Indian Journal of Critical Care Medicine最新文献

{"title":"Indian Society of Critical Care Medicine Guidelines on Evidence-based Recommendations for the Treatment of Carbapenem-resistant Enterobacterales, Carbapenem-resistant <i>Acinetobacter baumannii</i>, and Carbapenem-resistant <i>Pseudomonas aeruginosa</i> in Critically Ill Patients: A GRADE-guided Approach.","authors":"Subhash K Todi, Bharat G Jagiasi, Deven Juneja, Justin A Gopaldas, Kapil D Soni, Sunil Karanth, Ritu Singh, Mohit Kharbanda, Ashutosh Bhardwaj, Tapas K Sahoo, Shilpushp Bhosale, Sharmili Sinha, Manish Bharti, Anuj M Clerk, Amit Kumar, Bram Rochwerg, Vinod K Singh, Pradip K Bhattacharya","doi":"10.5005/jp-journals-10071-25216","DOIUrl":"10.5005/jp-journals-10071-25216","url":null,"abstract":"<p><strong>Background: </strong>Carbapenem-resistant Enterobacterales (CRE), <i>Acinetobacter baumannii</i> (CRAB), and <i>Pseudomonas aeruginosa</i> (CRPA) are major antimicrobial resistance (AMR) threats in Indian intensive care units, with mortality rates often exceeding 40-70%. Despite the clinical burden, there is a lack of standardized treatment guidelines. This study aimed to develop Grading of Recommendations Assessment, Development and Evaluation (GRADE)-based recommendations for managing carbapenem-resistant gram-negative (CRGN) infections in critically ill patients.</p><p><strong>Methodology: </strong>A systematic review was conducted following the GRADE framework. PubMed was searched through October 2024 for studies comparing polymyxin B/colistin with alternative regimens for CRE, CRAB, and CRPA, and sulbactam-based therapy vs comparators for CRAB. Meta-analyses were performed using RevMan. Evidence of certainty was graded, and recommendations were formulated through structured expert consensus. Outcomes included clinical cure, microbiological eradication, mortality, and adverse events (AEs).</p><p><strong>Results: </strong>Fifty-two studies were included: 36 evaluating polymyxin/colistin and 16 evaluating sulbactam. For CRE, β-lactam/β-lactamase inhibitor (BL/BLI) combinations achieved higher cure rates (58.7 vs 48.9%), fewer AEs (10.3 vs 13.3%), and trends toward reduced mortality compared with polymyxin-based regimens, leading to a strong recommendation for non-polymyxin therapy (very low certainty). For CRAB, sulbactam-based regimens, particularly sulbactam-durlobactam, showed superior cure rates (61.9 vs 39.7%) and reduced nephrotoxicity (13 vs 38%), supporting a strong recommendation (very low certainty). For CRPA, efficacy appeared comparable, but polymyxin therapy caused higher toxicity (42.1 vs 17.9%), resulting in a weak recommendation for non-polymyxin options (very low certainty).</p><p><strong>Conclusion: </strong>These findings provide GRADE-based treatment recommendations for carbapenem-resistant infections in Indian ICUs. Non-polymyxin regimens are preferred for CRE and CRPA, while sulbactam-based therapy is favored for CRAB. This shift away from polymyxin use may improve outcomes and reduce toxicity, though robust randomized trials are urgently needed.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"472-517"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407482/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608653","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":"Multidependency of Electroencephalographic and Bispectral Index Reactivity Rule Them Out as Outcome Predictors of Head Trauma.","authors":"Josef Finsterer","doi":"10.5005/jp-journals-10071-25201","DOIUrl":"10.5005/jp-journals-10071-25201","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"537-538"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608617","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":"Carbapenem Resistance at the Crossroads: A New Therapeutic Era for Critical Care.","authors":"Jay Prakash","doi":"10.5005/jp-journals-10071-25230","DOIUrl":"10.5005/jp-journals-10071-25230","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"457-459"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608656","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 Courtroom to Intensive Care Unit: The Unfinished Journey of End-of-life Care in India.","authors":"Ripenmeet Salhotra","doi":"10.5005/jp-journals-10071-25213","DOIUrl":"10.5005/jp-journals-10071-25213","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"541"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408506/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622011","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":"Comparison of Two Doses of Prophylactic Melatonin on Incidence of Delirium in Intensive Care Unit Patients: A Randomized Controlled Trial.","authors":"Nishanth Baliga","doi":"10.5005/jp-journals-10071-25212","DOIUrl":"10.5005/jp-journals-10071-25212","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"543"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608644","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":"Bayesian Thinking in the Intensive Care Unit: From Statistical Theory to Clinical Practice.","authors":"Marcus J Schultz, Prashant Nasa, Swagata Tripathy, Tonny Veenith, Ary Serpa Neto","doi":"10.5005/jp-journals-10071-25229","DOIUrl":"10.5005/jp-journals-10071-25229","url":null,"abstract":"<p><p>Critical care medicine operates in an environment of profound uncertainty, where clinicians must make high-stakes decisions based on incomplete, evolving, and often conflicting information. Despite this, most critical care research is frequentist-based, relying on static thresholds, dichotomous interpretations of evidence, and delayed incorporation of new data. This paradigm may not fully align with the dynamic and probabilistic nature of critical illness. Bayesian approaches offer an alternative framework that explicitly incorporates prior knowledge, continuously updates probabilities as new data emerge, and supports real-time, individualized decision-making. Rather than asking whether an intervention \"works\" in a binary sense, Bayesian methods estimate the probability of benefit or harm in a given clinical context, thereby aligning more closely with bedside reasoning. Importantly, such approaches are no longer theoretical. Adaptive platform trials have demonstrated the feasibility of Bayesian methodologies at scale, enabling continuous learning, dynamic treatment allocation, and simultaneous evaluation of multiple interventions. In this viewpoint, we explore how Bayesian decision-making could extend beyond research into routine intensive care practice. We discuss its potential to enhance clinical judgment, personalize therapy, and integrate heterogeneous data streams into coherent probabilistic estimates. The question is no longer whether Bayesian methods can be implemented, but how quickly and effectively they can be embedded into everyday critical care practice.