Indian Journal of Critical Care Medicine最新文献

{"title":"Author Response: Postoperative Recovery from a Cardiac Anesthesiologists' Perspective.","authors":"André L Cordeiro, Luiz A Forgiarini","doi":"10.5005/jp-journals-10071-24963","DOIUrl":"10.5005/jp-journals-10071-24963","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"467"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144114","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":"Is Enterococcal Bacteremia a Cause or Corollary of Severe Illness? 5 Years' Experience from an Indian Teaching Hospital.","authors":"Gauri Kumar, Muralidhar Varma, Chiranjay Mukhopadhyay, Vandana K Eshwara","doi":"10.5005/jp-journals-10071-24969","DOIUrl":"10.5005/jp-journals-10071-24969","url":null,"abstract":"<p><strong>Background and aims: </strong>Enterococci have emerged as successful pathogens in healthcare-associated infections due to their hardiness and survival ability in environments with high background antimicrobial pressure. Enterococcal bacteremia (EB) present an intriguing link between the host, environmental and healthcare practices. We present here the detailed clinical epidemiology of EB from an Indian hospital.</p><p><strong>Patients and methods: </strong>We retrospectively studied adult patients diagnosed with bacteremia by Enterococcal species for 5 years. The details of clinical characteristics, implicated species, factors contributing to the development of bacteremia and the underlying source were analyzed. All the clinical and laboratory findings and antimicrobial therapy associated with clinical outcome were assessed.</p><p><strong>Results: </strong><i>Enterococcus faecium</i> was the predominant pathogen in 82(42.5%) of the total 193 cases. Prior healthcare exposure was evident in 136(70.46%). Direct admission to intensive care during initial presentation was noted in 107(55.4%) of study cohort. Among 82(42.5%) of EB, source could be identified and central line infection was the commonest source in 45(23.3%). In-hospital mortality was 47, 23%, while 40(21%) left the hospital due to poor clinical outcome. Multivariate analysis indicated age >60 years, intra-abdominal disease as initial presentation, staying in the ICU during bacteremia, presence of central line and invasive mechanical ventilation as independent risk factors for fatality and poor clinical outcome.</p><p><strong>Conclusion: </strong>Enterococcal bacteremia can present both as cause and outcome of severe illness. Multiple comorbidities, healthcare acquisition, and limited therapy options suggest the need for strategies to prevent the invasive infections by enterococci.</p><p><strong>How to cite this article: </strong>Kumar G, Varma M, Mukhopadhyay C, Eshwara VK. Is Enterococcal Bacteremia a Cause or Corollary of Severe Illness? 5 Years' Experience from an Indian Teaching Hospital. Indian J Crit Care Med 2025;29(5):441-448.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"441-448"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144128","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-dose Vitamin D may Have No Effect on Mortality in Vitamin D-deficient Pediatric ICU Patients because the Study Design is Inappropriate.","authors":"Mrityunjay Sakkarwal, Pallavi Pallavi, Urmila Jhamb, Romit Saxena","doi":"10.5005/jp-journals-10071-24964","DOIUrl":"10.5005/jp-journals-10071-24964","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"470-471"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144090","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":"Optimizing the Treatment of Critically Ill Patients Utilizing Beta-D-glucan: The Time is Now.","authors":"Anjali Shetty","doi":"10.5005/jp-journals-10071-24974","DOIUrl":"10.5005/jp-journals-10071-24974","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"404-406"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144132","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 Noninvasive Ventilation on Quality of Sleep among Patients Admitted to the Critical Care Unit.","authors":"Aiswarya Kunjappan, Madhura M Reddy, Samruddha S Prabhu, Margiben T Bhatt, R Vani Lakshmi","doi":"10.5005/jp-journals-10071-24962","DOIUrl":"10.5005/jp-journals-10071-24962","url":null,"abstract":"<p><strong>Background and aims: </strong>Patients in critical care units (CCUs) on noninvasive ventilation (NIV) may experience sleep disturbances due to various reasons. Identifying the variables that affect a patient's sleep quality is essential for the medical treatment process, as it ensures the maintenance of a regular sleep cycle. The study aimed to assess the impact of NIV on the quality of sleep among patients admitted to the CCU.