Publications by authors named "Hemanshu Prabhakar"

Unlabelled: This position statement is documented based on the input from all contributing coauthors from the Indian Society of Critical Care Medicine (ISCCM), following a comprehensive literature review and summary of current scientific evidence. Its objective is to provide the standard perspective for the management of potential organ/tissue donors after brain death (BD) in adults only, regardless of the availability of technology. This document should only be used for guidance only and is not a substitute for proper clinical decision making in particular circumstances of any case.

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The term "urban-rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural-urban differences in terms of facilities related to neurocritical care (NCC) in LMICs.

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Background: Glasgow coma scale (GCS) score is the most widely used clinical score for the initial assessment of neurologically injured patients and is also frequently used for prognostication. Other scores such as the Full Outline of UnResponsivness (FOUR) score and the Glasgow Coma Scale-Pupils (GCS-P) score have been more recently developed and are gaining popularity. This prospective cohort study was conducted to compare various scores in terms of their ability to predict outcomes at 3 months in patients with traumatic brain injury (TBI).

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: Kapoor I, Prabhakar H. Can Bispectral Index be a Point-of-care Monitor for Sleep Quality Assessment in Critically Ill Patients? Indian J Crit Care Med 2023;27(11):782-783.

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Background: The limited representation from developing countries in the original COME TOGETHER survey gave us an impetus to conduct this survey in the Indian subcontinent.

Methods: This cross-sectional online survey was conducted from August through September 2022. Participants were health care physicians caring for patients with coma and disorders of consciousness.

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: Singhal V, Prabhakar H. Readiness of the Stroke Treatment in India: Still an Uphill Task! Indian J Crit Care Med 2023;27(9):607-608.

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Article Synopsis
  • The study tested whether the Glasgow Coma Scale-Pupils (GCS-P) score is a better predictor of mortality than the traditional Glasgow Coma Scale (GCS) in patients with traumatic brain injury (TBI).
  • Researchers conducted a prospective study with 573 adult TBI patients, analyzing their GCS and GCS-P scores upon ICU admission along with various clinical data to determine outcomes.
  • Results showed that both GCS and GCS-P had similar predictive power for mortality and functional outcomes at discharge and 6 months later, indicating that while GCS-P is effective, it is not superior to GCS in predicting these outcomes.
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Prabhakar H. Augmenting Hypertensive Therapy in Patients with Postoperative Subarachnoid Hemorrhage: What's the Right Choice? Indian J Crit Care Med 2023;27(4):233-234.

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Article Synopsis
  • End-of-life (EOL) care involves providing support to terminally ill patients, focusing on palliative, hospice, and patient choice in medical interventions.
  • A survey conducted among 91 clinicians across various Indian hospitals revealed that factors like years of experience and practice setting significantly affect EOL care strategies.
  • The findings highlighted critical gaps in EOL care in India, indicating a need for substantial reforms in the healthcare system to enhance care for terminally ill patients.
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Background: The Curing Coma Campaign (CCC) was launched by the Neurocritical Care Society (NCS) in 2019, with the purpose to bring together a diverse group of coma scientists, neurointensivists, and neurorehabilitationists.

Methods: The aim of this campaign is to move beyond the limitations imposed by current definitions of coma and identify mechanisms to improve prognostication, identify test therapies, and impact outcomes. At the moment, whole approach of the CCC appears ambitiously challenging.

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Traumatic brain injury (TBI) incurs substantial health and economic burden, as it is the leading reason for death and disability globally. Endocrine abnormalities are no longer considered a rare complication of TBI. The reported prevalence is variable across studies, depending on the time frame of injury, time and type of testing, and variability in hormonal values considered normal across different studies.

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Background: Multidrug-resistant (MDR) organisms in the critical care unit are a worldwide concern. The vulnerability to MDR infection in pediatric patients admitted in neurocritical care are due to altered mental status, immature immune system, higher risk of aspiration, and more frequent use of invasive devices. We aimed to measure the burden of MDR infection in pediatric neurosurgical intensive care unit (NSICU) patients.

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Article Synopsis
  • Midline shift (MLS) is a significant finding in brain imaging for patients with traumatic brain injury (TBI), and transcranial sonography (TCS) may offer a bedside diagnostic alternative to CT scans.
  • This study examined the relationship between TCS and CT measurements of MLS in 17 adults with moderate-to-severe TBI undergoing surgery, using various statistical methods including Pearson's correlation.
  • Results showed a minimal difference in MLS measurements between TCS (0.52 cm) and CT (0.58 cm), suggesting TCS can effectively detect MLS if performed within a specific time frame after CT scanning.
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