Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India.

Aim and background: High-quality cardiopulmonary resuscitation (CPR) is associated with improved patient outcomes, but healthcare workers (HCWs) may be frequently undertrained. This study aimed to assess baseline knowledge and skills among HCWs about basic and advanced life support and the effect of simulation-based training on it. Methods: It was a single-center prospective quasi-interventional study among resident doctors and nurses at a Tertiary Center in New Delhi, India. A questionnaire-based assessment was done to assess baseline knowledge. The participants then underwent simulation-based training followed by questionnaire-based knowledge assessment and skill assessment. A repeat questionnaire-based assessment was done 6 months post-training to assess knowledge retention. Results: A total of 82 HCWs (54 doctors and 28 nurses) were enrolled. The participants scored 22.28 ± 6.06 out of 35 (63.65%) in the pre-training knowledge assessment, with low scores in post-cardiac arrest care, advanced life support, and defibrillation. After the training, there was a significant rise in scores to 28.32 ± 4.08 out of 35 (80.9%) (p < 0.01). The retention of knowledge at 6 months was 68.87% (p < 0.01). The participants scored 92.61 ± 4.75% marks in skill assessment with lower scores in chest compressions and team leadership roles. There was a positive correlation (r = 0.35) between knowledge and skills scores (p < 0.01). Conclusion: There is a progressive decrease in baseline knowledge of HCWs with the further steps in the adult chain of survival. The simulation training program had a positive impact on the knowledge of HCWs. The training programs should focus on defibrillation, advanced life support, post-cardiac arrest care, and leadership roles. How to cite this article: Agarwal A, Baitha U, Ranjan P, Swarnkar NK, Singh GP, Baidya DK, et al. Knowledge and Skills in Cardiopulmonary Resuscitation and Effect of Simulation Training on it among Healthcare Workers in a Tertiary Care Center in India. Indian J Crit Care Med 2024;28(4):336-342.

Integration of simulation-based teaching in anaesthesiology curriculum.

Simulation refers to the replication of various elements of a real-world situation to achieve pre-specified objectives by enabling experiential learning. As the global burden of preventable medical errors remains high, simulation-based teaching may be used to standardise medical training and improve patient safety. With the same intent, the National Medical Commission has adopted simulation as part of the Competency Based Medical Education approach. Simulation-based training creates immersive and experiential learning, which keeps the new generation of learners actively involved in the learning process. Simulation is widely used to impart technical and non-technical skills for postgraduate trainees in anaesthesiology, but it is still not integrated as a structured part of the curriculum. This article aims to identify technical and non-technical skills that can be taught using simulation and suggests opportunities for using the existing infrastructure and resources to integrate simulation as part of the anaesthesiology training curriculum.

Postoperative pulmonary complications with high versus standard FiO2 in adult patients undergoing major abdominal surgery: A noninferiority trial.

BACKGROUND: Despite the possible clinical benefit of high intraoperative oxygen therapy on surgical site infection, the effect on postoperative respiratory function is debatable. However, it remains yet to be elucidated whether hyperoxia due to a high fraction of inspired oxygen used in conjunction with lung protective ventilation can lead to increased incidence of postoperative pulmonary complications. METHODS: In this noninferiority randomized trial, an intraoperative high fraction of inspired oxygen of 0.8 (group H) was compared to a standard fraction of inspired oxygen of 0.3 to 0.4 (group S) in adult patients undergoing major elective or emergency surgery. A lung protective ventilation strategy was employed in all patients, including volume control ventilation with a tidal volume of 6 to 8 mL/kg of predicted body weight, respiratory rate of 12 beats per minute, and positive end-expiratory pressure of 5 to 8 cm H2O. Postoperative pulmonary complications were assessed on postoperative days 3 and 5 by the Melbourne group scale. RESULTS: In this trial, n = 226 patients were randomized; among them, 130 patients underwent routine surgery, and 96 patients underwent emergency surgery. The median (interquartile range) of the patients was 48 (35-58) years, and 47.3% were female. Melbourne group scale scores at postoperative day 3 (median [interquartile range] 2 [1-4] in group S vs 2 [1-3] in group H; the difference in median [95% confidence interval] 0 [0, -1]; P = .13) and day 5 (median [interquartile range] 1 (0-3) in group S vs 1 [0-3] in group H; the difference in median [95% confidence interval] 0 [0, 0.5]; P = .34) were statistically similar in both the groups and the upper margin was within the predefined margin of 1. Incidence of surgical site infection (P = .46), postoperative hospital stay (P = .29), and days alive without antibiotic therapy at postoperative day 28 (P = .95) were similar in both groups. CONCLUSION: High intraoperative fiO2 was noninferior to standard fiO2 in postoperative pulmonary complications in adult patients undergoing major surgery.