</p><p><strong>Patients and methods: </strong>This observational questionnaire study was conducted between July 2023 to February 2024, which included 84 subjects who received NIV for more than 24 hours. The sleep quality was assessed using The St. Mary's Hospital (SMH) Sleep Questionnaire. The impact of NIV on sleep quality and sleep-disruptive factors was analyzed.</p><p><strong>Results: </strong>A total of 84 subjects (71.4% weaned and 28.5% intubated) were included, and a significant association was found between the impact of NIV and sleep quality (<i>p</i> < 0.05). Leakage from the NIV mask impacted the quality of sleep (<i>χ</i>² = 15.6) and falling back to sleep (<i>χ</i>² = 18.4). Discomfort with the NIV mask interruption from sleep (<i>χ</i>² = 15.8), quality of sleep (<i>χ</i>² = 23.6), and falling back to sleep (<i>χ</i>² = 22.3). Excessive air from the ventilator impacted the quality of sleep (<i>χ</i>² = 13.5) and falling back to sleep (<i>χ</i>² = 13.5). Nasal and oral dryness influenced the quality of sleep (<i>χ</i>² = 9.79) and alertness (<i>χ</i>² = 14.6). The major factors that interfered with sleep were thirst (84.5%), pain (60.7%), and light (58.3%).</p><p><strong>Conclusion: </strong>Our study highlights that the impact of NIV on sleep quality among patients in critical care is significant, with factors such as mask leakage, discomfort, excessive air delivery, and dryness affecting sleep negatively. Addressing these issues can potentially improve sleep quality and reduce the need for intubation.</p><p><strong>How to cite this article: </strong>Kunjappan A, Reddy MM, Prabhu SS, Bhatt MT, R Vani Lakshmi. Impact of Noninvasive Ventilation on Quality of Sleep among Patients Admitted to the Critical Care Unit. Indian J Crit Care Med 2025;29(5):424-430.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"424-430"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144057","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":"Serum Ferritin Level in Children with Severe Dengue Infection and Its Association with Outcome: A Single-center Prospective Cohort Study.","authors":"Nikhil Pawan Jha, Tanay Gupta, Ravikumar Krupanandan, Kalaimaran Sadasivam, Sudeep Kumar Kapalavai, Bala Ramachandran","doi":"10.5005/jp-journals-10071-24972","DOIUrl":"10.5005/jp-journals-10071-24972","url":null,"abstract":"<p><strong>Background and aims: </strong>Dengue viral infection (DENVI) can vary from a simple fever to severe dengue infection (SDI) and death. The study aims to identify the utility of serum ferritin (SF) and its association with intensive care unit (ICU) mortality in children with SDI.</p><p><strong>Patients and methods: </strong>This is a prospective cohort study of 144 children aged 1 month to 18 years admitted to the pediatric intensive care unit (PICU) with SDI. The association between peak SF level with disease severity and outcome variables were assessed. A receiver-operating characteristic curve and a logistic regression analysis were conducted to evaluate the association of peak SF levels with ICU mortality.</p><p><strong>Results: </strong>Our study included 144 children; 83 (57.6%) were males and 61 (42.36%) were females. Among these, 131 (90.97%) recovered, 9 (6.25%) died, 3 (2.08%) underwent liver transplant, and 1 (0.69%) left against medical advice. Median peak SF level was 6732 ng/mL (range 2813-17890 ng/mL). Majority of our patients recovered with standard supportive management alone. In our study, a peak SF level of 15691 ng/mL observed during the PICU stay was a \"good\" predictor of mortality among patients with SDI, with an area under curve of 0.826. Peak SF level greater than 10000 ng/mL (<i>n</i> = 51/144) was significantly associated with the development of disease-related complications (<i>p</i> < 0.05).</p><p><strong>Conclusion: </strong>Hyperferritinemia is common among children with SDI. A peak SF level > 10000 ng/mL is associated with a higher risk of mortality and disease related complications.