 44 patients were recruited, of which 20 patients developed VAP and 24 were non-VAP patients. NMR spectra of serum were recorded, and statistical analysis was done.</p><p><strong>Results: </strong>The 2D scatter plot of PC1 versus PC2 scores clearly shows a distinction between the groups, with the principal component analysis explaining 18.9% of the variance. Partial least-squares discriminant analysis demonstrated <i>R</i> ² and <i>Q</i> ² values of 0.328 and 0.0552, respectively, indicating a probability to model fit. A total of 27 distinct metabolites were identified. Univariate receiver operating characteristic curve analysis identified phenylalanine (area under the curve [AUC] = 0.720), acetoacetate (AUC = 0.706), and glutamate (AUC = 0.690) as significant metabolites. With AUC values within the fair accuracy range, these three metabolites are considered acceptable biomarkers for the diagnosis of VAP.</p><p><strong>Conclusion: </strong>The elevated metabolites indicate lung injury and perturbed inflammatory pathways, which may result from invasive mechanical ventilation. We conclude that the levels of phenylalanine, acetoacetate, and glutamate may serve as biomarkers and aid in the diagnosis of VAP, disease monitoring, and therapeutic stratification.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 2","pages":"57-66"},"PeriodicalIF":0.0,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252672/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224802","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 value of hematological ratios in sepsis: A prospective observational study of neutrophil-to-lymphocyte, platelet-to-lymphocyte, and monocyte-to-lymphocyte ratios.","authors":"Navanath Deokate, Sourya Acharya, Rajvardhan Patil, Faizan Khan, Nishant Rathod, Sohail Sheikh","doi":"10.4103/ijciis.ijciis_94_25","DOIUrl":"10.4103/ijciis.ijciis_94_25","url":null,"abstract":"<p><strong>Background: </strong>Early identification of high-risk sepsis patients remains a clinical priority. Hematological ratios such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR) have emerged as potential prognostic biomarkers reflecting systemic inflammation and immune dysregulation in sepsis. To evaluate the prognostic significance of NLR, PLR, and MLR in predicting clinical outcomes in patients with sepsis, including mortality, hospital stay duration, and need for mechanical ventilation.</p><p><strong>Methods: </strong>This prospective cross-sectional observational study included 200 adult patients (>18 years) with clinically diagnosed sepsis admitted to a tertiary care hospital from January 2023 to March 2025. Complete blood counts were used to calculate NLR, PLR, and MLR. The Sequential Organ Failure Assessment score was used to assess organ dysfunction. Statistical comparisons were performed using <i>t</i>-tests, ANOVA, Chi-square tests, and receiver operating characteristic (ROC) curve analysis. Correlation analyses were also conducted.</p><p><strong>Results: </strong>Higher NLR and MLR values were significantly associated with prolonged hospital stay (<i>P</i> = 0.0031 and <i>P</i> = 0.0027, respectively) and need for mechanical ventilation (<i>P</i> = 0.0018 and <i>P</i> = 0.0012, respectively). ROC analysis revealed that NLR (area under the curve [AUC] =0.797) and PLR (AUC = 0.707) had good predictive accuracy for mortality. No significant difference was observed in inflammatory ratios between death and discharge groups.</p><p><strong>Conclusion: </strong>NLR and MLR serve as reliable prognostic indicators in sepsis and correlate significantly with disease severity and outcomes. Their inclusion in the initial sepsis workup may support early risk stratification and clinical decision-making.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 2","pages":"36-40"},"PeriodicalIF":0.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252668/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224850","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":"Plasma lactate and severity of illness for acute pulmonary embolism: A Bayesian probability model.","authors":"Amado Alejandro Báez, Faith Ibu, Helena Halasz","doi":"10.4103/ijciis.ijciis_116_25","DOIUrl":"10.4103/ijciis.ijciis_116_25","url":null,"abstract":"<p><strong>Background: </strong>Plasma lactate >2 mmol/L has been associated with increased mortality in acute pulmonary embolism (PE), even among hemodynamically stable patients. Despite strong evidence, lactate remains underutilized in risk stratification tools such as the simplified PE Severity Index (sPESI). To assess the incremental prognostic value of plasma lactate when integrated into a Bayesian probability model for Pulmonary Embolism.