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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 Day Celebrations, Theme
Organ Donation - 8th Oct 2017
4 General Secretary's Desk
5 New Office Bearers of ISCCM
Branches
6 Best of Brussels 2017
9 Results of ISCCM Election 2017
10 Results of ICCM Election 2017
10 Branch Events - Jalandhar
10 DCCS 2017
11 Journal Scan
12 Battle of the Brains
12 Image Section
12 ‘Bronchoscopy in ICU : 8th FMRI -
ISCCM Hands on Workshop’
13 Guidelines for the Management of
Candidiasis
14 Welcome New Members to the
ISCCM family
16 CRITICARE 2018
Best of Brussels 2017 – An academic extravaganza
Elections 2017
Regional meetings across the country
Journal Scan
‘Battle of the Brains’ – Quiz
CritiCarE 2018
Volume 12.3 JulY-AuGuST 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
Editorial
dr. yatin MehtaEditor in Chief,
the Critical Care CommunicationsPresident-Elect, iSCCM
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,
It is a pleasure to publish the next addition of critical care
communication. My editorial team particularly Yash Javeri has
put in a lot of effort to put it all together. I am also happy that most of the
ISCCM branches are quite active academically which is reflected in the Branch
activity section of the CCC. It is also a step forward that we have made CCC
online and have got away with the hard copy/ printed version as it was a
substantial financial burden on the ISCCM which was completely avoidable
in the modern era of e-communications.
Best of Brussels in Pune was a great success and a memorable academic feast.
I must congratulate the Pune team Drs. Prayag, Kapil Zirpe, Subhal Dixit,
Sameer Jog and the others for making it an annual event which we all look
forward to.
2017 Elections have been over. We had enthusiastic response of the candidates
which is a good sign that ISCCM is becoming more participatory and popular!
The results have been declared and detailed report is printed in this issue.
I request you to encourage abstract submission and registrations for
CRITICARE 2018.
Best Wishes.
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine 3
President's Desk
Dear ISCCM members &
Colleagues, Greetings!
ISCCM elections have once
again been successfully concluded. I
congratulate Dr Yatin Mehta and his
election committee for conducting
the elections smoothly. This time
record voting has been happened. My
congratulations to all the successful
candidates. As always I request you
again, to update your e-mail id's and
mobile nos. so that you can vote in the
next election.
Much awaited document on a patient
safety in ICU “Quality Up gradation
Enabled by Space Technology: QUEST”
was released on 10 th August at Delhi
during Health Conclave 2017. Dr J V
Peter has prepared this document. I
congratulate him & team for excellent
performance.
I am happy to share that ISCCM has
decided to bid for 16 th world congress
meeting for 2023 in INDIA. Venue may
be Mumbai. I & Subhal will lead bid
process at Rio de Janeiro ,Brazil. Let’s
hope for best.
The ISCCM day is fast approaching and
we have decided on “Saving Life: Organ
Donation” as a theme. Dr. Rahul Pandit
and team is working hard to put together
dr. Kapil ZirpePresident, iSCCM
at least 5 webinars one at each zone
across country in the month of October.
ISCCM has produced documentary
short film on “Organ Donation” which
will be screened during these webinars.
ISCCM Has decided to support local
branches to celebrate our founder day: 9
TH Oct. I request those who need help,
please approach secretary ISCCM.
Criticare Varanasi 2018 preparations are
in full swing .The scientific program is
being prepared and promises to be a
great feast. Regional conferences are
growing in strength. This year also,
North Zone conference, a Gujarat
Criticon, Mahacriticon, South Zone
conference, East Zone conference are
all scheduled. If I have missed out any
ONE, please excuse.
At the outset let me allow to convey
my sincere apologies for the delay in
bringing out this issue.
ISCCM Day Celebrations Theme Organ Donation - 8th Oct 2017
• All city branches encouraged to
participate
• A simultaneous walk of members from
7.00 am to 8.00 am
• Local Media, Rotary club, Lions club
etc participation and local coverage
promoting organ Donation
• The focus should be to promote Organ
Donation and emphasis that Intensive
Care is the center pillar in the process of
Organ Donation
• One street show or promotional booth
in a busy local mall promoting organ
donation, taking pledge cards and
submitting it to the NOTTO directly
• From ISCCM center- Tie up with 92.7 Big FM for promotion of organ donation, cost is being worked out.
• 10- 15 second Messages by the Office bearers – President, President Elect, Past President, general secretary, Secretary, Treasurer, Members
• Local Big FM channel will also run messages by the local ICU specialist / City Branch Office Bearers who are known in the community
• Afternoon or evening session for members of branch promoting Organ Donation and Talks about how to diagnose Brain death and Donor Maintenance
• Donor Maintenance Guidelines to be
distributed from IJCCM again on that
day- Prints can be made if committee
agrees
• Organ Donation film-President to
elaborate- To be tied up with a news/
entertainment channel to show it or else
to do online marketing on FB/You TUBE/
Twitter/WhatsApp
• Film to be shown for all committee
members during the scientific session.
• Local Print media to be involved to gain
publicity, have approaches Malti Iyer
from TOI to see if that will participate
and give us coverage for the noble cause
and not as Paid Publicity
Dr. Rahul Pandit, Chairperson • 9820595519 • [email protected] Dr. Yash Javeri, Co-Chairperson • 9818716943 • [email protected]
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine4
dr. Subhal dixitgeneral Secretary, iSCCM
Dear all
Dear Friends,
Greetings from ISCCM !
I am delighted to invite you all to Varanasi for the annual congress.
The preparations for the congress are on full swing. It will be an academic extravaganza.
Scientific abstracts can be submitted online.
There have been excellent workshops and conferences in last few months.Best of Brussels was an academic feast for all.
General Secretary's Desk
More academic events and regional conferences have been planned for coming months.
Public forums and other specialties will be engaged in ISCCM Day.
The branches should organise public events and academic activities on the day.
Looking forward for your participation at Varanasi.
