Critical Care - ISCCM1).pdf · 4 TIC C A T i A MONTHL NEWSLETT I SOCIET TIC MEDICINE dr. Subhal...

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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

[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,

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

[email protected]

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]


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


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


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


Dr. Alok Modi

Dr. Jai Prakash Pednekar

Dr. Suparna Nirgudkar

Dr. Bhavesh Nanda

Dr. Vinayak Gudekar

Dr. Ravindra Ghawat


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


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.


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 " 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 !!!!!!!!!!!!!!


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)

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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


dr Suresh ramasubbanMember - Executive and


dr Srinivas SamavedamMember - Executive and

Election Committee, iSCCM


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

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dr yatin Mehta President-Elect and Chief Election Commissioner, iSCCM

dr Vijaya P Patil Secretary and


dr Pradip Kumar Bhattacharya general Secretary - Elect and


dr Suresh ramasubbanMember - Executive and


dr Srinivas SamavedamMember - Executive and

Election Committee, iSCCM

Branch Events - Jalandhar


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


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


Guidelines for the Management of Candidiasis

CID 2016;62:1-50

Treatment of Candidemia in nonneutropenic 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


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


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


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


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


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

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

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

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

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