International Journal of Critical Illness and Injury Science最新文献

{"title":"An innovative method to do incentive spirometry in tracheostomized critically ill patients.","authors":"Sachin Wali, Afzal Azim, Mohan Gurjar","doi":"10.4103/ijciis.ijciis_68_25","DOIUrl":"10.4103/ijciis.ijciis_68_25","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 4","pages":"163-164"},"PeriodicalIF":0.0,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178831/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963397","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":"Prolonged somatic support in a brain-dead pregnant woman: An ethical statement.","authors":"Alan Silburn","doi":"10.4103/ijciis.ijciis_86_25","DOIUrl":"10.4103/ijciis.ijciis_86_25","url":null,"abstract":"<p><p>This ethical position statement critically examines the case of a 35-year-old female who was declared brain-dead at 16 weeks' gestation and maintained on life support for 110 days, resulting in the successful delivery of a viable infant at 32 weeks. The case, reported by Said <i>et al</i>., raises complex ethical questions regarding the balance between beneficence and nonmaleficence, respect for autonomy, and fairness in the allocation of healthcare resources. Applying the four quadrants approach developed by Jonsen, Siegler, and Winslade, this analysis explores key domains of ethical reasoning, including medical indications, patient preferences, quality of life, and contextual features. Counterarguments are addressed concerning the prolongation of somatic support in the absence of explicit maternal consent, the ethical costs of intensive intervention, and the implications for the dignity of the deceased. Conversely, arguments supporting the continuation of care focus on surrogate decision-making, fetal interests, and a presumption in favor of maternal intent to sustain the pregnancy. The discussion highlights the role of multidisciplinary consultation and the importance of ethical frameworks in navigating morally complex scenarios. In addition to clinical ethics, this case also presents public health challenges concerning equitable access, intensive care unit resource allocation, and the sustainability of rare but resource-intensive interventions within publicly funded health systems. Ultimately, the continuation of somatic support may be ethically defensible when guided by structured deliberation, respect for presumed maternal values, and commitment to both individual and societal responsibilities.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 4","pages":"139-142"},"PeriodicalIF":0.0,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963409","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":"Chawla's modified Griggs percutaneous tracheostomy: A safe, cost-effective alternative for resource-limited intensive care units.","authors":"Vikas Chawla, Siddharth Goyal, Gopichand Reddy Yarkareddy, Kulwant","doi":"10.4103/ijciis.ijciis_45_25","DOIUrl":"10.4103/ijciis.ijciis_45_25","url":null,"abstract":"<p><strong>Objective: </strong>Percutaneous tracheostomy (PCT) offers advantages over surgical tracheostomy but remains underutilized in resource-limited settings due to dependence on bronchoscopy and costly commercial kits. Therefore, we conducted a retrospective study to evaluate the role of Chawla's modified Griggs PCT to overcome these barriers by eliminating bronchoscopy while maintaining safety.</p><p><strong>Methods: </strong>This retrospective study analyzed 72 intensive care unit patients undergoing modified PCT (2021-2023) using sterilized reusable instruments and low-cost disposables. Outcomes included success rates, complications, procedure time, and cost savings versus commercial kits.</p><p><strong>Results: </strong>The technique achieved 100% success with a mean procedure time of 6.2 ± 2.1 min. Only 3 cases (4.2%) had minor bleeding, with no major complications. Notably effective in 46 traumatic brain injury patients (63.9%), it reduced costs by 75%-85%. No delayed complications emerged at the 6-8 week follow-up.</p><p><strong>Conclusion: </strong>This modification demonstrates PCT can be performed safely and cost-effectively without bronchoscopy in resource-limited settings. The substantial cost savings and good outcomes in high-risk patients suggest strong potential for wider adoption in low- and middle-income countries, though prospective multicenter validation is needed.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 4","pages":"157-162"},"PeriodicalIF":0.0,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963413","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":"Bilirubin is not an independent predictor of mortality in patients admitted to intensive care with sepsis - A prospective, single-center cohort from South India.","authors":"Jophin John, V Arul Selvan, A Senthil Vadivu, T Ravishankar","doi":"10.4103/ijciis.ijciis_65_25","DOIUrl":"10.4103/ijciis.ijciis_65_25","url":null,"abstract":"<p><strong>Background: </strong>Hyperbilirubinemia is frequently observed in critically ill patients with sepsis and is proposed as a prognostic marker for mortality. However, its independent predictive value, particularly when accounting for established severity indices, remains unclear.</p><p><strong>Methods: </strong>We conducted a prospective cohort study in the intensive care unit (ICU) of a tertiary care center in South India from April 2021 to April 2022. Adults (≥18 years) with sepsis were enrolled, excluding those with preexisting liver disease or alternative causes for hyperbilirubinemia. Serum total bilirubin was measured within 48 h of ICU admission and categorized as normal (≤1.2 mg/dL), mildly elevated (1.21-2 mg/dL), or significantly elevated (>2 mg/dL). Demographic, clinical, and laboratory data were collected. The primary outcome was ICU mortality. Univariate and multivariate logistic regression analyses identified the independent predictors of mortality.