Indian Journal of Critical Care Medicine

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2025 | February | Volume 29 | Issue 2

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EDITORIAL

Deepak Govil, Anant Vikram Pachisia

Blue Hopes, Red Flags: The Methylene Blue Dilemma in Sepsis Shock

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:3] [Pages No:95 - 97]

Keywords: Circulatory failure, Methylene blue, Septic shock, Vasoplegia, Vasopressin, Vasopressors

   DOI: 10.5005/jp-journals-10071-24912  |  Open Access |  How to cite  | 

316

EDITORIAL

Asif Ahmed, Anu Prasad, Sujeet Ashok Joshi

Intubation during Uninterrupted Chest Compressions: How Easy?

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:3] [Pages No:98 - 100]

Keywords: Direct laryngoscope, Endotracheal intubation, Manikin, Uninterrupted chest compressions, Videolaryngoscope

   DOI: 10.5005/jp-journals-10071-24915  |  Open Access |  How to cite  | 

175

EDITORIAL

Atul P Kulkarni

High-frequency Nasal Cannula Oxygenation in Thoracic Trauma: Unrealistic Expectations?

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:3] [Pages No:101 - 103]

Keywords: High-flow nasal cannula oxygen therapy, Need for intubation, Non-invasive ventilation, Thoracic trauma, Thoracic trauma severity score

   DOI: 10.5005/jp-journals-10071-24918  |  Open Access |  How to cite  | 

117

EDITORIAL

Mradul Kumar Daga, Naresh Kumar, Harpreet Singh

Biomarkers in Snakebite: Will This be a Reality in Near Future?

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:2] [Pages No:104 - 105]

Keywords: Antisnake venom, Phospholipase, Snakebite severity score

   DOI: 10.5005/jp-journals-10071-24917  |  Open Access |  How to cite  | 

179

EDITORIAL

Abdul Samad Ansari

Amlodipine Intoxication: Resin Revival or Fait Accompli

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:2] [Pages No:106 - 107]

Keywords: Calcium channel blocker overdose, Extracorporeal blood purification, Hemoadsorption, Hypotension, Toxicology

   DOI: 10.5005/jp-journals-10071-24920  |  Open Access |  How to cite  | 

135

Original Article

Harshavardhan R Kuri, Ankur Sharma, Tanvi Meshram, Nikhil Kothari, Shilpa Goyal, Bharat Paliwal, Sadik Mohammed, Pradeep Bhatia

Effects of Early Use of Methylene Blue and Vasopressin on Noradrenaline Dose in Septic Shock: A Randomized Controlled Trial

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:5] [Pages No:108 - 112]

Keywords: Hemodynamic stability, Methylene blue, Noradrenaline, Septic shock, Vasopressin

   DOI: 10.5005/jp-journals-10071-24905  |  Open Access |  How to cite  | 

Abstract

Background: This study aimed to assess the influence of early administration of methylene blue (MB) and vasopressin on the dose of noradrenaline required to manage septic shock. Materials and methods: This study was a parallel, randomized, controlled trial including 74 adult patients with septic shock admitted to the intensive care unit (ICU). Once the noradrenaline requirement exceeded 0.2 µg/kg/min, patients were randomly allotted to group M and group V. Group M received an intravenous 1 mg/kg bolus of MB over 30 minutes, then an infusion of 0.5 mg/kg over 6 hours. Group V received intravenous vasopressin at a rate of 0.04 units/min for 6 hours. The primary outcome of this research was the dose of noradrenaline required to reach the target mean arterial pressure (MAP) of ≥ 65 mm Hg at 6, 12, and 24 hours. Secondary outcomes included changes in lactate levels, urine output, and sequential organ failure assessment (SOFA) score. Results: The M group required a higher dose of noradrenaline compared with the V group to maintain MAP above the target level at 12 and 24 hours. There had been no significant variation in lactate levels along with SOFA scores between the two groups at earlier time points. However, at 24 hours, the M group had higher lactate levels and SOFA scores than the V group. The V group also showed improvements in urine output at 24 hours compared with the M group. Conclusion: Early administration of vasopressin compared with MB was associated with a reduced dose of noradrenaline required for maintaining target MAP in patients presenting with septic shock.

