Plens GM, Morais CCA, Gregol T
… +12 more, Colpani PB, Alcala GC, Pacheco É, Xia YHW, Dos Santos AC, Malbouisson LM, Brochard L, Kassis EB, Goligher EC, Carvalho CRR, Amato MBP, Costa ELV
Crit Care Med
· 2026 Jul · PMID 42165647
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OBJECTIVE: Current methods for estimating inspiratory muscle pressure ( Pmus ) during mechanical ventilation are either invasive or dependent on occlusion maneuvers. A noninvasive artificial intelligence (AI) algorithm e...OBJECTIVE: Current methods for estimating inspiratory muscle pressure ( Pmus ) during mechanical ventilation are either invasive or dependent on occlusion maneuvers. A noninvasive artificial intelligence (AI) algorithm estimating in real-time the amplitude and timing of Pmus , enabling continuous monitoring of patient effort, driving pressure, and synchrony with the ventilator was designed, and its performance was evaluated against the gold standard obtained with esophageal manometry ( Pmus,es ). DESIGN: A prospective diagnostic accuracy study. SETTING: Two ICUs from the University of São Paulo, Brazil. PATIENTS: Adult patients under pressure support ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Pmus estimated using AI ( Pmus,AI ) was compared with Pmus,es and to values derived from occlusion maneuvers, the pressure muscle index and the occlusion pressure ( Pocc ). Automatic detection of dyssynchronies based on Pmus,AI was compared with experts' classification. A total of 48 participants with 4918 cycles were analyzed. Pmus,es varied from 1.0 to 28.4 cm H 2 O. Pmus,AI showed a bias of 0.9 cm H 2 O, 95% limits of agreement -5.1, 6.9 cm H 2 O and detected extreme values of both Pmus,es and dynamic driving pressure with area under the receiver operating characteristic curve greater than 0.8. Pmus,AI accuracy was comparable to occlusion-based techniques. Sensitivity and specificity to detect ineffective effort, autotriggering or reverse triggering were 86.5% and 77.4%, respectively. CONCLUSIONS: AI presented good performance in detecting high and low Pmus , and allowed the automatic detection of specific types of dyssynchronies. This novel noninvasive method was comparable to intermittent techniques requiring occlusion maneuvers.
Harrison DS, Dhruva N, Ford JL
… +5 more, Greer DM, Wahlster S, Chhabra N, Morris NA, Simulation-based mastery learning to assess and Ensure COmpetency in death by Neurologic criteria Determination (SECOND) Study Group
Crit Care Med
· 2026 Jun · PMID 42161897
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OBJECTIVES: To develop a comprehensive checklist, define critical actions, and establish a minimal passing standard for adult and pediatric critical care clinicians as well as other clinicians to facilitate formative and...OBJECTIVES: To develop a comprehensive checklist, define critical actions, and establish a minimal passing standard for adult and pediatric critical care clinicians as well as other clinicians to facilitate formative and summative assessment of brain death/death by neurologic criteria (BD/DNC) determination. DESIGN: A prespecified three-round modified Delphi consensus process to define checklist items followed by a modified Angoff standard setting process to determine critical actions and item average ratings. SETTING: Electronic surveys. SUBJECTS: Selected authors of the 2023 Pediatric and Adult BD/DNC Consensus Practice Guideline, World Brain Death Project, and experts recommended by these authors ( n = 16) participated in the Delphi panel. Neurocritical Care United Council for Neurologic Subspecialties and Accreditation Council for Graduate Medical Education examination committee members ( n = 13) participated in Angoff standard setting. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 98 unique checklist items related to assessment of prerequisites (23 items), performance of the clinical examination (28 items), apnea testing (36 items), and ancillary testing (11 items) were retained by the Delphi panel. Seven items were designated as critical actions based upon Angoff panelist consensus. The remaining 91 items were assigned item average ratings. The minimum passing score for an assessment including all noncritical items was set at 89%. CONCLUSIONS: These guideline-concordant consensus checklist items, including critical actions and noncritical actions with their assigned item average ratings, may be applied selectively to simulated cases of BD/DNC determination for adults and children to determine a minimum passing score and readiness for independent practice, mitigating the risk of inaccurate BD/DNC determination among critical care clinicians. Our process for systematically defining critical actions on a behavior checklist may be replicated for simulation-based summative assessment of learners in other critical care scenarios.
