Indian Journal of Critical Care Medicine最新文献

{"title":"Prevention of Delirium in the Intensive Care Unit through Nonpharmacological Interventions: An Umbrella Review.","authors":"Moirangthem Sonia, Sukhpal Kaur, Nikhil Kothari","doi":"10.5005/jp-journals-10071-24884","DOIUrl":"10.5005/jp-journals-10071-24884","url":null,"abstract":"<p><strong>Introduction: </strong>Delirium is a syndrome commonly seen in intensive care unit (ICU) patients. It is characterized by acute changes in mental status, inattention, disorganized thinking, and altered level of consciousness. Due to its higher prevalence in mechanically ventilated ICU patients, it is crucial to recognize it early and implement standardized evidence-based protocols for preventing it in regular practice.</p><p><strong>Objectives: </strong>To identify the benefits and effectiveness of nonpharmacological interventions for preventing delirium among critically ill patients admitted to the ICU.</p><p><strong>Methods: </strong>The preferred reporting items for systematic reviews and meta-analyses statement guidelines were followed. Two independent authors searched electronic and grey literature for systematic review and meta-analysis in the following databases: PubMed, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Google Scholar.</p><p><strong>Results: </strong>This umbrella review included 12 studies on delirium prevention interventions, excluding reviews, abstracts, case studies, and pharmacological interventions. Our finding shows that multicomponent strategies are the most promising intervention for preventing delirium. Inclusion of family participation is the most vital part, with flexible visitation to be included in delirium care protocols. Multidisciplinary approaches raise workloads among healthcare professionals through increased coordination, assessments, and documentation.</p><p><strong>Conclusions: </strong>Multicomponent interventions are regarded as the most effective among all nonpharmacological interventions for reducing and preventing delirium.</p><p><strong>Highlights: </strong>Delirium syndrome is preventable among mechanically ventilated patients. The study aims to identify the benefits and effectiveness of nonpharmacological interventions for preventing delirium among critically ill patients admitted to the ICU.</p><p><strong>How to cite this article: </strong>Sonia M, Kaur S, Kothari N. Prevention of Delirium in the Intensive Care Unit through Nonpharmacological Interventions: An Umbrella Review. Indian J Crit Care Med 2025;29(1):75-83.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 1","pages":"75-83"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972581","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":"ARDS Ventilation, The Man Behind the Evolution.","authors":"Shirish Prayag","doi":"10.5005/jp-journals-10071-24887","DOIUrl":"10.5005/jp-journals-10071-24887","url":null,"abstract":"<p><p><b>How to cite this article:</b> Prayag S. ARDS Ventilation, The Man Behind the Evolution. Indian J Crit Care Med 2025;29(1):12-13.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 1","pages":"12-13"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972675","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":"Insulin Degludec vs Insulin Glargine for Glycemic Control in Critical Illness Hyperglycemia.","authors":"Ibrahim Mohammed El Sherif, Adham Magdy Haggag, Mohamed Hussen Abbas, Walid Y Kamel","doi":"10.5005/jp-journals-10071-24842","DOIUrl":"10.5005/jp-journals-10071-24842","url":null,"abstract":"<p><strong>Aim and background: </strong>Hyperglycemia is a serious condition and associated with an increased risk of complications and mortality in both critically ill and non-critically ill people. Improvement in the glycemic level reduces the length of hospital stay, systemic infections and short- and long-term mortality. The aim was to test the effectiveness of insulin degludec vs insulin glargine and regular insulin in controlling blood sugar in patients with critical hyperglycemia.</p><p><strong>Materials and methods: </strong>Using random control trial, the patients were randomly divided into three equal groups-group R, group G and group D. Each group included 30 patients. Group G was managed using regular insulin together with an insulin glargine. Group D was managed using regular insulin together with an insulin degludec. However, group R was managed using only regular insulin.</p><p><strong>Results: </strong>The incidence of hypoglycemia was statistically more significant in the group of regular insulin than in groups G and group D with a <i>p</i>-value 0.0069. There was no statistically significant difference between the three groups regarding the frequency of hypoglycemia.</p><p><strong>Conclusion: </strong>Ultra-long-acting insulin can effectively control random blood sugar (RBS) with a decrease in the total dose of insulin used. It is recommended that using insulin degludec is a safe and effective alternative to regular insulin for glycemic control in critically ill patients.</p><p><strong>How to cite this article: </strong>El Sherif IM, Haggag AM, Abbas MH, Kamel WY. Insulin Degludec vs Insulin Glargine for Glycemic Control in Critical Illness Hyperglycemia. Indian J Crit Care Med 2025;29(1):52-58.