Critical Care Medicine[JOURNAL]
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200 papers
From Descriptive Hemodynamics to Decision-grade Vasoplegia Phenotyping: The Next Translational Step for Temporal Diastolic Shock Index.
Vijayasimha M, Srikanth M, Kapoor D … +3 more , Dhillon A, Verma V, Mishra S
Indian J Crit Care Med · 2026 Apr · PMID 42147704 · Full text
Vijayasimha M, Srikanth M, Kapoor D, Dhillon A, Verma V, Mishra S. From Descriptive Hemodynamics to Decision-grade Vasoplegia Phenotyping: The Next Translational Step for Temporal Diastolic Shock Index. Indian J Crit Car...
Vijayasimha M, Srikanth M, Kapoor D, Dhillon A, Verma V, Mishra S. 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):354-355.
Development and Validation of a Multivariable Machine Learning Model for Mortality Prediction among Intensive Care Unit Patients.
Dash A, Majhi K, Ghosh N … +7 more , Jena P, Choudhury S, Anushapreethi S, Samal S, Panda S, Patra SK, Mishra SB
Indian J Crit Care Med · 2026 Apr · PMID 42147703 · Full text
BACKGROUND AND AIMS: Precise forecasting of mortality in intensive care units (ICUs) is essential for enhancing patient management and resource distribution. Traditional scoring methods like the Acute Physiology and Chro...
BACKGROUND AND AIMS: Precise forecasting of mortality in intensive care units (ICUs) is essential for enhancing patient management and resource distribution. Traditional scoring methods like the Acute Physiology and Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA) are prevalent yet may inadequately encompass the intricacies of critical illness. The aim of this work was to create and internally test machine learning models for predicting mortality in the ICU, utilizing routinely gathered electronic health record data. PATIENTS AND METHODS: This retrospective cohort analysis encompassed 5,553 adult ICU hospitalizations from September 2021 to December 2023. Patients were randomly allocated into development (80%) and test (20%) cohorts. Three predictive models-Logistic Regression, Random Forest, and Extreme Gradient Boosting (XGBoost)-were developed utilizing demographic information, APACHE II and SOFA values, comorbidities, and ventilatory support status. The evaluation of model performance was conducted utilizing the area under the receiver operating characteristic curve (AUROC), precision, recall, and F1 score. RESULTS: Among the 5,553 analyzed ICU admissions, 1,869 patients succumbed during their ICU stay, yielding an ICU mortality rate of 33.6% (95% CI: 32.4-34.9). The Random Forest model had the superior discriminative capability for mortality prediction, achieving an AUROC of 0.842, followed by XGBoost with an AUROC of 0.835, and Logistic Regression with an AUROC of 0.833. Although Logistic Regression demonstrated slightly superior overall accuracy, ensemble models more effectively identified non-linear correlations among predictors. Acute Physiology and Chronic Health Evaluation II and SOFA values proved to be the most significant predictors in all models. Temporal validation and sensitivity analysis produced consistent outcomes, demonstrating the resilience of model performance. CONCLUSION: Machine learning models exhibited strong efficacy in predicting ICU mortality, with Random Forest and XGBoost displaying slight advantages over Logistic Regression. The incorporation of machine learning algorithms into existing ICU scoring systems may improve risk categorization and facilitate clinical decision-making. HOW TO CITE THIS ARTICLE: Dash A, Majhi K, Ghosh N, Jena P, Choudhury S, Anushapreethi S, . Development and Validation of a Multivariable Machine Learning Model for Mortality Prediction among Intensive Care Unit Patients. Indian J Crit Care Med 2026;30(4):282-290.
Author Response: Efficacy of Noninvasive Ventilation Compared with Invasive Mechanical Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis.
Attachaipanich T, Kaewboot K, Attachaipanich S
Indian J Crit Care Med · 2026 Apr · PMID 42147702 · Full text
Attachaipanich T, Kaewboot K, Attachaipanich S. Author Response: Efficacy of Noninvasive Ventilation Compared with Invasive Mechanical Ventilation in Cardiogenic Shock: A Systematic Review and Meta-analysis. Indian J Cri...
Attachaipanich T, Kaewboot K, Attachaipanich S. Author Response: 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):352-353.
Development and Validation of a Comprehensive Acute Encephalitis Syndrome Severity Score in Children with Acute Encephalitis Syndrome.
Sharawat IK, Panda PK, Rathaur VK … +5 more , Palayullakandi A, Sopanam S, Gupta D, Sherwani P, Tiwari LK
Indian J Crit Care Med · 2026 Apr · PMID 42147701 · Full text
BACKGROUND AND AIMS: No comprehensive scoring system is currently available to predict functional neurological outcomes in children with acute encephalitis syndrome (AES). We therefore developed and validated a score spe...