</p><p><strong>Methods: </strong>Pretest probabilities were defined by SI and sPESI. Sensitivity and specificity for plasma lactate >2 mmol/L were derived from prior meta-analyses and validated multicenter datasets. Likelihood ratios were applied within a Bayesian nomogram to estimate posttest probabilities. Diagnostic efficiency was evaluated using Bayesian Diagnostic Gain (BDG) and Bayesian Number Needed to Diagnose (BNND).</p><p><strong>Results: </strong>Thirty-day mortality for SI >1 was 24.1% versus 10.7% for low-risk SI and 10.7% versus 1.5% for sPESI. Lactate >2 mmol/L yielded 82.4% sensitivity (95% confidence interval [CI]: 56.8-95.3) and 73.5% specificity (95% CI: 71.8-74.4). Integrating lactate into the SI model produced an Absolute Diagnostic Gain (ADG) of 25.9% (BNND = 4), outperforming the sPESI model (ADG: 16.3%, BNND = 6).</p><p><strong>Conclusions: </strong>Bayesian integration of plasma lactate with the SI enhances prognostic accuracy and produces superior diagnostic gains compared with sPESI-based models. This supports a probabilistic, physiology-driven approach to PE risk stratification.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 2","pages":"67-71"},"PeriodicalIF":0.0,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224839","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 diagnostic utility of heart-type fatty acid-binding protein as a novel biomarker for acute coronary syndrome in the emergency department: A 1-year cross-sectional study.","authors":"Raju H Badiger, S V Dinesha","doi":"10.4103/ijciis.ijciis_63_25","DOIUrl":"10.4103/ijciis.ijciis_63_25","url":null,"abstract":"<p><strong>Background: </strong>Acute myocardial infarction (AMI) and related cardiac conditions are leading global causes of mortality. Timely diagnosis and intervention in AMI are vital; however, existing biochemical markers such as myoglobin, creatine kinase-MB (CK-MB), and troponins have limitations in early detection. Heart-type fatty acid-binding protein (H-FABP), abundant in cardiac tissue, has emerged as a potential early biomarker for AMI. This study evaluates the diagnostic efficacy of H-FABP compared to troponin-T (Trop-T) and CK-MB, aiming to establish H-FABP as a reliable biomarker for early acute coronary syndrome (ACS) diagnosis.</p><p><strong>Methods: </strong>This prospective comparative cross-sectional study was conducted at KLES Dr. Prabhakar Kore Hospital from January to December 2023, enrolling 50 patients presenting with chest pain suggestive of ACS. Laboratory assessments were executed for cardiac Trop-T, CK-MB, and H-FABP. Trop-T and CK-MB levels were measured upon presentation and again 6-12 h postadmission, while H-FABP was qualitatively assessed at presentation only. Data on symptoms and medical history were recorded. Laboratory analyses utilized electrochemiluminescence immunoassay for Trop-T and CK-MB and rapid chromatographic immunoassay for H-FABP. The primary outcome was sensitivity for diagnosing ACS within the initial 3-h window, with secondary outcomes including specificity, positive predictive value, and negative predictive value.</p><p><strong>Results: </strong>The mean age was 52.68 ± 12 years, with a significant male predominance (74.4% in AMI). Typical chest pain was reported by 80% of patients. H-FABP showed 76.92% sensitivity, 100% specificity, and a highly significant <i>P</i> < 0.0001 within the 3-h window, while Trop-T's sensitivity improved over time from 35.90% at presentation to 84.60% at 6-12 h. CK-MB exhibited moderate sensitivity (43.59% at presentation and 66.70% at 6-12 h) and significant specificity (100%).</p><p><strong>Conclusion: </strong>This study highlights clinical and diagnostic differences between AMI and UA. H-FABP demonstrated high diagnostic accuracy during the early hours of presentation, suggesting its potential as a valuable early biomarker for ACS diagnosis. However, larger multicentric studies are necessary to validate these findings before routine clinical adoption.