ISCCM Position Statement on the Management of Severe Malaria in Intensive Care Unit.

Malaria is a worldwide health concern, but a great majority of cases occur in tropical countries like India. With almost 95% of Indian population living in malaria endemic regions, India contributes to most of the global malaria cases and deaths, outside of African countries. Despite significant advances towards malaria control and eradication, mortality associated with severe malaria remains particularly high. Changing epidemiology, vulnerable patient population, overlapping symptomatology, and limited availability of parenteral preparations of artemisinin derivatives pose significant challenges in management of severe malaria. Further, the dearth of large-scale randomized trials from the developing countries makes it difficult to establish evidence-based guidelines pertaining to their situation. Thus, this position paper aims to provide guidance to critical care physicians across the country on managing patients with severe malaria in intensive care units (ICUs). How to cite this article: Hegde A, Chhallani AK, Gupta B, Kadapatti K, Karnad D, Maheshwarappa HM, et al. ISCCM Position Statement on the Management of Severe Malaria in Intensive Care Unit. Indian J Crit Care Med 2024;28(S2):S59-S66.

ISCCM Position Statement: Management of Severe Dengue in Intensive Care Unit.

Dengue is one of the commonest causes of undifferentiated acute febrile illness in India as well as South East Asia. Nearly two-fifths of the world population is at risk of infection, and nearly 96 million infections reported worldwide, it is a major cause of concern across the globe. The ISCCM leadership felt that there have been no new directives/guidelines except the MOH guidelines for the management of dengue fever since 2014. Under the auspices of the Indian Society of Critical Care Medicine (ISCCM), an expert group of 14 intensivists from across the country, was formed. The task force members formulated questions that needed to be answered. These questions were validated by the members of ISCCM attending research conclave 2023. All the members systematically searched PubMed, MEDLINE, and Science Direct for original articles on different aspects of dengue management between January 1, 2000, and July 1, 2023. From the collected articles, duplicates were removed. Based on the evidence collected, the expert group members prepared statements/answers to the questions. Since most of the evidence is of moderate to low quality, a consensus was generated amongst the members of the task force. Each statement was agreed upon by 70% of the task force. The statements presented in the article are consensus statements as answers to queries raised. How to cite this article: Bhalla A, Singh H, Suri V, Yaddanapudi L, Poddar B, Ghawat R, et al. ISCCM Position Statement: Management of Severe Dengue in Intensive Care Unit. Indian J Crit Care Med 2024;28(S2):S42-S58.

Guidelines for Antibiotics Prescription in Critically Ill Patients.

How to cite this article: Khilnani GC, Tiwari P, Mittal S, Kulkarni AP, Chaudhry D, Zirpe KG, et al. Guidelines for Antibiotics Prescription in Critically Ill Patients. Indian J Crit Care Med 2024;28(S2):S104-S216.

A Diagnostic Journey.

We describe the case of a patient who came with features suggestive of diabetic ketoacidosis. On further evaluation of DKA, we found that it was caused by acute pancreatitis. This acute pancreatitis was found to be caused by hypercalcemia, which was in turn due to primary hyperparathyroidism. Imaging studies done for hyperparathyroidism revealed a thyroid nodule which later turned out to be malignant. This patient was also incidentally found to have hypertrophic obstructive cardiomyopathy.

Early Antibiotics in Septic Shock: A Desirable Goal but "Curb Your Enthusiasm".

How to cite this article: Hegde A. Early Antibiotics in Septic Shock: A Desirable Goal but "Curb Your Enthusiasm". Indian J Crit Care Med 2023;27(7):459-460.

Risk of Bleeding in Dengue: Making Predictions is Difficult Especially about the Future.

How to cite this article: Hegde AV. Risk of Bleeding in Dengue: Making Predictions is Difficult Especially about the Future. Indian J Crit Care Med 2023;27(12):865-866.

Candida auris is Coming.

How to cite this article: Hegde A. Candida auris is Coming. Indian J Crit Care Med 2022;26(5):543-544.

Drug Levels in ICU - T or F.

How to cite this article: Hegde A. Drug Levels in ICU - T or F. Indian J Crit Care Med 2022;26(6):663.

Measurement of Interleukin-6 Levels in COVID: Illuminative or Illogical?

How to cite this article: Hegde A. Measurement of Interleukin-6 Levels in COVID: Illuminative or Illogical? Indian J Crit Care Med 2022;26(1):9-10.

Malaria in the Intensive Care Unit.