Ultrasonographic assessment of brachial artery reactivity as a predictor of adverse outcome in patients undergoing emergency laparotomy for perforated peritonitis - Prospective observational study.

Background and Aims: This study aimed to assess if pre- and postoperative parameters of brachial artery reactivity (BAR), like flow-mediated dilation (FMD) and hyperaemic velocity (HV), could predict in-hospital mortality in perforation peritonitis patients undergoing emergency laparotomy. Methods: In this prospective observational study, adult patients with perforation peritonitis undergoing emergency laparotomy were recruited. FMD and HV were measured preoperatively, postoperatively and at 24 and 48 h post-surgery. Adult patients undergoing elective laparotomy served as the control group. The primary outcome was in-hospital mortality. Baseline and BAR parameters were compared between survivors and non-survivors. Risk factors for mortality were identified by univariate analysis. Prognostic performances of BAR parameters were assessed by different models using logistic regression. All statistical analyses were performed on STATA version 13 for Mac OS. Results: Seventy-six emergency laparotomy patients were recruited, and 26 died during the hospital stay. FMD and HV were comparable at all time points between survivors and non-survivors, except that HV was higher in survivors at 48 h post-surgery (median [interquartile range] 1.28 [1.16-1.49] vs. 1.16 [0.86-1.35], P = 0.010]. HV at 48 h predicted mortality (adjusted odds ratio [OR] [95% confidence interval] 21.05 [1.04-422.43], P = 0.046), and a model consisting of age, Acute Physiology and Chronic Health Evaluation (APACHE) score and HV at 48 h was the best predictor of mortality (area under the receiver operating characteristic (AUROC) curve 0.82). Conclusion: HV, as measured by ultrasonography of the brachial artery at 48 h postoperatively, is a good predictor of mortality in patients undergoing emergency laparotomy for perforation peritonitis.

Effect of incremental PEEP titration on postoperative pulmonary complications in patients undergoing emergency laparotomy: a randomized controlled trial.

Postoperative pulmonary complications (PPC) has a significant negative impact and are associated with increased length of hospital stay and cost of care. Emergency surgery is a well-established risk factor for PPC. Previous studies reported that personalized positive end-expiratory pressure (PEEP) might reduce postoperative atelectasis and postoperative pulmonary complications. N = 168 adult patients undergoing major emergency laparotomy under general anesthesia were recruited in this study. A minimum driving pressure based incremental PEEP titration was compared to a fixed PEEP of 5 cmH2O. The primary outcome was PPC up to postoperative day 7. The mean (standard deviation) of the recruited patients was 41.7(16.1)y, and 48.8% (82 of 168 patients) were female. The risk of PPC at postoperative day 7 was similar in both the study groups [Relative risk (RR) (95% Confidence interval, CI) 0.81 (0.58, 1.13); p = 0.25]. In addition, the incidence of intraoperative hypotension [p = 0.75], oxygen-free days at day 28 [p = 0.27], duration of postoperative hospital stay [p = 0.50], length of postoperative intensive care unit stay [p = 0.28], and in-hospital mortality [p = 0.38] were similar in two groups. Incidence of PPC was not reduced with the use of an individualized PEEP strategy based on lowest driving pressure. However, the incidence of hypotension and bradycardia was also not increased with titrated PEEP.Trial Registration: www.ctri.nic.in ; CTRI/2020/12/029765.

Carotid artery corrected flow time and respiratory variation of blood flow peak velocity for prediction of hypotension after induction of general anesthesia in adult patients undergoing emergency laparotomy for peritonitis: A prospective, observational study.

