critical care - isccm care editorial office dr. yatin mehta 272 espace, nirvana country, gurgaon...

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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

www.isccm.org

C O M M U N I C A T I O N SCritical Care

Editorial officE

dr. Yatin Mehta272 Espace, Nirvana Country, Gurgaon 122001Mobile : +91 9971698149 • emails : [email protected]

Published By :

IndIan SocIety of crItIcal care MedIcIneFor Free Circulation Amongst Medical ProfessionalsUnit 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]

We request our esteemed readers to send their valued feedback,

suggestions & views at [email protected]

Contents ISCCM News HeadlIneS1 ISCCM News Headlines

2 Editorial

2 Editorial Board 2017-2018

3 President's Desk

3 ISCCM Office Inauguaration

4 General Secretary's Desk

4 Guidelines PG Section

5 The Mathura Declaration

5 ISCCM Examination – Prometric

6 Quiz Sixth Edition

6 Answers to Fifth Episode

6 Critical Care Update 2017

7 ORCC-CON Bhopal 2017

8 ISCCM Research Grant Proposal

8 Young Talent Hunt -

CRITICARE 2018

8 3rd Annual Conference

ECMO ASIA 2017

8 Image Challenge

9 Branch Report 2017

13 8th GCC 2017 - A Report

14 Journal Scan

15 CRITICARE 2018

Inauguration of new office Mathura Declaration Original Research in Critical Care Conference – Bhopal Gujarat Critical Care Regional conferences across the country Journal Scan ‘Battle of the Brains’ – Quiz Criticare 2018 – Young Talent Hunt

Volume 12.2 mAy-june 2017

BlockYour

Dates

CRITICARE 20187-11 March, 2018 • Varanasi

The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine2

Editorial Board 2017-2018

Editor in ChiEfDr. Yatin Mehta, Delhi

[email protected]

Editorial

dr. yatin MehtaEditor in Chief,

the Critical Care CommunicationsPresident-Elect, iSCCM

[email protected]

www.isccm.org

dEPuty EditorS

Dr. Yash Javeri, Delhi Dr. Rajesh Mishra, AhmeDAbAD

[email protected] [email protected]

EditorS

Dr. Samir Jog, Pune Dr. Sachin Gupta, Delhi Dr. Pradeep Bhatia, JoDhPur Dr. R. Senthil Kumar, ChennAi Dr. Suresh Ramasubban, KolKAtA

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

Quiz SECtion

Dr. Yatin Mehta, Delhi Dr. Yash Javeri, Delhi

[email protected] [email protected]

Journal SCan

Dr. Srinivas Samavedan Dr. Prashant [email protected] [email protected]

iMagES SECtion

Dr. Abhinav Gupta Dr. Tapas Kumar [email protected] [email protected]

Dear Friends,

I am happy to present another issue of the prestigious critical care

newsletter.

There have been conferences across the length and breadth of country under

the flagship of ISCCM.

Students must have benefited with various sections in the newsletter.

Mathura Declaration was possible only because of huge efforts from

Dr RK Mani.

Quiz section will keep on scintillating your brains.

There has been good response to both image and quiz section.

Encourage your team members for young talent award.

Please suggest what else can be incorporated in the newsletter.

Happy Reading!

The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine 3

President's Desk

Dear ISCCM members,

Greetings from Pune.

I would like to take this

opportunity to share with you about

various projects undertaken by us

during the past few months.

ISCCM has decided to adopt concept of

“GO GREEN”. We were spending lots

of funds on hard copies of our journal

and Newsletter. With this concept of

GO GREEN, we have provided the

choice of “OPT OUT” from receiving

the hard copies for all life members. We

will send hard copies of journal only

to those members who desire to get

hard copy. We are sending quarterly

mails, also option is kept on website to

choose your choice. I sincerely request

all of you to accept our request to save

papers.

I take this opportunity to congratulate

Dr Rahul Pandit and his whole team for

publishing “Management of Potential

Cadaver Donor Guidelines” in time.

These guidelines are probably first and

only document available at present in

our country. I would like to put it on

record Dr Sushma Patil did excellent

job of compiling and editing of these

guidelines.

I am happy to share that ISCCM

is planning to get in association

with NABH and Beuro Heritas for

accreditation of ICUs across country.

We have requested previous team

of experts who has laid down “ICU

designing and planning guidelines” to

update these guidelines so that we can

implement same with association of

different organization.

dr. Kapil ZirpePresident, iSCCM

[email protected]

Dr J V Peter has done excellent work of

completing document on “Quality Up

gradation Enable by Space Technology

(QUEST) “related to reduce errors in

ICU. ISCCM is major contributor along

with ISRO, NABH, AHPI, and CAHO&

SEMI.It is a very compressive and well

written document which is due for

publication in August.

The elections for the National Executive

Committee of ISCCM are around the

corner and I urge all of you to update

your e-mail IDs and mobile nos. with

the ISCCM office.

Last but not the least, the preparation

for Criticare 2018 is well underway. I

recommend that all of you register for

the conference. The younger members

of the society can become faculty if they

participate in the Young Talent Hunt

competition.Pleasevisit to website to

know details.

I extend my personnel thanks and

sincere appreciation to all my colleagues

and I trust that in coming years we

will maintain an active interest in the

ISCCM Programs.

ISCCM Office Inauguaration


dr. Subhal dixitgeneral Secretary, iSCCM

Dear allGreetings from General Secretary's desk.ISCCM branches have organised many thematic

conferences and workshops in last two months.The Mathura Declaration has been a landmark document on end of life realeased by the ELICIT group.ISCCM released the donor maintance guidelines which can be downloaded from website.ISCCM is calling for young talent for CRITICARE 2018 at Varanasi, you can find details on website .We promise an academic delight at Varanasi.Please get yourself and your team members registered for the conference.

General Secretary's Desk

The examinations process have been further streamlined.Many new centres and teachers have been approved in last few months.I am delighted to share the news of inauguration of new office complex and the first executive committee meeting was held in its office.Dr Kapil Zirpe has taken ISCCM to new places.Please feel free to share suggestions or comments and encourage your friends to join ISCCM.I also request you to update your contact details with isccm office and also fill the form for accepting the soft copy of IJCCM.Best Wishes

Guidelines PG SectionAcid-Base Disorders Worksheet

Step 1: Gather the necessary data (electrolytes and an ABG). Make sure the HCO3 from the electrolyte panel and ABG are within 2 (if not, the results are uninterpretable). pH / pCO2 / HCO3Step 2. Look at the pH. Pt has primary: If pH > 7.4, then pt is alkalemic (proceed to Step 3a). Acidemia / Alkalemia If pH < 7.4, then pt is acidemic (proceed to Step 3b). Step 3. Determine the primary etiology.

