Epidemiology, Clinical Characteristics, and Prognostic Factors in Critically Ill Patients with Hematolymphoid Malignancy.

OBJECTIVE: Despite advances in the field of oncology and intensive care, the outcomes of hematolymphoid malignancy (HLM) patients admitted to ICU are poor. This study was carried out to look at the demographic data, clinical features, and predictors of hospital mortality in these patients. MATERIALS AND METHODS: We prospectively studied 101 adult critically ill patients with HLM admitted to the 14-bedded mixed medical surgical ICU of a tertiary care cancer center. Out of 101 patients, end-of-life care decisions were taken in 7 patients, who were excluded from the outcome analysis. Predictors of in-hospital mortality were evaluated using univariate and multivariate analysis. RESULTS: The ICU and in-hospital mortality recorded in our study were 48.9 and 54.3%, respectively. Neutropenia at ICU admission, Simplified Acute Physiology Score III (SAPS III) score, and mechanical ventilation (MV) within 24 hours of ICU admission were associated with in-hospital mortality on univariate analysis. On multivariate logistic regression analysis, neutropenia at ICU admission (OR 4.621; 95% CI, 1.2-17.357) and MV within 24 hours of ICU admission (OR 2.728; 95% CI, 1.077-6.912) were independent predictors of in-hospital mortality. CONCLUSION: The HLM patients needing critical care have high acuity of illness, and acute respiratory failure is the commonest reason for ICU admission in these patients. In our study, the ICU survival was more than 50% and more than 45% patients were discharged alive from the hospital. We found a need for MV within 24 hours of ICU admission and presence of neutropenia at ICU admission to be independent predictors of hospital mortality in our study. HOW TO CITE THIS ARTICLE: Siddiqui SS, Prabu NR, Chaudhari HK, Narkhede AM, Sarode SV, Dhundi U, et al. Epidemiology, Clinical Characteristics, and Prognostic Factors in Critically Ill Patients with Hematolymphoid Malignancy. Indian J Crit Care Med 2021;25(1):56-61.

Preeclampsia and Related Problems.

Hypertensive disorders of pregnancy can be classified as chronic hypertension (present before pregnancy), gestational hypertension (onset after 20 weeks of pregnancy), and preeclampsia (onset after 20 weeks of pregnancy, along with proteinuria and other organ dysfunction). Preeclampsia and related disorders are a major cause of maternal and fetal morbidity and mortality. Preeclampsia is believed to result from an angiogenic imbalance in the placenta circulation. Antenatal screening and early diagnosis may help improve outcomes. Severe preeclampsia is characterized by SBP ≥160 mm Hg, or DBP ≥110 mm Hg, thrombocytopenia (platelet count <100 × 109/L), abnormal liver function, serum creatinine >1.1 mg/dL, or a doubling of the serum creatinine concentration in the absence of other renal diseases, disseminated intravascular coagulation, pulmonary edema, new-onset headache, or visual disturbances. Severe preeclampsia or eclampsia (preeclampsia with seizures) needs ICU management and is the main cause of morbidity and mortality. Severe hypertension can also result in life-threatening intracranial hemorrhage. Blood pressure control, seizure prevention, and appropriate timing of delivery are the cornerstones of the management of preeclampsia. Besides intravenous antihypertensive drugs, intravenous magnesium sulfate is the drug of choice to prevent or treat seizures, when preparing for urgent delivery. At present, delivery remains the most effective treatment for preeclampsia, and organ dysfunction rapidly recovers after delivery. Novel therapeutic interventions are under development to reduce complications. How to cite this article: Narkhede AM, Karnad DR. Preeclampsia and Related Problems. Indian J Crit Care Med 2021;25(Suppl 3):S261-S266.

Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study.

