Indian Journal of Critical Care Medicine最新文献

{"title":"Early Electroencephalographic Background Evolution as a Predictor of Airway Outcomes in Severe Traumatic Brain Injury: A Pilot Study.","authors":"Adnan Qadri, Soumya N Maiti, Eman A Khan, Immia Bukhari, Duha Wani","doi":"10.5005/jp-journals-10071-25220","DOIUrl":"10.5005/jp-journals-10071-25220","url":null,"abstract":"<p><strong>Background and aims: </strong>Determining the optimal timing for extubation or tracheostomy in patients with severe traumatic brain injury (TBI) remains challenging. Standard weaning criteria often fail to account for neurological readiness, leading to high rates of extubation failure. This study evaluated whether the evolution of electroencephalography (EEG) background activity over the first 96 hours could predict airway outcomes better than standard clinical assessments.</p><p><strong>Patients and methods: </strong>We conducted a prospective observational study on 43 patients with severe TBI requiring mechanical ventilation. Electroencephalography recordings were obtained on admission to the intensive care unit (ICU) and at 96 hours. Background activity was classified as improving (alpha/beta dominance) or non-improving (theta/delta dominance). The primary outcome was successful extubation vs extubation failure (defined as re-intubation or need for tracheostomy).</p><p><strong>Results: </strong>Of the 43 patients, 25 (58%) were successfully extubated, while 18 (42%) failed. Dominant EEG frequency at 96 hours was a powerful predictor of outcome. Patients with improving alpha/beta backgrounds demonstrated a positive predictive value (PPV) of 92.9% for successful extubation. Conversely, persistent theta/delta slowing was significantly associated with extubation failure [odds ratio (OR): 18.41; 95% confidence interval (CI): 2.1-160.3; <i>p</i> = 0.008], regardless of the patient's age (<i>p</i> = 0.42).</p><p><strong>Conclusion: </strong>Early improvement in EEG background activity is a robust indicator of airway competence in severe TBI. A non-improving EEG warrants caution, while an improving background suggests that tracheostomy may be judiciously deferred to allow for successful extubation. Integrating serial EEG into weaning protocols may prevent unnecessary surgical interventions and reduce extubation failure rates.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"585-590"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457895/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714131","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 Herbicide Crisis: Addressing the High Fatality of Paraquat Poisoning.","authors":"Gunchan Paul","doi":"10.5005/jp-journals-10071-25249","DOIUrl":"10.5005/jp-journals-10071-25249","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"551-553"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13457630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714198","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":"Development and Validation of a Standardized Intrahospital Patient Transfer Checklist for Intensive Care Unit Nurses: A Methodological Study.","authors":"Arshdeep K Dhanoa, K Bindu, Jyoti Sharma","doi":"10.5005/jp-journals-10071-25222","DOIUrl":"10.5005/jp-journals-10071-25222","url":null,"abstract":"<p><strong>Background: </strong>Intrahospital transport of critically ill patients is high risk. This study aimed to develop and validate a standardized transport checklist for intensive care unit (ICU) nurses in a tertiary care hospital.</p><p><strong>Methods: </strong>A four-phase methodological design was used: Phase I (item pooling), phase II (modified Delphi validation with 17 experts), phase III (reliability testing via 40 observed transfers), and phase IV (usability testing with 10 nurses).</p><p><strong>Results: </strong>The final 42-item checklist covered pre-, intra-, and post-transport phases. Content validity [Scale Content Validity Index/Universal Agreement (S-CVI)/UA] reached 1.0. Inter-rater reliability showed substantial agreement (Cohen's κ = 0.75). All nurses reported positive perceptions regarding the clarity and usability of the checklist among ICU nurses.</p><p><strong>Conclusion: </strong>The checklist is a valid, reliable, and feasible tool with high perceived usability among ICU nurses.