Adequately powered randomized controlled trials (RCTs) are considered the highest level of evidence in guiding clinical practice. Reports using Bayesian hypothesis-testing to reanalyze RCTs are increasing. One distinct advantage of Bayesian analysis is that we can obtain a range of numerical probabilities that reflect how likely a study intervention is more effective than the alternative after considering both pre-existing available evidence and the alternate hypotheses. A recent analysis of critical care trials showed that some trials with an indeterminate result according to the frequentist analysis could have a high probability of being effective when reinterpreted by Bayesian analysis. In this perspective article, we will discuss the caveats in interpreting the results of Bayesian reanalysis of RCTs before we change clinical practice. When overoptimistic hypothesis prior probabilities are used, it carries a risk to translate noises into false signals. Using Bayes factors (BFs) to quantify evidence contained in data (by the ratio of the probability of data under each hypothesis) is thus more preferable than using a single prior probability, such that the BF approach becomes the mainstream in Bayesian hypothesis-testing. Still, BFs are dependent on the prior parameter distributions; comparing different hypotheses would invariably result in different results.

Background: To estimate a correlation between change in lung ultrasound aeration score (LUSS) and mortality in patients with ventilator-associated pneumonia. Materials and methods: We conducted a prospective observational study in which lung ultrasound, the partial pressure of arterial oxygen to fraction of inspired oxygen ratio (PaO₂/FiO₂ ratio), and static lung compliance were performed for five consecutive days since the diagnosis of ventilator-associated pneumonia (day 1–5) in a 20-bed multidisciplinary intensive care unit in at a tertiary care academic institute in Northern India. A hundred and seventeen ventilated patients were studied for the first 5 days after ventilator-associated pneumonia (VAP) development. Lung ultrasounds were performed with an ultrasonography machine using a round-tipped probe of 2–5 MHz at six different areas of each hemithorax, which includes superior and inferior in anterior, lateral, and posterior lung fields. Patients with a decreased LUSS of 2 were labeled as responders. A decrease of LUSS of less than 2 or an increase of LUSS were leveled as nonresponders. Results: The correlation between the change in LUSS between days 1 and 5 was significant with 28-day mortality (26.3% in responders vs 87.8% nonresponses with p < 0.001) Conclusion: The responders to treatment for VAP described by LUSS had lower mortality than non-responders.

Aim and Background: A combination of terlipressin and albumin is the standard of care for patients with hepatorenal syndrome-acute kidney injury (HRS-AKI). The study aimed to compare the venous congestion using lung ultrasound score (LUS) and radiographic assessment of lung edema (RALE) scores among terlipressin responders and nonresponders and survivors and non-survivors. Materials and methods: In this single-center, prospective, observational study, we included adult patients with HRS-AKI who had received terlipressin and albumin from 28th April 2022 to 16th October 2022. Results: Of the 102 patients included, 74.5% (95%CI: 58.7–93.2) responded to terlipressin. The median dose of terlipressin and albumin was 2 (1–8) mg/day and 100 (40–200) g for a duration of 5 (2–10) days. On Kaplan–Meier analysis, survival was 26.9% of patients in the nonresponder group compared to 61.4% in the responder group (p = 0.001). Day 3 LUS score worsened in 76.9% of patients in nonresponders group compared to 52.6% in responder group (p = 0.03). There was a significant increase in RALE score in those who died [6 (–6–48) vs alive: 0 (–4– 30); p < 0.001]. Lung ultrasound score had improved or been maintained in 63.6% of patients who were alive, compared to 14.9% in those who had died (p < 0.001). On multivariable Cox regression analysis, age [HR, 1.02 (1.002–1.05)], terlipressin non-response [HR, 2.8 (1.47–5.34)], APACHE score [HR, 1.07 (1.03–1.12)], duration of terlipressin therapy [HR, 0.37 (0.27–0.5)] and worsening of LUS [HR, 2.9 (1.81–7)] predicted mortality. Conclusion: Lung ultrasound score and chest X-ray can accurately identify venous congestion in the lungs, which is common in patients with advanced liver disease who receive terlipressin and albumin in the intensive care unit (ICU).

