Indian Journal of Critical Care Medicine最新文献

{"title":"Validity of Blood Urea Nitrogen to Serum Albumin Ratio as an Independent Biomarker to Predict Severity and Mortality of Community-acquired Pneumonia.","authors":"Abdeali Ginwala, Sanjay Pujari, Deepak Phalgune, Vihita Kulkarni, Arun Bahulikar","doi":"10.5005/jp-journals-10071-24926","DOIUrl":"10.5005/jp-journals-10071-24926","url":null,"abstract":"<p><strong>Background and objective: </strong>Certain serum biomarkers have been reported to predict the severity and mortality of community-acquired pneumonia (CAP). There is a dearth of studies on this subject in the Indian population in patients with CAP. The present prospective observational study was conducted to find the utility of the blood urea nitrogen (BUN)/serum albumin (B/A) ratio as a biomarker to predict the severity and mortality in patients with CAP.</p><p><strong>Materials and methods: </strong>All 90 patients aged ≥ 18 years of either sex, with a new radiographic infiltrate, were included. Various biochemical parameters such as BUN, serum albumin, and procalcitonin were tested. The serum B/A ratio was calculated. A chest radiograph was obtained. Patients were followed up for the duration of their stay in hospital till discharge or death.</p><p><strong>Results: </strong>The sensitivity and specificity of the B/A ratio at the optimum cut-off value of 10.66 to predict the severity of CAP was about 79.0%, whereas the sensitivity and specificity of the procalcitonin at the optimum cut-off value of 1.50 ng/dL to predict the severity of CAP were 71.15 and 84.21%, respectively. The sensitivity and specificity of the B/A ratio at the optimum cut-off value of 19.8 to predict the mortality of CAP was about 99.0%, whereas the sensitivity and specificity of the procalcitonin at the optimum cut-off value of 5.55 ng/dL to predict the mortality of CAP was about 92.0%.</p><p><strong>Conclusion: </strong>The B/A ratio and procalcitonin are simple but independent predictors of mortality and severity of CAP.</p><p><strong>How to cite this article: </strong>Ginwala A, Pujari S, Phalgune D, Kulkarni V, Bahulikar A. Validity of Blood Urea Nitrogen to Serum Albumin Ratio as an Independent Biomarker to Predict Severity and Mortality of Community-acquired Pneumonia. Indian J Crit Care Med 2025;29(4):333-337.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"333-337"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990949","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":"Enhancing Advance Care Planning in India through a 12-step Pathway.","authors":"Anuja Damani, Arun Ghoshal, Krithika Rao, Shreya Nair, Roop Gursahani, Srinagesh Simha, Raj Kumar Mani, Naveen Salins","doi":"10.5005/jp-journals-10071-24938","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24938","url":null,"abstract":"<p><strong>Background: </strong>Advanced care planning (ACP) and advance medical directives (AMDs) are vital for aligning medical decisions with patient preferences, particularly for end-of-life care. The 2018 Supreme Court judgment in India established the legality of AMDs, enabling patients to exercise their autonomy. Recent amendments in 2023 simplified procedural requirements, replacing judicial magistrate approval with a streamlined two-tier medical board system. This article proposes a culturally sensitive and practical 12-step framework for implementing ACP and AMDs in India.</p><p><strong>Materials and methods: </strong>A structured and consensus-driven process was undertaken by experts in palliative medicine, neurology, critical care, and geriatrics, supported by key medical organizations. The development process included multiple iterations, public consultations, and feedback from legal and medical stakeholders. The framework integrates legal, ethical, and cultural considerations to address procedural and systemic challenges in ACP implementation.</p><p><strong>Results: </strong>The proposed 12-step pathway focuses on three phases: creating living wills, periodic reviews and updates, and executing AMDs. Key components include initiating discussions, identification and appointment of surrogate decision-makers, ensuring legal compliance through simplified procedures, and providing guidance for withholding or withdrawing life-sustaining treatments. Implementation strategies emphasize public awareness, provider training, and institutional policies to normalize ACP. Simplified legal requirements introduced in 2023 facilitate broader adoption and reduce procedural barriers.</p><p><strong>Conclusion: </strong>This framework provides a practical, culturally relevant model for ACP in India, ensuring patient-centered, ethical, and transparent end-of-life care. By integrating simplified legal procedures and addressing misconceptions through education and policy initiatives, the proposed approach empowers individuals, families, and healthcare providers to make informed decisions, fostering dignity and autonomy in medical care.</p><p><strong>How to cite this article: </strong>Damani A, Ghoshal A, Rao K, Nair S, Gursahani R, Simha S, <i>et al</i>. Enhancing Advance Care Planning in India through a 12-step Pathway. Indian J Crit Care Med 2025;29(4):301-307.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"301-307"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045040/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018584","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":"Planning for a Dignified Death with a Living Will.","authors":"Jigeeshu V Divatia","doi":"10.5005/jp-journals-10071-24958","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24958","url":null,"abstract":"<p><p><b>How to cite this article:</b> Divatia JV. Planning for a Dignified Death with a Living Will. Indian J Crit Care Med 2025;29(4):283-284.