Indian Journal of Critical Care Medicine

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2023 | October | Volume 27 | Issue 10

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Amarja A Havaldar

Wean to Win

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:2] [Pages No:695 - 696]

Keywords: Cardiac dysfunction, Diaphragm, Mechanical ventilation, Parasternal intercostal muscles, Pulmonary edema, Spontaneous breathing trial, Ultrasonography, Weaning.

   DOI: 10.5005/jp-journals-10071-24556  |  Open Access |  How to cite  | 



Amol Trimbakrao Kothekar, Rakesh Mohanty, Anand Vinaykumar Joshi

Goal-directed Fluid Therapy in Neurosurgery: Three Feet from Gold?

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:2] [Pages No:697 - 698]

Keywords: Aged, Cardiac output blood pressure, Goal-directed therapy, Neurosurgery, Ringer's lactate.

   DOI: 10.5005/jp-journals-10071-24557  |  Open Access |  How to cite  | 



Subhash Todi

Arterial Blood Gas Analysis: A New Look at the Old Formula

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:2] [Pages No:699 - 700]

Keywords: Arterial blood gas, Arterial blood gas analysis, Formula.

   DOI: 10.5005/jp-journals-10071-24558  |  Open Access |  How to cite  | 



Tanmay Banerjee, Payel Bose

Kidney-lung Crosstalk in Determining the Prognosis of Acute Kidney Injury Phenotypes in Acute Respiratory Distress Syndrome Patients

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:3] [Pages No:701 - 703]

Keywords: Acute kidney injury, Acute respiratory distress syndrome, Critically ill patients, Sub-phenotypes.

   DOI: 10.5005/jp-journals-10071-24562  |  Open Access |  How to cite  | 


Retraction Notice

Arjun Ramaswamy, Mahendran Arul, Manu Madan, Neeraj Kumar Gupta, Nitesh Gupta

Prediction of Weaning Outcome from Mechanical Ventilation Using Ultrasound Assessment of Parasternal Intercostal Muscle Thickness

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:5] [Pages No:704 - 708]

Keywords: Critical illness, Ultrasonography, Ventilator weaning

   DOI: 10.5005/jp-journals-10071-24548  |  Open Access |  How to cite  | 


The authors wish to withdraw the article Ramaswamy A, Arul M, Madan M, Gupta NK, Gupta N. Prediction of Weaning Outcome from Mechanical Ventilation Using Ultrasound Assessment of Parasternal Intercostal Muscle Thickness, IJCCM 2023; 27 (10):704-708. doi: 10.5005/jp-journals-10071-24548 published in the Indian Journal of Critical Care Medicine in 2023; 27 (10):704-708. doi: 10.5005/jp-journals-10071-24548, due to major errors in data.


Original Article

Vorrachai Sae-phua, Sophitnapa Tanasittiboon, Sunisa Sangtongjaraskul

The Effect of Goal-directed Fluid Management based on Stroke Volume Variation on ICU Length of Stay in Elderly Patients Undergoing Elective Craniotomy: A Randomized Controlled Trial

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:8] [Pages No:709 - 716]

Keywords: Craniotomy, Elderly, Fluid therapy, Goal-directed therapy, Length of ICU stay, Stroke volume variation

   DOI: 10.5005/jp-journals-10071-24551  |  Open Access |  How to cite  | 


Background: Inappropriate fluid management during neurosurgery can increase postoperative complications. In this study, we aimed to investigate the effect of goal-directed fluid therapy using stroke volume variation (SVV) in elderly patients undergoing elective craniotomy. Materials and methods: We randomized 100 elderly patients scheduled for elective craniotomy into two groups: goal-directed therapy (GDT, n = 50) group and conventional group (n = 50). Fluid management protocol using SVV was applied in the GDT group. Decisions about fluid and hemodynamic management in the conventional group were made by the anesthesiologist. Perioperative variables including fluid balance, lactate level, and intensive care unit (ICU) length of stay were assessed. Results: There was no significant difference in ICU length of stay between the two groups: 14 (12, 16.75) hours in GDT group vs 15 (13, 18) hours in control group (p = 0.116). Patients in the GDT group received a significantly less amount of crystalloid compared with the control group: 1311.5 (823, 2018) mL vs 2080 (1420, 2690) mL (p < 0.001). Our study demonstrated a better fluid balance in the GDT group as 342.5 (23, 607) mL compared with the conventional group 771 (462, 1269) mL (p < 0.001). Conclusion: Intraoperative goal-directed fluid management based on SVV in elderly patients undergoing elective craniotomy did not reduce the ICU length of stay or postoperative complications. It did result in an improved fluid balance with no evidence of inadequate organ perfusion. Clinical trial registration number: TCTR20190812003.