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"465-471"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408714/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148622056","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":"Extended Reality at Bedside: Point-of-Care Simulation for Learning Point-of-Care Ultrasound.","authors":"Vivek Kumar, Suchitra Mohite, Parag Rishipathak, Shrimathy Vijayaraghavan","doi":"10.5005/jp-journals-10071-25233","DOIUrl":"10.5005/jp-journals-10071-25233","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"460-462"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621985","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":"Bridging the Gap between Evidence and Clinical Practice in the Management of Acute Viral Bronchiolitis: Insights from the PRERNI-PAVB Survey.","authors":"Seenivasan Subramani, Muthu Chidambaram","doi":"10.5005/jp-journals-10071-25231","DOIUrl":"10.5005/jp-journals-10071-25231","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"463-464"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13408349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608698","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":"Tracheostomy Decannulation Practices in Indian Intensive Care Units: A National Cross-sectional Survey of Intensive Care Unit Consultants.","authors":"Anirban Bhattacharjee, Ankur Khandelwal, Dalim K Baidya, Mohan Gurjar, Reshu Gupta, Habib Md R Karim","doi":"10.5005/jp-journals-10071-25228","DOIUrl":"10.5005/jp-journals-10071-25228","url":null,"abstract":"<p><strong>Background and aims: </strong>Tracheostomy is performed in 10-20% of critically ill patients. Once the underlying indication is resolved, the next critical step is decannulation. There is a paucity of data on decannulation approaches adopted in Indian intensive care units (ICUs). This survey assessed the current tracheostomy decannulation practices in Indian ICUs: \"Respiratory readiness\" for decannulation, use of corking trials or downsizing, pre-decannulation assessments, and post-decannulation care.</p><p><strong>Patients and methods: </strong>An online 15-item questionnaire-based survey was conducted among ICU consultants with ≥3 years of post-qualification experience across India.</p><p><strong>Results: </strong>Three hundred unique responses were collected across India. The respondents demonstrated marked heterogeneity across all assessed domains. For respiratory readiness, 72% decannulated on minimal oxygen via T-piece or heat and moisture exchanger (HME), whereas 33% withheld decannulation if any oxygen was required. Regarding methodology, 36% performed direct decannulation, 35% employed capping trials, and 28.7% preferred gradual downsizing. Only 59.7% performed routine swallowing assessment decannulation, with clinical bedside evaluation predominating over objective methods.</p><p><strong>Conclusion: </strong>There is marked practice variation in decannulation approaches and an urgent need for evidence-based decannulation protocols in Indian ICUs.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 6","pages":"530-536"},"PeriodicalIF":2.0,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13407472/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608683","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":"Comparison of Effects of Postextubation Noninvasive Ventilation with Passive Humidification and High-flow Nasal Cannula in Patients with High Risk of Extubation Failure: A Randomized Comparative Study.","authors":"Nimisha S Patil, Madhulika Dubey, Mohd Mustahsin, Krishna P Mall, Supriya Singh","doi":"10.5005/jp-journals-10071-25202","DOIUrl":"10.5005/jp-journals-10071-25202","url":null,"abstract":"<p><strong>Background and aims: </strong>Weaning patients with a high risk of extubation failure off the ventilator can be challenging and associated with complications. High-flow nasal cannula (HFNC) and noninvasive ventilation (NIV) have been used after extubation in various settings. This study suggests the better modality between HFNC and NIV to prevent reintubation in these patients.</p><p><strong>Patients and methods: </strong>A single-centered, prospective, randomized comparative study was conducted in the adult medical intensive care unit (ICU) of our center. A total of 150 critically ill patients with a high risk of extubation failure were randomized in a 1:1 ratio to receive either HFNC or NIV immediately after extubation for 48 hours. The rate of reintubation within 48 hours of extubation was compared between the groups.</p><p><strong>Results: </strong>The rate of reintubation within 48 hours was lower in the HFNC group than the NIV group (<i>p</i> = 0.041). The rate of postextubation respiratory failure after 7 days, incidence of ventilator-associated pneumonia (VAP), sepsis, intolerance to therapy, number of patients with hospital length of stay ≤7 days, and hospital mortality was lower in the HFNC group (<i>p</i> < 0.05). The incidence of nasal discomfort was lower in the NIV group (<i>p</i> < 0.05). The heart rate (HR) and respiratory rate (RR) were lower in the HFNC group at 1 hour and 48 hours, respectively, after extubation (<i>p</i> < 0.05). The partial pressure of oxygen (PaO₂) and mean arterial pressure (MAP) at 48 hours after extubation were higher in HFNC group (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>High-flow nasal cannula performed better than NIV in preventing reintubation at 48 hours in patients with a high risk of extubation failure.</p><p><strong>How to cite this article: </strong>Patil NS, Dubey M, Mustahsin M, Mall KP, Singh S. Comparison of Effects of Postextubation Noninvasive Ventilation with Passive Humidification and High-flow Nasal Cannula in Patients with High Risk of Extubation Failure: A Randomized Comparative Study. Indian J Crit Care Med 2026;30(5):371-378.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"371-378"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406470","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}