Aim: Disasters worldwide are increasing, impacting millions annually. In Saudi Arabia, disaster planning is crucial for emergency department (ED) staff, who must be trained in disaster management plans and operational strategies to handle disasters such as epidemics and Hajj overcrowding. Methodology: A cross-sectional study targeting ED staff in 92 hospitals all over Saudi Arabia. Using a self-administered survey, we surveyed ED staff, including providers (physicians and nurses). The purpose of the study is to determine the knowledge, attitudes, and practices of ED staff regarding disaster preparedness in Saudi Arabia. Results: A survey comprised 410 participants, 57% of whom were Saudi nationals. A significant correlation was shown between years in practice and some of the answers: 54% had less than 5 (53%) or 3 (43%) years of experience for every answer of ED staff. Conclusion: The study indicates that healthcare providers possess adequate knowledge concerning disaster preparedness. However, their attitudes, practices, and familiarity with the subject vary. Highlights: This study evaluates Saudi Arabian ED personnel's preparedness for disasters. The results show there is variation in knowledge, attitudes, and practices, which emphasizes the necessity of continuous education to improve preparedness for disasters. Future plans have to concentrate on boosting everyone's level of preparedness in the emergency services.

Introduction: Fluid administration is a commonly practiced intervention in the intensive care unit (ICU) with normal saline being the preferred fluid. We sought to understand the current practice of fluid administration and choice of fluids in Indian ICUs and its effect on renal outcomes. Materials and methods: The Indian Society of Critical Care Medicine (ISCCM)-endorsed multicenter prospective observational study was conducted on practice of fluid administration in critically ill patients between May 1, 2020, and January 31, 2023. SPSS software was used for statistical analysis. Results: Private sector hospitals contributed 79.16% of data out of 144 ICUs. Around 961 patients belonged to the normal saline (NS) group, 672 to the Ringer's lactate (RL) group, and 891 to the balanced salt solution (BSS) group out of 2,452 patients. Patients with chronic obstructive pulmonary disease were more in the BSS and NS group as compared to RL group (p < 0.00001). Acute kidney injury (AKI) incidence was higher in the NS group, followed by RL and BSS (p < 0.0001). The serum creatinine rise was higher in the NS group on the first 2 days (p < 0.001). Daily fluid balance, urine output, and renal replacement therapy (RRT) needs were similar among the groups. The BSS group had shorter ICU and hospital length of stay (LOS) than the NS group (p < 0.001). The ICU survival was 63.3% in the NS group and 79.44% in the BSS group (p < 0.001). The AKI patients had higher survival in the BSS group (78.81%) as compared to the NS group (63.08%) (p < 0.001). Conclusion: Balanced salt solution is the preferred intravenous fluid with a safe renal profile among critically ill patients. The AKI patients had shorter hospital and ICU LOS with BSS as compared to NS.

Background: Frailty poses unique challenges for patients undergoing major cancer surgeries due to their extreme vulnerability to physiological stressors and can be an important factor in determining postoperative outcomes. Aims and objective: The objective of the study was to determine the incidence of frailty in patients undergoing major abdominal cancer surgeries and identify the risk factors predicting poor outcomes. Materials and methods: This was a prospective observational study conducted following institutional ethics approval and CTRI registration. We included 308 adult patients who underwent major abdominal cancer surgeries over two years. The preoperative frailty score was calculated using the 11-point modified frailty index score (mFI scale). Patients with a mFI score ≥ 3 points were considered frail. Clinical outcomes such as postoperative complications (Clavien–Dindo grades III and IV), surgical site infections, need for vasopressors, mechanical ventilation, acute kidney injury (AKI), length of ICU and hospital stay, and mortality at 30 days were recorded. Results: The overall incidence of frailty according to the mFI scale was 8.1%. Age and higher American Society of Anesthesiology (ASA) status were significantly associated with frailty (OR –1.073, p < 0.001, and OR –10.220, p < 0.001) respectively. Frailty was an independent predictor of major postoperative complications (OR –8.147, 95%; CI –2.524–26.292, p < 0.001). Frailty was also significantly associated with an increased duration of mechanical ventilation and length of stay (p < 0.001). Conclusion: The modified frailty index (mFI) score remains a strong predictor of postoperative complications in patients undergoing major abdominal cancer surgeries and can help optimize risk factors to minimize complications.

