Indian J Crit Care Med
· 2026 Mar · PMID 42146982
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Salotagi S, Jindal A. From Indications to Outcomes: Fluid Overload, Sepsis, and Severity Shaping Contemporary Renal Replacement Therapy in Pediatric Acute Kidney Injury. Indian J Crit Care Med 2026;30(3):191-193.Salotagi S, Jindal A. From Indications to Outcomes: Fluid Overload, Sepsis, and Severity Shaping Contemporary Renal Replacement Therapy in Pediatric Acute Kidney Injury. Indian J Crit Care Med 2026;30(3):191-193.
Indian J Crit Care Med
· 2026 Mar · PMID 42146981
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Parameswaran P, Venkatachalam B. Authors Response: Correspondence Regarding: "A Prospective Comparative Study of Optic Nerve Sheath Diameter Measurement by Ultrasonography vs Computed Tomography Scan for the Detection of...Parameswaran P, Venkatachalam B. Authors Response: 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):264.
Indian J Crit Care Med
· 2026 Mar · PMID 42146980
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BACKGROUND: Micronutrient adequacy is essential for wound healing, immune competence, antioxidant defense, and erythropoiesis, all critical to perioperative recovery. Deficiencies in iron, vitamin C, vitamin D, selenium,...BACKGROUND: Micronutrient adequacy is essential for wound healing, immune competence, antioxidant defense, and erythropoiesis, all critical to perioperative recovery. Deficiencies in iron, vitamin C, vitamin D, selenium, and zinc are common in surgical patients and may worsen outcomes. This review evaluated evidence linking micronutrient status or supplementation with surgical outcomes. METHODS: A PRISMA-based systematic review of major databases and trial registries (through August 2025) included randomized controlled trials (RCTs) and observational studies assessing endpoints such as wound healing, surgical-site infection, transfusion, organ dysfunction, pain, and length of stay. Risk of bias was assessed using standard tools. Narrative summarization of data was done because the outcome measures and study designs were different in eligible studies. RESULTS: Twenty-two studies met the inclusion criteria. Intravenous iron consistently increased hemoglobin and iron stores but showed variable transfusion effects. Vitamin C supplementation reduced perioperative pain and modestly improved wound healing. Selenium normalization did not translate into outcome benefits. Low vitamin D and zinc levels were associated with higher infection rates and delayed healing, though interventional evidence remains limited. The results of individual studies were put into perspective using the previously published systematic reviews. CONCLUSIONS: Routine high-dose supplementation is not justified. Targeted preoperative screening and correction of iron, vitamin D, zinc, and selenium deficiencies may improve recovery in high-risk surgical patients. Further large, standardized trials are needed to define optimal timing, dosing, and clinical benefits. HOW TO CITE THIS ARTICLE: Banerjee D, Yadav R. Role of Micronutrients in Perioperative Care: A Systematic Review. Indian J Crit Care Med 2026;30(3):244-254.
Indian J Crit Care Med
· 2026 Mar · PMID 42146979
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Parameswaran P, Venkatachalam B. Author's Response: The Indirect Assessment of Intracranial Pressure by Measuring the Optic Nerve Sheath Diameter is Unreliable as Long as Interfering Factors are Disregarded. Indian J Cri...Parameswaran P, Venkatachalam B. Author's Response: 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):259.
Indian J Crit Care Med
· 2026 Mar · PMID 42146978
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Garg SK. An Unexpected Outcome during Transition from Open to Closed Intensive Care Unit: What Went Wrong? Indian J Crit Care Med 2026;30(3):255-256.Garg SK. An Unexpected Outcome during Transition from Open to Closed Intensive Care Unit: What Went Wrong? Indian J Crit Care Med 2026;30(3):255-256.
