Indian Journal of Critical Care Medicine

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2024 | March | Volume 28 | Issue 3

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EDITORIAL

Ram E Rajagopalan, Farhad Kapadia

The ISCCM/IAPC Position Statement: Ending the Sisyphean Struggle to Practice Ethical End-of-life Care in India

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:2] [Pages No:189 - 190]

Keywords: End-of-life care, Guidelines, Legal considerations

   DOI: 10.5005/jp-journals-10071-24660  |  Open Access |  How to cite  | 

308

EDITORIAL

Rajavardhan Rangappa

A Game Changer for ARDS? Unraveling the Potential of the SF Ratio

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:2] [Pages No:191 - 192]

Keywords: Acute respiratory distress syndrome, Kigali modification, PF ratio, SF ratio

   DOI: 10.5005/jp-journals-10071-24678  |  Open Access |  How to cite  | 

421

EDITORIAL

Mathangi Krishnakumar

Unveiling the Complexity of Traumatic Brain Injury: Insights from Clinical Scoring Systems

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:3] [Pages No:193 - 195]

Keywords: Clinical outcome, Clinical score, Full outline of unresponsiveness, Glasgow coma scale, Traumatic brain injury

   DOI: 10.5005/jp-journals-10071-24666  |  Open Access |  How to cite  | 

244

EDITORIAL

Anant Vikram Pachisia, Deepak Govil

Pregnancy and SARS-COV2 Infection

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:2] [Pages No:196 - 197]

Keywords: Coronavirus disease pneumonia, Intensive care unit, Pregnancy

   DOI: 10.5005/jp-journals-10071-24672  |  Open Access |  How to cite  | 

219

EDITORIAL

Manoj K Singh

Hail the HACOR as a Customized Indian Weaning Score!

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:2] [Pages No:198 - 199]

Keywords: Extubation prediction score, HACOR score, Weaning, WEANSNOW score

   DOI: 10.5005/jp-journals-10071-24675  |  Open Access |  How to cite  | 

309

POSITION STATEMENT

Raj K Mani, Sushma Bhatnagar, Savita Butola, Roop Gursahani, Dhvani Mehta, Srinagesh Simha, Jigeeshu V Divatia, Arun Kumar, Shiva K Iyer, Jayita Deodhar, Rajani S Bhat, Naveen Salins, Raghu S Thota, Roli Mathur, Rajam K Iyer, Sudeep Gupta, Priyadarshini Kulkarni, Sangeetha Murugan, Prashant Nasa, Sheila N Myatra

Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:51] [Pages No:200 - 250]

Keywords: Compassionate care in the intensive care unit, End-of-life care, End-of-life care communication, End-of-life decision making, End-of-life care foregoing of life support, withdrawal and withholding ethics, Legal issues in end-of-life care, Palliative care, Terminal care

   DOI: 10.5005/jp-journals-10071-24661  |  Open Access |  How to cite  | 

Abstract

End-of-life care (EOLC) exemplifies the joint mission of intensive and palliative care (PC) in their human-centeredness. The explosion of technological advances in medicine must be balanced with the culture of holistic care. Inevitably, it brings together the science and the art of medicine in their full expression. High-quality EOLC in the ICU is grounded in evidence, ethical principles, and professionalism within the framework of the Law. Expert professional statements over the last two decades in India were developed while the law was evolving. Recent landmark Supreme Court judgments have necessitated a review of the clinical pathway for EOLC outlined in the previous statements. Much empirical and interventional evidence has accumulated since the position statement in 2014. This iteration of the joint Indian Society of Critical Care Medicine–Indian Association of Palliative Care (ISCCM–IAPC) Position Statement for EOLC combines contemporary evidence, ethics, and law for decision support by the bedside in Indian ICUs.