</p><p><strong>How to cite this article: </strong>Jha NP, Gupta T, Krupanandan R, Sadasivam K, Kapalavai SK, Ramachandran B. Serum Ferritin Level in Children with Severe Dengue Infection and Its Association with Outcome: A Single-center Prospective Cohort Study. Indian J Crit Care Med 2025;29(5):458-462.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"458-462"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144136","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":"Evaluating the Role of Serum Beta-D-glucan Testing in Safely Reducing Antifungal Therapy in Critically Ill Patients: A Retrospective Study.","authors":"Ripenmeet Salhotra, Debasish Biswal, Narayanan Sarat, Aayush Chawla, Sandeep Mangla, Pranjal Gupta, Rajeshwari Subramaniam","doi":"10.5005/jp-journals-10071-24961","DOIUrl":"10.5005/jp-journals-10071-24961","url":null,"abstract":"<p><strong>Background and aims: </strong>The role of (1→3)-β-D-glucan (BDG) testing in guiding antifungal therapy (AFT) in critically ill patients remains unclear. While BDG has a high negative predictive value (NPV), is it safe to withhold AFT in critically ill BDG-negative patients has not been well studied.</p><p><strong>Patients and methods: </strong>This retrospective cohort study analyzed BDG-negative intensive care unit (ICU) patients (<60 pg/mL) at a tertiary care hospital from March 2024 to January 2025. The ICU survival was compared between those who received AFT and those who did not. Propensity score matching (PSM) adjusted for illness severity, and logistic regression identified independent predictors of survival.</p><p><strong>Results: </strong>Among 100 BDG-tested patients, 53 (53%) were BDG-negative. Of these, 22 (41.5%) received AFT, while 31 (58.5%) did not. Unadjusted ICU survival was lower in the AFT group (45.5%) vs no AFT (80.6%) (<i>p</i> = 0.008). Antifungal therapy recipients had higher sequential organ failure assessment (SOFA) scores (9.7 ± 3.46 vs 7.4 ± 3.15, <i>p</i> = 0.014), indicating greater illness severity. Proven invasive candidiasis was rare (3.77%), with both cases due to Candida auris (<i>p</i> = 0.168). After PSM, survival differences were no longer significant (<i>p</i> = 0.246). Logistic regression confirmed AFT was not an independent predictor of survival [odds ratio (OR): 0.363, <i>p</i> = 0.156].</p><p><strong>Conclusions: </strong>Withholding AFT in BDG-negative critically ill patients did not impact ICU survival, supporting BDG's role in antifungal stewardship. However, its limitations in detecting Candida auris warrant further prospective studies.</p><p><strong>How to cite this article: </strong>Salhotra R, Biswal D, Sarat N, Chawla A, Mangla S, Gupta P, <i>et al</i>. Evaluating the Role of Serum Beta-D-glucan Testing in Safely Reducing Antifungal Therapy in Critically Ill Patients: A Retrospective Study. Indian J Crit Care Med 2025;29(5):413-417.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"413-417"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144051","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 Analysis of Modified Nutrition Risk in Critically Ill (mNUTRIC) Score for Mortality Prediction in Critically Ill Patients.","authors":"Jay Prakash, Khushboo Saran, Vivek Verma, Kunal Raj, Archana Kumari, Pradip K Bhattacharya, Shio Priye, Bram Rochwerg, Raj Kumar","doi":"10.5005/jp-journals-10071-24971","DOIUrl":"10.5005/jp-journals-10071-24971","url":null,"abstract":"<p><strong>Background and aims: </strong>Malnutrition has a considerable influence on critically ill patients by increasing mortality and poorer clinical outcomes. The modified Nutrition Risk in Critically Ill (mNUTRIC) score is commonly used to assess nutritional risk and predict death; however, its sensitivity, specificity, and optimal cut-off values differ between studies. This study uses a Bayesian approach to assess the accuracy of the mNUTRIC score in predicting mortality in critically ill patients.</p><p><strong>Patients and methods: </strong>A preplanned Bayesian analysis was performed using data from 31 cohort studies, which included 13,271 intensive care unit (ICU) patients. The study investigated the mNUTRIC score's sensitivity, specificity, diagnostic odds ratio, and area under the curve (AUC). Subgroup analysis compared mortality rates at 28-day, 90-day, and in-hospital time points, along with cut-off values (<5 vs ≥5). Bayesian modeling was performed using the rjags and brms packages in R version 3.2.1. These tools also facilitated the visualization of results, including posterior distributions, forest plots, and Fagan nomograms.