Indian Journal of Critical Care Medicine

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2022 | October | Volume 26 | Issue 10

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EDITORIAL

Natesh Prabu R

Long-term Survival after Critical Illness: Are We There Yet?

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:2] [Pages No:1065 - 1066]

Keywords: Critical illness, Health-related quality of life, Long-term survival, Post-intensive care syndrome

   DOI: 10.5005/jp-journals-10071-24343  |  Open Access |  How to cite  | 

98

EDITORIAL

Deepak Govil, Anant Vikram Pachisia

Debunk the Myth: Percutaneous Tracheostomy in Cervical Spine Injury

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:2] [Pages No:1067 - 1068]

Keywords: Cervical spine injury, Percutaneous tracheostomy, Ultrasound

   DOI: 10.5005/jp-journals-10071-24342  |  Open Access |  How to cite  | 

85

EDITORIAL

Sunil Kumar Garg

Anti-cytokine Therapy in Hospitalized Patients with COVID-19: The Jury is Out

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:3] [Pages No:1069 - 1071]

Keywords: Anakinra, Anti-cytokine therapy, Anti-inflammatory therapy, Corona virus-2019, Cytokine storm, Interleukin 1, Interleukin receptor antagonist, Interleukin 6 receptor antagonists, Inflammatory biomarker, Tocilizumab

   DOI: 10.5005/jp-journals-10071-24336  |  Open Access |  How to cite  | 

87

EDITORIAL

Anuj M Clerk

Sepsis in Intensive Care Unit: Which Score Predicts Better about Outcome?

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:2] [Pages No:1072 - 1073]

Keywords: Acute physiology and chronic health evaluation score, Mortality prediction, Sepsis, Sequential organ failure assessment score

   DOI: 10.5005/jp-journals-10071-24337  |  Open Access |  How to cite  | 

112

EDITORIAL

Lalita Gouri Mitra, Atul Prabhakar Kulkarni

Great Expectations: Care Bundles can only be as Effective as the Component Elements!

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:2] [Pages No:1074 - 1075]

Keywords: Endotracheal intubation, Intensive care unit, Intubation bundle, Intubation complication, Quality improvement

   DOI: 10.5005/jp-journals-10071-24340  |  Open Access |  How to cite  | 

93

View Point

Akshaya Kumar Das, Ankur Sharma, Sandeep Kumar, Shilpa Goyal, Nikhil Kothari

New Threat at Doorstep: What an Intensivist should Know

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:2] [Pages No:1076 - 1077]

Keywords: Intensivist, Monkeypox, Virus

   DOI: 10.5005/jp-journals-10071-24328  |  Open Access |  How to cite  | 

97

Original Article

Rakesh Kodati, Valliappan Muthu, Ritesh Agarwal, Sahajal Dhooria, Ashutosh Nath Aggarwal, Kuruswamy Thurai Prasad, Digambar Behera, Inderpaul Singh Sehgal

Long-term Survival and Quality of Life among Survivors Discharged from a Respiratory ICU in North India: A Prospective Study

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:8] [Pages No:1078 - 1085]

Keywords: Acute respiratory distress syndrome, Neuromuscular weakness, Critical care, Critically ill, Critically ill patients, Domiciliary ventilation, Delirium

