Mohan Gurjar

Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS) · Department of Critical Care Medicine

Patients with end-stage renal disease (ESRD) on renal replacement therapy (RRT) have a reported incidence of COVID 19 varying between 2-20%. While early reports from China indicated that these patients had fewer symptoms and required less intensive care than expected, more recent data has shown mortality varying between 9 and 31%. (1,2,3) This coul...

Although more than 90% of infected pregnant women with COVID-19 recover, the clinical course is considered as worse compared with non-pregnant individuals of the same sex and age, especially in moderate and severe COVID illness. COVID-19 infected pregnant women, who develop pneumonia, appear to have an increased frequency of preterm birth (birth be...

Renal transplant recipients are labelled under a high-risk population for severe COVID-19 disease, with mortality rates of 11-28%, varying between series from India and the developed world. (1,2) This augmented risk might be secondary to transplant-specic factors such as use of induction therapies and steroids in immunosuppression, and nonspecic...

Sheehan's syndrome is a life-threatening endocrine emergency seen in postpartum females secondary to ischemic pituitary necrosis. It is a frequent cause of hypopituitarism in developing countries that occurs secondary to post-partum haemorrhage (PPH). Patients with Sheehan's syndrome often present with organ dysfunctions in critical care settings,...

Objective Evaluation of glucometrics in the first week of ICU stay and its association with outcomes. Design Prospective observational study. Setting Mixed ICU of teaching hospital. Patients Adults initiated on insulin infusion for 2 consecutive blood glucose (BG) readings ≥180 mg/dL. Main variables of interest Glucometrics calculated from the...

Intra-abdominal infections are known to complicate the course of acute pancreatitis. Invasive fungal infections (Candida spp.) are not the uncommon microorganisms which isolate from intra-abdominal specimen in acute necrotizing pancreatitis. However, we are reporting first case of invasive gastric mucormycosis in a postpartum acute pancreatitis pat...

Hypoalbuminemia has been associated with poor outcome in critically ill population including sepsis and COVID-19. The observational study by Su et al showed a favorable albumin kinetics, with an initial downwards trend followed by recovery back to the predicted albumin levels, in survivors of COVID-19 and sepsis-induced acute respiratory distress s...

Coronavirus disease-2019 (COVID-19) pandemic is raging all over the world. As we are delving more into management of COVID-19, certain new challenges are emerging. One of these is emergence or reactivation of viral infections belonging to Herpesviridae family, especially cytomegalovirus (CMV). Although we have come across the threat of fungal and r...

Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without CO...

Background Two acute respiratory distress syndrome (ARDS) subphenotypes (hyperinflammatory and hypoinflammatory) with distinct clinical and biological features and differential treatment responses have been identified using latent class analysis (LCA) in seven individual cohorts. To facilitate bedside identification of subphenotypes, clinical class...

Background: health-related quality of life (HRQoL) is an important patient-centred outcome in patients surviving ICU admission for COVID-19. It is currently not clear which domains of the HRQoL are most affected. Objective: to quantify HRQoL in order to identify areas of interventions. Design: prospective observation study. Setting: admissions to E...

Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In thi...

During the last decade, utilization of direct oral anticoagulants (DOACs) has increased due to their pharmacokinetic profile and the fact that they are non-inferior to warfarin in the prevention of stroke in patients with atrial fibrillation, as well as for the treatment of venous thromboembolism. However, there are few studies about their use in c...

Direct oral anticoagulants (DOACs) have revolutionized the field of anticoagulation in the last decade, mainly due to their fixed dosing, rapid onset of anticoagulant effect, and non-inferiority to vitamin K antagonists for both efficacy and safety. Also, the availability of specific and non-specific reversal agents makes these drugs popular. Howev...

Introduction: There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-sever...

Background: Data regarding delivery of evidence-based care to critically ill patients in Intensive Care Units (ICU) during the COVID-19 pandemic is crucial but lacking. This study aimed to evaluate the implementation rate of the ABCDEF bundle, which is a collection of six evidence-based ICU care initiatives which are strongly recommended to be inco...

Background: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score...

Although weaning failure is multifactorial, assessment of inspiratory effort and respiratory muscle strength bedside in mechanically ventilated is a challenge to intensive care physician. Factors like poor peak expiratory flow (cough strength), increased airway resistance, reduced compliance, impairment in gas exchange, cardiac dysfunction, electro...

Background : - Intravenous administration of radiocontrast media is referred to as contrast-induced kidney injury (CI-AKI).CI-AKI is described as the third most common cause of new AKI in hospitalized patients. The occurrence of CI-AKI is reported up to 55% in these high-risk patients.: NGAL (Neutrophil gelatinase-associated Lipocalin)and Cystatin...