Best Wishes
New Office Bearers of ISCCM BranchesBaroda Nagpur Sonepat ThaneChairMan
Dr. Ankur Bhavsar
SECrEtary
Dr. Udgeeth Thaker
trEaSurEr
Dr. Jasmin Rachhadia
ExECutivE CoMMittEE MEMbErS
Dr. Hiren Patel
Dr. Nikunjal Patel
Dr. Punit Ghetia
Dr. Amit Chauhan
Dr. Akash Chavda
Dr. Divyesh Patel
ChairMan
Dr. Nikhil Balankhe
SECrEtary
Dr. Ashish Ganjare
trEaSurEr
Dr. Imran Noormohammad
ExECutivE CoMMittEE MEMbErS
Dr. Jitesh Chavan
Dr. Rakesh Dhoke
Dr. Virendra Belekar
Dr. Vinay Kulkarni
Dr. Shahnawaz
Dr. Tushar Pande
ChairMan
Dr. Divya
SECrEtary
Dr. Anurag Arora
trEaSurEr
Dr. Anupama Sethi Arora
ExECutivE CoMMittEE MEMbErS
Dr. Akhil Saxena
Dr. Garima sharma
Dr. Naresh More
Dr. Reena Gupta
Dr. K. Srivastava
Dr. Amit Rawal
ChairMan
Dr. Sunil Katkade
SECrEtary
Dr. Hrushikesh Vaidya
trEaSurEr
Dr. Kuldeep Dalal
ExECutivE CoMMittEE MEMbErS
Dr. Alok Modi
Dr. Jai Prakash Pednekar
Dr. Suparna Nirgudkar
Dr. Bhavesh Nanda
Dr. Vinayak Gudekar
Dr. Ravindra Ghawat
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine 5
The 5th Annual “BeST oF BRuSSelS” Symposium on Intensive care & emergency medicine 2017
2nd – 9th July 2017 Pune, INDIA
Jointly Organized by ISCCm, Pune Branch &
the Department of Intensive Care, erasme university Hospital, Brussels
5 Pre-conference hands on workshops were held from 2nd – 6th July 2017
2017, PUNE - INDIA2017, PUNE - INDIA2017, PUNE - INDIA
Course: 15th Annual Review Course on Intensive Care2nd, 3rd & 4th July 2017 • 5th Floor, Ruby Hall Clinic & Mock Test at Tehmi Grant Nursing SchoolDelegates: 157 • Course Director: Dr Balasaheb Pawar
Co-Directors: Dr Sushma Patil Gurav
This year at the review course one day was dedicated for 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 ISCCM examiners. The pattern selected has consists of a mixture of written MQC, Cases discussions, didactic lectures and table viva to give a comprehensive exposure to all components of examination
Workshop / Course: Mechanical Ventilation5th & 6th July 2017 • Hyatt Regency, Pune
Delegates: 201 • Course Director: Dr Sandhya Talekar • Co-Director: Dr B D Bande
Workshop / Course: Hemodynamic Monitoring5th & 6th July 2017 • Hyatt Regency, Pune
Delegates: 60 • Course Director: Dr Kayanoosh Kadapatti • Course Coordinator: Dr Jyoti Shendge
Lectures & Workstation Presentations & Mock Test held at the Review Course on Intensive Care Workshop
Plenary Lectures & Workstations in Mechanical Ventilation Workshop
Hemodynamic Monitoring Lectures Hemodynamics Monitoring Workstations in process
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine6
Workshop / Course: Ultrasound & 2D Echocardiography 5th & 6th July 2017 • KEM Hospital & Research Center
Delegates: 80 • Course Director: Dr Pradeep D’costa • Course Coordinator: Dr Jayant Shelgaonkar
Renal Replacemnet Therapy5th & 6th July 2017 • Hyatt Regency, Pune
Delegates: 63 • Course Directors: Dr Valentine Lobo, Dr Sunitha Varghese
LAUNCH PAD at BOB – Alkem Launched the Hospicare Knowledge Center App for Critical care
doctors for fulfilling the scientific needs and a platform to share experiences
App Lunch By Alkem Hosipcare
INDUSTRY SESSION7th & 8th July 2017
Pfizer Industry Session 1
GE Healthcare Industry Session 2
Abbott Industry Session 4 Fresenius Kabi Industry Session 5
MSD Industry Session 3
Workstations & Hands on Training at the USG / 2D Echo Workshop
Lectures & Workstation Presentations held at the Renal Replacement Therapy Workshop
Day 1 - 8.27am - The Full Hall Dr Shirish Prayag giving the welcome address
8.30 am ON TIME …Everytime
Prof Luciano Gattinoni
The Fifth Annual “BEST OF BRUSSELS” Symposium on Intensive Care & Emergency Medicine held in Pune, India7th to 9th July 2017 • Hyatt Regency, PuneISCCM, Pune Branch under the chairmanship of Dr Shirish Prayag & Prof Jean L Vincent has successfully conducted the Fifth Annual “BEST
OF BRUSSELS” symposiumin PUNE, India from the 7th to the 9th July 2017 at the Hyatt Regency, Pune.
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine 7
Sanofi Industry Session 6
Biocon Industry Session 8
MSD Industry Session 7
LAUNCH PAD at BOB - Hamilton Medical AG Switzerland launched their High End Ventilator
HAMILTON C6
Eleven International Faculty on the dias - Jama Session
Eleven International Faculty on the dias - Jama Session
International Faculty from Belgium, Germany, Netherland, France, Hungary, Spain, Sweden The brain storming Scientific Sessions: The Brilliant TEAM………………in process……….
JAMA Session in BOB 2017JAMA Session simply means -Just Ask Me Anything which was held on 8th July 2017. It was truly interactive open live forum with all 11 faculty members on the dais
There were No presentations, No talks, No debates; just an hour-long Q& A session with world renowned professors.
Delegates could just ask any questing to the faculty and they got the best possible answers from these SMARTY Eleven!!
DEBATES – 1
Pro: Didier PayenCon: Christiaan Boerma
Chairpersons: Dr Deepak Salunke &
Dr Manish Munjal
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine8
The " Translational session " which was held on Sunday 9th July, National & International experts held discussions on topics of major presentations made during the preceding 2 days of BOB, which was case based and interactive with the audience, this session was aimed
to convert the points at the BOB sessions in to real TAKE HOME Messages related to cases that we see in our ICU’s. This session was rated as the most welcome and useful change by all the delegates as well as International and National faculty
The Moderators Prof J L Vincent & Dr Shirish Prayag
The EXPERTS: Prof Didier Payen, Prof
Christiaan Boerma & Dr Farhad Kapadia
Dr Subhal Dixit presenting a case on
SEPSIS
The EXPERTS: Prof Daniel DeBacker &
Dr Vasant Nagvekar
The engrossed audience during the Cultural Program, Performed Experience the real world of Lavani artists
The EXPERTS: Prof Jean Daniel Chiche
& Dr J D Sunavala
Dr Kayanoosh Kadapatti presenting a case ARDS
The EXPERTS: Prof Luciano Gattinoni & Dr Suresh Ramasubban
Dr Urvi Shukla presenting a case
ACUTE KIDNEY INJURY
Dr Kapil Zirpe presenting a case on
COMMUNITY-ACQUIRED
PNEUMONIA
Entertainment programs
BOB MASTERCHEF: The Food Court
Our Friends
The Team behind it !!!!!!!!!!!!!!
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine 9
Results of ISCCM Election 2017The following members have been elected to the ISCCM Executive Committee after declaration of results in the ISCCM Executive meeting held on 13th August 2017
President – Elect (2018 -19) Vice President (2018- 20)
Dr. Subhal Dixit, Pune (ELECTED UNOPPOSED)
Dr. Susruta Bandyopadhyay, Kolkata (ELECTED UNOPPOSED)
General Secretary - Elect (2018 – 19) Secretary (2018 – 19) Treasurer (2018 – 19)
Dr Rajesh Chandra Mishra, Ahmedabad Dr. Vandana Agarwal, Mumbai (ELECTED UNOPPOSED)
Dr Rahul Pandit, Mumbai (ELECTED UNOPPOSED)
Executive Committee Members (2018 -20)
Dr. Kapil Borawake, Pune
Dr. Ganshyam Jagathkar, Secunderabad
Dr. Anirban Hom Choudhuri, Delhi
Dr. Sachin Gupta, New Delhi
Zonal Member - North (2018 – 20) Zonal Member - South (2018 – 20) Zonal Member - East (2018 – 20)
Dr Deven Juneja, New Delhi Dr Raghunath Aladakatti, Mysuru (ELECTED UNOPPOSED)
Dr Sauren Panja, Kolkata
Zonal Member - West (2018 – 20) Zonal Member - Central (2018 – 20) Chairman - Pediatric Section (2018 – 20)
Dr Bharat Jagiasi, Navi Mumbai Dr Rakesh Kumar Tyagi, Agra Dr Anil Sachdev, New Delhi (ELECTED UNOPPOSED)
TM
dr yatin Mehta President-Elect and Chief Election Commissioner, iSCCM
dr Vijaya P Patil Secretary and
Member - Election Committee, iSCCM
dr Pradip Kumar Bhattacharya general Secretary - Elect and
Member - Election Committee, iSCCM
dr Suresh ramasubbanMember - Executive and
Member - Election Committee, iSCCM
dr Srinivas SamavedamMember - Executive and
Election Committee, iSCCM
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine10
Results of ICCM Election 2017The following members have been elected unopposed as Vice Chancellor and Members of the College Board after declaration of results in the ISCCM Executive meeting held on 13th August 2017
Vice Chancellor (2018 -19)
Dr Rajesh Kumar Pande, New Delhi
Members of College Board (2018 -20)Secretary - Elect Secretary - Elect, Accreditation Secretary - Elect, Examinations Secretary - Elect, Nursing
Prof. Sheila Nainan Myatra, Mumbai
Dr Sandhya Talekar, Pune
Dr Sumit Ray, New Delhi
Dr Manish Munjal, Jaipur
TM
dr yatin Mehta President-Elect and Chief Election Commissioner, iSCCM
dr Vijaya P Patil Secretary and
Member - Election Committee, iSCCM
dr Pradip Kumar Bhattacharya general Secretary - Elect and
Member - Election Committee, iSCCM
dr Suresh ramasubbanMember - Executive and
Member - Election Committee, iSCCM
dr Srinivas SamavedamMember - Executive and
Election Committee, iSCCM
Branch Events - Jalandhar
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine 11
Antibiotic Therapy in Comatose Mechanically Ventilated Patients Following Aspiration: Differentiating Pneumonia From Pneumonitis*Design: Prospective observational study.
