Indian Journal of Critical Care Medicine最新文献

How to cite this article: Bhattacharjee A, Tamboli AA, Sathe P, Kundu R. Antibiotic Choice for Carbapenem-resistant Pseudomonas aeruginosa: Need to Look beyond the Forest. Indian J Crit Care Med 2026;30(8):700-701.

Background: Airway management is a commonly performed procedure in critically ill patients. In addition to anatomic challenges, these patients often have a physiologically difficult airway, which is associated with worse patient outcomes. Despite increasing awareness, specific teaching and training for physicians involved with airway management in these patients is poorly defined.

Methods: The primary aim is to establish expert consensus on core competencies and curriculum elements for training physicians in physiologically difficult airway management in critically ill adults. The study will employ the Delphi methodology to generate insights from a diverse panel of international experts and trainees, selected based on predefined criteria. The study will address key domains such as scope, methods, elements, and assessment of teaching and training, as well as patient preparation and monitoring. The study findings will then be reported according to the accurate consensus reporting document (ACCORD) criteria. ClinicalTrials.gov identifier: NCT06689748.

Results: Consensus will be defined as ≥75% of votes for multiple-choice questions and Likert-scale statements. Stability will be assessed using the Chi-square or Kruskal-Wallis test. The statements that achieve consensus and stability in the Delphi process will be used to generate consensus statements.

Conclusion: The objective of this study is to establish a comprehensive training curriculum for physicians involved in airway management while concurrently identifying critical knowledge gaps within the field. The collective expertise of the panel will generate consensus statements during the Delphi process to delineate the essential educational requirements of physicians involved with the management of a physiologically difficult airway.

How to cite this article: Karamchandani K, Higgs A, Nasa P, Brown W, Greif R, Jabaley CS, et al. Curriculum for Airway Skills in Critically Ill Adults: Protocol for a Delphi Evaluation (CASCADE). Indian J Crit Care Med 2026;30(8):628-631.

How to cite this article: Pal D, Govil D. Author Response: Comment on-Practice Pattern of Critical Care Ultrasonography in India (POCUS India)/A Multicenter Cross-sectional Survey. Indian J Crit Care Med 2026;30(8):706-707.

Delphi methodology is increasingly employed in health care, particularly in areas where evidence is limited, ambiguous, or conflicting. Consensus-based approaches are integral to guideline development; however, the processes underpinning consensus are often inadequately described or lack transparency, particularly in relation to mitigating cognitive biases within expert panels. The epistemological principles of the Delphi method-anonymous voting, iteration, and controlled feedback-are designed to minimize group convergence and peer pressure commonly observed in face-to-face discussions. While efforts have been made to improve reporting standards for Delphi studies, there remains a lack of comprehensive guidance and uniform standards for their design and conduct. This viewpoint examines the limitations of consensus methods used in guideline development and highlights how the Delphi methodology can enhance transparency, methodological rigor, and robustness in this process.

How to cite this article: Schultz MJ, Nasa P. From the Oracle of Delphi to Intensive Care Unit Guidelines: Consensus Building Using the Delphi Method. Indian J Crit Care Med 2026;30(8):623-627.

Background and aims: Acute-on-chronic liver failure (ACLF) carries a 28-day mortality of 30-55%, driven largely by systemic inflammation that is not captured by model for end-stage liver disease-sodium (MELD-Na) or chronic liver failure consortium ACLF (CLIF-C ACLF) scores. We evaluated whether serial measurements of C-reactive protein (CRP) and procalcitonin (PCT), and their 48- to 72-hour dynamic changes, predict 28-day mortality in critically ill ACLF patients.

Patients and methods: Prospective observational study of 70 consecutive ACLF patients [European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) criteria] at a tertiary intensive care unit (ICU) in Northeast India (October 2024-September 2025). C-reactive protein and PCT were measured at day 1 and day 3 (48-72 hours); ΔCRP and ΔPCT were calculated and analyzed against ACLF grade, severity scores, and 28-day outcome. Receiver operating characteristic (ROC) analysis with DeLong 95% confidence intervals (CIs) and multivariable logistic regression were performed.

Results: Mean age was 42.2 ± 9.6 years; 88.6% were male; alcohol-related liver disease accounted for 68.6%; grade III ACLF was present in 48.6%. Overall 28-day mortality was 55.7% (82.4% in grade III). Day 3 values and dynamic changes were more discriminative than baseline values. For 28-day mortality, ΔCRP achieved an area under the curve (AUC) of 0.845 (95% CI 0.741-0.950) and ΔPCT 0.810 (95% CI 0.699-0.920), both substantially exceeding admission CRP (0.712, 95% CI 0.587-0.837), admission PCT (0.671, 95% CI 0.541-0.800), MELD-Na (0.611, 95% CI 0.474-0.748), and CLIF-C ACLF (0.637, 95% CI 0.506-0.767). On multivariable logistic regression, ΔCRP [odds ratio (OR) 2.19, 95% CI 1.15-4.16; p = 0.017] and grade III ACLF (OR 11.36, 95% CI 2.66-48.46; p = 0.001) were independently associated with 28-day mortality.

Conclusions: Dynamic 48- to 72-hour changes in CRP and PCT outperform single admission values and conventional scores in predicting 28-day mortality in ACLF, providing a practical, low-cost prognostic adjunct for the ICU.