Background and Aims: Doppler waveform analysis of carotid artery has been found to predict fluid responsiveness in patients undergoing elective surgeries. We evaluated the role of carotid artery corrected flow time (FTc) and respiratory variation of blood flow peak velocity (ðVpeak) in predicting post induction hypotension in patients undergoing emergency laparotomy for peritonitis. Material and Methods: Adult patients (n = 60) with perforation peritonitis undergoing emergency laparotomy under general anesthesia (GA) were recruited in this prospective, observational study. Carotid ultrasonography was performed pre-induction, to determine FTc and ðVpeak. Post-induction hemodynamic parameters were recorded for 5 minutes. Spearman's rank correlation coefficient was used to determine the relationship between hypotension and carotid artery measurements. Results: Post-induction hypotension occurred in 48.3% of patients. The carotid artery FTc was significantly lower (P = 0.008) in patients who developed post-induction hypotension, but ðVpeak was statistically similar (P = 0.62) in both groups. Spearman's rank correlation coefficient revealed a statistically significant correlation between FTc and systolic blood pressure (SBP) change at one-minute post induction (r2 = -0.29, P = 0.03); however statistical significance were not achieved at 2 minutes and 3 minutes (P = 0.05 at both time points). Carotid artery FTc had an area under the receiver operating characteristic (AUROC) curve (95% CI) of 0.70 (0.57-0.84) to predict post-induction hypotension and best cutoff value of 344.8 ms with a sensitivity and specificity of 61% and 79%, respectively. Carotid artery ðVpeak had an AUROC curve (95% CI) of 0.54 (0.39-0.69) to predict post-induction hypotension and best cutoff value of 7.9% with a sensitivity and specificity of 62% and 55%, respectively. Conclusion: Carotid artery FTc and ðVpeak are not reasonable predictors of hypotension in patients undergoing emergency laparotomy for perforation peritonitis.

Subphenotypes of SARS-CoV-2-Associated ARDS Overlap Each Other: A Retrospective Analysis.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus-associated pneumonia and acute respiratory distress syndrome (ARDS) were often associated with hyperinflammation and elevation of several serum inflammatory markers but usually less than what is observed in non-coronavirus disease (COVID) ARDS. Elevated inflammatory markers such as C-reactive protein, interleukin (IL)-6, etc., are associated with severe infection. This study identified subphenotypes of COVID-19 ARDS patients by latent profile analysis in a cohort of Indian patients. Methods Data of n = 233 adult Indian patients with laboratory-confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital were analyzed in this retrospective study. Only patients with acute respiratory failure (defined by partial pressure of oxygen/fraction of inspired oxygen ratio < 200 mm Hg) and chest X-ray showing bilateral infiltrates were included. Results The patients' mean (standard deviation) age was 53.3 (14.9) years, and 62% were male. A two subphenotypic model was formulated based on the lowest Bayesian information criterion. Neutrophil-to-lymphocyte ratio and serum IL-6 were latent variables in that model (entropy 0.91). The second phenotype (hyperinflammatory) had lower platelet count ( p = 0.02), higher serum creatinine ( p = 0.004), higher C-reactive protein ( p = 0.001), higher ferritin ( p < 0.001), and serum lactate dehydrogenase ( p = 0.009). Age-adjusted hospital mortality ( p = 0.007), duration of hospital stay ( p < 0.001), and duration of intensive care unit stay ( p < 0.001) were significantly higher in the second subphenotype. Conclusion Two distinct but overlapping subphenotypes were identified in SARS-CoV-2-associated respiratory failure. Hyperinflammatory subphenotype was associated with significantly poor short-term outcomes.

Comparison of ultrasound guided dorsal radial artery cannulation and conventional radial artery cannulation at the volar aspect of wrist: A pilot randomized controlled trial.

BACKGROUND: Distal radial artery cannulation at the "anatomical snuffbox" carries several theoretical advantages over conventional radial arterial cannulation at the wrist. However, these two techniques have not been evaluated in perioperative settings. METHODS: In this randomized controlled trial, n = 200 patients requiring arterial cannulation for perioperative monitoring were recruited. Patients were randomized to either ultrasound guided distal radial artery cannulation group (group D) or ultrasound guided conventional radial artery cannulation group (group W). Primary outcome of this study was first attempt cannulation success rate. RESULTS: First attempt cannulation success rate was significantly lower in distal radial artery cannulation (57% in group D and 77% in group W; p = 0.003). Use of alternative cannulation site was significantly higher in group D when compared to group W (p = 0.015) and number of attempts for successful cannulation was significantly higher in group D when compared to group W (p = 0.015). None of the patients in any group developed thrombosis and related complications and intraoperative catheter dislodgement. Time to puncture the artery (p < 0.0001), total cannulation time (p < 0.0001), and actual catheter insertion time (p < 0.0001) were significantly higher in group D in comparison to group W. CONCLUSION: Distal radial artery cannulation was associated with lower first attempt cannulation success rate and requires longer time to perform. As distal radial artery is a new technique, further studies are required in different clinical settings.

