Hypervirulent Klebsiella pneumoniae (HvKp) is a virulent strain associated with invasive infections. While initially community-acquired, hospital-acquired HvKp (HA-HvKp) and carbapenem-resistant HvKp (CR-HvKp) are increasingly reported. This meta-analysis evaluates the prevalence, risk factors, and clinical outcomes associated with HvKp, including CR-HvKp and HA-HvKp, among Kp infections. A systematic search of PubMed, Scopus, Embase, and Cochrane Library was conducted until December 2024. Observational studies comparing HvKp vs classical Kp (cKp), CR-HvKp vs carbapenem-sensitive HvKp (CS-HvKp), and HA-HvKp vs community-acquired HvKp (CA-HvKp) were included. Quality was assessed using the Joanna Briggs Critical Appraisal Tool, and pooled prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Fifty studies with 6,663 participants were included. The HvKp prevalence was 33.0%, with most studies from Asia, predominantly China. Temporal analysis revealed an increase in HvKp prevalence (27.7% in 2006–2018 to 38.5% in 2019–2024). The CR-HvKp prevalence rose from 9.5% to 16.5% (2016–2024). The HA-HvKp prevalence increased from 25.9 to 47.1%. Key risk factors included diabetes mellitus (OR = 1.56), CA-Kp (OR = 2.59), and hypermucoviscous (HM)-phenotype (OR = 29.79). Complications included liver abscess (OR = 6.35), metastatic spread (OR = 4.74), meningitis (OR = 11.14), and septic shock (OR = 1.30). Mortality was higher in HvKp infections but not statistically significant (p = 0.219). HA-HvKp and immunosuppression were significant CR-HvKp risk factors, with CR-HvKp showing higher mortality. Diabetes mellitus, CA-Kp infections, and HM-phenotype are significant risk factors for HvKp. The rising prevalence of CR-HvKp and HA-HvKp highlights the need for early detection, infection control, and targeted treatment strategies. Nagendra D, Chaudhuri S, Gupta N, Shanbhag V, Eshwara VK, Rao S, et al. Prevalence, Risk Factors, and Clinical Outcomes of Hypervirulent Klebsiella pneumoniae Strains among Klebsiella pneumoniae Infections: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(4):370–393.

The expiratory muscles are an indispensable component of respiratory function in critically ill patients, yet is often overlooked. We evaluated the association of abdominal expiratory muscles thickness pattern with weaning. This was a single-center, prospective observational study done on 81 adult mechanically ventilated patients who underwent the weaning process. Sixteen patients had simple weaning and 65 patients had either difficult or prolonged weaning. The mean and standard deviation (SD) of the thickness of expiratory abdominal muscles—rectus abdominis (RA), internal oblique (IO), external oblique (EO), and transversus abdominis (TA) were significantly more in patients with simple weaning than those with difficult or prolonged weaning. The receiver operating curve (ROC) of expiratory muscles showed RA, IO, EO, TA cut-offs 0.638, 0.492, 0.315, and 0.253 cm, respectively, to predict simple weaning. The pattern of expiratory muscle thickness RA > IO > EO > TA was maintained in both simple and difficult/prolonged weaning groups (p = 0.362). The ROC of diaphragmatic excursion (DE) for predicting simple weaning had cut-off 1.79 cm. The lung ultrasound score (LUS) was 5.75 ± 3.32 in the simple weaning group, compared to 9.71 ± 5.18 in the difficult/prolonged weaning group (p = 0.005). Abdominal expiratory muscles were significantly thicker in patients with simple weaning compared to those with difficult or prolonged weaning. The pattern of expiratory muscle thickness followed the pattern of RA > IO > EO > TA in both simple weaning and difficult or prolonged weaning groups. DE >1.79 cm predicted simple weaning and LUS was significantly lesser in patients with simple weaning (CTRI/2020/11/028895). Amara V, Vishwas P, Maddani SS, Natarajan S, Chaudhuri S. Evaluation of Abdominal Expiratory Muscle Thickness Pattern, Diaphragmatic Excursion, and Lung Ultrasound Score in Critically Ill Patients and Their Association with Weaning Patterns: A Prospective Observational Study. Indian J Crit Care Med 2022;26(3):307–313.

Background: We compared i-gel and ProSeal laryngeal mask airway (PLMA) regarding time taken for insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Materials and Methods: In a prospective, randomized manner, 48 adult patients of American Society of Anesthesiologists I-II of either gender between 18 and 60 years presenting for a short surgical procedure were assigned to undergo surgery under general anesthesia on spontaneous ventilation using either the i-gel or PLMA. An experienced nonblinded anesthesiologist inserted appropriate sized i-gel or PLMA in patients using standard insertion technique and assessed the intraoperative findings of the study regarding regarding time taken for respective device insertion, effective seal, fiberoptic view of larynx, ease of Ryle's tube insertion, and postoperative sore throat assessment. Postoperative assessment of sore throat was done by blinded anesthesia resident. Results: The time required for insertion of i-gel was lesser (21.98 ± 5.42 and 30.60 ± 8.51 s in Group I and Group P, respectively; P = 0.001). Numbers of attempts for successful insertions were comparable and in majority, device was inserted in first attempt. The mean airway leak pressures were comparable. However, there were more number of patients in Group P who had airway leak pressure >20 cm H ₂ O. The fiberoptic view of glottis, ease of Ryle's tube insertion, and incidence of complications were comparable. Conclusion: Time required for successful insertion of i-gel was less in adult patients undergoing short surgical procedure under general anesthesia on spontaneous ventilation. Patients with airway leak pressure >20 cm H ₂ O were more in PLMA group which indicates its better suitability for controlled ventilation.