1,258

Original Article

Rajender Kumar, Rakesh Kumar, Naveen Kumar

Comparison of Macintosh Direct Laryngoscope with the C-MAC and Tuoren Videolaryngoscopes in Facilitating Endotracheal Intubation during Uninterrupted Manual Chest Compression: A Randomized Crossover Manikin Study

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:4] [Pages No:113 - 116]

Keywords: Airway management, Cardiac arrest, Direct laryngoscopy, Endotracheal intubation, Videolaryngoscope

   DOI: 10.5005/jp-journals-10071-24897  |  Open Access |  How to cite  | 

Abstract

Background: Videolaryngoscopes (VLS) frequently provide superior views of the glottis compared with traditional direct laryngoscopy (DL), especially during unexpected difficult airways. Chest compressions during attempts to intubate the trachea make it a difficult situation. Although VLS have been compared with DL for intubation during resuscitation, there is a paucity of literature comparing VLS with integrated screen and distant screen with DL during continued manual chest compressions. Materials and methods: This was a prospective, randomized, crossover observational manikin study. A total of 20 participants performed intubation, while manual chest compression was continuing, with each of the three devices on six occasions, but in different, randomized order. The primary outcome parameter was the total time taken for successful intubation. The secondary outcome criteria included the number of attempts, ease of intubation, and the device preference. Results: Time taken for successful intubation and ease of intubation were significantly better with C-MAC VLS and DL as compared with Tuoren VLS (C-MAC vs Tuoren p < 0.000 for both; DL vs Tuoren p < 0.001 for time and p = 0.021 for ease). There was no significant difference between C-MAC and DL (p = 1.0 for time and p = 0.69 for ease). There was no significant difference with regard to the number of attempts for successful intubation with any of these devices (p = 0.310). C-MAC was the most and Tuoren was the least preferred device. Conclusion: C-MAC VLS and Macintosh DL are significantly easier to use and require significantly less time to achieve successful intubation as compared with the Tuoren VLS during continued manual chest compression. Among the devices tested, C-MAC VLS was the most preferred for endotracheal intubation during uninterrupted manual chest compressions.

106

Original Article

Rania G Elsayed, Amr F Hafez, Mohammed M Maarouf, Farouk KE AbdElAziz

Impact of the Early Use of High-flow Nasal Cannula in Patients with Post-traumatic Lung Contusion: A Randomized Clinical Trial

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:8] [Pages No:117 - 124]

Keywords: Acute hypoxemic respiratory failure, Acute lung injury/acute respiratory distress syndrome, High-flow nasal cannula oxygen therapy, Unilateral pulmonary contusion, Venturi mask

   DOI: 10.5005/jp-journals-10071-24904  |  Open Access |  How to cite  | 

Abstract

Background: Patients with pulmonary contusion (PC) following blunt chest trauma are at risk of developing acute lung injury. High-flow nasal cannula (HFNC) is an established method for managing hypoxic respiratory failure (HRF). Aim: This study aims to evaluate the efficacy of oxygen therapy delivered through HFNC vs venturi mask (VM) in patients with hypoxia following traumatic lung contusion, to reduce the need for intubation and ventilation. Materials and methods: This is an open-label randomized controlled trial conducted on 120 patients with HRF following traumatic PC and a PaO2/FiO2 of 100–200 mm Hg. Patients were divided into two groups: Group A (60 patients) received oxygen therapy through HFNC, while group B (60 patients) received oxygen therapy through VM. Results: High-flow nasal cannula significantly improved pulmonary oxygenation as early as 1 hour after randomization and the after with statistically significant improvement of PaO2/FiO2 over time (p < 0.001). However, it was associated with a nonsignificant reduction in the rate of intubation and mechanical ventilation (p = 0.255) and a nonsignificant reduction in the mortality rate (p = 0.491). The extent of PC was found to be an independent predictor of mortality (p = 0.589) and length of hospital stay (p = 0.581) by multivariate analysis. Conclusion: The early use of HFNC is associated with a significant improvement in pulmonary oxygenation. We suggest that HFNC can be used as a first-line oxygen therapy in hypoxic patients with lung contusion following blunt chest trauma.

