tm critical care - isccmisccm.org/newsletterfiles/586705045_com.pdf · · 2017-09-28the critical...

Editorial officE

dr. atul P. KulkarniProfessor & Head, Division of Critical Care, Dept. of Anaesthesiology, Critical Care & Pain Tata Memorial Hospital, Parel, Mumbai 400012

Phone : 022-24177049 • emails : [email protected]

Published By :

IndIan SocIety of crItIcal care MedIcIneFor Free Circulation Amongst Medical Professional

Unit 6, First Floor, Hind Service Industries Premises Co-operative Society, Near Chaitya Bhoomi, Off Veer Savarkar Marg, Dadar, Mumbai – 400028

Tel. 022-24444737 • Telefax :022-24460348 • email : [email protected]

1 ISCCM News Headlines

2 Editorial

2 Editorial Board 2014-2015

3 President's Desk

3 WFSICCM Seoul 2015

4 General Secretary's Desk

4 Gujarat CRITICON 2014 Rajkot - A Report

5 ISCCM - Mumbai 1st Criticon - A Report

6 14th Comprehensive Critical Care Course

(4c) of Indian Society of Critical Care

Medicine Organized by ISCCM Pune

Branch

6 Image Challenge

7 MAHACRITICON 2014 - A Report

7 ICU Protocols

8 New Office Bearers of ISCCM Branches

10 Branch Activities

13 Journal Scan

16 CRITICARE 2015We request our esteemed readers to send their valued feedback,

suggestions & views at [email protected]

Multiple Regional ISCCM conferences in the country such as

Mahacriticon 14, 2nd Gujarat Criticon 14, Mumbai Criticon 14.

All conferences were well attended and hugely popular.

Preparations for ISCCM National Conference at Bengaluru in full

swing.

Excellent response from the delegates, most workshops already full.

3rd Best of Brussels announced, sounds very good again.

Results of election to the National Executive Committee declared.

4 C course establishes in a niche position in Indian Critical Care

community, entices the budding intensivists.

4 C to modules to be revised, new modules will be unveiled at the

National Conference in Bengaluru.

A B I - M O N T H LY N E W S L E T T E R O F I N D I A N S O C I E T Y O F C R I T I C A L C A R E M E D I C I N E

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www.isccm.org

Critical Care

C O M M U N I C A T I O N S

Volume 9.6NoVemBeR-DeCemBeR, 2014

Contents ISCCM News HeadlIneS

T h e C r i T i C a l C a r e C o m m u n i C aT i o n s a B i - m o n T h ly n e w s l e T T e r o f i n d i a n s o C i e T y o f C r i T i C a l C a r e m e d i C i n e

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Editorial Board 2014-2015

ediTor in ChiefDr. Atul P. Kulkarni, Mumbai

[email protected]

depuTy ediTors

Dr. Vijaya Patil, MuMbai Dr. Jayashree M., Chandigarh

[email protected] [email protected]

memBers

norTh Zone wesT Zone easT Zone souTh Zone CenTral Zone

Dr. Vandana Agarwal, MuMbai Dr Avdhesh Bansal, delhi Dr. Manoj Singh, ahMedabad Dr. Susruta Bandyopadhyay, KolKata Dr. Pradeep Rangappa, bangalore Dr. Ranvir Singh Tyagi, agra

[email protected] [email protected] [email protected] [email protected] [email protected] [email protected]

Editorial

Dear Colleagues,

Wish you a very pleasant, prosperous as well as

professionally successful new year. This issue contains the reports of the highly successful regional conferences; the Mumbai Criticon, the 2nd Mahacriticon held at Aurangabad as well as the 2nd Gujarat Criticon held at Rajkot along with some selected photographs.

The preparations for the forthcoming Criticare 2015 at Bengaluru are in full swing. All workshops are already full, and the scientific program for the main conference looks superb. We have a feast awaiting us. If you have not registered already please register. I will print the entire scientific program schedule in our next issue.

The research proposal of the ISCCM is finally going ahead. Once the App is ready for use we will send you an

e-mail and let you know when you can start contributing data to the national data base. I cannot emphasize the importance of this endeavor enough. I urge all of you to contribute to this database.

Please send in Image Challenge, both image and question and answers. Unfortunately there is no image challenge in this issue since I did not get any from anybody. Members who wish to express their views can easily do so in our 'Members Speak' corner. So please send these to me and we will be happy to publish the same.

Please note that for a small payment of Rs. 8000/- you can advertise for job placements and other related activities.

Dr Srinivas Samavedam has contribut-ed the journal scan for this issue.

Happy reading!

dr. atul P. Kulkarnieditor,

The Critical Care Communicationspresident-elect, [email protected]

www.isccm.org

Happy New Year 2015


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President's Desk

Dear ISCCM Members,

Greetings to all ISCCM colleagues! The year 2014

has been a tumultuous year in many ways. It has seen the first majoritarian government in India in the last 3 decades and has also seen the ambitious launch of many schemes including the “Swacch Bharat Abhiyaan” that promise to change the way the world thinks about India. Several changes have also been made to the administrative structure of our country as this is vital for the implementation of the various schemes of our Prime Minister.

Unfortunately, there is likely to be a drop in the budgetary allocation for health care and in an already stretched health care delivery system this does not augur well for the health of our patients. Intensive Care is only likely to get more expensive and unaffordable for the poorest of our poor patients.

How can we work towards making intensive care more affordable, at the same time maintaining the quality? I hope our ISCCM national conference in Bengaluru with the theme of “Outreach, Austerity and Quality” will throw up some answers.

Within ISCCM last year our Foundation Day theme was “We must know when to stop” – Towards appropriate “End of Life Care” for our patients. I will soon be sending an ISCCM “End of Life” Care issues questionnaire that addresses the

important issues surrounding “End of Life Care in our country and this data will hopefully drive the necessary changes that are required to be made. Dr. Mani is also planning a book around these issues. There will also be a workshop and several thematic sessions on Communication and EOL issues at Bengaluru.

The paucity of epidemiological data on intensive care will be addressed by the ISCCM research database, the start of which will be launched in Bengaluru. St. John’s Research Institute and ISCCM will be partnering for this important

work.

At the international level our relationship with the WFSICCM is getting stronger and the there will be a strong contingent representing India at the WFSICCM Seoul meeting including several past presidents and the current leadership. Several ISCCM members will also be part of the various task

forces planned by WFSICMM. Dr. Ramesh Venkataraman will present the ISCCM MOSER study as “Epidemiology of Resistant ICU infections in India”. A joint ISCCM-ESICM meeting is also planned at our national conference and discussions are on for strengthening our ties on various other issues. Dr. Dilip Karnad has been nominated on the “Surviving Sepsis Guidelines Committee” and will represent ISCCM on this international collaboration. The Bengaluru conference will also see the launch of the Cardiac Resuscitation beyond BASIC by the international BASAIC collaboration. This course on in-

hospital resuscitation will provide a cost effective alternative to the ACLS courses being currently run in our country.

A society is only as strong as it’s individual members and I appeal to all of you to participate more actively in all activities of ISCCM and write to me with all your ideas. Our website is now more active and we hope to initiate discussion groups that will help us reach out to all our ISCCM colleagues.

dr. Shivakumar Iyerpresident, isCCm

[email protected]

WFSICCM Seoul 201512th Congress of the World Federation of

Societies of Intensive and Critical Care medicine

in collaboration with the WFCCN and WFPICCS

World Congress of the Intensive and Critical Care medicine

29th August - 1st September 2015

SECRETARIAT

9th FI., Samick Lavied'or Bldg., 234, Teheran-ro, Gangnam-gu, Seoul 135-920, Korea

Phone : +82-2-3452-7291 Fax : +82-2-6254-8049 e-mail : [email protected]

www.wfsiccm2015.com

SPONSOR APPEAL

21st Annual Conference of Indian Society of Critical Care Medicine

www.criticare2015.com

Setting New FrontiersTheme : QUALITY | OUTREACH | AUSTERITY

SPONSOR APPEAL

21st Annual Conference of Indian Society of Critical Care Medicine


Setting New FrontiersTheme : QUALITY | OUTREACH | AUSTERITY


Block Your Dates

TM


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dr. dhruva chaudhryGeneral secretary, isCCm

Dear Friends

Warm wishes to you all for a wonderful & happy new year.