3a. Alkalemia: Increased HCO3 = Metabolic alkalosis (go to Step 5). Primary process is: Decreased pCO2 = Respiratory alkalosis (go to Step 4a). Respiratory / Metabolic3b. Acidemia Decreased HCO3 = Metabolic acidosis (go to Step 5). Elevated pCO2 = Respiratory acidosis (go to Step 4b)

Res

pira

tory

D

isor

ders

Step 4. If primary respiratory disorder, determine whether acute or chronic. 4a. Respiratory acidosis: Acute: pH decrease by 0.08 for every 10 pCO2 is above 40 Respiratory process: Chronic: pH decrease by 0.03 for every 10 pCO2 is above 40 Acute / Chronic4b. Respiratory alkalosis: Acute: pH increased by 0.08 for every 10 pCO2 is below 40 Unknown Chronic: pH increases by 0.03 for every 10 pCo2 is below 40

ALL

Step 5. Calculate the anion gap. 5a: Na - (HCO3 + Cl) = ___________. Anion gap present If > 12 (or 3 X albumin), then pt has an anion gap metabolic acidosis (proceed to Step 5b). Yes / No If < 12, skip to Step 6b. 5b. Calculate the excess anion gap. Excess anion gap = _________. Calculated anion gap - 12 (or 3 X albumin) = __________.

Met

abol

ic A

cido

sis

Step 6. Identify concominant disorders. 6a. Calculate the corrected HCO3. You must understand that this step essentially compares the decrease in measured HCO3 to the expected decrease in HCO3 based on the degree of anion gap.Measured HCO3 + excess anion gap = ________.

*If the corrected HCO3 is > 30, then the pt has a concominant metabolic alkalosis (more HCO3 than expected for the degree of gap acidosis).

Metabolic alkalosis presentYes / No

*If the corrected HCO3 is < 23, then the pt has a concominant non-gap metabolic acidosis (less HCO3 than expected for the degree of gap acidosis).

Non-gap acidosis presentYes / No

6b. Calculate the expected pCO2. Winter’s formula shows what the pCO2 should be for the level of acidosis present (omit if primary disorder is respiratory).

Winter’s formula = expected pCO2 = 1.5 (HCO3) + 8 +/- 2 1.5 (_______) = _________ + 8 +/- 2 = _________. Respiratory disorder present *If the actual pCO2 > calculated pCO2, then pt has a concominant Respiratory acidosis. Yes / No *If the actual pCO2 < calculated pCO2, then pt has a concominant Respiratory alkalosis. Identify:________Step 7. Figure out what’s causing the problem(s):Anion Gap Metabolic

AcidosisNon-gap Metabolic

AcodosisAcute Respiratory Acidosis Metabolic Alkalosis Respiratory Alkalosis

“MUD PILERS” “HARD UPS” anything that causes hypoven-tilation

“CLEVER PD” “CHAMPS”Methanol Hyperalimentation Contraction anything that causes hyperventi-

lationUremia Acetazolamide LicoriceDKA/Alkoholic KA Renal tubular acidosis CNS depression Endo (Conn’s, Cushing’s, Bartter’s)

Paraldohyde Diarrhea Airway obstruction CNS diseaseIsoniazid Uretero-pelvic shunt Pneumonia Vomiting Hypoxia

Lactic acidosis Post-hypercapnea Pulmonary edema Excess Alkali AnxietyEtOH/Ethylene glycol Spironolactone Hemo/pneumothorax Refeeding Alkalosis Mechanical ventilators

Rhabdo Myopathy ProgesteroneSalicylates Post-hyopercapnea Salicylates/Sepsis

(Chronic respiratory acidosis caused by COPD and restrictive

lung disease)

Diuretics

Step 8. Fix it!!!!


The Mathura DeclarationTo take the Mission of EOLC forward, ELICIT(End of life care in India Task force) conducted a unique symposium on 29-30th April at Nayati Medicity, Mathura. For the first time it brought together about 75 delegates including eminent physicians from multiple specialities and distinguished lay delegates across many walks of life. There was representation of critical care, Pulmonology, Anaesthesia, Internal Medicine, Oncology, Nephrology, neurology, Surgery, Palliative Care, Transplant surgery and Paediatrics.

Among non doctors we had social workers, an NGO Founder, writer,professor of sociology and columnist,administrators, civil servants,priest practicing palliative care,clinical psychologists and lawyers. The brain storming was on a round table meeting format with each talk of 20 mins succeeded by 45 mins of Q&A.

It was heartening to find meeting of minds on the basic principles that have driven us in the ISCCM to espouse the cause of humane care of the terminally ill and to stop

irrational application of life support. The lay delegates formed an advocacy group called CANDID (Citizens' Action Needed for Dignity in Death). The meeting culminated in a historic document called the "Mathura Declaration". Hopefully our initiatives will find a groundswell of support and win the critical care community the trust and respect we have needed to deliver the best. Only wit public support can we get the government to progress on the EOLC Bill.


Quiz Sixth Edition

CRITICAL CARE UPDATE 2017 BOOK

thematic Quiz - the dVt Quiz

Q1. Venous thromboembolism is a major national health problem, with an overall age- and sex-adjusted incidence of more than ...... per 1,000 annually?

Q2. Which is the preferred probe for diagnosis of DVT?

Q3. Which of following is NOT a known risk factor for VTE development?

a. Obesity.

b. Hypertension.

c. Factor V Leiden gene mutation.

d. Total knee replacement surgery.

e. Birth control pills.

Q4. D-dimer levels remain elevated in DVT for what duration?

Q5. What is this image better known as?

Q6. Spot on

Q7. Which month is DVT awareness month? Which day is World Thrombosis Day

Q8. 75% of UEDVT are secondary (indwelling catheters, pacemakers, malignancy, etc.) and 25% are primary in nature; #1 primary cause of UEDVT is …………………….......

Q9. Economy class syndrome is venous thromboembolism following air travel. This syndrome was firstly reported in the year ………

Q10. Which of the following agents don't increase the risk of DVT when used alone?

1. Thalidomide

2. Tamoxifen

3. Adjuvant hormonal therapy

4. Antiangiogenic agents

Answers to Fifth Episode1. Objective of above question is to

highlight the fact that patients on ECMO and HD may have lower AT III level. This may be related to cannula itself. As these patients, while in ICU frequently requires heparin, deficiency of AT may cause ineffective anticoagulation. In such scenarios administration of AT may be required. Normal pregnancy does not cause any AT deficiency but may be present in preeclampsia or eclampsia.

Cirrhosis and Nephrotic syndrome are understandably the causes of AT deficiency.

2. Various risk factors have been identified via various studies for TRALI and it includes positive fluid balance. Other factors include liver transplantation, alcohol abuse, septic shock, high peak airway, smoking, high interleukin (IL)-8 levels, emergency cardiac surgery, hematologic malignancy, massive transfusion and others.

3. July 1997

4. Colon cancer

About 7 percent of all infective endocarditis occurs due to 'Streptococcus Bovis', which has high association with colon cancer as well as underlying inflammatory bowed disease (IBD). 54 is somewhate late for diagnosis of IBD and should raise high suspicion of colon cancer. Another bacteria which is highly associated with colon cancer is Clostridium septicum.

