Indian Journal of Critical Care Medicine最新文献

{"title":"Deciphering Oxygenation Metrics in ARDS: A Deep Dive into the OXIVA-CARDS Study.","authors":"Sathwik Gangireddy, Pratyusha Kambagiri, Atul Jindal","doi":"10.5005/jp-journals-10071-24846","DOIUrl":"10.5005/jp-journals-10071-24846","url":null,"abstract":"<p><p>Gangireddy S, Kambagiri P, Jindal A. Deciphering Oxygenation Metrics in ARDS: A Deep Dive into the OXIVA-CARDS Study. Indian J Crit Care Med 2025;29(3):282.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"282"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915399/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665168","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":"The Effect of Perioperative Fluid Therapy on Postoperative Renal Functions in Patients Receiving Liver Transplantation from Living Donors: A Retrospective Observational Study.","authors":"Nurcan Kızılcık","doi":"10.5005/jp-journals-10071-24907","DOIUrl":"10.5005/jp-journals-10071-24907","url":null,"abstract":"<p><strong>Background: </strong>Perioperative fluid management (PFM) is critical in liver transplantation, especially regarding its impact on postoperative renal function. Acute kidney injury (AKI) is a common complication in liver transplant recipients, often influenced by the type and volume of fluids administered during the perioperative period. This study investigates the effects of different fluid management strategies on renal outcomes following liver transplantation from living donors.</p><p><strong>Patients and methods: </strong>This retrospective observational study included 91 liver transplant recipients who were categorized into three groups based on their PFM strategy: restrictive (<i>n</i> = 1), moderate (<i>n</i> = 34), and liberal (<i>n</i> = 56). Data were collected from patient medical records, focusing on fluid types, peak serum creatinine levels, urine output, and length of hospital stay. Statistical analyses, including ANOVA and logistic regression, were conducted to assess renal outcomes among the groups.</p><p><strong>Results: </strong>The moderate fluid management group demonstrated the best renal outcomes, with the lowest peak serum creatinine (1.02 ± 0.25 mg/dL) and shorter ICU stays (2.47 ± 0.62 days) compared to the liberal fluid strategy group (1.40 ± 0.92 mg/dL and 2.88 ± 0.83 days, respectively). Moreover, liberal fluid strategies were associated with fluid overload and increased peak serum creatinine levels. Intraoperative fluid administration showed a greater protective effect on renal function compared to postoperative fluid administration.</p><p><strong>Conclusions: </strong>Moderate PFM, particularly with careful intraoperative fluid administration, is optimal for minimizing the risk of AKI and improving renal outcomes in liver transplant patients. These findings emphasize the importance of individualized fluid therapy in reducing renal complications after liver transplantation.</p><p><strong>How to cite this article: </strong>Kızılcık N. The Effect of Perioperative Fluid Therapy on Postoperative Renal Functions in Patients Receiving Liver Transplantation from Living Donors: A Retrospective Observational Study. Indian J Crit Care Med 2025;29(3):251-261.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"251-261"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664921","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":"VExUS Score: Making Waves in an Ocean but Still a Mirage in the Desert.","authors":"Vivek Kumar","doi":"10.5005/jp-journals-10071-24931","DOIUrl":"10.5005/jp-journals-10071-24931","url":null,"abstract":"<p><p>Kumar V. VExUS Score: Making Waves in an Ocean but Still a Mirage in the Desert. Indian J Crit Care Med 2025;29(3):205-207.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"205-207"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665009","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":"Prokineticin-2 and Procalcitonin's Diagnostic Accuracy for Sepsis in Critically Ill Patients: A Prospective Observational Study.","authors":"Kavyashree Bhat, Nikhil Kothari, Ankur Sharma, Shilpa Goyal, Tanvi Meshram, Bharat Paliwal, Pradeep Bhatia, Shrimanjunath Sankanagoudar","doi":"10.5005/jp-journals-10071-24930","DOIUrl":"10.5005/jp-journals-10071-24930","url":null,"abstract":"<p><strong>Objective: </strong>Sepsis stands as a significant contributor to mortality in ICU settings worldwide. Early diagnosis and appropriate treatment are therefore essential to reduce mortality. We planned this study to investigate the diagnostic significance of prokineticin-2 (PK-2) in patients with sepsis.