114

Original Article

Ram S Kaulgud, Tousif Hasan, Muragendraswami Astagimath, Gulamnabi L Vanti, Veeresh S, Mahantesh M Kurjogi, Shivakumar Belur

Nucleotidase as a Clinical Prognostic Marker in Snakebites: A Prospective Study

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:5] [Pages No:125 - 129]

Keywords: Envenomation, Neurotoxin, Nucleotidase, Snakebite, Snake venom

   DOI: 10.5005/jp-journals-10071-24901  |  Open Access |  How to cite  | 

Abstract

Background: Snakebite envenomation is a critical global health issue, causing substantial mortality and morbidity. Snake venom includes various enzymes, such as nucleotidase, phosphatases, etc. which impact physiological functions. However, research on the role of serum 5’-nucleotidase levels in assessing the severity and outcomes of snakebites is limited. This study aims to measure serum 5’-nucleotidase levels and explore their correlation with the severity of envenomation, to better understand its role in predicting patient prognosis. Methods: This is a single-center, prospective observational analysis involving 82 snakebite patients. Serum 5’-nucleotidase levels were measured using enzyme-linked immunosorbent assay, and clinical severity was evaluated using the snakebite severity score (SSS). Statistical analyses were performed to determine the correlation between 5’-nucleotidase levels and SSS, as well as various complications. Results: Among the 82 snakebite patients, 71.9% were male and 28.1% were female. Most bites (62.2%) occurred during the day, and 83% involved the lower limbs. Recovery was high, with 93.9% discharged, 3.7% deceased, and 2.4% lost to follow-up. A positive correlation was observed between 5’-nucleotidase levels and SSS at both 0 and 24 hours, with correlation coefficients of 0.55 and 0.61, respectively (p < 0.001). Conclusion: Serum 5’-nucleotidase serves as an effective biomarker for assessing the severity of snakebite envenomation and predicting patient outcomes. Its strong correlation with clinical severity scores makes it a valuable tool for improving the prognostication and management of snakebite cases when used in conjunction with clinical assessments.

144

Original Article

Shahed Omar, Varadaben Shukla, Ayesha B Khan, Ziyaad Dangor

Hemoadsorption Therapy for Calcium Channel Blocker Overdose at a Tertiary-level Intensive Care Unit: A Retrospective Study

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:7] [Pages No:130 - 136]

Keywords: Calcium channel blocker overdose, Critically ill, Extracorporeal blood purification, Hemoadsorption, Hypotension, Toxicology

   DOI: 10.5005/jp-journals-10071-24906  |  Open Access |  How to cite  | 

Abstract

Objective: To describe the burden of calcium channel blocker (CCB) overdose at a tertiary intensive care unit (ICU). Design and setting: Retrospective study of patients admitted to the ICU with CCB overdose from 2020 to 2022. Participants: Adult participants with clinically confirmed CCB overdose. Main outcome: Admission frequency, management strategies, and patient outcomes. Results: A total of 1719 ICU admissions over the study period, 24 (1.4%) had CCB overdose with a case fatality rate of 12.5% (3/24). Interventions included mechanical ventilation (MV) (71%), vasopressors (92%), high-dose insulin euglycemic therapy (HIET) (71%), calcium (42%), methylene blue (4%), and fluid therapy (100%). Thirteen patients (54%) received hemoadsorption therapy (HA), and eleven received standard of care (SoC) based on current guidelines. The resin hemoadsorption group had a higher SAPS II score (p = 0.002), and a greater total maximal vasopressor dose (p = 0.001) than SoC group. The HA group also had a lower admission mean arterial pressure (MAP), (p = 0.014), a greater MAP increase at 48 hours (p = 0.044), and a longer ICU length of stay (LOS) (p = 0.004) compared to the SoC group. There was one death in the HA group (7.7%) and two in the SoC group (18.2%). Conclusion: Calcium channel blocker overdose is an important and life-threatening cause of toxicology admissions in the ICU. Modern resin HA may contribute to improved hemodynamic stability providing a safe and important rescue therapy in cases with refractory shock. Well-designed studies are required to confirm its role in enhancing drug clearance thereby improving the hemodynamic state and clinical outcomes.