How to cite this article: Saravanamuthu PK, Das AK, Rajkakati R, Sonowal A. Dynamic Changes in C-reactive Protein and Procalcitonin as Predictors of 28-day Mortality in Acute-on-chronic Liver Failure: A Prospective Observational Study from Northeast India. Indian J Crit Care Med 2026;30(8):650-655.

Mukkelli VG, Gupta R. Sulbactam-Durlobactam for Carbapenem-resistant Acinetobacter baumannii in India: Does Local Molecular Epidemiology Support Current Guideline Recommendations? Indian J Crit Care Med 2026;30(8):698-699.

Background and aims: The COVID-19 pandemic impacted families financially. In this context, we assessed caregivers' willingness-to-pay (WTP) for the treatment of a critical illness among non-COVID admissions.

Patients and methods: This prospective study was conducted over 1 year in a 38-bed level-3 adult medical intensive care unit (ICU) at a not-for-profit tertiary care teaching hospital in India. Intensive care unit costs were assessed using a bottom-up micro-costing approach. Utility score was evaluated on day 2 by the intensivist on a scale of 0 to 1 with increments of 0.1; 0 indicating death/severe disability and 1 indicating cure/perfect health. Caregivers' WTP was assessed by the admitting physician using the bidding method. Demographic details, Acute Physiology and Chronic Health Evaluation (APACHE) II score, ICU outcome, and costs were recorded. Willingness-to-pay and actual caregiver contribution were expressed as percentages of the total hospitalization cost.

Results: The mean [standard deviation (SD)] age (n = 105, 68 males) was 45.3 (17.2) years. A total of 83.8% belonged to the lower socioeconomic strata. Acute Physiology and Chronic Health Evaluation II score was 15.2 (8.0); day 2 utility score was 0.68 (0.14). The median [interquartile range (IQR)] hospitalization cost was 2,49,767 (1,59,251-4,19,602) rupees. Intensive care unit treatment and medications accounted for 95.5-20.5% of the total cost, respectively. Although caregivers' median WTP was 60.1% of the hospitalization cost, families ultimately paid 67.9%. Lower utility scores were independently associated with higher WTP.

Conclusion: Critical illness imposes substantial financial burden on families. Caregivers were WTP more for sicker patients with lower utility scores. Subsidy for treatment was required despite caregivers' final payment exceeding their initial WTP.How to cite this article: Alex RM, Peter JV, Paul A, George T, Yadav B, Kalimuthu MB, et al. Willingness and Ability to Pay for Critical Care Treatment for Non-COVID Illness during the COVID-19 Pandemic: A Prospective Observational Study in a Tertiary Care Centre in India. Indian J Crit Care Med 2026;30(8):679-685.

Background and aims: Hemorrhage remains a leading cause of preventable mortality in trauma. Existing massive transfusion (MT) prediction scores are often context-specific and limited by resource availability. This study aimed to identify early transfusion predictors in a high-volume civilian trauma center and develop a simplified, locally applicable scoring system.

Patients and methods: This retrospective cohort study analyzed trauma registry data from a level 1 trauma center over 2 years (July 2022-July 2024). All trauma patients with an Injury Severity Score (ISS) ≥16 were included. Massive transfusion was defined using standard composite criteria. Clinical variables, imaging findings, and laboratory parameters were analyzed using logistic regression. Significant predictors were incorporated into a regression coefficient-based scoring system, and diagnostic performance was assessed using receiver operating characteristic (ROC) analysis.

Results: Among 687 patients, 36 (5.2%) required MT. On multivariable analysis, systolic blood pressure (SBP) ≤90 mm Hg [odds ratio (OR) = 8.15], heart rate (HR) >120 bpm (OR = 4.27), packed cell volume (PCV) ≤30 (OR = 3.76), base deficit (BD) ≥6 mmol/L (OR = 4.15), lactate ≥5 mmol/L (OR = 2.62), and mean arterial pressure (MAP) <70 mm Hg (OR = 8.81) were significant predictors (all p < 0.01). Arterial pH was not predictive. A model incorporating SBP, HR, and BD demonstrated good calibration and fair discrimination [area under the curve (AUC) = 0.753]. A simplified three-variable score demonstrated high sensitivity (98.5%) when two or more parameters were positive.

Conclusion: A concise combination of physiological and biochemical parameters can reliably predict the need for MT. The proposed trauma transfusion trigger offers a pragmatic, context-sensitive tool requiring prospective validation.

How to cite this article: Das S, Jonish AP, Grace R, Chellaiya GK, Daniel D, Mathuram SR, et al. Identifying Transfusion Triggers in Trauma Patients and Developing the Vellore Trauma Transfusion Score: A Retrospective Cohort Study. Indian J Crit Care Med 2026;30(8):673-678.

Gopaldas JA, Singamsetty A, Rai PP, Puttige K. Comment on: Practice Pattern of Critical Care Ultrasonography in India [Point-of-care Ultrasound (POCUS) India]: A Multicenter Cross-sectional Survey. Indian J Crit Care Med 2026;30(8):704-705.

How to cite this article: Todi SK. Author Response: Sulbactam-Durlobactam for Carbapenem-resistant Acinetobacter baumannii in India: Does Local Molecular Epidemiology Support Current Guideline Recommendations? and Antibiotic Choice for Carbapenem-resistant Pseudomonas aeruginosa: Need to Look beyond the Forest. Indian J Crit Care Med 2026;30(8):702-703.