OBJECTIVES: Critically ill solid organ malignancy patients admitted to intensive care unit (ICU) as unplanned medical admissions behave differently from other subsets of cancer patients (hematolymphoid malignancies and cancer patients admitted for postoperative care). These patients if appropriately selected may benefit from the ICU care. There is paucity of data on critically ill unplanned admissions of solid organ malignancies from South Asia. We analyzed data of patients with solid tumors with unplanned admissions to the ICU to determine the clinical, epidemiological characteristics, and predictors of hospital mortality in an Indian ICU. MATERIALS AND METHODS: This prospective, observational study was done in our 14-bedded mixed medical-surgical ICU from July 2014 to November 2015. We included all consecutive adult unplanned admissions with solid organ malignancies having ICU stay of >24 hours. Surgical admissions, hematolymphoid malignancies, advanced malignancy with no treatment options, and those cured of cancer >5 years were excluded. RESULTS: Two hundred and thirty-five consecutive patients were included in this cohort. ICU and hospital mortalities were 36.6 and 40%, respectively. On multivariate analysis, cancer status [odds ratio (OR): 3.204; 95% confidence interval (CI): 1.271-8.078], invasive mechanical ventilation (OR: 5.940; 95% CI: 2.632-13.408), and sequential organ failure assessment (SOFA) score on the day of ICU admission (OR: 1.199; 95% CI: 1.042-1.379) were independent predictors of hospital mortality. CONCLUSION: Acute respiratory failure and septic shock are the common reasons of unplanned ICU admission for patients with solid organ malignancies. With good patient selection, more than half of such patients are likely to be discharged alive from the hospital. HOW TO CITE THIS ARTICLE: Siddiqui SS, Narkhede AM, Chaudhari HK, Ravisankar NP, Dhundi U, Sarode S, et al. Clinico-demographic and Outcome Predictors in Solid Tumor Patients with Unplanned Intensive Care Unit Admissions: An Observational Study. Indian J Crit Care Med 2021;25(12):1421-1426.

Evaluation and Validation of Four Scoring Systems: the APACHE IV, SAPS III, MPM0 II, and ICMM in Critically Ill Cancer Patients.

BACKGROUND AND AIMS: To evaluate and validate four severity-of-illness scores, acute physiology and chronic health evaluation IV (APACHE IV), simplified acute physiology score III (SAPS III), mortality probability models II at 0 hours (MPM0 II), and ICU cancer mortality model (ICMM), in a prospective cohort of critically ill cancer patients. MATERIALS AND METHODS: Single-center, prospective observational study performed in a 14-bedded combined medical-surgical ICU of a tertiary care cancer center of India, from July 2014 to November 2015. Score performance was judged by discrimination and calibration, using the area under receiver-operating characteristics (ROC) curve and Hosmer-Lemeshow goodness-of-fit test, respectively. RESULTS: A total of 431 patients were included in the study. Intensive care unit (ICU) and hospital mortality were 37.4% and 41.1%, respectively. The area under ROC curve for APACHE IV, SAPS III, MPM0 II, and ICMM were 0.73, 0.70, 0.67, and 0.67, respectively. Calibration as calculated by Hosmer-Lemeshow analysis type C statistics for APACHE IV, SAPS III, MPM0 II, and ICMM shows good calibration with Chi-square values of 5.32, 9.285, 9.873, and 9.855 and p values of 0.723, 0.319, 0.274, and 0.275, respectively. CONCLUSION: All the four models had moderate discrimination and good calibration. However, none of the mortality prediction models could accurately discriminate between survivors and nonsurvivors in our patients. HOW TO CITE THIS ARTICLE: Siddiqui SS, Narkhede AM, Kulkarni AP, Prabu NR, Chaudhari HK, Divatia JV, et al. Evaluation and Validation of Four Scoring Systems: the APACHE IV, SAPS III, MPM0 II, and ICMM in Critically Ill Cancer Patients. Indian J Crit Care Med 2020;24(4):263-269.

Combined Tracheal Suctioning and Expiratory Pause: Novel Theory but Tricky Implementation.

How to cite this article: Kothekar AT, Narkhede AM. Combined Tracheal Suctioning and Expiratory Pause: Novel Theory but Tricky Implementation. Indian J Crit Care Med 2020;24(1):82.

Indian Antimicrobial Prescription Guidelines in Critically Ill Immunocompromised Patients.

How to cite this article: Kulkarni AP, Sengar M, Chinnaswamy G, Hegde A, Rodrigues C, Soman R, Khilnani GC, Ramasubban S, Desai M, Pandit R, Khasne R, Shetty A, Gilada T, Bhosale S, Kothekar A, Dixit S, Zirpe K, Mehta Y, Pulinilkunnathil JG, Bhagat V, Khan MS, Narkhede AM, Baliga N, Ammapalli S, Bamne S, Turkar S, Bhat KV, Choudhary J, Kumar R, Divatia JV. Indian Journal of Critical Care Medicine 2019;23(Suppl 1): S64-S96.