BACKGROUND AND AIMS: No comprehensive scoring system is currently available to predict functional neurological outcomes in children with acute encephalitis syndrome (AES). We therefore developed and validated a score specifically tailored for these children. PATIENTS AND METHODS: We developed the comprehensive acute encephalitis syndrome severity score (CAESS), which consists of five items [Glasgow Coma Scale (GCS)], focal deficit, status epilepticus, features of raised intracranial pressure (ICP), and pediatric logistic organ dysfunction-2 (PELOD-2) score selected after reviewing published literature. The content validity was assessed through the content validity index (CVI) and content validity ratio (CVR). The model's fit was examined using confirmatory factor analysis (CFA). Functional outcome was determined as good or poor at 6 months, based on the pediatric cerebral performance category (PCPC) score. Construct validity was established by correlating CAESS scores with the functional status scale (FSS), the intelligence quotient (IQ), and the gross motor function measure (GMFM-88). RESULTS: Comprehensive acute encephalitis syndrome severity score was evaluated in 159 children with AES; 114 (71%) had favorable outcomes at 6 months. Inter-rater reliability was good to excellent across items [intraclass correlation coefficient (ICC) range 0.82-0.94; kappa 0.80-0.92]. Internal consistency was good (Cronbach's alpha = 0.80). Content validity was also good (I-CVI 0.9-1.0; CVR 0.8-1.0). Confirmatory factor analysis supported a unidimensional structure, demonstrating good model fit [Tucker-Lewis index (TLI) = 0.98, comparative fit index (CFI) = 0.99, and root mean square error of approximation (RMSEA) = 0.05]. Comprehensive acute encephalitis syndrome severity score demonstrated strong discriminant validity (AUC = 0.91). At a cut-off ≥6, CAESS showed sensitivity of 88.9%, specificity of 84.2%, and a Youden index of 0.73. Strong correlations were observed with FSS ( = 0.82), PCPC ( = 0.84), GMFM-88 ( = -0.83), IQ ( = -0.71), and pediatric quality of life inventory (PedsQL) score ( = -0.74). CONCLUSION: The CAESS score may be a valid and reliable tool for predicting functional outcomes in children with acute encephalitis syndrome. However, given the absence of internal split-sample validation and external validation in an independent population, further prospective studies with robust internal validation and external replication are required before it can be recommended for routine clinical use. HOW TO CITE THIS ARTICLE: Sharawat IK, Panda PK, Rathaur VK, Palayullakandi A, Sopanam S, Gupta D, . Development and Validation of a Comprehensive Acute Encephalitis Syndrome Severity Score in Children with Acute Encephalitis Syndrome. Indian J Crit Care Med 2026;30(4):311-318.
Impact of Frailty (Clinical Frailty Scale) on Weaning from Mechanical Ventilation: A Systematic Review and Meta-analysis.
Mehra SS, Das SK, Das D … +1 more , Gupta A
Indian J Crit Care Med · 2026 Apr · PMID 42147700 · Full text
BACKGROUND AND AIMS: Frailty is a multidimensional syndrome marked by reduced physiological reserve and increased vulnerability to stress, often seen in critically ill patients. It may affect outcomes such as weaning fro...
BACKGROUND AND AIMS: Frailty is a multidimensional syndrome marked by reduced physiological reserve and increased vulnerability to stress, often seen in critically ill patients. It may affect outcomes such as weaning from mechanical ventilation. It has been associated with adverse intensive care unit (ICU) outcomes, but its relationship with liberation from mechanical ventilation remains unclear. This study systematically reviewed and meta-analyzed the association between frailty [Clinical Frailty Scale (CFS)] and weaning outcomes in mechanically ventilated patients, hypothesizing worse outcomes with higher frailty. METHODS: We systematically searched PubMed, Cochrane Library, ScienceDirect, KoreaMed, Google Scholar, and Semantic Scholar from inception for studies assessing frailty using the CFS and reporting weaning outcomes in mechanically ventilated ICU patients. Effect sizes were pooled as log odds ratios (OR) using a random-effects model. Risk of bias and certainty of evidence were evaluated using risk of bias in nonrandomized studies - of exposure (ROBINS-E) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools. RESULTS: Seven observational studies, including 13,746 patients, met the inclusion criteria. Frailty was associated with higher odds of weaning failure (OR: 2.52, 95% confidence interval: 1.46-4.34; = 0.001; = 7; prediction interval: 0.75-8.47). Substantial heterogeneity ( = 92.9%), high risk of bias, inconsistency, and potential publication bias were noted. Associations were directionally consistent across subgroups and sensitivity analyses. The certainty of evidence was very low. CONCLUSION: Frailty appears to be associated with an increased risk of weaning failure, with approximately 2.5-fold higher odds observed in pooled analysis, supporting its role as a potential prognostic marker in clinical decision-making. However, the certainty of evidence is very low, with substantial heterogeneity, risk of bias, and possible residual confounding. These findings should be considered hypothesis-generating and underscore the need for standardized weaning definitions and well-designed prospective studies to better evaluate frailty's predictive value. TRIAL REGISTRATION: PROSPERO CRD420251028375. HOW TO CITE THIS ARTICLE: Mehra SS, Das SK, Das D, Gupta A. Impact of Frailty (Clinical Frailty Scale) on Weaning from Mechanical Ventilation: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2026;30(4):324-334.