Havaldar AA, Saji A, Thomas T
… +4 more, Selvam M, Josy J, Nandhini CS, Madhammal N
Indian J Crit Care Med
· 2026 Mar · PMID 42146977
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BACKGROUND AND AIMS: Sepsis is a leading cause of intensive care unit (ICU) admission and mortality. Although early antibiotic therapy in the emergency department improves outcomes, the clinical impact of delays in ICU-b...BACKGROUND AND AIMS: Sepsis is a leading cause of intensive care unit (ICU) admission and mortality. Although early antibiotic therapy in the emergency department improves outcomes, the clinical impact of delays in ICU-based antibiotic escalation is not well established. This study evaluated the association between time to ICU-based initiation of newly prescribed antibiotics and ICU mortality using a Bayesian analytical framework. PATIENTS AND METHODS: A prospective observational study (2019-2021) was conducted in a tertiary care hospital, including adult patients admitted to the ICU. New antibiotic administration represented an escalation of therapy for suspected new-onset or worsening infection. Delay was defined as the interval between prescription and actual administration. Repeated antibiotic escalation events within patients were analyzed using a Bayesian generalized linear mixed model (GLMM) accounting for within-patient correlation. RESULTS: A total of 695 antibiotic escalation events occurred in 467 patients (mean age 50.6 ± 17.7 years; 61.7% male). The majority of patients received antibiotics within 3 hours of sepsis recognition (90.6%), and 42.8% within 1 hour. Intensive care unit mortality was 25.9%. Each hour delay in administration of newly prescribed ICU antibiotics was associated with increased odds of ICU mortality [posterior odds ratio (OR): 1.13, 95% credible interval (CrI): 1.11-1.15]. Higher mortality was also associated with septic shock, hospital-acquired infection, higher delta sequential organ failure assessment (Δ SOFA), and higher Acute Physiology and Chronic Health Evaluation (APACHE II) Score. CONCLUSION: Delays in ICU-based antibiotic escalation are associated with increased mortality. Timely escalation may represent an important, modifiable target to improve outcomes in critically ill patients with suspected sepsis. HOW TO CITE THIS ARTICLE: Havaldar AA, Saji A, Thomas T, Selvam M, Josy J, Nandhini CS, . Time to Initiation of Antibiotic Therapy in Critically Ill Patients with Suspected Sepsis and Its Effect on Intensive Care Unit Mortality: Analysis Using Bayesian Approach. Indian J Crit Care Med 2026;30(3):204-210.
Indian J Crit Care Med
· 2026 Mar · PMID 42146976
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BACKGROUND AND AIMS: Cirrhosis is a major cause of morbidity, frequently leading to complications like hepatorenal syndrome (HRS). Diagnosing HRS is difficult, as serum creatinine (SCr), commonly used to assess renal dys...BACKGROUND AND AIMS: Cirrhosis is a major cause of morbidity, frequently leading to complications like hepatorenal syndrome (HRS). Diagnosing HRS is difficult, as serum creatinine (SCr), commonly used to assess renal dysfunction, has significant limitations in cirrhosis. This study explored renal resistive index (RRI) as a potential alternative for early detection of HRS.This study aimed to evaluate the utility of RRI as an early predictor of HRS in cirrhotic adults admitted to a tertiary intensive care unit (ICU). PATIENTS AND METHODS: A prospective observational study was conducted on 78 cirrhotic adult ICU patients. Renal resistive index was measured within 24 hours of admission. Clinical, biochemical, and ultrasound parameters were collected. Statistical analyses included analysis of variance (ANOVA), -tests, Pearson correlation, logistic regression, and receiver operating characteristic (ROC) analysis. RESULTS: Of 78 patients, 88.5% were male and 78.2% had alcohol-related cirrhosis. Hepatorenal syndrome occurred in 30.8% of cases. Renal resistive index showed a strong correlation with ascites grade, MELD-Na, and Child-Pugh class. Receiver operating characteristic analysis revealed RRI >0.705 had 87.5% sensitivity and 87.0% specificity in predicting HRS. The RRI elevation preceded the SCr rise by 24-48 hours. Backward stepwise conditional logistic regression, however, identified ascitic grade as the independent predictor of HRS ( < 0.001). CONCLUSION: Although ascitic grade was the sole independent predictor of HRS in our multivariate model, RRI was strongly associated with HRS onset and may offer additional utility alongside clinical parameters for early identification of at-risk patients. HOW TO CITE THIS ARTICLE: Peter D, Kuruvilla CS, John JK. A Prospective Observational Study on Renal Resistive Index as an Early Predictor of Hepatorenal Syndrome. Indian J Crit Care Med 2026;30(3):231-236.
Indian J Crit Care Med
· 2026 Mar · PMID 42146975
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Agrawal U. Bacteriophages: A Long-forgotten Past, or Hope for the Future? Indian J Crit Care Med 2026;30(3):185-188.Agrawal U. Bacteriophages: A Long-forgotten Past, or Hope for the Future? Indian J Crit Care Med 2026;30(3):185-188.