Sosnowski KJ, Ranse KL, Mitchell ML
… +5 more, Ware RS, White HT, Morrison LA, Schweitzer VC, Chaboyer WP
Crit Care Med
· 2026 Jul · PMID 42159452
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OBJECTIVES: To test whether the ABCDEF bundle, compared with usual care, decreases delirium incidence and duration, improves functional status in the ICU, and enhances 90-day post-ICU discharge quality of life in critica...OBJECTIVES: To test whether the ABCDEF bundle, compared with usual care, decreases delirium incidence and duration, improves functional status in the ICU, and enhances 90-day post-ICU discharge quality of life in critically ill Australian adults. DESIGN: Single-center, pragmatic, randomized controlled trial. SETTING: Eight-bed medical/surgical ICU in a metropolitan Australian hospital. PATIENTS: Adult patients expected to remain in ICU for at least 48 hours. INTERVENTIONS: ABCDEF bundle or usual care. MEASUREMENTS AND MAIN RESULTS: Complete ABCDEF bundle adherence was achieved in 50% of patients each study day. The primary outcome, cumulative incidence of delirium (measured with the Confusion Assessment Method for ICU), was similar between groups (ABCDEF, 37.9%; usual care, 36.4%; odds ratio, 1.1; 95% CI, 0.5-2.2; p = 0.86), as was median delirium duration (ABCDEF, 2.0 d; interquartile range [IQR], 1.3-3.5 d; usual care, 2.5 d; IQR, 1.0-4.4 d; mean difference, -0.4 d; 95% CI, -1.6 to 0.8 d; p = 0.53). Median functional scores at ICU discharge (measured with the Functional Independence Measure) were 55.0 (IQR, 37.0-67.3) in the ABCDEF group and 53.0 (IQR, 43.8-62.5) in the usual care group (mean difference, 0.0; 95% CI, -7.7 to 7.6; p = 0.83). At 90 days post-ICU discharge, the ABCDEF bundle group reported higher scores in the "usual activities" domain ( p < 0.001) (measured with the EuroQol 5D five-level questionnaire), with no differences in other domains. CONCLUSIONS: In adult ICU patients, the ABCDEF bundle, compared with usual care, did not reduce the cumulative incidence or duration of delirium. While no effect was observed on the primary outcomes, higher scores in the "usual activities" quality of life domain suggest potential long-term benefits that warrant further investigation.
Crit Care Med
· 2026 Jul · PMID 42159375
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OBJECTIVE: Sepsis-associated acute kidney injury (SAKI) is a heterogeneous condition that lacks disease-modifying treatments, and precision medicine approaches are needed. We previously derived two reproducible pediatric...OBJECTIVE: Sepsis-associated acute kidney injury (SAKI) is a heterogeneous condition that lacks disease-modifying treatments, and precision medicine approaches are needed. We previously derived two reproducible pediatric SAKI subphenotypes (pSAKI-1 and pSAKI-2) from readily available clinical data. We aimed to externally validate the prognostic relevance of these subphenotypes, evaluate their molecular signatures, and assess for heterogeneity of treatment effect (HTE) across subphenotypes with sepsis therapies. DESIGN: Secondary analysis of an ongoing multicenter, prospective, observational study of children. SETTING: Ten PICUs in the United States from January 2002 to February 2025. PATIENTS: Patients 1 week to 18 years old with early (day 1-2) SAKI. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among 871 patients, 665 (76%) were assigned pSAKI-1 and 206 (24%) to pSAKI-2. On day 1-2, the pSAKI-2 cohort had greater severity of illness, including higher acute kidney injury stage and vasoactive burden, lower platelet counts, and higher lactate values and International Normalized Ratios. These pSAKI-2 patients also had uniformly worse outcomes, including independently higher odds of day 7 severe acute kidney injury (adjusted odds ratio [aOR] 3.2; 95% CI, 2.1-4.7; p < 0.001), death (aOR 2.7; 95% CI, 1.6-4.4; p < 0.001), and fewer PICU-free and vasoactive-free days ( p < 0.001). The biomarker signature of pSAKI-2 was characterized by greater inflammation, endothelial dysfunction, and hyperreninemia. On propensity score matched (PSM) analysis, pSAKI-1 patients who received corticosteroids had more day 7 severe acute kidney injury (28% vs. 19%, p = 0.023), 2 fewer PICU-free days ( p = 0.04) and greater mortality (10% vs. 3.7%, p = 0.008); no differences were seen in pSAKI-2 patients. Although no HTE was identified on PSM analysis for vasopressin, inverse probability treatment weighting analysis demonstrated a significant interaction between subphenotype-, vasopressin- and vasoactive-free days ( p = 0.003). CONCLUSIONS: We externally validated the prognostic relevance of two pSAKI subphenotypes derived from readily available data. These subphenotypes have unique biomarker signatures and differential responses to treatment, representing a potential mechanism for bedside enrichment.