Gastrointestinal Tolerance to (Arrowroot) Powder Added to Formula Feeds in Intensive Care Unit Patients: A Nonrandomized Controlled Quasi-experimental Trial.
Mathew M, Verghese S
Indian J Crit Care Med · 2026 Apr · PMID 42147699 · Full text
BACKGROUND AND AIMS: Diarrhea is common in critically ill patients receiving enteral nutrition and often leads to feed interruption. Arrowroot () is rich in soluble fiber, and may improve gastrointestinal (GI) tolerance....
BACKGROUND AND AIMS: Diarrhea is common in critically ill patients receiving enteral nutrition and often leads to feed interruption. Arrowroot () is rich in soluble fiber, and may improve gastrointestinal (GI) tolerance. This study evaluated the safety and GI tolerance of adding arrowroot powder to enteral formula (EF) feeds. PATIENTS AND METHODS: A nonrandomized controlled open labeled, quasi-experimental, posttest-only trial was conducted in intensive care unit (ICU) patients receiving nasogastric enteral feeding. The intervention group received 100 gm of arrowroot powder added to formula feeds for 5 days; controls received standard formula feeds. Gastrointestinal intolerance to the specified weight of arrowroot powder was observed as incidence of new-onset noninfectious diarrhea, vomiting, and abdominal distension. Clinical outcomes included hospital-acquired infections, ICU/hospital length of stay (LOS) and ICU mortality. RESULTS: Ninety-four patients were included (34 intervention, 60 control). Arrowroot supplementation was well tolerated, with no adverse GI effects. New-onset diarrhea was lower in the intervention group (8.8 vs 26.7%), though not statistically significant. Relative risk reduction was 0.67. No differences in nosocomial infections, mortality, or LOS were observed. CONCLUSION: Arrowroot supplementation in enteral feeds appears feasible and, safe in critically ill patients. Its potential as a supplement to enteral feeds to reduce diarrhea needs to be explored with larger studies. HOW TO CITE THIS ARTICLE: Mathew M, Verghese S. Gastrointestinal Tolerance to (Arrowroot) Powder Added to Formula Feeds in Intensive Care Unit Patients: A Nonrandomized Controlled Quasi-experimental Trial. Indian J Crit Care Med 2026;30(4):291-297.
Renal Biomarkers of Injury as Early Predictors of COVID-19 Associated Acute Kidney Injury: A Prospective Observational Trial (BRICOAKI Study).
Kumar N, Mahto M, Kumar A … +2 more , Kumar A, Kumar A
Indian J Crit Care Med · 2026 Apr · PMID 42147698 · Full text
BACKGROUND AND AIMS: Acute kidney injury (AKI) is a common and serious complication among critically ill COVID-19 patients. Early identification of patients at risk is challenging because serum creatinine rises late in t...
BACKGROUND AND AIMS: Acute kidney injury (AKI) is a common and serious complication among critically ill COVID-19 patients. Early identification of patients at risk is challenging because serum creatinine rises late in the course of renal injury. Unlike prior COVID-19 AKI studies that measured serum neutrophil gelatinase-associated lipocalin (sNGAL) or Cystatin-C at a single time point, this study evaluates their serial trajectories and quantifies biomarker-creatinine lead-time in a critically ill intensive care unit (ICU) cohort. PATIENTS AND METHODS: This prospective observational study involved 65 adults with moderate to severe COVID-19 in the ICU. Serum biomarkers [NGAL, cystatin-C, interleukin (IL)-6, kidney injury molecule (KIM)-1, tissue inhibitor of metalloproteinases (TIMP)-2, creatinine] and urinary Klotho (uKlotho) were measured on days 0, 1, 2, 3, 5, 7, and 10. Acute kidney injury was defined per kidney disease: Improving global outcomes (KDIGO) criteria. Receiver operating characteristic (ROC) analysis and lead-time estimation evaluated predictive performance. RESULTS: Acute kidney injury occurred in 47/65 (72.3%) patients; of them, 36/47 (76.6%) progressed to KDIGO stages 2-3, and 5 (10.6%) required renal replacement therapy (RRT). Among the biomarkers studied, sNGAL demonstrated the highest discrimination for KDIGO-defined AKI [area under curve (AUC): 0.71-0.79] and increased approximately 1 day before creatinine-based AKI diagnosis. Serum cystatin-C (sCystatin-C) showed moderate predictive value (AUC: 0.63-0.70) with a median lead time of approximately 1-2 days. Serum KIM-1 (sKIM-1) demonstrated only borderline variation across severity groups, while uKlotho did not show significant discriminatory performance. Although TIMP-2 and IL-6 were significantly elevated with increasing disease severity, their overall discriminative performance for AKI was lower compared with NGAL and cystatin-C. CONCLUSION: In critically ill COVID-19 patients, serial sNGAL and sCystatin-C demonstrated modest but consistent discrimination for KDIGO-defined AKI and showed a tendency to rise 1-2 days prior to creatinine-based diagnosis. In contrast, sKIM-1, serum TIMP-2, uKlotho, and serum IL-6 exhibited limited discriminatory performance for early AKI detection. HOW TO CITE THIS ARTICLE: Kumar N, Mahto M, Kumar A, Kumar A, Kumar A. Renal Biomarkers of Injury as Early Predictors of COVID-19 Associated Acute Kidney Injury: A Prospective Observational Trial (BRICOAKI Study). Indian J Crit Care Med 2026;30(4):298-304.