Indian J Crit Care Med
· 2026 Mar · PMID 42146974
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Aydemir FD. Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients. Indian J Crit Care Med 2026;30(3):260.Aydemir FD. Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients. Indian J Crit Care Med 2026;30(3):260.
Kruger N, Durr K, Fernando SM
… +8 more, Rochwerg B, Inaba K, Kim D, Yadav K, Kubelik D, Engels PT, Glen P, Tran A
Crit Care Med
· 2026 Jul · PMID 42138515
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OBJECTIVE: Necrotizing soft-tissue infections (NSTIs) are rapidly progressive infections often characterized by widespread necrosis, sepsis, and multiple organ failure. As such, it is important to individualize treatment...OBJECTIVE: Necrotizing soft-tissue infections (NSTIs) are rapidly progressive infections often characterized by widespread necrosis, sepsis, and multiple organ failure. As such, it is important to individualize treatment decisions using evidence-based prognostication. We aimed to summarize the prognostic association between patient and disease factors and mortality among adult patients with NSTI. DATA SOURCES: We searched three databases (Medline, Embase, and the Cochrane Central Register of Controlled Trials) from inception to September 29, 2025. STUDY SELECTION: We included studies that enrolled adult patients with NSTI and evaluated prognostic factors associated with short-term mortality using adjusted models that account for at least age and comorbidity. DATA EXTRACTION: We pooled effect estimates using a random-effects model. We assessed risk-of-bias using the Quality in Prognosis Studies tool and assessed certainty of evidence using Grading of Recommendations, Assessment, Development, and Evaluations methodology. DATA SYNTHESIS: We included 41 observational cohort studies involving 168,261 patients. Studies were predominantly retrospective cohorts. Patient factors with a moderate or high certainty of association with increased mortality include older age, chronic liver disease, chronic kidney disease, high Charlson Comorbidity Index, and immunosuppression. Disease factors with a moderate or high certainty of association with increased mortality include hypotension, bacteremia, acute kidney injury, coagulopathy, thrombocytopenia, and shock. CONCLUSIONS: Several patient and illness factors demonstrate important association with mortality among patients with NSTI. Clinicians should consider these factors in decisions related to escalation of therapy, and counseling patients and family members on potential outcomes.
Hardt MM, Lichtenthal WG, Saviano S
… +7 more, Rosen A, Lief L, Berlin DA, Kolla S, Rogers M, Maciejewski PK, Prigerson HG
Crit Care Med
· 2026 Jul · PMID 42133624
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OBJECTIVES: Examine ICU caregivers' experience of patient-related financial strain and its association with caregiver psychological distress (i.e., posttraumatic stress, anxiety, and depressive symptoms) and healthcare p...OBJECTIVES: Examine ICU caregivers' experience of patient-related financial strain and its association with caregiver psychological distress (i.e., posttraumatic stress, anxiety, and depressive symptoms) and healthcare perceptions (i.e., medical mistrust, decisional regret). DESIGN: Cross-sectional secondary analysis using baseline data from an ongoing, multicenter randomized controlled trial intervention study ( ClinicalTrials.gov identifier NCT05587517). SETTING: Three medical ICU sites in the United States. SUBJECTS: Family caregivers ( n = 97) of patients in medical ICUs admitted from October 2022 to December 2025, with a mean age of 52.32 years, of whom 67 (69.1%) were female, and 42 (43.3%) were the spouse/partner of the patient. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Caregivers completed measures assessing degree of difficulty paying for patient medical care, posttraumatic stress symptoms, anxiety symptoms, depressive symptoms, medical mistrust, and decisional regret. Analyses found 63.9% participants reported difficulty paying for patient medical care and that financial strain was positively associated with severity of posttraumatic stress symptoms ( r = 0.35; p < 0.001; 95% CI, 0.15-0.52), anxiety symptoms ( r = 0.22; p < 0.05; 95% CI, 0.02-0.41), depressive symptoms ( r = 0.27; p < 0.01; 95% CI, 0.07-0.45), decisional regret ( r = 0.30; p < 0.05; 95% CI, 0.03-0.52), and medical mistrust ( r = 0.30; p < 0.01; 95% CI, 0.10-0.48). CONCLUSIONS: Over half of ICU caregivers endorsed difficulty paying for patient medical care. Caregivers with greater difficulty paying for patient medical care had more severe posttraumatic stress symptoms, anxiety symptoms, and depressive symptoms; greater decisional regret; and higher levels of medical mistrust.