Aims and background: Carbapenem-resistant Acinetobacter baumannii (CRAb), a major public health threat, causes severe infections in Intensive Care Unit (ICU) patients. It resists β-lactam antibiotics through mechanisms like New Delhi metallo-beta-lactamase (NDM). Materials and methods: In ICU patients, 69 Acinetobacter species were isolated from 86 non-fermenting Gram-negative bacilli. Isolates were identified using biochemical methods and Matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry (MS), and carbapenem resistance detection was done by both phenotypic (mCIM and eCIM) and molecular methods. Results: Out of 66 A. baumannii, 61 were carbapenem-resistant, with 20 confirmed as NDM producers. NDM-positive isolates exhibited higher resistance and were associated with significant mortality (75%). Conclusion: NDM-positive Acinetobacter isolates are significant ICU pathogens with poor outcomes. Key risk factors include prolonged ICU stays, prior antimicrobial use, and inadequate therapy. Early detection and infection control are crucial. Clinical significance: NDM-positive Acinetobacter infections in ICU patients are linked to poor outcomes, highlighting the need for early detection and control measures.

Aim and background: Tracheostomy is a commonly conducted surgical intervention in intensive care settings, and many complications result from tracheostomy. The use of an evidence-based methodology for tracheostomy care can effectively mitigate the occurrence of complications. This study aimed to assess tracheostomy complications among patients, determine nurses’ knowledge and practice of tracheostomy care, and evaluate the effectiveness of a tracheostomy care protocol (TCP) in terms of improving knowledge and practice of tracheostomy care and reducing complications among patients. Materials and methods: To conduct this study, a quasi-experimental research design was selected. Ninety-eight intensive care nurses were divided into two groups, with 49 nurses in each group. The experimental group received an intervention, and both groups underwent pre- and posttests using tools related to tracheostomy care knowledge and practice checklists. Complications among patients were observed using a tracheostomy complication checklist. Data analysis involved both descriptive and inferential statistics. Results: This study identified complications, including bleeding, tube obstruction, hypoxia, and local wound site infection, among tracheostomy patients. About 49% of the nurses in the experimental group and 34.7% in the control group had poor knowledge. There was a statistically significant difference in pre- and postintervention knowledge and practice scores between the groups (p < 0.001). Conclusion: This study revealed a gap in participants’ knowledge and practices regarding tracheostomy care. After the TCP was implemented, intensive care nurses improved their knowledge and practices. Postintervention, the number of complications and the length of hospital stay among patients were reduced.

