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Indian J Crit Care Med
Indian J Crit Care Med
IJCCM
Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine
0972-5229
1998-359X
Jaypee Brothers Medical Publishers

10.5005/jp-journals-10071-24671
Letter to the Editor
Author Response
Ramaswamy Arjun 1https://orcid.org/0009-0007-6904-2638

Kumar Rohit 2https://orcid.org/0000-0001-6398-7840

Ish Pranav 3https://orcid.org/0000-0003-1701-4970

Gupta Nitesh 4https://orcid.org/0000-0002-5842-5584

1–4 Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
Nitesh Gupta, Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India, Phone: +91 9873096364, e-mail niteshgupta2107@gmail.com
4 2024
30 3 2024
28 4 405405
Copyright © 2024; The Author(s).
2024
https://creativecommons.org/licenses/by-nc/4.0/ © The Author(s). 2024 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
How to cite this article: Ramaswamy A, Kumar R, Ish P, Gupta N. Author Response. Indian J Crit Care Med 2024;28(4):405.

Keywords

Diaphragm
Paracostal muscles
Weaning
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pmc Dear Editor,

We appreciate the comments provided by Mandal et al. in response to our study.1 We welcome the opportunity to address their queries and provide further clarification on our findings.

Firstly, we confirm that our study did not include coronavirus disease-2019 (COVID-19) patients. Our cohort primarily consisted of patients with hypoxemic respiratory failure, with the majority presenting with acute respiratory distress syndrome (ARDS), followed by patients who had hypercapnic respiratory failure and altered sensorium.2 It is important to note that our hospital operated a separate ICU dedicated to COVID-19 patients, and all study participants were screened for COVID-19 before admission to the pulmonary intensive care unit (ICU).

Secondly, our study identified an inverse relationship between parasternal intercostal muscle thickness fraction (PICTF%) and weaning success.3 This observation underscores the significance of poor diaphragm function, which leads to increased parasternal muscle activity. While the etiology of weaning failure requires further evaluation, the advantage of measuring PICTF% lies in its ability to accurately predict weaning success without the need for direct assessment of diaphragm activity. However, we acknowledge that additional diagnostic evaluations may be necessary to determine the underlying cause of weaning failure in individual patients.4

Thirdly, a majority of our patients were managed using lung protective ventilation strategies for ARDS, with ventilatory settings in line with institutional protocols. Notably, minimal pressure support was provided during spontaneous breathing trials, however, recruitment maneuvers were not performed due to unclear evidence supporting their efficacy in our clinical context.3,4

In conclusion, we concur with Mandal et al. that parasternal intercostal muscle ultrasound represents an emerging and valuable tool in the intensive care setting for predicting weaning success. We appreciate their engagement with our study and welcome further discussion and collaboration to advance our understanding of respiratory care in critically ill patients.

Author's Contribution

PI, NG: involved in Conceptualization, literature search, writing the original draft of manuscript, literature search, planning, conduct and editing; PI, AR, RK, NG: involved in review and editing. Dr Nitesh Gupta will act as guarantee on behalf of all authors.

Orcid

Arjun Ramaswamy https://orcid.org/0009-0007-6904-2638

Rohit Kumar https://orcid.org/0000-0001-6398-7840

Pranav Ish https://orcid.org/0000-0003-1701-4970

Nitesh Gupta https://orcid.org/0000-0002-5842-5584

Source of support: Nil

Conflict of interest: None
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References

1. Mandal M Bhattacharya D Esquinas AM Parasternal intercostal muscle thickness fraction: Ultrasound a new tool for weaning prediction. Indian J Crit Care Med 2024 (Accepted) Manuscript ID: IJCCM_24_84
2. Havaldar AA Krishna B Wean to win Indian J Crit Care Med 2023 27 10 695 696 10.5005/jp-journals-10071-24556 37908418
3. Grasselli G Calfee CS Camporota L Poole D Amato MBP Antonelli M et al. ESICM guidelines on acute respiratory distress syndrome: Definition, phenotyping and respiratory support strategies Intensive Care Med 2023 49 7 727 759 10.1007/s00134-023-07050-7 37326646
4. Qadir N Sahetya S Munshi L Summers C Abrams D Beitler J et al. An update on management of adult patients with acute respiratory distress syndrome: An official American thoracic society clinical practice guideline Am J Respir Crit Care Med 2024 209 1 24 36 10.1164/rccm.202311-2011ST 38032683