5. MDMA has dual effect. It not only causes direct drug-induced inappropriate secretion of ADH decreasing water excretion but also causes polydipsia. Major cause of death in Ecstasy is hyponatremia. It is found to be more common in female gender.

6. Walter Edward Dandy (April 6, 1886 – April 19, 1946) was an American neurosurgeon and scientist.

In 1923, Dr Walter E Dandy opened a special three-bed unit for the more

critically ill postoperative neurosurgical patients at the Johns Hopkins Hospital in Baltimore, MD, USA, using specially trained nurses to help monitor and manage them.

7. Silver Coated Endotracheal Tube

8. Weak recommendation, low quality of evidence

9. Conventional chest radiograph of a patient receiving ECMO with perflubron in the lungs. Perflubron is distributed uniformly in the lungs and imparts high radiopacity.

10. ECG

dr. yatin Mehta and dr. yash JaveriPlease mail the answers at the earliest to [email protected] answers with the name of first two correct entries will be

published in next issue

Winners of Critiquiz 2016-2017 “Bat tle of the Brains”

Episode 5

dr. Mohd Saif Khan MD, DNB

Tata Memorial Hospital, Mumbai

dr. Yusuf BhambhaniPorbandar

Available at ISCCM Secretariat ofce, Mumbai

Tel: 022- 24444737/ 24460348

Email : [email protected]

Price : Rs 1,050 *(For members)

Rs 1,200 * (For non-members)

* Including Rs 200/- for courier charges

To order your copy, please send the following order slip with cheque/DD payable at Mumbai favouring INDIAN SOCIETY OF CRITICAL CARE MEDICINE to ISCCM Secretariat office, Mumbai

ORDER SLIP

CRITICAL CARE UPDATE 2017 BOOK

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Available at ISCCM Secretariat office, Mumbai

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Price : Rs 1,050 *(For members)Rs 1,200 * (For non-members)


To order your copy, please send the following order slip with cheque/DD payable at Mumbai favouring INDIAN SOCIETY OF CRITICAL CARE MEDICINE to ISCCM Secretariat office, MumbaiNote :i. Price – Rs 1,050* (for members)

Rs 1,200* (for Non – members) * Including Rs 200/- for courier chargesii. Cheque/DD payable at Mumbai should

be drawn in favour of Indian Society of Critical Care Medicine

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

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

Tel:022-24444737/24460348

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Block Your DatesCRITICARE 20187-11 March, 2018 • Varanasi


ISCCM Research Grant Proposal

ISCCM Research committee invites application for Research Grants on Clinical and Basic Science projects

relevant to critical careThe proposal with letter of intent (LOI) should be submitted to research committee at [email protected]. The LOI should be submitted at least a month before the review date. The Grant review committee will review the proposals three times a year March /July/November of each year . The person submitting the proposal should be an ISCCM Life member .The manuscript should be initially submitted to IJCCM and acknowledge ISCCM grant. The grant amount will be subject to fund

availability.The Letter of Intent (LOI) should contain

the followingi. Project Nameii. Name, affiliation, and complete

address (including e-mail, phone and fax numbers) of the principal investigator

iii. Team compositioniv. Justification of the study, and a

very brief summary of the related work from the literature, and an assessment of the feasibility of the proposed activity

v. Objectives

vi. Brief description of the proposed methodologies (study area, target population, study design, sample size and sampling, data collection, data analysis, etc.)

vii. Ethical issuesviii. Expected results, challenges, and

potential contribution of the project as a value addition to critical care

ix. Timetablex. Budgetxi. Short Curriculum vitae of the

Principal Investigator

Research Committee, ISCCM

Young Talent Hunt - CriTiCare 2018

ISCCM is committed for giving opportunity to young and new talent in Criticare 2018. We hereby invite

online applications from our members to participate in Young Talent Hunt and to be a national Faculty at Criticare 2018, Varanasi. The members are required to upload their presentation on ISCCM website.1. Member should not have spoken/

delivered lecture at previous ISCCM National Conferences.

2. Age <35 years.

3. The member can select his/her topic for the presentation.

4. The member's presentation should not be more than 12 minutes.

5. The last date of Application is 16th October 2017.

6. The last date to upload the Presentation is 16th Nov 2017.

7. The eligible members may please log on to ISCCM website and upload their presentation for Young Talent Hunt.

8. The conference secretariat will bear

the expenses for your stay during conference only.

9. ISCCM center will pay for travel by II A/C.

10. All the presentations uploaded on the web site will be viewed and the best will be selected. The selected members will be invited to speak at Criticare 2018, Varanasi.

Click below link to submit your Young Talent Hunt PresentationLink:- http://www.isccm.org/RegEligibilityTalentHuntForm.aspx

Image Challenge

(Answer in the next issue)

A 68-year-old man presented with unilateral ptosis with no other symptoms. Application of an ice pack to the left eye improved his symptoms. What is the diagnosis?

Acute Colonic pseudo-obstruction

The radiograph reveals a distended, air-filled colon to the level of the splenic flexure, with the cecum and transverse colon each measuring more than 10 cm. A diagnosis of acute colonic pseudo-obstruction (Ogilvie’s syndrome) was made. The patient recovered following colonoscopic decompression.

Answer to last Image Challenge

3rd Annual Conference ECMO ASIA 2017

29th-30th July 2017

Workshop on Ex tracorporeal Life Support (Simulator Based)

28th July 2017 at The Meditorium and ECMO Lab, Fortis Memorial Research

Institute, Gurgaon

Organised by ISCCM, Delhi Branch & Department of Critical Care Medicine,

Fortis Memorial Research Institute, GurgaonCOnFEREnCE HIGHLIGHTS

Scientific Agenda: Mix of basics of ECMO with more advanced topics

Main Focus: Veno-Arterial (VA) ECMO as it has a much wider potential for application and is more complex.

Extensive case discussions: Ranging from Pulmonology, Cardiac, Toxicology and Hepatobiliary and Pancreatic disease.

Speakers: Both International and National speakers who are experts in the field of ECMO.