Frail to Fail: More Support for Less Reserve-Can Clinical Frailty Scale Predict Path to Liberation?
Paul G, Dodda SRD
Indian J Crit Care Med · 2026 Apr · PMID 42147697 · Full text
Paul G, Dodda SRD. Frail to Fail: More Support for Less Reserve-Can Clinical Frailty Scale Predict Path to Liberation? Indian J Crit Care Med 2026;30(4):268-269.
Paul G, Dodda SRD. Frail to Fail: More Support for Less Reserve-Can Clinical Frailty Scale Predict Path to Liberation? Indian J Crit Care Med 2026;30(4):268-269.
Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational Study.
Jhunjhunwala M, Sachdev A, Gupta S … +2 more , Gupta D, Gupta N
Indian J Crit Care Med · 2026 Apr · PMID 42147696 · Full text
BACKGROUND AND AIMS: The COMFORT B score is a validated method for the assessment of the level of sedation in children, but it has its limitations. The bispectral index (BIS) is an electroencephalogram (EEG)-based tool u...
BACKGROUND AND AIMS: The COMFORT B score is a validated method for the assessment of the level of sedation in children, but it has its limitations. The bispectral index (BIS) is an electroencephalogram (EEG)-based tool used to assess the level of consciousness. The primary objective was to evaluate agreement between the BIS and the COMFORT B score for sedation in children on mechanical ventilation (MV). PATIENTS AND METHODS: This prospective, noninterventional study was conducted on 138 patients, aged >6 months, receiving MV in the pediatric intensive care unit (PICU). COMFORT B score and BIS were taken 30 minutes after initiation or dosage change of sedatives and then once every 8 hours for a maximum of 96 hours. RESULTS: A total of 1,534 datasets were analyzed. Bispectral index values ranged from 11 to 89, while COMFORT B scores were between 6 and 28. The mean [± standard deviation (SD)] value for the BIS and COMFORT B scores was 54.4 ± 13.8 and 14 ± 4, respectively. Adequate sedation was recorded in 82.5 and 79.9% instances with BIS and COMFORT B scores, respectively. The correlation coefficient () of BIS and COMFORT B scores was 0.7. Overall agreement ( value) between the BIS and COMFORT B score was 0.642. A BIS score of 43 had 93% sensitivity and 70% specificity in differentiating oversedation from adequate sedation (AUROC 0.81). Similarly, a BIS value of 79 distinguished between adequate and undersedation (sensitivity 90%; specificity 98%; AUROC 0.966). The best AUROC (0.777) was observed in children with central nervous system (CNS) diseases, while the worst (0.54) occurred in patients with neuromuscular diseases. CONCLUSION: The BIS and COMFORT B scores have a good level of agreement in children, except in children with neuromuscular diseases. HOW TO CITE THIS ARTICLE: Jhunjhunwala M, Sachdev A, Gupta S, Gupta D, Gupta N. Bispectral Index and COMFORT B Score for Sedation in Mechanically Ventilated Children: A Prospective Observational Study. Indian J Crit Care Med 2026;30(4):305-310.
Diagnostic Accuracy of Point-of-care Ultrasonography for Endotracheal Tube Confirmation: Interpreting Evidence beyond Pooled Estimates.
Prakash J, Saran K, Swarna K … +2 more , Choudhuri B, Gupta BK
Indian J Crit Care Med · 2026 Apr · PMID 42147695 · Full text
Prakash J, Saran K, Swarna K, Choudhuri B, Gupta BK. Diagnostic Accuracy of Point-of-care Ultrasonography for Endotracheal Tube Confirmation: Interpreting Evidence beyond Pooled Estimates. Indian J Crit Care Med 2026;30(...