Background: Out-of-hospital cardiac arrest (OHCA) is a significant global health challenge with high incidence and low survival rates; this study aimed to predict mortality in these patients. Methods: This 5-year retrospective chart review, conducted at the emergency departments (EDs) of two tertiary hospitals, systematically categorized, coded, and analyzed variables to assess mortality risk in OHCA patients. Results: Of the 822 (36.5%) patients who met the inclusion criteria, the mean age was 60.2 years (SD ± 17.6), with 65.7% being male. Cardiopulmonary resuscitation (CPR) was attempted on 586 patients, with 178 (30.4%) achieving return of spontaneous circulation (ROSC) in the ED. Significant risk factors for mortality included hypertension (p = 0.01), diabetes mellitus (p = 0.05), respiratory illnesses (p = 0.04), and having three or more comorbidities (p = 0.01). Manifestations in previous ED visits (<180 days), such as cardiac complaints (p = 0.05) and dyspnea due to fluid overload (p = 0.02), were significant. Among the cohort, 76.4% visited the ED (<180 days) and had a mortality rate of 95.7%, compared to 78.4% for those who did not visit. Asystole and pulseless electrical activity (PEA) were significant factors for the nonachievement of ROSC (p < 0.001 vs p = 0.032) and mortality (p < 0.001 vs p = 0.03). Overall, 49 patients (8.4%) survived to hospital discharge. Conclusion: Elderly males with hypertension, diabetes, respiratory ailments, and multiple comorbidities constituted a significant risk group. Factors such as prior episodes of chest pain and fluid overload were associated with higher mortality. Patients with asystole and PEA had low survival rates.

Objective: To study the efficacy of intravenous dexamethasone in preventing postextubation airway obstruction (PEAO). Design: A double-blinded randomized controlled trial. Study setting: The study was conducted in level 3 PICU at AIIMS, Raipur, India, from December 2019 to September 2022. Subjects: Children requiring intubation for at least 24 hours and not beyond 14 days were included. Children with upper airway anomalies or who received corticosteroids within the last 7 days were excluded. Intervention: The children who satisfied the inclusion criteria were randomized into dexamethasone or placebo group by stratified variable block randomization. Dexamethasone (0.5 mg/kg/dose) or placebo was given four doses (–12 hr., –6 hr., 0 hr., and 6 hr. of extubation). Outcome: The occurrence of any clinically significant stridor (Westley stridor score ≥3) was the primary outcome. Measurements and main results: Of the seventy (n = 70) children included in the study, 35 received dexamethasone while 35 received placebo. Westley stridor score ≥3 was present in 25.71% (n = 9) in dexamethasone group vs 31.42% (n = 11) in placebo (p = 0.792). Reintubation occurred in 14.28% (n = 10/70) patients, 11.42% (4/35) in dexamethasone group, and 17.14% (6/35) in placebo group (p = 0.734). Five children in the dexamethasone group and six in placebo group died (p = 1.00). There was no difference in the length of PICU stay (p = 0.84) and hospital stay (p = 0.75) among both the groups. Conclusion: Administration of multiple doses of dexamethasone may not help in the prevention of reintubation but may help in the reducing the incidence of clinically significant stridor.

Objectives: To examine the effect of hypocaloric/hyperproteic enteral feeding vs normocaloric feeding on the survival of critically ill patients in the acute phase in the intensive care unit (ICU). Methodology: Randomized clinical trials utilizing hypocaloric, hyperproteic, and normocaloric enteral feeding in the ICU were searched using the following terms ((((critically ill) OR (intensive care) OR (mechanically ventilated)) AND ((low-calorie enteral feeding) OR (high-protein enteral feeding)))) in MEDLINE, PubMed, Scopus, and Google Scholar by two independent authors. Results: There were no significant differences in hospital mortality [odds ratio (OR), 1.0; 95% confidence interval (CI), 0.77, 1.31; p = 0.99, I² = 0%], days on mechanical ventilation (MD, −0.05; 95% CI, −0.37, 0.28; p = 0.78, I² = 0%), the odds of acquiring infectious complications (OR, 0.90; 95% CI, 0.71, 1.14; p = 0.38, I² = 0%), and the length of ICU stay (MD, 0.60; 95% CI, −2.39, 3.59; p = 0.69, I² = 96%). The length of hospital stay was significantly lower by 4.18 days in the normocaloric group (MD, 4.18; 95% CI, 2.50, 5.85; p < 0.00001, I² = 0%). Conclusion: This meta-analysis showed no significant differences in mortality, infectious complications, days of mechanical ventilation, and ICU length of stay between groups. Findings on hospital length of stay were interpreted with caution due to the low quality of evidence and clinical heterogeneity.