   DOI: 10.5005/jp-journals-10071-24321  |  Open Access |  How to cite  | 

Abstract

Background: Advancements in the intensive care unit (ICU) have improved critically ill subjects’ short-term outcomes. However, there is a need to understand the long-term outcomes of these subjects. Herein, we study the long-term outcomes and factors associated with poor outcomes in critically ill subjects with medical illnesses. Materials and methods: All subjects (≥12 years) discharged after an ICU stay of at least 48 hours were included. We evaluated the subjects at 3 and 6 months after ICU discharge. At each visit, subjects were administered the World Health Organization Quality of Life Instrument (WHO-QOL-BREF) questionnaire. The primary outcome was mortality at 6 months after ICU discharge. The key secondary outcome was quality of life (QOL) at 6 months. Results: In total, 265 subjects were admitted to the ICU, of whom 53 subjects (20%) died in the ICU, and 54 were excluded. Finally, 158 subjects were included: 10 (6.3%) subjects were lost to follow-up. The mortality at 6 months was 17.7% (28/158). Most subjects [16.5% (26/158)] died within the initial 3 months after ICU discharge. Quality of life scores were low in all the domains of WHO-QOL-BREF. About 12% (n = 14) of subjects could not perform the activity of daily living at 6 months. After adjusting for covariates, ICU-acquired weakness at the time of discharge (OR 15.12; 95% CI, 2.08–109.81, p <0.01) and requirement for home ventilation (OR 22; 95% CI, 3.1–155, p <0.01) were associated with mortality at 6 months. Conclusion: Intensive care unit survivors have a high risk of death and a poor QOL during the initial 6 months following discharge.

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Original Article

Amrutha Liz Paul, Ram Varaham, Kannan Balaraman, S Rajasekaran, VM Balasubramani

Safety and Feasibility of Very Early Bronchoscopy-assisted Percutaneous Dilatational Tracheostomy in Anterior Cervical Spine Fixation Patients

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:5] [Pages No:1086 - 1090]

Keywords: Cervical spine fixation, Complications, Feasibility, Percutaneous tracheostomy

   DOI: 10.5005/jp-journals-10071-24322  |  Open Access |  How to cite  | 

Abstract

Background: Anterior cervical spine fixation (ACSF) is a common mode of stabilization of cervical spine injuries. These patients usually need a prolonged mechanical ventilation, so an early tracheostomy is beneficial for them. However, it is often delayed due to the close proximity to the surgical site, due to the concerns of infection, and increased bleeding. Percutaneous dilatational tracheostomy (PDT) is also considered a relative contraindication due to the inability to achieve adequate neck extension. Objectives: The objectives of our study are to assess the: • Feasibility of performing a very early percutaneous dilatational tracheostomy in cervical spine injury patients, post-anterior cervical spine fixation. • Safety in doing so with regard to surgical-site infection, early, and late complications. • Benefits with regard to outcome measures like ventilator days and length of stay (LOS) in the intensive care unit (ICU) and hospital. Materials and methods: We performed a retrospective review of all patients who underwent anterior cervical spine fixation and bedside percutaneous dilatational tracheostomy in our ICU from 1st January 2015 to 31st March 2021. Results: Out of the 269 patients admitted to our ICU with cervical spine pathology, 84 were included in the study. About 40.4% patients had injury above C5 level (n-34) and 59.5% had below C5 level. About 86.9% patients had ASIA-A neurology. In our study, percutaneous tracheostomy was done at an average of 2.8 days from the cervical spine fixation. Average length of ventilator days post-tracheostomy was 8.32 days, ICU stay was 10.5 days, and hospital stay was 28.6 days. One patient developed anterior surgical-site infection. Conclusion: We conclude from our study that a very early percutaneous dilatational tracheostomy can be done in post-anterior cervical spine fixation patients as early as within 3 days without significant complications.

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Original Article

Feyza Ozkan, Süleyman Sari

Comparison of Anakinra and Tocilizumab in Anticytokine Therapy in the Treatment of Coronavirus Disease-2019

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:8] [Pages No:1091 - 1098]

