Indian Journal of Critical Care Medicine最新文献

{"title":"Lung Ultrasound Protocols: From Diagnostic Expansion to Physiological Integration.","authors":"Ashok K Pannu","doi":"10.5005/jp-journals-10071-25192","DOIUrl":"10.5005/jp-journals-10071-25192","url":null,"abstract":"<p><p><b>How to cite this article:</b> Pannu AK. Lung Ultrasound Protocols: From Diagnostic Expansion to Physiological Integration. Indian J Crit Care Med 2026;30(5):443.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"443"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406455","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":"Letter in Response to the Article: Network Meta-analysis of the Efficacy of Different Music Therapy Interventions for Delirium in Adult Intensive Care Unit Patients.","authors":"Lucas Ts Kwakernaak, Markus Klimek","doi":"10.5005/jp-journals-10071-25206","DOIUrl":"10.5005/jp-journals-10071-25206","url":null,"abstract":"<p><p><b>How to cite this article:</b> Kwakernaak LTS, Klimek M. Letter in Response to the Article: Network Meta-analysis of the Efficacy of Different Music Therapy Interventions for Delirium in Adult Intensive Care Unit Patients. Indian J Crit Care Med 2026;30(5):446-447.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"446-447"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337671/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406388","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":"Cyber-resilient Intensive Care Unit: Ransomware is a Patient-safety Crisis-A Resource-stratified Approach for India.","authors":"Bodhisatwa Choudhuri, Jay Prakash, Biplab Pal, Tonny Veenith","doi":"10.5005/jp-journals-10071-25203","DOIUrl":"10.5005/jp-journals-10071-25203","url":null,"abstract":"<p><p>Ransomware and cyber incidents targeting hospital digital infrastructure have emerged as genuine patient-safety threats yet remain under-recognized in critical care practice. Intensive care units (ICUs) are uniquely vulnerable: Physiological states are tightly coupled to digital workflows, electronic health records (EHRs) anchor medication safety, and dense Internet of Medical Things (IoMT) environments expand the attack surface. India faces a compounded risk-the 2022 All India Institute of Medical Sciences (AIIMS) Delhi ransomware attack exposed fragmented systems, an absence of post-incident clinical surveillance, and the operational reality that \"Western\" cybersecurity fixes do not translate directly to resource-variable settings. This Viewpoint reframes cyber-resilience as a bedside safety competency rather than an information technology (IT) concern and proposes a resource-stratified three-tier preparedness framework. Tier 1 defines minimum viable controls achievable by any ICU: Downtime kits, paper medication administration records (MARs), designated roles, and structured drills. Tier 2 adds targeted redundancy; tier 3 outlines advanced capabilities for tertiary centers. When digital systems fail, patient survival depends on analog competencies practiced before the crisis.</p><p><strong>How to cite this article: </strong>Choudhuri B, Prakash J, Pal B, Veenith T. Cyber-resilient Intensive Care Unit: Ransomware is a Patient-safety Crisis-A Resource-stratified Approach for India. Indian J Crit Care Med 2026;30(5):363-367.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"363-367"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406436","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":"Clinical Utility of Positive End-expiratory Pressure-incorporated PaO₂/FiO₂ Ratio in Prognosticating Mortality and Severity Reclassification in Acute Respiratory Distress Syndrome: A Systematic Review and Meta-analysis.","authors":"Vignesh Prabhu, Souvik Chaudhuri, Shwethapriya Rao, Pratibha Todur","doi":"10.5005/jp-journals-10071-25205","DOIUrl":"10.5005/jp-journals-10071-25205","url":null,"abstract":"<p><strong>Introduction: </strong>PaO₂/FiO₂ (PF) ratio is globally used for defining and classifying acute respiratory distress syndrome (ARDS), yet it does not take ventilatory support into consideration, which is crucial in achieving oxygenation. Incorporating the positive end-expiratory pressure (PEEP) into the PF ratio (PaO₂/FiO₂*PEEP; PFP ratio) may provide a more physiologically meaningful index of disease diagnosis, severity, and prognosis.