Indian Journal of Critical Care Medicine最新文献

{"title":"Diagnostic Accuracy of Point-of-care Ultrasonography for Endotracheal Tube Confirmation: Interpreting Evidence beyond Pooled Estimates.","authors":"Jay Prakash, Khushboo Saran, Kalavathy Swarna, Bodhisatwa Choudhuri, Bikram K Gupta","doi":"10.5005/jp-journals-10071-25179","DOIUrl":"10.5005/jp-journals-10071-25179","url":null,"abstract":"<p><p><b>How to cite this article:</b> Prakash J, Saran K, Swarna K, Choudhuri B, Gupta BK. Diagnostic Accuracy of Point-of-care Ultrasonography for Endotracheal Tube Confirmation: Interpreting Evidence beyond Pooled Estimates. Indian J Crit Care Med 2026;30(4):357-358.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"357-358"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178135/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965247","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":"Renal Biomarkers of Injury as Early Predictors of COVID-19 Associated Acute Kidney Injury: A Prospective Observational Trial (BRICOAKI Study).","authors":"Neeraj Kumar, Mala Mahto, Abhyuday Kumar, Ajeet Kumar, Amarjeet Kumar","doi":"10.5005/jp-journals-10071-25177","DOIUrl":"10.5005/jp-journals-10071-25177","url":null,"abstract":"<p><strong>Background and aims: </strong>Acute kidney injury (AKI) is a common and serious complication among critically ill COVID-19 patients. Early identification of patients at risk is challenging because serum creatinine rises late in the course of renal injury. Unlike prior COVID-19 AKI studies that measured serum neutrophil gelatinase-associated lipocalin (sNGAL) or Cystatin-C at a single time point, this study evaluates their serial trajectories and quantifies biomarker-creatinine lead-time in a critically ill intensive care unit (ICU) cohort.</p><p><strong>Patients and methods: </strong>This prospective observational study involved 65 adults with moderate to severe COVID-19 in the ICU. Serum biomarkers [NGAL, cystatin-C, interleukin (IL)-6, kidney injury molecule (KIM)-1, tissue inhibitor of metalloproteinases (TIMP)-2, creatinine] and urinary Klotho (uKlotho) were measured on days 0, 1, 2, 3, 5, 7, and 10. Acute kidney injury was defined per kidney disease: Improving global outcomes (KDIGO) criteria. Receiver operating characteristic (ROC) analysis and lead-time estimation evaluated predictive performance.</p><p><strong>Results: </strong>Acute kidney injury occurred in 47/65 (72.3%) patients; of them, 36/47 (76.6%) progressed to KDIGO stages 2-3, and 5 (10.6%) required renal replacement therapy (RRT). Among the biomarkers studied, sNGAL demonstrated the highest discrimination for KDIGO-defined AKI [area under curve (AUC): 0.71-0.79] and increased approximately 1 day before creatinine-based AKI diagnosis. Serum cystatin-C (sCystatin-C) showed moderate predictive value (AUC: 0.63-0.70) with a median lead time of approximately 1-2 days. Serum KIM-1 (sKIM-1) demonstrated only borderline variation across severity groups, while uKlotho did not show significant discriminatory performance. Although TIMP-2 and IL-6 were significantly elevated with increasing disease severity, their overall discriminative performance for AKI was lower compared with NGAL and cystatin-C.</p><p><strong>Conclusion: </strong>In critically ill COVID-19 patients, serial sNGAL and sCystatin-C demonstrated modest but consistent discrimination for KDIGO-defined AKI and showed a tendency to rise 1-2 days prior to creatinine-based diagnosis. In contrast, sKIM-1, serum TIMP-2, uKlotho, and serum IL-6 exhibited limited discriminatory performance for early AKI detection.</p><p><strong>How to cite this article: </strong>Kumar N, Mahto M, Kumar A, Kumar A, Kumar A. Renal Biomarkers of Injury as Early Predictors of COVID-19 Associated Acute Kidney Injury: A Prospective Observational Trial (BRICOAKI Study). Indian J Crit Care Med 2026;30(4):298-304.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"298-304"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964866","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 Essentials of Compassionate End-of-life Care in the Intensive Care Unit: Lessons from the Harish Rana Case.","authors":"Raj K Mani","doi":"10.5005/jp-journals-10071-25189","DOIUrl":"10.5005/jp-journals-10071-25189","url":null,"abstract":"<p><p>Over the last two decades, many legal developments and professional recommendations notwithstanding, end-of-life practice on the ground is limited by physician hesitancy, lack of commitment to ensure appropriateness in decision-making, persistent fear of legal liability, and inadequate attention to quality of dying. This commentary attempts to spell out the salient messages in the recent Harish Rana vs Union of India judgment and reiterates the essential components of end-of-life care (EOLC) in intensive care unit (ICU) practice. Thoughtful and compassionate care is integral to critical care practice.