Indeed it is a time to share with you regarding the preparations of our annual conference Criticare 2015 at Bengaluru.

1. The scientific committee under the chairperson-ship of our President & local Scientific Chairperson has prepared an elaborate programme for the benefit of all with judicial mix of recent advances, contemporary topics in critical care & issues relevant to us.

2. We are also going to have a large number of workshops including the popular ones like mechanical ventilation,sonography, basics of critical care, haemodynamic monitoring, neurocritical care etc to name a few. In addition we shall after the introduction of Simulation Workshop in Criticare 2014 intend to make it as one of the high points of the criticare to not only sensitise the teachers in critical care & emergency medicine but also the administrators as well, because the benefits of training through simulation are immense as it encourages team approach & patient safety.

3. All of you will agree that it is because of the work of our visionary leadership since the inception of the society that we have reached so far. Therefore the onus is on us to carry the legacy forward. During the last decade huge expansion has taken place in the critical care including starting of DM in critical care because of persistent efforts of ISCCM. Therefore to carry forward the baton it is proposed to start subspecialties group within the society like Neurocritical care, Cardiocritical care, ECMO , Obstetrical critical care & Nephrocritical care to name a few as we are holding workshops regularly on them & there are enough resources available within the society & country.

4. In the present era once sacred doctor patient relationship has come under immense challenge. In a complex environment of

General Secretary's Desk

ICU it is further strained because of anxiety, apprehensions & uncertainty of outcomes. Most of our physicians feel handicapped to speak to the families because of poor training in communications. This is further compounded by the costs as majority pay through their nose & has lead to significant financial hardship even acknowledged in the recently drafted National Health Policy.This has resulted in mistrust, argument & in extreme physical violence & damage to property & surge in court case against doctors & hospitals. Therefore it should be our endeavour to have a forum where we can assure the public that it is their welfare which is our prime motive & we are partner in it. It is therefore suggested & proposed to have a patient safety & welfare forum within the aegis of ISCCM. Therefore for the first time in conference a moot court as well as communication workshop is also planned.

5. As a general secretary I shall be remitting the office after criticare 2015. During a year I learned a lot about the functioning of the the society. I am leaving as a satisfied person as I feel secure & confident because of robustness of our systems in running the society & harmonisation of functioning between ISCCM & its college (ICCM).

6. Before I bid adieu I must thank the office staff of ISCCM because without their active support & brilliant functioning it is not possible to work as a non resident general secretary. Lastly my sincere thanks to Dr Shiva Iyer for his faith, Dr Atul Kulkarni for his advice & lastly other two pillars namely Dr Vijaya Patil our treasurer & Dr Vandana Agarwal our Secretary without their active participation & help I would not have been able to run the office smoothly.

In the end thanks to all the members, senior colleague & entire team of executive for reposing faith & active cooperation.

Warm regards & best wishes

See you all in CRITICARE 2015.

Gujarat CRITICON 2014 Rajkot - A Report


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ISCCM - Mumbai 1st CRITICON - A Report

dr. rahul Panditsecretary

[email protected]

dr. Sheila nainan MyatraChairman

[email protected]

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The 1st Mumbai Criticon was held under the Auspice of ISCCM Mumbai Branch from 14th to 16th

Nov 2014 at the magnificent Trident Hotel and Convention Centre, Nariman Point Mumbai.

The conference comprised of workshop conducted on 14th November and Main Conference on the 15th and 16th Nov 2014. There were three Workshops. The Advance Ventilation Workshop, The Renal Replacement Therapy Workshop and Nursing Workshop. The workshops were fully subscribed and more than 175 delegated participated in the workshop. The Nursing workshop saw over 65 nurses actively participating in the discussion. The Advance Ventilation and Renal Replacement workshop were very well received. The highlight of both were the hands on session, which gave the

delegates an opportunity to experience the technology first hand and also interact with the eminent faculty.

There were two International faculty and over 20 National faculties who enthusiastically contributed and shared their knowledge and experience during the workshops.

The Main conference was a themed conference - “ADVANCES IN CRITICAL CARE”, it attracted over 270 delegates. The delegates from all corners of India and Maharashtra actively converged for the academic feast. There were two International and over 32 National faculties who over the two days endeavored to bring forward the recent ADVANCES over a wide range of topics pertaining to Critical Care Practice. There were some excellent talks from the overseas faculty, ISCCM President, Professors and Eminent

Clinicians. The feed back received rated the academic content as very high. The ISCCM Students and Junior Doctors specially enjoyed the “Meet the Teachers” session where case based discussion generated a lot of interaction between them and the ISCCM teachers.

The evening of 15th was a special one with Dr. Murad Lala giving a talk about his expedition to Mount Everest – “From Scalpel to Summit”. It was truly a inspiring talk which had everybody in awe of Dr. Lala’s achievement . The talk left many thinking about the wide possibilities that one can accomplish if he/she is truly determined to do it.

The conference was well supported by the industry and the lovely seaside location was an added bonus to enjoy the lovely evening.

A second annual state conference of ISCCM Gujarat Chapter was successfully organized at Rajkot.

It was memorable and milestone academic event in region of Saurashtra & Kutchh draining approximately 20 Million people. The detailed reporting is as under.

On day 1st : 21st of November, five workshop was held at three different venues and approximately 170 doctors participated in workshops viz abc of critical care, do & don’t in ICU, mechanical ventilation, vascular access and basic hemodynamic monitoring.

Approximately 225 paramedics & nursing staff attend the critical care nursing workshops.

On day 2 & 3 : 22nd & 23rd of November, approximately 600 consultants got the exposers by 30 renowned international

and national faculties and 45 sessions of core critical care was served.

Moreover on 3rd day 23rd November Sunday evening we were given unique public awareness program “Critical Care ane Aapne” at Atmiya College Auditorium Rajkot and with help of different media like skit, short movie, question & answers and laughter show we tried to minimize dillamas and misbelief about ICU practice and treatment. Moreover with this public awareness program we also publish a book “Critical Care ane Aapne” in Gujarat local language to make people understood about ICU, intensivist and different medical devices, instruments& medicines used in ICU.

Moreover we also composed a theme song on critical care which is also appreciated and on lips of peoples of Rajkot. To make awareness we also composed jingles and

published on 93.5 FM & 92.7 FM radios for 15 days.

Approximately 3000 people including all big shots of the town were present in the program and till today all medias including press media, electronic media and social media highly appreciate the event.

I am sure that these three days conference and public awareness program will be milestone and index finger for future path of critical care medicine of India.

Dr. Jayesh Dobariya, President, ISCCM Rajkot Branch

Dr. Tejas Karmata, Secretary, ISCCM Rajkot Branch

Dr. Sankalp Vanzara, Organizing Secretary, Gujarat Criticon 2014

Dr. Chirag Martavadia, Organizing Chairman, Gujarat Criticon 2014


6

14th Comprehensive Critical Care Course (4c) ofIndian Society of Critical Care MedicineOrganized by ISCCM Pune Branch

TM

Days : Friday, Saturday & Sunday • Dates : 19th, 20th & 21st December 2014 • Venue: ISCCM Office & Training Centre, Pune

National Faculty : Dr Rajesh Chaw-la, Dr J V Divatia, Dr Atul Kulkar-ni, Dr G C Khilnani.

Host Faculty : Dr Shiva Iyer, Dr Kayanoosh Kadapatti, Dr Sandhya Talekar, Dr Sameer Jog, Dr Jayant Shelgaonkar, Dr Kapil Zirpe,

Dr Subhal Dixit, Dr B D Bande, Dr Prasad Rajhans, Dr Jignesh Shah.

This three day course was designed espe-cially for exam going students. It was an exam oriented Comprehensive Critical Care Course with various workstations.