Air-Q ILA as a conduit for orotracheal intubation in children: A randomized control trial for comparison between supine and lateral patient positions.

Background and Aims: Airway management in children is always challenging and becomes a concern if required in the lateral position. We evaluated the efficacy of orotracheal intubation using the Air-Q intubating laryngeal Airway (Air-Q ILA) in supine and lateral positions in children. Material and Methods: This study included 100 children weighing 7-30 kg, scheduled for elective surgeries under general anesthesia. They were randomized into the supine (S) group or lateral (L) group. After anesthesia induction, the child was placed in a standard sniffing position for conventional laryngoscopy in the S group, and the child was turned into the lateral position in the L group. Both Air-Q ILA and endotracheal tube were placed blindly in the supine position in the S group and lateral position in group L. The grading of glottic view, success rate, insertion time of the Air-Q ILA, and endotracheal intubation were noted in both the groups. Results: The Air-Q ILA was successfully placed at the first attempt in 47 children in group S and 48 in group L. The overall blind orotracheal intubations, including first and second attempts, were successful in 45 children in the S group and 47 in the L group (P = 0.715). Eighty percent of patients in group L and 70% in group S had glottis grade 1 or 2 compared to grade 3, 4,5 (P = 0.249). The mean time of Air-Q ILA placement in groups S and L was 15.73 ± 5.64 s and 14.42 ± 4.16 s (P = 0.195). The mean duration of blind endotracheal intubation through the Air-Q ILA was 24.88 ± 14.75 s in group S and 17.57 ± 5.35 s in group L (P = 0.002). In both the groups, none of the children had bronchospasm, laryngospasm, desaturation, or aspiration. The airway trauma evident by blood staining on the Air-Q ILA on removal was revealed in 2 cases in group S, and 3 cases in group L. None of the children in group S and 4 children in group L had postoperative stridor. Postoperative hoarseness was reported in 3 children in group S and none in group L within 24 hours. Conclusion: The Air-Q ILA can be used as a conduit for blind orotracheal intubation in children in both supine and lateral positions while maintaining an effective airway seal.

Development of an institutional protocol for percutaneous dilatational tracheostomy in critically ill COVID-19 patients: Initial experience.

Background and Aims: Percutaneous dilatational tracheostomy (PDT) may improve the outcome in critically ill COVID-19 patients on mechanical ventilation. However, the timing of performing tracheostomy may be controversial, and it is an aerosol-generating procedure with a potential risk of viral exposure to healthcare workers. Material and Methods: An operational protocol for performing PDT was made and subsequently followed in a designated COVID-19 ICU. Critically ill adult patients on mechanical ventilators who underwent PDT were included in this retrospective cohort study. Case files were retrospectively reviewed and patient characteristics, clinical outcome, and procedure-related details were noted. Results: Forty-one patients were included in the analysis. The median age was 49 (39-67) years, and 41.5% of patients were females. The median duration of mechanical ventilation before tracheostomy was 10 (8-16) days, and the median (IQR) PaO2/FiO2 ratio on the day of PDT was 155 (125-180) mm Hg. Further, 48.8% of patients had transient desaturation to SpO2 <90%, and 41.5% survived to ICU discharge. None of the health care providers involved in PDT developed any symptoms of COVID 19. Conclusion: This descriptive study demonstrates the feasibility, implementation, and apparent safety of the PDT protocol developed at our institution.

Physiological effect of prone positioning in mechanically ventilated SARS-CoV-2- infected patients with severe ARDS: An observational study.