Prakash J, Saran K, Swarna K, Choudhuri B, Gupta BK. Diagnostic Accuracy of Point-of-care Ultrasonography for Endotracheal Tube Confirmation: Interpreting Evidence beyond Pooled Estimates. Indian J Crit Care Med 2026;30(4):357-358.
Correspondence Regarding: "A Prospective Comparative Study of Optic Nerve Sheath Diameter Measurement by Ultrasonography vs Computed Tomography Scan for the Detection of Elevated Intracranial Pressure in Patients with Acute Neurological Emergencies".
Kumar RM, Brahmam D, Samireddypalle Y … +2 more , Mithilesh A, Madhuri M
Indian J Crit Care Med · 2026 Mar · PMID 42146992 · Full text
Kumar RM, Brahmam D, Samireddypalle Y, Mithilesh A, Madhuri M. Correspondence Regarding: "A Prospective Comparative Study of Optic Nerve Sheath Diameter Measurement by Ultrasonography vs Computed Tomography Scan for the...
Kumar RM, Brahmam D, Samireddypalle Y, Mithilesh A, Madhuri M. Correspondence Regarding: "A Prospective Comparative Study of Optic Nerve Sheath Diameter Measurement by Ultrasonography vs Computed Tomography Scan for the Detection of Elevated Intracranial Pressure in Patients with Acute Neurological Emergencies". Indian J Crit Care Med 2026;30(3):262-263.
Clinical Profile and Survival Outcomes of Children with Acute Kidney Injury Requiring Renal Replacement Therapy: A Retrospective Study from a Tertiary Pediatric Intensive Care Unit.
Swarnim S, Ghorui A, Kumar S … +1 more , Prasad A
Indian J Crit Care Med · 2026 Mar · PMID 42146991 · Full text
BACKGROUND AND AIMS: Acute kidney injury (AKI) in children is a serious and potentially life-threatening condition, particularly among critically ill patients. Despite advances in renal replacement therapy (RRT), mortali...
BACKGROUND AND AIMS: Acute kidney injury (AKI) in children is a serious and potentially life-threatening condition, particularly among critically ill patients. Despite advances in renal replacement therapy (RRT), mortality remains high. This study aimed to evaluate the etiology and indications for RRT in pediatric AKI, identify predictors of mortality, and compare survival outcomes between hemodialysis (HD) and peritoneal dialysis (PD). PATIENTS AND METHODS: This single-center, retrospective observational study included children aged 1 month to 18 years who received RRT for AKI at a tertiary care hospital in Eastern India between January 2023 and December 2024. Acute kidney injury was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 criteria. Demographic, clinical (including illness severity scores), and laboratory data were extracted from medical records. Predictors of mortality were evaluated using univariate and multivariate logistic regression analysis. Kaplan-Meier estimation, the log-rank test, and Cox proportional hazards regression analysis were used to compare survival between HD and PD. RESULTS: Out of 40 patients, 28 (70%) received HD and 12 (30%) underwent PD. The overall in-hospital mortality rate was 27.5% (11/40). The most common cause of AKI necessitating RRT was sepsis (39.5%), which included urosepsis and systemic sepsis. Refractory fluid overload (>10%) was the primary indication for RRT initiation in 67.5% of patients. Non-survivors had a significantly higher prevalence of sepsis, multiple organ dysfunction syndrome (MODS), underlying comorbidities, vasopressor use, and greater mean percentage of fluid overload (mean: 16.8% in non-survivors vs 8.3% in survivors; = 0.003). In univariate analysis, dialysis modality, comorbidities, fluid overload, sepsis, MODS, and vasopressor use were significantly associated with mortality. However, none of these were independently predictive in the multivariate logistic regression analysis. Median time to in-hospital death or discharge was significantly longer in the HD group (88 vs 22 days, = 0.0012). Cox regression showed an increased association with in-hospital mortality risk in the PD group [hazard ratio (HR) = 4.41, 95% confidence interval (CI): 1.19-16.33, = 0.026]. CONCLUSION: Higher mortality was observed in patients with sepsis, MODS, and significant fluid overload. The higher mortality in the PD group is likely attributable to selection bias, as PD was preferentially used in sicker, hemodynamically unstable patients. HOW TO CITE THIS ARTICLE: Swarnim S, Ghorui A, Kumar S, Prasad A. Clinical Profile and Survival Outcomes of Children with Acute Kidney Injury Requiring Renal Replacement Therapy: A Retrospective Study from a Tertiary Pediatric Intensive Care Unit. Indian J Crit Care Med 2026;30(3):211-217.