</p><p><strong>Materials and methods: </strong>Adult patients with sepsis who were admitted to our intensive care unit (ICU) were included in this prospective observational study. On the day of admission and the 7th day of the ICU stay, the levels of procalcitonin (PCT) and PK-2 were assessed. Patients' mortality was observed for 28 days.</p><p><strong>Results: </strong>This research involved 83 patients meeting the inclusion criteria. Prokineticin-2 showed a diagnostic sensitivity of 70.6% for sepsis, outperforming PCT with a sensitivity of 64.7%. In predicting mortality, PCT displayed a sensitivity of 95.5%, whereas Prokineticin-2 demonstrated an even higher sensitivity at 98.4%.</p><p><strong>Conclusion: </strong>Prokinectin-2 can be used for screening adult patients with sepsis admitted to ICU.</p><p><strong>How to cite this article: </strong>Bhat K, Kothari N, Sharma A, Goyal S, Meshram T, Paliwal B, <i>et al</i>. Prokineticin-2 and Procalcitonin's Diagnostic Accuracy for Sepsis In Critically Ill Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(3):268-272.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"268-272"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915404/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664050","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":"Cracking the Code of AKI: Evaluating the Predictive Power of VExUS Scoring in Critically Ill Noncardiac Patients.","authors":"Waseem Ahmad Khan, Vikas Saini, Alisha Goel, Anas Valiyaparambath","doi":"10.5005/jp-journals-10071-24924","DOIUrl":"10.5005/jp-journals-10071-24924","url":null,"abstract":"<p><strong>Background: </strong>Numerous signs of venous congestion exist, but each has limitations. Previous studies have shown the utility of venous excess ultrasound (VExUS) scoring in predicting acute kidney injury (AKI) in patients postcardiac surgery. This study aimed to evaluate whether serial VExUS scoring could predict AKI in intensive care unit (ICU) patients without cardiac conditions.</p><p><strong>Materials and methods: </strong>This single-center observational study was conducted in the main ICU of PGIMER, Chandigarh, India. Thirty patients with an inferior vena cava (IVC) diameter of ≥2 cm and a normal biventricular function were included. Serial VExUS scoring was performed on admission and daily for up to six days or until AKI developed, whichever occurred first.</p><p><strong>Results: </strong>Among 30 participants, 22 (73.3%) developed AKI. In the AKI group, mean VExUS scores were 1.95 on day 2, 1.92 on day 3, and 3.0 on day 5 (<i>p</i> = 0.001, 0.003, and 0.002, respectively). A significant positive correlation was observed between VExUS scores and fluid balance on day 2 (ρ = 0.375, <i>p</i> = 0.041) and day 3 (ρ = 0.579, <i>p</i> = 0.006). Multivariate analysis showed no correlation between the VExUS score on day 2 and fluid balance, duration of mechanical ventilation, or ICU length of stay. No association was found between VExUS scores and 30-day mortality.</p><p><strong>Conclusion: </strong>In critically ill noncardiac patients, VExUS scores do not predict AKI onset. However, higher daily fluid balance may moderately correlate with VExUS scores.</p><p><strong>How to cite this article: </strong>Khan WA, Saini V, Goel A, Valiyaparambath A. Cracking the Code of AKI: Evaluating the Predictive Power of VExUS Scoring in Critically Ill Noncardiac Patients. Indian J Crit Care Med 2025;29(3):236-243.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"236-243"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665165","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":"Beyond Sound Sleep: The Wake-up Call on Benzodiazepine Overdose.","authors":"Carol S D'Silva, Bhuvana Krishna","doi":"10.5005/jp-journals-10071-24935","DOIUrl":"10.5005/jp-journals-10071-24935","url":null,"abstract":"<p><p>D'Silva CS, Krishna B. Beyond Sound Sleep: The Wake-up Call on Benzodiazepine Overdose. Indian J Crit Care Med 2025;29(3):203-204.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"203-204"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915393/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665162","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":"The Range of Nonpharmacological Measures to Prevent Delirium in ICUs is Broader than Assumed.","authors":"Josef Finsterer, Joao Gama Marques","doi":"10.5005/jp-journals-10071-24900","DOIUrl":"10.5005/jp-journals-10071-24900","url":null,"abstract":"<p><p>Finsterer J, Gama Marques J. The Range of Nonpharmacological Measures to Prevent Delirium in ICUs is Broader than Assumed. Indian J Crit Care Med 2025;29(3):278-279.