Indian Journal of Critical Care Medicine最新文献

{"title":"Mechanical Power Indexed to Estimated Functional Residual Capacity as a Predictor of Mortality in Acute Respiratory Distress Syndrome: <i>Post Hoc</i> Analysis.","authors":"Enrique Monares-Zepeda, Christopher Barrera-Hoffmann, Jesús S Sanchez-Diaz, Karla G Peniche-Moguel, Diego Escarraman-Martinez","doi":"10.5005/jp-journals-10071-25232","DOIUrl":"10.5005/jp-journals-10071-25232","url":null,"abstract":"<p><strong>Background and aims: </strong>Mechanical power (MP) reflects the energy delivered by the ventilator and has been associated with mortality in acute respiratory distress syndrome (ARDS). We evaluated whether MP indexed to estimated functional residual capacity (MP/FRC) was associated with intensive care unit (ICU) mortality in ARDS.</p><p><strong>Patients and methods: </strong>This <i>post hoc</i> analysis included 158 adult patients with ARDS who required invasive mechanical ventilation between 2016 and 2022. Functional residual capacity was physiologically estimated from standard ventilatory variables. Mechanical power, MP/FRC, dynamic strain, and global strain were calculated. The primary outcome was ICU mortality. Discrimination was evaluated using receiver operating characteristic (ROC) analysis, and survival was assessed using Cox regression.</p><p><strong>Results: </strong>Eighty-one patients (51%) died during ICU stay. Mechanical power/FRC demonstrated the highest observed discrimination for ICU mortality among the evaluated respiratory indices [area under the curve (AUC) 0.71; 95% CI 0.62-0.81]. A cutoff value of 33.94 J/min/L was associated with significantly lower ICU survival (log-rank <i>p</i> < 0.001). Mechanical power/FRC remained independently associated with ICU mortality in multivariable analysis [hazard ratio (HR) 1.06 per unit increase; <i>p</i> = 0.005].</p><p><strong>Conclusion: </strong>Mechanical power/FRC was independently associated with ICU mortality and showed the highest observed discriminative performance among the evaluated respiratory indices. Because FRC was estimated rather than directly measured, these findings should be considered hypothesis-generating and require prospective validation.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"557-561"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714196","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":"Does the Age, APACHE II Score, Glasgow Coma Scale, and Creatinine Model Offer Incremental Value over APACHE II for Mortality Prediction in Sepsis?","authors":"Faruk Yildiz","doi":"10.5005/jp-journals-10071-25238","DOIUrl":"10.5005/jp-journals-10071-25238","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"620"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714146","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":"CRIT AI 4.0: A Locally Deployable Artificial Intelligence System for Mortality Risk Stratification and Clinical Decision Support in Intensive Care Units.","authors":"Pratik Kumar Mitra","doi":"10.5005/jp-journals-10071-25243","DOIUrl":"10.5005/jp-journals-10071-25243","url":null,"abstract":"<p><strong>Background and aims: </strong>Intensive care unit (ICU) mortality in India remains high, with risk stratification inconsistently applied in resource-limited settings where AI-based decision support requires cloud connectivity unavailable to most Indian hospitals. We describe CRIT AI 4.0, a proof-of-concept, locally deployable, offline-capable AI-assisted decision support system for resource-constrained Indian ICUs.</p><p><strong>Patients and methods: </strong>A Python-based Windows application was developed, operating fully offline. A random forest (RF) classifier was trained on a synthetic dataset of 16,000 encounters across 17 disease categories with 37 input variables. Seven validated clinical scoring modules, six-shift fluid balance tracking, nursing documentation, and an on-device large language model (LLM) assistant were integrated, with no external data transmission.</p><p><strong>Results: </strong>On the synthetic held-out test set (<i>n</i> = 3,200), the model achieved an area under the receiver operating characteristic curve (AUROC) of 0.90 (95% confidence interval (CI): 0.88-0.92), sensitivity 0.86, specificity 0.77. All metrics reflect synthetic test-set performance only.</p><p><strong>Conclusion: </strong>CRIT AI 4.0 demonstrates the technical feasibility of offline artificial intelligence (AI)-augmented ICU decision support in resource-constrained settings. This is a proof-of-concept study; prospective validation is underway.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"562-565"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714003","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":"Impact of an Acute Kidney Injury Prevention Bundle in High-risk Intensive Care Unit Patients: A Single Center Before-After Study.","authors":"Vittobaraju Muralidharan, Anusha Cherian, Muthapillai Senthilnathan, Pankaj Kundra","doi":"10.5005/jp-journals-10071-25240","DOIUrl":"10.5005/jp-journals-10071-25240","url":null,"abstract":"<p><strong>Background and aims: </strong>Acute kidney injury (AKI) is a frequent and serious complication in critically ill patients and is associated with increased morbidity, mortality, prolonged hospitalization, and significant healthcare costs. We evaluated the impact of an AKI prevention bundle on the incidence, severity, and outcomes in patients at high-risk of developing AKI in the intensive care unit (ICU).</p><p><strong>Patients and methods: </strong>In this single-center before-and-after study, high-risk patients were identified using a prediction score. A bundle comprising daily assessments, risk factor modification, nephrotoxin avoidance, hemodynamic optimization, and renal dose adjustment was implemented after a 2 months education period. Preimplementation lasted 6 months, followed by 8 months of bundle application. Outcomes including AKI incidence and severity, need for renal replacement therapy (RRT), length of ventilation days and ICU stay, and mortality were compared between pre- and post-implementation groups.