WORkSHOp HIGHLIGHTSFirst ever ECMO course based on

Simulations

One to One Interaction with Faculty

Hands on Wet Drills for each delegate

Real Life Based Case Scenarios and troubleshooting under simulated Conditions

Clinical Case Discussions: Faculty and Student Generated

FOR REGISTRATIOn AnD pAyMEnT DETAILS COnTACT:Dr. Madhur Arora +91-9899345337 • Dr. Munish Chauhan +91-9650773633

email ID: [email protected]

COnFEREnCE SECRETARIATDept. of Critical Care Medicine, Division of Extra Corporeal Life Support,

Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana 122001, India

www.ecmoasia.org


Branch Report 2017pune

Academic Program1. Dates: 12th Jan 2017 Venue: ISCCM TRAINIG CENTRE,

Pune Delegates: 40 Faculty – Dr Sunitha Varghese, Dr

Balasaheb Pawar, Dr Sushma Patil This Academic program held for the

IDCCM 2017 exam going students, for exam preparation Dr Sunitha Varghese had talked on Principles of RRT in critically ill patients Dr Balasaheb Pawar had talked on Rational Use of Antibiotics in ICU Dr Suhama Patil had talked on Interactive session - Important Drugs in ICU 40 students attended the session

CME ON ACUTE CARDIAC UPDATE 20172. Dates: 19th February 2017 Venue: Hotel Crowne Plaza, Pune

Delegates: 150 Speaker Faculty – Dr Rituparna shinde,

Dr Siddharth Gadge, Dr Anirudha Chandorkar

Chairperson – Dr Subhal Dixit, Dr Kapil Zirpe, Dr Suresh Shinde, Dr Kapil Borawake

ISCCM Pune Branch conducted CME on ACUTE CARDIAC UPDATE 2017 on 19TH FEB 2017 at Venue – HOTEL CROWNE PLAZA, Pune. The response to meeting was huge as total around 150 attended the meeting from hospitals of Pune and nearby cities. We are happy for such overwhelming response to the meeting. The meeting started with the introduction By Dr Subhal Dixit who briefed the schedule and introduction of the speakers. The meeting started with lecture by Dr. Rituparna Shinde on ECG in Acute Coronary Syndromes, Subtle T’s in ACS ECGs, All that Elevates is not AMI…, Antiarrythmic basics, What to do for Patients with asymptomatic WPW patterns, PVCs : when to refer: when to reassure, Atrial tachy vs a flutter why differentiate?, To WARF or not to WARF – era if NOAs . Dr Rituparna Shinde had covered all this topics.

After that Dr. Siddharth Ghadge presented PQRST of Heart Failure, ECG in poisoning, drugs over dosage and electrolyte imbalance, What to do for patients with newly discovered bundle branch block, VT diagnosis & Management in ICU, ‘’Can’t miss’’ life threatening diagnoses in ICU ECGs - SCD.

The Next Presentation was by Dr Aniruddha Chandorkar on – Arrhythmias that do not require treatment, Medical management of ACS – does it have a place in era of INTERVENTIONSI?

The delegates participated in this with very much enthusiasm

Academic Program

3. Dates: 07th March 2017

Venue: ISCCM TRAINIG CENTRE, Pune Delegates: 35

Faculty – Dr Shirish Prayag

Dr Shirish Prayag sir Conducted a lecture on - The New Surviving Sepsis Guidelines: for the exam going IDCCM Students on 07th March 2017 at ISCCM Training Centre Pune.

CME ON CRRT UPDATE4. Dates: 19th March 2017 Venue: ISCCM TRAINING CENTRE,

Pune Delegates: 80 Speaker Faculty – Dr Valentine Lobo,

Dr Arindam Kar, Dr R K Sharma, Dr Rajsekhara Chakravarty, Dr Tarun Jeloka, Dr Abdul Ansari, Dr Rajiv Annigeri, Dr Vaishali Solao, Dr Ranajit Chatterjee, Dr Sarvanan

Chairperson Faculty - Dr Kapil Zirpe, Dr Subhal Dixit, Dr Urvi Shukla

CRRT WORKSHOP

SPEAKER FACULTY


There is a clinical perspective review on CRRT use in AKI Speaker Faculties re-views the implications of CRRT and the current state of practice. Renal Replace-ment therapy (RRT) is therapy that replac-es the normal blood-filtering function of the kidneys. It is used when the kidneys are not working well, which is called renal failure and includes acute kidney injury and chronic kidney disease. Renal replace-ment therapy includes dialysis (hemodial-ysis or peritoneal dialysis), hemofiltration, and hemodiafiltration, which are various ways of filtration of blood with or without machine. Renal replacement therapy also includes kidney transplantation, which is the ultimate form of replacement in that the old kidney is replaced by a donor kidney. In the context of chronic kidney disease, they are more accurately viewed as life-extending treatments, although if chronic kidney disease is managed well with dial-ysis and a compatible graft is found early and is successfully transplanted, the clini-cal course can be quite favorable, with life expectancy of many years. Likewise, in certain acute illnesses or trauma result-ing in acute kidney injury, a person could very well survive for many years, with relatively good kidney function, before needing intervention again, as long as they had good response to dialysis, they got a kidney transplant fairly quickly if needed, their body did not reject the transplanted kidney, and they had no other significant health problems.The meeting started with the introduction By Dr Subhal Dixit who briefed the sched-ule and introduction of the speakers. On First Session CME started with lecture by Dr. Valentine Lobo on AKI – Definition, Classification, Diagnostic Strategies, Role of Biomarkers & OutcomeDr Arindam Kar Presented AKI – in ICU – Global & Indian DataAfter that R K Sharma presented Critical Care Nephrology – Current Scenario in In-diaAfter That on Second Session Dr Ra-jasekhara Chakracarty Presented CRRT in AKI management – Evolvement over last decade, Dr Tarun Jeloka Presented Estab-lishing & Maintaining Core Competencies for Nurses for CRRT

After That on Third session which is Case Scenarios Dr Abdul Ansari Presented CRRT : Sepsis Management,Dr Rajeev Annigeri Presented CRRT Pro-tocols : Need of the Hour, Dr Vaishali So-lao Presented CRRT : Beyond AKI,Dr Ranajit Chatterjee Presented CRRT : Government Setting, And last case Dr Sar-vanam Presented on Pediatric Setting, af-ter that two groups explained & show how to operate CRRT Machine in WorkshopCandidates are impressed by the topic and LecturesCME on Arterial Blood Gases5. Dates: 26th March 2017 Venue: Aditya Birla Hospital,

Chinchwad Delegates: 200 Speaker Faculty – Dr Sangita Thakare,

Dr Urvi Shukla, Dr Tarun Jeloka, Sunitha Varghese,

Dr Lalitha Pillai, Dr Manish Mali, Dr Varsha Shinde, Dr Vankatesh Dhat, Dr Ashish Pathak, Dr Dalvi

Aditya Birla Hospital Auditorium

ISCCM Pune Branch conducted CME on Arterial Blood Gases on 26TH March 2017 at Venue – Aditya Birla Hospital Auditorium, Chinchwad The response to meeting was huge as total around 200 attended the meeting from hospitals of Pune and nearby cities. We are happy for such overwhelming response to the meeting. The meeting started with the introduction By Dr Urvi Shukla who briefed the schedule and introduction of the speakers. The meeting started with lecture by Dr. Sangita Thakare on Collection of ABG, After that Dr. Urvi Shukla presented Hemoglobin & O2 Transport, The Next Presentation was by Dr Tarun Jeloka on –