109

Original Article

Moses Siaw-Frimpong, Pritish J Korula, Reka Karuppusami, Nana F Gyapon, Kandasamy Subramani, Rajendran U Chander, Shoma Rao, William Addison

Combined Effect of the Timing of Initiation of Nutrition and Nutrition Risk on Outcomes in a Mixed Intensive Care Unit of a Tertiary Hospital in a Middle-income Country

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:6] [Pages No:137 - 142]

Keywords: 30-day hospital-free days, Early nutrition, ICU-free days, mNUTRIC score, Nutrition risk

   DOI: 10.5005/jp-journals-10071-24891  |  Open Access |  How to cite  | 

Abstract

Background: The importance of nutrition in the critically ill is well known but its practice is varied globally. Determining the nutrition risk is important to help improve outcomes. Materials and methods: A prospective observational study involved patients admitted to the intensive care unit (ICU) who stayed for at least 48 hours. The demographics of participants modified the NUTRIC score, and comorbidities were assessed. The timing of nutrition initiation was noted to get two main cohorts: Early (within 48 hours of admission) and delayed (after 48 hours of admission). All the patients were followed for a maximum of 30 days in the hospital to determine outcome variables such as mortality and length of hospital stay. The ICU-free days (30 minus days in ICU) and 30-day hospital-free days were calculated and recorded for each patient. Results: A total of 489 patients, 59.9% were males, 75.5% were mechanically ventilated and total parenteral nutrition utilization was 13.2%. The prevalence of nutrition risk was 21.1%. The patients who had early nutrition constituted 36.6%. There was no difference in the primary outcome of ICU-free days between the two groups; 24 (19–25.5) and 24 (16–25) days, respectively; p = 0.591. The high modified NUTRIC score cohort had lower ICU-free days (p < 0.001), 30-day hospital-free days, and higher mortality; 18 (0–24) vs 25 days (20–26), p < 0.001. Conclusion: The timing of the initiation of nutrition does not affect ICU-free days and 30-day hospital-free days irrespective of the nutrition risk on admission. A high modified NUTRIC score is associated with reduced ICU-free days and 30-day hospital-free days and increased mortality.

104

Original Article

V Dinesh K Gontla, Srinivas Samavedam, Narmada Aluru, Radhika Rudravarapu, Shravani Pabba, Mohammad N Shaik

ADAMTS-13 Behavior in Thrombocytopenia of Infectious Origin in ICU Patients

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:5] [Pages No:143 - 147]

Keywords: A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13, ICU severity, Non-viral infections, Thrombocytopenia, Prognosis, Viral infections

   DOI: 10.5005/jp-journals-10071-24890  |  Open Access |  How to cite  | 

Abstract

Introduction: Thrombocytopenia is a common hematological abnormality in intensive care unit (ICU) patients, with varying incidence across populations. A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13 (ADAMTS-13), a plasma serine protease, plays a crucial role in modulating von Willebrand factor (vWF) activity by cleaving its ultra-large (UL) multimers and preventing excess platelet aggregation. This study aimed to evaluate the association between ADAMTS-13 levels, viral and non-viral (NV) infections, and thrombocytopenia severity. Materials and methods: This Prospective observational study included adult ICU patients with thrombocytopenia, categorized into viral and non-viral groups. Thrombocytopenia severity was assessed by absolute platelet count on diagnosis day. Statistical analyses evaluated correlations between ADAMTS-13 levels, thrombocytopenia severity, and clinical outcomes, including bleeding episodes, transfusion needs, and overall patient outcomes. Results: Among 72 patients (30 viral, 42 non-viral), lower ADAMTS-13 activity correlated significantly with thrombocytopenia severity in both groups (p < 0.05), with a greater deficiency observed in NV cases. A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13 levels were associated with bleeding episodes, transfusion requirements, and thrombocytopenia progression in both groups but did not predict increased transfusion needs despite lower platelet counts. Conclusion: This study highlights an association between reduced ADAMTS-13 activity, infection type, and thrombocytopenia severity, especially in NV infections. A disintegrin-like metalloproteinase and thrombospondin-like activity motif 13 (ADAMTS-13) depletion and increased vWF activity may contribute to infection-related thrombocytopenia pathogenesis. These findings suggest that ADAMTS-13 levels could aid in assessing thrombocytopenia severity and prognosis, informing early management strategies and transfusion guidelines. Clinical significance: This study found that low ADAMTS-13 activity is associated with higher disease severity in both viral and non-viral infections, particularly in NV cases. While thrombocytopenia correlated with reduced ADAMTS-13 activity, it did not lead to increased platelet transfusions.

