Background: Emergency intubation in critically ill patients may cause post-intubation hypotension, impairing organ perfusion and increasing mortality. Early risk identification is therefore important. The Modified Shock Index (MSI), calculated as heart rate divided by mean arterial pressure, offers a physiologically plausible alternative to the conventional Shock Index (SI). Objective: To compare MSI and SI for predicting post-intubation hypotension in adult critically ill patients undergoing emergency intubation in the ICU. Methods: This prospective observational study enrolled 80 haemodynamically stable adults requiring emergency intubation at Dhaka Medical College Hospital between July 2019 and June 2020. Pre-intubation vital signs were recorded and both indices calculated. Hypotension was defined as systolic blood pressure ≤90 mmHg, mean arterial pressure ≤65 mmHg, or vasopressor initiation within 30 minutes, with a structured assessment at 20 minutes to facilitate early response. Receiver operating characteristic (ROC) analysis and the Youden index assessed predictive performance and optimal cutoffs. Paired DeLong testing compared areas under the curve (AUCs). Results: Hypotension occurred in 42 patients (52.5%). MSI had a numerically higher AUC than SI: 0.830 (95% CI 0.733–0.927) versus 0.751 (95% CI 0.642–0.860), but paired DeLong testing did not establish superiority (z = 1.53, p = 0.127). MSI remained independently associated with hypotension after adjustment for age, sex, traumatic brain injury, and comorbidity (adjusted odds ratio 193.7; 95% CI 17.3–2172; p < 0.001). Organophosphate poisoning was excluded from the model because all 10 affected patients developed hypotension (complete separation; Fisher’s exact p = 0.0012, assessed separately). Optimal cutoffs were 1.15 for MSI and 0.85 for SI. Sensitivity, specificity, positive predictive value, and negative predictive value were 90.5%, 76.3%, 80.9%, and 87.9% for MSI, compared with 81.0%, 63.2%, 70.8%, and 75.0% for SI. Conclusion: MSI showed numerically higher discrimination than SI and remained independently associated with post-intubation hypotension, although the AUC difference was not statistically significant. An MSI ≥1.15 may help identify patients for haemodynamic optimisation. Larger multicentre studies are needed to confirm its additional predictive value over SI. Bangladesh Crit Care J September 2026; 14 (2): 74-83
Intensive care units (ICUs) concentrate the sickest patients, the most invasive devices, and the heaviest antibiotic exposure in any hospital, making them the focal point for healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). In Bangladesh, where critical care has expanded rapidly but unevenly, these risks are amplified by workforce shortages, inconsistent infection prevention and control (IPC) implementation, and a heavy burden of multidrug-resistant organisms. This narrative review synthesises published and grey literature on ICU infection epidemiology, national IPC policy, antimicrobial stewardship, and the structural constraints on Bangladeshi critical care. Ventilator-associated pneumonia, carbapenem-resistant Gram-negative infection, surgical site infection, and neonatal sepsis all occur well above rates reported from high-income settings, driven by low hand hygiene compliance, limited surveillance, understaffing, and largely empirical prescribing. National IPC and AMR policies now exist, but implementation is uneven outside Dhaka and a few well-resourced tertiary centres, while WHO-aligned multimodal pilots show that low-cost improvement is achievable even in district hospitals. Progress requires investment in a trained workforce, functioning surveillance, waste-management infrastructure, enforceable accreditation, and routine ICU stewardship. Bangladesh Crit Care J September 2026; 14 (2): 116-121
Post-intubation tracheal stenosis is an uncommon but potentially life-threatening complication of prolonged or repeated endotracheal intubation. We report a 61-year-old woman who developed progressive dyspnea and inspiratory stridor 35 days after her final extubation following three episodes of endotracheal intubation totaling 23 days. Endotracheal tube cuff pressure had not been routinely monitored. Computed tomography with multiplanar and three-dimensional reconstructions demonstrated a 4.15-cm circumferential upper thoracic tracheal stenosis with approximately 60% luminal narrowing. Flexible bronchoscopy confirmed circumferential stenosis 2.5 cm below the vocal cords, consistent with Cotton–Myer Grade II obstruction. Serial bronchoscopic tracheal dilatation resulted in significant symptomatic improvement. This case highlights the importance of recognizing post-intubation tracheal stenosis in patients with delayed post-extubation respiratory symptoms and emphasizes routine objective cuff-pressure monitoring as a simple preventive measure. Bangladesh Crit Care J September 2026; 14 (2): 148-150