</p><p><strong>How to cite this article: </strong>Mani RK. The Essentials of Compassionate End-of-life Care in the Intensive Care Unit: Lessons from the Harish Rana Case. Indian J Crit Care Med 2026;30(4):270-271.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"270-271"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964993","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 Tele-ICU \"Alerts\" to Tele-ICU \"Assurance\": Making Hemodynamic Surveillance Decision-grade and Globally Transferable.","authors":"Mulavagili Vijayasimha, Mulavagili Srikanth, Keerthi Rao, Pallav Mishra, Shweta, Arun Juneja","doi":"10.5005/jp-journals-10071-25174","DOIUrl":"10.5005/jp-journals-10071-25174","url":null,"abstract":"<p><p><b>How to cite this article:</b> Vijayasimha M, Srikanth M, Rao K, Mishra P, Shweta, Juneja A. From Tele-ICU \"Alerts\" to Tele-ICU \"Assurance\": Making Hemodynamic Surveillance Decision-grade and Globally Transferable. Indian J Crit Care Med 2026;30(4):344.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"344"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178124/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964621","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":"P Ajith Kumar, Kashish Chawla, Santvana Kohli, Rajpal Singh","doi":"10.5005/jp-journals-10071-25187","DOIUrl":"10.5005/jp-journals-10071-25187","url":null,"abstract":"<p><strong>Background and aims: </strong>Delirium is a frequent and serious complication in critically ill patients, contributing to prolonged mechanical ventilation, extended intensive care unit (ICU) stays, and increased mortality. Disruption of circadian rhythms plays a key role in its pathogenesis. Melatonin, a neurohormone with chronobiotic and antioxidant properties, may help prevent ICU delirium, though the optimal dose remains uncertain.</p><p><strong>Patients and methods: </strong>This prospective, randomized, interventional study enrolled 120 adult ICU patients, randomized to receive either 3 mg (group A) or 6 mg (group B) oral melatonin nightly for at least 5 days. Baseline parameters were comparable between groups. Delirium incidence was assessed twice daily using the confusion assessment method for the ICU (CAM-ICU). Secondary outcomes included the timing of delirium onset, adverse effects, ICU stay, and mortality.</p><p><strong>Results: </strong>Delirium occurred in 55.0% of patients in group A and 36.7% in group B (χ² = 4.062, <i>p</i> = 0.044), indicating a significant reduction with 6 mg of melatonin. The mean (SD) day of delirium onset and ICU length of stay were comparable between groups. Daytime somnolence was mild and similar across groups.</p><p><strong>Conclusions: </strong>Prophylactic administration of 6 mg of oral melatonin significantly reduced ICU delirium incidence compared with 3 mg, without added adverse effects. Higher-dose melatonin appears safe and more effective for delirium prevention in critically ill adults.</p><p><strong>How to cite this article: </strong>Kumar PA, Chawla K, Kohli S, Singh R. Comparison of Two Doses of Prophylactic Melatonin on Incidence of Delirium in Intensive Care Unit Patients: A Randomized Controlled Trial. Indian J Crit Care Med 2026;30(4):319-323.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"319-323"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965216","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":"Outcomes in Traumatic Brain Injury: Can Electroencephalography Predict the Unpredictable?","authors":"Atul Phillips","doi":"10.5005/jp-journals-10071-25173","DOIUrl":"10.5005/jp-journals-10071-25173","url":null,"abstract":"<p><p><b>How to cite this article:</b> Phillips A. Outcomes in Traumatic Brain Injury: Can Electroencephalography Predict the Unpredictable? Indian J Crit Care Med 2026;30(4):265-267.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"265-267"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964927","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 Tele-ICU \"Alerts\" to Tele-ICU \"Assurance\": Making Hemodynamic Surveillance Decision-grade and Globally Transferable.","authors":"Dharanindra Moturu, Ramesh B Potineni, Supriya Rayana, Sravani Thommandru, Jahangeer Shaik, Karthikeya Jampala, Lakshmi Ssb Kakumanu, Sai T Uppalapati, Silpa C Nallapaneni, Vamsi K Madduri, Karthik C Yalavarthi","doi":"10.5005/jp-journals-10071-25182","DOIUrl":"10.5005/jp-journals-10071-25182","url":null,"abstract":"<p><p><b>How to cite this article:</b> Moturu D, Potineni RB, Rayana S, Thommandru S, Shaik J, Jampala K, et al. Author Response: From Tele-ICU \"Alerts\" to Tele-ICU \"Assurance\": Making Hemodynamic Surveillance Decision-grade and Globally Transferable. Indian J Crit Care Med 2026;30(4):345-346.