Sanjeevan Hospital is a private hospital located in Daryaganj, New Delhi. The hospital was founded by Dr. Prem Aggarwal, cardiologist & specialist in critical care along with a group of senior doctors from Maulana Azad Medical College in 1983. The hospital has more than 100 beds and 10 bedded ICU.
BACKGROUND:Cytokines and chemokines play a crucial role in orchestrating the immune response to chikungunya virus (CHIKV) infection, influencing disease course and outcome. Although significant efforts have been made to understand the cytokine signatures associated with CHIKV infection, the identification of specific cytokine biomarkers across different disease stages remains incomplete. MATERIAL AND METHOD:We have assessed CHIKV-specific cytokine, chemokine profiles of 17 analytes in 50 acute chikungunya patients, 31 chronic chikungunya arthritis patients, 30 recovered individuals, and 23 healthy controls. The cytokine and chemokines were measured in the supernatant of PBMCs stimulated in vitro with inactivated chikungunya virus. RESULTS:It was observed that chronic chikungunya arthritis patients exhibited significantly higher levels of IL-1β, IL-6, and GM-CSF compared to all other groups. MCP-1 levels were elevated in patient groups compared to recovered and control individuals. IL-1β emerged as a potential biomarker for chronic chikungunya arthritis based on ROC analysis. A negative correlation between IFN-γ levels and CHIKV load was observed in acute patients, suggesting its antiviral role. IL-12 levels were higher in recovered individuals compared to all other groups, while IFN-γ levels were elevated in recovered individuals compared to acute patients. CONCLUSION:Our findings highlight IL-1β as a potential biomarker for chronic chikungunya arthritis and suggest that GM-CSF inhibition could serve as a therapeutic intervention for disease-associated chronic inflammation. The observed co-regulation of IL-12 and IFN-γ in recovered individuals needs further investigation into their role in disease resolution. These insights provide a deeper understanding of the immunopathogenesis of CHIKV infection and may contribute in future diagnostic and therapeutic strategies.
Background and purpose:Intrahospital transport (IHT) of critically ill patients is essential for diagnostic and therapeutic indications, requiring thorough assessment and careful preparation of patients, staff, and equipment throughout the process. Variability in practices among hospitals can affect patient safety and may result in adverse events (AEs). This position statement is designed to provide guidance to multidisciplinary critical care teams in the adoption of evidence-based recommendations aimed at mitigating risks and improving safety during patient transport. Method:This position statement has been drafted by an expert committee on IHT constituted by the Indian Society of Critical Care Medicine. The process involved thorough review of literature from electronic database using PubMed services. Recommendations made are tailored with considerations for Indian setting; the units may further modify these as per local needs and equipment and staffing available. The final manuscript was written after achieving consensus among members, and final draft was accepted by all the committee members. Results:This position statement offers a compilation of 38 strategic recommendations, which are comprehensive and deal with all aspects of IHT of the critically ill. Recommendations provided in this document are, therefore, applicable for routine use during the IHT. They cover all phases of transport and answer questions pertaining to pre-, intra-, and post-transport considerations. It will help to achieve uniformity, minimize AEs, and enhance safety. Conclusions:This is a standard set of 38 evidence-based recommendations to ensure safety for IHT, tailored for implementation in various criticalcare settings across India. Science is ever-changing, and periodic review will be needed to keep it up to date with emerging evidence and standards. How to cite this article:Zirpe KG, Tiwari AM, Kulkarni AP, Govil D, Samavedam S, Sharma J, et al. Position Statement of ISCCM on Intrahospital Transport of Critically Ill Patients. Indian J Crit Care Med 2025;29(4):291-300.
Sepsis is a global health problem with high morbidity and mortality. Low- and middle-income countries have a higher incidence and poorer outcome with sepsis. Large epidemiological studies in sepsis using Sepsis-3 criteria, addressing the process of care and deriving predictors of mortality are scarce in India. A multicentre, prospective sepsis registry was conducted using Sepsis 3 criteria of suspected or confirmed infection and SOFA score of 2 or more in 19 ICUs in India over a period of one year (August 2022–July 2023). All adult patients admitted to the Intensive Care Unit who fulfilled the Sepsis 3 criteria for sepsis and septic shock were included. Patient infected with Covid 19 were excluded. Patients demographics, severity, admission details, initial resuscitation, laboratory and microbiological data and clinical outcome were recorded. Performance improvement programs as recommended by the Surviving Sepsis guideline were noted from the participating centers. Patients were followed till discharge or death while in hospital. Registry Data of 1172 patients with sepsis (including 500 patients with septic shock) were analysed. The average age of the study cohort was 65 years, and 61
We assessed long-term outcomes of dexamethasone 12 mg versus 6 mg given daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia. We assessed 180-day mortality and health-related quality of life (HRQoL) using EuroQoL (EQ)-5D-5L index values and EQ visual analogue scale (VAS) in the international, stratified, blinded COVID STEROID 2 trial, which randomised 1000 adults with confirmed COVID-19 receiving at least 10 L/min of oxygen or mechanical ventilation in 26 hospitals in Europe and India. In the HRQoL analyses, higher values indicated better outcomes, and deceased patients were given a score of zero. We obtained vital status at 180 days for 963 of 982 patients (98.1%) in the intention-to-treat population, EQ-5D-5L index value data for 922 (93.9%) and EQ VAS data for 924 (94.1%). At 180 days, 164 of 486 patients (33.7%) had died in the 12 mg group versus 184 of 477 (38.6%) in the 6 mg group [adjusted risk difference − 4.3%; 99% confidence interval (CI) − 11.7–3.0; relative risk 0.89; 0.72–1.09; P = 0.13]. The adjusted mean differences between the 12 mg and the 6 mg groups in EQ-5D-5L index values were 0.06 (99% CI − 0.01 to 0.12; P = 0.10) and in EQ VAS scores 4 (− 3 to 10; P = 0.22). Among patients with COVID-19 and severe hypoxaemia, dexamethasone 12 mg compared with 6 mg did not result in statistically significant improvements in mortality or HRQoL at 180 days, but the results were most compatible with benefit from the higher dose.
How to cite this article: Khilnani GC, Tiwari P, Zirpe KG, Chaudhary D, Govil D, Dixit S, et al. Guidelines for the Use of Procalcitonin for Rational Use of Antibiotics. Indian J Crit Care Med 2022;26(S2):S77-S94.