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"591-594"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458385/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714109","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 Explains the Reported Benefit of High-flow Nasal Cannula in High-risk Extubated Patients?","authors":"Vijay Sundarsingh, Pramela R Rodrigues, Manoj Kumar","doi":"10.5005/jp-journals-10071-25236","DOIUrl":"10.5005/jp-journals-10071-25236","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"617"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458495/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714188","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 Erosion of Trainee Engagement in Critical Care: A Systems Problem or a Generational Failure?","authors":"Tanmoy Ghatak, Debmoy Ghatak","doi":"10.5005/jp-journals-10071-25223","DOIUrl":"10.5005/jp-journals-10071-25223","url":null,"abstract":"<p><p>Critical care training traditionally depends upon immense bedside learning, responsible watchfulness, and physiological reasoning. However, teachers' concern regarding declining trainee engagement, reduced procedural confidence, and diminished intellectual curiosity are increasingly reported. While these observations are often attributed to generational differences, emerging evidence suggests that systemic factors play a more substantial role. This viewpoint examines key contributors to perceived disengagement, including post-pandemic educational disruption, burnout, duty-hour reforms, increasing protocolization of care, digital-era attention fragmentation, and psychologically unsafe learning environments. These factors collectively influence trainee independence, professional behaviour, and bedside ownership. Rather than viewing disengagement as a failure of the current generation, we argue that it reflects evolving pressures within healthcare and medical education. Rebuilding engagement requires intentional redesign of training systems through protected bedside teaching, reduction of administrative burden, promotion of psychological safety and encouragement, and proactive strategies to address burnout. Sustaining the future of critical care will depend not only on technological advances but also on creating learning environments that foster curiosity, responsibility, resilience, and meaningful mentorship.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"554-556"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714194","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":"Tricyclic Antidepressant Poisoning: A 6-year Retrospective Observational Cross-sectional Analysis of Emergency Department Presentation, Clinical Severity, and Hospital Outcomes in a Tertiary Academic Center.","authors":"Renie G Sahayaraj, Darpanarayan Hazra, Gina M Chandy, Lingameenashiwaran Thangaraju","doi":"10.5005/jp-journals-10071-25219","DOIUrl":"10.5005/jp-journals-10071-25219","url":null,"abstract":"<p><strong>Background and aims: </strong>Tricyclic antidepressant (TCA) poisoning remains a significant cause of toxicological morbidities due to its cardiotoxic and neurotoxic effects. We aimed to study the clinical profile, management, and outcomes of patients presenting with TCA overdose to an Indian emergency department (ED).</p><p><strong>Patients and methods: </strong>This retrospective study analyzed patients with TCA poisoning over a 6-year period. A multivariate logistic regression model was constructed to identify factors independently associated with poor outcomes.</p><p><strong>Results: </strong>Our study analyzed 75 patients with TCA overdose (mean age: 35.1 ± 13.01 years, 84.0% female). Amitriptyline was the most common drug (69.3%), followed by imipramine (17.3%). Interpersonal issues were the most common trigger (40 cases). Clinical presentations included altered mental status (46.7%) and drowsiness (29.3%). Emergency department management included intubation (20.0%), gastric lavage/charcoal (29.3%), and sodium bicarbonate (70.7%). Patients with poor outcomes had a higher median amitriptyline dose than those with good outcomes [474.47 mg (interquartile range [IQR]: 590) vs 266.43 mg (IQR: 375), <i>p</i> = 0.028]. Patients who required intubation had poor outcomes (<i>p</i> < 0.001). Kaplan-Meier analysis of time to in-hospital death showed significantly lower survival in the amitriptyline overdose group than in the other TCA overdose group (log-rank <i>p</i> = 0.017). There were 12 deaths overall.</p><p><strong>Conclusions: </strong>Tricyclic antidepressant overdose, predominantly involving amitriptyline, was commonly triggered by interpersonal issues and frequently presented with altered mental status. Poor outcomes were associated with a higher amitriptyline dose and need for intubation.