MCQ s with Interactive Sessions were added as a part of the program, renowned ISCCM National and Local Faculty who are experienced examiners were invited as Faculty.

48 delegates attended the course

NIV Workstation

Hymodynamic MonitoringWorkstation Nutrition Workstation Faculty: Dr Rajesh Chawla, Dr G C Khilnani,

Dr Kapil Zirpe & Dr Atul Kulkarni

Trauma Workstation Workstation on ABGWorkstation onCardiac Arrhythmias

Image ChallengeDear Colleagues,

Please send in Image Challenge, both image

and question and answers. Members who

wish to express their views can easily do so

in our Members Speak corner. So please send

these to me and we will be happy to publish

the same.

Answer of September-October 2014 Issue :The CT abdoemen shows gas in portal vein

Causes for gas in portal vein:

Necrotising enterocolitis

Bowel ischaemia

Inflammatory bowel disease

Trauma/iotrogenic

Perforated gastric carcinoma & ulcer

dr. Harish MMfinal year dm (Critical Care), division of Critical Care, dept of anaesthesiology, Critical Care & pain,Tata memorial hospital, mumbai

dr. atul P. Kulkarnieditor, The Critical Care Communications president-elect, isCCm

[email protected] www.isccm.org

TM


7

TM

The Society of critical medicine Aurangabad (a branch of ISCCM) conducted the 2nd state critical care

conference (MAHACRITICON 2014) on 18th to 21st September 2014. The conference was attended by almost 800 delegates from all over India.

Pre-conference workshops were held on 18th and 19th September 2014. Five different workshops were held:

1. BASIC by CUHK,

2. Mechanical Ventilation,

3. Hemodynamic monitoring,

4. 2D echo and USG in ICU, and

5. Obstetrics critical care workshop.

All these workshops were conducted

MAHACRITICON 2014 - A Reportby very experienced faculties. There was overwhelming response and highly appreciated for the quality lectures and hands on training.

Conference was inaugurated at the hands of two patients who recovered from life threatening illness after critical care treatment. The function was preceded by chief guest Dr Shirish Prayag and graced by ISCCM president Dr. Shivakumar Iyer, President Elect Dr. Atul Kulkarni. This function was followed by Oration by Dr J V Divatia.

The conference was conducted in three parallel halls. Lectures were delivered by all imminent faculties from India and abroad like Dr Micheal O’Leary (Australia), Dr Shirish Prayag, Dr J V Divatia, Dr. Shivakumar Iyer, Dr. Atul Kulkarni,

Dr Rajesh Chawala, Dr Ashit Hegde, Dr Subhash Todi, Dr Kapil Zirpe, Dr Khusrav Bajan, Dr Pradeep Rangappa, Dr Paras Jain( Australia) and other well known faculties.

The scientific programme was highly appreciated as it addressed to local critical care issues along with recent advances in the field of critical care. The delegates enjoyed food and venue arrangements.

Dr Anand Nikalje (Organizing Chairman), Dr Samidh Patel (Organizing Secretary), Dr Venkatesh Deshpande, Dr Nahush Patel, Dr Sandeep Wyavhare ( Jt Org Secretaries), Dr Yogesh Deogirikar( Scientific Chairman) and all the committee members took efforts to make this event successful and memorable.

ICU ProtocolsEDITORS :Dr. Rajesh Chawla &Dr. Subhash Todi

Available at ISCCM Secretariat Office, MumbaiTel: 022-24444737 / 24460348 • Email : [email protected]

Price : Rs. 1,200 (For members) • Rs. 1,600 (For non-members)

To order your copy, please send the following order slip with cheque/DD payable at Mumbai to ISCCM - Secretariat office, Mumbai. Please add Rs. 50/- for outstation cheque.

ORDER SLIP

ICU PROTOCOLS BOOK

Name : .......................................................................................................

Address : ..................................................................................................

....................................................................................................................

Mobile No : ..............................................................................................

Email id : .................................................................................................

Membership No. (Only for members) : ..............................................

Number of books required : ..................................................................

Amount (Rs.) : .........................................................................................

Signature : ................................................................................................

Note : i. Price : Rs. 1,200 (for members) • Rs. 1,600 (for non-members)ii. Cheque/DD payable at Mumbai should be drawn in favour of

Indian Society of Critical Care Medicine – College. Please add Rs. 50/- for outstation cheque.

iii. Order slip and Cheque/DD to be sent at following ISCCM Secretariat, Mumbai office address :

Indian Society of Critical Care Medicine Unit 6, First Floor, Hind Service Industries Premises Co-

operative Society, Near Chaitya Bhoomi, Off Veer Savarkar Marg, Dadar, Mumbai 400028.


8

New Office Bearers of ISCCM Branches

LucknowChairman

Dr. Afzal Azim

seCreTary

Dr. Mohan Gurjar

Treasurer

Dr. Piyush Srivastava

exeCuTive CommiTTee memBers

Dr. A K Baronia

Dr. Ratendra Singh

Dr. Anant Sheel Choudhary

Dr. Narendra Gupta

Dr. Monica Kohli

Dr. Zia Arshad

KakinadaChairman

Dr. K Rama Swaroop Jawahar Lal

seCreTary

Dr. S V Lakshmi Narayana

Treasurer

Dr. M Rama Rao


Dr. G Prasanna Kumar

Dr. S. CH. Rama Krishna

Dr. K Vindhya

Dr. M Santhisree

Dr. R Satish

Dr. Shaheeda Parveen

JamshedpurChairman

Dr. D P Samaddar

seCreTary

Dr. Rajiv Shukla

Treasurer

Dr. Binita Panigrahi


Dr. B S Rao

Dr. C S Mitra

Dr. Nirmal Kumar

Dr. Koshy Varghese

Dr. Asif Ahmed

GwaliorChairman

Dr. R C Upadhyay

seCreTary

Dr. Devendra Gupta

Treasurer

Dr. V K Govil


Dr. Sushma Trikha

Dr. Archna Kansal

Dr. Jai Mathur

Dr. V B Verma

Dr. Santosh Singhal

Dr. S G Gadkar

GuwahatiChairman

Dr. Partha P Ghosh

seCreTary

Dr. Biraj Saikia

Treasurer

Dr. Rakesh Periwal


Dr. Dharani Talukdar

Dr. Daboo Patwary

Dr. Apurba Bora

Dr. Kripesh Ranjan Sarma

Dr. Chandana Sarma

Dr. Reshu Gupta

IndoreChairman

Dr. Santosh Padhy

seCreTary

Dr. Trishla Singhvi

Treasurer

Dr. Nikhilesh Jain


Dr. Vivek Joshi

Dr. Vikram Balwani

Dr. Santosh Ahuja

Dr. Vinod Porwal

Dr. Anand Verma

Dr. Saurabh Singhal


9

SolapurChairman

Dr. Harshawardhan Joshi

seCreTary

Dr. Sidhheshwar Rudrakshi

Treasurer

Dr. Sunil Hogade


Dr. Mahendra Joshi

Dr. Yatin Joag

Dr. Nitin Toshniwal

Dr. Pradeep Singhal

Dr. Raviraj Gurav

Dr. Nizamuddin Kotawal

MysoreChairman

Dr. Jayaraj B. S.

seCreTary

Dr. Mohankumar G.

Treasurer

Dr. Narahari M. G.