Original Article

Rajini Samuel

Application of Boston Compensation Rules in the Development of a Stepwise Approach for Novel Diagnostic Arterial Blood Gas Interpretation Method

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:7] [Pages No:717 - 723]

Keywords: Compensation rules, Novel arterial blood gas interpretation, Stepwise approach

   DOI: 10.5005/jp-journals-10071-24552  |  Open Access |  How to cite  | 


Background: Arterial blood gas (ABG) interpretation plays an indispensable role in health care. The total changes in hydrogen ion concentration or actual pH are due to both the changes in respiratory and non-respiratory (metabolic) components affecting the hydrogen ion concentration or pH in the acid–base homeostasis. Using this concept, an innovative ABG interpretation method was developed and published by the current author. The aim of this study is to apply the compensation rules and to develop a stepwise approach in this novel method to interpret various acid–base disorders. Methods: The total change in pH (ΔpH), non-respiratory hydrogen ion concentration (NRH+), changes in non-respiratory pH (ΔNRpH), and respiratory change in pH (ΔRpH) were calculated for 232 ABG samples. The expected pCO2 (Exp pCO2) or expected bicarbonate (Exp HCO3) values were calculated using the compensation rules and compared with their actual given values. Results: Few acid–base disorder cases were shown as examples comparing the physiological, standard base excess (Std BE) and parameters such as ΔpH, ΔRpH, and ΔNRpH values of novel ABG interpretation method which change in different acid–base disorders. Conclusion: The stepwise approach in this novel method appears to be much user-friendly providing interpretation of various acid–base disorders easily and quickly. Clinical significance: This innovative method may help to overcome the challenging task of ABG interpretation.


Original Article

Thejesh Srinivas

Incidence, Outcomes, and Predictors of Subphenotypes of Acute Kidney Injury among Acute Respiratory Distress Syndrome Patients: A Prospective Observational Study

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:8] [Pages No:724 - 731]

Keywords: Acute respiratory distress syndrome, Acute kidney injury, DRONE score (driving pressure, oxygenation, and nutritional evaluation), Mortality, Non-resolving, Subphenotypes, Serum creatinine trajectory

   DOI: 10.5005/jp-journals-10071-24553  |  Open Access |  How to cite  | 


Background: Acute kidney injury (AKI) is a heterogeneous syndrome with subphenotypes. Acute kidney injury is one of the most common complications in acute respiratory distress syndrome (ARDS) patients, which influences mortality. Material and methods: It was a single-center observational study on 266 ARDS patients on invasive mechanical ventilation (IMV) to determine the subphenotypes of AKI associated with ARDS. Subphenotyping was done based on the serum creatinine (SCr) trajectories from day 1 to day 5 of IMV into resolving (subphenotype 1) or non-resolving (subphenotype 2) AKI. Results: Out of 266 ARDS patients, 222 patients were included for data analysis. 141 patients (63.51%) had AKI. The incidence of subphenotype 2 AKI among the ARDS cohort was 78/222 (35.13%). Subphenotype 2 AKI was significantly more among the non-survivors (87.7% vs 36.2 %, p < 0.001). Subphenotype 2 AKI was an independent predictor of mortality among ARDS patients (p < 0.001, adjusted odds ratio 8.978, 95% CI [2.790–28.89]. AKI subphenotype 1 had higher median day 1 SCr than subphenotype 2 but lower levels by day 3 and day 5 of IMV. The median time of survival was 8 days in AKI subphenotype 2 vs 45 days in AKI with subphenotype 1 [Log-Rank (Mantel-Cox) p < 0.001]. The novel DRONE score (Driving pressure, Oxygenation, and Nutritional Evaluation) ≥ 4 predicted subphenotype 2 AKI. Conclusion: The incidence of subphenotype 2 (non-resolving) AKI among ARDS patients on IMV was about 35% (vs 20% subphenotype 1 AKI), and it was an independent predictor of mortality. The DRONE score ≥4 can predict the AKI subphenotype 2. Highlights: The serum creatinine trajectory-based subphenotype of AKI (resolving vs non-resolving) determines survival in ARDS patients. Non-resolving AKI subphenotype 2 is an independent predictor of mortality in ARDS. The novel DRONE score (driving pressure, oxygenation, and nutritional evaluation) ≥ 4 within 48 hours of IMV predicted the AKI subphenotype 2 among ventilated ARDS patients.