</p><p><strong>Objectives: </strong>To evaluate the clinical utility of the PFP ratio in prognosticating mortality and its impact on reclassification of ARDS severity as compared to the traditional PF ratio.</p><p><strong>Materials and methods: </strong>This systematic review and meta-analysis (SRMA) was performed following PRISMA guidelines and registered in PROSPERO (CRD420251110685). A search for relevant studies from inception to July 2025 was performed, and the studies on adults with ARDS receiving invasive mechanical ventilation (IMV) and those that reported PFP ratio and mortality outcomes were included. Summary receiver operating characteristic (sROC) model was used to evaluate the prognostic accuracy, while the reclassification of ARDS severity using PFP vs PF ratio was descriptively analyzed.</p><p><strong>Results: </strong>A total of five studies with 4,454 patients were included for meta-analysis. The pooled sensitivity and specificity of the PFP ratio for prognosticating mortality were 0.55 [95% confidence interval (CI): 0.41-0.67] and 0.90 (95% CI: 0.80-0.96), respectively. The area under the sROC was 0.84 (95% CI: 0.80-0.85), inferring good discriminant ability. For reclassification of ARDS severity based on PFP ratio, a total of four studies were included, and 30-71.9% of patients were reclassified, showing significant bidirectional shifts.</p><p><strong>Conclusion: </strong>Positive end-expiratory pressure incorporation to the PF ratio improves the prognostic ability and leads to meaningful reclassification of ARDS severity.</p><p><strong>How to cite this article: </strong>Prabhu V, Chaudhuri S, Rao S, Todur P. Clinical Utility of Positive End-expiratory Pressure-incorporated PaO₂/FiO₂ Ratio in Prognosticating Mortality and Severity Reclassification in Acute Respiratory Distress Syndrome: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2026;30(5):420-429.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"420-429"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406462","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":"Right Ventricular Dysfunction Score in the Prognostic Evaluation of Patients with Sepsis and Septic Shock.","authors":"Sindhuja Kasinathan, Souvik Maitra, Puneet Khanna, Rahul K Anand, Meera Ekka, Bikash Ranjan Ray","doi":"10.5005/jp-journals-10071-25209","DOIUrl":"10.5005/jp-journals-10071-25209","url":null,"abstract":"<p><strong>Background and aims: </strong>Right ventricular dysfunction (RVD) in sepsis carries a poor prognosis, and there is heterogeneity in its assessment methods. The RVD score, incorporating multiple domains of RV function, was originally designed for chronic heart failure grading. This study evaluated its ability to predict 28-day all-cause mortality in sepsis and septic shock.</p><p><strong>Patients and methods: </strong>In this prospective observational cohort, 211 adults with septic shock were enrolled within 48 hours of diagnosis. The RVD score was calculated using five transthoracic echocardiographic parameters: Pulmonary artery (PA) systolic pressure (PASP), RV end-diastolic area/body surface area (RVEDA/BSA), tricuspid annular plane systolic excursion (TAPSE), tricuspid regurgitation (TR) grade, and inferior vena cava (IVC) collapsibility. One point was assigned to each component if the measurements deviated from predefined cut-offs. Tricuspid annular plane systolic excursion/PASP ratio, a marker of RV-PA coupling, was also computed. Patients were followed for 28-day prognostic outcomes.</p><p><strong>Results: </strong>Among 189 analyzed patients, 39.68% were nonsurvivors. An RVD score of >2 and a TAPSE/PASP ratio of ≤0.447 mm/mm Hg predicted 28-day mortality with an area under receiving operating characteristic curve (AUROC) of 0.857 [95% confidence interval (CI): 0.801-0.914] and an AUROC of 0.883 (95% CI: 0.829-0.937), respectively. Their performance did not significantly differ (ΔAUROC = 0.026, <i>p</i> = 0.09). In a multivariable logistic regression model, after adjustment for key clinical covariates, RVD score of >2 [adjusted odds ratio (OR): 3.48, 95% CI: 1.37-8.83] remained an independent predictor of mortality.