132

Original Article

Avichal Rajpal, Ashok Kumar Pannu, Ashish Behera, Navneet Sharma, Mohan Kumar Hanumanthappa

Utilization of Local Remedies among Dengue Patients Admitted to the Emergency Department of a Tertiary Care Center: An Observational Study

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:3] [Pages No:148 - 150]

Keywords: Dengue viral Infection, Goat's milk, Local remedies, Papaya extract

   DOI: 10.5005/jp-journals-10071-24896  |  Open Access |  How to cite  | 

Abstract

Background: Dengue viral infection (DVI) affects ~ 400 million people annually, with ~ 100 million cases causing clinical illness. Limited therapeutic options often lead patients to adopt alternative remedies. This study evaluates the prevalence and impact of such remedies on outcomes in patients admitted to a tertiary care emergency department. Materials and methods: A single-center, observational study was conducted from July 2022 to September 2023, including 170 patients aged >12 years with severe DVI or DVI with warning signs, as per the World Health Organization (WHO) criteria. The use of local remedies such as goat's milk, papaya leaves/extract, neem leaves, giloy juice, and alternative medicine was documented. Outcomes, including mortality and hospital stay duration, were compared between remedy users and non-users. Results: The mean age of participants was 36 years, with 60% males and 50% from rural areas. 35.29% used local remedies, with goat's milk (23.52%) and papaya leaves/extract (15.29%) being the most common. The median duration of remedy use was 2 days. Mortality was 6.67% in remedy users and 8.4% in non-users (p = 0.28). The median hospital stay was 4 days for both groups, with no significant outcome differences. Conclusion: One-third of DVI patients used local remedies, with goat's milk being the most prevalent. However, no significant impact on mortality or hospital stay was observed.

114

Original Article

Jayaprakash Narayanan B, Shoma V Rao, Subramani Kandasamy

Peripheral Perfusion Index for Prediction of Fluid Responsiveness in Spontaneously Breathing Critically Ill Patients: A Prospective Observational Study

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:4] [Pages No:151 - 154]

Keywords: Fluid responsiveness, Fluid resuscitation, Hemodynamic instability, Intensive care unit, Noninvasive blood pressure, Peripheral Perfusion Index, Pulse oximetry, Pleth variability index monitoring, Shock, Spontaneous ventilation

   DOI: 10.5005/jp-journals-10071-24898  |  Open Access |  How to cite  | 

Abstract

Background: Peripheral perfusion index (PPI), measured via plethysmography using a pulse oximeter, provides noninvasive, continuous insights into peripheral circulation. This study evaluates PPI's potential as a predictive marker for fluid responsiveness in critically ill patients, aiming to reduce vasopressor use. Methods: A 20-month prospective study was conducted in the multidisciplinary surgical ICU of Christian Medical College, Vellore. Patients meeting specific inclusion criteria were enrolled. Parameters including blood pressure, pulse pressure (PP), heart rate, left ventricular outflow tract velocity time integral (LVOT VTI), oxygen saturation, and PPI were recorded before and after a passive leg raise (PLR) test. Positive PLR responders received fluid resuscitation, and PPI changes were monitored at regular intervals. The study excluded patients with peripheral vascular disease, burns involving extremities, those on nitroglycerin or other vasodilator infusions, and those on high doses of vasopressors. Results: A 39% increase in PPI was identified as the threshold for fluid responsiveness. Subgroup analysis revealed variability: trauma patients showed a 55% increase, obstetrics patients 41%, and postoperative patients 6%. Notably, the study found that spontaneous breathing and minimal vasopressor requirements enhanced the reliability of PPI as a fluid responsiveness marker. Conclusion: Peripheral perfusion index is a reliable and practical tool for predicting fluid responsiveness in spontaneously breathing critically ill patients. It offers a noninvasive and dynamic method to guide volume resuscitation, particularly when combined with established hemodynamic markers such as LVOT VTI and PP changes. This study underscores the importance of using PPI in conjunction with other parameters for comprehensive fluid management. Further validation in larger and more diverse patient populations is warranted to confirm these findings and optimize resuscitation strategies.