Author Response: Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients.
Sundaramurthy SK, Ramakrishnan N, Savio RD
Indian J Crit Care Med · 2026 Mar · PMID 42146990 · Full text
Sundaramurthy SK, Ramakrishnan N, Savio RD. Author Response: Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients. Indian J Crit Care Med 2026;30(3):261.
Sundaramurthy SK, Ramakrishnan N, Savio RD. Author Response: Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients. Indian J Crit Care Med 2026;30(3):261.
Evaluation of the Potential Efficacy of Bacteriophage Therapy for the Management of Pressure Ulcers and Its Comparison to Conventional Therapy: A Randomized Controlled Trial.
Meena K, Meena RK, Kumari S … +2 more , Thambidurai P, Nath G
Indian J Crit Care Med · 2026 Mar · PMID 42146989 · Full text
BACKGROUND AND AIMS: Pressure ulcers (PUs) are common in physical trauma patients who require prolonged stays in the intensive care unit (ICU). Despite standard preventive and therapeutic measures, healing is often a slo...
BACKGROUND AND AIMS: Pressure ulcers (PUs) are common in physical trauma patients who require prolonged stays in the intensive care unit (ICU). Despite standard preventive and therapeutic measures, healing is often a slow process. Conventional systemic antibiotics offer limited therapeutic benefits due to inadequate tissue penetration and the associated risk of driving antimicrobial resistance. Bacteriophage therapy, with its ability to target resistant and biofilm-associated bacteria, offers a potential "alternative." We aimed to evaluate the efficacy and safety of topical bacteriophage therapy for the management of PUs in critically ill ICU patients and its comparison to conventional therapy. PATIENTS AND METHODS: This prospective, randomized, double-blind controlled trial was conducted in the ICU of a tertiary care center between April 2024 and May 2025. Seventy-six adult patients with grade II-IV PUs were screened, and 68 were enrolled (34 in each group). Group C received conventional therapy, while group B received conventional plus customized topical bacteriophage therapy. Healing was assessed using the Pressure Ulcer Scale for Healing (PUSH) tool; tissue type, exudate amount, and ulcer dimensions were assessed at baseline and on days 5, 7, 14, 21, and 28. The primary objective was to evaluate the efficacy of bacteriophage therapy for the management of PUs. The secondary objective was to observe the safety profile of bacteriophage therapy. RESULTS: Both groups demonstrated healing over time, but group B demonstrated significantly greater improvement as compared to group C. The reduction in the mean PUSH score was higher in group B ( < 0.05). Group B also showed faster epithelialization, an earlier decrease in exudate, and more closed ulcers. These differences became statistically significant from day 7 onward. No adverse events were reported. CONCLUSION: Topical bacteriophage therapy is a safe and effective adjunct to conventional care in the management of PUs among ICU patients. HOW TO CITE THIS ARTICLE: Meena K, Meena RK, Kumari S, Thambidurai P, Nath G. Evaluation of the Potential Efficacy of Bacteriophage Therapy for the Management of Pressure Ulcers and Its Comparison to Conventional Therapy: A Randomized Controlled Trial. Indian J Crit Care Med 2026;30(3):196-203.
Every Hour Does Matter: A Bayesian Confirmation of Antibiotic Urgency in Sepsis.
Das SK
Indian J Crit Care Med · 2026 Mar · PMID 42146988 · Full text
Das SK. Every Hour Does Matter: A Bayesian Confirmation of Antibiotic Urgency in Sepsis. Indian J Crit Care Med 2026;30(3):189-190.
Das SK. Every Hour Does Matter: A Bayesian Confirmation of Antibiotic Urgency in Sepsis. Indian J Crit Care Med 2026;30(3):189-190.
Hepatic Elastography in the Intensive Care Unit: Are We Ready to Use It as a Window into Critical Illness?
Ghatak T, Zafar K
Indian J Crit Care Med · 2026 Mar · PMID 42146987 · Full text
BACKGROUND: The liver is highly susceptible to hemodynamic and inflammatory insults in critical illness, yet conventional biomarkers often detect injury only after it is established. Two-dimensional shear wave elastograp...