</p><p><strong>Results: </strong>A total of 374 patients were included, 187 in the pre and 187 in the post implementation phase. The primary outcome, incidence of AKI within 72 hours of ICU admission, was lower in the post-bundle implementation group than pre-bundle implementation group (21.9 vs 27.8%); however, the difference was not statistically significant. Overall incidence of AKI was lower in the post-bundle group than in the pre-bundle group (28.9 vs 37.9%); while between 72 hours and 1week, incidences were 6.9 vs 10.1%, which were not statistically significant. Importantly, moderate-to-severe AKI was significantly reduced post-bundle implementation (13.9 vs 25.6%, <i>p</i> = 0.042). This group also showed significantly shorter ICU stays (6.17 vs 7.25 days, <i>p</i> = 0.03) and reduced mechanical ventilation duration (4.34 vs 5.30 days, <i>p</i> = 0.02). Renal replacement therapy requirement, 30 days mortality, and persistent renal dysfunction were lower post-bundle implementation but without statistical significance.</p><p><strong>Conclusion: </strong>While the AKI prevention bundle did not significantly affect overall AKI incidence in high-risk ICU patients, it was associated with reductions in moderate-to-severe AKI, ICU stay, and duration of mechanical ventilation. A simple clinical risk score can identify patients for early intervention, and larger multicenter studies are warranted to confirm these findings.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"566-571"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458382/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714098","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":"High-flow Nasal Cannula Over Non-invasive Ventilation in Preventing Reintubation: Signal Bias or Both?","authors":"Riddhi Kundu, Anirban Bhattacharjee, Aayush Chawla","doi":"10.5005/jp-journals-10071-25237","DOIUrl":"10.5005/jp-journals-10071-25237","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"616"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714126","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":"Making an Impact with the Indian Journal of Critical Care Medicine.","authors":"Jigeeshu V Divatia","doi":"10.5005/jp-journals-10071-25251","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-25251","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"547"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714162","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":"Author Response: Methodological Reflections Regarding the LASSO-derived AAGC Model for In-hospital Mortality Prediction in Sepsis.","authors":"Hemant Gulia, Mohit Suhag, Nikhil Bagal, Prity R Deshwal, Sandeep Kumar, Rahul K Joshi","doi":"10.5005/jp-journals-10071-25239","DOIUrl":"10.5005/jp-journals-10071-25239","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"614-615"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714023","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":"Acute Kidney Injury Prevention in the Real World: Is Bundled Approach a Scalable Solution?","authors":"Kanwalpreet Sodhi, Neeru Sahni","doi":"10.5005/jp-journals-10071-25248","DOIUrl":"10.5005/jp-journals-10071-25248","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"548-550"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457395/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714009","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":"Change in Nutritional Status of Children in the Pediatric Intensive Care Unit over First 14 Days: A Prospective Cohort Study.","authors":"Morik Loyi, Devendra Mishra, Urmila Jhamb, Romit Saxena","doi":"10.5005/jp-journals-10071-25227","DOIUrl":"10.5005/jp-journals-10071-25227","url":null,"abstract":"<p><strong>Background and aims: </strong>We studied changes in nutritional status from baseline, as measured by serial skinfold thickness measurements and their association with patient factors, disease factors, and biochemical factors, as well as time to the start of enteral feeds.</p><p><strong>Patients and methods: </strong>We enrolled 50 consecutive children aged 2-5 years from the pediatric intensive care unit (PICU) of a public sector hospital in India between 14 February, 2024 and 31 August, 2024. Baseline demographic and clinical data were recorded. Serial anthropometric parameters were measured for all children at the time of admission (+4 hours), day 3, day 7, and day 14 or at hospital discharge, if earlier. We used the World Health Organization (WHO) growth charts to interpret the anthropometric data.</p><p><strong>Results: </strong>Of the 50 children enrolled (mean age 3.17 ± 1.22 years; 46% females), 58% were underweight, 52% had wasting, and 52% had short stature at admission. Only 10% children (<i>n</i> = 5) had triceps skinfold thickness for age <-2 standard deviation (SD) at baseline. 32 (64%) of the children demonstrated a reduction in triceps skinfold thickness, 72% (<i>n</i> = 36) experienced weight loss, and 58% (<i>n</i> = 29) showed a decrease in mid-upper arm circumference (MUAC). However, we did not find a statistically significant association of change in triceps skinfold thickness with age, severity of illness, outcome, duration of stay, and early start of enteral feeds.</p><p><strong>Conclusion: </strong>This study shows the feasibility of skinfold calipers as a serial monitoring tool in the PICU. Nutritional status worsens during the initial 2 weeks of PICU stay, despite early enteral feeding policies.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"595-600"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457648/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714029","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":"Author Response: High Flow Nasal Cannula Over Non-invasive Ventilation in Preventing Reintubation: Signal Bias or Both?","authors":"Nimisha S Patil, Madhulika Dubey, Mohd Mustahsin, Krishna P Mall, Supriya Singh","doi":"10.5005/jp-journals-10071-25241","DOIUrl":"10.5005/jp-journals-10071-25241","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"618-619"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148713975","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}