Original Article

Nurcan Uysal, Doğancan Vaizoğlu

The Effect of Video Call with Family Members on Physiological Parameters of Critically Ill Patients in Intensive Care Unit: A Quasi-experimental Study

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:5] [Pages No:732 - 736]

Keywords: Communication, Family, Intensive care unit, Intensive care unit patients

   DOI: 10.5005/jp-journals-10071-24549  |  Open Access |  How to cite  | 


Aim and background: There are not enough studies on the direct effect of virtual patient visits on patients’ vital signs in intensive care. The aim of this study is to determine the effect of video calls made between conscious patients and their families on the patient's vital signs and to determine the level of satisfaction. Materials and methods: The research was carried out quasi-experimentally. Study data were collected from 135 patients and their relatives. The data were collected from the vital signs monitoring form and the Glasgow Coma Scale (GCS). Satisfaction with the video call was measured with a score scale between 0 and 5. Video calls were conducted by an intensive care unit (ICU) nurse every day between 13:00 and 15:00 for 5 days. Physiological parameters were measured 30 minutes before, during, and 30 minutes after the video calls. Results: The mean patient pulse rate (PR) value was 92.04 ± 12.87, respiratory rate (RR) value was 22.89 ± 3.63, and GCS total score was 14.01 ± 0.12 during the call. There was a statistically significant difference between these values measured during the video calls and the values measured before and after the interview (p < 0.00). The mean score of patient satisfaction with the video call was 4.80 ± 0.44; for relatives, the mean score was 4.87 ± 0.33. Conclusion: This study revealed that video calls with family members affected PR, RR, and GCS of patients hospitalized in ICU. Clinical significance: Video calls can be implemented in all ICUs where visits are restricted. This practice is well recognized by both families and patients.


Original Article

Kapil Zirpe, Upendrakumar S Kapse, Sushma Kirtikumar Gurav, Anand Mohanlal Tiwari, Abhijit Manikrao Deshmukh, Prasad Bhimrao Suryawanshi, Abhaya Pramodrao Bhoyar, Prajkta Prakash Wankhede, Devashish Desai, Rupali Suryawanshi, Rebecca John, Soniya Bhagat

Impact of an Antimicrobial Stewardship Program on Broad Spectrum Antibiotics Consumption in the Intensive Care Setting

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:6] [Pages No:737 - 742]

Keywords: Antimicrobial stewardship, Antibiotic consumption, Days of therapy, Defined daily dose