BACKGROUND: The liver is highly susceptible to hemodynamic and inflammatory insults in critical illness, yet conventional biomarkers often detect injury only after it is established. Two-dimensional shear wave elastography (2D-SWE) is a noninvasive bedside tool that quantifies liver stiffness and may offer real-time insights into hepatic congestion and perfusion. AIM: This viewpoint evaluates the current evidence, practical applications, and limitations of integrating 2D-SWE into routine intensive care unit (ICU) practice. MAIN FINDINGS: Emerging data suggest that 2D-SWE can detect hepatic congestion secondary to right heart dysfunction and may identify early sepsis-related liver injury before biochemical changes manifest. It also holds potential for monitoring hepatosplanchnic perfusion in patients on vasopressors. However, widespread adoption is hindered by significant physiological confounders in the ICU (e.g., positive pressure ventilation, edema), a lack of randomized outcome trials, and operational challenges. Currently, its most pragmatic role lies in serial, trend-based monitoring as an adjunct to clinical assessment. CONCLUSION: While 2D-SWE is a promising physiological tool that can enrich our understanding of shock and organ dysfunction, it is not yet ready to dictate management. High-quality, context-specific research-particularly in high-burden settings like India-is required to transition this technology from hypothesis-generating to practice-changing. HOW TO CITE THIS ARTICLE: Ghatak T, Zafar K. Hepatic Elastography in the Intensive Care Unit: Are We Ready to Use It as a Window into Critical Illness? Indian J Crit Care Med 2026;30(3):194-195.
An Observational Study on Diagnostic Accuracy of Lung Ultrasound Compared to High-resolution Computed Tomography Scan of Thorax in Patients Admitted with Respiratory Problems to Critical Care Unit of a Tertiary Care Hospital in Eastern India.
Dhenki A, Dasgupta S, Choudhury A … +3 more , Mondal T, Mukhopadhyay S, Bardhan J
Indian J Crit Care Med · 2026 Mar · PMID 42146986 · Full text
BACKGROUND AND AIM: Acute respiratory failure in critically ill patients poses a diagnostic challenge, often requiring high-resolution computed tomography (HRCT) of the thorax for definitive diagnosis. However, the inher...
BACKGROUND AND AIM: Acute respiratory failure in critically ill patients poses a diagnostic challenge, often requiring high-resolution computed tomography (HRCT) of the thorax for definitive diagnosis. However, the inherent risks of transporting hemodynamically unstable patients to the radiology suite necessitate safer bedside alternatives. The objective of the present study was to evaluate the diagnostic yield of both six-zone and extended 12-zone lung ultrasound (LUS) compared to HRCT thorax. PATIENTS AND METHODS: In this cross-sectional observational study conducted on 150 patients, admitted in the critical care unit and surgical intensive care unit (ICU), six-zone and 12-zone LUS were performed within 24 hours of an HRCT thorax for the most common etiologies of respiratory failure. Diagnostic yield of six-zone and 12-zone LUS to HRCT thorax was compared through calculating Cohen's kappa statistic (value ≥ 0.7) being interpreted as indicating strong agreement between two modalities. RESULTS: For consolidation, the 12-zone protocol showed superior sensitivity (0.84 vs 0.76) and negative predictive value (NPV) (0.61 vs 0.47) compared to the six-zone protocol. Agreement with HRCT was "moderate" for the six-zone protocol (kappa = 0.52) but "substantial" for the 12-zone protocol (kappa = 0.81). For pleural effusion and edema, LUS maintained high sensitivity (>0.85). CONCLUSION: Both LUS protocols are effective, but the 12-zone protocol significantly improves the diagnostic yield for lung consolidation, providing substantial agreement with HRCT. HOW TO CITE THIS ARTICLE: Dhenki A, Dasgupta S, Choudhury A, Mondal T, Mukhopadhyay S, Bardhan J. An Observational Study on Diagnostic Accuracy of Lung Ultrasound Compared to High-resolution Computed Tomography Scan of Thorax in Patients Admitted with Respiratory Problems to Critical Care Unit of a Tertiary Care Hospital in Eastern India. Indian J Crit Care Med 2026;30(3):237-243.
The Indirect Assessment of Intracranial Pressure by Measuring the Optic Nerve Sheath Diameter is Unreliable as Long as Interfering Factors are Disregarded.
Finsterer J, Mehri S
Indian J Crit Care Med · 2026 Mar · PMID 42146985 · Full text
Finsterer J, Mehri S. The Indirect Assessment of Intracranial Pressure by Measuring the Optic Nerve Sheath Diameter is Unreliable as Long as Interfering Factors are Disregarded. Indian J Crit Care Med 2026;30(3):257-258.
Finsterer J, Mehri S. The Indirect Assessment of Intracranial Pressure by Measuring the Optic Nerve Sheath Diameter is Unreliable as Long as Interfering Factors are Disregarded. Indian J Crit Care Med 2026;30(3):257-258.
Functional Status Scale as a Measure of Functional Impairment and Residual Morbidity in Pediatric Intensive Care Unit Survivors: A Single-center Observational Study.
Bajpai N, Dubey KC, Chowdhoury SR … +2 more , Nandi M, Irene M
Indian J Crit Care Med · 2026 Mar · PMID 42146984 · Full text
BACKGROUND AND AIMS: Limited data are available on the functional impairments of critically ill patients who survive the pediatric intensive care unit (PICU). There is rising interest among clinicians and intensivists in...