</p><p><strong>Results: </strong>Among 110 patients, ICU mortality was 29.1%. Nonsurvivors had significantly higher bilirubin levels (6.2 ± 5.5 mg/dL vs. 1.8 ± 2.3 mg/dL, <i>P</i> < 0.001) and higher Acute Physiology and Chronic Health Evaluation II (APACHE-II) scores. Elevated bilirubin was associated with mortality in univariate analysis (univariate odds ratio [OR] 1.3/1 mg/dL increase, 95% confidence interval [CI] 1.2-1.5, <i>P</i> < 0.001). However, after adjusting for APACHE-II score and comorbidity burden, bilirubin was not an independent predictor of mortality (adjusted OR [aOR] 1.3, 95% CI 0.8-2.2, <i>P</i> = 0.266). APACHE-II score remained the only independent predictor (aOR 1.8, 95% CI 1.1-2.9, <i>P</i> = 0.02).</p><p><strong>Conclusion: </strong>While hyperbilirubinemia is associated with increased ICU mortality in sepsis, it is not an independent predictor after accounting for disease severity.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 4","pages":"150-156"},"PeriodicalIF":0.0,"publicationDate":"2025-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178848/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963359","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":"A Bayesian genomic-enhanced precision critical care early warning model for septic shock outcomes.","authors":"Amado Alejandro Báez, Naomi Reyes, Raghavan Raju","doi":"10.4103/ijciis.ijciis_26_25","DOIUrl":"10.4103/ijciis.ijciis_26_25","url":null,"abstract":"<p><strong>Background: </strong>Septic shock remains a significant contributor to mortality, with high patient variability in treatment response. Precision medicine offers promise in addressing this complexity. This study aimed to develop a Bayesian genomic-enhanced precision critical care clinical decision/probability model to predict outcomes in septic shock patients.</p><p><strong>Methods: </strong>Utilizing Bayesian modeling, we integrated clinical scoring systems (e.g., the Miami sepsis score and point of care lactate) with genomic data. Sensitivity and specificity from prior studies were incorporated into the model. The effectiveness of a genomic-based approach versus a Bayesian model was evaluated using paired <i>t</i>-tests with a significance threshold of <i>P</i> < 0.05.</p><p><strong>Results: </strong>The mean difference between the GENOMIC and Bayesian groups was -19.8900, with a 95% confidence interval ranging from -39.7944 to 0.0144. The combined Bayesian model, integrating clinical, lactate, and genomic data outperformed standalone genomic models. Mean score for the Bayesian model was 92.75 (standard deviation [SD] = 5.1881), significantly higher than the genomic model's 72.86 (SD = 15.4196) (<i>P</i> < 0.05). This suggests that the Bayesian model offers more consistent performance in predicting septic shock outcomes and a statistically significant improvement in accuracy. These findings underscore the Bayesian framework's potential for real-time decision-making in precision critical care.</p><p><strong>Conclusion: </strong>A Bayesian genomic-enhanced model offers a promising pathway for improving septic shock outcomes. Future studies with larger datasets and further model refinement are warranted to validate its potential and explore its broader application in critical care.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 4","pages":"143-149"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147963612","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":"Role of extracorporeal therapy in poisoning - A case based narrative.","authors":"Saif Quaiser, Ramindla Sruthi, Ruhi Khan, Neha Agrawal","doi":"10.4103/ijciis.ijciis_34_25","DOIUrl":"10.4103/ijciis.ijciis_34_25","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal treatment (ECTR) have been employed for poison elimination dating back to as early as the 1960s, but during the current day and time, the indications for ECTR are mostly arbitrary and are considered when other treatments of poison elimination or reduction below toxic levels are not available. It is invaluable, especially when the toxins or poison are amendable to removal by ECTR, especially in a setting of clinical deterioration, the unavailability of specific antidotes, or when other treatment modalities are cost prohibitive in a tertiary setting with ECTR facilities.</p><p><strong>Objective: </strong>To reiterate the efficacy of extracorporeal therapy techniques in poisoning focusing on the indications, available modalities, and outcomes.</p><p><strong>Methods: </strong>Three clinical cases of acute poisoning with phenobarbitone, copper sulfate, and snake envenomation, effectively managed by ECTR, in detail were reviewed. A literature review on ECTR in poisoning was also conducted to summarize the principles.</p><p><strong>Results: </strong>All three patients were managed with appropriate ECTR modalities. Therapeutic plasma exchange was used to treat snakebite-induced thrombotic microangiopathy, hemodialysis was used to treat phenobarbital toxicity, and plasma exchange was used effectively for copper sulfate poisoning. ECTR was initiated early, which resulted in clinical improvement and recovery in all cases.</p><p><strong>Conclusion: </strong>HD remains a pivotal treatment option for the management of severe poisonings. Nevertheless, given the rare possibility of an encounter with cases necessitating treatment with extracorporeal therapies and the lack of recommendations and guidelines to standardize the practice, the evidence supporting the application of ECTR still remains limited and needs to be studied further for high-quality evidence.