Dr. Laxmikant BS

Dr. Mahesh Nerkar

Dr. Prakash

Dr. Vaidyanathan

Dr. Badrinarayan H R

Dr. Ramakrishnan

VaranasiChairman

Prof. D. K. Singh

seCreTary

Dr. A. P. Singh

Treasurer

Dr. Rajeev Kumar Dubey


Dr. P Ranjan

Dr. Udai Singh

Dr. Prashant Sahai

MumbaiChairman

Dr. Rahul Pandit

seCreTary

Dr. Reshma Ambulkar

Treasurer

Dr. Bharat Jagiasi


Dr. Akshay Kumar Chhallani

Dr. Sonali Vari

Dr. S. Janarthanan

Dr. Amit Kumar Shaha

Dr. Shilpushp Bhosale

Dr. Rishi Kumar

LudhianaChairman

Dr. Rajesh Mahajan

seCreTary

Dr. Vivek Gupta

Treasurer

Dr. Gurpreet Singh


Dr. Vikas Bansal

Dr. Sushil Gupta

Dr. Anil Kashyap

Dr. Amit Gupta

Dr. Gaurav Bhatia

Dr. Gunchan Paul

RaipurChairman

Dr. Mahesh Sinha

seCreTary

Dr. Varsha Zanwar

Treasurer

Dr. S P Sahu


Dr. Sonal Bajpayee

Dr. Girish Agrawal

Dr. G R Agrawal

Dr. Pradeep Sharma

Dr. Rahul Goel

Dr. Sanjeev Shrivastav

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10

Branch ActivitiesAhmedAbAd

ISCCM Day CelebrationWe had a great programme of our Life

Time in the history of Critical Care of Gujarat

Salient features of the programme is as follows

1. Attended by more than 400 Medical, Paramedical and the common Man

2. A partnership between ISCCM Ahmedabad Branch, Ahmedabad Physician Association (APA), Ahmedabad Family Physician Association (AFPA), Indian Medical Association (IMA) Ahmedabad Branch, Ahmedabad Medical Association (AMA), Gujarat Nursing Council, Indian Association of Physiotherapist, Taalay (Music Academy) and Bar Council of Gujarat made this event a Mega Successful moment.

3. Venue: Sabaramati River Front (a much talked about Globally now) Sahitya Parishad Hall, known for Gujarats’ theatrical glory and a very well maintained Library.

4. Promotions before the ISCCM Day a. My FM aired this programme

highlights 3 days with real life time questions asked to the public about serious medical issues needing ICU admissions (attached)

b. All leading English, Hindi and Gujarati print and AV media had coverage before and after the programme (Attached)

c. Few of the Major Public Figures who chaired the debate (attached)

d. All public places had big life size hoardings asking leading questions and having published a punch line….Saving Lives through Critical Care

5. Partnership of all ICUs’ of Private and Public Hospitals

6. A two and a half hour long debate on all the questions related to ICU, audience shared there negative, positive, emotional and financial angles and asked the panelist all the relevant questions apart from our main THEME END of LIFE ISSUES. All the moral, ethical and legal aspects of the theme was ably taken in a mature way by our Leading Psychiatrist Dr Hansal Bachech as a Moderator (Ahmedabads’ Amitabh Bachchan)

7. Progamme was opened with a beautiful note on Tabla Vadan by TAALAY of Mr Munjal Mehta (Guinness Book Record Holder for Single Hand Tabla of a large Participants) (30 minutes of refreshing Music)

8. Apollo Hospital Staff performed a wonderful skit, on 'How Critical Care Saves Lives' and changed the perception of a common man who had brought his brother to ICU with Community Acquired Pneumonia, Acute Respiratory Failure, Sepsis, MODS over a 8 days battle in ICU on life support

9. I had the introductory speech on Overview of Critical Care (Past, Present and Future) in local language (PPT of Half and hour)

10. Aarti Vandana followed by Lamp lightening by all Dignataries

11. Perception of ICU By a Common Man: Speech by Mr Subhash Bramhbhatt (Philosopher and famous Columnist and Principal of Famous HK College): He mesmerized the audience by his charming way.

12. The debate followed (as discussed above) had to be forcefully stopped due to time constraints….(few audience also commented that Doctors please take money but listen to our questions!!!!) Famours RJ Dhvanit Thaker and Owner of Rachna School & Lalbhai group (Arvind group) Mrs Jayshree Lalbhai represented the common mans

question. Mr Yatin Oza (High Court Advocate), Mr Yogesh Lakhani (Past- President Bar Council of Gujarat) and Dr Geetendra Sharma (Famous Medico-legal Advisor, also a practicing gynecologist), Dr Shilin Shukla (Past Director GCRI Institute and Senior Medical Oncologist), Dr Vidyut Desai (Past President IMA) and Dr Raj Rawal ( Past President, ISCCM Ahmedabad) shared and discussed all the medical debate related issues.

13. All rounder Dr Raj Rawal released for the first time probably in world history of Critical Care a song called Bacha Lenge”. The music is composed by Mr Aakash Shah, creative director Mr Vinay Dave, singer and lyrics by Dr Raj Rawal. The song will be mailed to the centre soon to be highlighted in Criticare Bangalore 2015.

14. We will be contributing this song to ISCCM Centre to be played in all our Conferences.

15. Dr Jigar Mehta (ISCCM Secretary) concluded with clear messages to audience about Critical Care Needs of a Common Man and stressed about when to contact ICU Doctors.

16. Thanks Giving by Dr Jigar

17. Three young dynamic intensivist who were the event managers need worth mentioning as without them the programme wouldn’t have been possible

a. Dr Anish Joshi

b. Dr Vivek Dave

c. Dr Mehul Solanki

18. All of them wore the common ISCCM Ahmedabad T Shirts with the Punch line on the back

I hope we from ISCCM Ahmedabad Branch did justice to the theme.

We thank the center for excellent slide sets send on 4th October 2014. We also thank our ISCCM Ahmedabad team for making it a FAMILY Progamme and showing a strong UNITY once again after GUJARAT CRITICON.


11Monthly Medical Forum1. Date : 28/02/13, 8pm onwards Venue : Hotel St Laurn Topic : DVT and PE,Pathophysiology

and Case Presentation Speakers : Dr Vivek A Dave, Dr Anish

Joshi, Dr Bhagyesh Shah2. Date : 28/03/13, 8pm onwards Venue : Hotel Park Plaza Topic : a. Viral Pneumonia,presented by

Dr Vipul Thakkar b. Guidelines of ARDS,presented by

Dr Hitesh Patel3. Date : 25/04/13 Venue : Hotel Radisson Blue Topic : a. Stroke – Recent Guidelines, by

Dr Mehul Solanki b. Traumatic Brain Injury, by

Dr Kuntal Shah4. Date : 30/05/13 Venue : Hotel Park plaza Topic : a. ILD Management, by

Dr Gopal Rawal b. Radiological Implications of ILD

By Dr Amrish Patel and Dr Sanjay Patel

5. Date : 27/06/13 Venue : Hotel Holliday Inn Topic : How to read a paper? Speakers : Dr Dipak Saxena, Dr S Nair6. Date : 25/07/13 Venue : Hotel Park Plaza Topic : Tropical Infection, Case

presentation By Dr Sandeep Vaghela7. Date : 30/01/14 Venue : Hotel Park Plaza Topic : Ethical Issues in ICU and How

to deal with it?. By Dr Vivek Dave (Consultant

Instensivist, NH Ahmedabad) Dr Geetendra Sharma (Medico Legal

Expert)8. Date : 27/02/14 Venue : Hotel Park Plaza Topic : Nutrition in ICU Enteral – vs –

Parenteral Nutrition Speakers : Dr Maharshi Desai,

Dr Anish Joshi Expert Opinion : Dr Ashwin Dabhi9. Date : 27/03/14 Venue : Hotel Park Plaza Topic : Gastroenterology Update Case 1 – Acute Necrotising Pancreatitis

By Dr Sagar Vyas Case 2 – Acute Abdomen

By Dr Amit Rupala Expert opinion : Dr Premal Desai (GI

Surgeon)10. Date : 24/04/14 Venue : Hotel Park Plaza Topic : Haematology Update Case 1 – Haematological