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 2","pages":"72-78"},"PeriodicalIF":0.0,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13252676/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224852","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":"Augmenting emergency medicine education with artificial intelligence: Promise, peril, and pathways forward.","authors":"Vivek Chauhan, Sagar Galwankar, Sarah Temple, Bill Boyer","doi":"10.4103/ijciis.ijciis_126_25","DOIUrl":"10.4103/ijciis.ijciis_126_25","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377394","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? Pediatric poison prevention - No more \"accidents\".","authors":"Sanjay Mohan, Elise Perlman","doi":"10.4103/ijciis.ijciis_108_25","DOIUrl":"10.4103/ijciis.ijciis_108_25","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 1","pages":"30-32"},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377482","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":"Identification of effective weaning through diaphragmatic ultrasound added to clinical parameters among mechanically ventilated patients in the intensive care unit at a tertiary care center: A prospective observational study.","authors":"Rakesh Bahadur Singh, Prashant Kumar Mishra, Urvashi Yadav, Ayush Kumar Pandey","doi":"10.4103/ijciis.ijciis_98_25","DOIUrl":"10.4103/ijciis.ijciis_98_25","url":null,"abstract":"<p><strong>Background: </strong>Effective and timely weaning is essential for improving the outcome of intensive care unit (ICU) patients. This study was conducted to determine whether diaphragmatic thickness fraction measured by ultrasound provides any additional benefit when combined with clinical parameters for successful weaning.</p><p><strong>Methods: </strong>This prospective observational study was conducted on 100 mechanically ventilated patients in the ICU. When the criteria for weaning were satisfactorily fulfilled, a spontaneous breathing trial was administered. Rapid Shallow Breathing Index (RSBI) and bedside ultrasound to measure diaphragmatic thickness fraction (DTF) were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of RSBI and DTF were calculated utilizing a cutoff value of RSBI <82 and a DTF cutoff of >37%. The predictability of weaning success was evaluated by the area under the receiver operating characteristic curve (AUROC).</p><p><strong>Results: </strong>Of the 100 patients observed, 68 patients had weaning success while 32 patients experienced weaning failure. The sensitivity, specificity, PPV, and NPV of RSBI were greater compared to DTF (88.23%, 96.87%, 98.36%, and 79.48% vs. 88.23%, 84.37%, 92.30%, and 77.14% respectively). The AUROC values for RSBI, DTF, and their combination were 0.86, 0.78, and 0.90, respectively. The Pearson correlation coefficient of RSBI with DTF was found to be -0.475.</p><p><strong>Conclusion: </strong>RSBI proved to be a highly reliable predictor of successful weaning, demonstrating superior diagnostic accuracy. The combination of RSBI and DTF improved the diagnostic validity profile, suggesting that integration of diaphragmatic ultrasound with conventional clinical indices enhances the reliability of weaning assessment.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 1","pages":"12-18"},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377447","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":"To compare the effect of ketamine versus dexmedetomidine spray at the surgical site during closure in lumbar spine fixation surgery for postoperative pain relief: Prospective, randomized, double-blinded, placebo-controlled study.","authors":"Annamalaei, Atul Kumar Singh, Yashpal Singh, Birju Manjhi, Arun Raj Pandey, Bikram Kumar Gupta","doi":"10.4103/ijciis.ijciis_89_25","DOIUrl":"10.4103/ijciis.ijciis_89_25","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spine surgeries are associated with severe postoperative pain due to the extensive handling of tissue and bone. Multimodal analgesia is the preferred choice but is associated with systemic side effects. Atomized drugs at the local surgical site may be a more attractive option than the intravenous route. In this study, we compare the atomized form of ketamine and dexmedetomidine at the surgical site for postoperative pain relief in lumbar spine surgeries.</p><p><strong>Methods: </strong>After approval from institutional ethics committee and the Clinical Trial Registry - India, 45 patients of age group between 18 and 60 years, scheduled for lumbar spine surgery under general anesthesia were divided into three equal groups: Group D: Received dexmedetomidine 1 µ/kg, Group K: Received Ketamine 1 mg/kg and Group N: Received 20 ml of normal saline. Drugs were diluted in 20 mL of normal saline and applied over the surgical site at the end of the surgery, before closure, in the form of fine droplets using an atomizer device. Our primary outcome was the postoperative analgesia measured by the Visual Analog Scale.