Setting: University-affiliated 30-bed ICU.
Patients: Prospective cohort of 250 patients admitted to the ICU with coma (Glasgow Coma Scale score ≤ 8) and treated with invasive mechanical ventilation.
Interventions: none.
Measurements and Main Results: the primary outcome was the proportion of patients with microbiologically documented bacterial aspiration pneumonia. Patients meeting predefined criteria for aspiration syndrome routinely underwent telescopic plugged catheter sampling during bronchoscopy before starting probabilistic antibiotic treatment. When cultures were negative, the antibiotic treatment was stopped. Of 250 included patients, 98 (39.2%) had aspiration syndrome, including 92 before mechanical ventilation discontinuation. Telescopic plugged catheter in these 92 patients showed bacterial aspiration pneumonia in 43 patients (46.7%). Among the remaining 49 patients, 16 continued to receive antibiotics, usually for infections other than pneumonia; of the 33 patients whose antibiotics were discontinued, only two subsequently showed signs of lung infection. in the six patients with aspiration syndrome after mechanical ventilation, and therefore without telescopic plugged catheter, antibiotic treatment was continued for 7 days. Mechanical ventilation duration, iCu length of stay, and mortality did not differ between the 43 patients with bacterial aspiration pneumonia and the 49 patients with non-bacterial aspiration pneumonitis. the 152 patients without aspiration syndrome did not receive antibiotics.
Conclusions: among comatose patients receiving mechanical ventilation, those without clinical, laboratory, or radiologic evidence of bacterial aspiration pneumonia did not require antibiotics. in those with suspected bacterial aspiration pneumonia, stopping empirical antibiotic therapy when routine telescopic plugged catheter sampling recovered no microorganisms was nearly always effective. this strategy may be a valid alternative to routine full-course antibiotic therapy. only half the patients with suspected bacterial aspiration pneumonia had this diagnosis confirmed by telescopic plugged catheter sampling (Crit Care Med 2017; 45:1268–1275).Our View: antibiotics are mostly overused to treat pulmonary opac-ity suspecting it to be caused by pneumonia. non-bacterial aspiration pneumonitis treated by antibiotics only increases resistance and tox-icity. Pulmonary samples taken and subjected to culture have great limitations due to the turnaround time. it is for the clinicians to decide whether the patient has infection based on clinical judgments.
Percutaneous short-term active mechanical support devices in cardiogenic shock: a systematic review and collaborative meta-analysis of randomized trialsAims: Evidence on the impact on clinical outcome of active mechanical circulatory support (MCS) devices in cardiogenic shock (CS) is scarce. this collaborative meta-analysis of randomized trials thus aims to investigate the efficacy and safety of percutanzeous active MCS vs. control in CS.
Methods and results: randomized trials comparing percutaneous active MCS to control in patients with CS were identified through searches of medical literature databases. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated to analyse the primary endpoint of 30-day mortality and device-related complications including bleeding and leg ischaemia. Mean differences (MD) were calculated for mean arterial pressure (MAP), cardiac index (CI), pulmonary capillary wedge pressure (PCWP), and arterial lactate. four trials randomizing 148 patients to either tandemheart™ or impella® MCS (n = 77) vs. control (n = 71) were identified. In all four trials intra-aortic balloon pumping (IABP) served as control. There was no difference in 30-day mortality (RR 1.01, 95% CI 0.70 to 1.44, P = 0.98, I2 = 0%) for active MCS compared with control. Active MCS significantly increased MAP (MD 11.85 mmHg, 95% CI 3.39 to 20.31, P = 0.02, I2 = 32.7%) and decreased arterial lactate (MD − 1.36 mmol/l, 95% CI − 2.52 to − 0.19, I2 = 0%, P = 0.02) at comparable CI (MD 0.32, 95% CI − 0.24 to 0.87, P = 0.14, I2 = 44.1%) and PCWP (MD − 5.59, 95% −15.59 to 4.40, P = 0.14, I2 = 81.1%). No significant difference was observed in the incidence of leg ischaemia (RR 2.64, 95% CI 0.83 to 8.39, P = 0.10, I2 = 0%), whereas the rate of bleeding was significantly increased in MCS compared to IABP (RR 2.50, 95% CI 1.55 to 4.04, P < 0.001, I2 = 0%).
Conclusion: results of this collaborative meta-analysis do not support the unselected use of active MCS patients with CS complicating aMi (European Heart Journal, ehx363, https://doi.org/10.1093/eurheartj/ehx363). Our View: While the short term mechanical circulatory device is beneficial on theoretical grounds and commonly used in our units too, this met analysis can be a great deviation to earlier concept. this is yet to see how long it takes the great majority to discard these devices at least from routine clinical usage.
Omega-3 supplementation in patients with sepsis: a systematic review and meta-analysis of randomized trialsBackground: nutritional supplementation of omega-3 fatty acids has been proposed to modulate the balance of pro- and anti-inflammatory mediators in sepsis. if proved to improve clinical outcomes in critically ill patients with sepsis, this intervention would be easy to implement. however, the cumulative evidence from several randomized clinical trials (RCTs) remains unclear.
Methods: We searched the Cochrane library, MEdlinE, and
EMBASE through December 2016 for RCTs on parenteral or enteral omega-3 supplementation in adult critically ill patients diagnosed with sepsis or septic shock. We analysed the included studies for mortality, intensive care unit (ICU) length of stay, and duration of mechanical ventilation, and used the grading of recommendations assessment, development and Evaluation approach to assess the quality of the evidence for each outcome.
Results: A total of 17 RCTs enrolling 1239 patients met our inclusion criteria. omega-3 supplementation compared to no supplementation or placebo had no significant effect on mortality [relative risk (RR) 0.85; 95% confidence interval (CI) 0.71, 1.03; P = 0.10; I 2 = 0%; moderate quality], but significantly reduced ICU length of stay [mean difference (MD) −3.79 days; 95% CI −5.49, −2.09; P < 0.0001, I 2 = 82%; very low quality] and duration of mechanical ventilation (Md −2.27 days; 95% CI −4.27, −0.27; P = 0.03, I 2 = 60%; very low quality). However, sensitivity analyses challenged the robustness of these results.
Conclusion: omega-3 nutritional supplementation may reduce iCu length of stay and duration of mechanical ventilation without significantly affecting mortality, but the very low quality of overall evidence is insufficient to justify the routine use of omega-3 fatty acids in the management of sepsis (Annals of Intensive Care20177:58 https://doi.org/10.1186/s13613-017-0282-5). Our View: industry pressure can modify your practice. advertise-ments and overemphasis on sporadic results of poor quality studies can lead to believe that some magic affects lies in the omega. We use it along with other highly effective supportive therapy.
Thiamine as a Renal Protective Agent in Septic Shock. A Secondary Analysis of a Randomized, Double-Blind, Placebo-controlled Trial Rationale: Acute kidney injury (AKI) is common in patients with sepsis and has been associated with high mortality rates. the provision of thiamine to patients with sepsis may reduce the incidence and severity of sepsis-related aKi and thereby prevent renal failure requiring renal replacement therapy (RRT).
Objectives: to test the hypothesis that thiamine supplementation mitigates kidney injury in septic shock.
Methods: this was a secondary analysis of a single-center, randomized, double-blind trial comparing thiamine to placebo in patients with septic shock. renal function, need for rrt, timing of hemodialysis catheter placement, and timing of rrt initiation were abstracted. the baseline creatinine and worst creatinine values between 3 and 24 hours, 24 and 48 hours, and 48 and 72 hours were likewise abstracted.