Sato R, Kondo S, Ali A
… +3 more, Abu Za'nouneh F, Hasegawa D, Daoud EG
Crit Care Med
· 2026 Jul · PMID 42153811
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OBJECTIVES: To investigate the association between mechanical power and mortality in adult critically ill patients receiving invasive mechanical ventilation. DATA SOURCES: We conducted a systematic search of MEDLINE, Emb...OBJECTIVES: To investigate the association between mechanical power and mortality in adult critically ill patients receiving invasive mechanical ventilation. DATA SOURCES: We conducted a systematic search of MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials on August 12, 2025. STUDY SELECTION: We included studies comparing mechanical power between survivors and nonsurvivors or reporting adjusted mortality estimates in adult critically ill patients receiving invasive mechanical ventilation. DATA EXTRACTION: Two reviewers independently extracted study characteristics, ventilator variables, and mortality outcomes. DATA SYNTHESIS: Pooled mean differences (MDs) were calculated using inverse-variance random-effects models. Secondary analyses evaluated mechanical power normalized to predicted body weight and respiratory system compliance. Adjusted odds ratios (AORs) and adjusted hazard ratios (AHRs) for mortality per 1 J/min increase in mechanical power were synthesized separately using generic inverse-variance random-effects models. A total of 34 studies met inclusion criteria and were included in the meta-analyses. Mechanical power was higher in nonsurvivors than survivors (MD, 1.91 J/min; 95% CI, 1.30-2.51 J/min). Mechanical power normalized to predicted body weight (MD, 0.06 J/min/kg; 95% CI, 0.04-0.08 J/min/kg) and normalized to respiratory system compliance (MD, 0.28 J/min/mL/cm H 2 O; 95% CI, 0.10-0.45 J/min/mL/cm H 2 O) were also higher among nonsurvivors. Mechanical power was independently associated with mortality, with pooled AOR (1.04 per 1 J/min increase; 95% CI, 1.03-1.06 per 1 J/min increase) and pooled AHR (1.03; 95% CI, 1.00-1.07). A mechanical power threshold older than 17 J/min was associated with greater mortality (odds ratio, 1.60; 95% CI, 1.34-1.91). CONCLUSIONS: Higher mechanical power was consistently associated with increased mortality in invasively ventilated adults. Mechanical power may serve as a clinically relevant marker of ergotrauma; however, whether interventions that reduce mechanical power improve outcomes requires prospective investigation.
