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Updated: Feb 24, 2026

Hemodynamic Precision in the Neonatal Intensive Care Unit using Targeted Neonatal Echocardiography
Published on: January 27, 2023
Tele-Intensive Care Unit-associated Early Recognition of In-hospital Hemodynamic Events and Clinical Outcomes: A
Moturu Dharanindra1, Ramesh B Potineni2, Supriya Rayana3
1Department of Intensive Care Medicine, Westmead Hospital, University of Sydney, Sydney, New South Wales, Australia.
Background And Aims:
In-hospital cardiac arrest (IHCA) remains a major cause of mortality among hospitalized patients globally. This prospective, multicenter, observational study assessed the associations of a tele-intensive care unit (Tele-ICU) hemodynamic surveillance program and clinical outcomes in adult inpatients monitored across three tertiary-care hospitals in India.
Patients And Methods:
From September 2024 to August 2025, 5,253 adult inpatients in ICUs, general wards, and Emergency Departments (EDs) were continuously monitored by a centralized Tele-ICU hub. Pre-specified thresholds for hemodynamic parameters generated real-time alerts, which were verified and adjudicated by Tele-ICU intensivists according to a standardized protocol. Outcomes, interventions, and mortality were analyzed using full multivariable logistic regression, with clearly defined denominators and clustering by site to account for within-site addressed.
Results:
A total of 2,278 patients (43.3%) experienced clinically significant hemodynamic alerts. The system's alerting and verification protocol demonstrated a sensitivity of 79.2% and specificity of 80.1%, with consistent performance across sites and locations. Median acute physiology and chronic health evaluation (APACHE) II score was 16 [interquartile range (IQR) = 12-22]. Patients experiencing verified alerts had a mortality rate of 12% (n = 273), which is lower than the APACHE-predicted rate of 24.5% (risk-adjusted mortality ratio = 0.69; calibration plot provided). Multivariable logistic regression, including age, sex, APACHE II, diagnosis group, comorbidities, admission location, and time to intervention, showed that early intervention ≤15 minutes after alert was associated with lower odds of in-hospital mortality [adjusted odds ratio (aOR) 0.65, 95% CI: 0.52-0.81, p < 0.001; C-statistic 0.83].
Conclusion And Clinical Significance:
The early recognition and verification of hemodynamic alerts in Tele-ICU were associated with improved clinical outcomes and a lower risk-adjusted mortality.
How To Cite This Article:
Dharanindra M, Potineni RB, Rayana S, Thommandru S, Shaik J, Jampala K, et al. Tele-Intensive Care Unit-associated Early Recognition of In-hospital Hemodynamic Events and Clinical Outcomes: A Multicenter Observational Study. Indian J Crit Care Med 2026;30(1):40-49.
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