Acid Base Physiology / Buffers, After that Dr Sunitha Varghese Presented Strong ion difference, The next presentation was by Dr Lalitha Pillai on Metabolic Acidosis, After that Dr Varsha Shinde Presented Respiratory Acidosis & Alkalosis, The next presentation was by Dr Manish Mali on Metabolic Alkalosis, Dr Vankatesh Dhad presented Where I should & should not give bicard, Dr Ashish Pathak presented Interpretation of ABG, Dr Vankates Dhat / Dr Dalvi/ Dr Sangital Thakre Presented the Cases.The delegates participated in this with very much enthusiasm

Review Cum Mock Practice Session6. Dates: 28th March 2017 Venue: ISCCM TRAINIG CENTRE,

PUNE Delegates: 30 Speaker Faculty – Dr Subhal Dixit, Dr

Kapil Zirpe, Dr Balasaheb Bande, Dr Kayanoosh Kadapatti

Mock examination designed to prepare trainees for practical & theory exit examination in critical care medicine. The objectives were to expose them to an exam environment, understanding the pattern of examination, what is expected, give a feed back after each interaction of what was good and what was missing and most importantly to be examined by Speaker Faculties.Comprehensive Webinar on ''CURRENT CONCEPTS IN CADAVER ORGAN DONATION''Venue – ISCCM TRAINING CETRE, PUNEFACULTY DOCTORS –Dr Kapil Zirpe, Dr Kayanoosh Kadapatti, Mrs Aarti Gokhale


Organ donation is the process of donating organs or biological tissue to a living recipient, who is in need of a transplant. The donor may be alive or deceased. There are two different kinds of transplant donations: 1. Living Donor Transplant – This occurs when a living person decides to donate his or her organ(s) to someone in need of a transplant. Living donors are usually family members or close friends of the person who requires a transplant. They must meet certain medical criteria and undergo comprehensive medical testing, as required by the particular circumstance, before being accepted as suitable donors. 2. Deceased Donor Transplant – This is when organs from a brain dead individual are transplanted into the body of a living recipient. The deceased individual in this scenario can only be a victim of brain death. This kind of transplant initially requires the recipient to wait on a list until a suitable organ is available based on the recipient’s medical profile.

Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. Organs and/or tissues that are transplanted within the same person's body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source

Dr Kayanoosh Kadapatti had talked on Role of Intensivist in Cadaver Organ Donation

Mrs. Aarti Gokhale had talked on Role of ZTCC in Organ Transplant Program in Maharashtra Dr Kapil Zirpe Had Talked on ‘‘Concept of Cadaver Organ Donation’’ & Diagnosis of Brain stem death

The need of Organ Donation in India Organ donation is fast developing into a major treatment protocol. However, it is yet to make a significant dent in India. Every year, hundreds of people die while waiting for an organ transplant. Due to lack of awareness and misconceptions, there is a shortage of organ donors, and with each passing year, the gap between the number of organs donated and the people waiting

for organ donation is getting larger. Some disturbing stats around the same are as follows:• Almost 1.75 lakh people in India need

a kidney; however, less than 5000 of them receive one.

• Only 1 out of 30 people who need a kidney receive one.

• 90% of people in the waiting list die without getting an organ.

• India’s annual liver transplant requirement is over100000, but we manage only about 1000.

• 70% liver transplants are taken care of by a live donor, but only 30% are dependent on cadaver (deceased) donors.

• Annually more around 50000 hearts are required along with 20000 lungs.

More than 100 doctors watched this live webinarIDCCM EXAM7. 15th & 16th April 2017 Venue: ISCCM Training Centre, Pune Course Directors: Dr Pradeep D’Costa

Practical Exam

Post MBBS Exam in ISCCM Training Centre Exam : Post MBBS8. Dates: 6th May 2017 Venue: ISCCM Training Centre, Pune Course Directors: Dr Prasad Rajhans

Table Presentation

Case Presentation

Participation ISCCM Pune Branch in Stop Violence against Doctors Rally on

18th March 2017


MYSOReWe are very happy to inform the activities of mysore branch, we successfully conducted 2 CME in the month of April 2017

1. Best of Mysore 2017

Theme - Obstetric Critical Care

Date -22-4-17 & 23-4-17

2 day CME was conducted successfully with one day Workshop on 22-4-17, at Hotel Southern Star, Mysore

2. Panel Discussion on H1N1-How to Confront

We conducted CME on 28-4-2017 at Hotel Moury Residency, Mysore

It was attended by 45 delegates & was very much appreciated & it was very interactive session, 5 Emenent Panelist were present & moderated by Dr. Laxmikanth, Intensivist

3. Website for ISCCM Mysore Was launched by Dr. Jayaraj, Pulmonologist, Mysore

E-journal (Bimonthly) for mysore branch was Launched by Dr. Ramakrisna G.

hYdeRabad

Executive Committee 2017-2019Elections to the Executive committee and office bearers of ISCCM Hyderabad Chapter for 2017-2019 were held in January 2017 with Dr Samavedam Srinivas as returning officer. This election stood out in its nature due to the fact that this was first time that a city chapter elections were conducted through online polling. The newly elected EC contains a healthy mix of experienced maturity and youthful enthusiasm. The elections were fought in competitive spirit and polling percentage was a record 93% of the city chapter members. Dr Palepu Gopal, Dr Venkat Raman Kola and Dr K Subba Reddy were elected as Chairperson, Secretary and Treasurer respectively, while Dr Anand Joshi, Dr Basant Rayani, Dr Madhusudan Jaju, Dr Vishnu Vardhan and Dr Kartik Munta were elected as executive members.While the previous EC signed off with a

dr. Palepu B.N. Gopal dr. Venkat ramana Kola dr Subba reddy Chairperson Secretary Treasurer

New ECof

ISCCM Hyderabad

First meeting of the new EC addressed by the outgoing chairperson

Dr. Shyam Sunder T.

IDCCM Prepatory Course in Progress Monthly Thematic Session in Progress

very successful south Congress (SZCCC), the new EC plans to further invigorate the society and give the members a feast of academic and social programs during their tenure. The newly elected committee swung into action with renewed enthusiasm and energy and planned activities for the full year ahead . The programs already initiated consist of systematic teaching for all critical care trainees of Hyderabad on a monthly basis, mock examinations, monthly evening meetings and workshops. The ISCCM members responded with vigor and enthusiasm and the programs witnessed a very good response. The new EC plans to initiate a novel signature critical care event in Hyderabad which will be conducted year on year. Inspired by seniors in the city and supported by the national ISCCM leaders, the EC aspires to keep up with the reputation the preceding executive have established for Hyderabad Chapter.

BlockYour

Dates

CRITICARE 20187-11 March, 2018 • Varanasi


baROda

bhubaneSWaRA critical care update was conducted on 11TH AND 12TH March 2017 at Mayfair Hotels,Bhubaneswar. It was jointly conducted by ISCCM Bhubaneswar branch & CARE Hospitals, Bhubaneswar. It was a two day programme which included one & half day of academic deliberation followed by half day of Workshop. Guest Faculty included Dr Subash Todi, Dr Ramesh Venkataraman, Dr Pavan Reddy, Dr Rajeev Menon, Dr D Suresh Kumar and Dr Tapas Sahoo, There were also local faculties who spoke on recent updates in nutrition, DVT, Infection control and Rheumatological issues.