Background and Aims: Mechanical ventilation in prone position was associated with a reduction in mortality and increase in arterial oxygenation in acute respiratory distress syndrome (ARDS) patients. However, physiological effects of prone position in COVID ARDS patients are unknown. Material and Methods: In this prospective observational study, data of n = 47 consecutive real time RT- PCR confirmed SARS-CoV-2-infected patients with severe ARDS were included. Respiratory mechanics and oxygenation data of recruited patients were collected before and after prone position. Results: Median (Interquartile range, IQR) age of the recruited patients was 60 (50-67) years and median (IQR) PaO2/FiO2 ratio of 61.2 (54-80) mm Hg with application of median (IQR) positive end expiratory pressure (PEEP) of 12 (10-14) cm H2O before initiation of prone position. Out of those patients, 36 (77%) were prone responders at 16 hours after prone session, evident by increase of PaO2 by at least 20 mm Hg or by 20% as compared to baseline, and 73% patients were sustained responders (after returning to supine position). Plateau airway pressure (p < 0.0001), peak airway pressure (p < 0.0001), and driving pressure (p < 0.0001) were significantly reduced in prone position, and static compliance (p = 0.001), PaO2/FiO2 ratio (p < 0.0001), PaO2 (p = 0.0002), and SpO2 (p = 0.0004) were increased at 4 hours and 16 hours since prone position and also after returning to supine position. Conclusion: In SARS-CoV-2-infected patients, mechanical ventilation in prone position is associated with improvement in lung compliance and oxygenation in almost three-fourth of the patients and persisted in supine position in more than 70% of the patients.

A Double-Blind, Randomized Controlled Pilot Trial to Assess the Analgesic Efficacy of Ultrasound-Guided Preemptive Caudal Morphine as an Adjunct to Bupivacaine for Lumbosacral Spine Surgeries in Adults.

Background The analgesic efficacy of preemptive administration of caudal morphine for spine surgeries in adults is not well studied. In a double-blinded, randomized controlled trial, safety and analgesic efficacy of preemptive, single-shot caudal morphine and bupivacaine was compared with caudal bupivacaine alone in lumbosacral spine surgeries. Methods After Institutional Ethics Committee approval, 40 patients aged 18-60 yrs planned for lumbosacral spine surgery were randomized to groups of 20 patients each. After induction and prone positioning, an ultrasound-guided caudal block was performed with morphine 50 µg/kg with 20 ml 0.25% bupivacaine in the study group (LM) and only bupivacaine in the control group (LA). Postoperatively, both groups received intravenous morphine via patient-controlled analgesia (PCA) pump (No basal, 1 mg/bolus, 10 minutes lockout interval). Intraoperative fentanyl use, postoperative 24-h morphine consumption, visual analogue pain scores (VAS) and adverse effects of morphine were noted. Results Demographics and baseline data were comparable. Postoperative 24-hour morphine requirement was more in LA group (34.3 ± 10.7 mg vs 19.65 ± 11.8 mg, p=0.0001). Total intraoperative supplemental fentanyl requirement was similar (79.25 ± 67.60 µg in LA vs 54 ± 50.20 µg in LM group, p=0.28). VAS scores at 2/4/6/12-hour in group-LM were significantly less than group-LA (p=0.005, 0.002, 0.001 and 0.047) but were comparable at 18 and 24 hours (p=0.25, 0.42). Postoperative incidence of adverse effects of morphine was comparable. Conclusions Ultrasound-guided, single-shot preemptive administration of caudal morphine with bupivacaine is a safe and effective modality of analgesia for patients undergoing lumbosacral spine surgeries.

Ten Practice Changes in COVID-19 Intensive Care Unit of a Tertiary Care Teaching Hospital in India during the Peak of Pandemic: Adapt and Improve.

During the peak of the coronavirus disease-2019 (COVID-19) pandemic, 10 practice-changing decisions were adopted which led to an improved standard of clinical care in the face of overwhelming burden to the healthcare setup. Formation of a control unit with the piggyback team, briefing before donning, replacement of personal protective equipment (PPE) with impermeable surgical gowns, a dedicated prone team and the prone bundle of care, weaning-extubation and tracheostomy protocol, online audiovisual family-patient meet, daily rounds by hospital infection control committee member, each one clean one policy, focused onsite training of healthcare support staff and discharge policy with post-discharge follow-up were the 10 important changes adopted. How to cite this article: Soni L, Pangasa N, Baidya DK, Subramaniam R. Ten Practice Changes in COVID-19 Intensive Care Unit of a Tertiary Care Teaching Hospital in India during the Peak of Pandemic: Adapt and Improve. Indian J Crit Care Med 2022;26(6):710-711.

