Introduction: Tracheal intubation (TI) is often needed in the intensive care unit (ICU) but can have disastrous consequences. The MACOCHA score was developed for prediction of difficult intubation (DI) in critically ill. Material and methods: After Institutional Ethics Committee approval, we conducted this prospective, single-center observational study. Evaluated the ability of MACOCHA score to predict difficult intubation in our ICU. We included 500 adults undergoing TI in our ICU. We collected the demographic data, details of ICU admission, and intubation-related data for calculating MACOCHA score. We used Statistical Package for the Social Sciences (version 21) for analysis. The accuracy of MACOCHA score for predicting DI was determined by area under the receiver operating characteristic (AUROC) curve. The Hosmer–Lemeshow goodness-of-fit statistics was used to determine calibration. Results: Since complete dataset was available for 449/500 patients, we analyzed their data. Acute renal failure and shock were the most frequent reasons for TI. Ketamine and rocuronium were most commonly used drugs for TI. The incidence of DI was 13.5% (60/449). There were 30 patients whose Mallampati score was either III and IV, while 84 and 45 patients had severe hypoxemia and coma before TI, respectively. The AUROC curve for the MACOCHA score was 0.659 (confidence interval, 0.574−0.743), suggesting a moderate discrimination. The Hosmer−Lemeshow goodness-of-fit test showed moderate calibration (χ² = 3.142, with p = 0.208). One hundred and seventy-one (26.5%) complications occurred in the entire cohort. Some patients had multiple complications. Conclusion: The MACOCHA score showed moderate discrimination and calibration in predicting DI in our study.

Aim and background: In the emergency department (ED), endotracheal intubation (ETI) is a critical, life-saving procedure. The MACOCHA score predicts difficult intubations in intensive care units (ICUs), but it has not been validated in the ED setting. This study aimed to validate the MACOCHA score for predicting first-pass success of ETI performed in the ED. Materials and methods: This prospective observational study was performed in the ED of a tertiary care institute, over a period of 18 months (September 2020 to February 2022). The study included 74 adult patients who underwent emergency ETI performed by emergency medicine residents. Number of ETI attempts, first-pass success rate, and complications were noted. The MACOCHA score was calculated, and its predictive performance was evaluated. Results: The first-pass success rate was 54.1%, and 54.1% of patients experienced complications, with hypoxia (18.9%) and hypotension (17.6%) being the most common. Four ETI attempts (p = 0.009) as well as presence of arrhythmia (p = 0.004) and cardiac arrest followed by death (p = 0.001) were significantly associated with a higher MACOCHA score, while MACOCHA score was not significantly associated with first-pass success, aspiration, hypotension, hypoxia, and local injury (p > 0.05). The number of ETI attempts and the number of complications were significantly correlated (r = 0.258, p = 0.026). At a cut-off score of 2.50, the MACOCHA score had a sensitivity and specificity of 50.0% and 35.3%, respectively, for the prediction of first-pass success rate [area under the curve: 0.593; 95% confidence interval (CI): 0.463–0.723]. Conclusion: MACOCHA score demonstrated limited performance in predicting the first-pass success rate of ETI in the ED.