Keywords: Anakinra, Coronavirus disease-2019, Cytokine, Tocilizumab

   DOI: 10.5005/jp-journals-10071-24320  |  Open Access |  How to cite  | 

Abstract

Background: It is known that coronavirus disease-2019 (COVID-19) pneumonia causes cytokine storm, and treatment modalities are being developed on inhibition of proinflammatory cytokines. We aimed to investigate the effects of anticytokine therapy on clinical improvement and the differences between anticytokine treatments. Materials and methods: A total of 90 patients with positive COVID-19 polymerase chain reaction (PCR) test were divided into three groups, group I (n = 30) was given anakinra, group II (n = 30) was given tocilizumab, and group III (n = 30) was given standard treatment. Group I was treated with anakinra for 10 days; tocilizumab, intravenously, was given in group II. Group III patients were selected from those who did not receive any anticytokine treatment other than the standard treatment. Laboratory values, Glasgow coma scale (GCS), and PaO2/FiO2 values were analyzed on days 1, 7, and 14. Results: The seventh-day mortality rates were 6.7% in group II, 23.3% in group I, and 16.7% in group III. In group II, the ferritin levels on the 7th and 14th days were significantly lower (p = 0.004), and the lymphocyte levels on the seventh day were significantly higher (p = 0.018). Examining the changes between the first intubation days, in the early period (seventh day), group I was found to be 21.7%, group II was 26.9%, and group III was 47.6%. Conclusion: We observed the positive effects of the use of tocilizumab on clinical improvement in the early period; mechanical ventilation requirement was delayed and at a lower rate. Anakinra treatment did not change mortality and PaO2/FiO2 rates. Mechanical ventilation requirements occurred earlier in the patients who were not receiving any anticytokine therapy. Studies with larger patient populations are needed to demonstrate the potential efficacy of anticytokine therapy.

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Original Article

Sameera Dronamraju, Sachin Agrawal, Sunil Kumar, Sourya Acharya, Shilpa Gaidhane, Anil Wanjari, Praraj Jaiswal, Nipun Bawiskar

Comparison of PIRO, APACHE IV, and SOFA Scores in Predicting Outcome in Patients with Sepsis Admitted to Intensive Care Unit: A Two-year Cross-sectional Study at Rural Teaching Hospital

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:7] [Pages No:1099 - 1105]

Keywords: Acute physiology and chronic health evaluation IV, Intensive care unit, Organ failure, Outcome, Sepsis, Sequential (sepsis-related) organ failure assessment

   DOI: 10.5005/jp-journals-10071-24323  |  Open Access |  How to cite  | 

Abstract

Introduction: Though many scoring systems for prognostication of sepsis are available in the intensive care set-up, predisposition, insult, response, and organ dysfunction (PIRO) score helps to assess each patient and evaluate response to therapy. There are few studies comparing the efficacy of PIRO score with other sepsis scores. Hence, our study was planned to compare PIRO score with acute physiology and chronic health evaluation IV (APACHE IV) score and sequential (sepsis-related) organ failure assessment (SOFA) score in predicting the mortality of intensive care patients with sepsis. Materials and methods: This prospective cross-sectional study was done in the medical intensive care unit (MICU) from August 2019 to September 2021 among patients above 18 years of age with the diagnosis of sepsis. Predisposition, insult, response, and organ dysfunction score, SOFA score, and APACHE IV score on admission and at day 3 were calculated and statistically analyzed in the terms of outcome. Results: A total of 280 patients fulfilling the inclusion criteria were included in the study, the mean age was 59.38 ± 15.9 years. There was a significant association of PIRO score, SOFA score, and APACHE IV score on admission and at day 3 with mortality (p-value <0.05). Among all three parameters, the PIRO score on admission and at day 3 was the best predictor of mortality at cut-off points of >14 and >16 with 92.50% and 96.50% chances of correctly predicting mortality, respectively. Conclusion: Predisposition, insult, response, and organ dysfunction score can be considered as a strong predictor of prognostication of patients with sepsis admitted to the intensive care unit (ICU) and predict mortality. It should be routinely used as it is a simple and comprehensive score.

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Original Article

Supradip Ghosh, Ripenmeet Salhotra, Garima Arora, Aditya Lyall, Amandeep Singh, Niranjan Kumar, Aayush Chawla, Meenakshi Gupta

Implementation of a Revised Montpellier Bundle on the Outcome of Intubation in Critically Ill Patients: A Quality Improvement Project

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:9] [Pages No:1106 - 1114]

Keywords: Endotracheal intubation, Intensive care unit, Intubation bundle, Intubation complications, Quality improvement