Walker HGM, Vo TK, Santamaria J
… +4 more, Serpa Neto A, Subramaniam A, Brown AJ, Australian and New Zealand Intensive Care Society Center for Outcome and Resource Evaluation (ANZICS CORE) Committee
Crit Care Med
· 2026 May · PMID 42153779
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OBJECTIVES: Frailty and readmission to the ICU are common, and both are associated with worse outcomes. However, there is limited literature that assesses how frailty impacts those patients who require readmission to the...OBJECTIVES: Frailty and readmission to the ICU are common, and both are associated with worse outcomes. However, there is limited literature that assesses how frailty impacts those patients who require readmission to the ICU during a hospitalization. Therefore, we sought to assess whether the association between ICU readmission and death differ by frailty state. DESIGN: A registry-based study used the Australian and New Zealand Intensive Care Society Adult Patient Database. SETTING AND PATIENTS: All adult patients (age ≥ 18 yr) admitted to 203 ICUs in Australia and New Zealand between January 2017 and December 2022 with a documented Clinical Frailty Scale (frailty defined as a score ≥ 5) were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary outcome was 60-day mortality. A Cox proportional hazards model, treating time to readmission as a time-dependent covariate and including an interaction term between frailty state and readmission, was used. Regression standardization was used to estimate absolute risk and risk differences, with 95% CIs calculated using a nonparametric bootstrap. A competing risk analysis was conducted, treating in-hospital death without ICU readmission as a competing risk. Secondary outcomes included length of hospital stay and discharge location. Six hundred fifteen thousand seven hundred nineteen ICU admission episodes were analyzed. Of the entire cohort, 19% (115,453) were frail, and 4.1% (25,329) were readmitted to the ICU. By day 60, 2.7% patients had died (16,353) in the hospital. Patients with frailty were at increased risk of both ICU readmission (subdistribution hazard ratio [SHR], 1.10; 95% CI, 1.07-1.14) and death without readmission (SHR, 2.83; 95% CI, 2.72-2.94). Observed 60-day mortality was greatest in frail, readmitted patients (22.7%). The standardized risk increase in 60-day mortality associated with ICU readmission was similar between patients with and without frailty (14.6% [95% CI, 13.7-15.6%] vs. 14.9% [95% CI, 13.4-16.6%]), respectively. CONCLUSIONS: This large, multicenter, retrospective study found that ICU readmission was associated with increased 60-day mortality in patients with and without frailty. Readmitted patients with frailty had the greatest risk of 60-day mortality; however, frailty state did not modify the incremental absolute risk of death relative to nonreadmitted patients.
Fresilli S, Belletti A, Labanca R
… +8 more, Monti G, Schultz MJ, Corbo F, Luciano AP, Ferrara B, Turi S, Landoni G, Nebulized Heparin Study Group
Crit Care Med
· 2026 Jul · PMID 42148826
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OBJECTIVES: Dysregulated pulmonary coagulation and inflammation is a hallmark of respiratory failure in various etiologies. Excessive fibrin deposition contributes to alveolar collapse, impaired gas exchange, and progres...OBJECTIVES: Dysregulated pulmonary coagulation and inflammation is a hallmark of respiratory failure in various etiologies. Excessive fibrin deposition contributes to alveolar collapse, impaired gas exchange, and progression to pulmonary fibrosis. Nebulized heparin can mitigate these coagulation and inflammation disturbances. Although several randomized controlled trials have explored its effects, results remain inconsistent and limited by small patient populations. We conducted a random-effects meta-analysis to calculate the risk ratio (RR) and 95% CIs. DATA SOURCES: We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials for randomized controlled trials comparing nebulized unfractionated heparin to standard care or placebo in adult patients with respiratory failure either invasively mechanical ventilated or not. The primary outcome was all-cause mortality at the longest follow-up. STUDY SELECTION: We included randomized clinical trials enrolling adult patients with respiratory failure, comparing nebulized heparin vs. standard care or placebo, and reporting at least one clinical outcome, including all-cause mortality. DATA EXTRACTION: Two independent investigators extracted data on trial design, setting, etiology of respiratory failure, heparin dosing regimens, follow-up duration, and outcomes. Discrepancies were resolved by consensus. DATA SYNTHESIS: We identified 16 studies (787 receiving nebulized heparin, 833 control). Six (38%) were multicenter, five focused on COVID-19, 12 enrolled ICU patients, and dosing clustered around 25,000 international units (IUs) three times a day (~75,000 IU/d for ~10 d). At the longest follow-up, nebulized heparin reduced all-cause mortality vs. control (110/645 [17.1%] vs. 157/711 [22.1%]; RR, 0.79; 95% CI, 0.66-0.95; with ten studies included). Nebulized heparin was also associated with more ventilation-free days by day 28 (mean difference, +4.85; 95% CI, 1.47-8.24). Major bleeding was rare (1.1 vs. 0.7%; RR, 1.48; 95% CI, 0.42-5.18), while no minor bleeding or heparin-induced thrombocytopenia was reported. CONCLUSIONS: Nebulized unfractionated heparin may improve survival in patients with respiratory failure without increasing adverse events.