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 1","pages":"52-58"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972764","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":"Association of Glycemic Variability with Outcomes in Non-diabetic Sepsis Patients: A Prospective Observational Study.","authors":"Prithiviraaj Prakash, Prayas Sethi, Naval Vikram, Maroof Khan, Yashdeep Gupta, Ranveer S Jadon, Arvind Kumar, Ved P Meena, Naveet Wig","doi":"10.5005/jp-journals-10071-24873","DOIUrl":"10.5005/jp-journals-10071-24873","url":null,"abstract":"<p><strong>Background: </strong>Glycemic variability (GV) is the third domain of sepsis-induced dysglycemia, after hyperglycemia and hypoglycemia, potentially leading to adverse outcomes. This study analyzed the association of GV with in-hospital mortality and length of stay (LOS) in non-diabetic sepsis patients.</p><p><strong>Materials and methods: </strong>In this prospective observational study, non-diabetic sepsis patients were followed till day 14 of hospital stay, and blood glucose levels were assessed by finger-prick method (seven times per day) daily; clinico-laboratory and GV parameters [standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE)] were assessed on days 1, 3, 5, 7, 10, and 14 of admission.</p><p><strong>Results: </strong>Two hundred thirteen patients were screened and 80 (mean age 45.6 ± 15.37 years; 50% men) were included in the final analysis. Patients with in-hospital mortality had significantly higher GV when compared to patients without in-hospital mortality [SD: 37.57 vs 25.21, adjusted odds ratio (aOR) 1.13, 95% confidence interval (CI) 1.02-1.24, <i>p</i> = 0.013; CV: 24.91 vs 16.88, aOR 1.19, 95% CI: 1.03-1.38, <i>p</i> = 0.016; MAGE: 73.13 vs 48.03, aOR 1.05, 95% CI: 1.01-1.11, <i>p</i> = 0.014], independent of illness severity (APACHE II), mean blood glucose and hypoglycemia on multivariate regression analysis. There was no significant correlation between GV and LOS. Multivariate analysis showed a significant independent association between CV and ventilator requirement (aOR 1.15, 95% CI: 1.03-1.29, <i>p</i> = 0.017) and between SD and need for renal replacement therapy (aOR 1.04, 95% CI: 1-1.09, <i>p</i> = 0.044).</p><p><strong>Conclusion: </strong>This study demonstrated that GV is independently associated with increased in-hospital mortality in non-diabetic sepsis patients. Further studies are required to investigate whether targeting lower GV in septic patients would translate to better outcomes.</p><p><strong>Clinical significance: </strong>Glycemic variability in sepsis is controversial, with discordant results and a paucity of studies on the Indian population in the literature. Despite blood sugar monitoring being routinely done in sepsis patients, GV is rarely measured and the results of our study indicate that it may be worthwhile to estimate GV in sepsis. This may aid in identifying a subset of patients with increased mortality risk, who may benefit from intensive glucose monitoring and modification of insulin regimen.</p><p><strong>How to cite this article: </strong>Prakash P, Sethi P, Vikram N, Khan M, Gupta Y, Jadon RS, <i>et al.</i> Association of Glycemic Variability with Outcomes in Non-diabetic Sepsis Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(1):27-35.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 1","pages":"27-35"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719557/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972676","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":"In Light of the LANDI-SEP Trial: New Evidence or Double Jeopardy?","authors":"Priyankar K Datta, Prachee Sathe, Anirban Bhattacharjee, Riddhi Kundu","doi":"10.5005/jp-journals-10071-24881","DOIUrl":"10.5005/jp-journals-10071-24881","url":null,"abstract":"<p><p><b>How to cite this article:</b> Datta PK, Sathe P, Bhattacharjee A, Kundu R. In Light of the LANDI-SEP Trial: New Evidence or Double Jeopardy? Indian J Crit Care Med 2025;29(1):84-85.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 1","pages":"84-85"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719546/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972762","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":"Controlling Glycemic Variability in Non-diabetic Sepsis Patients: A Step toward Precision in Critical Care.","authors":"Jay Prakash, Vishal Vaibhaw, Khushboo Saran","doi":"10.5005/jp-journals-10071-24880","DOIUrl":"10.5005/jp-journals-10071-24880","url":null,"abstract":"<p><p><b>How to cite this article:</b> Prakash J, Vaibhaw V, Saran K. Controlling Glycemic Variability in Non-diabetic Sepsis Patients: A Step toward Precision in Critical Care. Indian J Crit Care Med 2025;29(1):6-7.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 1","pages":"6-7"},"PeriodicalIF":1.5,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11719553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972693","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":"Ultrasound in Shock: Is It the Elusive Magic Bullet?","authors":"Balaji Kannamani, Shrikanth Srinivasan","doi":"10.5005/jp-journals-10071-24863","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24863","url":null,"abstract":"<p><p><b>How to cite this article:</b> Kannamani B, Srinivasan S. Ultrasound in Shock: Is It the Elusive Magic Bullet? Indian J Crit Care Med 2024;28(12):1091-1092.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"28 12","pages":"1091-1092"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695891/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932983","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 Altitude Liver Failure: An Infrequent Trigger.","authors":"Arunkumaar Srinivasan, B Saroj Kumar Prusty","doi":"10.5005/jp-journals-10071-24844","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24844","url":null,"abstract":"<p><p><b>How to cite this article:</b> Srinivasan A, Prusty BSK. Author Response-High Altitude Liver Failure: An Infrequent Trigger. Indian J Crit Care Med 2024;28(12):1181.