Aims and background: Hypoxemia is a common and serious complication occurring during deep sedation for prolonged upper gastrointestinal endoscopy (UGE). We evaluated and compared the efficacy of high-flow nasal cannula (HFNC) oxygen therapy vs conventional nasal cannula oxygen therapy (COT) in preventing hypoxemia in patients admitted to the intensive care unit (ICU) and who underwent prolonged (>15 minutes) UGE under deep sedation. Materials and methods: Seventy patients aged 20–60 years with American Society of Anesthesia (ASA) I, II, or III who were admitted to the ICU and were scheduled for an anticipated prolonged UGE were included. They were randomly assigned to be administered either oxygen through a standard nasal cannula (COT group) or oxygen through an HFNC (HFNC group). The primary outcome was any occurrence of at least moderate hypoxemic episodes [oxygen saturation (SpO₂) < 90%] of any duration. Results: Regarding the occurrence of hypoxemic episodes, 18 patients (51.4%) in the COT group experienced hypoxemia with 11 (31.4%) experiencing mild hypoxemia, six (17.1%) experiencing moderate hypoxemia, and only one patient (2.9%) experienced severe hypoxemia, with a total of seven patients (20.0%) whose SpO₂ was <90%. Conversely, only two patients (5.7%) in the HFNC group had mild hypoxemia, and no patients had SpO₂ < 90%. Additionally, nine patients in the COT group experienced clinically significant hypoxemia, whereas no patients in the HFNC group (p = 0.001). Conclusion: High-flow nasal cannula (HFNC) oxygen therapy was safe, well tolerated, and significantly decreased the incidence of hypoxemic episodes, compared to COT, among high-risk ICU patients who underwent prolonged UGE under propofol deep sedation. (Registered at ClinicalTrials.gov with ID: NCT06350864)

Background: Deliberate self-harm (DSH) is a significant health concern in developing countries, associated with high morbidity and mortality. Several factors influence patient outcomes. This study aimed to better understand the profile and outcomes of patients with benzodiazepine (BZD) overdose. Materials and methods: This two-year analysis conducted in the Emergency Department (ED) focused on patients with DSH and BZD toxicity. Key factors and outcomes were recorded and analyzed. Results: The study included 95 patients with BZD overdoses, some of whom had also taken other drugs. The mean age was 36.52 (SD: 14.2) years, with a female predominance (59.9%). The most common reasons for DSH were interpersonal issues, such as relationship failure (n = 48; 50.5%) and domestic fights or abuse (n = 37; 38.9%). Single-drug BZD overdose was more frequent among individuals aged 46–60 years. The predominant symptoms were drowsiness (n = 45; 47.4%) and nausea or vomiting (n = 32; 33.7%). Six patients (6.3%) required definitive airway stabilization in the ED, while two patients (2.1%) required inotropic support. Flumazenil was administered to 19 (20%) patients with no reported side effects. A majority (n = 49; 51.6%) of patients were admitted to the hospital, of whom 30 (61.2%) were discharged in stable condition, while 19 (38.8%) left against medical advice. No deaths were reported. Conclusion: Middle-aged females were most frequently involved in DSH cases. Single-drug BZD overdose was more common in this age-group. The predominant symptoms included drowsiness and gastrointestinal complaints. Most patients required hospital admission.

Background: Numerous signs of venous congestion exist, but each has limitations. Previous studies have shown the utility of venous excess ultrasound (VExUS) scoring in predicting acute kidney injury (AKI) in patients postcardiac surgery. This study aimed to evaluate whether serial VExUS scoring could predict AKI in intensive care unit (ICU) patients without cardiac conditions. Materials and methods: This single-center observational study was conducted in the main ICU of PGIMER, Chandigarh, India. Thirty patients with an inferior vena cava (IVC) diameter of ≥2 cm and a normal biventricular function were included. Serial VExUS scoring was performed on admission and daily for up to six days or until AKI developed, whichever occurred first. Results: Among 30 participants, 22 (73.3%) developed AKI. In the AKI group, mean VExUS scores were 1.95 on day 2, 1.92 on day 3, and 3.0 on day 5 (p = 0.001, 0.003, and 0.002, respectively). A significant positive correlation was observed between VExUS scores and fluid balance on day 2 (ρ = 0.375, p = 0.041) and day 3 (ρ = 0.579, p = 0.006). Multivariate analysis showed no correlation between the VExUS score on day 2 and fluid balance, duration of mechanical ventilation, or ICU length of stay. No association was found between VExUS scores and 30-day mortality. Conclusion: In critically ill noncardiac patients, VExUS scores do not predict AKI onset. However, higher daily fluid balance may moderately correlate with VExUS scores.