Complications in ICU. By Dr Dipak Sharma

Case 2 – Coagulopathy and Transfusion Strategy By Dr Amit Prajapati

Expert Opinion : Dr Urmish Chudgar

11. Date : 22/05/14 Venue : Hotel Epsilon Topic : Non Invasive Ventilation

Update a. Recent Advances By Mr M A Riaz

(Clinical Manager,Respironics) b. Controversies in NIV By Dr Harjit

Dumra

12. Workshop : Bedside Ultrasonography & 2D echo (WINFOCUS)

Date : 30, 31st May 2014 Venue : Apollo Hospital, Auditorium

13. Date : 19/06/14 Venue : Hotel Eastin Easy Citizen Topic : Controversies and Recent

Advances in Neuro Critical Care By Dr Bhavik Shah

Expert: Dr Ajit Sowani, Dr Sudhir Shah

14. Workshop : Advanced Mechanical Ventilation Workshop

Date : 29 June 2014 Venue : Hotel Regenta, Ahmedabad

15. Date : 24/07/14 Venue : Hotel Park Plaza Topic : Extracorporeal therapy in ICU Speakers : Dr H Shoji (Torray Medical

Division, Japan)

16. Workshop on Critical Care Nursing Date : 27/07/14 Venue : Hotel Metropole

17. Date : 28/08/14 Venue : Hotel Eastin Easy Citizen Topic : Nephrology Update – 1 a. AKI in ICU By Dr Asit Mehta

(Nephrologist, Narayana Multispeciality Hospital)

b. Recent Advances in Nephrology By Dr Anish Joshi

18. Date : 24/09/14 Venue : Hotel Eastin Easy Citizen Topic : Nephrology Update – 2, Renal

Replacement Therapy in ICU, SLEDD – vs – CRRT, By Dr Mehul Solanki

Expert Opinion : Dr Himanshu Patel (Nephrologist, Gujarat Kidney Foundation)

Dr Haresh Patel (Nephrologist, Apollo Hospital)

19. Grand Event Critical Care Awareness Programme Held at Riverfront on 11/10/14, invited

esteemed dignitories from different professions,received huge response

20. Documentary Movie Documentary movie on Critical Care

Awareness by ISCCM Ahmedabad. Name : Critical Moments Song: Bacha Lenge

bArodA

bhubAneswAr

September 2014Topic : Role of Imaging in Critical Care Medicine (CT-MRI)Speaker : Dr Sushil Mansinghani (Radiologist)November 2014Participated in Gujarat Criticon 2014 held at Rajkot.Workshop : Baroda Branch had conducted workshop on Mechanical Ventilation. Experts who participated : Dr Ankur Bhavsar, Dr Purvesh Umarania, Dr Alok Prapanna, Dr Raviraj Gohil, Dr Neeta Bose, Dr Udgeet Thaker, Dr Bhavin Patel, Dr Hiren Patel along with National Faculties Dr Sameer Jog.Dr Ritesh Shah has participated in conducting Workshop on “Do’s and Don’ts in ICU - An Error Prevention Module” – along with Dr Anuj ClerkConference : Dr Ankur Bhavsar has taken a lecture on “Toxidromes.Dr Ritesh J Shah has moderated a session on PRO-CON debate on “CVP monitoring in Critical Care”Dr Udgeet Thaker has moderated a session on “TECHNOLOGY IN ICU”Dr Neeta Bose has moderated a session on “NEUROLOGY AND NEUROSURGERY”Dr Raviraj Gohil has moderated a session on “TRAUMA”December 2014A lecture on “Liver Dysfunction in Critically Ill patients” taken by Dr Ashish Sethi (Gastroenterologist)

The Bhubaneswar branch of Indian Society of Critical Care Medicine was formed on 17th March 2007. It has been conducting academic meetings regularly every 3rd Friday in each month, along with an annual course or update every year.


12On 1-2 Nov 2014 we conducted Critical Care Update 2014, our annual event attended by more than 100 delegates with faculties from all over India. The following Academic meetings were conducted: 17.01.2014 : Use of Antifungals in Immune-compromised patients in ICU - Dr. R. K. Jena 21.02.2014 : Tuberculosis in Critical Care Unit - Dr Samir Sahu21-03-2014 : Markers in Sepsis : The Evidence to Date - Dr. Sharmili Sinha03.05.2014 : Workshop on ABG analysis - Dr. Pragyan Routaray20.06. 2014 : Glycaemic control in critically ill pts. - Dr. Pragyan Routaray 15.08.2014 : “Update on Neuro-Critical care” - Dr. Shivakumar Iyer19.09.2014 : “Medical statistics made easy” - Dr. E.Venkata Rao09.10.2014 : ISCCM Foundation Day Celebration (End of life care) - ISCCM, ISA, IMA, IAP1-2 Nov 2014 : Critical Care Update 2014 - Dr Saroj PattnaikDr. Saroj PattnaikSecretary, ISCCM, Bhubaneswar BranchConsultant, CCU, Apollo Hospitals, Bhubaneswar

ChAndigArh

JAlAndhAr

KAKinAdA

rAipur

surAT

mYsore

First Meeting in the year 2014 was held on 19th January 2013 at Hotel Park Plaza, Sector 17, Chandigarh . A CME on “Management of metabolic abnormalities in ICU: Potassium homeostasis” Scientific program was Chaired by Prof Vinay Sakhuja, Consultant Nephrologist, Max Hospital, Mohali and Prof Satinder Gombar, Prof and Head, Anesthesia, GMCH-32, Chandigarh. Dr J P Singhvi, Consultant Neurologist, INSCOL Hospital, Chandigarh presented a case of hypokalemic paralysis and Management of Hypokalemia in Critically ill patient was discussed by Dr Charanjit Lal, Consultant Nephrology, INSCOL Hospital, Chandigarh. A CME on “Management of ARDS in ICU: Pediatric perspective” was held on 21th March 2014 at Hotel Park Plaza, Sector 17, Chandigarh. Scientific program was chaired by Prof Sunit Singhi, Prof and Head, APC, PGIMER, Chandigarh and Prof Narayana Y, Professor, Anesthesia and critical care, PGIMER, Chandigarh. Dr Karthi N, Assistant professor, PGIMER, Chandigarh presented a case on Scrub Typhus with ARDS with MODS. Dr. Arun Bansal, PGIMER, Chandigarh Updated everyone on management of ARDS The third meeting of ISCCM, Chandigarh chapter was a CME on “Management of Acute Pancreatitis” held on 21st May 2014 at Hotel Park Plaza, Sector 17, Chandigarh. There was a case based discussion on Fluid resuscitation by Dr Vipul and antibiotics usage by Dr A K Mandal from Fortis Hospital, Mohali. Dr Namrata presented the local experience at Fortis hospital mohali. The session was chaired

1. Election : 5/9/2014 2. Lecture and Workshop at Kapurthala

Army Camp on Cardiac Arrest and CPR on 7/9/2014

3. Lecture on MDRS VAP in ICU by Dr R Mahajan from DMC Ludhiana 19/10/2014

We have Celebrated ISCCM Foundation Day on 9-10-2014. On the same day we have conducted the elections of our branch.Dr. B.V. Mahesh Babu

Topics covered were :• Fulids mamagemant in ICU.• Electrolytes in ICU.• Antiobiotics mangemant.• Reading ABG.• Sepsis n Septic shock.• Reading on an antibiogram, covered

by Microbiologist.• Case discussion.• Arrthymias in ICU.• HAP n VAP- treatment n contrveries.

• 27th June 2014 at hotel Taj Gateway, Surat

Presenters : Dr. Nikesh Davda, Dr. Ronal Nagori

Topic : Bird Flu an update Doctors attended : 25• 25th July 2014 at hotel Taj Gatway,

Surat Presenters : Dr. Anuj Clerk, Dr. Ronak

Nagori Topic : Synopsis of Best of Brussels

Conference - Case presentation Doctors attended : 38• 29th August 2014 at hotel Taj Gateway,

Surat Presenters : Dr.Kiran Shah, Dr. Gaurish

Gadbel Topic : Trama Induced Coaglopathy -

Case presentation Doctors attended : 38• 26th September 2014 at hotel Taj

Gateway, Surat

A CME was organized on 28th November 2014 at Hotel Regaalis, Mysore. The details are as mentioned below.Topics 1 : Practice

changing guidelines in the Management of Methicillin-Resistant Staphylococcus Aureus (MRSA) Infections in adult patients in ICU Speaker : Dr . Chaya D R, MD, Consultant, Microbiologist and Infection Control, Naryana Multispecialty Hospital, Mysore

by Prof. JD Wig and Dr. Arvind Sahni. This was followed by a panel discussion. The panelists were Prof. JD Wig, Prof. Atul Sachdev, Prof Navneet Sharma. The discussion was moderated by Dr. S K Sinha. A joint meeting with Punjab Chapter of ISCCM was held on 4th August 2014. a clinical case presentation of sepsis with emphasis on utility of Endotoxin Removal by Polymyxin B-Immobilized Cartridge.ISCCM day was celebrated on 7th October at Fortis Hospital Mohali. A case based discussion on End of Life Issues was moderated by Dr Amit Mandal and panelist were, Prof Atul Sachdev, Prof KK Gombar, Prof Sunit Singhi and Dr Ashish Bhalla. Since the elections were held last year October, the new executive body election would be held in 2016 march.Ashish BhallaSecretary, ISCCM, Chandigarh ChapterAdditional Professor (Internal medicine)PGIMER, Chandigarh.