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"278-279"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915398/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143664933","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":"Utility of Serum Prolactin Levels as a Marker for Disease Severity and Short-term Prognosis in Patients with Cirrhosis: A Prospective Observational Study.","authors":"Rajneesh Singh, Ramu Ramadoss, Pazhanivel Mohan, Balasubramaniyan Vairappan","doi":"10.5005/jp-journals-10071-24899","DOIUrl":"10.5005/jp-journals-10071-24899","url":null,"abstract":"<p><strong>Background: </strong>Cirrhosis, a leading cause of global mortality, necessitates an accurate assessment of disease severity and prognosis. While traditional scoring systems like Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) are used to assess the severity, specific biomarkers are lacking. This study explores serum prolactin levels as a potential biomarker for evaluating cirrhosis severity and predicting short-term mortality.</p><p><strong>Methods: </strong>A prospective observational study was conducted from December 2021 to December 2023. After a thorough clinical examination, serum prolactin levels were measured. The correlation between prolactin levels and established severity scores [CTP, MELD, chronic liver failure consortium organ failure (CLIF-C OF), and MELD-sodium (MELD-Na)] was analyzed. The study also evaluated the prognostic value of prolactin levels in predicting 28-day and 90-day mortality.</p><p><strong>Results: </strong>A total of 90 patients with liver cirrhosis were included. There were 82% men, with a mean age of 47.6 years. Alcohol was the most common cause of cirrhosis (73%). The median (interquartile range (IQR)) serum prolactin level was 29 (10-54) ng/mL, with higher levels correlating with increased disease severity: CTP (<i>r</i> = 0.73), MELD (<i>r</i> = 0.64), MELD-Na (<i>r</i> = 0.67), and CLIF-C OF (<i>r</i> = 0.82) scores. Elevated prolactin levels were significantly associated with increased mortality, with an area under the receiver operating characteristic curve of 0.83 for predicting 28-day mortality and 0.79 for 90-day mortality. A prolactin cut-off of 35.12 ng/mL demonstrated high sensitivity (93% and 77%, respectively) and specificity (63% and 72%, respectively) for 28-day and 90-day mortality prediction.</p><p><strong>Conclusion: </strong>Serum prolactin levels significantly correlated with the severity of cirrhosis and also effectively predicted the short-term mortality. Prolactin may offer a noninvasive and cost-effective adjunct for severity assessment and short-term prognosis in cirrhosis.</p><p><strong>How to cite this article: </strong>Singh R, Ramadoss R, Mohan P, Vairappan B. Utility of Serum Prolactin Levels as a Marker for Disease Severity and Short-term Prognosis in Patients with Cirrhosis: A Prospective Observational Study. Indian J Crit Care Med 2025;29(3):244-250.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"244-250"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665006","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":"The Utility of Muscle Ultrasound as a Predictor of Outcome in Guillain-Barré Syndrome Patients in the Intensive Care Unit: A Prospective Cohort Study.","authors":"Shweta S Naik, Meshwa Desai, Mathangi Krishnakumar, Saraswati Nashi, Bhadrinarayan Varadarajan","doi":"10.5005/jp-journals-10071-24928","DOIUrl":"10.5005/jp-journals-10071-24928","url":null,"abstract":"<p><strong>Aims and background: </strong>Guillain-Barré syndrome (GBS) is associated with significant muscle loss, which can result in prolonged intensive care. The aim of this study was to evaluate muscle atrophy in GBS patients using serial ultrasound measurements of rectus femoris cross-sectional area (RFCSA).</p><p><strong>Materials and methods: </strong>A prospective study was carried out among GBS patients admitted to the intensive care unit (ICU). All clinical and demographic variables were recorded at admission.Ultrasound measurement of RFCSA was done at baseline and 3, 7, and 14 days after ICU admission. Clinical outcomes such as the ICU stay and duration of mechanical ventilation were studied at discharge.