629

Original Article

T Rakesh Alur, Shivakumar S Iyer, Jignesh N Shah, Sampada Kulkarni, Prashant Jedge, Vishwanath Patil

A Prospective Observational Study Comparing Oxygen Saturation/Fraction of Inspired Oxygen Ratio with Partial Pressure of Oxygen in Arterial Blood/Fraction of Inspired Oxygen Ratio among Critically Ill Patients Requiring Different Modes of Oxygen Supplementation in Intensive Care Unit

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:5] [Pages No:251 - 255]

Keywords: Acute hypoxemic respiratory failure, Berlin criteria, Kigali modification, Oxygen saturation/fraction of inspired oxygen ratio

   DOI: 10.5005/jp-journals-10071-24652  |  Open Access |  How to cite  | 

Abstract

Background: Intensive care unit (ICU) patients face a significant rise in mortality rates due to acute hypoxemic respiratory failure (AHRF). The diagnosis of AHRF is based on the PF ratio, but it has limitations in resource-constrained settings. Instead, the Kigali modification suggests using the oxygen saturation/fraction of inspired oxygen (SF) ratio. This study aims to correlate SF ratio and arterial oxygen pressure (PF) ratio in critically ill adults with hypoxemic respiratory failure, who required O2 therapy through different modes of oxygen supplementation. Materials and methods: In an ICU, a prospective observational study included 125 adult AHRF patients receiving oxygen therapy, with data collected on FiO2, PaO2, and SpO2. The SF ratio and PF ratio were calculated, and their correlation was assessed using statistical analysis. The receiver operator characteristics (ROC) curve analysis was conducted to assess the diagnostic precision of the SF ratio in identifying AHRF. Results: Data from a total of 250 samples were collected. The study showed a positive correlation (r = 0.622) between the SF ratio and the PF ratio. The SF threshold values of 252 and 321 were established for PF values of 200 and 300, respectively, featuring a sensitivity of 69% and specificity of 95%. Furthermore, it is worth noting that the PF ratio and SF ratio are interchangeable, regardless of the type of oxygen therapy, as the median values of both the PF ratio and SF ratio displayed statistical significance (p < 0.01) in both acidosis and alkalosis conditions. Conclusion: For patients with AHRF, the noninvasive SF ratio can effectively serve as a substitute for the invasive PF ratio across all oxygen supplementation modes.

330

Original Article

Abraham L Chawnchhim, Charu Mahajan, Indu Kapoor, Tej P Sinha, Hemanshu Prabhakar, Arvind Chaturvedi

Comparison of Glasgow Coma Scale Full Outline of UnResponsiveness and Glasgow Coma Scale: Pupils Score for Predicting Outcome in Patients with Traumatic Brain Injury

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:9] [Pages No:256 - 264]

Keywords: Extended Glasgow outcome score, Full outline of UnResponsiveness score, Glasgow coma scale – Pupils score, Glasgow coma score, Traumatic brain injury

   DOI: 10.5005/jp-journals-10071-24651  |  Open Access |  How to cite  | 

Abstract

Background: Glasgow coma scale (GCS) score is the most widely used clinical score for the initial assessment of neurologically injured patients and is also frequently used for prognostication. Other scores such as the Full Outline of UnResponsivness (FOUR) score and the Glasgow Coma Scale-Pupils (GCS-P) score have been more recently developed and are gaining popularity. This prospective cohort study was conducted to compare various scores in terms of their ability to predict outcomes at 3 months in patients with traumatic brain injury (TBI). Materials and methods: The study was carried out between October 2020 and March 2022. Patients who presented to the hospital with TBI were assessed for inclusion. Initial coma scores were assessed in the emergency department and again after 48 hours of admission. Outcome was assessed using the extended Glasgow outcome score (GOSE) at 3 months after injury. The receiver operating curve (ROC) was plotted to correlate coma scores with the outcome, and the area under the curve (AUC) was compared. Results: A total of 355 patients with TBI were assessed for eligibility, of which 204 patients were included in the study. The AUC values to predict poor outcomes for initial GCS, FOUR, and GCS-P scores were 0.75 each. The AUC values for 48-hour coma scores were 0.88, 0.87, and 0.88, respectively. Conclusion: The GCS, FOUR, and GCS-P scores were found to be comparable in predicting the functional outcome at 3 months as assessed by GOSE. However, coma scores assessed at 48 hours were better predictors of poor outcomes at 3 months than coma scores recorded initially at the time of hospital admission.