163

Original Article

Dinesh Krishnamoorthy, Senthilkumar, Ramesh Venkataraman, Nagarajan Ramakrishnan, Vignesh C

Decision-making Preferences and Levels of Anxiety and Depression in Family Members of Patients Admitted to the ICU

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:9] [Pages No:155 - 163]

Keywords: Anxiety, Decision making, Decision making preferences, Depression, Hospital anxiety and depression scale score

   DOI: 10.5005/jp-journals-10071-24894  |  Open Access |  How to cite  | 

Abstract

Objectives: We aimed to study decision-making preferences and levels of anxiety and depression in family members of patients admitted to the intensive care unit (ICU). Materials and methods: This was a prospective observational study done in the mixed medical-surgical ICU. About 127 patients were recruited in first analysis and 100 patients were recruited in second analysis. Decision-making preferences were obtained only during first analysis. Hospital anxiety and depression scale (HADS) scores were calculated during both times. Hospital anxiety and depression scale scores more than or equal to 11 were found to have anxiety and depression. We also aimed to study the association between decision-making preferences and levels of anxiety and depression. Results: Around 27 relatives did not give consent during second time analysis. About 61% preferred shared decision-making and 27 and 12% preferred active and passive decision-making respectively. About 63% of the relatives had anxiety during first analysis and 54% had anxiety during second analysis. 66.9% had symptoms of depression during first analysis and 62% had depression during second analysis. There was a significant association between decision-making preferences and level of anxiety and depression. Conclusion: In our study, the majority of the relatives preferred shared decision-making, and the incidence of anxiety and depression seems to be high in the Indian population. A significant association was found between decision-making preferences and level of anxiety and depression, with passive decision-making being associated with a higher risk of anxiety and depression.

97

Original Article

Khuram Maqbool, Munish Chauhan, Sandeep Dewan

Comparison of Braden Score vs APACHE to Predict Occurrence of Bed Sores in a Tertiary Care ICU

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:6] [Pages No:164 - 169]

Keywords: Acute physiology and chronic health evaluation II, Braden score, Pressure sores

   DOI: 10.5005/jp-journals-10071-24908  |  Open Access |  How to cite  | 

Abstract

Introduction: Pressure sores, or bedsores, pose a challenge in intensive care unit (ICU) care due to patients’ immobility and compromised circulation. This study explores the effectiveness of the Braden Scale and acute physiology and chronic health evaluation II (APACHE II) in predicting pressure sore occurrences. Materials and methods: Conducted over a year in an Indian ICU, this observational study assessed the predictive capability of both scores. Participants (≥18 years) underwent Braden and APACHE II assessments upon admission, with daily monitoring for pressure sore development. Statistical analysis compared scores and ulcer occurrences. Results: Older patients, particularly males, showed a higher tendency for ICU admission. 20.3% had pressure ulcers, significantly correlating with lower Braden and higher APACHE II scores. Acute physiology and chronic health evaluation II showed superior efficiency in predicting ulcers. Discussion: While Braden scores’ variability was less in ICU patients, APACHE II scores reflected acute illness severity, strongly correlating with ulcer incidence. The study advocates for a combined utilization of both scores for tailored interventions. Conclusion: Acute physiology and chronic health evaluation II demonstrated better efficiency in predicting pressure ulcers, while the Braden score remains valuable for focused assessments. The study highlights the importance of considering age, gender, acute health status, and localized risk factors in ICU pressure ulcer assessment. Future directions: Further research might explore integrated scoring systems or protocols combining the strengths of both scores for more precise risk assessment in ICU settings.

