Short-term central venous catheterization (CVC) is one of the commonly used invasive interventions in ICU and other patient-care areas. Practice and management of CVC is not standardized, varies widely, and need appropriate guidance. Purpose of this document is to provide a comprehensive, evidence-based and up-to-date, one document source for practice and management of central venous catheterization. These recommendations are intended to be used by critical care physicians and allied professionals involved in care of patients with central venous lines. This position statement for central venous catheterization is framed by expert committee members under the aegis of Indian Society of Critical Care Medicine (ISCCM). Experts group exchanged and reviewed the relevant literature. During the final meeting of the experts held at the ISCCM Head Office, a consensus on all the topics was made and the recommendations for final document draft were prepared. The final document was reviewed and accepted by all expert committee members and after a process of peer-review this document is finally accepted as an official ISCCM position paper.Modified grade system was utilized to classify the quality of evidence and the strength of recommendations. The draft document thus formulated was reviewed by all committee members; further comments and suggestions were incorporated after discussion, and a final document was prepared. This document makes recommendations about various aspects of resource preparation, infection control, prevention of mechanical complication and surveillance related to short-term central venous catheterization. This document also provides four appendices for ready reference and use at institutional level. In this document, committee is able to make 54 different recommendations for various aspects of care, out of which 40 are strong and 14 weak recommendations. Among all of them, 42 recommendations are backed by any level of evidence, however due to paucity of data on 12 clinical questions, a consensus was reached by working committee and practice recommendations given on these topics are based on vast clinical experience of the members of this committee, which makes a useful practice point. Committee recognizes the fact that in event of new emerging evidences this document will require update, and that shall be provided in due time. ABHR: Alcohol-based hand rub; AICD: Automated implantable cardioverter defibrillator; BSI: Blood stream infection; C/SS: CHG/silver sulfadiazine; Cath Lab: Catheterization laboratory (Cardiac Cath Lab); CDC: Centers for Disease Control and Prevention; CFU: Colony forming unit; CHG: Chlorhexidine gluconate; CL: Central line; COMBUX: Comparison of Bedside Ultrasound with Chest X-ray (COMBUX study); CQI: Continuous quality improvement; CRBSI: Catheter-related blood stream infection; CUS: Chest ultrasonography; CVC: Central Venous Catheter; CXR: Chest X-ray; DTTP: Differential time to positivity; DVT: Deep venous thrombosis; ECG: Electrocardiography; ELVIS: Ethanol lock and risk of hemodialysis catheter infection in critically ill patients; ER: Emergency room; FDA: Food and Drug Administration; FV: Femoral vein; GWE: Guidewire exchange; HD catheter: Hemodialysis catheter; HTS: Hypertonic saline; ICP: Intracranial pressure; ICU: Intensive Care Unit; IDSA: Infectious Disease Society of America; IJV: Internal jugular vein; IPC: Indian penal code; IRR: Incidence rate ratio; ISCCM: Indian Society of Critical Care Medicine; IV: Intravenous; LCBI: Laboratory confirmed blood stream infection; M/R: Minocycline/rifampicin; MBI-LCBI: Mucosal barrier injury laboratory-confirmed bloodstream infection; MRSA: Methicillin-resistant Staphylococcus aureus; NHS: National Health Service (UK); NHSN: National Healthcare Safety Network (USA); OT: Operation Theater; PICC: Peripherally-inserted central catheter; PIV: Peripheral intravenous line; PL: Peripheral line; PVI: Povidone-iodine; RA: Right atrium; RCT: Randomized controlled trial; RR: Relative risk; SCV/SV: Subclavian vein; ScVO2: Central venous oxygen saturation; Sn: Sensitivity; SOP: Standard operating procedure; SVC: Superior vena cava; TEE: Transesophageal echocardiography; UPP: Useful Practice Points; USG: Ultrasonography; WHO: World Health Organization. Javeri Y, Jagathkar G, Dixit S, Chaudhary D, Zirpe KG, Mehta Y, et al. Indian Society of Critical Care Medicine Position Statement for Central Venous Catheterization and Management 2020. Indian J Crit Care Med 2020;24(Suppl 1):S6-S30.

Hypertriglyceridemia is the third most common cause of acute pancreatitis (AP). However, the evidence on the management of hypertriglyceridemia-induced AP is lacking. We undertook a systematic review of all published case reports and series to evaluate the clinical characteristics of hypertriglyceridemia-induced AP patients in whom plasmapheresis was used, and the effect of plasmapheresis on plasma triglycerides levels and procedure-related safety. A systematic literature search was performed for case reports and series published between January 1, 1975 and April 30, 2023 in PubMed, Science Direct, Embase and Google Scholar databases using keywords “hypertriglyceridemia” AND “pancreatitis” AND “plasmapheresis” OR “plasma exchange.” The inclusion criteria were (1) hypertriglyceridemia-induced AP and (2) use of plasmapheresis to manage AP. Seventy-one studies involving 91 unique patients were included in this meta-summary. Nearly three-fourth had severe AP and one-fifth with recurrent pancreatitis. A previous history of hypertriglyceridemia and diabetes was known in 52.7% of the patients, and alcohol abuse in 17.6%. The majority of the patients were young males, with 15 pregnant females. A median of two sessions with a plasma exchange volume of 3 L significantly reduced serum triglycerides in patients with hypertriglyceridemia. Most (96.7%) of the patients recovered with a median hospital and intensive care unit length of stay (LOS) of 11 and 5 days, respectively. Plasmapheresis is an effective therapeutic procedure that can significantly reduce triglycerides levels in hypertriglyceridemia-induced AP. The procedure is reasonably safe, including in patients with severe AP and pregnancy. Future prospective randomized studies are required to evaluate the impact of plasmapheresis on patient-centered outcomes compared with pharmacological management of AP. Nasa P, Jain R, Singh O, Juneja D. Plasmapheresis for Hypertriglyceridemia-induced Acute Pancreatitis: A Systematic Review and Meta-summary of Case Reports. Indian J Crit Care Med 2025;29(7):604–611.