Background Mental health disturbances have been well documented due to COVID-19 pandemic. There was surge in literature about use of various Mind Body Therapies during pandemic to curb these disturbances. But none have been studied to prospectively during COVID-19 pandemic. Hence, present study was planned to evaluate the efficacy of Yoganidra in f...

Background To determine the frequency of, and factors associated with, death in hospital following ICU discharge to the ward. Methods The Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE study was an international, multicenter, prospective cohort study of patients with severe respiratory failure, conduc...

Background: Clinical pulmonary infection score (CPIS) is an established diagnostic parameter for ventilator-associated pneumonia (VAP). Lung ultrasound (LUS) is an evolving tool for diagnosing VAP. Various scores have been proposed for the diagnosis of VAP, taking LUS as a parameter. We proposed whether replacing LUS with chest radiograph in CPIS c...

Purpose The primary aim of this study was to identify the modifiable risk factors for acquiring VAE. Secondary aims were to investigate the ICU course and impact of VAE on patient outcome. Methods This prospective, observational single center cohort study included 247 patients on mechanical ventilation for 4 calendar days at a 20-bed ICU between J...

There are risk factors related to architecture and designing labeled as “structural risk factors,” causing hospital-acquired infections (HAIs) which are less highlighted in the literature. Through this communication, we wish to reiterate the importance of structural risk factors such as space surrounding the patient, furniture with focus on constru...

Introduction: The current pandemic of novel Corona Virus Disease 2019 (COVID-19) has created a significant shortage of personal protective equipment (PPE) in many countries of the world, stressing medical services during this crisis. Along with addressing problems of demand and supply mismatch, there also need to ensure procurement of high quality...

During the current coronavirus disease (COVID-19) pandemic, it is estimated that tens of thousands of health care workers have been infected. The doffing of personal protective equipment (PPE) has been identified an important place and procedure that might influence the self-contamination of health care workers. More recent evidence suggests that,...

Background: Ceftazidime–avibactam combination with aztreonam and role of rapid synergy reporting has not been widely evaluated. Also the synergy correlation with various betalactamases has not been widely studied. Methods: We studied phenotypic synergy testings and molecular detection of betalactamases in our university hospital where we have large...

Background: A diverse country like India may have variable intensive care units (ICUs) practices at state and city levels. Aim: To gain insight into clinical services and processes of care in ICUs in India, this would help plan for potential educational and quality improvement interventions. Methods: The Indian ICU needs assessment research gr...

The aim of this review is to describe variation in standards and guidelines on 'heating, ventilation and airconditioning (HVAC)' system maintenance in the intensive care units, across the world, which is required to maintain good 'indoor air quality' as an important non-pharmacological strategy in preventing hospital-acquired infections. Health Tec...

Background: Prolonged invasive ventilation is common in patients with severe brain injury. Information on optimal management of extubation and on the use of tracheostomy in these patients is scarce. International guidelines regarding the ventilator liberation and tracheostomy are currently lacking. Methods: The aim of 'Extubation strategies in N...

Crosstalk between various organs exists in the human body. This can be part of physiological reflexes such as cardiac reflexes that protect the organs during stressful stimuli or can be part of pathological conditions where an insult to an organ releases cytokines that cause distant effects on other organs. In critically ill patients, these crossta...

Background: Management of H1N1 viral infection-associated acute respiratory distress syndrome (ARDS) has primarily been focused on lung protective ventilation strategies, despite that mortality remains high (up to 45%). Other measures to improve survival are prone position ventilation (PPV) and extracorporeal membrane oxygenation. There is scarcit...

In managing critically ill patients, the understanding of pathophysiological abnormalities, monitoring of clinical variables, and timely intervention makes an impact on patient outcome. The Textbook of Ventilation, Fluids, Electrolytes and Blood Gases encompasses essential topics for which thorough education and training is a must for any clinician...

Objectives: To evaluate the effect of prolonged duration of prone position (with head laterally rotated) on intraocular pressure in acute respiratory distress syndrome patients. Design: Prospective observational study. Setting: University hospital ICU. Patients: Twenty-five acute respiratory distress syndrome patients, age 60 years (51-67 yr...

Introduction: Noninvasive ventilation (NIV) is an increasingly used method of respiratory support. The use of NIV is expanding over the time and if properly applied, it can save patients’ lives and improve long-term prognosis. However, both knowledge and skills of its proper use as life support are paramount. This systematic review aimed to assess...