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"28 12","pages":"1181"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695883/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933142","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":"Diagnostic Accuracy of Ultrasound in Intensive Care Patients with Undifferentiated Shock: A Systematic Review and Meta-analysis.","authors":"Lohith Karigowda, Bhavna Gupta, Hatem Elkady, Kush Deshpande","doi":"10.5005/jp-journals-10071-24851","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24851","url":null,"abstract":"<p><strong>Purpose: </strong>This systematic review aimed to assess the accuracy of ultrasound in diagnosing shock types among intensive care patients.</p><p><strong>Materials and methods: </strong>A comprehensive search of PubMed, Embase, Scopus, Cochrane Central Register, and Google Scholar was conducted for controlled trials published up to June 2023. Two intensivists independently screened articles for full-text reviews and abstracts, evaluating study quality using the QUADAS-2 tool. Prospective studies assessing ultrasound for diagnosing shock types in critically ill patients with undifferentiated shock were included.</p><p><strong>Results: </strong>Among 7287 articles identified, four met the inclusion criteria for meta-analysis. Pooled positive likelihood ratios were 8.8 (95% CI: 2.4-32.37) for distributive shock and 137.56 (95% CI: 27.76-681.64) for obstructive shock. Summary receiver operating characteristic (SROC) curves showed an area under the curve (AUC) of 0.99 for cardiogenic and obstructive shock, 0.5 for hypovolemic and mixed shock, and 0.76 for distributive shock. Pooled negative likelihood ratios ranged from 0.05 (95% CI: 0.010 to 0.24) for cardiogenic shock to 0.22 (95% CI: 0.127-0.38) for mixed-etiology shock.</p><p><strong>Conclusion: </strong>Ultrasound demonstrates high accuracy in diagnosing obstructive and cardiogenic shock among intensive care patients with undifferentiated shock. However, its utility for other shock types appears limited.</p><p><strong>How to cite this article: </strong>Karigowda L, Gupta B, Elkady H, Deshpande K. Diagnostic Accuracy of Ultrasound in Intensive Care Patients with Undifferentiated Shock: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2024;28(12):1159-1169.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"28 12","pages":"1159-1169"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933146","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":"Efficacy and Safety of Continuous vs Intermittent Linezolid Infusion in Critically Ill Patients with Septic Shock.","authors":"Ahmed M Albadry, Hend Y Zakaria, Mai M Elhefny, Ibrahim M Elsherif","doi":"10.5005/jp-journals-10071-24848","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24848","url":null,"abstract":"<p><p>The synthetic antimicrobial agent Linezolid effectively penetrates many tissues and exhibits effectiveness against drug-resistant Gram-positive bacteria. This agent's pharmacokinetic qualities cast doubt on the need for intravenous treatment in cases of serious illness. For its time-dependent action to have an impact, serum levels must stay above the minimum inhibitory concentration throughout the dosage interval. According to our research, Linezolid infusions have been proposed to be given as continuous infusions to maintain adequate tissue and serum levels without trough concentration fluctuations. This will optimize the drug's effects and protect against toxicity and drug resistance. In critically ill individuals experiencing septic shock in the ICU, this study sought to validate the safety and efficacy of continuous Linezolid infusion in comparison to the conventional regimen. A prospective, randomized, controlled research involving 140 individuals suffering from septic shock who were older than 18 was carried out. Two groups of patients were randomly assigned. With an average treatment duration of 9.83 ± 2.537 in the intermittent infusion group and 7.39 ± 1.653 in the continuous infusion group, the first group obtained IV linezolid 600 mg twice daily as an intermittent infusion (II) over 60 minutes, whereas the second group obtained 300 mg IV as a loading dosage, and then continuous infusion of 900 mg/day in the first day and 1,200 mg/day in the subsequent days. There was a significantly high clinical cure and less ICU and hospital stay in the continuous infusion group (<i>p</i> < 0.001). Moreover, there was a lower incidence of developing thrombocytopenia in patients with renal impairment who got continuous infusion. Continuous infusion modality showed an advantage in terms of enhancing clinical efficacy in seriously ill cases with septic shock secondary to Gram-positive bacterial infection, especially in cases with renal impairment.</p><p><strong>How to cite this article: </strong>Albadry AM, Zakaria HY, Elhefny MM, Elsherif IM. Efficacy and Safety of Continuous vs Intermittent Linezolid Infusion in Critically Ill Patients with Septic Shock. Indian J Crit Care Med 2024;28(12):1118-1121.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"28 12","pages":"1118-1121"},"PeriodicalIF":1.5,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695889/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142933155","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}