Background: Cirrhosis, a leading cause of global mortality, necessitates an accurate assessment of disease severity and prognosis. While traditional scoring systems like Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) are used to assess the severity, specific biomarkers are lacking. This study explores serum prolactin levels as a potential biomarker for evaluating cirrhosis severity and predicting short-term mortality. Methods: A prospective observational study was conducted from December 2021 to December 2023. After a thorough clinical examination, serum prolactin levels were measured. The correlation between prolactin levels and established severity scores [CTP, MELD, chronic liver failure consortium organ failure (CLIF-C OF), and MELD-sodium (MELD-Na)] was analyzed. The study also evaluated the prognostic value of prolactin levels in predicting 28-day and 90-day mortality. Results: A total of 90 patients with liver cirrhosis were included. There were 82% men, with a mean age of 47.6 years. Alcohol was the most common cause of cirrhosis (73%). The median (interquartile range (IQR)) serum prolactin level was 29 (10−54) ng/mL, with higher levels correlating with increased disease severity: CTP (r = 0.73), MELD (r = 0.64), MELD-Na (r = 0.67), and CLIF-C OF (r = 0.82) scores. Elevated prolactin levels were significantly associated with increased mortality, with an area under the receiver operating characteristic curve of 0.83 for predicting 28-day mortality and 0.79 for 90-day mortality. A prolactin cut-off of 35.12 ng/mL demonstrated high sensitivity (93% and 77%, respectively) and specificity (63% and 72%, respectively) for 28-day and 90-day mortality prediction. Conclusion: Serum prolactin levels significantly correlated with the severity of cirrhosis and also effectively predicted the short-term mortality. Prolactin may offer a noninvasive and cost-effective adjunct for severity assessment and short-term prognosis in cirrhosis.

Background: Perioperative fluid management (PFM) is critical in liver transplantation, especially regarding its impact on postoperative renal function. Acute kidney injury (AKI) is a common complication in liver transplant recipients, often influenced by the type and volume of fluids administered during the perioperative period. This study investigates the effects of different fluid management strategies on renal outcomes following liver transplantation from living donors. Patients and methods: This retrospective observational study included 91 liver transplant recipients who were categorized into three groups based on their PFM strategy: restrictive (n = 1), moderate (n = 34), and liberal (n = 56). Data were collected from patient medical records, focusing on fluid types, peak serum creatinine levels, urine output, and length of hospital stay. Statistical analyses, including ANOVA and logistic regression, were conducted to assess renal outcomes among the groups. Results: The moderate fluid management group demonstrated the best renal outcomes, with the lowest peak serum creatinine (1.02 ± 0.25 mg/dL) and shorter ICU stays (2.47 ± 0.62 days) compared to the liberal fluid strategy group (1.40 ± 0.92 mg/dL and 2.88 ± 0.83 days, respectively). Moreover, liberal fluid strategies were associated with fluid overload and increased peak serum creatinine levels. Intraoperative fluid administration showed a greater protective effect on renal function compared to postoperative fluid administration. Conclusions: Moderate PFM, particularly with careful intraoperative fluid administration, is optimal for minimizing the risk of AKI and improving renal outcomes in liver transplant patients. These findings emphasize the importance of individualized fluid therapy in reducing renal complications after liver transplantation.