Results: There were 70 patients eligible for analysis after excluding 10 patients in whom hemodialysis was initiated before study drug administration. baseline serum creatinine in the thiamine group was 1.2 mg/dl (interquartile range, 0.8–2.5) as compared with 1.8 mg/dl (interquartile range, 1.3–2.7) in the placebo group (P = 0.3). After initiation of the study drug, more patients in the placebo group than in the thiamine group were started on RRT (eight [21%] vs. one [3%]; P = 0.04). In the repeated measures analysis adjusting for the baseline creatinine level, the worst creatinine levels were higher in the placebo group than in the thiamine group (P = 0.05).
Conclusions: in this post hoc analysis of a randomized controlled trial, patients with septic shock randomized to receive thiamine had lower serum creatinine levels and a lower rate of progression to RRT than patients randomized to placebo. These findings should be considered hypothesis generating and can be used as a foundation for further, prospective investigation in this area (Annals of the American Thoracic Society vol. 14, no. 5 | May 01, 2017 https://doi.org/10.1513/AnnalsATS.201608-656BC).Our View: We have not used thiamine for this indication. but, if the results of the studies are favorable then harmless measures deserves our attention.
The use of fibrinogen concentrate for the management of trauma-related bleeding: a systematic review and meta-analysisHaemorrhage following injury is associated with significant morbidity and mortality. The role of fibrinogen concentrate in trauma-induced coagulopathy has been the object of intense research in the last 10 years and has been systematically analysed in this review. a systematic search of the literature identified six retrospective studies and one prospective one, involving 1,650 trauma patients. There were no randomised trials. Meta-analysis showed that fibrinogen concentrate has no effect on overall mortality (risk ratio: 1.07, 95% confidence interval: 0.83-1.38). Although the meta-analytic pooling of the current literature evidence suggests no beneficial effect of fibrinogen concentrate in the setting of severe trauma, the quality of data retrieved was poor and the final results of ongoing randomised trials will help to further elucidate the role of fibrinogen concentrate in traumatic bleeding (Blood Transfus 2017; 15: 318-24 DOI 10.2450/2017.0094-17). Our View: We do not have any experience of using such blood prod-uct in the trauma patients.
Preadmission Use of Calcium Channel Blocking Agents Is Associated With Improved Outcomes in Patients With Sepsis: A Population-Based Propensity Score–Matched Cohort StudyObjectives: use of calcium channel blockers has been found to improve sepsis outcomes in animal studies and one clinical study. this study determines whether the use of calcium channel blockers is associated with a decreased risk of mortality in patients with sepsis.
Design: Population-based matched cohort study.
Setting: national health insurance research database of taiwan.
Patients: Hospitalized severe sepsis patients identified from National
Health Insurance Research Database by International Classification of Diseases, Ninth Revision, Clinical Modification codes.
Interventions: none.
Measurements and Main Results: the association between calcium channel blocker use and sepsis outcome was determined by multivariate-adjusted Cox proportional hazard models and propensity score analysis. To examine the influence of healthy user bias, beta-blocker was used as an active comparator. Our study identified 51,078 patients with sepsis, of which, 19,742 received calcium channel blocker treatments prior to the admission. use of calcium channel blocker was associated with a reduced 30-day mortality after propensity score adjustment (hazard ratio, 0.94; 95% CI, 0.89–0.99), and the beneficial effect could extend to 90-day mortality (hazard ratio, 0.95; 95% CI, 0.89–1.00). In contrast, use of beta-blocker was not associated with an improved 30-day (hazard ratio, 1.06; 95% CI, 0.97–1.15) or 90-day mortality (hazard ratio, 1.00; 95% CI, 0.90–1.11). On subgroup analysis, calcium channel blockers tend to be more beneficial to patients with male gender, between 40 and 79 years old, with a low comorbidity burden, and to patients with cardiovascular diseases, diabetes, or renal diseases.
Conclusions: in this national cohort study, preadmission calcium channel blocker therapy before sepsis development was associated with a 6% reduction in mortality when compared with patients who have never received calcium channel blockers (Critical Care Medicine DOI: 10.1097/CCM.0000000000002550).Our View: Good to learn yet another finding favoring the multifacto-rial nature of sepsis outcomes. in our experience however cardiac patients have poor outcomes when having sepsis.
Ultrasound Versus Traditional Palpation to Guide Radial Artery Cannulation in Critically Ill Children: A Randomized TrialObjectives: to identify success rates for radial artery cannulation in a pediatric critical care unit using either palpation or ultrasound guidance to cannulate the radial artery.Methods: a prospective randomized comparative study of critically ill children who required invasive monitoring in a tertiary referral center was conducted. All patients were randomized by a stratified block of 4 to either ultrasound-guided or traditional palpation radial artery cannulation. The primary outcomes were the first attempt and total success rates.Results: Eighty-four children were enrolled, with 43 randomized to the palpation technique and 41 to the ultrasound-guided technique. Demographic data between the groups were not significantly different. The total success and first attempt rates for the ultrasound-guided group were significantly higher than those for the palpation group (success ratio, 2.03; 95% confidence interval, 1.13–3.64; P = .018; and success ratio, 4.18; 95% confidence interval, 1.57–11.14; P = .004, respectively). The median time to success for the ultrasound-guided group was significantly shorter than that for the palpation group (3.3 versus 10.4 minutes; P < .001). Cannulation complications were lower in the ultrasound-guided group than the palpation group (12.5% versus 53.3%; P < .001).Conclusions: the ultrasound-guided technique could improve the success rate and allow for faster cannulation of radial artery catheterization in critically ill children (Journal of ultrasound in Medicine; 2017. DOI: 10.1002/jum.14291).Our View: We do not apply ultrasound for arterial cannulation. the results of this study are encouraging. however, personal and institu-tional experience is required to widely believe the results.
High-flow nasal cannula oxygen therapy is superior to conventional oxygen therapy but not to noninvasive mechanical ventilation on intubation rate: a systematic review and meta-analysisBackground: High-flow nasal cannula oxygen (HFNC) is a relatively new therapy used in adults with respiratory failure. Whether it is superior to conventional oxygen therapy (COT) or to noninvasive mechanical ventilation (NIV) remains unclear. The aim of the present study was to investigate whether hfnC was superior to either Cot or niv in adult acute respiratory failure patients.Methods: a review of the literature was conducted from the electronic databases from inception up to 20 October 2016. Only randomized clinical trials comparing hfnC with Cot or hfnC with niv were included. the intubation rate was the primary outcome; secondary outcomes included the mechanical ventilation rate, the rate of escalation of respiratory support and mortality.Results: Eleven studies that enrolled 3459 patients (HFNC, n = 1681) were included. there were eight studies comparing hfnC with Cot, two comparing hfnC with niv, and one comparing all three. hfnC was associated with a significant reduction in intubation rate (OR 0.52, 95% CI 0.34 to 0.79, P = 0.002), mechanical ventilation rate (OR 0.56, 95% CI 0.33 to 0.97, P = 0.04) and the rate of escalation of respiratory support (OR 0.45, 95% CI 0.31 to 0.67, P < 0.0001) when compared to Cot. there was no difference in mortality between hfnC and Cot utilization (OR 1.01, 95% CI 0.67 to 1.53, P = 0.96). When HFNC was compared to niv, there was no difference in the intubation rate (or 0.96; 95% CI 0.66 to 1.39, P = 0.84), the rate of escalation of respiratory support (OR 1.00, 95% CI 0.77 to 1.28, P = 0.97) or mortality (OR 0.85, 95% CI 0.43 to 1.68, P = 0.65).Conclusions: Compared to Cot, hfnC reduced the rate of intubation, mechanical ventilation and the escalation of respiratory support. When compared to niv, hfnC showed no better outcomes. large-scale randomized controlled trials are necessary to prove our findings.Our View: We are using hfnC in our centre with good results. We hope wider availability and spread of information will definitely reduce the rate of intubation and will benefit many patients. The situation is akin to a couple of decades ago when niv was brought in and ac-cepted more enthusiastically and helped several patients at the verge of intubation. the time starts now for hfnC.
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]
dr. Prashant KumarMD, IDCCM, FNB (Critical Care), EDIC, PgdPha, doaEditor 'Critical Care Waarticles'Senior Consultant Critical Care, Medanta the Medicity, global health Private ltd, Sector - 38, Gurgaon 122001, Haryana, IndiaMobile: +919899302959 e-mail: [email protected]
JOUR
NAL SCAN
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine12
Battle of the Brains
Image Section
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
Q1. Which antibiotic interferes with the measurement of serum creatinine and cause "pseudo-acute renal failure" ?