This was the 8th GCC conference in a row, a huge success story . The theme was USG guided cardiopulmonary critical care. We discussed ten cases of day today use and had two pro-con debates. Due to its unique theme we have got registration from all over the country. Thirty two national and two international faculty brought their best experience to address the gathering of two hundred sixty two delegates. Simultaneously two hundred and forty two delegates logged in to watch the web cast.This conference has also guided us in planning future conferences. Nowadays

Blood transfusion remains the integral part of critical care management.To correct the myths with facts regarding the blood transfusion practices going on in the medical fraternity ISCCM, Baroda has organized a half day CME I the month of march at Hotel Grand Mercure [Surya Palace], Baroda.The programme was attended by the more than 280 delegates from different specialities, including the medical practitioners of Vadodara, and also from surrounding regions. CME was a grand success. Prominent intensivists from Vadodara and also Hemato-oncologist from Ahmedabad, as well as critical care specialist from Ahmedabad have addressed the delegates.There was also a session of case discussion and panel discussion, in which there were gynaecologist; orthopaedic surgeon, haematologist, physician and intensivist were there as Panel and various cases like HELLP, Pre-operative orthopaedic fitness and etc. were discussed in detail. During panel discussion there was

heated discussion among the delegates & panellists regarding indications of blood component transfusions. The moderator had to intervene and clarify the guidelines. The Aim of the conference was to clarify the

concepts amongst the medical fraternity regarding use and misuse of blood & component transfusions was achieved. Also, carry home print out was given to the delegates.

There were two workshops regarding VENTILATOR and USG Approach to Shock. The CME and Workshop was organized by Dr Pragyan Kumar Routray, SECRETARY, ISCCM Bhubaneswar. The CME was attended by 178 delegates from various specialties. Workshop was attended by 124 delegates.

Dr Pragyan Kumar RoutraySecretary, ISCCM Bhubaneswar branchConsultant Critical Care & Internal Medicine, CARE Hospitals, Bhubaneswar, Odisa

8th GCC 2017 - A Reportpracticing consultant wish to learn from more of the specific case based approach which are useful in day to day practice.Our case discussion was focused on how USG can help us in diagnosing and managing cases like, (CAP, Shock diagnosis & resuscitation, Cardiac arrest , Infective Endocarditis, Severe Hypoxemia, Acute Massive Pulmonary Embolism, Acute Interstitial Pneumonitis, ARDS, Ischemic Cardiomyopathy & Supraventricular Tachycardia).The 1st Debate which was on diuretics in Acute LVF, the message was very clear to use only if volume overload is there and

that also under strict monitoring and not overdose like five or ten ampules.2nd Debate was on Steroid in CAP. The conclusion remark was to avoid its use and if at all wish to use in selected cases where the infection in non bacterial or viral and atypical the dose should be very low 20-40 mg/methylprednisolone per day for 3-5 days. Should be avoided in bacterial pneumonia.The complete online recorded discussion is available on web site: www.gujaratcriticalcare.com. https://www.youtube.com/watch?v=Bu4up2wNQ-A&feature=youtu.be

dr rajesh MishraOrganising Chairpeson

Sunday, 2nd April, 2017Crown Plaza Hotel Ahmedabad


JOUR

NAL SCAN

this journal scan attempts to analyse thought provoking studies with innovative hypotheses in addition to major rCts and Meta analysesThe Changes in Pulse Pressure Variation or Stroke Vol‑ume Variation After a “Tidal Volume Challenge” Reli‑ably Predict Fluid Responsiveness During Low Tidal Vol‑ume Ventilation*Sheila nainan Myatra; natesh r Prabu,; Jigeeshu Vasishtha di-vatia et al Crit Care Med 2017; 45:415–421it is indeed a proud moment for the Critical Care fraternity in this country to see a publication from a premier group being published in a high impact value journal. in this thought provoking prospective study, Myatra et al hy-pothesised that change in pulse pressure and stroke volume, caused by a challenge with a tidal volume increment of 2ml/kg IBW would predict fluid responsiveness. Using this concept, they sought to circumvent the problem of stroke volume varia-tion and pulse pressure variation not being standardised for low tidal volume ventilation. the choice of tidal volume ranges (6 to 8 ml/kg iBW) still keeps the volumes within the currently rec-ommended range. the investigators could enrol 20 patients into this study. the investigators measured the cardiac index, PPV and SPV coupled with an End Expiratory occlusion test with 6ml/kg and 8 ml/kg iBW tidal volume. fluid challenge was con-sidered successful if the cardiac index rose by 15 %. the authors identified that a change in SVV by 2.5% and PPV by 3.5% ,when the tidal volume is increased by 2ml/kg iBW reliably predicts fluid responsiveness. The absolute values of PPV and SVV at 8 ml /kg iBW had less discriminatory value. reviewer’s comments: it is a proof of concept. it could be tried in patients with ardS. however, the normal caveats that work against PPV and SVV will also apply here. it needs a system to measure Ci and PPV ( Philips Pulsion PiCCo system was used in the study). However, given the problems associated with fluid overload, this study attempts to provide a solution to the prob-lem of SVV and PPV being unreliable with low tidal volume ven-tilation, which is currently the standard of Care.

Effect of Acetazolamide vs Placebo on Duration of In‑vasive Mechanical Ventilation Among Patients With Chronic Obstructive Pulmonary Disease : A Random‑ized Clinical TrialChristophe faisy, ferhat Meziani, Benjamin Planquette et alJAMA. 2016;315(5):480-488.Chronic obstructive Pulmonary disease is frequently encoun-tered in intensive Care units. Some of these patients need in-vasive ventilation. Weaning them could be a challenge due to multiple factors. one of the issues which interferes with weaning and liberation from mechanical ventilation is Metabolic alkalosis, which hypothetically could result in a poor respiratory drive. one of the attempted measures to overcome the primary metabolic alkalosis that sometimes accompanies CoPd is to use the car-bonic anhydrase inhibitor – acetazolamide. there is no concrete scientific evidence to support this strategy so far. Faisy et al at-tempted to evaluate the role of higher doses of acetazolamide in reducing the number of days on ventilator among CoPd patients. this was a multi centre double blind rCt carried out in french ICUs. Patients with bronchiectasis and cystic fibrosis were ex-cluded. Patients were assessed within 24 hours of randomisation for evidence of primary metabolic alkalosis. if they found alkalotic 500-1000mg of acetazolamide ( higher dose for those on diuret-ics) twice a day or a matching placebo was given for a maximum of 28 days. Successful weaning was defined as not requiring rein-tubation within 48 hours of extubation. duration of invasive me-chanical ventilation was the primary outcome studied. the study could include around 380 patients with 187 in the treatment arm. No statistically significant difference in the primary outcome was noted. Secondary outcome of serum bicarbonate decrement was significant but this did not have a bearing on triggering or minute ventilation. What was however noted that the patients who re-ceived acetazolamide spent 16 hours less on ventilator support which is not insignificant. This difference was more pronounced among patients receiving diuretics and corticosteroids.Reviewer’s comments: A definite evidence in favour of using ac-etazolamide in CoPd patients did not emerge from this study. the correlation between lower bicarbonate levels and a higher minute ventilation could also not be established. there could however be a subset of CoPd patients receiving diuretics who might benefit from this strategy.