Assessment of role of inferior vena cava collapsibility index and variations in carotid artery peak systolic velocity in prediction of post-spinal anaesthesia hypotension in spontaneously breathing patients: An observational study.

Background and Aims: Post-spinal anaesthesia hypotension (PSH) is common and can lead to significant morbidity and mortality. The inferior vena cava collapsibility index (IVCCI) and carotid artery peak systolic velocity variations (CAPVV) are two widely used parameters for assessing the volume status of critically ill patients which have also been investigated as predictors of PSH and hypotension after induction of general anaesthesia. In this study, we evaluated the diagnostic accuracy of IVCCI and CAPVV as predictors of PSH. Methods: A total of 50 patients aged between 18 and 65 years undergoing elective lower abdominal surgeries under spinal anaesthesia were included. The IVCCI and CAPVV were measured using ultrasound pre-operatively. After administering spinal anaesthesia, haemodynamic data were collected till 15 min. Our primary objective was to evaluate the role of IVCCI and CAPVV to predict PSH. The secondary objectives were to compare the predictive efficacy of these two parameters and to detect other parameters for predicting PSH. We constructed the receiver operator characteristic (ROC) curves for IVCCI and CAPVV and obtained the best cut-off values. Results: The PSH occurred in 34% of the patients. IVCCI >21.15 could predict PSH with 58.8% sensitivity and 69.7% specificity. CAPVV >18.33 predicted PSH with 70.6% sensitivity and 54.6% specificity and IVC max/IVCCI >60 could predict PSH with 58.8% sensitivity and 54.5% specificity. A composite model comprising IVCmax (maximum IVC diameter), CAPVV, and baseline mean blood pressure was able to predict PSH. Conclusion: Both IVCCI and CAPVV have poor diagnostic accuracy in predicting PSH in adult patients undergoing elective infra-umbilical surgery.

Bygone Ether: Theriac to Obstinate Hiccups-Food for Thought!

How to cite this article: Hirolli D, Panda R, Baidya DK. Bygone Ether: Theriac to Obstinate Hiccups-Food for Thought! Indian J Crit Care Med 2022;26(7):884.

Effect of Early Administration of Vitamin D on Clinical Outcome in Critically Ill Sepsis Patients: A Randomized Placebo-controlled Trial.

BACKGROUND: Administration of vitamin D to unselected heterogeneous critically ill patients did not demonstrate outcome benefit. The current study was undertaken to identify if early administration of vitamin D can reduce intensive care unit (ICU) length of stay and improve clinical outcomes in critically ill patients with sepsis. METHODS: This single-center randomized double-blind placebo-controlled trial was done in the ICU and emergency inpatient ward of a tertiary care teaching institute in New Delhi, India. A total of 126 adult patients aged 18 to 80 years of either sex diagnosed to have sepsis were included within 24 hours of admission to the hospital and randomized into vitamin D or placebo groups. The patients in the intervention group received vitamin D3 540,000 units dissolved in 45 mL of milk. The placebo group received 45 mL of milk. RESULTS: The median length of ICU stay (8 vs 9 days; p = 0.32), median length of hospital stay (12 vs 12 days; p = 0.33), median duration of vasopressors requirement (4 vs 3 days; p = 0.84), median duration of mechanical ventilation (5 vs 7 days; p = 0.23), requirement of tracheostomy (34 vs 39%; p = 0.71), and 90-day mortality [35 vs 46%; p = 0.29; HR 0.72 (0.42-1.24)] were similar in vitamin D and placebo arm.A subgroup analysis in patients with severe vitamin D deficiency (vitamin D <12 ng/mL) revealed a significantly decreased incidence of tracheostomy (28 vs 57%; p = 0.04), a trend toward decreased 90-day mortality [34 vs 66%; p = 0.08; HR 0.44 (0.19-1.01)], and duration of mechanical ventilation (6 vs 11 days; p = 0.05) in patients receiving vitamin D. CONCLUSION: Administration of large-dose vitamin D within 24 hours of admission does not reduce the length of ICU stay in critically ill sepsis patients. HOW TO CITE THIS ARTICLE: Bhattacharyya A, Subramaniam R, Baidya DK, Aggarwal P, Wig N. Effect of Early Administration of Vitamin D on Clinical Outcome in Critically Ill Sepsis Patients: A Randomized Placebo-controlled Trial. Indian J Crit Care Med 2021;25(10):1147-1154.