Sakrikar G, Surve RM, Venkatapura R
… +3 more, Chakrabarti D, Mundlamuri R, Shukla D
Indian J Crit Care Med
· 2026 Apr · PMID 42147716
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BACKGROUND AND AIMS: This observational study aimed to assess electroencephalographic reactivity (EEG-R) and bispectral index reactivity (BIS-R) as early prognostic indicators and to evaluate their association with funct...BACKGROUND AND AIMS: This observational study aimed to assess electroencephalographic reactivity (EEG-R) and bispectral index reactivity (BIS-R) as early prognostic indicators and to evaluate their association with functional outcomes in patients with acute severe traumatic brain injury (sTBI). PATIENTS AND METHODS: Patients aged over 18 years with a Glasgow Coma Scale Score ≤8 were enrolled between days 3 and 5 postinjury. Baseline pan cranial electroencephalography (EEG) and BIS (from the hemisphere contralateral to injury) were recorded, followed by two painful and two auditory stimuli on each side at two-minute intervals. Electroencephalographic reactivity was independently rated as present or absent by three assessors. Bispectral index reactivity was defined as a change of ten or more points from baseline within 20 seconds of stimulation. Functional outcome was assessed at 3 and 6 months using the Glasgow Outcome Scale Extended (GOSE). RESULTS: Among 40 patients analyzed, EEG-R was present in 18 (45%) and absent in 22 (55%). Absence of EEG-R was significantly associated with lower GOSE scores at both 3 months ( = 0.001) and 6 months ( = 0.016). Absence of EEG-R demonstrated specificity and positive predictive value of 100% for non-recovery of consciousness at 3 months. Bispectral index reactivity was observed in 21 patients (52.5%) and absent in 19 (47.5%). Bispectral index reactivity did not show a significant association with functional outcomes and demonstrated poor concordance with EEG-R. CONCLUSION: The absence of EEG-R in the acute phase of sTBI was a strong predictor of poor clinical outcome. Bispectral index reactivity showed limited prognostic value in this study. HOW TO CITE THIS ARTICLE: Sakrikar G, Surve RM, Venkatapura R, Chakrabarti D, Mundlamuri R, Shukla D. Electroencephalography and Bispectral Index Reactivity to Predict Outcome in Unconscious Patients with Acute Severe Traumatic Brain Injury: A Prospective Observational Study. Indian J Crit Care Med 2026;30(4):275-281.
Indian J Crit Care Med
· 2026 Apr · PMID 42147715
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Finsterer J. NETosis Markers, Such as Citrullinated Histones, Myeloperoxidase, and Elastase, should not be Recommended as Predictors of COVID-19 Severity. Indian J Crit Care Med 2026;30(4):347-348.Finsterer J. NETosis Markers, Such as Citrullinated Histones, Myeloperoxidase, and Elastase, should not be Recommended as Predictors of COVID-19 Severity. Indian J Crit Care Med 2026;30(4):347-348.
Indian J Crit Care Med
· 2026 Apr · PMID 42147714
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Kumar A. Author Response: NETosis Markers such as Citrullinated Histones Myeloperoxidase and Elastase should not be Recommended as Predictors of COVID-19 Severity. Indian J Crit Care Med 2026;30(4):349.Kumar A. Author Response: NETosis Markers such as Citrullinated Histones Myeloperoxidase and Elastase should not be Recommended as Predictors of COVID-19 Severity. Indian J Crit Care Med 2026;30(4):349.
Indian J Crit Care Med
· 2026 Apr · PMID 42147713
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BACKGROUND: Artificial intelligence (AI), particularly large language models (LLMs), is increasingly being used in intensive care environments to assist with documentation, literature synthesis, and clinical information...BACKGROUND: Artificial intelligence (AI), particularly large language models (LLMs), is increasingly being used in intensive care environments to assist with documentation, literature synthesis, and clinical information retrieval. While these tools offer efficiency and cognitive support in high-pressure settings such as the intensive care unit (ICU), they also introduce risks related to hallucination, automation bias, and a lack of explainability. AIM: To examine the emerging challenges associated with AI use in critical care-especially hallucination and algorithmic overconfidence-and to highlight the need for structured AI literacy and governance frameworks for intensivists. FINDINGS: Recent analyses show that AI hallucination-the generation of fabricated or distorted information-is an intrinsic feature of probabilistic language models rather than a rare technical error. In critical care contexts, this may manifest as fabricated references, distorted clinical reasoning, or overconfident recommendations. Additional concerns include automation bias, where clinicians may inadvertently rely on algorithmic outputs, and opacity in AI decision-making processes. Emerging evidence demonstrates that while AI tools may enhance efficiency in tasks such as documentation and knowledge summarization, they remain unreliable for unsupervised clinical reasoning. CONCLUSION: The integration of AI into intensive care practice should be guided by structured AI literacy, institutional governance frameworks, and continued human oversight. Artificial intelligence can serve as a supportive cognitive tool, but responsibility for clinical judgment, patient safety, and ethical decision-making must remain firmly with the clinician. HOW TO CITE THIS ARTICLE: Ghatak T. Artificial Intelligence Literacy in Intensive Care: From Algorithmic Fluency to Clinical Accountability. Indian J Crit Care Med 2026;30(4):272-274.