Q2. 34 year old female with history of recurrent DVT now on chronic Coumadin therapy, presented with black tarry stool and probable GI bleed. There was on change on her usual coumadin dose of 5 mg/day on which she had therapeutic INR of 2.8 since last 2 years. Today her INR is 7.8. One week ago, she has a bout of severe UTI (urinary tract infection) and started on antibiotics by her primary care physician?
Q3. In which of the following conditions mixed venous oxygen saturation (SvO2) could be more than 80%?
Chest X ray40 years old male smoker presented with cough, right sided chest pain massive hemoptysis. He had h/o pulmonary Koch’s 15 years back. CXR was done. What is the diagnosis? Name the sign?
Answers of May-June 2017 Issue1. Venous thromboembolism is a major
national health problem, with an overall age- and sex-adjusted incidence of more than 1 per 1,000 annually?
2. Which is the preferred probe for diagnosis of DVT? The preferred probe is the high-frequency linear array probe, because it provides better resolution, and its flat surface is ideal for achieving adequate compression
3. Hypertension.
Winners of Critiquiz “Bat tle of the Brains”
May-June Issue
dr apurva Kumar BorahGauhati
Q4. Following antibiotics have concentration dependent killing activity EXCEPT:
A. Amikacin B. Levofloxacin C. Amphotericin B D. Metronidazole E. Clarithromycin Q5. What is PCC rich in?Q6. What is The Rancho Los Amigos
Scale ?Q7. This abnormal pattern of breathing is
caused by damage to the ……….. and is characterized by groups of quick shallow inspirations followed by regular or irregular periods of apnea.
How do know this as?Q8. What unique advantage Etomidate
has to be use in intubation in traumatic brain injury patients?
Q9. Transfusion associated circulatory overload (or TACO) is characterized by 4 main signs. Of them 3 are dyspnea, orthopnoea and peripheral edema. What is the 4th?
Q 10.
4. D-dimer levels remain elevated in DVT for what duration? Around 7 days
5. How is this image better known as? Head of Mickey Mouse
6. Spot on Phlegmasia Cerulea Dolens
7. March is Deep Vein Thrombosis (DVT)Awareness Month. October 13 is World Thrombosis Day
8. 75% of UEDVT are secondary (indwelling catheters, pacemakers, malignancy, etc.) and 25% are primary in nature; #1 primary cause of UEDVT is Paget – Schroetter disease
9. Economy class syndrome is venous thromboembolism following air travel. This syndrome was firstly reported in the year 1946
10. Thalidomide
ANSWER TO LAST IMAGE SECTION
Myasthenia Gravis
‘Bronchoscopy in ICU : 8th FMRI - ISCCM Hands on Workshop’
‘Bronchoscopy in ICU : 8th FMRI - ISCCM Hands on Workshop’to be held at Fortis Memorial Research Institute, Gurgaon, on 08th October 2017. This exclusive training course is being organized to provide a rich flare of scientific material and practical approach of performing Bronchoscopy and Percutaneous Trache-ostomy in Critical Care setting.
The highlights of this training course are
1. Live cases of Bronchoscopy
2. Hands on Training
3. CD of the course material and videos
4. Precise and accurate time management of programme schedule
5. CD of Atlas of Bronchoscopy
6. Real time Bronchoscopy Simulation
This training course is designed for specialists and post graduate trainees in Crit-ical Care Medicine, Emergency Medicine, Respiratory Medicine, General Med-icine and Anaesthesia. Therefore, we also request you to widely circulate this program amongst your colleagues for their active participation. As your gracious presence will enrich the scientific content, we are sure that you would enjoy our hospitality.
Dr. Manoj K Goel Dr Yash Javeri Course Director Secretary, SCCM Delhi NCR
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine 13
Guidelines for the Management of Candidiasis
CID 2016;62:1-50
Treatment of Candidemia in non- neutropenic patients
Strong recommendation; high-quality evidence
1. An echinocandin (caspofungin: loading dose 70 mg, then 50 mg daily; micafungin: 100 mg daily; anidulafungin: loading dose 200 mg, then 100 mg daily) is recommended as initial therapy
2. Fluconazole, intravenous or oral, 800-mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg) daily is an acceptable alternative to an echinocandin as initial therapy in selected patients, including those who are not critically ill and who are considered unlikely to have a fluconazole-resistant Candida species
3. Lipid formulation amphotericin B (AmB) (3–5 mg/kg daily) is a reasonable alternative if there is intolerance, or resistance to other antifungal agents
Strong recommendation; moderate-quality evidence
4. Transition from an echinocandin to fluconazole (usually within 5–7 days) is recommended for patients who are clinically stable, have isolates that are susceptible to fluconazole (eg, C. albicans), and have negative repeat blood cultures following initiation of antifungal therapy
5. Recommended duration of therapy for candidemia without obvious metastatic complications is for 2 weeks after documentedclearance of Candida species from the bloodstream
6. Central venous catheters (CVCs) should be removed as early as possible in the course of candidemia when the source is presumed to be the CVC
7. Empiric antifungal therapy should be considered in critically ill patients with risk factors for invasive candidiasis and no other known cause of fever and should be based on clinical assessment of risk factors, surrogate markers for invasive candidiasis, and/or culture data from nonsterile sites. Empiric antifungal therapy should be started as soon as possible in patients who have the above risk factors and who have clinical signs of septic shock
8. Preferred empiric therapy for suspected candidiasis in nonneutropenic patients in the intensive care unit (ICU) is an echinocandin
Strong recommendation; low-quality evidence
9. All nonneutropenic patients with candidemia should have a dilated ophthalmological examination,
preferably performed by an ophthalmologist, within the first week after diagnosis
10. Follow-up blood cultures should be performed every day or every other day to establish the time point at which candidemia has been cleared