119

PEDIATRIC CRITICAL CARE MEDICINE

Mrityunjay Sakkarwal, Pallavi Pallavi, Urmila Jhamb, Romit Saxena

Effect of Single High Dose Vitamin D Administration in Critically Ill Vitamin D-deficient Pediatric Patients: A Randomized Trial

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:7] [Pages No:170 - 176]

Keywords: Critically ill, Outcome, Pediatric intensive care units, Vitamin D deficiency

   DOI: 10.5005/jp-journals-10071-24895  |  Open Access |  How to cite  | 

Abstract

Objective: Vitamin D deficiency (VDD) has been thought to be a common modifiable risk factor for severity and clinical outcome during critical illness. The primary objective was to evaluate the effect of single high-dose vitamin D supplementation on mortality in critically ill vitamin D-deficient children. The secondary objective was to study the change in vitamin D levels after the intervention. Design and setting: This study was a randomized controlled trial conducted at the Department of Pediatrics of a Tertiary Care Hospital from May 2019 to March 2020. Subjects and intervention: Two hundred and fifty vitamin D-deficient children aged 1 month–12 years admitted in pediatric intensive care units (PICU) were randomized into 2 groups (group A received 10,000 U/kg cholecalciferol intramuscularly, group B received no intervention), with 125 in each group. Measurement: Baseline serum calcium, ionized calcium, serum phosphate, vitamin D and parathyroid hormone (PTH) levels were measured at the time of recruitment. Ionized calcium, and kidney function tests (KFT) were repeated at 24 and 72 hours, while vitamin D and PTH levels were repeated at 72 hours only. Results: Both the groups were comparable for baseline characteristics. There was no statistically significant difference between mortality (p = 0.439), length of PICU stay (p = 0.57) need and duration of mechanical ventilation (p = 0.449) between 2 groups. The subgroup analysis between severe and less severe VDD had similar results. However, there was a significant increase in levels of vitamin D after intervention in group A at 72 hours (p = 0). Conclusion: Administration of single high dose of vitamin D increases the vitamin D levels but does not convincingly improve the outcomes in vitamin D-deficient critically sick children admitted in PICU.

106

Systematic Review/Meta Analysis

Pratibha Todur, Anitha Nileshwar, Souvik Chaudhuri, Danavath Nagendra, Vishal Shanbhag, Vennila J

Prognostic Significance of Driving Pressure for Initiation and Maintenance of ECMO in Patients with Severe ARDS: A Systematic Review and Meta-analysis

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:9] [Pages No:177 - 185]

Keywords: Acute respiratory distress syndrome, Driving pressure, Extracorporeal membrane oxygenation, Mortality

   DOI: 10.5005/jp-journals-10071-24893  |  Open Access |  How to cite  | 

Abstract

Introduction: In life-threatening conditions like severe acute respiratory distress syndrome (ARDS), rescue interventions like extracorporeal membrane oxygenation (ECMO) should be initiated urgently to resolve an otherwise potentially adverse clinical outcome. Driving pressure (DP) is an independent prognosticator of the survival of ARDS during mechanical ventilation. We conducted this review with the objective to identify the optimal DP for initiating ECMO in severe ARDS and to study the change in DP during ECMO strategy in survivors and non-survivors. Materials and methods: A systematic search of EMBASE, PubMed, Cochrane Library, and SCOPUS databases was conducted from their inception to January 2024. Two investigators independently carried out the processes of literature search, study selection, data extraction, and quality assessment. The analysis was conducted using comprehensive meta-analysis software (CMA). Results: For meta-analysis, six studies comprising 668 patients were included. In survivors, the DP at ECMO initiation was lower (mean DP = 14.56 cm H2O, 95% CI: [11.060–18.060]) than non-survivors (mean DP = 17.77 cm H2O, 95% CI: [12.935–22.607]). During ECMO, the survivors had lower DP (mean DP = 11.63 cm H2O, 95% CI: [10.070–13.195]) than non-survivors (mean DP = 14.67 cm H2O, 95% CI: [12.810–15.831]). Conclusion: The optimum DP to initiate ECMO in severe ARDS patients on MV is 15 cm H2O. Extracorporeal membrane oxygenation reduces the intensity of MV, as reflected by a reduction in DP in both survivors and non-survivors during the ECMO by 3 cm H2O. The DP ≤ 12 cm H2O during ECMO strategy is a predictor of survival, and DP persisting ≥ 15 cm H2O on ECMO prompts the search for strategies to reduce DP. Trial Registration: PROSPERO CRD42022327846.