294

Original Article

Sharmili Sinha, Gunchan Paul, Bhagyesh A Shah, Tejas Karmata, Naveen Paliwal, Jayesh Dobariya, Srikant Behera, Aarti Mona, Vipul P Thakkar, Gunadhar Padhi, Pooja Bihani, Saurabh Karmakar, Jay Prakash, Mayurdhwaja Rath, Anand Mishra, Vinay Singhal, Alpesh Ruparelia, Alisha Chaudhury, Alaukik Goyal

Retrospective Analysis of Clinical Characteristics and Outcomes of Pregnant Women with SARS-CoV-2 Infections Admitted to Intensive Care Units in India (Preg-CoV): A Multicenter Study

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:8] [Pages No:265 - 272]

Keywords: Coronavirus disease-2019, Intensive care unit, Maternal mortality, Obstetric critical care, Pregnant women

   DOI: 10.5005/jp-journals-10071-24656  |  Open Access |  How to cite  | 

Abstract

Aim: The aim was to examine the outcomes of pregnant women admitted to intensive care unit with coronavirus disease-2019 (COVID-19) infection during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic in India. The primary outcome of the study was maternal mortality at day 30. The secondary outcomes were the intensive care unit (ICU) and hospital length of stay, fetal mortality and preterm delivery. Materials and methods: This was a retrospective multicentric cohort study. Ethical clearance was obtained. All pregnant women of the 15–45-year age admitted to ICUs with SARS-CoV-2 infection during 1st March 2020 to 31st October, 2021 were included. Results: Data were collected from nine centers and for 211 obstetric patients admitted to the ICU with a confirmed diagnosis of COVID-19. They were divided in to two groups as per their SpO2 (saturation of peripheral oxygen) level at admission on room air, that is, normal SpO2 group (SpO2 > 90%) and low SpO2 group (SpO2 < 90%). The mean age was (30.06 ± 4.25) years and the gestational age was 36 ± 8 weeks. The maternal mortality rate was10.53%. The rate of fetal death and preterm delivery was 7.17 and 28.22%, respectively. The average ICU and hospital length of stay (LOS) were 6.35 ± 8.56 and 6.78 ± 6.04 days, respectively. The maternal mortality (6.21 vs 43.48%, p < 0.001), preterm delivery (26.55 vs 52.17%, p = 0.011) and fetal death (5.08 vs 26.09%, p = 0.003) were significantly higher in the low SpO2 group. Conclusion: The overall maternal mortality among critically ill pregnant women affected with COVID-19 infection was 10.53%. The rate of preterm birth and fetal death were 28.22 and 7.17%, respectively. These adverse maternal and fetal outcomes were significantly higher in those admitted with low SpO2 (<90%) at admission compared with those with normal SpO2.

301

Original Article

Gautham Nayak, Souvik Chaudhuri, Sunil Ravindranath, Pratibha Todur

Comparison of the Recent ExPreS Score, WEANSNOW Score, and the Parsimonious HACOR Score as the Best Predictor of Weaning: An Externally Validated Prospective Observational Study

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:7] [Pages No:273 - 279]

Keywords: ExPreS score, HACOR score, Predictors, Weaning, WEANSNOW score

   DOI: 10.5005/jp-journals-10071-24663  |  Open Access |  How to cite  | 

Abstract

Background: Since weaning failure is multifactorial, comprehensive weaning scores encompassing not only the respiratory component but also nonrespiratory aspects are quintessential for successful weaning prediction. Materials and methods: This was a single-center prospective observational study on 128 intensive care unit (ICU) patients undergoing spontaneous breathing trials (SBT). The extubation prediction score (ExPreS), heart rate, acidosis, consciousness, oxygenation, respiratory rate (HACOR), and weaning parameters, endotracheal tube size, arterial blood gas analysis, nutrition, secretions, neuromuscular affecting agents, obstructive airway problems and wakefulness (WEANSNOW) scores were compared for their diagnostic accuracy for successful weaning prediction. Results: Out of 128 patients, 49 (38.3%) patients had weaning failure, and 79 (61.7%) had weaning success. The patients in the weaning failure group had significantly higher APACHE II scores, WEANSNOW scores, HACOR scores, MV days, and significantly lower ExPreS scores as compared to the successful weaning group. Multivariable regression analysis showed that ExPreS score p = 0.015, adjusted OR 0.960, 95% CI (0.929–0.992) and HACOR score p < 0.001, adjusted OR 1.357, 95% CI (1.176–1.567) were independent predictors of weaning failure. The HACOR score had an AUC of 0.830, cut-off ≥5, p < 0.001, sensitivity 76%, specificity 68%, diagnostic accuracy 70% to predict weaning failure. The ExPreS score had an AUC of 0.735, cut-off ≥69, p < 0.001, sensitivity of 70.9%, specificity of 69.4%, and diagnostic accuracy of 70.3% to predict weaning success. Both the HACOR and ExPreS scores were good models for predicting weaning outcomes (model quality 0.76 and 0.64 respectively). Conclusion: The parsimonious HACOR score is comparable to the ExPreS score for the prediction of weaning outcomes in critically ill patients.