Efficacy and toxicity of aerosolised colistin in ventila‑tor‑associated pneumonia: a prospective, randomised trialSami Abdellatif, Ahlem Trifi, Foued Daly et alAnn. Intensive Care (2016) 6:26Multi-drug resistance is an increasing challenge in iCus. the emergence of Mdr acinetobacter and Klebsiella has necessi-tated the use of potentially toxic antibiotics like Colistin and Polymyxin B. although the incidence of kidney injury with the use of Colistin is not to the magnitude expected, it is not some-thing to be overlooked either. delivery of Colistin by nebulisa-tion appears to be an attractive alternative to avoid the toxic effects of systemically administered drug.

Abdellatif et al attempted to study the efficacy as well as toxicity of colistin delivered as an aerosol. although several such studies were published in the past, the reviewer has chosen this study because of its demographic origin. this study comes from tuni-sia where the cohort of patients is likely to be similar to what is seen in india. this is a single centre rCt. the investigators chose to exclude patients with septic shock. the treatment arm involved giving 4 million units of Colistin delivered 8 hourly via an ultrasonic plate nebuliser with volume controlled mode of ventilation. Patients in both arms received imipenem as an ad-ditional antibiotic. treatment was continued for 2 weeks. after extubation colistin was delivered as a nebulised drug with dose escalation by 45 %. dose adjustments for low creatinine clear-ance was done wherever indicated. Primary outcome was VaP cure rate. Secondary outcomes included aKi incidence, iCu loS and 28 day mortality. the VaP cure rates with aerosolised Colistin were similar to that achieved by systemic therapy. acinetobacter, Pseudomonas and Enterobactriaceae were the predominant organisms. aKi incidence was much lesser and oc-curred much later when colistin was delivered in aerosolised form. the investigators reported a lesser need for rrt when aKi did occur with the use of aerosolised colistin. the incidence of neurotoxicity with both forms of colistin was comparable. improvement in oxygenation seemed to occur earlier among patients who were treated with aerosolised Colistin.reviewer’s comments.this is a practical study attempting to answer a common di-lemma. The results are definitely encouraging. This might be a trigger for a larger study with more robust analysis to enhance the utility of an effective drug.

Opening pressures and atelectrauma in acute respira‑tory distress syndromeMassimo Cressoni, davide Chiumello, ilaria algieri et alIntensive Care Med (2017) 43:603–611ardS is a syndrome which continues to evolve as a concept. at present an “open -lung” strategy with a cap on plateau pres-sures @ 30cm h20 with PEEP levels of 15cm h20 is accepted as standard of care. this approach is expected to open the lung and keep it open. Cressoni et al attempted to evaluate if this strategy actually opens the lung and avoids atelectrauma. this study comes from luciano gattinoni’s group which has used complex measuring systems and Ct scans to evaluate whether a PEEP of 15 cm h20 at a capped pressure of 30 cm h20 actu-ally opens up the lung and prevents expiratory atelectasis. in a two centre prospective study, the authors included patients with mild, moderate and severe ardS including those on ECMo. all patients underwent multiple Ct scans with PEEP set at two lev-els – 5 and 15 cm h20 – and plateau pressures of 19 , 29 and 40 cm H20. The lung was imaged for uninflated, poorly aerated, normally inflated and hyperinflated areas based on Hounsfield characteristics. The authors found that a significant portion of the lung remains uninflated at Plateau pressure of 30 cm H20. The authors identified a need for a PEEP of greater than 15 to keep the lung open at end expiration. this non recruited tis-sue volume increases with the severity of ardS. Severe forms of ardS were associated with a higher volume of unopened lung at pressures capped at current evidence based levels. the authors however, cautioned that it is better to have atelectasis and consequent atelectrauma rather than have the volutrauma associated with attempts to increase the plateau pressure limits.reviewer’s comments: this study gives an explanation why se-vere ardS often does not respond to conventional ventilatory strategies. The fact that the lung aeration can be quantified has been highlighted in this study. however, it may not be the safest option to increase the limits of plateau pressure and PEEP in an attempt to achieve better recruitment of lung tissue.

Beta Lactam plus Macrolide or Beta Lactam alone for Community Acquired Pneumonia : A systematic review and Meta Analysisnobuyuki horita, tatsuya otsuka, Shushaku haranaga et alRespirology ( 2016) 21. 1193-1200Community acquired Pneumonia is a common clinical problem in hospitalised patients. recommendations and guidelines for the management of this condition have been established and frequently revised. the idSa guidelines recommend a combina-tion of beta lactam plus macrolide for severe forms of the dis-ease. however, two recent rCts have failed to show a survival benefit. This meta analysis has sought to answer the question including the more recent trials. after scrutiny and application of screening criteria 14 studies were identified for the meta analysis. there seemed to be a variation in outcomes between observational studies and rCts. Severity of Pneumonia also seemed to be a significant factor related to outcome. This meta analysis found a benefit with combination of beta lactam and macrolide for severe CaP. this difference was apparent in ob-servational studies and not RCTs. The benefit with macrolides among CaP patients with CurB 65 > 2 appears to be associ-ated with their non antimicrobial actions. reviewers comments: from this meta analysis it emereges that for patients whose CaP is deemed severe ( CurB 65 or PSi), addition of macrolides to a beta lactam prescription appears to improve outcome due to anti-inflammatory actions

Effect of Dexmedetomidine on Mortality and Ventila‑tor‑Free Days in Patients Requiring Mechanical Ventila‑tion With Sepsis A Randomized Clinical Trialyu Kawazoe, Kyohei Miyamoto, takeshi Morimoto et al for the dexmedetomidine for Sepsis in intensive Care unit random-ized Evaluation (dESirE) trial investigatorsJAMA. 2017;317(13):1321-1328.analgesia and sedation among critically ill patients is a crucial intervention especially if the patient is mechanically ventilated. Search for an ideal drug which provides appropriate levels of an-algesia without disproportionate sedation continues. remifen-tanil has shown some promise but is yet to make a consistent appearance in india. over the last few years dexmedetomidine has emerged as a viable choice for analgo-sedation in the iCu. It is proposed to have some anti-inflammatory properties as well. Some of the earlier studies – both observational as well as randomised – have shown a benefit in terms of ICU survival and length of stay. Evidence for its efficacy in sepsis have essentially come from subgroup analyses of various studies. Kawazoe et al attempted to carry out an rCt among Septic patients needing mechanical ventilation beyond 24 hours. the primary outcomes studied were 28 day mortality and ventilator free days. Patients requiring niV were also included in this rCt. arrhythmias and myocardial ischemia were specifically looked for. Close to 200 patients were enrolled into this study. there was no difference in the primary outcomes in patients who received dexmedeto-midine versus those who did not. Patients who were in the dex-medetomidine group had more controlled sedation and needed lesser doses of propofol or midazolam but required the same dose of opioids. in a subgroup analysis, however, patients with a higher aPaChE score had a lower mortality when they were sedated with dexmedetomidine. Inflammatory markers also showed no difference except for a favourable CRP profile with the use of dexmedetomidine.reviewers comments: in a broad spectrum of septic critically ill patients with a wide spectrum of severity dexmedetomidine does not improve survival or ventilator days while providing better controlled sedation. however, sicker patients might do better with the use of dexmedetomidine. this needs to be eval-uated further.