   DOI: 10.5005/jp-journals-10071-24332  |  Open Access |  How to cite  | 

Abstract

Introduction: The feasibility of implementing a revised Montpellier intubation bundle incorporating recent evidences was tested in a quality-improvement project. It was hypothesized that this “Care Bundle” implementation would reduce intubation-related complications. Materials and methods: The project was conducted in an 18-bedded multidisciplinary intensive care unit (ICU). Baseline data for intubations were collected over 3-month “Control Period”. During the 2-month “Interphase”, a revised intubation bundle was developed, and staff members involved in the intubation process were extensively trained on different aspects of intubation with emphasis on bundle components. Various components of the bundle were pre-intubation fluid loading, pre-oxygenation with NIV plus PS, positive-pressure ventilation post-induction, succinylcholine as a first-line induction agent, routine use of stylet, and lung recruitment within 2 minutes of intubation. Intubation data were collected again in the 3-month “Intervention Period”. Results: Data were collected for 61 and 64 intubations, respectively, during control and intervention periods. There was significant improvement in compliance to five of six-bundle components; improvement in pre-intubation fluid loading during the intervention period did not reach statistical significance. Overall, at least 3 components of the bundle were complied within over 92% of intubations in the intervention period. However, whole-bundle compliance was limited to 14.3%. Incidences of major complications were reduced significantly in the intervention period (23.8% vs 45.9%, p = 0.01). There was significant reduction in profound hypotension (21.77% vs 29.51%, p = 0.04) and a nonsignificant 11.89% reduction in profound hypoxemia. There were no differences in minor complications. Conclusion: Implementation of an evidence-based revised Montpellier intubation bundle is feasible and it reduces major complications related to endotracheal intubation.

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Original Article

Prannoy George Mathen, KP Gireesh Kumar, Naveen Mohan, TP Sreekrishnan, Sabarish B Nair, Arun Kumar Krishnan, S Bharath Prasad, D Riaz Ahamed, Manna Maria Theresa, VR Kathyayini, U Vivek

Prediction of Noninvasive Ventilation Failure in a Mixed Population Visiting the Emergency Department in a Tertiary Care Center in India

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:5] [Pages No:1115 - 1119]

Keywords: HACOR score, High-sensitivity C-reactive protein, Noninvasive ventilation failure, Noninvasive ventilation, PaO2/FiO2 ratio, Prediction, Respiratory rate

   DOI: 10.5005/jp-journals-10071-24338  |  Open Access |  How to cite  | 

Abstract

Background: Noninvasive ventilation (NIV) is an established first-line treatment of acute respiratory failure both in emergency departments (ED) and intensive care unit (ICU) settings. It is however not always successful. Materials and methods: Prospective, observational study was done among patients above 18 years presenting with acute respiratory failure initiated on NIV. Patients were placed in one of two groups covering successful NIV treatment and NIV failure. Two groups were compared on four variables: initial respiratory rate (RR), initial high-sensitivity C-reactive protein (hs-CRP), PaO2/FiO2 ratio (p/f ratio), and heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) score at the end of 1 hour of initiation of NIV. Results: A total of 104 patients fulfilling the inclusion criteria were included in the study, of which 55 (52.88%) were exclusively treated with NIV (NIV success group), and 49 (47.11%) required endotracheal intubation and mechanical ventilation (NIV failure group). Noninvasive ventilation failure group had a higher mean initial RR compared with NIV success group (40.65 ± 3.88 vs 31.98 ± 3.15, p <0.001). Mean initial PaO2/FiO2 ratio was also significantly lower in the NIV failure group (184.57 ± 50.33 vs 277.29 ± 34.70, p <0.001). Odds ratio for successful NIV treatment with a high initial RR was 0.503 (95% confidence interval (CI), 0.390–0.649) and with a higher initial PaO2/FiO2 ratio was 1.053 (95% CI: 1.032–1.071 and with a HACOR score of >5 at the end of 1 hour of initiation of NIV was highly associated with NIV failure (p <0.001). A high initial level of hs-CRP was 0.949 (95% CI: 0.927–0.970). Conclusion: Noninvasive ventilation failure could be predicted with information available at presentation in ED, and unnecessary delay in endotracheal intubation could possibly be prevented.