Aims and background: Guillain–Barré syndrome (GBS) is associated with significant muscle loss, which can result in prolonged intensive care. The aim of this study was to evaluate muscle atrophy in GBS patients using serial ultrasound measurements of rectus femoris cross-sectional area (RFCSA). Materials and methods: A prospective study was carried out among GBS patients admitted to the intensive care unit (ICU). All clinical and demographic variables were recorded at admission. Ultrasound measurement of RFCSA was done at baseline and 3, 7, and 14 days after ICU admission. Clinical outcomes such as the ICU stay and duration of mechanical ventilation were studied at discharge. Results: A total of 25 patients were studied. The mean age was 48.96 ± 14.82 years, 44% were female, and 25% experienced significant muscle atrophy in the first 72 hours. The percentage changes in the RFCSA were 5.21 (3.38–8.39), 9.18 (5.52–11.76), and 12.63 (8.65–15.09) on days 3, 7, and 14, respectively. A greater muscle atrophy rate was strongly positively correlated with longer ventilation periods [atrophy day 14 (r = 0.88, p < 0.001)] and atrophy day 7 (r = 0.87, p < 0.001) and total number of ICU days [atrophy day 14 (r = 0.93, p < 0.001)]. Conclusion: Muscle ultrasound (MUSG) shows potential as a tool for monitoring muscle atrophy in GBS patients. However, its ability to reliably identify patients at risk for prolonged ICU stays and mechanical ventilation requires cautious interpretation and further validation due to the absence of a comparator. Clinical significance: The findings of this study highlight the utility of bedside MUSG as a non-invasive tool for monitoring muscle atrophy in neuromuscular diseases and critically ill patients. Early identification of significant muscle loss allows for timely interventions, risk stratification, and resource optimization, ultimately improving ICU outcomes and patient recovery trajectories.

Objective: Sepsis stands as a significant contributor to mortality in ICU settings worldwide. Early diagnosis and appropriate treatment are therefore essential to reduce mortality. We planned this study to investigate the diagnostic significance of prokineticin-2 (PK-2) in patients with sepsis. Materials and methods: Adult patients with sepsis who were admitted to our intensive care unit (ICU) were included in this prospective observational study. On the day of admission and the 7th day of the ICU stay, the levels of procalcitonin (PCT) and PK-2 were assessed. Patients’ mortality was observed for 28 days. Results: This research involved 83 patients meeting the inclusion criteria. Prokineticin-2 showed a diagnostic sensitivity of 70.6% for sepsis, outperforming PCT with a sensitivity of 64.7%. In predicting mortality, PCT displayed a sensitivity of 95.5%, whereas Prokineticin-2 demonstrated an even higher sensitivity at 98.4%. Conclusion: Prokinectin-2 can be used for screening adult patients with sepsis admitted to ICU.

Background: There are limiting factors that influence the assessment of mobility after cardiac surgery. Therefore, the Perme intensive care unit mobility score scale becomes more appropriate because it analyzes physical and psychological limitations in the intensive care unit (ICU), taking into account extrinsic problems. Objective: Describe the behavior of the Perme scale and its correlation with clinical outcomes in the postoperative stage of cardiac surgery. Materials and methods: This is a prospective cohort study. The patients were evaluated in four moments, to analyze the perception of pain, the degree of dyspnea, muscle strength, and functionality according to the Perme scale which ranges from 0 to 32 points. It was applied at hospital admission, ICU discharge, admission to the ward (UI), and hospital discharge. Values expressed as Delta 1 (d1) and Delta 2 (d2) were used to determine the comparison of preoperative and hospital discharge, respectively. Results: Twenty-one patients were included. Among the correlation variables at the different moments, it was perceived that cardiopulmonary bypass time d1 (r = 0.19; p = 0.42); d2 (r = 0.07; p = 0.98); ICU time d1 (r = 0.34; p = 0.17); d2 (r = 0.35; p = 0.16); hospital time d1 (r = 0.17; p = 0.54); d2 (r = 0.21; p = 0.47) and mechanical ventilation (MV) time d1 (r = 0.09; p = 0.70); d2 (r = 0.44; p = 0.06) showed no statistically significant difference. The variables hospital admission (31 ± 1) and ICU discharge (20 ± 4) showed significant losses in the length of stay in these units. Conclusion: The evaluation performed with the Perme scale showed significance when comparing the values between ICU admission and discharge. However, in relation to the clinical outcomes of this study, no relevant correlations were proven.