N‑acetylcysteine in Acute Organophosphorus Pesticide Poisoning: A Randomized, Clinical Trialahmad a. El-Ebiary, rasha E. Elsharkawy, nema a. SolimanBasic & Clinical Pharmacology & Toxicology, 2016, 119, 222–227organophosphorus pesticide poisoning is a problem which is seen across the country and across the spectrum of health care facilities. the pathophysiology of oPP toxicity is incompletely understood. reactive oxygen Species ( roS) seem to play some role in the toxic effects of oPPs. naC is a potential scavenger of roS and is proposed to act as glutathione precursor. El-Ebiary attempted to evaluate if administration of naC at an early stage of oPP poisoning decreases the mortality as a primary outcome measure. they also attempted to evaluate secondary outcomes like length of stay and dose of atropine required. Biomarkers of oxidative stress like malondialdehyde and reduced glutiathione were measured to see the effect of naC on roS. the dose of naC used was an oral dose of 600 mg administered twice daily. Monitoring was essentially clinical. this is a very small study of 30 patients with half of them in each arm. the study showed a decrease in the dose of atropine with the use of naC. Malo-ndialdehyde levels showed significant improvement in the NAC group. Reduced Glutathione levels also showed significant im-provement. however primary outcome measure of better sur-vival could not be demonstrated in this study.reviewers comments: it appears to be an inexpensive interven-tion for a problem that is frequently encountered. if not gen-eralizable, this study could in the least trigger a similar bigger study in india

Performance and economic evaluation of the molecular detection of pathogens for patients with severe infec‑tions: the EVAMICA open‑label, cluster‑randomised, in‑terventional crossover trialEmmanuelle Cambau , isabelle durand-zaleski, Stéphane Bretagne et alIntensive Care Med DOI 10.1007/s00134-017-4766-4Microbiological diagnosis with early identification of causative organism plays a vital role in the successful management of in-fections and sepsis. Conventional microbiological techniques re-main the gold standard but have a turn around time of greater than 48 hours. Cambau et al compared the time to microbio-logical diagnosis in patients with Sepsis, febrile neutropenia and infective Endocarditis. they compared the effect of molecular diagnostics on the cost effectiveness and length of stay in the hospital. this was designed as a superiority trial. the trial was conducted in two parts – one period in which only conven-tional microbiological diagnosis was used and the second period during which molecular diagnostics were included. Microbio-logical diagnosis was higher during the period when molecular diagnostics were used. the effect of molecular diagnostics on quicker diagnosis was more pronounced in patients with sepsis and less obvious among patients with endocarditis. the effect of Molecular diagnostics on quicker diagnosis was equivocal in patients with febrile neutropenia. the performance of Molecular diagnostics in the earlier diagnosis of infection appears to be better in situations where Pneumonia is not the infection being evaluated. Appropriateness of antibiotics was not significantly different during the two periods. the use of molecular diagnos-tics for quicker diagnosis did not appear to increase the cost of hospitalisation.reviewers comments: With the increasing availability of molecu-lar diagnostics in the country, protocols for the workup of pa-tients with Sepsis could probably incorporate these techniques especially when the source of infection is not in the lung.

dr. Srinivas SamavedamMd, dnB, frCP, fnB, EdiC, fiCCMdiploma in health Care Quality Management, diploma in Medical law and Ethics, head, Critical Care unit, Virinchi hospitals, hyderabadMobile: +919866343632e-mail: [email protected]


CRITICARE 2018 7-11 March, 2018 • Varanasi

SWaGatHaM!

Friends,

I am honoured and privileged to assume the role of Chairperson of the 24th Annual Congress at Varanasi.

Situated on the bank of River Ganga. Varanasi is the oldest living city & considered as the holiest and most sacred place on this planet. Mark Twain once said, "Varanasi is older than history, older than tradition, older even than legend & looks twice as old as all of them put together." It is also an important industrial center, famous for its carpet, silk fabrics, perfumes, ivory works & sculptures.

Banaras Hindu University is an internationally reputed temple of learning. It was founded by the great nationalist leader, Pt. Madan Mohan Malviya, in 1916. It played a stellar role in the independence

dr. Kapil Zirpenational PrESidEnt, iSCCM &

ChairMan SCiEntifiC CoMMittEE

movement & has developed into one of the greatest center of learning. It has produced many a great freedom fighters, renowned scholars, artists, scientists & technologist all contributing immensely towards the

progress of modern India. We also proud to be associated with six Bharat Ratna Award.

I am confident that we will be steadfast in addressing the pressing challenges. On behalf of all of us, I am most pleased to welcome Prof. D K Singh who is organizing secretary of 24 TH Annual Congress of ISCCM. Over his years of service in BHU, he has distinguished himself as a person with dedication, integrity, and professionalism. We are confident that he and his team will continue to make outstanding contributions to ISCCM.

Thus, on the behalf of Organizing Committee, Varanasi City Branch & BHU, I invite you all to join this excellent scientific feast at Varanasi in 2018. The city is eager to greet with you with spiritual music to enlighten your soul with learning & knowledge.

Dr. Michael S Niederman Dr. Michale Oleary Dr. Rupert Pearse Dr. Vito Marco Ranieri Dr. Claudio Ronco

Prof. Alain Combes Prof. Dr. Med. Tobias Welte Prof. Giuseppe Citerio Prof. Jean-Louis Teboul Prof. Paul Wischmeyer

INTERNATIONAL FACULTY

Editorial officEdr. Yatin Mehta

272 Espace, Nirvana Country, Gurgaon 122001Mobile : +91 9971698149

[email protected]

Published By : IndIan SocIety of crItIcal care MedIcIneFor Free Circulation Amongst Medical Professionals

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Printed at : urvi compugraphics • 022-2494 5863 • email : [email protected]

7-11 March, 2018 • Varanasi

Venue:Hotel Ramada, The Mall, Cantonment, Mall Rd, Varanasi, Uttar Pradesh 221002

Hotel Clarks, Cantt The Mall, Mall Road, Varanas, Uttar pradesh 221002

www.criticare2018.com

critical care - isccm care editorial office dr. yatin mehta 272 espace, nirvana country, gurgaon...

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