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Hemophagocytic Lymphohistiocytosis in a PICU of a Developing Economy: Clinical Profile, Intensive Care Needs, Outcome, and Predictors of Mortality
Conclusions: Hemophagocytic lymphohistiocytosis in PICU is commonly secondary to tropical infections and associated with high mortality. Higher severity of illness; shock and multiple organ dysfunction syndrome; need for blood and blood products, mechanical ventilation, vasoactive drugs, and renal replacement therapy; higher Vasoactive-Inotropic Score; and prolonged mechanical ventilation predicted death. Treatment of underlying infection and a less intense immunosuppressive therapy (steroids ± IV immunoglobulin) are suggested options. A high index of suspicion for complicating hemophagocytic lymphohistiocytosis is re...
Source: Pediatric Critical Care Medicine - January 1, 2021 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Empowered Nurses: A Win-win Situation in Pediatric Critical Care
Indian Pediatr. 2022 Sep 9:S097475591600451. Online ahead of print.ABSTRACTThe atmosphere of a Pediatric Intensive Care Unit is charged, fast paced, stressful, and tiring with emphasis on precision of care. Pediatric critical care nursing is still in its infancy stage in India and other low middle income countries. The lack of resources, staff shortage, migration and brain drain are persistent issues in India. There is lack of career advancement as well as exposure to research activities. Keeping these barriers in mind, over the years, we have adopted certain multipronged strategies in our PICU with the objective of empowe...
Source: Indian Pediatrics - September 12, 2022 Category: Pediatrics Authors: Manjinder Kaur Muralidharan Jayashree Source Type: research

Targeted interventions in critically ill children with severe dengue
Conclusion: Children with SD with refractory shock are at extremely high mortality risk. We describe the proactive application of several targeted ICU supportive interventions in addition to ST and could show that these interventions resulted in decreased resuscitation morbidity and improved outcomes in SD.
Source: Indian Journal of Critical Care Medicine - March 16, 2018 Category: Intensive Care Authors: Suchitra Ranjit Gokul Ramanathan Balasubramaniam Ramakrishnan Niranjan Kissoon Source Type: research

Heart rate variability in children following drowning injury
Madhuradhar Chegondi, Jun Sasaki, Sayed Naqvi, Wei-Chiang Lin, Andre Raszynski, Balagangadhar R TotapallyIndian Journal of Critical Care Medicine 2018 22(1):53-55Heart rate variability (HRV) has been used as prognostic tool in various disorders in pediatric and adult patients. In our study we aimed to evaluate heart rate variability indices and their association with neurological outcome in three children with anoxic brain injury following drowning. Three children included in the study were admitted following drowning and required mechanical ventilation and targeted temperature management. All physiologic data, including e...
Source: Indian Journal of Critical Care Medicine - January 15, 2018 Category: Intensive Care Authors: Madhuradhar Chegondi Jun Sasaki Sayed Naqvi Wei-Chiang Lin Andre Raszynski Balagangadhar R Totapally Source Type: research

Recurrent metabolic acidosis during high-dose midazolam therapy for refractory status epilepticus
Shalendra Singh, Ankur Khandelwal, Rashmi Datta, Ashutosh Kaushal, Gyaninder Pal SinghIndian Journal of Critical Care Medicine 2018 22(2):119-121 High-dose continuous midazolam therapy has been used successfully for control of refractory status epilepticus. However, normal anion gap (AG) metabolic acidosis, a deleterious complication of this therapy is underrecognized. Even though previously reported in an isolated case report in a pediatric patient, we observed similar complication in an adult patient. Stereotyped normal AG metabolic acidosis along with hypotension developed on two occasions during high-dose continuous m...
Source: Indian Journal of Critical Care Medicine - February 19, 2018 Category: Intensive Care Authors: Shalendra Singh Ankur Khandelwal Rashmi Datta Ashutosh Kaushal Gyaninder Pal Singh Source Type: research

Clinicohematological profile of febrile neutropenia in childhood acute leukemia and utility of serum procalcitonin levels in neutropenic patients
Conclusion: The higher levels of PCT had a high negative correlation with ANC but low correlation with microbiologically detected infections.
Source: Indian Journal of Critical Care Medicine - May 17, 2018 Category: Intensive Care Authors: Rajan Kapoor Ashish K Simalti Shuvendu Roy Pulkit Agarwal Source Type: research

Adult influenza A (H1N1) related encephalitis: A case report
Devinder Midha, Arun Kumar, Pratibha Vasudev, Zafar Ahmad Iqbal, Amit Kumar MandalIndian Journal of Critical Care Medicine 2018 22(5):384-387The year 2009–2010 saw H1N1 influenza outbreaks occurring in almost all countries of the world, causing the WHO to declare it a pandemic of an alert level of 6. In India, H1N1 influenza outbreaks were again reported in late 2014 and early 2015. Since then, sporadic cases of H1N1 influenza have been reported. H1N1 influenza usually presents itself with respiratory tract symptoms. In a minority of patients, abdominal symptoms may occur as well. Acute influenza-associated en...
Source: Indian Journal of Critical Care Medicine - May 17, 2018 Category: Intensive Care Authors: Devinder Midha Arun Kumar Pratibha Vasudev Zafar Ahmad Iqbal Amit Kumar Mandal Source Type: research

