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Original Article
- Epidemiology
- Admission characteristics and factors associated with outcomes in elderly patients aged 75 years and older in a level 3 ICU in Nepal: a 4-year registry-based retrospective study
- Kishor Khanal, Saroj Poudel, Sunidhi Aryal, Rabin Bhurtel, Anup Ghimire, Ashim Regmi
- Acute Crit Care. 2026;41(3):542-549. Published online August 19, 2026
- DOI: https://doi.org/10.4266/acc.002912
- 674 View
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Abstract
PDF - Background
The global rise in elderly populations has led to increasing admissions of older adults to intensive care units (ICUs). Understanding predictors of mortality in the very elderly is essential, particularly in low- and middle-income countries (LMICs) where ICU resources are limited. Methods: This retrospective observational study analyzed 1,028 ICU patients aged ≥75 years admitted to a level 3 ICU in Nepal. Demographics, comorbidities, frailty score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, interventions, and outcomes were collected. Univariate analysis, bivariate analysis, and multivariate logistic regression were used for statistical analysis to determine independent predictors of ICU mortality. Results: The cohort had a mean age of 82±5 years and 58.1% were male. ICU mortality was 17.5%. Non-survivors were older and had higher APACHE II scores, more comorbidities, and a greater requirement for mechanical ventilation and vasopressors than survivors. Logistic regression identified age (adjusted odds ratio [aOR], 1.05), comorbidity burden (aOR, 1.40), APACHE II score (aOR, 1.08), mechanical ventilation (aOR, 2.10), and the use of vasopressors (aOR, 1.80) as independent predictors of mortality. Frailty, sex, aggressiveness of therapy, and primary system involvement were not independently associated with ICU mortality. Conclusions: Age, comorbidity burden, and organ support requirements strongly predicted mortality among elderly ICU patients in Nepal. These findings support early risk stratification, prognostic assessment, and informed clinical discussions in resource-limited ICU settings.
Review Article
- Pharmacology
- Predictors of intermediate syndrome after organophosphorus poisoning and its management in Nepal
- Kishor Khanal, Saroj Poudel
- Acute Crit Care. 2026;41(2):262-269. Published online April 17, 2026
- DOI: https://doi.org/10.4266/acc.002825
- 6,562 View
- 109 Download
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Abstract
PDF
- Organophosphorus (OP) poisoning is a global public health challenge, is common in agricultural regions, and is associated with high morbidity and mortality. Intermediate syndrome (IMS) is a delayed complication of OP poisoning that usually occurs 24–96 hours post-exposure and is characterized by proximal muscle weakness, cranial nerve palsies, and respiratory failure. The syndrome significantly increases mortality if not identified and managed promptly. This review comprehensively examines the predictors of IMS, including clinical, biochemical, and electrophysiological markers, and evaluates current management strategies. The key predictors are severe initial poisoning, low initial acetylcholinesterase level, and specific electrophysiological abnormalities. Management involves early recognition, antidote administration (atropine and oximes), respiratory support, and emerging therapies like magnesium sulfate. Challenges such as diagnostic uncertainty and resource constraints in low-income settings are discussed, alongside future directions for research and prevention. Understanding these predictors and optimizing management protocols are critical to improving outcomes in IMS following OP poisoning.
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