Abstract
How to cite this article: Moturu D, Potineni RB, Rayana S, Thommandru S, Shaik J, Jampala K, et al. Author Response: From Tele-ICU “Alerts” to Tele-ICU “Assurance”: Making Hemodynamic Surveillance Decision-grade and Globally Transferable. Indian J Crit Care Med 2026;30(4):345–346.
Keywords: Early recognition, Hemodynamic monitoring, In-hospital cardiac arrest
Dear Editor,
We thank the reader for their insightful comments regarding our study published in the Indian Journal of Critical Care Medicine (IJCCM). Their proposal to transition from simple tele-ICU “alerts” to a robust framework of “assurance” is timely and aligns with our vision of remote monitoring as an essential, hospital-wide safety layer.
We strongly agree that standardizing a minimum viable safety dataset (MVSD) is a logical next step to ensure that tele-ICU surveillance is consistently actionable and auditable across different resource settings. Our multicenter study utilized a standardized protocol where automated alerts were reviewed in real time by tele-ICU intensivists. This adjudication process achieved a sensitivity of 79.2% and a specificity of 80.1%, which we believe provides the “decision-grade” foundation the reader describes.1
Regarding the specific points raised by the reader:
Workflow and human factors: We concur that human-factors outcomes are critical and should be treated as primary results. In our cohort, the median time from alert generation to bedside intervention was 12 minutes, with 89.4% of interventions occurring within 30 minutes.2
Time-to-first-beneficial-action: This is indeed a globally meaningful metric that directly tests patient-centered outcomes. Our multivariable analysis showed that early intervention (≤15 minutes) was independently associated with a lower risk of in-hospital mortality (aOR: 0.65; 95% CI: 0.52–0.81, p < 0.001).1
Reporting standards: We agree that as tele-ICU moves from “innovation” to “infrastructure,” adopting frameworks such as DECIDE-AI, TRIPOD+AI, and PROBAST+AI will be essential for reducing bias and ensuring evidence is globally deployable.3–5
While we acknowledge the limitations of our observational design, the observed 47% reduction in in-hospital cardiac arrest (IHCA) incidence and a risk-adjusted mortality ratio of 0.69 suggest that current tele-ICU systems are already delivering tangible safety benefits in middle-income healthcare environments.
We embrace the reader's suggestion to incorporate these rigorous reporting spines into future evaluations to accelerate the responsible scale-up of tele-ICU technology.
Sincerely,
Dr Moturu Dharanindra
Orcid
Moturu Dharanindra https://orcid.org/0000-0002-9446-5460
Ramesh B Potineni https://orcid.org/0000-0001-6983-0828
Supriya Rayana https://orcid.org/0000-0001-9904-2574
Sravani Thommandru https://orcid.org/0009-0002-3510-9447
Jahangeer Shaik https://orcid.org/0009-0003-3345-8827
Karthikeya Jampala https://orcid.org/0009-0003-8519-259X
Lakshmi SSB Kakumanu https://orcid.org/0009-0005-9752-3207
Sai T Uppalapati https://orcid.org/0009-0004-0286-3384
Silpa C Nallapaneni https://orcid.org/0009-0009-8018-536X
Vamsi K Madduri https://orcid.org/0009-0005-4890-1785
Karthik C Yalavarthi https://orcid.org/0009-0007-6639-9252
Footnotes
Source of support: Nil
Conflict of interest: None
References
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