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"283-284"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045050/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144021964","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":"Should We Scope? Or is there a Scope for the Probe?","authors":"Mahesha Padyana, Sunil Karanth","doi":"10.5005/jp-journals-10071-24950","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24950","url":null,"abstract":"<p><p><b>How to cite this article:</b> Padyana M, Karanth S. Should We Scope? Or is there a Scope for the Probe? Indian J Crit Care Med 2025;29(4): 287-288.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"287-288"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045049/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054176","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":"Correlation of Ultrasound Examination with FOB for Airway Assessment in Burn Patients with Inhalational Injury: A Prospective Observational Study.","authors":"Heena Garg, Savita Agarwal, Amit Kumar, Shailendra Kumar, Vanlal Darlong, Lokesh Kashyap, Maneesh Singhal, Shivangi Saha","doi":"10.5005/jp-journals-10071-24936","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24936","url":null,"abstract":"<p><strong>Aim/background: </strong>Fiberoptic bronchoscopy (FOB) is the gold standard for assessing airway involvement in burn patients but is invasive. Ultrasound (USG) has not been previously used to evaluate the airway in burn patients. Our study evaluated the feasibility of using USG to assess airway involvement in inhalational burn injury and correlated its efficacy with FOB.</p><p><strong>Materials and methods: </strong>This prospective observational study was conducted in the burns intensive care unit (ICU) of a tertiary care hospital. Bedside airway USG was performed to evaluate vocal cord (VC) width for edema and other airway parameters, including tongue thickness, pre-epiglottis space depth, inter-arytenoid distance, epiglottis-to-midpoint of VC, distance between the true VCs, distance between the false VCs, tracheal wall thickness, and tracheal air column width. Fiberoptic bronchoscopy was then performed to assess airway involvement, and findings were correlated with USG at the VC level.</p><p><strong>Results: </strong>About 51 patients were included. Airway USG assessment was able to predict the VC edema, correlating with FOB findings in 30 patients. Ultrasound showed a sensitivity and specificity of 85.2 and 81.3%, respectively, with a positive and negative predictive value of 90.9 and 72.2%, respectively, for assessing airway edema at the level of VC. The mean right and left VC widths were 21.15 ± 9.52 mm and 22.03 ± 9.52 mm, respectively, in patients with VC edema. The pre-epiglottis space in patients with (<i>n</i> = 33) vs without VC edema (<i>n</i> = 18) was found to be statistically significant (14.5± 5.64 mm vs 10.87 ± 4.36 mm; <i>p</i> = 0.02).</p><p><strong>Conclusion: </strong>Ultrasound can be used as a reliable, non-invasive bedside predictor of airway involvement in patients with suspected inhalational injury.</p><p><strong>How to cite this article: </strong>Garg H, Agarwal S, Kumar A, Kumar S, Darlong V, Kashyap L, <i>et al</i>. Correlation of Ultrasound Examination with FOB for Airway Assessment in Burn Patients with Inhalational Injury: A Prospective Observational Study. Indian J Crit Care Med 2025;29(4):314-319.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"314-319"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045054/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144057298","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":"Role of Antimicrobial Air Purifier in Reducing the Microbial Load in the Critical Care Unit in Oncology Center: An Intervention Study.","authors":"Vijeta B Batra, Jyotirmay Kirtania, Shashank Tiwari, Priyanshu Kumar, Amit Kumar, Subarna Chakraborty","doi":"10.5005/jp-journals-10071-24910","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24910","url":null,"abstract":"<p><strong>Introduction: </strong>High quality and effective ventilation system operation plays a major role in maintaining indoor air quality in critical care unit (CCU). Aim of this study was to detect the role of antimicrobial-air-purifier in reducing the colony counts of microbes in air and high surface.</p><p><strong>Methods: </strong>This prospective study was conducted in CCU over a period of 18 months from November 2022 to May 2024 after approval from Hospital Ethics Committee. Microbial load was tested in CCU in the presence of and absence of purifier and air/high touch surface sampling was done by using settle-plate method on consecutive days in two phases (with/without purifier). Microorganism culture and identification was done using VITEK-2, and colony counting was performed using Omeliansky formula.</p><p><strong>Results: </strong>The comparison of microbial load in the CCUs between two phases revealed significant difference in the air and surface on days 1, 7, 14, 30, and 60 (<i>p</i> < 0.0001). Among gram-positive cocci (GPC), the most common isolate identified was coagulase-negative <i>Staphylococcus</i> species [35 (92.10%)], followed by <i>Micrococcus luteus</i> [5 (13.15%)] and <i>Staphylococcus aureus</i> [1 (2.63%)]. All GPC were resistant to methicillin and erythromycin while 1 (5%) strain was resistant to vancomycin, teicoplanin, and linezolid. Among gram-negative bacilli (GNB), the most common isolate was <i>Acinetobacter</i> species [8/23 (34.78%)], followed by <i>P</i>. species [5 (21.74%)]. About 19-23 (85-100%) GNB strains were resistant to third-generation cephalosporins and beta-lactam and beta-lactamase inhibitors. About 9-15 (42.3-67.64%) were resistant to tigecycline and carbapenems. Decreased bloodstream infections/catheter-associated urinary tract infections (CAUTI) rate of 3.49-2.92/3.97-1.95/1,000 patient-days was observed in CCU, while the device utilization ratio was same.