Indian J Crit Care Med
· 2026 Apr · PMID 42147712
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Yadav R, Banerjee D. Efficacy of Noninvasive Ventilation Compared with Invasive Mechanical Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2026;30(4):350-351.Yadav R, Banerjee D. Efficacy of Noninvasive Ventilation Compared with Invasive Mechanical Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2026;30(4):350-351.
Indian J Crit Care Med
· 2026 Apr · PMID 42147711
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BACKGROUND AND AIMS: Delirium is common in adult intensive care unit (ICU) patients and is associated with worse outcomes. Music-based interventions are increasingly used, but the relative effectiveness of different prog...BACKGROUND AND AIMS: Delirium is common in adult intensive care unit (ICU) patients and is associated with worse outcomes. Music-based interventions are increasingly used, but the relative effectiveness of different programs remains unclear. We conducted a network meta-analysis (NMA) to compare multiple music therapy interventions for ICU delirium. DATA SOURCES: We searched major Chinese and English databases (e.g., CNKI, PubMed, and the Cochrane Library) from inception to 21 August 2025. STUDY SELECTION: Randomized controlled trials comparing music-based interventions with usual care (UC) in adults (≥18 years) in the ICU were eligible. Interventions were categorized as simple music (SM) therapy, traditional Chinese medicine (TCM) five-element music, family voice stimulation combined with music (FS), and combined music (CM) therapy (music combined with another nonpharmacological component). DATA SYNTHESIS: A frequentist random-effects NMA (R, netmeta) was performed. Compared with UC, all music-based interventions were associated with a reduced delirium incidence [CM: Risk ratio (RR) = 0.43; TCM: RR = 0.45; FS: RR = 0.48; SM: RR = 0.51]. For delirium duration, CM [mean difference (MD) = -3.21 days] and TCM (MD = -2.89 days) showed statistically significant reductions, whereas SM and FS did not. The network ranking suggested CM had the highest probability of benefit; however, between-intervention differences were mainly supported by indirect comparisons and small trials. Heterogeneity and potential small-study effects were observed. CONCLUSION: Music-based interventions may reduce ICU delirium incidence, and some programs may shorten delirium duration. Because evidence is limited by heterogeneity, possible publication bias, and a paucity of head-to-head trials, rankings should be interpreted cautiously. Well-designed, multicenter RCTs with standardized protocols are needed before firm recommendations can be made. HOW TO CITE THIS ARTICLE: Hao Y, Song R, Wang A. Network Meta-analysis of the Efficacy of Different Music Therapy Interventions for Delirium in Adult Intensive Care Unit Patients. Indian J Crit Care Med 2026;30(4):335-343.
Indian J Crit Care Med
· 2026 Apr · PMID 42147710
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BACKGROUND AND AIMS: Delirium is a frequent and serious complication in critically ill patients, contributing to prolonged mechanical ventilation, extended intensive care unit (ICU) stays, and increased mortality. Disrup...BACKGROUND AND AIMS: Delirium is a frequent and serious complication in critically ill patients, contributing to prolonged mechanical ventilation, extended intensive care unit (ICU) stays, and increased mortality. Disruption of circadian rhythms plays a key role in its pathogenesis. Melatonin, a neurohormone with chronobiotic and antioxidant properties, may help prevent ICU delirium, though the optimal dose remains uncertain. PATIENTS AND METHODS: This prospective, randomized, interventional study enrolled 120 adult ICU patients, randomized to receive either 3 mg (group A) or 6 mg (group B) oral melatonin nightly for at least 5 days. Baseline parameters were comparable between groups. Delirium incidence was assessed twice daily using the confusion assessment method for the ICU (CAM-ICU). Secondary outcomes included the timing of delirium onset, adverse effects, ICU stay, and mortality. RESULTS: Delirium occurred in 55.0% of patients in group A and 36.7% in group B (χ² = 4.062, = 0.044), indicating a significant reduction with 6 mg of melatonin. The mean (SD) day of delirium onset and ICU length of stay were comparable between groups. Daytime somnolence was mild and similar across groups. CONCLUSIONS: Prophylactic administration of 6 mg of oral melatonin significantly reduced ICU delirium incidence compared with 3 mg, without added adverse effects. Higher-dose melatonin appears safe and more effective for delirium prevention in critically ill adults. HOW TO CITE THIS ARTICLE: Kumar PA, Chawla K, Kohli S, Singh R. Comparison of Two Doses of Prophylactic Melatonin on Incidence of Delirium in Intensive Care Unit Patients: A Randomized Controlled Trial. Indian J Crit Care Med 2026;30(4):319-323.