Topic 2 : 2014 Guidelines on the Management of Acute Pulmonary EmbolismSpeaker : Dr. Raghunath A, IDCCM, EDIC, Consultant Intensivist, GGSMH, MysoreChairpersons : Dr. H G Manjunath, President of ISA Mysore Branch, Assoc. Prof of Anesthesiology, MMC & RI, Mysore, Dr. Ramakrishna, Consultant Intensivist, Apollo BGS, MysoreDr. Raghunath H ASecretary, ISCCM Mysore Chapter


13

VArAnAsi

VisAKhApATnAm

1. Workshop on Invasive and Non-invasive ventilation - 31st May 2014

2. CME on tropical fever attended by national faculty -1st june 2014

3. CME on emerging trends of microbial resistance in ICU 2nd August 2014

CME - MEETS from January 2014 to November 2014

1. 4th Jan, 2014 Topic : Antibiotic Stewardship Speaker : Dr.Lavanya Nutankalva

2. 17th May, 2014 Topic : Pre & Post operative

management of Liver Transplantation Speaker : Dr. Dharmesh Kapoor

3. 21st June, 2014 Topic : Phosphate and Calcium

significance and correction in ICU patients

Speaker : Dr. Atchyuth R Gongada

4. 3rd July, 2014 Topic : Recent guidelines on Clinical

Nutrition Speaker : Dr. Mudassor Mor

Presenters : Dr. Ramesh Surati, Dr. Ronal Nagori

Topic : Ebola an Update - Case presentation

Doctors attended : 35• 6th October 2014 at Auditorim

Sunshine Global Hospital Presenters : Dr. Anuj Clerk, Dr. Mitul

Chavda, Dr. Vinesh Shah, Lawyer Mr. Kirit Panwala, Dr. Kamlesh Dave, Public Procecutor Mr. Dignat Tevar

• Topic : Panel discussion on end of life care joinlty organised with pixie medicolegall consultancy

Doctors attended : 45• 17th November 2014 at Auditorim

Sunshine Global Hospital Presenters : Dr. Andrew Ullman, Dr.

Dinesh Bhurani Topic : Webinar Released from Delhi

Selection of Emipiric Antifungals in ICU

Doctors attended : 12• 21st November 2014 at V Patel College,

Rajkot Presenters : Dr. Arool Shukla, Dr.

Chetan Mehta Topic : Critical Care nursing workshop

as preconferance workshop from ISCCM Surat branch

Attended by 120 Nurses

5. 9th,August,2014 Topic : 5Ws in Clinical Nutrition Speaker : Dr. A. Mohan Rao

6. 11th Oct, 2014 Topic : End of Life Care - ISCCM Day

Celebrations Speakers : Dr. Narendra Rungta,

Dr. Srinivas Samavedam

7. 11th Oct, 2014 Topic : Critical Care: “Past, Present &

Future,Options & Opportunities Speaker : Dr. Arindam Kar

8. 2nd Nov, 2014 Topic : FCCS - Course conducted Speaker : Dr. P.B.N. Gopal

Fundamental Critical Care Support Course11-12 October 2014Dr. Narendra Rungta, Dr.Manish Munjal

JOUR

NAL SCANdr. Srinivas SamavedamChief intensivist, Care hospitals, [email protected]

Procalcitonin Algorithm in Critically Ill Adults with UndifferentiatedInfection or Suspected Sepsis - A Randomized

Controlled Trial

Association between intravenous chloride

load during resuscitation and in-hospital mortality

among patients with SIRS

Yahya Shehabi, Martin Sterba, Peter Maxwell Garrett, Kanaka Sundaram Rachakonda, Dianne Stephens et al. the ProGUARD Study Investigators*, and the ANZICS Clinical Trials Group

Am J Respir Crit Care Med Vol 190, Iss 10, pp 1102–1110, Nov 15, 2014

procalcitonin is an investigation ordered frequently among iCu patients. The role and relevance have been a point of debate ever since the test became widely available in the country. The debate on whether procalcitonin influences antibiotic prescriptions and whether it predicts severity of sepsis, goes on unabated. There is evidence to say that procalcitonin driven strategies might prolong overall length of stay and dialysis days. The investigators sought to study whether a cut off value of 0.1ng/ml results in more rational antibiotic use and whether the values correlate with the severity of sepsis.

This was a multi centre randomized trial across 11 units in australia.

The patients were stratified into a PCT guided therapy group and a standard Care group. surprisingly, eight out of the 11 units were not using pCT to guide antibiotic prescriptions prior to this study. according to the study protocol, antibiotics were withdrawn if the initial pCT value was <0.1ng/ml, or if values fell by more than 90%. similarly, antibiotic appropriateness was reviewed if pCT values rose by more than 70%. The primary outcome is time to antibiotic cessation at 28 days,

hospital discharge, or death. The main secondary outcome was

the number of antibiotic daily defined doses (DDD) at day 28. other secondary outcomes included iCu and hospital length of stay and mortality and 90-day all-cause mortality.

The study randomized close to 200 patients in both the groups. at baseline, more patients with intra abdominal sepsis were managed by standard therapy. Compliance to the algorithm was high. There was no difference amongst the two groups in the duration of antibiotic therapy. however, pCT guided group returned more patients with multi drug resistant isolates while the standard treatment group yielded more patients needing readmissions due to secondary infections. Baseline pCT value did not predict mortality; however, decrement in pCT values proved to be a marker of survival. values of pCT were expectedly higher in the group who ultimately had positive blood cultures results. a delayed rise in pCT also predicted mortality. procalcitonin was not sensitive to pickup pulmonary infections when compared to other sources of infection. a value of less than 0.1 ng/ml excluded a positive blood culture with 100% sensitivity.

Reviewers comments : This study seems to water down the enthusiasm with which pCT is used in iCus. The previously accepted advantage of antibiotic de escalation is also questioned by this study. in addition, this study raises concerns about mdr pathogens emerging in units depending on pCT for antibiotic strategies. however, on the positive side a decremental pCT trend is a good

Andrew D. Shaw, Karthik Raghunathan, Fred W. Peyerl, Sibyl H. Munson, Scott M. Paluszkiewicz, Carol R. Schermer

Intensive Care Med (2014) 40:1897–1905

The current interest and focus seems to be on the effect of volume overload and acid base disequilibrium, on overall mortality among patients undergoing resuscitation. hypothetically, a positive balance 24 hours after resuscitation and hyperchloremic acidosis should impact the outcomes. shaw et al sought to perform a retrospective analysis from a large data base to address this issue. The authors investigated the association between chloride load and in-hospital mortality among patients meeting systemic inflammatory response syndrome (SIRS) criteria who received iv crystalloids, with and without adjustment for the total fluid volume administered. Baseline and peak chloride concentrations were defined as the lowest concentration

on the day of SIRS qualification and highest

predictor of survival. a second peak indicates secondary infection. a value of > 0.1 ng/ml warrants attention towards sources of sepsis.