</p><p><strong>Conclusion: </strong>Right ventricular dysfunction score of >2, as a composite marker of RVD, demonstrates a robust prognostic utility in sepsis and septic shock. Tricuspid annular plane systolic excursion/PASP of ≤0.447 is a simpler alternative, given its comparable predictive performance for 28-day mortality.</p><p><strong>Clinical significance: </strong>Right ventricular dysfunction score of >2 and TAPSE/PASP of ≤0.447, being prognostic echocardiographic parameters, can be used to indicate the timing of incorporation of various RV-protective measures during the course of management of septic shock.</p><p><strong>How to cite this article: </strong>Kasinathan S, Maitra S, Khanna P, Anand RK, Ekka M, Ray BR. Right Ventricular Dysfunction Score in the Prognostic Evaluation of Patients with Sepsis and Septic Shock. Indian J Crit Care Med 2026;30(5):389-397.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"389-397"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337780/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406432","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 Diagnostic Concordance to Implementation-grade Lung Ultrasound in Critical Care.","authors":"Antara Dhenki, Sugata Dasgupta, Arpita Choudhury, Tanmoy Mondal, Soma Mukhopadhyay, Jayati Bardhan","doi":"10.5005/jp-journals-10071-25207","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-25207","url":null,"abstract":"<p><p><b>How to cite this article:</b> Dhenki A, Dasgupta S, Choudhury A, Mondal T, Mukhopadhyay S, Bardhan J. Author Response: From Diagnostic Concordance to Implementation-grade Lung Ultrasound in Critical Care. Indian J Crit Care Med 2026;30(5):455.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"445"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406296","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 Trial Results to Bedside Judgment: A Feynman Lesson in Evidence-based Critical Care.","authors":"Vijay Sundarsingh, Shakti B Mishra, Kumar R Manoj","doi":"10.5005/jp-journals-10071-25200","DOIUrl":"10.5005/jp-journals-10071-25200","url":null,"abstract":"<p><p>The expansion of evidence-based medicine has profoundly shaped contemporary critical care practice, with randomized trials and guidelines increasingly informing bedside decisions. While trainees are often familiar with the headline results of major studies, many struggle to critically appraise trial design, methodology, and applicability to individual patients. This gap risks uncritical adoption of evidence without adequate consideration of context, limitations, or potential harms. Drawing on Richard Feynman's distinction between knowing labels and understanding underlying principles, this viewpoint argues that knowing trial outcomes is not equivalent to understanding the evidence itself. We highlight how headline-driven interpretations can mislead clinical practice and emphasize the importance of critical appraisal as a core clinical skill. A practical checklist is proposed to support structured bedside interpretation of ICU trials.</p><p><strong>How to cite this article: </strong>Sundarsingh V, Mishra SB, Kumar RM. From Trial Results to Bedside Judgment: A Feynman Lesson in Evidence-based Critical Care. Indian J Crit Care Med 2026;30(5):368-370.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"368-370"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406382","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":"Hepatic Elastography in Critical Illness: Moving from Physiological Signal to Clinical Utility.","authors":"Pranav K Mandal, Dabbiru Sreenvas Nageswar Rao, Shio Priye","doi":"10.5005/jp-journals-10071-25193","DOIUrl":"10.5005/jp-journals-10071-25193","url":null,"abstract":"<p><p><b>How to cite this article:</b> Mandal PK, Rao DSN, Priye S. Hepatic Elastography in Critical Illness: Moving from Physiological Signal to Clinical Utility. Indian J Crit Care Med 2026;30(5):450-451.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"450-451"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406474","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: Lung Ultrasound Protocols: From Diagnostic Expansion to Physiological Integration.","authors":"Antara Dhenki, Sugata Dasgupta, Arpita Choudhury, Tanmoy Mondal, Soma Mukhopadhyay, Jayati Bardhan","doi":"10.5005/jp-journals-10071-25194","DOIUrl":"10.5005/jp-journals-10071-25194","url":null,"abstract":"<p><p><b>How to cite this article:</b> Dhenki A, Dasgupta S, Choudhury A, Mondal T, Mukhopadhyay S, Bardhan J. Author Response: Lung Ultrasound Protocols: From Diagnostic Expansion to Physiological Integration. Indian J Crit Care Med 2026;30(5):444-445.