Indian J Crit Care Med
· 2026 Apr · PMID 42147709
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UNLABELLED: Over the last two decades, many legal developments and professional recommendations notwithstanding, end-of-life practice on the ground is limited by physician hesitancy, lack of commitment to ensure appropri...UNLABELLED: Over the last two decades, many legal developments and professional recommendations notwithstanding, end-of-life practice on the ground is limited by physician hesitancy, lack of commitment to ensure appropriateness in decision-making, persistent fear of legal liability, and inadequate attention to quality of dying. This commentary attempts to spell out the salient messages in the recent Harish Rana vs Union of India judgment and reiterates the essential components of end-of-life care (EOLC) in intensive care unit (ICU) practice. Thoughtful and compassionate care is integral to critical care practice. HOW TO CITE THIS ARTICLE: Mani RK. The Essentials of Compassionate End-of-life Care in the Intensive Care Unit: Lessons from the Harish Rana Case. Indian J Crit Care Med 2026;30(4):270-271.
Indian J Crit Care Med
· 2026 Apr · PMID 42147708
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Sarkar S, Azim A. Author Response: From Descriptive Hemodynamics to Decision-grade Vasoplegia Phenotyping: The Next Translational Step for Temporal Diastolic Shock Index. Indian J Crit Care Med 2026;30(4):356.Sarkar S, Azim A. Author Response: From Descriptive Hemodynamics to Decision-grade Vasoplegia Phenotyping: The Next Translational Step for Temporal Diastolic Shock Index. Indian J Crit Care Med 2026;30(4):356.
Indian J Crit Care Med
· 2026 Apr · PMID 42147707
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Moturu D, Potineni RB, Rayana S, Thommandru S, Shaik J, Jampala K, et al. Author Response: From Tele-ICU "Alerts" to Tele-ICU "Assurance": Making Hemodynamic Surveillance Decision-grade and Globally Transferable. Indian...Moturu D, Potineni RB, Rayana S, Thommandru S, Shaik J, Jampala K, et al. Author Response: From Tele-ICU "Alerts" to Tele-ICU "Assurance": Making Hemodynamic Surveillance Decision-grade and Globally Transferable. Indian J Crit Care Med 2026;30(4):345-346.
Vijayasimha M, Srikanth M, Rao K
… +3 more, Mishra P, Shweta, Juneja A
Indian J Crit Care Med
· 2026 Apr · PMID 42147706
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Vijayasimha M, Srikanth M, Rao K, Mishra P, Shweta, Juneja A. From Tele-ICU "Alerts" to Tele-ICU "Assurance": Making Hemodynamic Surveillance Decision-grade and Globally Transferable. Indian J Crit Care Med 2026;30(4):34...Vijayasimha M, Srikanth M, Rao K, Mishra P, Shweta, Juneja A. From Tele-ICU "Alerts" to Tele-ICU "Assurance": Making Hemodynamic Surveillance Decision-grade and Globally Transferable. Indian J Crit Care Med 2026;30(4):344.
Indian J Crit Care Med
· 2026 Apr · PMID 42147705
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Phillips A. Outcomes in Traumatic Brain Injury: Can Electroencephalography Predict the Unpredictable? Indian J Crit Care Med 2026;30(4):265-267.Phillips A. Outcomes in Traumatic Brain Injury: Can Electroencephalography Predict the Unpredictable? Indian J Crit Care Med 2026;30(4):265-267.