14

Meta-analysis of high- versus low-chloride

content in perioperative and critical care fluid

resuscitation

Impact of positive fluid balance on

critically ill surgical patients: A prospective

observational study

When to stop septic shock resuscitation:

clues from a dynamic perfusion monitoring

Cost-effectiveness of Dalteparin vs Unfractionated Heparin for the

Prevention of Venous Thromboembolism

in Critically Ill Patients

Heparin therapy reduces 28-day mortality in adult severe sepsis patients: a systematic review and

meta-analysis

M. L. Krajewski, K. Raghunathan, S. M. Paluszkiewicz, C. R. Schermer & A. D. Shaw

Wiley Online Library (www.bjs.co.uk).

This is a meta analysis from the same group which published the preceding article. studies published so far have evaluated “buffered” vs “non buffered” fluids and chloride rich and chloride poor fluids. This study aimed to determine whether the chloride content of resuscitation fluids used in the operating theatre or intensive care unit (iCu) setting is associated with differences in outcomes. for purposes of this analysis, isotonic crystalloids with supra physiological chloride concentrations are referred to as high-chloride fluids 9 (only normal saline fit it into this group), whereas those with near-physiological chloride concentrations are referred to as low-chloride fluids. Studies comparing colloids with crystalloids were not included in the meta analysis. a total of 15 rCT s and 6 non rCTs involving 6253 patients were initially eligible for analysis. eleven of these studies evaluated patients who needed resuscitation and the rest received peri operative fluids. The studies which studied mortality as an endpoint did not show any difference. however the incidence of aKi was higher in the high chloride group. hospital length of stay appeared to be longer in the patients resuscitated or treated with high chloride fluids. volume of blood transfused was higher and the duration of mechanical ventilation was longer among patients treated with high chloride fluids. however, on sensitivity analysis, some of the results seemed to be influenced by a couple of studies. when these studies were excluded, the statistical significance faded.

Reviewer’s comments : This meta analysis raises concerns about using normal saline as a resuscitating fluid. Whether statistical significance exists or not, concern definitely is genuine. A paradigm shift seems to be on.

Glenn Hernandez, Cecilia Luengo,Alejandro Bruhn, Eduardo Kattan, Gilberto Friedman, Gustavo A Ospina-Tascon, Andrea Fuentealba, Ricardo Castro, Tomas Regueira, Carlos Romero, Can Ince and Jan Bakker

Annals of Intensive Care 2014, 4:30

resuscitation and markers of its success have received a lot of attention of late. as is evident from the preceding reviews, over resuscitation seems to have an adverse impact on outcomes. it is therefore important to know when resuscitation should stop. hernandez et al carried out a prospective study to evaluate the specific normalization rates of several perfusion-related variables in a cohort of consecutive septic shock patients subjected to protocolized resuscitation and multimodal perfusion assessment. The study analysed data obtained from survivors. data was collected over a 24 hr period. multi modal assessment of perfusion included mean arterial pressure, Cvp, heart rate, vasoactive drug dosages, pulse pressure variation , pa catheter derived variables, scvo2, lactate and central venous-arterial Co2 gradient. in addition, mechanically ventilated patients were also evaluated for thenar muscle oxygen saturation and microcirculatory derived variables. lactate levels seemed to be the most consistent trigger for initiating resuscitation. all variables showed a quick fall in the first six hours followed by a much slower decay subsequently. lactate returned to normal by the end of 24 hours in a little more than half the patients. among the rest, the values returned to normal over variable intervals of time without any major changes in sofa or vasopressor requirements. microcirculatory based variables showed a much slower decay pattern. But the patients had already showed significant recovery by the time the microcirculatory variables reached baseline. resuscitating patients on the basis of these parameters could therefore result in over resuscitation. The authors concluded that goals of resuscitation are multiple and definition of septic shock depends on which variable is being used to define shock. More studies on this issue are warranted.

Galinos Barmparas, Douglas Liou, Debora Lee, Nicole Fierro, Matthew Bloom, Eric Ley, Ali Salim, Marko Bukur

Changsong Wang, Chunjie Chi, Lei Guo, Xiaoyang Wang, Libo Guo, Jiaxiao Sun, Bo Sun, Shanshan Liu, Xuenan Chang and Enyou Li

Critical Care 2014, 18:563

Robert A. Fowler, Nicole Mittmann, William Geerts, Diane Heels-Ansdell, et al for the Canadian Critical Care Trials Group and the Australia and New Zealand Intensive Care Society Clinical Trials Group

JAMA. 2014;312(20):2135-2145

Thromboprophylaxis is an integral part of all checklists in iCu. pharmacoprophylaxis is generally provided by either unfractionated heparin (uh) or low molecular weight heparin (lmwh). one of the factors influencing the choice of agent is the cost involved and cost effectiveness. potential for triggering heparin induced thrombocytopenia is also one of the issues associated with selecting the drug for pharmacoprophylaxis. fowler et all carried out a prospective economic evaluation of the data collected during the proTeCT study. Their primary objective was to compare the clinical and economic outcomes of the lmwh dalteparin compared with ufh

for the prevention of vTe in critically ill medical-surgical patients. The study was carried out over 4 years and included 3746 patients. The frequency of dvT, pulmonary embolus, major bleeding, and suspected and confirmed heparin-induced thrombocytopenia were recorded. death in the iCu or hospital was a tertiary endpoint. The cost implications were recorded for drugs, laboratory tests, personnel, diagnostic testing, procedures and operations, bleeding and blood product transfusion services, and infrastructure. medical critical illness accounted for 76% of the cohort and 90% were ventilated. rates of dvT, other thromboses and major bleeding were not different between the two drug allocations. however, heparin induced thrombocytopenia was seen less often in the lmwh group. Taking into account investigations for dvT, correction of bleeding complications and length of stay, lmwh showed a cost advantage over unfractionated heparin. rates of pulmonary embolism despite prophylaxis tended to be higher for uh. The higher incidence of hiT and its workup added to the cost disadvantage with uh.

Reviewers comments : The debate over uh vs lwmh seems to be swinging against uh. The issue of costs also seems to be against UH. The benefit seems to be arising from lesser embolii and hiT rates – both capable of changing outcomes - with lmwh.

concentration within 72 h following sirs qualification, respectively. Both pre- and post fluid loading chloride values were recorded as well as the fluid balance status. Chloride was expressed as volume adjusted chloride load by summing up all fluid administrations exceeding 250 ml. patients with chloride values between 130-140 mmol/ l at baseline had the highest mortality. in hospital mortality also followed a similar pattern. The quantum of deviation from baseline also determined the mortality. The volume of chloride containing fluid also determined the outcome, with higher volumes associated with higher mortality. This effect on mortality was statistically shown to be independent of the severity of illness.

Reviewer’s comments : This is another study which stresses on the importance of monitoring chloride post resuscitation. The importance of regulating volume of resuscitation is also reemphasized.

Journal of Critical Care 29 (2014) 936–941

This is a prospective study of a cohort of patients admitted to a surgical intensive Care unit. more than 63% patients had severe illness as determined by the APACHE scores. The fluid balance was recorded on a day to day basis by chart review. fluid balance was assessed for five days. The primary end point was in-hospital mortality, and secondary outcomes included complications during the surgical iCu stay, ventilation days, and surgical iCu length of stay. it was however a small study including about 144 patients. The positive balance began to appear after two days of iCu stay and plateaued by day 5. The positive fluid balance group had higher crude mortality but statistical significance could not be demonstrated. Complication rates also were not significantly different. Cox regression analysis using predictors of mortality showed that inability to achieve a negative balance by day 5 was an independent predictor of mortality. similarly, complication rated were lower if negative balance could be achieved on day 1.

Reviewer’s comments : The paradigm of resuscitation seems to be changing and overdoing the fluid resuscitation could be deleterious for critically ill patients. a meticulous attention to fluid balance seems to be part of assessing quality of intensive care.