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Original Article

Mehul Shah, Nirankar Bhatuka, Kavita Shalia, Mayur Patel

A 30-day Survival and Safety of Percutaneous Tracheostomy in Moderate-to-severe COVID-19 Pneumonia Patients: A Single-center Experience

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:6] [Pages No:1120 - 1125]

Keywords: Aerosolized procedure, Coronavirus disease-2019 acute respiratory distress syndrome, Endotracheal intubation, Healthcare workers, Infection transmission

   DOI: 10.5005/jp-journals-10071-24341  |  Open Access |  How to cite  | 

Abstract

Aims and objectives: In coronavirus disease-2019 (COVID-19) pneumonia, guidelines on timing and method of tracheostomy are evolving. The aim of the study was to analyze the outcomes of moderate-to-severe COVID-19 pneumonia patients who required tracheostomy and the safety with regard to the risk of transmission to the healthcare workers. Materials and methods: We retrospectively analyzed 30-day survival outcome of a total of 70 moderate-to-severe COVID-19 pneumonia patients on a ventilator, wherein tracheostomy was performed only in 28 (tracheostomy group), and the remaining were with endotracheal intubation beyond 7 days (non-tracheostomy group). Besides demographics, comorbidities and clinical data including 30-day survival and complications of tracheostomy were analyzed in both groups with respect to the timing of tracheostomy from the day of intubation. Healthcare workers were monitored for COVID-19 symptoms by carrying out periodical COVID tests. Results: The 30-day survival of the tracheostomy group was 75% as compared to 26.2% of the non-tracheostomy group. The majority of the patients (71.4%) had severe disease with PaO2/FiO2 (P/F ratio) <100. The first wave showed an 80% (4/5) while the second wave 100% (8/8) thirty days survival in the tracheostomy group performed before 13 days. All patients during the second wave underwent tracheostomy before 13 days with a median of 12th day from the day of intubation. These tracheostomies were performed percutaneously at the bedside, without any major complications and no transmission of disease to healthcare workers. Conclusion: Early percutaneous tracheostomy within 13 days of intubation demonstrated a good 30-day survival rate in severe COVID-19 pneumonia patients.

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Original Article

Kai Yang Lim, Wan Fadzlina Wan Muhd Shukeri, Wan Mohd Nazaruddin Wan Hassan, Mohd Basri Mat-Nor, Muhammad Hafiz Hanafi

The Combined Use of Interleukin-6 with Serum Albumin for Mortality Prediction in Critically Ill Elderly Patients: The Interleukin-6-to-albumin Ratio

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:5] [Pages No:1126 - 1130]

Keywords: Albumin, Elderly, Intensive care unit, Intensive care unit mortality, Interleukin-6

   DOI: 10.5005/jp-journals-10071-24324  |  Open Access |  How to cite  | 

Abstract

Background: The association between interleukin-6 (IL-6) and serum albumin (ALB) with mortality in critically ill elderly patients, either as stand-alone biomarkers or in combination, has been scarcely reported. We, therefore, aimed to investigate the prognostic value of the IL-6-to-albumin ratio in this special population. Patients and methods: This was a cross-sectional study conducted in the mixed intensive care unit (ICU) of two university-affiliated hospitals in Malaysia. Consecutive elderly patients (aged above or equal to 60 years) admitted to the ICU, who underwent simultaneous measurement of plasma IL-6 and serum ALB, were recruited. The prognostic value of the IL-6-to-albumin ratio was assessed by analysis of the receiver-operating characteristic (ROC) curve. Results: A total of 112 critically ill elderly patients were recruited. The outcome of all-cause ICU mortality was 22.3%. The calculated IL-6-to-albumin ratio was significantly higher in the non-survivors compared to the survivors {14.1 [interquartile range (IQR), 6.5–26.7] vs 2.5 [(IQR, 0.6–9.2) pg/mL, p <0.001]}. The area under the curve (AUC) of IL-6-to-albumin ratio for discrimination of ICU mortality was 0.766 [95% confidence interval (CI), 0.667–0.865, p <0.001] which was slightly higher than that of IL-6 and albumin alone. The ideal cut-off value of the IL-6-to-albumin ratio was above 5.7 with a sensitivity of 80.0% and specificity of 64.4%. After adjusting for severity of illness, the IL-6-to-albumin ratio remained as an independent predictor of ICU mortality with an adjusted odd ratio of 0.975 (95% CI, 0.952–0.999, p = 0.039). Conclusion: The IL-6-to-albumin ratio offers a slight improvement in mortality prediction than either of its constituent individual biomarkers and as such, it may be a potential tool to aid in the prognostication of critically ill elderly patients although this requires further validation in a larger prospective study.