</p><p><strong>Results: </strong>Bayesian analysis affirmed the mNUTRIC score's high discriminative capacity, with a pooled sensitivity of 0.84 (95% credible interval (CrI): 0.80-0.88), specificity of 0.77 (95% CrI: 0.73-0.80), and AUC of 0.88 (95% CrI: 0.83-0.92). A cut-off of <5 resulted in higher sensitivity (0.83) and AUC (0.87), whereas ≥5 remained accurate but had somewhat lower sensitivity. The score consistently predicted 28-day, 90-day, and in-hospital mortality.</p><p><strong>Conclusions: </strong>The Bayesian analysis validates the mNUTRIC score as a reliable predictor of mortality in critically ill patients. Its excellent diagnostic performance suggests its incorporation into ICU for early risk assessment and nutritional interventions.</p><p><strong>How to cite this article: </strong>Prakash J, Saran K, Verma V, Raj K, Kumari A, Bhattacharya PK, <i>et al</i>. Bayesian Analysis of Modified Nutrition Risk in Critically Ill (mNUTRIC) Score for Mortality Prediction in Critically Ill Patients. Indian J Crit Care Med 2025;29(5):449-457.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"449-457"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144121","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":"5'-Nucleotidase for Predicting Snakebite Outcomes: A Biomarker Breakthrough?","authors":"Anirban Bhattacharjee, Priyam Saikia, Habib Mr Karim, Mrinal K Mandal","doi":"10.5005/jp-journals-10071-24947","DOIUrl":"10.5005/jp-journals-10071-24947","url":null,"abstract":"","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"463-464"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144023","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 Prognostic Significance of Serum Uric Acid in Sepsis: A Comparative Study on Adult Patients.","authors":"Santhoshi N Katakam, Mounika Cherukuri, Mayank Kada, Pooja Hanji, Chandrashekar U Kudru","doi":"10.5005/jp-journals-10071-24968","DOIUrl":"10.5005/jp-journals-10071-24968","url":null,"abstract":"<p><strong>Background and aims: </strong>Sepsis is an oxidative state characterized by a dysregulated immune response to infection, causing multiorgan dysfunction. Uric acid, with its dual role in oxidation and antioxidation, may influence sepsis severity and outcomes. This study aimed to investigate the association between hyperuricemia and the severity and clinical outcomes in sepsis patients.</p><p><strong>Patients and methods: </strong>A prospective, observational cohort study was conducted in medical intensive care units (ICUs) from February 2023 to May 2024. A total of 224 patients aged ≥18 years with clinical suspicion of sepsis and sequential organ failure assessment (SOFA) score ≥2 on admission were enrolled. The patients were divided into hyperuricemic (serum uric acid ≥7 mg/dL) and normouricemic groups.</p><p><strong>Results: </strong>One hundred and twelve patients were enrolled in each group. The hyperuricemic group had significantly higher SOFA (7 vs 5, <i>p</i> = 0.001) and Acute Physiology and Chronic Health Evaluation (APACHE) II (33.5 vs 18, <i>p</i> = 0.001) scores. They also had higher rates of shock at admission (23.2% vs 12%, <i>p</i> = 0.036), acute kidney injury (AKI) (89.3% vs 58%, <i>p</i> = 0.001), need for hemodialysis (42.9% vs 23.2%, <i>p</i> = 0.002), and longer ICU stays (6 vs 4 days, <i>p</i> = 0.003). Mortality was higher in the hyperuricemic group (25% vs 13.4%, <i>p</i> = 0.052). Kaplan-Meier analysis revealed significantly lower survival rates in hyperuricemic patients (log-rank test, <i>p</i> = 0.022). Multivariate analysis identified hyperuricemia as an independent predictor of poor outcomes.</p><p><strong>Conclusion: </strong>Hyperuricemia is associated with increased severity of illness and a higher incidence of AKI, prolonged ICU stays, and increased mortality in sepsis.</p><p><strong>How to cite this article: </strong>Katakam SN, Cherukuri M, Kada M, Hanji P, Kudru CU. The Prognostic Significance of Serum Uric Acid in Sepsis: A Comparative Study on Adult Patients. Indian J Crit Care Med 2025;29(5):407-412.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 5","pages":"407-412"},"PeriodicalIF":1.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12101988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144140","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}