Publications by authors named "Sheila Nainan Myatra"

Objectives: Randomized clinical trials informing clinical practice (e.g., like large, pragmatic, and late-phase trials) should ideally mostly use harmonized outcomes that are important to patients, family members, clinicians, and researchers.

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Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resource-limited settings.

Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacific Sepsis Alliance (APSA). The committee selected an international panel of clinicians and researchers with expertise in sepsis management.

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Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study Design And Methods: This was a sub-study of an international, prospective, observational cohort.

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Background: Integrating artificial intelligence (AI) into intensive care practices can enhance patient care by providing real-time predictions and aiding clinical decisions. However, biases in AI models can undermine diversity, equity, and inclusion (DEI) efforts, particularly in visual representations of healthcare professionals. This work aims to examine the demographic representation of two AI text-to-image models, Midjourney and ChatGPT DALL-E 2, and assess their accuracy in depicting the demographic characteristics of intensivists.

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Although current clinical practice guidelines have discordant conclusions, a judicious approach to using NMBA infusions may include reserving their use for patients with early severe ARDS who are already deeply sedated and for patients under light sedation who have significant ventilator dyssynchrony, despite attempts to adjust both ventilator settings and sedation requirements. Based on current evidence, the duration of NMBA use should be limited to 48 hours, whenever possible.

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Article Synopsis
  • Mental health issues among healthcare professionals in ICUs are serious, with burnout rates reaching up to 50%, and factors affecting burnout include communication and support systems.
  • The 'Hello Bundle' intervention was created to combat burnout by enhancing social interactions and team cohesion, using elements like posters, email reminders, and daily greetings.
  • A cluster randomized controlled trial will assess the effectiveness of the 'Hello Bundle', involving around 7,300 participants from various ICUs, comparing burnout levels before and after the intervention.
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  • * The study focused on creating a set of expert guidelines for managing difficult airways in critically ill adults, specifically those with physiologically challenging conditions like obesity and pregnancy.
  • * An international group of airway management specialists used the Delphi method, which involved multiple rounds of surveys, to achieve consensus on 53 out of 61 proposed statements regarding best practices.
  • * Key recommendations included forming a robust intubation team, using videolaryngoscopy, optimizing patient conditions before intubation, and carefully monitoring the patient's status post-intubation to improve overall outcomes.
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Acute circulatory shock is a life-threatening emergency requiring an efficient and timely management plan, which varies according to shock etiology and pathophysiology. Specific guidelines have been developed for each type of shock; however, there is a need for a clear timeline to promptly implement initial life-saving interventions during the early phase of shock recognition and management. A simple, easily memorable bundle of interventions could facilitate standardized management with clear targets and specified timeline.

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Purpose: To identify key components and variations in family-centered care practices.

Methods: A cross-sectional study, conducted across ESICM members. Participating ICUs completed a questionnaire covering general ICU characteristics, visitation policies, team-family interactions, and end-of-life decision-making.

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  • Central line-associated bloodstream infection (CLABSI) rates in Latin American ICUs are significantly higher than in high-income countries, prompting a need for intervention.
  • The INICC multidimensional approach, which includes an 11-component bundle, was implemented across 122 ICUs in nine Asian countries, resulting in a substantial decrease in CLABSI rates from 16.64 to 2.18 over 29 months.
  • The intervention not only reduced CLABSI rates by 87% but also significantly lowered the all-cause in-ICU mortality rate from 13.23% to 10.96%.
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Background: There is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income (LLMIC), upper middle income (UMIC) and high income (HIC) countries/regions.

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Objectives: To identify research priorities in the management, epidemiology, outcome, and pathophysiology of sepsis and septic shock.

Design: Shortly after publication of the most recent Surviving Sepsis Campaign Guidelines, the Surviving Sepsis Research Committee, a multiprofessional group of 16 international experts representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine, convened virtually and iteratively developed the article and recommendations, which represents an update from the 2018 Surviving Sepsis Campaign Research Priorities.

Methods: Each task force member submitted five research questions on any sepsis-related subject.