Background: Maternal mortality is a crucial issue throughout the world. In Bangladesh, Maternal mortality ratio was 196 (uncertainty range = 159-234) per 100 000 live births. Maternal deaths occurred on the day of delivery is 30% and 6% on one day post-delivery.1 it is necessary to point out those factors for improvement. Objective: This study was focused to identify those factors, attributed to morbidity and mortality among the pregnant women and women in the postpartum period , who needed ICU admission. Methods: This study is a retrospective observational study from January 2024 to December 2025 (two years) in a tertiary care privet hospital, Dhaka. In the study period, 1697 patients got admitted in the two unit of ICU (7+8=15) 15 beds in a same hospital. Total of 57 patients were enrolled in this study. Results: Mean age of patients was 27.87 ± 7.62 years. Most of the patients got admitted in ICU, during postpartum period {42(73.68%)}. Indications for ICU admission were hypoxemic respiratory failure (77.19%), resp distress (57.89%), pulmonary oedema (38.59%), fluid overload (45.61%), & shock (36.84%). Among the study population, 57.89% received NIV, 40.35% got conventional oxygen, 15.78% were on MV, 10.52% on HFNC, 40.35% required vasopressor support, 10.52% needed dialysis & 29.82% needed transfusion. Diagnoses were divided as obstetric and non-obstetric types. Obstetric diagnoses were pregnancy-induced hypertension (n=20, 35.08%), eclampsia (n=15, 26.31%), postpartum hemorrhage (n=16, 28.07%), HELLP syndrome (n=6, 10.52%), peripartum cardiomyopathy (n=4, 7.01%), intra uterine death with MODS (n=2, 3.50%), ruptured ectopic pregnancy (n=7, 12.28%), and abortion (n= 2, 3.50%). Non-obstetric diagnoses were pulmonary oedema (n=15, 26.31%), AKI (n=10, 17.54%), TRALI (n=10, 17.54%), ARDS (n=4, 7.01%), DIC: 5(8.77%), cerebral venus sinus thrombosis: 2(3.50%), MODS:7(12.28%), Sepsis (n=2, 3.50%), Dengue (n=2, 3.50%), PRES (n=5, 8.77%), congenital methemoglobinemia (n=1, 1.75%), TTP (n=1, 1.75%), and acute pancreatitis (n=2, 3.50%). Non-urban patients were younger than urban patients (25.24 ± 5.57 vs 31.62 ± 5.87, p = 0.031) and higher number of primipara pregnancies among non-urban patients than urban group ( 23 vs 2, p = 0.013). Non-urban patients’ length of hospital stays and ICU stay were longer and had more MODS (15.38%) at admission and mortality rate (12.82%) compared to urban population and APACHE II scoring was higher in non-urban (10.35 ± 3.14, vs 6.43 ± 2.59, p = 0.002). Higher severity of metabolic acidosis and lower P/F ratio and higher serum lactate were observed in non-survivor in compared to survivor group. SOFA score was significantly higher in nonsurvivors compared to survivors (6.5 ± 0.83 vs 2.60 ± 1.07; p < 0.0001). The APACHE II score was also significantly higher in non-survivors compared to survivors’ group (15.3 ± 1.09 vs 7.7 ± 0.6; p < 0.0001). The mean hospital stay was significantly longer in nonsurvivors group compared to survivors (9.0 ± 4.9 Vs 5.3 ± 2.4; p < 0.0001). Conclusions: To improve the outcome, attention should be paid to the non-urban early risk assessment, emergency maternal health care and transportation system and increase awareness about obstetric critical care in non-urban area. Bangladesh Crit Care J September 2026; 14 (2): 98-103
Chlorine gas is a potent pulmonary irritant capable of causing acute lung injury and acute respiratory distress syndrome (ARDS). Although accidental chlorine exposure is relatively common, severe hypoxemic respiratory failure requiring hospitalization is uncommon, and reports from Bangladesh are lacking. We describe the first reported Bangladeshi case series of seven patients admitted following accidental chlorine gas inhalation. All patients presented with acute respiratory distress and hypoxemia and received early supportive critical care, including supplemental oxygen or high-flow nasal cannula (HFNC) therapy, while one patient required brief non-invasive ventilation. Adjunctive treatment included intravenous methylprednisolone, bronchodilators, nebulized sodium bicarbonate, and antioxidants. None of the patients required invasive mechanical ventilation or extracorporeal membrane oxygenation, and all achieved complete clinical recovery without apparent residual complications. This case series highlights the importance of early recognition and prompt supportive management in achieving favorable outcomes and underscores the need for prospective studies to define the role of adjunctive therapies in chlorine-induced lung injury. Bangladesh Crit Care J September 2026; 14 (2): 122-129