   DOI: 10.5005/jp-journals-10071-24543  |  Open Access |  How to cite  | 


Background and objectives: Antibiotics are the most commonly exploited agents in intensive care units. An antimicrobial stewardship program (ASP) helps in the optimal utilization of antibiotics and prevents the development of antibiotic resistance. The aim of this study was to assess the impact of ASP on broad-spectrum antibiotic consumption in terms of defined daily dose (DDD) and days of therapy (DOT) before and after the implementation of an ASP. Materials and methods: It was a prospective, quasi-experimental, pre- and post-study. Group A consisted of 5 months of ASP data, ASP activities were implemented during the next 2 months and continued. Group B (post-ASP) data was collected for the next 5 months. Total and individual DDDs and DOTs of broad-spectrum antibiotics utilized were compared between group A and group B. Results: Total DDDs used per 100 patient bed days were reduced by 18.72% post-ASP implementation (103.46 to 84.09 grams). The total DOT per 100 patient bed days used was 90.91 vs 71.25 days (21.62% reduction). As per the WHO classification of antibiotics use, the watch category (43.4% vs 43.04%) as well as reserve category (56.6% vs 56.97%) used between the two groups were found similar. The average length of stay (8.9 ± 2 days) after ASP was found significantly lesser than baseline (10.8 ± 3.4 days) (p < 0.05), however, there was no significant change in mortality between the two groups. Conclusion: Antimicrobial stewardship program implementation may reduce overall antibiotic consumption both in terms of DDD and DOT.


Original Article

Kiran Rajagopal, Deepak Vijayan, Sujith M Thomas

Association of SOFA Score with Severity of Muscle Wasting in Critically Ill Patients: A Prospective Observational Study

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:5] [Pages No:743 - 747]

Keywords: Correlation, Critical illness, Intensive care unit, Muscle wasting, Organ dysfunction score, Prospective observational study, Sequential organ failure assessment, Ultrasound

   DOI: 10.5005/jp-journals-10071-24540  |  Open Access |  How to cite  | 


Background: Muscle wasting is a frequent complication in critically ill patients. This study aimed to evaluate whether muscle wasting occurs in these patients and its association with the severity of the disease. Materials and methods: This was a prospective, observational study including 50 patients admitted to the multidisciplinary ICU of a tertiary care hospital. Using a linear ultrasound probe, the thickness of the rectus femoris was measured on day 1 of admission and repeated at the same point on day 7. Sequential organ failure assessment (SOFA) scores were calculated daily during the study period. The highest SOFA score during this period was recorded. The mean difference in the thickness of the rectus femoris between day 1 and day 7 was used to predict the occurrence of muscle wasting and the correlation between this difference and the highest SOFA score was analyzed. Results: The mean thickness of the rectus femoris on day 1 was 1.32 + 0.06 cm and on day 7 was 1.16 + 0.08 cm. The mean difference was found to be 0.16 cm (p < 0.01). There was a statistically significant difference in the thickness of the rectus femoris between day 1 and day 7. It was found to have a positive correlation with the highest SOFA score r = 0.886 (p < 0.01). Conclusion: This study demonstrates that there is significant muscle wasting in critically ill patients and this positively correlates with the severity of illness. Our study also highlights the role of bedside ultrasound in detecting muscle wasting.


Original Article

Merve Misirlioglu, Dincer Yildizdas, Damla Pinar Yavas, Faruk Ekinci, Ozden Ozgur Horoz, Ahmet Yontem

Central Venous Catheter Insertion for Vascular Access: A 6-year Single-center Experience

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:6] [Pages No:748 - 753]

Keywords: Catheterization, Child, Intensive care, Ultrasonography, Vascular access

   DOI: 10.5005/jp-journals-10071-24536  |  Open Access |  How to cite  | 


Background: Central venous catheterization is performed for such reasons as hemodynamic monitoring, parenteral nutrition, drug and fluid administration, and extracorporeal treatment. This study aimed to retrospectively review the indications for central venous catheter (CVC) insertion for vascular access and removal by pediatric intensive care unit (PICU) physicians, catheter types, and catheter-associated complications. Materials and methods: The indications for CVC insertion and removal, catheter insertion site, types of catheters, catheter-associated complications, whether or not insertion was ultrasonographically guided, catheter-associated infections, and duration of use of 1200 catheters used by PICU physicians between 2015 and 2020 were retrospectively reviewed. Results: In all, 315 (26.3%) hemodialysis catheters and 885 (73.8%) CVCs were inserted. Mean duration of catheter use was 12.33 ± 7.28 days. CVCs were inserted most commonly (28.4% [n = 341]) based on the indication of multiple drug infusions. In total, 44.8% of the CVCs were inserted under ultrasonographic guidance. The most common reason for the removal of catheters was that they were no longer needed (76.8% [n = 921]). Catheter-associated bloodstream infection occurred at the rate of 5.5 days per 1000 catheter days. Conclusion: Central venous catheterization is becoming more widespread because of the benefits it provides during the follow-up and treatment of children. As central venous catheterization is a more invasive procedure than peripheral localization and is associated with severe complications, especially in pediatric patients, it should be carefully performed under sterile conditions and by experienced personnel based on appropriate indications. Central venous catheters should be removed as soon as the need disappears.