Treatment of Candidemia in neutropenic patients
Strong recommendation; moderate-quality evidence
1. An echinocandin (caspofungin: loading dose 70 mg, then 50 mg daily; micafungin: 100 mg daily; anidulafungin: loading dose 200 mg, then 100 mg daily) is recommended as initial therapy
2. Lipid formulation AmB, 3–5 mg/kg daily, is an effective but less attractive alternative
Strong recommendation; low-quality evidence
3. Fluconazole, 800-mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg) daily, is an alternative for patients who are not critically ill and have had no prior azole exposure
4. For infections due to C. krusei, an echinocandin, lipidformulation AmB, or voriconazole is recommended
5. Recommended minimum duration of therapy for candidemia without metastatic complications is 2 weeks after documented clearance of Candida from the bloodstream, provided neutropenia and symptoms attributable to candidemia have resolved
6. Ophthalmological findings of choroidal and vitreal infection are minimal until recovery from neutropenia; therefore, dilated funduscopic examinations should be performed within the first week after recovery from neutropenia
Prophylaxis to Prevent Invasive Candidiasis
1. Fluconazole, 800-mg (12 mg/kg) loading dose, then 400 mg (6 mg/kg) daily, could be used in high-risk patients
2. Daily bathing of ICU patients with chlorhexidine
Treatment of Intra-abdominal Candidemia
Strong recommendation; moderate-quality evidence
1. Empiric antifungal therapy should be considered for patients with clinical evidence of intra-abdominal infection and significant risk factors for candidiasis, including recent abdominal surgery, anastomotic leaks, or necrotizing pancreatitis
2. Treatment of intra-abdominal
candidiasis should include source control, with appropriate drainage and/or debridement
3. The choice of antifungal therapy is the same as for the treatment of candidemia or empiric therapy for nonneutropenic patients in the ICU
Isolation of Candida from respiratory secretions
Growth of Candida from respiratory secretions usually indicates colonization and rarely requires treatment with antifungal therapy
Candida infections with implantable devices
1. For native valve endocarditis, lipid formulation AmB, 3–5 mg/kg daily, with or without flucytosine, 25 mg/kg 4 times daily
2. For prosthetic valve endocarditis, the same antifungal regimens suggested for native valve endocarditis are recommended
3. For pacemaker and implantable cardiac defibrillator infections, the entire device should be removed
4. Antifungal therapy is the same as that recommended for native valve endocarditis
Central nervous system Candida infection
1. For initial treatment, liposomal AmB, 5 mg/kg daily, with or without oral flucytosine, 25 mg/kg 4 times daily is recommended
2. For step-down therapy after the patient has responded to initial treatment, fluconazole, 400–800 mg (6–12 mg/kg) daily, is recommended
3. Infected CNS devices, including ventriculostomy drains, shunts should be removed
Urinary tract candida infection
For asymptomatic candiduria
1. Elimination of predisposing factors, such as indwelling bladder catheters, is recommended
2. Treatment with antifungal agents is NOT recommended
For symptomatic ascending pyelonephritis
1. For fluconazole-susceptible organisms, oral fluconazole, 200–400 mg (3–6 mg/kg) daily for 2 weeks is recommended
2. For fluconazole-resistant C. glabrata, AmB deoxycholate, 0.3–0.6 mg/kg daily for 1–7 days with or without oral flucytosine, 25 mg/kg 4 times daily, is recommended
3. Elimination of urinary tract obstruction is strongly recommended
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine14
Welcome New Members to the ISCCM family1 Neeraj Agrawal, Indore ALM-17/A-544
2 Sanjay Singhal, Lucknow LM-17/S-1468
3 Anumeha Omar, New Delhi ALM-17/O-20
4 Vinutha V, Bangalore ALM-17/V-305
5 Raju Sikilammetla, Dist Yadadri Bhuvanagiri ALM-17/S-1498
6 Vipin V, Malappuram ALM-17/V-306
7 Sanjay Saxena, Dehradun ALM-17/S-1500
8 Rakesh Nakshatram, Hyderabad ALM-17/N-277
9 Sanjay Sharma, New Delhi LM-17/S-1499
10 Dilip Bhattacharya, Kolkata LM-17/B-671
11 Govind Rajgarhia, Kolkata LM-17/R-553
12 Sandip Thakarar, Rajkot LM-17/T-310
13 Rakhi Sanyal, Kolkata LM-17/S-1501
14 Hardikkumar Vekariya, Rajkot LM-17/V-307
15 Sarang Kshirsagar, Nagpur LM-17/K-893
16 Manjunatha L, Mandya LM-17/L-98
17 Megha Sharma, Mandya LM-17/S-1502
18 Prabhat Kumar, New Delhi LM-17/K-914
19 Geeta Appannavar, Bangalore LM-17/A-545
20 Ankur Agrawal, Rohtak LM-17/A-546
21 Rajnish Kaushik, New Delhi LM-17/K-921
22 Diksha Tyagi, Rohtak LM-17/T-315
23 Debraj Jash, Rohtak LM-17/J-446
24 Manjunath Govindagowdar, Rohtak LM-17/G-687
25 Sahir Aftab, Malappuram LM-17/A-538
26 Brijesh Prajapati, Rohtak LM-17/P-851
27 Shreedhara S, Bangalore LM-17/S-1503
28 Priyanka Chavana, Bangalore LM-17/C-438
29 Sandeep Dandin, Mumbai LM-17/D-541
30 Dalia Bhanare, Goa LM-17/B-672
31 Udit Goel, Jaipur ALM-17/G-686
32 Kaushal Premlani, Faridabad ALM-17/P-849
33 Mahamadtaqi Sundrani, Gate Mahuva ALM-17/S-1504
34 Manmohan Borse, Chennai ALM-17/B-660
35 Kaweeta Maheshwari, Ahmedabad ALM-17/M-801
36 Arindam Hazra, Kolkata LM-17/H-120
37 Priyanka Mehta, Mumbai LM-17/M-790
38 Chintakindi Shekhar, Hyderabad LM-17/S-1457
39 Pradnya Hingole, Nanded LM-17/H-119
40 Manish Sharma, Kolkata LM-17/S-1458
41 Ananda Datta, New Delhi LM-17/D-530
42 Uthra Kumaresaw N K, Chennai LM-17/K-888
43 Sha Ruknuddin, Bangalore LM-17/R-545
44 Abhay Rituraj, Gurgaon ALM-17/R-546
45 Neethu Kumar, Ernakulam LM-17/K-925
46 Manjunath G K, Erode LM-17/G-673
47 Umar Khan, New Delhi ALM-17/K-890
48 Gowher Masoodi, New Delhi ALM-17/M-791
49 Deepak Bajaj, New Delhi ALM-17/B-655
50 Sahebrao Toke, Pune LM-17/T-302
51 Shah Navinchandra, Surat LM-17/N-269
52 Deepa Vanjari, Navi Mumbai LM-17/V-297
53 Lalit Chandwani, Ulhasnagar LM-17/C-428
54 Nikhil Patil, Thane LM-17/P-835
55 Saptesh Shirbhate, Amravati LM-17/S-1459
56 Uday Jonnalagadda, Secunderabad ALM-17/J-431
57 Harsha Gupta, Bhopal LM-17/G-674
58 Shibnath Das, Kolkata ALM-17/D-531
59 Bhupendrakumar Rathod, Vadodara LM-17/R-547