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SYSTEMATIC REVIEW

Avishek Roy, Puneet Khanna, Sumit Roy Chowdhury, Damarla Haritha, Soumya Sarkar

The Impact of High-flow Nasal Cannula vs Other Oxygen Delivery Devices during Bronchoscopy under Sedation: A Systematic Review and Meta-analyses

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:10] [Pages No:1131 - 1140]

Keywords: Bronchoscopy, High-flow nasal cannula, Noninvasive ventilation

   DOI: 10.5005/jp-journals-10071-24339  |  Open Access |  How to cite  | 

Abstract

Background: The widespread diagnostic and therapeutic application of bronchoscopy is often associated with complications like desaturation. This systematic review and meta-analysis intend to scrutinize whether the high-flow nasal cannula (HFNC) is advantageous for providing respiratory support during bronchoscopic procedures under sedation, in comparison with other conventional modalities for oxygen therapy. Materials and methods: A thorough screening of electronic databases was done till 31st December 2021 after obtaining registration in PROSPERO (CRD42021245420). Randomized controlled trials (RCT), evaluating the impact of HFNC and standard/any other oxygen-delivery devices during bronchoscopy were included in this meta-analysis. Results: We retrieved in nine RCTs, with a total of 1306 patients, the application of HFNC during bronchoscopy led to decreased number of desaturation spells [relative risk (RR) 0.34, 95% confidence interval (CI) 0.27–0.44, I2 = 23%], higher nadir value of SpO2 [Mean difference (MD) 4.30, 95% CI 2.41–6.19, I2 = 96%], and improved PaO2 from baseline (MD 21.77, 95% CI 2.8–40.74, I2 = 99%), along with similar PaCO2 values (MD –0.34, 95% CI –1.82 to 1.13, I2 = 58%) just after the procedure. However, apart from desaturation spell, the findings are significantly heterogeneous. In subgroup analysis, HFNC had significantly lesser desaturation spells and better oxygenation than low-flow devices, but in comparison to noninvasive ventilation (NIV) had a lower nadir value of SpO2 with no other significant difference. Conclusion: High-flow nasal cannula led to greater oxygenation and prevented desaturation spells more effectively in comparison with low-flow devices like nasal cannula, venturi mask, etc., and may be considered as an alternative to NIV during bronchoscopy in certain high-risk patients.

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SYSTEMATIC REVIEW

Medhavi Gautam, Sulekha Saxena, Sai Saran, Armin Ahmed, Amita Pandey, Prabhakar Mishra, Afzal Azim

Etiology of Pregnancy-related Acute Kidney Injury among Obstetric Patients in India: A Systematic Review

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:11] [Pages No:1141 - 1151]

Keywords: Maternal mortality, Pregnancy-induced hypertension, Pregnancy-related acute kidney injury, Sepsis