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 7","pages":"578-584"},"PeriodicalIF":2.0,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13458188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148714243","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":"Survey of Practice Variations in Management of Acute Viral Bronchiolitis in India (PRERNI-PAVB Survey).","authors":"Sahil Vikas, Suresh K Angurana, Jayashree Muralidharan, Simon Craig, Indumathy Santhanam, Raghavendra Vanaki, Bharat Choudhary, Mounika Reddy","doi":"10.5005/jp-journals-10071-25221","DOIUrl":"10.5005/jp-journals-10071-25221","url":null,"abstract":"<p><strong>Background and aims: </strong>To identify the practice variations in the management of acute viral bronchiolitis (AVB) in different healthcare settings across India.</p><p><strong>Methods: </strong>This online survey was conducted over 2½ months (May-July 2025) involving healthcare professionals (pediatricians, emergency physicians, and pediatric intensivists) working in different healthcare settings in India. Questions were related to demographic profile, caseload and seasonal variations, diagnosis, admission/discharge criteria, and treatment.</p><p><strong>Results: </strong>Among 100 respondents across 21 states/union territories, the majority were pediatric intensivists (<i>n</i> = 55) and pediatricians (<i>n</i> = 30) working in tertiary-level hospitals (<i>n</i> = 90). The pediatric intensive care unit (PICU) was available to 88 respondents. Most respondents diagnose AVB in children <2 years (<i>n</i> = 66) based on clinical history and examination alone (<i>n</i> = 41) and the addition of chest radiograph (<i>n</i> = 44). Common investigations performed among admitted children were chest radiograph (<i>n</i> = 76), sepsis screen (<i>n</i> = 64), and viral polymerase chain reaction (<i>n</i> = 47). Common admission criteria were high-risk babies (<i>n</i> = 94), severe respiratory distress (<i>n</i> = 91), doubtful follow-up (<i>n</i> = 72), and SpO₂ <94% (<i>n</i> = 50). Once admitted, most respondents measure SpO₂ intermittently (<i>n</i> = 59), start oxygen therapy if SpO₂ <94% (<i>n</i> = 52), and maintain SpO₂ >92% during treatment (<i>n</i> = 49). Once off oxygen, SpO₂ >94% was used as a threshold to discharge (<i>n</i> = 58). Common modes to start oxygen were simple nasal prongs (<i>n</i> = 75) and high-flow nasal cannula (<i>n</i> = 58). The majority (<i>n</i> = 96) use nebulizations, including 3% saline (<i>n</i> = 86) and adrenaline (<i>n</i> = 52). Antibiotic use was reported by most as sometimes or rarely (<i>n</i> = 87). Most respondents use either the Indian Academy of Pediatrics (<i>n</i> = 48) or the American Academy of Pediatrics (<i>n</i> = 25) guidelines, and only 36 have a written policy/flowchart in the unit for management of AVB.</p><p><strong>Conclusion: </strong>We noted wide variations in the diagnosis, severity assessment, investigations, treatment, and adherence to guidelines for AVB. However, the majority of respondents use antibiotics sometimes or rarely.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"523-529"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407736/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608649","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":"From Intensive Care Unit Prediction to Intensive Care Unit Accountability: A Global Readiness Passport for Machine-learning Prognostication.","authors":"Mulavagili Vijayasimha, Mulavagili Srikanth, Ravinder Kaur, Bhawana Thukral, Kanakala P Malini, Simranpreet Kaur","doi":"10.5005/jp-journals-10071-25224","DOIUrl":"10.5005/jp-journals-10071-25224","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"544-545"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608695","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: From Courtroom to Intensive Care Unit: The Unfinished Journey of End-of-life Care in India.","authors":"Raj K Mani","doi":"10.5005/jp-journals-10071-25218","DOIUrl":"10.5005/jp-journals-10071-25218","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"542"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621940","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: Multidependency of Electroencephalographic and Bispectral Index Reactivity Rule Them Out as Outcome Predictors of Head Trauma.","authors":"Gayatri Sakrikar, Rohini M Surve, Ramesh Venkatapura, Dhritiman Chakrabarti, Dhaval Shukla, Ravindra Mundlamuri","doi":"10.5005/jp-journals-10071-25214","DOIUrl":"10.5005/jp-journals-10071-25214","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"539-540"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407605/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608622","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}