335

Original Article

Snehal S Mavkar, Manish P Shukla

Effect of Buteyko Breathing Technique as an Adjunct to Routine Physiotherapy on Pulmonary Functions in Patients Undergoing Off-pump Coronary Artery Bypass Surgery: A Randomized Controlled Trial

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:6] [Pages No:280 - 285]

Keywords: Buteyko breathing technique, Cardiac rehabilitation, Coronary artery bypass graft, Off-pump CABG, Pulmonary functions

   DOI: 10.5005/jp-journals-10071-24655  |  Open Access |  How to cite  | 

Abstract

Background: Coronary artery disease (CAD) poses a substantial and increasing public health concern in India, particularly among individuals aged 20 and above. The postoperative phase following coronary artery bypass graft (CABG) surgery presents potential complications, notably impacting the pulmonary system. Emerging evidence suggests that the Buteyko breathing technique not only improves lung function but also positively influences the psychological well-being of CABG patients. This study seeks to assess the impact of the Buteyko breathing technique on pulmonary functions in individuals who have undergone off-pump CABG. Materials and methods: In this randomized controlled trial, patients undergoing off-pump CABG were allocated to either the Buteyko breathing technique group (n = 35) or the control group (n = 35). The intervention group received supervised Buteyko breathing technique sessions twice daily for 15 minutes, concurrently with cardiac rehabilitation from postoperative day (POD-2 to POD-7). The control group underwent phase I cardiac rehabilitation. Outcome measures, including pulmonary function test (PFT), chest expansion, and breath-holding tests were evaluated at baseline (POD-2) and conclusion (POD-7). Results: Statistical analyses were conducted with a significance level set at p < 0.05. Both the control and intervention groups exhibited statistically significant improvements in pulmonary function, chest expansion at three levels, and breath-holding time (p = 0.0001). However, the Buteyko breathing group demonstrated a more significant improvement compared with the control group. Conclusion: The integration of the Buteyko breathing technique into conventional physiotherapy proves to be a beneficial strategy, leading to improvements in pulmonary function, breath-holding duration, and chest expansion for individuals who underwent off-pump CABG surgery. CTRI Number: CTRI/2022/12/048295.

373

Original Article

Dnyaneshwar Diwane, Prasad A Rajhans, Sameer A Jog, Mousami Dalvi

Study of Colistin Resistant Gram Negative Organism in Hospitalized Patients: A Retrospective Study

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:4] [Pages No:286 - 289]

Keywords: Colistin-resistant infections, Extensive drug resistance, Intensive care units

   DOI: 10.5005/jp-journals-10071-24658  |  Open Access |  How to cite  | 

Abstract

Background: Intensive care units have become hotspots for antimicrobial resistance, particularly concerning colistin resistance, posing a threat of untreatable infections. Aim: This study aims to analyze the epidemiological and clinical aspects of patients carrying colistin-resistant organisms. It focuses on identifying risk factors, the microbiological profile, susceptibility patterns, and treatment outcomes. Materials and methods: Isolates with colistin MIC >2 µg/mL, identified via BD PHOENIX, were subjected to colistin broth disc elution testing (as per CLSI guidelines) in our Microbiology Department between January and December 2022. Results: Among the 30 patients, colistin-resistant gram-negative isolates were found predominantly in blood cultures (50%), followed by ET/TT cultures (23.3%), urine cultures (10%), and other sites (16.7%). Klebsiella pneumoniae was the most common organism (80%), showing the highest sensitivity to Ceftazidime-avibactam + Aztreonam (CAZ-AVI + ATM) (76.7%). Of these patients, 66.7% recovered and were discharged, while 33.3% succumbed during hospitalization despite treatment. Conclusion: The study underscores a notable presence of colistin-resistant gram-negative isolates, predominantly in blood cultures, with K. pneumoniae being predominant. The combination of CAZ-AVI + ATM exhibited the highest sensitivity. However, the mortality rate of 33.3% despite sensitive antibiotic treatment highlights the urgency for ongoing vigilance and research to combat colistin-resistant infections and improve patient outcomes.