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"444-445"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337832/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406355","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 Heated Humidified High-flow Nasal Cannula and Noninvasive Ventilation in Children with Acute Hypoxemic Respiratory Failure Using Clinical Respiratory Score: A Prospective Observational Study.","authors":"Tejas R Kadappanavar, Namita Ravikumar, Somashekar A Ramu","doi":"10.5005/jp-journals-10071-25198","DOIUrl":"10.5005/jp-journals-10071-25198","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aims and background: &lt;/strong&gt;Comparative data on the efficacy of high-flow nasal cannula (HFNC) vs noninvasive ventilation (NIV) in children are limited. This study aims to address this gap by comparing the modalities using the clinical respiratory score (CRS) and factors that predict failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Patients and methods: &lt;/strong&gt;This prospective observational study was conducted in the pediatric intensive care unit (PICU) of a tertiary care hospital over a period of 20 months. Children (2-18 years) admitted to PICU with acute hypoxemic respiratory failure requiring HFNC or NIV were eligible. Multiorgan dysfunction, hemodynamic instability, intubation within 2 hours, cyanotic congenital heart disease, craniofacial malformations, chronic lung diseases, neuromuscular diseases, and upper airway obstruction were exclusions. Children were allocated to either HFNC or NIV therapy at the clinician's discretion. The severity of respiratory distress was assessed using CRS at baseline, 2, 6, 12, 24, and 48 hours. Escalation of therapy was considered a treatment failure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 59 children were enrolled in the study and categorized into HFNC (&lt;i&gt;n =&lt;/i&gt; 38) and NIV (&lt;i&gt;n =&lt;/i&gt; 21) groups. Baseline CRS was slightly higher in the NIV group [9 (8-10) vs 10 (9-10); &lt;i&gt;p&lt;/i&gt; = 0.072]. Diagnosis distribution differed significantly, with pneumonia being higher in the HFNC group (63.1%), and acute respiratory distress syndrome (ARDS) and capillary leak syndrome (33.3-28.6%, respectively) were more common in the NIV group. Treatment success rates were similar (76.3 vs 71.4%; &lt;i&gt;p&lt;/i&gt; = 0.680). Escalation to NIV occurred in 10.5% of the HFNC group and to invasive mechanical ventilation in 13.2% of HFNC and 28.6% of NIV patients. Clinical respiratory score at initiation and at 2 hours was comparable. At 6 hours, CRS showed significantly better improvement in the NIV group [7 (6-8) vs 5 (4-7); &lt;i&gt;p =&lt;/i&gt; 0.023]. Clinical respiratory score at initiation and at 2 hours was significantly higher in the failures in both groups compared to the successes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;There was no significant difference in treatment failures between the two groups. Noninvasive ventilation demonstrated early respiratory improvement, while HFNC was not inferior in the long term. Lower CRS at initiation and improvement at 2 hours were predictive of treatment success.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical significance: &lt;/strong&gt;Stringent bedside monitoring during the initial hours of noninvasive respiratory support is critical, along with an individualized approach for choice of modality to improve the chances of success of HFNC and NIV.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;How to cite this article: &lt;/strong&gt;Kadappanavar TR, Ravikumar N, Ramu SA. Comparison of Heated Humidified High-flow Nasal Cannula and Noninvasive Ventilation in Children with Acute Hypoxemic Respiratory Failure Using Clinical Respiratory Score: A Prospective Observational Study. Indian J ","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 5","pages":"414-419"},"PeriodicalIF":2.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13337617/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148406450","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}