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Objective: To identify urinary catheter (UC)-associated urinary tract infection (CAUTI) incidence and risk factors.

Design: A prospective cohort study.

Setting: The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries.

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Background: Ventilator associated pneumonia (VAP) occurring in the intensive care unit (ICU) are common, costly, and potentially lethal.

Methods: We implemented a multidimensional approach and an 8-component bundle in 374 ICUs across 35 low and middle-income countries (LMICs) from Latin-America, Asia, Eastern-Europe, and the Middle-East, to reduce VAP rates in ICUs. The VAP rate per 1000 mechanical ventilator (MV)-days was measured at baseline and during intervention at the 2nd month, 3rd month, 4-15 month, 16-27 month, and 28-39 month periods.

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Background: Qualitative data on the opinions of anaesthesiologists regarding the impact of peri-operative night-time working conditions on patient safety are lacking.

Objectives: This study aimed to achieve in-depth understanding of anaesthesiologists' perceptions regarding the impact of night-time working conditions on peri-operative patient safety and actions that may be undertaken to mitigate perceived risks.

Design: Qualitative analysis of responses to two open-ended questions.

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Article Synopsis
  • The study examined current mechanical ventilation practices in Asian intensive care units, specifically focusing on tidal volume, plateau pressure, and PEEP in patients.
  • Data from 1408 patients were analyzed, highlighting that while low tidal volume was utilized in patients with ARDS, a large proportion of those without ARDS received intermediate tidal volumes, with adequate plateau pressure noted in most cases.
  • The research found that factors like income classification, patient age, severity of illness, and certain clinical measures significantly influenced mortality rates, which escalated with higher predictive scores for mortality.
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Background: The optimal dose of dexamethasone for severe/critical COVID-19 is uncertain. We compared higher versus standard doses of dexamethasone in adults with COVID-19 and hypoxia.

Methods: We searched PubMed and trial registers until 23 June 2023 for randomised clinical trials comparing higher (>6 mg) versus standard doses (6 mg) of dexamethasone in adults with COVID-19 and hypoxia.

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  • RBC transfusions are a frequent intervention in ICUs, yet there's a gap in understanding how hemoglobin (Hb) thresholds for transfusion are applied in practice.
  • An international study analyzed transfusion practices in 233 ICUs across 30 countries, including 3,643 adult patients from March 2019 to October 2022.
  • Of the patients studied, 25% received RBC transfusions, with variations in transfusion rates observed across different ICUs, countries, and continents, highlighting diverse clinical practices.
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  • * It focuses on adult patients with upper aerodigestive tract squamous cell carcinoma who had surgery, analyzing data from 245 patients between July and December 2019.
  • * Findings indicate that surgical site infections (SSI) significantly increase the risk of UHR and delay in adjuvant treatment, also correlating with poorer disease-free survival rates among affected patients.
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Myatra SN, Divatia JV, Salins N. Evaluating Determinants of End-of-life Care Provision in Indian Intensive Care Units. Indian J Crit Care Med 2023;27(5):299-300.

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Article Synopsis
  • The study aimed to analyze the rates and risk factors of central line-associated bloodstream infections (CLABSI) across 281 ICUs in 9 Asian countries from 2004 to 2022.
  • Out of 150,142 patients, a total of 1514 CLABSIs were recorded, with an overall infection rate of 5.08 per 1000 central line days, highest in femoral and temporary hemodialysis catheters.
  • Key risk factors for CLABSI included longer hospital stays before infection, tracheostomy use, hospitalization type, and facility ownership, particularly in publicly-owned and lower-middle-income country facilities.
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Objective: To identify central-line (CL)-associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs).

Design: From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms.

Setting: The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries.

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Airway management is a core skill essential for anaesthesiologists and health care providers involved in resuscitation and acute care of patients. Advancements in airway management are continuously evolving. This narrative review highlights the recent advancements with respect to innovations, tools, techniques, guidelines, and research in both technical and non-technical aspects of airway management.

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