339

Original Article

TV Sreevalsan, Rohitha Chandra

Relevance of Polymerase Chain Reaction in Early Diagnosis of Leptospirosis

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:4] [Pages No:290 - 293]

Keywords: Intensive care unit patients, Immunoglobulin M, Leptospirosis, Polymerase chain reaction, Serology

   DOI: 10.5005/jp-journals-10071-24649  |  Open Access |  How to cite  | 

Abstract

Aim and background: Leptospirosis is common in India, especially in the southern states. Mortality is high among untreated cases. Diagnosis of leptospirosis remains a challenge in India as polymerase chain reaction (PCR), which is more sensitive than Immunoglobulin M (IgM) is not widely available. This study aimed to find out the difference in diagnostic yield with PCR and IgM in early leptospirosis. Materials and methods: This retrospective, single-center study included 67 adults with laboratory-confirmed leptospirosis (IgM, PCR, or both) who presented within 7 days of symptom onset and were admitted to the intensive care unit (ICU). The difference in the diagnostic yield with PCR and IgM ELISA was studied. Results: About 77.6% of the patients tested positive by PCR and 55.2% tested positive by IgM. There was a statistically significant difference in the detection of leptospirosis by PCR and IgM (p-value = 0.036). In the subgroup of patients who presented within 3 days of onset of symptoms, PCR positivity was 90.32% whereas IgM positivity was only 25.8%. Conclusion: Our study showed that the sensitivity of leptospira PCR is significantly higher than IgM in the first week of illness. It also showed that among the subset of patients who died, a majority were detected only by PCR. Since PCR is not widely available, leptospirosis remains underdiagnosed and mortality from the same is underestimated. Polymerase chain reaction, if routinely done along with IgM for all suspected cases of leptospirosis that present within the first week of illness helps in prompt diagnosis and treatment.

214

Original Article

Susri Mishra, Nikhil Kothari, Ankur Sharma, Shilpa Goyal, Darshna Rathod, Tanvi Meshram, Pradeep Bhatia

Comparison of Oxygen Delivery Devices in Postoperative Patients with Hypoxemia: An Open-labeled Randomized Controlled Study

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:5] [Pages No:294 - 298]

Keywords: Hypoxemia, Oxygenation, Oxygen delivery device, P/F ratio

   DOI: 10.5005/jp-journals-10071-24659  |  Open Access |  How to cite  | 

Abstract

Background: Acute hypoxemic respiratory failure is among the more commonly occurring complications in postoperative patients. Supplemental oxygen and addressing the primary etiology form the basis of its treatment. Materials and methods: We conducted an open-labeled randomized control trial with 90 adult patients and compared three oxygen delivery vehicles (ODV), i.e., noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), and venturi mask (VM) in postoperative hypoxemic patients. The primary outcome variable was a change in the P/F ratio after 2 hours of use of ODV. Results: It was observed that the change in P/F ratio after 2 hours was similar in all three ODV groups (p = 0.274). The mean values of the post-ODV P/F ratio were comparable with the pre-ODV P/F ratio in all three modalities. The P/F ratio after HFNC was 358.08 ± 117.95; after NIV was 357.60 ± 220.67; and after VM was 355.47 ± 101.90 (p = 0.997). Conclusion: Among HFNC, NIV, and VM, none of the devices proved superior to the other for use in postoperative hypoxemia.

427

Original Article

Rahul Chouhan, Tej P Sinha, Sanjeev Bhoi, Atin Kumar, Deepak Agrawal, Jamshed Nayer, Ravindra M Pandey, Praveen Aggarwal, Meera Ekka, Prakash R Mishra, Akshay Kumar, Divya C Chouhan

Correlation between Transcranial Ultrasound and CT Head to Detect Clinically Significant Conditions in Post-craniectomy Patients Performed by Emergency Physician: A Pilot Study

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:8] [Pages No:299 - 306]

Keywords: Decompressive craniectomy, Point of care ultrasound, Transcranial ultrasound