Original Article

Aya Osama Mohamed, Mohamed Abdallah Abd El-Megied, Yomna Ahmed Hosni

Prognostic Value of Serum Glucose Level in Critically Ill Septic Patients on Admission to Pediatric Intensive Care Unit

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:5] [Pages No:754 - 758]

Keywords: Children, Hypoglycemia, Mortality, Sepsis

   DOI: 10.5005/jp-journals-10071-24546  |  Open Access |  How to cite  | 


Background: Sepsis is one of the major causes of admission to the pediatric intensive care unit (PICU), as well as a primary cause of poor outcomes. Glycemic variation may occur because of sepsis resulting in either hypoglycemia or hyperglycemia. Measuring the random blood glucose (RBG) level of patients presenting with sepsis in PICU is an easy way to assess their prognosis. Objectives: A prospective study was done from February 2023 to June 2023 to evaluate the relation between the outcome of pediatric septic patients and blood glucose level upon PICU admission. Patients and methods: One hundred three children diagnosed with sepsis underwent clinical assessment upon admission to the PICU and initial labs including blood glucose levels were done. Pediatric Sequential Organ Failure Assessment (pSOFA) was calculated for every patient. The outcome of sepsis including length of stay, review of body systems, and mortality was documented. Results: Hypoglycemic patients had the highest percentage of non-survivors (20.4%). They had a higher pSOFA score with a median of 11 (interquartile range—IQR 7–15), shorter PICU stay with a median of 2 (IQR 1–6) days, lower RBG with a median of 95 (45–120), a higher percentage of ventilation (55.1%), and a higher percentage of inotropic support (87.8%) with statistical significance with p-value (< 0.001, < 0.001, 0.001, < 0.001, 0.002), respectively. Conclusion: Critically ill patients with abnormal random blood sugar (RBS) had a higher possibility of non-survival particularly those with hypoglycemia. Accordingly, RBS measurement is a rapid and cheap method that could be used in any emergency and as an early indicator to detect outcome.



Harsh Sheth, Shilpa Rao, V Karthik

Clinical and Health Economic Evaluation of a Novel Device for Fecal Management in Bedridden Patients

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:7] [Pages No:759 - 765]

Keywords: Balloon catheter, Critical care, Dermatitis, Diarrhea, Fecal incontinence, Fecal management, FMS, Hospital-acquired pressure injury (HAPI), Incontinence-associated dermatitis, Pressure ulcer

   DOI: 10.5005/jp-journals-10071-24544  |  Open Access |  How to cite  | 


Purpose: To evaluate the clinical effectiveness and health economic benefits of a novel indwelling lattice-based device for fecal management in bedridden patients. Materials and methods: This nonrandomized, two-arm study included 70 bedridden patients (≥18 years exhibiting liquid stool) referred from the ICU of surgery and medicine units of a 2000-bed tertiary care referral hospital, assigned to the intervention and control groups. About 35 patients were eligible to be included in the intervention group while 35 patients with contraindications to the intervention device were included in the usual care control group. Assessments were made before and every 24 hours during the study, and all patients were closely monitored for development of incontinence-associated dermatitis (IAD) and hospital-acquired pressure injury. Results: The test device was successfully deployed on the first attempt and effectively diverted fecal matter in all 35 patients, with no adverse events. In the control group, 83% of the patients developed IAD, which resulted in prolonged hospitalization and increased expenses. Overall, the control group (with adult diapers) required greater time, resources, and efforts for fecal management and resulted in increased patient morbidity. Conclusion: The patient management time, resource consumption, overall cost of hospital admission, and the complication rates are significantly lower with the use of the novel lattice-based device than with the use of adult diapers for fecal management.