Most cases of severe malaria are caused by Plasmodium falciparum. Severe malaria is characterized by severe organ dysfunction. Both peripheral smear examination and rapid diagnostic test have a role in the diagnosis. Parenteral artesunate is clearly the drug of choice for the management of severe malaria. Parenteral artesunate should always be followed up with ACT. Most of the complications of severe malaria require supportive care only. The role of exchange transfusions in the management of severe malaria is questionable in the postartesunate era. Malaria in pregnancy can be quite severe and artesunate is now the drug of choice for all three trimesters. Vivax malaria is being increasingly recognized as a cause of severe malaria. The cause for this increased virulence is still not clear. Management of severe vivax malaria is similar to that of severe falciparum malaria. How to cite this article: Hegde A. Malaria in the Intensive Care Unit. Indian J Crit Care Med 2021;25(Suppl 2):S127-S129.

Antibiotic Stewardship: Easy to Preach, Difficult to Practice.

How to cite this article: Hegde A. Antibiotic Stewardship: Easy to Preach, Difficult to Practice. Indian J Crit Care Med 2021;25(6):608-609.

Diuretics in Acute Kidney Injury.

How to cite this article: Hegde A. Diuretics in Acute Kidney Injury. Indian J Crit Care Med 2020;24(Suppl 3):S98-S99.

Acute Kidney Injury in the Critically Ill: Herein Lies the Problem!

How to cite this article: Kulkarni AP, Hegde A, Ramakrishnan N. Acute Kidney Injury in the Critically Ill: Herein Lies the Problem! Indian J Crit Care Med 2020;24(Suppl 3):S83.

Methicillin-resistant Staphylococcus aureus in Intensive Care Unit Setting of India: A Review of Clinical Burden, Patterns of Prevalence, Preventive Measures, and Future Strategies.

AIM: The aim of this review article is not only to analyze the clinical burden of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care unit (ICU) setting of India, along with the patterns of prevalence and its prevention measures, but also to focus on the new anti-MRSA research molecules which are in late stage of clinical development. BACKGROUND: Methicillin resistance is reported to be present in 13-47% of Staphylococcus aureus infections in India. Therapeutic options to combat MRSA are becoming less, because of emerging resistance to multiple classes of antibiotics. Intensive care units are the harbinger of multidrug-resistant organisms including MRSA and are responsible for its spread within the hospital. The emergence of MRSA in ICUs is associated with poor clinical outcomes, high morbidity, mortality, and escalating treatment costs. There is an urgency to bolster the antibiotic pipeline targeting MRSA. The research efforts for antibiotic development need to match with the pace of emergence of resistance, and new antibiotics are needed to control the impending threat of untreatable MRSA infections. REVIEW RESULTS: Fortunately, several potential antibiotic agents are in the pipeline and the future of MRSA management appears reassuring. CLINICAL SIGNIFICANCE: The authors believe that this knowledge may help form the basis for strategic allocation of current healthcare resources and the future needs. HOW TO CITE THIS ARTICLE: Mehta Y, Hegde A, Pande R, Zirpe KG, Gupta V, Ahdal J, et al. Methicillin-resistant Staphylococcus aureus in Intensive Care Unit Setting of India: A Review of Clinical Burden, Patterns of Prevalence, Preventive Measures, and Future Strategies. Indian J Crit Care Med 2020;24(1):55-62.

Approach to an Anemic Critically Ill Patient.

How to cite this article: Hegde A. Approach to an Anemic Critically Ill Patient. Indian J Crit Care Med 2019;23(Suppl 3):S178-S180.

Data is the New Gold!

How to cite this article: Hegde AV. Data is the New Gold! Indian J Crit Care Med 2019;23(6):246.

Success is the Sum of Small Efforts!

How to cite this article: Kulkarni AP, Samavedam S, Hegde A. Success is the Sum of Small Efforts! Indian J Crit Care Med 2019;23(Suppl 3):S171.

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.

Is it Time to Rethink the Use of Steroids for Pulmonary Leptospirosis?

Pulmonary involvement is a fairly common complication of leptospirosis. A high dose of steroids is often used in the treatment of pulmonary leptospirosis. Here we report two cases who developed severe invasive fungal infections following the use of steroids for pulmonary leptospirosis. Routine use of steroids for pulmonary leptospirosis may do more harm than good as the evidence for this practice is sparse.

Intensive Care in India: The Indian Intensive Care Case Mix and Practice Patterns Study.

AIMS: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). PATIENTS AND METHODS: An observational, 4-day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. RESULTS: On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self-paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. CONCLUSIONS: The high proportion of TDs and the association of public hospitals, self-paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India.