Publications by authors named "Devachandran Jayakumar"

Importance: The impact of awake prone positioning (APP) on clinical outcomes in patients with COVID-19 and acute hypoxemic respiratory failure (AHRF) remains uncertain.

Objective: To assess the association of APP with improved clinical outcomes among patients with COVID-19 and AHRF, and to identify potential effect modifiers.

Data Sources: PubMed, Embase, the Cochrane Library, and ClinicalTrials.

View Article and Find Full Text PDF
Article Synopsis
  • The study aimed to investigate the prevalence and risk factors of frailty among critically ill patients in India, as well as its impact on health outcomes.
  • Conducted in 7 ICUs, the research involved 838 patients, finding that nearly 20% were frail, with certain health conditions like malnourishment significantly linked to frailty.
  • Results showed frail patients faced higher risks of ICU and in-hospital mortality, and were more likely to require aggressive treatments, indicating frailty is prevalent and detrimental among this patient group.
View Article and Find Full Text PDF

Background: The burden of sepsis is high in India and is associated with substantial morbidity and mortality. Vitamin C, an endogenous antioxidant, may improve patient outcomes.

Methods: This was a parallel-group pilot feasibility randomized controlled trial conducted at 2 intensive care units in India.

View Article and Find Full Text PDF

Importance: The efficacy of vitamin C for hospitalized patients with COVID-19 is uncertain.

Objective: To determine whether vitamin C improves outcomes for patients with COVID-19.

Design, Setting, And Participants: Two prospectively harmonized randomized clinical trials enrolled critically ill patients receiving organ support in intensive care units (90 sites) and patients who were not critically ill (40 sites) between July 23, 2020, and July 15, 2022, on 4 continents.

View Article and Find Full Text PDF

Coronavirus disease 2019 (COVID-19) has been responsible for over 3.4 million deaths globally and over 25 million cases in India. As part of the response, India imposed a nation-wide lockdown and prioritized COVID-19 care in hospitals and intensive care units (ICUs).

View Article and Find Full Text PDF
Article Synopsis
  • A clinical trial investigated whether therapeutic-dose anticoagulation could improve outcomes for critically ill patients with severe Covid-19 compared to standard thromboprophylaxis.
  • The study found no significant difference in organ support-free days between the two groups, with the anticoagulation group showing a median of 1 day compared to 4 days for the usual-care group.
  • The trial was halted due to a high probability of futility, with similar hospital discharge survival rates and a slightly higher occurrence of major bleeding in the anticoagulation group.
View Article and Find Full Text PDF

Background: Thrombosis and inflammation may contribute to the risk of death and complications among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation may improve outcomes in noncritically ill patients who are hospitalized with Covid-19.

Methods: In this open-label, adaptive, multiplatform, controlled trial, we randomly assigned patients who were hospitalized with Covid-19 and who were not critically ill (which was defined as an absence of critical care-level organ support at enrollment) to receive pragmatically defined regimens of either therapeutic-dose anticoagulation with heparin or usual-care pharmacologic thromboprophylaxis.

View Article and Find Full Text PDF

Rationale: The feasibility and safety of awake prone positioning and its impact on outcomes in non-intubated patients with acute respiratory distress syndrome secondary to COVID-19 is unknown. Results of the observational studies published during this pandemic have been conflicting. In this context, we conducted a multi-center, parallel group, randomized controlled feasibility study on awake prone positioning in non-intubated patients with COVID-19 pneumonia requiring supplemental oxygen.

View Article and Find Full Text PDF

The Randomized Embedded Multifactorial Adaptive Platform (REMAP-CAP) adapted for COVID-19) trial is a global adaptive platform trial of hospitalised patients with COVID-19. We describe implementation in three countries under the umbrella of the Wellcome supported Low and Middle Income Country (LMIC) critical  care network: Collaboration for Research, Implementation and Training in Asia (CCA). The collaboration sought to overcome known barriers to multi centre-clinical trials in resource-limited settings.

View Article and Find Full Text PDF

The epidemiology of critical illness in India is distinct from high-income countries. However, limited data exist on resource availability, staffing patterns, case-mix and outcomes from critical illness. Critical care registries, by enabling a continual evaluation of service provision, epidemiology, resource availability and quality, can bridge these gaps in information.

View Article and Find Full Text PDF

Unlabelled: Contrast-induced acute kidney injury (CI-AKI) is the third common cause of kidney injury in hospitalized patients. It describes a wide spectrum of kidney injury from mild and reversible to permanent and irreversible. The mechanism of contrast-induced AKI and strategies to prevent it are not clearly understood.

View Article and Find Full Text PDF