Aims: To estimate the prevalence of antibiotic de-escalation at admission in patients referred to a tertiary hospital in India. The secondary outcomes were the adequacy of empirical antibiotic therapy and culture positivity rates in the de-escalated group. Materials and methods: A prospective observational study, in a 20-bedded ICU of tertiary care...

Introduction Lung-protective ventilation strategy and prone positioning are the strategies practiced to manage patients suffering from acute respiratory distress syndrome (ARDS). Inferior Vena Cava Distensibility (dIVC) Index has been used for predicting fluid responsiveness (FR) in supine position. We conducted this study to observe the utility of...

Pyomyositis is a tropical infection affecting skeletal muscles manifesting as high-grade fever with pain in the affected limbs usually caused by Gram-positive microorganisms. Gram-negative organisms causing pyomyositis is uncommon but has been reported. Burkholderia cepacia is a Gram-negative nonfermenter causing opportunistic infections in immunoc...

Background: Effect of prone positioning on acute hemodynamic changes (within 10 minutes) in acute respiratory distress syndrome (ARDS) has not been studied. Methods: In this prospective observational study, hemodynamic assessment by trans-esophageal Doppler (TED) was done with the primary aim to measure early changes in cardiac index (CI), if an...

What we already know about this topic: Hospital mortality in acute respiratory distress syndrome is approximately 40%, but mortality and trajectory in "mild" acute respiratory distress syndrome (classified only since 2012) are unknown, and many cases are not detected WHAT THIS ARTICLE TELLS US THAT IS NEW: Approximately 80% of cases of mild acute...

Introduction Neutrophil CD64 (nCD64) has been found to identify sepsis from nonseptic patients. It is also reported to be a predictor of survival and severity of sepsis. The goal of this study was to correlate serial nCD64 with Intensive Care Unit (ICU) outcome and severity of sepsis. Materials and Methods A prospective observational study was con...

Background Isolated renal mucormycosis (IRM) is a potentially fatal disease affecting immunocompromised hosts. IRM affecting apparently immunocompetent patients is rare, with few previous reports, mostly from India. We describe 10 cases of bilateral IRM with no underlying risk factors. Methods We performed a retrospective analysis of cases of IRM...

Purpose: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. Methods: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. Results: LST limitation was iden...

Purpose: To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification. Methods: Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24 h. Secondary obje...

Introduction: While prone positioning (PP) has been shown to improve patient survival in moderate to severe acute respiratory distress syndrome (ARDS) patients, the rate of application of PP in clinical practice still appears low. Aim: This study aimed to determine the prevalence of use of PP in ARDS patients (primary endpoint), the physiologica...

Background Diaphragm ultrasound (DUS) is a well-established point of care modality for assessment of dimensional and functional aspects of the diaphragm. Amongst various measures, diaphragmatic thickening fraction (DTf) is more comprehensive. However, there is still uncertainty about its capability to predict weaning from mechanical ventilation (MV...

Objectives: Aspiration of oropharyngeal or gastric contents in intubated patients can lead to ventilator-associated pneumonia. Amylase in respiratory secretion has been reported as a possible marker of aspiration. We studied whether elevated α-amylase in mini bronchoalveolar lavage specimens can be suggestive of ventilator-associated pneumonia in...

Isolated renal mucormycosis is a rare entity in children. It is potentially fatal when not detected and managed early with antifungal therapy, and surgery as and when needed. We present two immunocompetent children who developed this infection and subsequently succumbed to it. The diagnosis was established postmortem on renal biopsy specimens. We a...

Aim of Study Acute kidney injury (AKI) is common in patients of septic shock. There is sparse data comparing sustained low-efficiency dialysis (SLED) and continuous renal replacement therapy (CRRT) in patients with septic shock. Materials and Methods This is a prospective randomized study in a 12-bedded medical intensive care unit. After clearance...

Background Thromboelastography (TEG) is a global test of coagulation which analyzes the whole coagulation process. TEG is popular in trauma, liver transplant, and cardiac surgeries, but studies in sepsis are limited. We have assessed the utility of TEG for evaluating coagulopathy in nonbleeding patients with sepsis. Materials and Methods A prospec...

Background: Thromboelastography (TEG) is a global test of coagulation which analyzes the whole coagulation process. TEG is popular in trauma, liver transplant, and cardiac surgeries, but studies in sepsis are limited. We have assessed the utility of TEG for evaluating coagulopathy in nonbleeding patients with sepsis. Materials and Methods: A prospe...