   DOI: 10.5005/jp-journals-10071-24662  |  Open Access |  How to cite  | 

Abstract

Background: The main objective is to detect clinically significant conditions by transcranial ultrasound (TCS) in post-decompressive craniectomy (DC) patients who come to the emergency department. Materials and methods: This was a cross-sectional observational study. We studied 40 post-DC patients. After primary stabilization, TCS was done. Computer tomography of head was done within 2 hours of performing TCS. The correlation between both modalities were assessed by the measurement of lateral ventricle (LV) (Bland-Altman plot), Midline shift and mass lesion. Additionally, normal cerebral anatomy, 3rd and 4th ventricles and external ventricular drainage (EVD) catheter visualization were also done. Results: About 14/40 patients came with non-neurosurgical complaints and 26/40 patients came with neurosurgical complaints. Patients with non-neurosurgical complaints (4/14) had mass lesions and 1/14 had MLS. Patients with neurosurgical complaints (11/26) had mass lesions and about 5 patients had MLS. A good correlation was found between TCS and CT of head in measuring LV right (CT head = 17.4 ± 13.8 mm and TCS = 17.1 ± 14.8 mm. The mean difference (95% CI) = [0.28 (–1.9 to 1.33), ICC 0.93 (0.88–0.96)], Left [CT head = 17.8 ± 14.4 mm and TCS = 17.1 ± 14.2 mm, the mean difference (95% CI) 0.63 (–1.8 to 0.61), ICC 0.96 (0.93–0.98)], MLS [CT head = 6.16 ± 3.59 (n = 7) and TCS = 7.883 ± 4.17 (n = 6)] and mass lesions (kappa 0.84 [0.72–0.89] [95% CI] p-value < 0.001). The agreement between both modalities for detecting mass lesions is 93.75%. Conclusion: Point of care ultrasound (POCUS) is a bedside, easily operable, non-radiation hazard and dynamic imaging tool that can be used for TCS as a supplement to CT head in post-DC patients in emergency as well as in ICU. However, assessment of the ventricular system (pre/post-EVD insertion), monitoring of regression/progression of mass lesion, etc. can be done with TCS. Repeated scans are possible in less time which can decrease the frequency of CT head.

Supplementary file

300

LETTER TO THE EDITOR

H Haroon, Sadananda B Naik

Fishermen and the Risk of Toxic Fumes from the Fish Storage Tanks

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:2] [Pages No:307 - 308]

Keywords: Fishermen, Hydrogen sulfide, Methane, Storage tanks, Toxic fumes

   DOI: 10.5005/jp-journals-10071-24638  |  Open Access |  How to cite  | 

214

LETTER TO THE EDITOR

V Shrinath, Vikas Marwah, MC Jyothis

Analgo-sedation in Patients on Non-invasive Mechanical Ventilation: Need for Guideline Recommendation

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:2] [Pages No:309 - 310]

Keywords: Analgesia, ICU sedation, Noninvasive mechanical ventilation

   DOI: 10.5005/jp-journals-10071-24642  |  Open Access |  How to cite  | 

231

LETTER TO THE EDITOR

Varun M Angadi, Atul Jindal

To C or not to C? Designing a Pragmatic Trial to Deploy a Novel Immunomodulatory Therapy to Fight Organ Dysfunction in Sepsis

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:1] [Pages No:311 - 311]

Keywords: Immunomodulation, Organ dysfunction, Sepsis, Vitamin C

   DOI: 10.5005/jp-journals-10071-24636  |  Open Access |  How to cite  | 

208

LETTER TO THE EDITOR

Bharath Kumar Tirupakuzhi Vijayaraghavan, Ramesh Venkataraman, Nagarajan Ramakrishnan

Author Response

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:1] [Pages No:312 - 312]

Keywords: Randomized controlled trial, Sepsis, Vitamin C

   DOI: 10.5005/jp-journals-10071-24654  |  Open Access |  How to cite  | 

221

Erratum

Ritu Singh, Suruchi Ambasta, Prateek S Bais, Afzal Azim, Sanjeev Kumar, Bhawesh Upreti, Siddharth Singh, Prabhakar Mishra

Role of Gabapentin in Traumatic Brain Injury: A Prospective Comparative Study

[Year:2024] [Month:March] [Volume:28] [Number:3] [Pages:1] [Pages No:313 - 313]

   DOI: 10.5005/jp-journals-10071-24679  |  Open Access |  How to cite  | 

229

journal videos

By fanning the probe from cranial to caudal, the whole brain was scanned

Correlation between Transcranial Ultrasound and CT Head to Detect Clinically Significant Conditions in Post-craniectomy Patients Performed by Emergency Physician: A Pilot Study

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The whole brain was scanned by fanning the probe from anterior to posterior

Correlation between Transcranial Ultrasound and CT Head to Detect Clinically Significant Conditions in Post-craniectomy Patients Performed by Emergency Physician: A Pilot Study

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