Methotrexate-induced toxic epidermal necrolysis: A rare case report and review of literature
Pritam Kataria, Pradip Kendre, Apurva Patel, Nahush Tahiliani, Sushant IkharIndian Journal of Critical Care Medicine 2018 22(10):740-742Acute lymphoblastic leukemia (ALL) is the most common malignancy in pediatric patients, and it is characterized by the presence of malignant lymphoblasts within the bone marrow and peripheral blood. The treatment of ALL involves induction, consolidation, reinduction, and maintenance therapy. Consolidation therapy in ALL-Berlin-Frankfurt-Münster 90 protocol involves the use of high-dose methotrexate (HDMTX, 5 g/m2) over 24 h as continuous infusion. The adverse effects due to HDM...
Source: Indian Journal of Critical Care Medicine - October 17, 2018 Category: Intensive Care Authors: Pritam Kataria Pradip Kendre Apurva Patel Nahush Tahiliani Sushant Ikhar Source Type: research

Clinical Profile and Predictors of Outcome of Pediatric Acute Respiratory Distress Syndrome in a PICU: A Prospective Observational Study*
Conclusions: Pediatric acute respiratory distress syndrome contributes to a significant burden in the PICU of a developing country and is associated with significantly higher mortality. Infection remains the most common etiology. Higher severity of illness scores at admission, development of pneumothorax, and a positive fluid balance at 48 hours predicted poor outcome.
Source: Pediatric Critical Care Medicine - June 1, 2019 Category: Pediatrics Tags: Online Clinical Investigations Source Type: research

Role of IV Immunoglobulin in Indian Children With Guillain-Barré Syndrome*
Conclusions: In Indian children with Guillain-Barré syndrome, the outcome at 6 months in IV immunoglobulin treated group was similar to non-IV immunoglobulin group. Children with acute motor axonal neuropathy responded better to IV immunoglobulin.
Source: Pediatric Critical Care Medicine - July 1, 2019 Category: Pediatrics Tags: Neurocritical Care Source Type: research

Practice guidelines for nutrition in critically Ill patients: A relook for indian scenario
Conclusion: This paper summarizes the optimum nutrition practices for critically ill patients. The possible solutions to overcome the challenges in this field are presented as practice guidelines at the end of each section. These guidelines are expected to provide guidance in critical care settings regarding appropriate critical-care nutrition practices and to set up Intensive Care Unit nutrition protocols.
Source: Indian Journal of Critical Care Medicine - April 18, 2018 Category: Intensive Care Authors: Yatin Mehta JD Sunavala Kapil Zirpe Niraj Tyagi Sunil Garg Saswati Sinha Bhuvaneshwari Shankar Sanghamitra Chakravarti MN Sivakumar Sambit Sahu Pradeep Rangappa Tanmay Banerjee Anshu Joshi Ganesh Kadhe Source Type: research

Diagnostic and prognostic role of neutrophil-to-lymphocyte ratio in early and late phase of sepsis
Conclusion: The study suggests that NLR can be a useful diagnostic and prognostic marker in sepsis.
Source: Indian Journal of Critical Care Medicine - September 17, 2018 Category: Intensive Care Authors: Rajnish Kaushik Monika Gupta Madhu Sharma Debraj Jash Neetu Jain Nitin Sinha Aditya Chaudhry Dhruva Chaudhry Source Type: research

Evaluation of Optic Nerve Sheath Diameter and Transcranial Doppler As Noninvasive Tools to Detect Raised Intracranial Pressure in Children
Objectives: To compare the diagnostic accuracy of the ultrasonography-guided optic nerve sheath diameter with transcranial Doppler-guided middle cerebral artery flow indices against the gold standard invasive intraparenchymal intracranial pressure values in children. Design: A single-center prospective cohort study. Setting: PICU of a tertiary care teaching hospital in North India. Patients: Eligible children (2–12 yr) are admitted to ICU and are undergoing intracranial pressure monitoring using an intraparenchymal catheter. Observations with a parallel measured intracranial pressure greater than...
Source: Pediatric Critical Care Medicine - November 1, 2020 Category: Pediatrics Tags: Neurocritical Care Source Type: research

A study on the psychometric properties of revised-nonverbal pain scale and original-nonverbal pain scale in Iranian nonverbal-ventilated patients
Conclusions: R-NVPS and O-NVPS can both be used as valid and reliable scales in studying pain in ventilated patient. However, in comparing the items, “respiration” (R-NVPS) had a higher sensitivity than “physiology II” (O-NVPS) in assessing pain.
Source: Indian Journal of Critical Care Medicine - July 14, 2017 Category: Intensive Care Authors: Hoda Chookalayi Mehdi Heidarzadeh Mohammad Hasanpour Sajjad Jabrailzadeh Fatemeh Sadeghpour Source Type: research