   DOI: 10.5005/jp-journals-10071-24325  |  Open Access |  How to cite  | 

Abstract

Background: Pregnancy-related acute kidney injury (PRAKI) is an important cause of fetomaternal mortality and morbidity in developing countries. We undertook a systematic review to identify the causes of PRAKI among obstetric patients in India. Materials and methods: We systematically searched PubMed, MEDLINE, Embase, and Google Scholar using appropriate search terminology between 1 January 2010 to 31 December 2021. Studies reporting the etiology of PRAKI among obstetric patients (pregnant and within 42 days postpartum) in India were included for evaluation. Studies done in any other geographical location besides India were excluded. We also excluded studies done in any one trimester or any specific subgroup of patients [e.g., postpartum acute kidney injury (AKI), postabortal AKI]. A five-point questionnaire was used to assess the risk of bias in included studies. The results were synthesized as per preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Results: A total number of 7 studies with 477 participants were included for analysis. All were single-center descriptive observational studies either done in tertiary care public or private hospitals. Sepsis (mean, 41.9%; median, 49.4%; and range, 6–56.1%) was the most common cause of PRAKI followed by hemorrhage (mean, 22.1%; median, 23.5%; and range, 8.3–38.5%) and pregnancy-induced hypertension (mean, 20.9%; median, 20.7; and range, 11.5–39%). Among these seven studies, five were of moderate quality, one was of high quality, and another one was of low quality. Our study is limited due to the lack of consensus definition of PRAKI in literature and heterogeneity in reporting methods. Our study highlights the need for a structured reporting format for PRAKI to understand the true disease burden and take control measures. Conclusion: There is a moderate quality of evidence to suggest that sepsis followed by hemorrhage and pregnancy-induced hypertension are the commonest causes of PRAKI in India.

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LETTER TO THE EDITOR

Antonio M Esquinas

Alveolar–arterial Oxygen Gradient in COVID-19 Pneumonia Initiated on Noninvasive Ventilation: Looking into the Mortality-prediction Ability

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:1] [Pages No:1152 - 1152]

Keywords: Alveolar–arterial oxygen gradient, Coronavirus disease of 2019, Mortality prediction, Noninvasive ventilation

   DOI: 10.5005/jp-journals-10071-24334  |  Open Access |  How to cite  | 

87

LETTER TO THE EDITOR

Ajay Kumar Jha, Sri Rama Ananta Nagabhushanam Padala, Satyen Parida, Sandeep Kumar Mishra

Diphtheritic Myocarditis Patient with an Impending Upper Airway Compromise

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:2] [Pages No:1153 - 1154]

Keywords: Airway management, Diphtheria, Myocarditis

   DOI: 10.5005/jp-journals-10071-24333  |  Open Access |  How to cite  | 

94

LETTER TO THE EDITOR

Rajalakshmi Arjun, Vettakkara Kandy Muhammed Niyas, Kalpana Elizabeth John, Ashalatha Nair, Febeena Hussain

Impact of Adding Rapid Polymerase Chain Reaction-based Blood Culture Identification Panel to Antimicrobial Stewardship Program: Initial Experience

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:3] [Pages No:1155 - 1157]

Keywords: Antibiotic stewardship, Bacteremia, Blood culture identification, Blood culture identification 2, Multiplex polymerase chain reaction

   DOI: 10.5005/jp-journals-10071-24329  |  Open Access |  How to cite  | 

84

LETTER TO THE EDITOR

Magnus Rasmussen, Torgny Sunnerhagen

Get the Species Right: Aerococcus viridans is Likely not Responsible

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:1] [Pages No:1158 - 1158]

Keywords: Aerococcus, Bacteremia, Vitek2

   DOI: 10.5005/jp-journals-10071-24330  |  Open Access |  How to cite  | 

90

LETTER TO THE EDITOR

Mohanchandra Mandal, Dipasri Bhattacharya, Antonio Matias Esquinas

Non-invasive Ventilation Delivered by Helmet vs Face Mask in Patients with COVID-19 Infection: Additional Measures to Reap Further Benefits

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:2] [Pages No:1159 - 1160]

Keywords: Acute respiratory failure, Coronavirus disease-2019, Intensive care unit, Non-invasive ventilation

   DOI: 10.5005/jp-journals-10071-24331  |  Open Access |  How to cite  | 

85

LETTER TO THE EDITOR

Antonio M Esquinas

Ketamine Sedation for Noninvasive Ventilation in Distressed Elderly Patients with Acute Decompensated Heart Failure: Is it Safe?

[Year:2022] [Month:October] [Volume:26] [Number:10] [Pages:1] [Pages No:1161 - 1161]

Keywords: Heart failure, Ketamine, Noninvasive ventilation

   DOI: 10.5005/jp-journals-10071-24335  |  Open Access |  How to cite  | 

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