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"16 1","pages":"25-29"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12962444/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147377475","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":"Management of boerhaave's syndrome in the intensive care unit.","authors":"Safiya Sherrin, Jasmine Kaur Kochhar, Wafabi Mustafa, Kartik Batham","doi":"10.4103/ijciis.ijciis_44_25","DOIUrl":"10.4103/ijciis.ijciis_44_25","url":null,"abstract":"<p><p>Boerhaave's syndrome (BS), or spontaneous esophageal perforation, is a rare and life-threatening condition. Despite advancements in medical and surgical management, BS carries a high mortality rate, up to 50%, and presents significant diagnostic and therapeutic challenges. Management options include both surgical and nonoperative approaches, with the Pittsburgh score providing a useful tool for predicting outcomes and guiding treatment. Complications such as mediastinitis and sepsis are common. This review explores the demographics, risk factors, clinical presentation, diagnostic modalities, and management strategies for BS. Furthermore, it stresses the importance of early diagnosis and individualized treatment to improve the outcomes in patients with BS.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 3","pages":"132-135"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085936","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":"Artificial intelligence: Revolutionizing pediatric emergency care - A narrative review.","authors":"Ayonna Saha, Anushruti Shukla, Vikram Bhaskar","doi":"10.4103/ijciis.ijciis_24_25","DOIUrl":"10.4103/ijciis.ijciis_24_25","url":null,"abstract":"<p><p>Artificial intelligence (AI) refers to machines capable of imitating human cognition, with abilities to learn, apply logic and reasoning, and adapt to new information. The scope of AI in medicine ranges from prehospital triage to assisting in diagnosis and prognosticating patients. AI has shown incredible potential in pediatric emergency department by focusing on the development of clinical prediction models, triage systems, and diagnostic aids, contributing to higher accuracy and efficiency in patient management, along with hospital management, medical education, and training. Our review article discusses the current applications of AI in pediatric emergency and explores the barriers to AI in health care and ways to circumnavigate them moving forward. We aim to offer an insight into this less-explored world where technology meets the unpredictable and fast-paced environment of pediatric emergency medicine, building a future with a promise of innovation and redefining standards of care.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 3","pages":"123-131"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085899","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":"Effect of early tracheostomy for determining patient outcomes vis-a-vis late tracheostomy in severe stroke patients: A randomized controlled trial.","authors":"Nitin Kumar, Mukesh Bairwa, Ravi Kant, Sahil Kumar, Amit Kumar Tyagi, Yogesh Bahurupi, Minakshi Dhar","doi":"10.4103/ijciis.ijciis_18_25","DOIUrl":"10.4103/ijciis.ijciis_18_25","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of mortality and disability in India, and the hospital and intensive care unit (ICU) beds are limited. This randomized controlled trial (RCT) aimed to assess the effectiveness of early tracheostomy (ET) in reducing 30-day mortality in stroke patients, and secondary objectives included evaluating rates of ventilator-associated pneumonia (VAP) and length of ICU stay compared to late tracheostomy (LT).</p><p><strong>Methods: </strong>This open-label RCT was conducted over 18 months at a tertiary care hospital in north India, involving 60 patients (30 in each group). Eligible participants were adults (≥18 years) with nontraumatic stroke (acute ischemic stroke, intracerebral hemorrhage, subarachnoid hemorrhage, and vasculitic infarcts) requiring prolonged intubation (stroke-related early tracheostomy score ≥8). Exclusions included preexisting pneumonia, high oxygen needs, pregnancy, and those on ventilation for over 4 days. Patients were assigned to ET (day 4) or LT (day 10), with demographics and clinical characteristics recorded. Mortality was assessed on day 30 postintubation and data for secondary outcomes were collected every other day.</p><p><strong>Results: </strong>Sixty-four patients were randomized, 30 to the ET group, and 34 to the LT group, with a mean age of 55.48 (±15.94) years. Mortality within 30 days was 50% in both groups. VAP rates were 43.3% in the ET group and 50% in the LT group (<i>P</i> = 0.605). The mean ICU length of stay was 12.07 days for ET and 18.43 days for LT (<i>P</i> = 0.0001).</p><p><strong>Conclusion: </strong>The RCT found no significant differences in mortality or VAP rates but noted reduced ICU hospital stays for the ET group, suggesting benefits for severe stroke patients.</p>","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 3","pages":"108-113"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085897","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? Cardiac dysfunction in patients with cirrhosis and its correlation with Child - Turcott - Pugh (CTP) SCORE.","authors":"Tarun Sharma, Christopher Caspers","doi":"10.4103/ijciis.ijciis_88_25","DOIUrl":"10.4103/ijciis.ijciis_88_25","url":null,"abstract":"","PeriodicalId":13938,"journal":{"name":"International Journal of Critical Illness and Injury Science","volume":"15 3","pages":"99-100"},"PeriodicalIF":0.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145085928","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}