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"345-346"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178121/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965210","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 of Noninvasive Ventilation Compared with Invasive Mechanical Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis.","authors":"Ravi Yadav, Debasrita Banerjee","doi":"10.5005/jp-journals-10071-25176","DOIUrl":"10.5005/jp-journals-10071-25176","url":null,"abstract":"<p><p><b>How to cite this article:</b> Yadav R, Banerjee D. Efficacy of Noninvasive Ventilation Compared with Invasive Mechanical Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2026;30(4):350-351.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"350-351"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965185","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: Efficacy of Noninvasive Ventilation Compared with Invasive Mechanical Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis.","authors":"Tanawat Attachaipanich, Kotchakorn Kaewboot, Suthinee Attachaipanich","doi":"10.5005/jp-journals-10071-25181","DOIUrl":"10.5005/jp-journals-10071-25181","url":null,"abstract":"<p><p><b>How to cite this article:</b> Attachaipanich T, Kaewboot K, Attachaipanich S. Author Response: Efficacy of Noninvasive Ventilation Compared with Invasive Mechanical Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2026;30(4):352-353.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"352-353"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178125/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965175","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":"Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational Study.","authors":"Megha Jhunjhunwala, Anil Sachdev, Suresh Gupta, Dhiren Gupta, Neeraj Gupta","doi":"10.5005/jp-journals-10071-25184","DOIUrl":"10.5005/jp-journals-10071-25184","url":null,"abstract":"<p><strong>Background and aims: </strong>The COMFORT B score is a validated method for the assessment of the level of sedation in children, but it has its limitations. The bispectral index (BIS) is an electroencephalogram (EEG)-based tool used to assess the level of consciousness. The primary objective was to evaluate agreement between the BIS and the COMFORT B score for sedation in children on mechanical ventilation (MV).</p><p><strong>Patients and methods: </strong>This prospective, noninterventional study was conducted on 138 patients, aged >6 months, receiving MV in the pediatric intensive care unit (PICU). COMFORT B score and BIS were taken 30 minutes after initiation or dosage change of sedatives and then once every 8 hours for a maximum of 96 hours.</p><p><strong>Results: </strong>A total of 1,534 datasets were analyzed. Bispectral index values ranged from 11 to 89, while COMFORT B scores were between 6 and 28. The mean [± standard deviation (SD)] value for the BIS and COMFORT B scores was 54.4 ± 13.8 and 14 ± 4, respectively. Adequate sedation was recorded in 82.5 and 79.9% instances with BIS and COMFORT B scores, respectively. The correlation coefficient (<i>r</i>) of BIS and COMFORT B scores was 0.7. Overall agreement (<i>kappa</i> value) between the BIS and COMFORT B score was 0.642. A BIS score of 43 had 93% sensitivity and 70% specificity in differentiating oversedation from adequate sedation (AUROC 0.81). Similarly, a BIS value of 79 distinguished between adequate and undersedation (sensitivity 90%; specificity 98%; AUROC 0.966). The best AUROC (0.777) was observed in children with central nervous system (CNS) diseases, while the worst (0.54) occurred in patients with neuromuscular diseases.</p><p><strong>Conclusion: </strong>The BIS and COMFORT B scores have a good level of agreement in children, except in children with neuromuscular diseases.</p><p><strong>How to cite this article: </strong>Jhunjhunwala M, Sachdev A, Gupta S, Gupta D, Gupta N. Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational Study. Indian J Crit Care Med 2026;30(4):305-310.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"305-310"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965200","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}