Reviewers comments : The goals of resuscitation vary. however, given the variability of decay of these targets, a multi modal approach is probably better. a trend in decay is good enough. relying on these markers beyond the first 24 hours might result in over resuscitation


15

Audits in real time for safety in critical care:

Definition and pilot study

Transfusion Triggers for Guiding RBC Transfusion

for Cardiovascular Surgery: A Systematic

Review and Meta-Analysis

Can non-invasive positive pressure ventilation

prevent endotracheal intubation in acute lung injury/acute respiratory

distress syndrome? A meta-analysis

Safety, Feasibility, and Outcomes of Induced Hypothermia Therapy Following In-Hospital

Cardiac Arrest – Evaluation of a Large Prospective Registry

Josef Dankiewicz, Simon Schmidbauer, Niklas Nielsen, Karl B. Kern, Michael R. Mooney, Pascal Stammet, Richard R. Riker, Sten Rubertsson, David Seder, Ondrej Smid, Kjetil Sunde, Eldar Søreide, Barbara T. Unger, Hans Friberg

Crit Care Med 2014; 42:2537–2545

mild induced hypothermia has become a standard inclusion in most guidelines dealing with post resuscitation care of patients suffering an out of hospital Cardiac arrest. The outcomes of patients suffering a cardiac arrest in hospital are surprisingly only marginally better. This cohort of patients generally has more comorbidities and confounding factors. on the other hand these patients are in closer proximity to medical attention and monitoring tools. Therapeutic hypothermia might be helpful in improving the outcomes among this cohort as well. dankiewicz et al carried out an observational study across 45 centres in europe and united status. initial rhythm and etiology of cardiac arrest were not factors for initiating hypothermia protocol. Target temperatures ranged between 32 -35 C. Cardiac arrest secondary to trauma were excluded from the study. favorable neurological outcome at discharge was the primary endpoint. secondary outcomes were neurological outcome at follow-up and presumed cause of death in hospital. 57% patients treated with Th survived to discharge. 41% had good neurological outcome. at follow up 34% of all patients had good outcomes. patients with a good outcome had a shorter time from cardiac arrest to attainment of target temperature compared with patients with a poor outcome. Rate of cooling did not influence outcome; however, initial lower body temperatures were associated with better outcomes. development of sepsis, tonic clonic seizures and myoclonic seizures were markers of poorer outcome. Therefore the authors considered Th as a feasible option for patients suffering a cardiac arrest in hospital.

Reviewers comments : it was always surprising why Th works only for vf arrests that happen outside the hospital. it was logical to presume that TH might benefit other types of cardiac arrests

G. Sirgo Rodrígueza, M. Olona Cabasesb, M.C. Martin Delgadoc, F. Esteban Rebolla, A. Pobo Peris a, M. Bodí Saeraa, ART-SACC study experts

Med Intensiva. 2014;38(7):473-482

adverse incidents are not uncommon in iCus. such incidents tend to increase the length of stay and ultimately the cost incurred in delivering care. most of the errors in medicine happen during the performance of the most common interventions or procedures. availability of a check list probably would help in making these interventions or procedures safer. rodrigueza et al carried out a pilot study to develop a checklist of safety measures (SMs) specifically designed for critically ill patients and based on sound scientific literature, and to apply them in real time (randomizing variables and patients) during routine clinical work (audits), with the aim of minimizing errors of both commission and omission, and evaluating the utility and feasibility of the procedure.

all routine interventions were grouped under common headings like hemodynamics, ventilation, nutrition, nursing etc. The utilization of the sms before and after the development of the check list was assessed. The utility and feasibility of this tool was studied over a two week period. The checklist seemed to contribute to important changes to the treatment for parameters like monitoring alveolar pressures limit, checking monitor alarms, assessment for aKi, reviewing the correctness of daily prescriptions, evaluation for the need of catheters and proper incorporation of the treatment plan. a total of 37 safety measures were part of the checklist.

Reviewers comments : The authors have put the issue of checklists in proper perspective. all sms they included are commonly followed but there is no format for the same. This check list puts all of them in a systematic order. But the time needed to complete the checklist needs to be defined. This could be a hurdle for adopting this good checklist.

Gerard F. Curley; Nadine Shehata, C. David Mazer, Gregory M. T. Hare, Jan O. Friedrich

Crit Care Med 2014; 42:2611–2624

Transfusion trigger has been a hot topic of research in critical care for quite some time. decision to transfuse often is a point of conflict between teams treating critically ill patients. one of the areas where the rates of transfusion are high is cardiovascular surgery. The issue whether morbidity and mortality are higher secondary to anemia or blood transfusion needs is not resolved yet. Curley et al carried out a meta analysis determine the effects of restrictive transfusion (transfusion of rBC at lower hemoglobin concentrations), compared with liberal transfusion (transfusion of rBCs at higher hemoglobin concentrations) in patients undergoing cardiac or vascular surgery, on clinical outcomes.

Jian Luo, Mao-Yun Wang,Hui Zhu, Bin-Miao Liang, Dan Liu, Xia-Ying Peng, Rong-Chun Wang, Chun-Tao Li, Chen-Yun He And Zong-An Liang

Respirology (2014) 19, 1149–1157

The management of ards is largely streamlined now after a series of studies by the ardsnet group. however, initiating invasive ventilation may not always be safe. moreover, resources may be a limiting factor in our country. The application of niv seems to be a first response although no guidelines mention its role. luo et al tried to review the data to investigate whether nippv have advantages in reducing the rate of endotracheal

intubation and mortality in ali/ards. six trials were identified which compared NIV with oxygen therapy having intubation rate as an endpoint. intubation rates were higher in the oxygen group but mortality was same.

reviewers comments: This is a very small meta analysis. The Berlin definition was not the criteria used for categorizing ards. more data is required before niv can be routinely tried atleast in mild ards.

Other relevant articles:

sheyin et al published a meta analysis (o. sheyin et al. / heart & lung xxx (2014) ) evaluating the role of elevated troponin in predicting mortality among septic patients. They concluded that elevated troponin is a marker of poor prognosis.

Janattul-ain Jamal et al ( prof lipman’s group) published an rCT (international Journal of antimicrobial agents) on meropenem dosing in critical illness, evaluating a continuous infusion versus intermittent bolus administration. They found that continuous infusion achieved more rapid and sustained meropenem levels in blood compared to intermittent bolus.

finally, lakhmir Chawla gave some glimmer of hope for the treatment of high output shock by a pilot study of intravenous angiotensin ii. (Chawla et al. Critical Care 2014, 18:534). This study (aThos) showed the efficacy of Angiotensin II as an effective rescue vasopressors agent.

The sepsis puzzle is yet to be fully unraveled. several interventions seem to be appearing on the horizon and vanishing as quickly. one of the potential thera-pies which has made repeated appearances on this stage is heparin. The current status is ambiguous with studies and reviews giving equivocal results. This meta analysis by wang et al attempts to address this question again. This analysis included 9 stud-ies which compared heparin with placebo. all the studies used heparin as a prophylaxis among septic patients. however, some of them used heparin as a continuous infusion on a weight based schedule. overall the group treated with heparin seemed to have a statistically significant lower mortality. This benefit appeared to be more pronounced in those with severe sepsis. Bleeding episodes were also not higher in the heparin group.

Reviewers comments : another meta analysis on heparin is published evaluating exactly the same studies which previous analyses have included. The fact that is clear is that using heparin as prophy-laxis is safe and might improve outcomes among selected patients with severe sepsis.

irrespective of location. This study lends some more credence to this theory. This is another area where indian iCus can embark on a multi centre study.

studies evaluating normovolemic hemodilution were also included. The range for restricted transfusion in the included studies ranged from 70-90gm/l and for liberal transfusion between 80-100g/l. The primary outcome of mortality was not influenced by the transfusion triggers. Similarly secondary outcomes like myocardial infarction, stroke, renal failure and blood loss were similar in both the groups. some other outcomes like infections and arrhythmias were not part of all the included studies, but did not appear to differ in incidence. however, the superiority of restrictive strategy on outcomes, demonstrated in studies relating to general iCu patients could not be replicated in this analysis.

Reviewers comments : Cardiac surgery seems to be the last bastion for liberal transfusion strategies. although this study has made an opening, the bastion seems to be left standing till further data accumulates.


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