60 Amit Das, Kolkata LM-17/D-532
61 Alex Fonseca, Mumbai LM-17/F-29
62 Ritu Yadav, Thane LM-17/Y-60
63 Shikha Sahi, New Delhi LM-17/S-1460
64 Vivek Menacherry, Kochi LM-17/M-792
65 Shikha Bansal, Gurgaon ALM-17/B-656
66 Abdul Shaheed, Bangalore ALM-17/S-1461
67 Nadeem Riyaz, Bangalore ALM-17/R-548
68 Chaitanya Jadhao, Mumbai LM-17/J-432
69 Vibhuti Jaju, Mumbai ALM-17/J-433
70 Megha Khandagale, Ambarnath ALM-17/K-891
71 Archana Kalaichelvam, Chennai LM-17/K-889
72 Sankara Prasanna, Chennai LM-17/P-834
73 Jayesh Jamnani, Godhra ALM-17/J-434
74 Puja Bhattad, Karad ALM-17/B-657
75 Tejashkumar Patel, Vadodara ALM-17/P-836
76 Kunal Kumar, Jamshedpur ALM-17/K-892
77 Yogesh Patel, Hyderabad ALM-17/P-837
78 Vaishali Jani, Bangalore ALM-17/J-435
79 Omprakash Jalamkar, Amravati LM-17/J-436
80 Khushbu Agarwal, Pune LM-17/A-534
81 Mohd Bagwan, Lucknow LM-17/B-658
82 Amisha Chawla, Ferozepur ALM-17/C-429
83 Namrata Jadhav, Mumbai ALM-17/J-437
84 Arun Parathody, Pune LM-17/P-838
85 Shraddha Deshmukh, Pune LM-17/D-533
86 Saurabh Shaha, Indapur LM-17/S-1462
87 Aditi Jain, Jaipur LM-17/J-438
88 Sanjeev Sharma, Ghaziabad ALM-17/S-1463
89 Bhatlapenumarthy Krishna, Hyderabad ALM-17/K-894
90 Pradeep Dagade, Pune ALM-17/D-534
91 Nihmathulla Madamdatt, Malappuram LM-17/M-793
92 Mohammed N, Malappuram LM-17/N-270
93 Waseem Iqbal Mushreef, Bangalore LM-17/M-794
94 Potti Chalamaiah, Prakasam LM-17/C-430
95 Ananya Lahiri, Kolkata LM-17/L-94
96 Karishma Jalan, Kolkata ALM-17/J-439
97 Preet Kagalwala, Surat ALM-17/K-895
98 Elizabeth Mathew, Mumbai ALM-17/M-795
99 Sowmya Andluru, Hyderabad LM-17/A-535
100 Chengappa Nanjunda, Mysore ALM-17/N-271
101 Dhruvang Mehta, Bharuch ALM-17/M-796
102 Faraza Sultana, Noida ALM-17/S-1464
103 Visal V, Kozhikode LM-17/V-298
104 Varun Gupta, Karnal LM-17/G-675
105 Vijay Yeldandi, Hyderabad LM-17/Y-61
106 Sagar Patel, Anand ALM-17/P-839
107 Ibrahim Sirki, Noida ALM-17/S-1465
108 Anveshi Sathyavadhi, Bangalore LM-17/S-1466
109 Malleswari Sara, Hyderabad LM-17/S-1467
110 Mavalapally Reddy, Hyderabad LM-17/R-549
111 Anirban Bose, Kolkata LM-17/B-659
112 Shruti Ugran, Hyderabad ALM-17/U-56
113 Kalpeshkumar Kalsariya, Surat ALM-17/K-896
114 Subhadev Sinha, Kolkata ALM-17/S-1469
115 Urmi Gada, Mumbai ALM-17/G-677
116 Preeti Balasundaram, Bangalore ALM-17/B-661
117 Nachiket Sawant, Mumbai ALM-17/S-1470
118 Deepika Dash, Ahmedabad LM-17/D-535
119 Narendra Kumar, Jaipur LM-17/K-899
120 Chinmay Naik, Bangalore LM-17/N-272
121 Samiran Das, Kolkata LM-17/D-536
122 Ranjitha HD, Bangalore LM-17/H-121
123 Shipra Surin, Raipur ALM-17/S-1471
124 Srikanth Koti, Chennai LM-17/K-900
125 Vignesh Vasudevan, Chennai LM-17/V-299
126 Parth Shah, Anand LM-17/S-1472
127 Bhushan Khole, Dist.Amaravati ALM-17/K-897
128 Swapnil Khadake, Jalgaon LM-17/K-898
129 Amit Ambesange, Mumbai ALM-17/A-536
130 Nishant Gupta, Patan LM-17/G-676
131 Kavitha Chendhilkumar, Chennai LM-17/C-431
132 Rajendra Mota, Kurnool ALM-17/M-797
133 Soumya Nath, Lucknow LM-17/N-273
134 Sunil Sharma, Jaipur LM-17/S-1475
135 Neha Goenka, Nagpur LM-17/G-678
136 Praveen Gajula, Serilingampally R.R(Dist) LM-17/G-679
137 Kuldeep Saini, New Delhi LM-17/S-1473
138 Juhi Chausalkar, Pune ALM-17/C-432
139 Samyogita Sethia, Chandigarh LM-17/S-1476
140 Priyanka Bhagade, Mumbai LM-17/B-662
141 Oruganti ShilpaReddy, Hyderabad ALM-17/S-1474
142 Bhaskara M, Mysore ALM-17/M-798
143 Nagaraja B.S, Bangalore LM-17/B-663
144 Muthukumar Marimuthu, Thiruvalla LM-17/M-799
145 Ramkumar R P, Thiruvalla LM-17/R-551
146 Kalash Hindu, Ahmedabad ALM-17/H-122
147 Naresh Kessani, Ahmedabad ALM-17/K-901
148 Suchita Patil, Sangli ALM-17/P-840
149 Bal Mukund, Mumbai LM-17/M-800
150 Chanakya Dumpala, Yendada ALM-17/D-537
151 Sai Lakshman P, Tirupathi LM-17/L-95
152 Divija Sannapareddy, Hyderabad LM-17/S-1480
153 Nikhil Mule, Anagar ALM-17/M-802
154 Shailendra Bakshi, Raipur LM-17/B-664
155 Amit Verma, Hisar LM-17/V-301
156 Niharkumar Marathe, Ahmedabad ALM-17/M-803
157 Lohitha Sarikonda, Secunderabad ALM-17/S-1481
158 Riyas A, Trivandrum LM-17/A-537
159 Sandeep Loha, Banaras LM-17/L-96
160 Vachaspati Kumar, New Delhi ALM-17/K-902
161 Aparna Singha, Gurgaon ALM-17/S-1479
162 Krishna Jinnuri, Tirupati ALM-17/J-440
163 Prashant Mukta, Latur LM-17/M-804
164 Sapna Yadav, Ghaziabad LM-17/Y-62
165 Abhishek Choudhury, Chennai LM-17/C-433
166 Kedar Verma, Kanpur ALM-17/V-302
167 Sreejith H H, Thiruvananthapuram LM-17/H-123
168 Bhasker Tammali, Hyderabad ALM-17/T-304
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169 Rohan Goswami, Noida ALM-17/G-680
170 Harsiddh Rajvanshi, Ahmedabad ALM-17/R-550
171 Darshita Singh, Faridabad ALM-17/S-1482
172 Nishit Patel, Ahmedabad ALM-17/P-841
173 Himeswari Mandal, Secunderabad ALM-17/M-805
174 Vipul Sengal, Ahmedabad LM-17/S-1478
175 Velupuri Prakash, Kakinada LM-17/P-842
176 Akashdeep Arora, Vasco da Gama LM-17/A-539
177 Deepak Verma, New Delhi ALM-17/V-300
178 Vaijayanti Nar, Thane ALM-17/N-274
179 Puneet Bhardwaj, Delhi ALM-17/B-665
180 Debashis Talukder, Kolkata ALM-17/T-305
181 Varsha Mathews, Thrissur LM-17/M-806
182 Hanish Shashidhar, Nizamabad ALM-17/S-1485
183 Karthik Guduru, Hyderabad ALM-17/G-681
184 Deepak Singla, Panchkula LM-17/S-1483
185 Kapil Gupta, Jaipur ALM-17/G-682
186 Subrata Saha, Kolkata ALM-17/S-1484
187 Nandlal Maheshwari, Ahmedabad ALM-17/M-807
188 Eishan Aryan, Chandigarh ALM-17/A-540
189 Rupa Raiyani, Rajkot ALM-17/R-552
190 Mohd Fasihuddin, Warangal ALM-17/F-30
191 Shrirang Madhav, New Delhi ALM-17/M-808
192 Kirti Berwal, Rohtak LM-17/B-666
193 Arvind Kumar, Rohtak LM-17/K-904
194 Chandra Prasad, New Delhi ALM-17/P-843
195 Minlun Chongloi, Shillong ALM-17/C-434
196 Kishan Vachhani, Rajkot ALM-17/V-303
197 Deepak Patil, Latur LM-17/P-844
198 Anish Thomas, Pathanamthitta Dist. LM-17/T-306
199 Balakrishana Goyal, Surat ALM-17/G-683
200 Abhay Bhadauria, Gwalior LM-17/B-667
201 Girijapati Machanalli, Bangalore LM-17/M-809
202 Amol Dhuldhule, Hingoli LM-17/D-538
203 Allamul Hasan, Noida LM-17/H-124
204 Arun Sahu, Bhubaneshwar LM-17/S-1486
205 Vijay Kedarasetty, Visakhapatnam LM-17/K-905
206 Neetu Singh, Agra LM-17/S-1487
207 Manish Gupta, Gwalior LM-17/G-684