BACKGROUND AND AIMS: Limited data are available on the functional impairments of critically ill patients who survive the pediatric intensive care unit (PICU). There is rising interest among clinicians and intensivists in newly acquired functional morbidity among such survivors. The Functional Status Scale (FSS) is an effective tool for assessing functional impairments. Our aim was to assess changes in the functional status of patients at discharge from the PICU and at a 3-month follow-up compared to baseline. We also intended to observe for any residual morbidity at 3 months after discharge from the PICU. PATIENTS AND METHODS: Children aged 2 months to 12 years with a PICU stay of 48 hours or more, or an age-adjusted quick sequential organ failure assessment (qSOFA) score of 2 or less, were included in the study. Functional assessment using the FSS was performed for these patients at PICU admission, during the PICU stay, at discharge from the PICU, and at the 3-month follow-up. RESULTS: We observed that 3.3% of patients had residual morbidity (≥1 increase in FSS scores from baseline) at the 3-month follow-up. Greater functional impairment was noted in the PICU cohort at discharge compared to baseline ( < 0.01) but not at 3 months ( = 0.09). A statistically significant difference was noted in PICU patients shifted for neurological causes ( = 0.007) and those receiving mechanical ventilation ( = 0.019). The score difference at discharge from baseline was more in patients with longer PICU stays (1.5 ± 0.5; = 0.04). CONCLUSION: The FSS is an effective tool to evaluate functional impairments among pediatric patients admitted in PICU. Multiple factors, including length of PICU stay, cause of shifting, and modalities of treatment, influence functional impairments. HOW TO CITE THIS ARTICLE: Bajpai N, Dubey KC, Chowdhoury SR, Nandi M, Irene M. Functional Status Scale as a Measure of Functional Impairment and Residual Morbidity in Pediatric Intensive Care Unit Survivors: A Single-center Observational Study. Indian J Crit Care Med 2026;30(3):225-230.
Comparison of Clinical Profile and Outcomes Associated with Adenovirus and Non-adenovirus Viral Pneumonia in Children Admitted to a Pediatric Intensive Care Unit: A Single-center Retrospective Study.
Agarwal S, Patra B, Goyal N … +4 more , Nanda S, Yadav S, Malik A, Kumar V
Indian J Crit Care Med · 2026 Mar · PMID 42146983 · Full text
BACKGROUND: Severe adenovirus (AdV) pneumonia is a significant cause of morbidity and mortality in pediatric intensive care units (PICUs). This study aims to compare the clinical profile, laboratory parameters, radiologi...
BACKGROUND: Severe adenovirus (AdV) pneumonia is a significant cause of morbidity and mortality in pediatric intensive care units (PICUs). This study aims to compare the clinical profile, laboratory parameters, radiological findings, and outcomes of children with severe AdV pneumonia with non-AdV viral pneumonia. PATIENTS AND METHODS: We conducted a retrospective review of case records of children diagnosed with viral pneumonia through PCR analysis of nasopharyngeal/throat swabs or bronchoalveolar lavage. Outcomes assessed included all-cause mortality, need for mechanical ventilation, duration of PICU and hospital stay, and incidence of bronchiolitis obliterans (BO) in each group. Univariate and multivariate logistic regression analyses were performed to identify risk factors for mortality and BO in the entire cohort. RESULTS: Among 148 children with severe pneumonia, 63 (42.5%) had one or more viral isolates: AdV (31, 49.2%) and non-AdV viruses (32, 50.7%). The clinical profiles of the AdV and non-AdV viral pneumonia groups were comparable, except that all children in the AdV group were under 5 years of age [32 (100%) vs 26 (81.2%), ( 0.02)]. Leukopenia was more common in the AdV group (16.1 vs 0%, 0.01). Short-term outcomes, including mortality, length of PICU and hospital stay, and duration of mechanical ventilation, were similar between the groups. However, BO incidence was significantly higher in AdV cases (22.5 vs 3.1%, 0.02). Multivariate analysis identified acute respiratory distress syndrome (ARDS) and acute kidney injury (AKI) as independent risk factors for mortality, while prolonged PICU and hospital stay were linked to BO development. CONCLUSION: While the overall clinical profile and short-term outcomes of severe AdV and non-AdV viral pneumonia are similar, children with AdV pneumonia are younger, more prone to leukopenia, and at a higher risk of developing BO. HOW TO CITE THIS ARTICLE: Agarwal S, Patra B, Goyal N, Nanda S, Yadav S, Malik A, . Comparison of Clinical Profile and Outcomes Associated with Adenovirus and Non-adenovirus Viral Pneumonia in Children Admitted to a Pediatric Intensive Care Unit: A Single-center Retrospective Study. Indian J Crit Care Med 2026;30(3):218-224.
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