Lung ultrasound score (LUS) as well as radiographic assessment of lung edema (RALE) score as calculated from chest radiography (CXR) have been applied to assess Acute Respiratory Distress Syndrome (ARDS) severity. CXRs, which are frequently performed in ARDS patients, pose a greater risk of radiation exposure to patients and health care staff. The aim of the study was to evaluate if LUS had a better correlation to oxygenation (PaO2/FiO2) compared with the RALE score in ARDS patients. We also aimed to analyse if there was a correlation between RALE score and LUS. We wanted to determine the LUS and RALE score cut-off, which could predict a prolonged length of intensive care unit (ICU) stay (≥10 days) and survival. Thirty-seven patients aged above 18 years with ARDS as per Berlin definition and admitted to the ICU were included in the study. It was a retrospective study done over a period of 11 months. On the day of admission to ICU, the global and basal LUS, global and basal RALE score, and PaO2 /FiO2 were recorded. Outcome and days of ICU stay were noted. Global LUS score and PaO2/FiO2 showed the best negative correlation (r = –0.491), which was significant (p = 0.002), followed by global RALE score and PaO2/FiO2 (r = –0.422, p = 0.009). Basal LUS and PaO2/FiO2 also had moderate negative correlation (r = –0.334, p = 0.043) followed by basal RALE score and PaO2/FiO2 (r = –0.34, p = 0.039). Global RALE score and global LUS did not show a significant correlation. Similarly, there was no significant correlation between basal RALE score and basal LUS. Global and basal LUS as well as global and basal RALE score were not beneficial in predicting either a prolonged length of ICU stay or survival as the area under curve was low. In ARDS patients, global LUS had the best correlation to oxygenation (PaO2/FiO2), followed by global RALE score. Basal LUS and basal RALE score also had moderate correlation to oxygenation. However, there was no significant correlation between global LUS and global RALE score as well as between basal LUS and basal RALE score. Global and basal LUS as well as global and basal RALE scores were not able to predict a prolonged ICU stay or survival in ARDS patients.

Objectives: “Post-COVID-19 syndrome,” which may be the new pandemic, has affected various domains of quality of life; even among those who have recovered from mild COVID-19 disease. The aim of our study was to explore the health, social and psychological impact on healthcare workers (HCWs) who have recovered from active COVID-19 illness and highlight their needs post-recovery. Materials and Methods: It was a web-based survey study. A total of 163 eligible consenting HCWs participated in this survey. The Institutional Ethical Committee approval was obtained before study recruitment and the study was registered with the Clinical Trial Registry of India. Each participant responded to 25 questions. Results: Among those participated, 51% were doctors, 32% were nurses and others were allied health professionals and students. About 82% had mild COVID-19 illness and 40% required hospitalisation for COVID-19 treatment. In the post-recovery period, 66% experienced health issues and fatigue on mild exertion was the most common symptom (42.94%). It was followed by anosmia and ageusia (21.47%), headache and myalgia (15.34%) and breathlessness (8.59%). About 82% HCW felt the need for a post-COVID-19 recovery health care unit. Potential risk of infecting family members was the most common concern (53.46%) followed by the fear of contracting the virus again (46.54%). About 35% of HCW experienced the fear of developing post-COVID-19 complications. About 78% of HCW did not report any psychological concerns, but one-third were stressed due to the financial impact. Conclusion: Post-COVID-19 syndrome impacts all domains of quality of life. Fatigue, loss of taste and smell, headache, myalgia and breathlessness continue to persist beyond recovery of active illness. Most of the HCWs emphasised the need to set up post-COVID-19 care units. The fear of contracting the virus again and financial drain due to hospital expenses continued to distress HCWs.

To determine the utility of the HACOR score in predicting weaning failure in resource-limited settings. The primary objective was to determine a cut-off value of the HACOR score, sensitivity, and specificity to predict failed weaning. The secondary objective was to determine which out of five components of the score was significantly different between the successful weaning and the failed weaning groups. Most weaning indices are either inaccurate or are dependent on complex ventilatory parameters, which are difficult to measure in resource-limited settings. This study aimed to determine the utility of the HACOR score consisting of heart rate, acidosis, consciousness level, oxygenation, and respiratory rate as a predictor of weaning in the intensive care unit. It was a prospective observational study on 120 patients between 18 and 90 years. The HACOR score was evaluated at 30 minutes of spontaneous breathing trial (SBT). The total duration of SBT was 120 minutes. Out of 120 patients, 83 (69.2%) had successful weaning, whereas 37 (30.8%) had weaning failure. The median and interquartile range (IQR) of the HACOR score in the successful weaning group was 2 (0–3) and 6 (5–8) in the failed weaning group (p-value <0.001). There was a significant difference in each of the five components of the HACOR score between the successful and failed weaning groups (p <0.05). HACOR score ≥5 predicted failed weaning, sensitivity 83.8%, specificity 96.4%, area under the curve (AUC) 0.950, and 95% confidence interval (CI) [0.907–0.993], p <0.001. Multivariable logistic regression analysis showed that HACOR score ≥5 is an independent predictor of weaning failure [p <0.001, 95% CI (1.9–4.2), adjusted odds ratio 2.82]. A HACOR score ≥5 is an excellent predictor of weaning failure. This score may be useful as a weaning strategy in the intensive care unit. Chaudhuri S, Gupta N, Adhikari SD, Todur P, Maddani SS, Rao S. Utility of the One-time HACOR Score as a Predictor of Weaning Failure from Mechanical Ventilation: A Prospective Observational Study. Indian J Crit Care Med 2022;26(8):900–905. Prior to the commencement of the study, Institutional Ethics Committee permission was obtained (IEC: 197/2021) and Clinical Trial Registry of India (CTRI) registration was done before recruitment (CTRI/2021/07/035139). We obtained written informed consent from the legally authorized representative prior to recruiting patients for the study.