</p><p><strong>Results: </strong>A total of 25 patients were studied. The mean age was 48.96 ± 14.82 years, 44% were female, and 25% experienced significant muscle atrophy in the first 72 hours. The percentage changes in the RFCSA were 5.21 (3.38-8.39), 9.18 (5.52-11.76), and 12.63 (8.65-15.09) on days 3, 7, and 14, respectively. A greater muscle atrophy rate was strongly positively correlated with longer ventilation periods [atrophy day 14 (<i>r</i> = 0.88, <i>p</i> < 0.001)] and atrophy day 7 (<i>r</i> = 0.87, <i>p</i> < 0.001) and total number of ICU days [atrophy day 14 (<i>r</i> = 0.93, <i>p</i> < 0.001)].</p><p><strong>Conclusion: </strong>Muscle ultrasound (MUSG) shows potential as a tool for monitoring muscle atrophy in GBS patients. However, its ability to reliably identify patients at risk for prolonged ICU stays and mechanical ventilation requires cautious interpretation and further validation due to the absence of a comparator.</p><p><strong>Clinical significance: </strong>The findings of this study highlight the utility of bedside MUSG as a non-invasive tool for monitoring muscle atrophy in neuromuscular diseases and critically ill patients.Early identification of significant muscle loss allows for timely interventions, risk stratification, and resource optimization, ultimately improving ICU outcomes and patient recovery trajectories.</p><p><strong>How to cite this article: </strong>Naik SS, Desai M, Krishnakumar M, Nashi S, Varadarajan B. The Utility of Muscle Ultrasound as a Predictor of Outcome in Guillain-Barré Syndrome Patients in the Intensive Care Unit: A Prospective Cohort Study. Indian J Crit Care Med 2025;29(3):262-267.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"262-267"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665004","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":"Validity of MACOCHA Score in Predicting First-pass Success of Endotracheal Intubation in Emergency Department: An Observational Study.","authors":"Krishna Shukla, Bharat B Bhardwaj, Ankita Kabi, Santosh Galagali, Harsimran Manchanda, Shrirang Joshi, Alok Raj","doi":"10.5005/jp-journals-10071-24914","DOIUrl":"10.5005/jp-journals-10071-24914","url":null,"abstract":"<p><strong>Aim and background: </strong>In the emergency department (ED), endotracheal intubation (ETI) is a critical, life-saving procedure. The MACOCHA score predicts difficult intubations in intensive care units (ICUs), but it has not been validated in the ED setting. This study aimed to validate the MACOCHA score for predicting first-pass success of ETI performed in the ED.</p><p><strong>Materials and methods: </strong>This prospective observational study was performed in the ED of a tertiary care institute, over a period of 18 months (September 2020 to February 2022). The study included 74 adult patients who underwent emergency ETI performed by emergency medicine residents. Number of ETI attempts, first-pass success rate, and complications were noted. The MACOCHA score was calculated, and its predictive performance was evaluated.</p><p><strong>Results: </strong>The first-pass success rate was 54.1%, and 54.1% of patients experienced complications, with hypoxia (18.9%) and hypotension (17.6%) being the most common. Four ETI attempts (<i>p</i> = 0.009) as well as presence of arrhythmia (<i>p</i> = 0.004) and cardiac arrest followed by death (<i>p</i> = 0.001) were significantly associated with a higher MACOCHA score, while MACOCHA score was not significantly associated with first-pass success, aspiration, hypotension, hypoxia, and local injury (<i>p</i> > 0.05). The number of ETI attempts and the number of complications were significantly correlated (<i>r</i> = 0.258, <i>p</i> = 0.026). At a cut-off score of 2.50, the MACOCHA score had a sensitivity and specificity of 50.0% and 35.3%, respectively, for the prediction of first-pass success rate [area under the curve: 0.593; 95% confidence interval (CI): 0.463-0.723].</p><p><strong>Conclusion: </strong>MACOCHA score demonstrated limited performance in predicting the first-pass success rate of ETI in the ED.</p><p><strong>How to cite this article: </strong>Shukla K, Bhardwaj BB, Kabi A, Galagali S, Manchanda H, Joshi S, <i>et al</i>. Validity of MACOCHA Score in Predicting First-pass Success of Endotracheal Intubation in Emergency Department: An Observational Study. Indian J Crit Care Med 2025;29(3):215-222.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 3","pages":"215-222"},"PeriodicalIF":1.5,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11915389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665008","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}