</p><p><strong>Conclusion: </strong>Antimicrobial air purifier showed an effective role in decreasing the central line-associated blood stream infections and CAUTI rates in CCU.</p><p><strong>How to cite this article: </strong>Batra VB, Kirtania J, Tiwari S, Kumar P, Kumar A, Chakraborty S. Role of Antimicrobial Air Purifier in Reducing the Microbial Load in the Critical Care Unit in Oncology Center: An Intervention Study. Indian J Crit Care Med 2025;29(4):327-332.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"327-332"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045054","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":"Can Early Use of HFNC through Improved Study Design Make a Statistically Significant Difference in the Rate of Intubation in Patients with Post-traumatic Lung Contusion?","authors":"Sachit Sharma, Pramesh S Shrestha, Subhash P Acharya","doi":"10.5005/jp-journals-10071-24943","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24943","url":null,"abstract":"<p><p>Sharma S, Shrestha PS, Acharya SP. Can Early Use of HFNC through Improved Study Design Make a Statistically Significant Difference in the Rate of Intubation in Patients with Post-traumatic Lung Contusion? Indian J Crit Care Med 2025;29(4):396-397.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"396-397"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045052/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064982","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":"Utility of Clinical Frailty Scale in Intensive Care Unit.","authors":"K M Ganesh, Bhuvana Krishna","doi":"10.5005/jp-journals-10071-24959","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24959","url":null,"abstract":"<p><p><b>How to cite this article:</b> Ganesh KM, Krishna B. Utility of Clinical Frailty Scale in Intensive Care Unit. Indian J Crit Care Med 2025;29(4):289-290.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"289-290"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045055/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024767","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":"Muscle Wasting in ICU Patients is Multifactorial and Requires Thorough Workup.","authors":"Josef Finsterer, Walter Strobl","doi":"10.5005/jp-journals-10071-24829","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24829","url":null,"abstract":"<p><p>Finsterer J, Strobl W. Muscle Wasting in ICU Patients is Multifactorial and Requires Thorough Workup. Indian J Crit Care Med 2025;29(4):394.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"394"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054423","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 the Clinical Frailty Score on Outcomes of Critically Ill Patients in a Tertiary Care ICU.","authors":"Sulekha Saxena, Priyamvada Gupta, Puneet Panwar, Ashish Jain, Srishti S Jain, Rohit Jain, Divyansh Gupta, Munesh Meena, Hemraj Acharya, Ravi Jain","doi":"10.5005/jp-journals-10071-24949","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-24949","url":null,"abstract":"<p><strong>Background: </strong>Advanced age is a known marker of vulnerability, but frailty is an independent predictor of poor outcomes in critically ill patients. The clinical frailty score (CFS) facilitates rapid assessment, aiding prognostication, care improvement, and resource allocation, particularly in resource-limited intensive care units (ICUs).</p><p><strong>Materials and methods: </strong>A prospective observational cohort study was conducted from April to September 2023 at a tertiary care ICU. The study included 166 patients aged ≥50 years with ICU stays longer than 48 hours, excluding those with contraindications for care escalation. Data were collected on demographics, Clinical parameters, and scoring systems including acute physiological and chronic health evaluation II (APACHE-II), sequential organ failure assessment (SOFA), Charlson comorbidity index (CCI), and CFS. Predictive analyses were performed using receiver operating curve (ROC) curves, cut-offs, and logistic regression.</p><p><strong>Results: </strong>The median age of patients was 65 years, with an APACHE-II score of 18 and a CFS of 4. In-hospital mortality was 46.4%. The CFS outperformed other scoring systems in predicting both in-hospital mortality [Area under the receiver operating characteristic curve (AUC-ROC) 0.73] and net negative outcomes (AUC ROC 0.75). Frailty (CFS ≥6) was present in 39.75% of patients, with each unit increase in CFS associated with a 41.8% higher odds of mortality and a 50.7% higher odds of net negative outcomes. The optimal CFS cut-offs were 4 for 80% sensitivity and 6 for 80% specificity.</p><p><strong>Conclusion: </strong>The CFS is a practical and reliable tool for predicting ICU outcomes, outperforming traditional scoring systems. It supports improved decision-making and resource allocation. Further multicenter studies are necessary to validate its broader use in critical care practice.</p><p><strong>How to cite this article: </strong>Saxena S, Gupta P, Panwar P, Jain A, Jain SS, Jain R, <i>et al</i>. Impact of the Clinical Frailty Score on Outcomes of Critically Ill Patients in a Tertiary Care ICU. Indian J Crit Care Med 2025;29(4):320-326.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"29 4","pages":"320-326"},"PeriodicalIF":1.5,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12045041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989754","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}