</p><p><strong>Results: </strong>Duration of postoperative analgesia was significantly higher in the ketamine group, 240 min (interquartile range [IQR]: 120-360) than the dexmedetomidine group, 120 min (IQR: 120-240) determined by the Kruskal-Wallis test (<i>P</i> < 0.001).</p><p><strong>Conclusion: </strong>Atomized ketamine and dexmedetomidine at the surgical site during closure in lumbar spine fixation surgery is an attractive choice for postoperative pain relief without any systemic side effects.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 1","pages":"19-24"},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377527","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":"Comparative effectiveness of laryngoscopes for successful intubation in difficult adult airways: A systematic review.","authors":"Mohammad Jamil G Alhemedi, Bayan Saleh A Zabin, Salim M J Bani Omar, Mahmoud H Alrabab'a, Yazan Alkhsealat, Esraa A Al-Nusour","doi":"10.4103/ijciis.ijciis_97_25","DOIUrl":"10.4103/ijciis.ijciis_97_25","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal intubation (ETI) is a commonly performed emergency procedure used to secure the airways in critically ill patients. Despite its importance, ETI presents significant risks to patients with difficult airways. The availability of different types of laryngoscopes, most notably video laryngoscopes and direct laryngoscopes (DLs), has contributed to improved intubation success rates and reduced complications. While numerous studies have compared video laryngoscopes and DLs, there remains a limited synthesis of evidence evaluating the full range of all laryngoscopes across different patient population and clinical settings.</p><p><strong>Methods: </strong>A narrative synthesis approach was employed in this review. Relevant articles were obtained from multiple databases, including PubMed (MEDLINE), CINAHL, and PsycINFO. Articles published up to June 23, 2025, were considered for inclusion. The methodological rigor and reporting quality of each article were appraised. The screening and exclusion process were documented using the PRISMA flow diagram. Titles, abstracts, full texts, and reference lists of all retrieved articles were thoroughly reviewed to identify potentially relevant publications.</p><p><strong>Results: </strong>Video laryngoscopes, particularly the McGrath, GlideScope, and C-MAC D-Blade, demonstrated superior performance compared to laryngoscopes. There was better first-pass success, better view of the larynx, less need for external adjusting maneuvers, and shorter time to intubation. Other devices such as Airtraq and Bonfils fiberscope have good results in some clinical settings, but are useful only where there is high operator dependence and have a more difficult learning curve.</p><p><strong>Conclusion: </strong>Video laryngoscopes have proven to be better than DLs in managing adult patients with difficult airways due to the advantages of the success rate, visualization of the glottis, and efficiency of the procedure. However, methodological heterogeneity and an absence of consistently high quality in clinical trial data lead to inadequate evidence for recommending one specific laryngoscope as being better for all difficult airway scenarios. Further well-designed high-quality clinical studies are required to determine the most effective laryngoscope for intubating adults with difficult airways across diverse clinical settings.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 1","pages":"4-11"},"PeriodicalIF":0.0,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962441/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377392","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? Bayesian genomics and the next frontier of early sepsis prediction: Promise, pitfalls, and the path forward.","authors":"Tanmoy Ghatak, Ryan Snitowsky","doi":"10.4103/ijciis.ijciis_130_25","DOIUrl":"10.4103/ijciis.ijciis_130_25","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 4","pages":"137-138"},"PeriodicalIF":0.0,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963400","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}