160

LETTER TO THE EDITOR

Josef Finsterer

Carbamazepine Intoxication Requires not only Elevated Serum Levels, but also Symptoms of Overdose

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:2] [Pages No:186 - 187]

Keywords: Anti-seizure drugs, Carbamazepine, Clinical presentation, Intoxication, Outcome

   DOI: 10.5005/jp-journals-10071-24879  |  Open Access |  How to cite  | 

87

LETTER TO THE EDITOR

Darpanarayan Hazra, Nejah F Ellouze, Suad Al Abri

Author's Response: Carbamazepine Intoxication Requires not only Elevated Serum Levels, but also Symptoms of Overdose

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:1] [Pages No:188 - 188]

Keywords: Anti-seizure drugs, Carbamazepine, Clinical presentation, Intoxication, Outcome

   DOI: 10.5005/jp-journals-10071-24888  |  Open Access |  How to cite  | 

79

LETTER TO THE EDITOR

Varun Singla, Sarthak Pal, Pramod Avti, Parul Gupta

Stuck Suction Catheters in Reinforced Endotracheal Tube: Hypotheses on Friction and Adhesive Forces

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:2] [Pages No:189 - 190]

Keywords: Endotracheal suctioning, Intensive care unit, Intubation endotracheal, Reintubation, Suctioning

   DOI: 10.5005/jp-journals-10071- 24892  |  Open Access |  How to cite  | 

79

LETTER TO THE EDITOR

Josef Finsterer, Carla A Scorza, Fulvio A Scorza

Appropriately Designed Studies are Needed before Thiamine and Vitamin C Plus Hydrocortisone are Judged Non-beneficial in Septic Shock

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:2] [Pages No:191 - 192]

Keywords: Mortality, Sepsis, Shock, Thiamine, Vitamin C

   DOI: 10.5005/jp-journals-10071-24889  |  Open Access |  How to cite  | 

96

LETTER TO THE EDITOR

Sachit Sharma, Hem R Paneru, Gentle S Shrestha, Pramesh S Shrestha, Subhash P Acharya

Author Response: Appropriately Designed Studies are Needed before Thiamine and Vitamin C Plus Hydrocortisone are Judged Nonbeneficial in Septic Shock

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:2] [Pages No:193 - 194]

Keywords: Sepsis, Septic shock, Vitamin C in sepsis

   DOI: 10.5005/jp-journals-10071-24902  |  Open Access |  How to cite  | 

104

LETTER TO THE EDITOR

Ashok K Pannu

Balanced Electrolyte Solutions in Diabetic Ketoacidosis: Where does Sterofundin Stand?

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:1] [Pages No:195 - 195]

Keywords: Balanced electrolyte solution, Crystalloids, Diabetic ketoacidosis, Fluid management

   DOI: 10.5005/jp-journals-10071-24903  |  Open Access |  How to cite  | 

142

LETTER TO THE EDITOR

Priyanka Gupta, Prashant Nasa

Author Response: Balanced Electrolyte Solutions in Diabetic Ketoacidosis: Where does Sterofundin Stand?

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:1] [Pages No:196 - 196]

Keywords: Balanced crystalloids, Diabetic ketoacidosis, Fluid therapy, Plasmalyte A, Sterofundin

   DOI: 10.5005/jp-journals-10071-24911  |  Open Access |  How to cite  | 

94

Corrigendum

Controlling Glycemic Variability in Non-diabetic Sepsis Patients: A Step toward Precision in Critical Care

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:1] [Pages No:197 - 197]

   DOI: 10.5005/jp-journals-10071-24909  |  Open Access |  How to cite  | 

98

Retraction Notice

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

[Year:2025] [Month:February] [Volume:29] [Number:2] [Pages:1] [Pages No:198 - 198]

   DOI: 10.5005/jp-journals-10071-24921  |  Open Access |  How to cite  | 

186

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