Tirupakuzhi Vijayaraghavan BK, Patodia S, Gamage Dona D
… +8 more, Venkataraman R, Beane A, Haniffa R, de Keizer N, Adhikari NKJ, Ramakrishnan N, Fowler R, Indian Registry of IntenSive care (IRIS) collaboration
Crit Care Med
· 2026 Jul · PMID 42132466
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OBJECTIVES: To evaluate the association between sex assigned at birth and outcomes for critically ill patients in India. DESIGN: Retrospective registry-embedded cohort study. SETTING: Forty-five ICUs that are part of the...OBJECTIVES: To evaluate the association between sex assigned at birth and outcomes for critically ill patients in India. DESIGN: Retrospective registry-embedded cohort study. SETTING: Forty-five ICUs that are part of the Indian Registry of IntenSive care (IRIS). PATIENTS: We included adult (≥ 16 yr) patients admitted to ICUs in the IRIS. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary exposure was sex at birth, and the primary outcome was ICU mortality. Secondary outcomes included in-hospital mortality, receipt of mechanical ventilation, kidney replacement therapy, and vasopressors. Logistic regression models for the primary and secondary outcomes were adjusted for prespecified baseline covariates. We included 82,151 patients from 45 ICUs. Median (interquartile range) age was 60.0 years (45.0-70.0 yr) and 38.2% ( n = 31,409) of the cohort was female. Baseline characteristics were similar. Comparing sexes, ICU mortality (9.5% females vs. 10.3% males; adjusted odds ratio [adjOR], 0.95; 95% CI, 0.90-1.00; p = 0.07) and hospital mortality (19.4% vs. 20.8%; adjOR, 1.00; 95% CI, 0.97-1.03; p = 0.66) were similar. Females less commonly received invasive ventilation (22.2% vs. 26.3%; adjOR, 0.78; 95% CI, 0.75-0.82; p < 0.001), kidney replacement therapy (4.9% vs. 6.3%; adjOR, 0.73; 95% CI, 0.68-0.78; p < 0.001), and vasopressors (19.1% vs. 20.2%; adjOR, 0.95; 95% CI, 0.92-0.99; p = 0.03). In contrast, females more commonly received noninvasive ventilation (11.7% vs. 9.7%; odds ratio, 1.23; 95% CI, 1.18-1.30; p < 0.001). Results of the sensitivity analyses were consistent with the primary findings. CONCLUSIONS: In this registry-embedded cohort study, critically ill females less commonly received most types of organ supports, yet had similar adjusted ICU mortality compared with males.
Hashmi M, Haniffa R, Jayakumar D
… +80 more, Beane A, Lorenzi E, Berry LR, Nasir Khoso M, Ain Khan Q, Kumar A, Altaf Kidwai A, Hills TE, Annane D, Aryal D, Au C, Baillie K, Beasley R, Best-Lane J, Bonten M, Bradbury CA, Brunkhorst FM, Burrell A, Buxton M, Cecconi M, Cheng AC, Cove ME, de Jong M, Detry MA, Duffy E, Estcourt LJ, Fitzgerald M, Fowler R, Goossens H, Green C, Hays LMC, Higgins AM, Huang DT, Ichihara N, Koirala S, Lamontagne F, Lawler PR, Lewis RJ, Litton E, Mahon N, Marshall JC, McAuley DF, McGlothlin A, McGuinness S, McQuilten ZK, McVerry BJ, Mouncey PR, Morpeth S, Netea M, Orr K, Parke RL, Parker JC, Patanwala A, Peters S, Reyes LF, Rowan KM, Saito H, Saunders CT, Santos M, Seymour CW, Shankar-Hari M, Singh V, Slater M, Tambyah PA, Tong SYC, Turgeon AF, Turner AM, van de Veerdonk F, Weis S, Zarychanski R, McArthur CJ, Angus DC, Berry SM, Gordon AC, Derde LPG, Webb SA, Murthy S, Arabi Y, Nichol AD, and the Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP) Investigators
Crit Care Med
· 2026 Jul · PMID 42101205
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OBJECTIVE: To determine whether ivermectin improves outcomes for critically and noncritically ill hospitalized patients with COVID-19. DESIGN: An ongoing international, multifactorial, adaptive platform, randomized, cont...OBJECTIVE: To determine whether ivermectin improves outcomes for critically and noncritically ill hospitalized patients with COVID-19. DESIGN: An ongoing international, multifactorial, adaptive platform, randomized, controlled trial. SETTING: Hospitals in Pakistan, India, and Ireland between June 11, 2021, and September 9, 2022. PATIENTS: Critically and noncritically ill patients. INTERVENTIONS: Randomized to ivermectin or no ivermectin (control). MEASUREMENTS AND MAIN RESULTS: The primary outcome was respiratory and cardiovascular organ support-free days, assessed on an ordinal scale combining in-hospital death (assigned a value of -1) and days free of organ support through day 21 in survivors. Analyses used a Bayesian cumulative logistic model. Enrollment was closed for operational futility, following external evidence suggesting no benefit with ivermectin in nonhospitalized patients with COVID-19. Among 61 critically ill patients, the median number of organ support-free days was -1, indicating death was the most common vital outcome (interquartile range [IQR], -1 to 17), for the ivermectin group and -1 (IQR, -1 to 17.25) for the control group (adjusted proportional odds ratio [OR], 0.94; 95% credible interval [CrI], 0.40-2.07) and the posterior probability of superiority to control was 44.2%. Among 89 noncritically ill patients, the median number of organ support-free days was 22 (IQR, 18.5-22) for ivermectin and 22 (IQR, 16-22) for control (adjusted proportional OR, 1.04; 95% CrI, 0.48-2.34) and the posterior probability of superiority was 53.7%. Among critically ill patients, hospital survival was 35.1% (13/37) for ivermectin and 37.5% (9/24) for control (adjusted OR, 1.00; 95% CrI, 0.39-2.32), posterior probability of superiority was 50.0%. Among noncritically ill patients, hospital survival was 84.1% (37/44) for ivermectin and 77.8% (35/45) for control (adjusted OR, 1.16; 95% CrI, 0.5-3.07), posterior probability of superiority was 63.3%. CONCLUSIONS: For critically and noncritically ill hospitalized patients with COVID-19, ivermectin was unlikely to improve the primary composite outcome of organ support-free days and hospital survival.
Crit Care Med
· 2026 Jul · PMID 42089734
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OBJECTIVES: To assess the socioeconomic consequences of critical illness by quantifying changes in household income level and unemployment among ICU survivors in a universal health coverage setting. DESIGN, SETTING, AND...OBJECTIVES: To assess the socioeconomic consequences of critical illness by quantifying changes in household income level and unemployment among ICU survivors in a universal health coverage setting. DESIGN, SETTING, AND PATIENTS: This nationwide retrospective cohort study used the Korean National Health Insurance Service database. Adult ICU survivors between January 1, 2020, and December 31, 2022, were included. Patients who died within 1 year or had missing data were excluded. The final cohort consisted of 582,341 survivors. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the change in household income level (scale 0-20) between pre-ICU and post-ICU years, analyzed using generalized estimating equation models. The most salient finding was a profound financial polarization among survivors. While the overall cohort experienced a significant and progressive decline in income rank (1-yr ratio of means [RoM], 0.994; 2-yr RoM, 0.976; both p < 0.001), this average masked a severe impact on the highest income quartile (Q4), which exhibited a substantial 6.5% relative drop in mean rank (RoM, 0.935). In contrast, the lowest quartile (Q1) showed relative stability (RoM, 2.198) due to a "floor effect" and transitions into the social safety net. Descriptively, 160,682 survivors (27.6%) experienced income decline, 60,432 (10.4%) suffered catastrophic decline, and 12.3% of 326,125 previously employed survivors were no longer employed within 1 year. CONCLUSIONS: Critical illness is associated with progressive socioeconomic deterioration characterized primarily by financial polarization. Even with universal health coverage, the economic burden hits previously high-earning households most severely, while lower income groups face potential asset depletion before transitioning to social safety nets. Policies integrating sustained financial protection and vocational rehabilitation into post-ICU survivorship care are essential.