Purpose: End-organ damage in coronavirus disease-2019 (COVID-19) is linked to "cytokine storm" and excessive release of inflammatory mediators. Various novel therapies have been used in COVID-19 including urinary trypsin inhibitor therapy. This study explores the efficacy of ulinastatin in COVID-19. Materials and methods: We retrieved the medical records of patients admitted during one month and did a propensity score analysis to create matched treatment and control groups. We analyzed these groups and the outcomes were presented with appropriate statistics. Survival curve was prepared to compare the survival effect of ulinastatin therapy at the end of hospitalization, among both the groups. Results: A total of 736 patients were admitted, and after adjusting the data with propensity score matching, 55 cases were selected by the system. On the final outcome analysis, we found that intensive care unit (ICU) length of stay [median (interquartile range) days 3 (3.5-7.8) vs 2 (0-4); p-value 0.28] in control vs intervention groups, and in hospital mortality (odds ratio: 0.491, CI 95%: 0.099-2.44, p-value 0.435) were not statistically different among the groups. In survival plot analysis also, there was no statistical difference (p-value 0.414) among both the groups. Conclusion: In this retrospective study, we conclude that the final outcome of the ICU length of stay, and overall, in hospital mortality were not different among both the groups. Hence, adequately powered randomized control trials are urgently required to confirm any benefit of ulinastatin therapy in COVID-19 treatment.

Advanced age is a known marker of vulnerability, but frailty is an independent predictor of poor outcomes in critically ill patients. The clinical frailty score (CFS) facilitates rapid assessment, aiding prognostication, care improvement, and resource allocation, particularly in resource-limited intensive care units (ICUs). A prospective observational cohort study was conducted from April to September 2023 at a tertiary care ICU. The study included 166 patients aged ≥50 years with ICU stays longer than 48 hours, excluding those with contraindications for care escalation. Data were collected on demographics, Clinical parameters, and scoring systems including acute physiological and chronic health evaluation II (APACHE-II), sequential organ failure assessment (SOFA), Charlson comorbidity index (CCI), and CFS. Predictive analyses were performed using receiver operating curve (ROC) curves, cut-offs, and logistic regression. The median age of patients was 65 years, with an APACHE-II score of 18 and a CFS of 4. In-hospital mortality was 46.4%. The CFS outperformed other scoring systems in predicting both in-hospital mortality [Area under the receiver operating characteristic curve (AUC-ROC) 0.73] and net negative outcomes (AUC ROC 0.75). Frailty (CFS ≥6) was present in 39.75% of patients, with each unit increase in CFS associated with a 41.8% higher odds of mortality and a 50.7% higher odds of net negative outcomes. The optimal CFS cut-offs were 4 for 80% sensitivity and 6 for 80% specificity. The CFS is a practical and reliable tool for predicting ICU outcomes, outperforming traditional scoring systems. It supports improved decision-making and resource allocation. Further multicenter studies are necessary to validate its broader use in critical care practice. Saxena S, Gupta P, Panwar P, Jain A, Jain SS, Jain R, et al. Impact of the Clinical Frailty Score on Outcomes of Critically Ill Patients in a Tertiary Care ICU. Indian J Crit Care Med 2025;29(4):320–326.

Airway management is central to the care of critically ill patients, yet it remains one of the most challenging interventions in emergency departments and intensive care units. Patients often present with severe physiological instability, limited cardiopulmonary reserve, and high acuity, while clinicians often work under constraints related to time for preparation, equipment availability, trained workforce, monitoring, and access to advanced rescue techniques. These challenges are particularly pronounced in low- and middle-income countries and other resource-limited or austere environments, where the margin for error is narrow and delays or repeated attempts in airway management may rapidly precipitate hypoxemia, hemodynamic collapse, or cardiac arrest. Although contemporary airway guidelines emphasize structured preparation and rescue pathways, many assume resources that are not consistently available in such settings. This narrative review discusses pragmatic, context-adapted strategies for airway management in constrained environments, with emphasis on physiology-first preparation, appropriate oxygenation and induction techniques, simplified rapid-sequence intubation, and the judicious use of basic airway adjuncts, supraglottic devices, and video laryngoscopy, where available. Adapted difficult airway algorithms, front-of-neck access in the absence of surgical backup, human factors, team training, and ethical considerations are also addressed. This review aims to support safer and effective airway management for critically ill patients in resource-limited emergency and intensive care settings.