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Invasive fungal diseases pose a significant threat to non-neutropenic ICU patients, with Candida and Aspergillus infections being the most common. However, diagnosing these infections in the ICU population remains challenging due to overlapping clinical features, poor sensitivity of blood cultures, and invasive sampling requirements. The classical host criteria for defining invasive fungal disease do not fully apply to ICU patients, leading to missed or delayed diagnoses. Recent advancements have improved our understanding of invasive fungal diseases, leading to revised definitions and diagnostic criteria. However, the diagnostic difficulties in ICU patients remain unresolved, highlighting the need for further research and evidence generation. Invasive candidiasis is the most prevalent form of invasive fungal disease in non-neutropenic ICU patients, presenting as candidemia and deep-seated candidiasis. Diagnosis relies on positive blood cultures or histopathology, while non-culture-based techniques such as beta-D-glucan assay and PCR-based tests show promise. Invasive aspergillosis predominantly manifests as invasive pulmonary aspergillosis in ICU patients, often associated with comorbidities and respiratory deterioration in viral pneumonia. Diagnosis remains challenging due to poor sensitivity of blood cultures and difficulties in performing lung biopsies. Various diagnostic criteria have been proposed, including mycological evidence, clinical/radiological factors and expanded list of host factors. Non-culture-based techniques such as galactomannan assay and PCR-based tests can aid in diagnosis. Antifungal management involves tailored therapy based on guidelines and individual patient factors. The complexity of diagnosing and managing invasive fungal diseases in ICU patients underscore the importance of ongoing research and the need for updated diagnostic criteria and treatment approaches. Invasive fungal disease, Invasive fungal infection, Invasive candidiasis, Invasive aspergillosis, Antifungal drugs.

Abstract Background Endotracheal intubation in critically ill is a high-risk procedure requiring significant expertise in airway handling as well as understanding of pathophysiology of the disease process. Main body Critically ill patients are prone for hypotension and hypoxemia in the immediate post-intubation phase due to blunting of compensatory sympathetic response. Preoxygenation without NIV is frequently suboptimal, as alveolar flooding cause loss of alveolar capillary interface in many of these patients. All these factors, along with relative fluid deficit, neuromuscular fatigue and coexistent organ dysfunction lead to physiologically difficult airway. Airway in ICU can be classified as anatomically difficult, physiologically difficult and anatomically as well as physiologically difficult. Though rapid sequence intubation is the recommended method for securing airway in these patients, other methods like delayed sequence intubation awake intubation and double setup approach can be used in specific subgroups. Further research is needed in this field to set guidelines and fine tune airway management for patients with specific organ failure or dysfunction. Conclusion Airway in ICU should be managed according to the physiological as well as the anatomical abnormalities.

Intra-abdominal candidiasis (IAC) is the second most common form of invasive candidiasis after candidaemia. IAC is a broad term and can be classified on the basis of anatomical site (Candida peritonitis, pancreatic candidiasis, biliary tract candidiasis, gastrointestinal candidiasis, and hepatosplenic candidiasis) as well as clinical setting (community acquired versus nosocomial). The risk factors linked with IAC are candida colonisation, anastomotic leak, multiple instrumentation, long-term broad spectrum antibiotic use, total parenteral nutrition, and immunocompromised state. Clinically, IAC is not different from intraabdominal bacterial infection. Patients generally present with signs and symptoms of intra-abdominal sepsis after not responding to antibiotic therapy and with a background history of multiple surgical interventions or history of delayed source control. Radiological investigations, like ultrasonography and computed tomography scan, not only aid in diagnosis but also assist in differentiating medical from surgical cases. Microbiological diagnosis requires isolation of candida from an intra-abdominal specimen. Differentiation between colonisation and infection is difficult. Generally, progressive and persistent colonisation is associated with high risk of infection. Blood cultures have poor sensitivity for IAC. Non-culture based techniques used for diagnosis are mannan/anti-mannan assay, beta-D glucan assay, and validated polymerase chain reaction. Four types of antifungal strategies described in the literature are prophylaxis (risk factor driven), pre-emptive (colonisation or biomarker driven), empirical (fever driven), and targeted therapy (microbiology driven). Over recent years, global epidemiology has shown a shift from Candida albicans to non-albicans. Local epidemiology plays an important role in selection of the appropriate empirical therapy. The purpose of this review is to discuss different types of IAC based on their classification, risk factors, and management.