Karthik Kumar Balasubramanian, Priyavarthini Venkatachalapathy, Saravanan Margabandhu, Rajeshwari Natraj, Vasanth Kumar Sridaran, Chidhambharam Lakshmanan

Scope, Safety, and Feasibility of Therapeutic Plasma Exchange in Pediatric Intensive Care Unit: A Single-center Experience

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:5] [Pages No:766 - 770]

Keywords: Acute liver failure, American society for apheresis, Paediatric Intensive care, Plasmapheresis, Therapeutic plasma exchange, Thrombotic microangiopathy

   DOI: 10.5005/jp-journals-10071-24541  |  Open Access |  How to cite  | 


Background: Indications for therapeutic plasma exchange (TPE) in the pediatric intensive care unit (PICU) are expanding. We aimed to study the demographics, clinical indications, and outcomes of patients who have undergone TPE in our PICU. Materials and methods: This is a retrospective study performed among children aged from 1 month to 16 years of age. Demographics, indications, therapeutic response, serious adverse events (SAE), PICU length of stay (LOS), and death during hospitalization were studied as outcome variables. Results: Therapeutic plasma exchange was performed in 115 sessions on 24 patients for 12 different indications falling under various American Society for Apheresis (ASFA) categories. Therapeutic plasma exchange was performed on ten, four, and ten children for ASFA category I, II, and III indications, respectively. The most common indications were thrombotic microangiopathy (TMA) (8/24) and acute liver failure (ALF) (6/24). During those 115 sessions, a total of five serious adverse events (SAEs) occurred, accounting for 4.3% of the cases. Minor adverse events occurred in 12 sessions (10.4%). Therapeutic response was good in 17 patients (71%) including 5 patients who underwent standard volume TPE (SV-TPE) for ALF. Median PICU LOS was 9 (range 2–120) days. The mortality rate was 12.5% (3/24). Conclusion: Therapeutic plasma exchange is effective in various clinical conditions involving various organ systems. It is an excellent therapeutic modality in children with ALF, irrespective of the exchange volume and TMA. However, SAEs do occur in the minority.



Vinod Govindasaami, Ajai Rajabalan

Communication Gap in ICU: SPIKES Can Be a Useful Tool!

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:1] [Pages No:771 - 771]

Keywords: Caregiving relatives, Critically ill patients, Intensive care unit.

   DOI: 10.5005/jp-journals-10071-24547  |  Open Access |  How to cite  | 



Shalini Nair

Author's Response to Letter to the Editor: Communication Gap in ICU—SPIKES can be a Useful Tool!

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:2] [Pages No:772 - 773]

Keywords: COVID-19, Communication, Critically ill patients.

   DOI: 10.5005/jp-journals-10071-24550  |  Open Access |  How to cite  | 



Bhavna Sriramka, Diptimayee Mallik, Sivani Nanda

Entangled Circuit during Transport of Patient

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:2] [Pages No:774 - 775]

Keywords: Bains circuit, Entangled, Patient transportation.

   DOI: 10.5005/jp-journals-10071-24531  |  Open Access |  How to cite  | 


Retraction Notice

Vikram Singh Chouhan

Job Satisfaction and Occupational Burnout among Healthcare Professionals during the COVID-19 Pandemic: A Mixed-method Approach

[Year:2023] [Month:October] [Volume:27] [Number:10] [Pages:2] [Pages No:776 - 777]

Keywords: COVID-19, Healthcare professionals, Job satisfaction, Occupational burnout

   DOI: 10.5005/jp-journals-10071-24507  |  Open Access |  How to cite  | 


This article has been retracted at the request of the author The reason is that author wants this to be full-length research paper.

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