208 Shrikant Lanje, Pune LM-17/L-97
209 Madhvi Narwal, New Delhi LM-17/N-275
210 Nagul Deepak, Hanmkonda LM-17/D-539
211 Prashant Singh, Delhi ALM-17/S-1490
212 Chaitra A, Mysore LM-17/A-541
213 Pradeep Meshram, New Delhi LM-17/M-810
214 Santosh J, Erode LM-17/J-441
215 Swaran Bhalla, New Delhi LM-17/B-668
216 Amrutha S, Anekal Taluk LM-17/S-1488
217 Riddhi Kundu, Delhi LM-17/K-908
218 Madhavi Pinnelli, Warangal LM-17/P-845
219 Sailaja Kambhampati, Hyderabad LM-17/K-906
220 Manish Khandelwal, Jaipur LM-17/K-907
221 Anjali Tated, Pune ALM-17/T-307
222 Yugandhara Joshi, Pune LM-17/J-442
223 Rameshwar Hudekar, Thane ALM-17/H-125
224 Pooja Shetty, Boisar ALM-17/S-1489
225 Malini T, Thiruvananthapuram LM-17/T-308
226 Anupama Zade, Mumbai LM-17/Z-19
227 Manish Mittal, Jaipur ALM-17/M-811
228 Sandeep M.B, Ranebennur LM-17/M-812
229 Shraddha Patharkar, Pune LM-17/P-846
230 Nati Sudheera, Visakhapatnam ALM-17/S-1491
231 Arvind Amar, New Delhi ALM-17/A-542
232 Deepak Choudhary, Jodhpur LM-17/C-435
233 Vandana Sharma, Jodhpur LM-17/S-1492
234 Senthil Krishnan, Coimbatore LM-17/K-911
235 Pradeep Chinnapotala, Hyderabad LM-17/C-436
236 Shilpi Verma, Lucknow LM-17/V-304
237 Umar Wani, New Delhi ALM-17/W-67
238 Chashamjot Kaur, Ambala LM-17/K-909
239 Suresh Harikumar, Bangalore LM-17/H-126
240 Pardeep Ohri, Amritsar LM-17/O-19
241 Gerard J, Coimbatore LM-17/J-443
242 Arnab Sarkar, Dist Malda LM-17/S-1494
243 Samatha Kolla, Hyderabad LM-17/K-912
244 Rakesh Alur T, Chitradurga LM-17/A-543
245 Saurabh Shah, Akola LM-17/S-1493
246 Urvashi Modi, Gurgaon LM-17/M-813
247 Radhey Gangwar, Lucknow LM-17/G-685
248 Jaseem Baliyambra, Kozhikode LM-17/B-669
249 Rupankar Nath, Silchar LM-17/N-276
250 Lovely Thomas, Vellore LM-17/T-309
251 Sandip Kumar, Chennai ALM-17/K-910
252 Priyanka Priyanka, Berhampur LM-17/P-847
253 Zinzala Chhaganbhai, Surat ALM-17/C-437
254 Lalit Mohan, New Delhi ALM-17/M-814
255 Vivekananthan Poongavanam, Coimbatore LM-17/P-850
256 Shreyas Sanghavi, Karad ALM-17/S-1505
257 Suresh KG, Chennai LM-17/K-915
258 Mohammed Zuhaib, Mysore LM-17/Z-20
259 Murugesh Sukumar, Kochi LM-17/S-1506
260 Harish Azhaguraj, Dindugul Dist LM-17/A-550
261 Mohan Kaur, New Delhi LM-17/K-916
262 Kunal Sinkar, Mumbai LM-17/S-1507
263 Niharika Chaudhari, Mumbai ALM-17/C-439
264 Ashwin Bhosle, Navi Mumbai LM-17/B-673
265 Shaji Kumar Vaidyan, Kollam LM-17/V-308
266 Uzzwal Mallick, Jessore LM (SAARC)-17/M-823
267 Rajasri Kunche, Hyderabad LM-17/K-917
268 Maheeja Reddy, Ludhiana LM-17/R-554
269 Sushil Kumar, Hisar LM-17/K-918
270 Vinod Dhir, Gurgaon LM-17/D-542
271 Rakesh Chintalapani, Warangal LM-17/C-440
272 Nanda Bompelli, Warangal LM-17/B-674
273 Bindu Vasu, Kochi LM-17/V-309
274 Sanjeet Shrestha, Sinamangal LM (SAARC)-17/S-1508
275 Sukesh Kumar, Patna LM-17/K-919
276 Subhas Bhagat, Burdwan LM-17/B-675
277 Joyal Mathew, Trivandrum LM-17/M-816
278 Saumen Das, Nandia ALM-17/D-543
279 Digvijay Tiwari, Varanasi LM-17/T-311
280 Ravi Sriramoju, Karimnagar LM-17/S-1509
281 Trilok Siddabattula, Secunderabad LM-17/S-1510
282 Abuhena Kamal, Rajshahi LM (SAARC)-17/K-920
283 Prabhakar Sathiah, Thanjavur LM-17/S-1511
284 Mohit Mahajan, Pathankot LM-17/M-817
285 Priyadarshi Kumar, New Delhi LM-17/K-903
286 Sunil Gupta, Ghazipur LM-17/G-688
287 Vijay Chakkaravarthy, Chennai LM-17/C-441
288 Prabhuram Niranjan Gopalkrishnan, Coimbatore LM-17/G-689
289 Rashmi Prasad, Kovai LM-17/P-852
290 Richa Lohani, Ranipur LM-17/L-99
291 Prateek Koolwal, Jaipur LM-17/K-922
292 Karambir Gill, Ludhiana LM-17/G-690
293 Abhinav Jain, Sikar ALM-17/J-447
294 Prashanth Mukka, Hyderabad LM-17/M-818
295 Shankarappa Kabber, Bangalore LM-17/K-923
296 Abul Jaish, Hyderabad ALM-17/A-533
297 Zenith Sinojiya, Rajkot LM-17/S-1512
298 Piyush Kumar, Samastipur ALM-17/K-924
299 Davy Jindal, Bathinda ALM-17/J-448
300 Siddharth Bhargava, Ludhiana LM-17/B-676
301 Rajiv Lakhotia, Lucknow LM-17/L-100
302 Phaneendra B.V, Uppal LM-17/B-677
303 Sumitra Agarwal, Bhubaneshwar ALM-17/A-547
304 Ramanjula Reddy C, Hyderabad LM-17/R-555
305 Sandeep Dumbala, Hyderabad ALM-17/D-544
306 Abhishek Tiwari, Pratapnagar LM-17/T-312
307 Sajit Babu V A, Mumbai LM-17/V-311
308 Senthilkumar Thambithurai, Viluppuram LM-17/T-303
309 Nandita Deka, Amingaon ALM-17/D-545
310 Mrunmaya Mohanty, Cuttack ALM-17/M-819
311 Sandeep Kumar, Saharanpur LM-17/K-926
312 DineshKumar Pandor, Patan LM-17/P-853
313 Umesh Patel, Mehsana LM-17/P-854
314 Hiteshkumar Patel, Patan LM-17/P-855
315 Alpesh Prajapati, Kadi LM-17/P-856
316 Yagnesh Trivedi, Kadi LM-17/T-313
317 Anand Kakani, Amravati LM-17/K-927
318 Ippa Reddy, Dulapally LM-17/R-556
319 Girishma Tambhale, Aurangabad ALM-17/T-314
320 Gautam Panda, Bhubaneshwar ALM-17/P-857
321 Piyush Karande, Satara LM-17/K-928
322 Shahbaz Ahmad, Gorakhpur LM-17/A-548
323 Satish Kumar, Gorakhpur LM-17/K-929
324 Narendra Deo, Gorakhpur LM-17/D-546
325 Javedan Motlekar, Mumbai ALM-17/M-820
326 Nadeem Motlekar, Mumbai LM-17/M-821
327 Rashid Vasi, Mumbai LM-17/V-310
328 Mukesh Balguri, Jeedihetla (VIL) LM-17/B-679
329 Mithun Maniyala, Kottayam LM-17/M-822
330 Shubha Singhai, Jabalpur LM-17/S-1513
331 Shivesh Tomar, Jaipur LM-17/T-316
332 Vijayakumar S, Mysore LM-17/S-1514
333 Joseph Fidelis, Palayamkottai LM-17/F-31
334 Darshan Banker, Baroda LM-17/B-678
335 Manojkumar Parmar, Baroda LM-17/P-858
336 Piyush Ranjan, New Delhi LM-17/R-557
337 Ashim Samanta, Medinipur ALM-17/S-1515
338 Mohd Feroz, Hyderabad ALM-17/F-32
339 Bharath Juluganti, Chittoor LM-17/J-444
340 Sudivya Sharma, Mumbai LM-17/S-1495
341 Vippakayala Kumar, Hyderabad LM-17/K-913
342 Sambit Dash, Bhubaneshwar ALM-17/D-540
343 Gautam Saikia, Guwahati ALM-17/S-1496
344 Krishnaben Patel, Surat ALM-17/P-848
345 Alok Jain, Jaipur LM-17/J-445
346 Raju B, Mysore LM-17/B-670
347 Prithwijit Malakar, Kolkata ALM-17/M-815
348 Rishi Shankar, Mumbai LM-17/S-1497
349 Mukadder Ahmed, Raipur LM-17/A-549
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine16
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
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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
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