Critical Care - ISCCMcase reports, brief communications, interesting ECG's, X-rays, CT scans, MRI's...

Volume 8.1 JANuARY-FeBRuARY, 2013

Editorial officE

dr. Shivakumar iyerIndian Society of Critical Care Medicine, (ISCCM) Pune Branch

Karnik Heritage, Flat No 08, 3rd floor, Sadubhau Kelkar Road, Off F. C. Road, Pune - 411004, Maharashtra

Phone : 020-25532320 (from 11 am to 3 pm) emails : [email protected]

Published By :

IndIan SocIety of crItIcal care MedIcIne

For Free Circulation Amongst Medical Professional

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

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

C O N T E N T S

ISCCM NewsHeadlines ................. 1

ISCCM Elections 2013 Appeal ...... 1

Editorial ......................................... 2

Editorial Board 2012-2013 ............. 2

President's Desk ............................. 3

General Secretary's Desk ............... 4

BOOKREVIEW: The Checklist Manifesto ............... 4

College News .................................. 5

FCCS Courses at Jaipur & Gangtok ............................ 5

"The Chennai Declaration" Recommendations of "A roadmap- to tackle the challenge of antimicrobial resistance" - A joint meeting of medical societies of India ......................... 6-9

Journal Scan............................. 11-13

New Branches Approved ..............13

ISCCM Day Celebrations - A Report ...................................14-16

Calender of Events ........................16

CRITICARE 2013 .....................17-24

ISCCM NewsHeadlines Chennai Declaration – A visionary statement from a joint

committee of multiple Indian medical societies including

the ISCCm to tackle the menace of antibiotic resistance

ISCCm Hand Hygiene Day – a resounding success all

over India

ISCCm Kolkata 2013 – A curtain-raiser.

ISCCM Elections 2013 AppealPlease update your Email ID and

Register your mobile phone no with ISCCM

Dear members

Free and fair elections are the foundation of any democratic society. ISCCm

elections are now held online only. It is therefore, imperative that ISCCm has

email ids and mobile phone nos. of all its members for registering them on the

electoral rolls. You are therefore, requested to please update your email ids and

mobile numbers as soon as possible. election participation has been only 30% in

ISCCm election 2012. Please visit our website www.isscm.org for downloading

the membership update form. All branches have special duty for following this

task. I will be in touch with all branch secretaries for continuing this important

work for ISCCm election 2013.

Dr. Shivakumar IyerChairperson Election Commission • [email protected]

Dr. Vijaya P. Patil • Dr. Babu Abraham • Dr. Rajesh PandeyMembers Election Commission • [email protected]

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

A BI-MONTHLY NEWSLETTER OF INDIAN SOCIETY OF CRITICAL CARE MEDICINE www.isccm.org

We request

our esteemed readers to

send their valued feedback,

suggestions & views

at [email protected]

2 The CriTiCal Care CommuniCaTionsa Bi-monthly newsletter of indian society of Critical Care medicine

Editorial Board 2012-2013

eDItoR IN CHIeFDr. Shivakumar Iyer, Pune

09822051719 [email protected]

DePutY eDItoR

Dr. Jayant Shelgaonkar Dr. Krishan Chugh

098812288205 [email protected] [email protected]

memBeRS

NoRtH ZoNe WeSt ZoNe SoutH ZoNe CeNtRAl ZoNe eASt ZoNe

Dr. Jignesh Shah Dr. Suninder Arora Dr. Vijaya Patil Dr. Palepu Gopal Dr. Ranvir Tyagi Dr. Arindam Kar


[email protected] 09819883535 [email protected]



[email protected]

Editorialdr. Shivakumar Iyereditor, the Critical Care CommunicationsPresident-elect, [email protected]

Dear ISCCM members,

I will be completing a year as the editor

of Critical Care Communications (CCC).

At the outset I would like to thank all of you for

your support and encouragement. My editorial team

especially Dr. Jayant Shelgaonkar with his journal

scan has contributed a lot. I hope to elicit a greater

contribution from the remaining team and from

readers all over the country over the next year. From the next issue the CCC will

have an interactive electronic format which will reach all you by email. Please do

respond to the various articles with comments. Your contributions in the form of

case reports, brief communications, interesting ECG's, X-rays, CT scans, MRI's

are welcome.

ISCCM day was celebrated all over the country with enthusiasm. There are

reports on various events with pictures from all over the country.

The results of the ISCCM election 2012 have been declared at the November EC

meeting.

Dr. RK Mani will take over reins of the IJCCM from Dr. Shirish Prayag who did a

wonderful job as editor. CCC wishes Dr. Mani all the best in his new endeavour.

In this issue you will also find a book review on "Checklist Manifesto" a best

seller on the topic of patient safety by famous Indian-American author, Dr. Atul

Gawande. You will also find the detailed scientific program of the ISCCM Kolkata

conference. Workshop registrations are almost full and interested members

should register ASAP to avoid disappointment.

Looking forward to seeing all of you in Kolkata

The CriTiCal Care CommuniCaTionsa Bi-monthly newsletter of indian society of Critical Care medicine 3

dr. narendra rungta mD, FISCCm, FCCmPresident, ISCCm • [email protected]

President's Desk

Dear Reader

Please accept new year Greetings for you and your family. ISCCM is as

vibrant and dynamic as you can expect. The activities, growth and innovation

continues at a fair pace. With new year starting, we are inundated with new ideas, new

programs and fresh vision for future. This all has been possible through participation

of all the members of the society and guidance of senior leadership of the society past

and present. We are almost completing one year. I am sure the society is ready to move

into new era- New era of enhanced accomplishment at national level and ambitious

outlook internationally.

Kolkata Criticare 2013 is finally on wheels after few hiccups and I am sure the Organizing

committee will leave no stone unturned to make it a memorable event. The journey

of success of ISCCM has always been mainly stimulated by our annual conferences.

The coming Kolkata conference will only be another feather in cap of ISCCM. I invite

you all to this mega event. The Organizing team has made elaborate arrangements to

provide you with a feast of Critical Care Medicine and Bangla Hospitality.

Landmark constitutional amendments are being proposed to ensure greater

participation by younger generation in the affairs of the society. The Indian Journal

of Critical Care Medicine is expected to be more frequent, Webinars by college should

become a regular activity of the society, more fellows of Indian College of Critical Care

Medicine will be decorated, more funds are being made available for research, education

and development of programs in Critical Care Medicine, yet absolute austerity is being

maintained at the organizational level. I will be giving you a complete report of year in

retrospect in the next bulletin which should be in your hands during the Criticare 13 at

Kolkata.

The dream of Taking Critical Care to Places is being coming true. Northeast is vibrant,

other areas of the country are being tracked for development of Critical care Medicine.

My special thanks to Dr. Yatin Mehta, Dr. Arinadam Kar, Dr. Sunit Singhi, Dr. Deepak

Govil and Dr. Rajesh Pande for going out of way to assist me in performing my

Presidential duties. I take this opportunity to thanks my other fellow colleagues, EC

members, Past Presidents for being so helpful to me since I took over the Presidency of

the society.

NewsDr. RK Mani has been unanimously nominated as editor

IJCCM by the credentials committee and this was ratified

by the ISCCM EC on 4th november 2012 and will assume

office for the years 2013 -2014. Dr. RK Mani has a number

of publications to his credit and is on the editorial board

of various national and international journals. He takes

over from Dr. Shirish Prayag who did wonderful job in

establishing IJCCM firmly as an indexed journal during

his tenure. We wish Dr. Mani every success in taking the

IJCCM to ever greater heights.


General Secretary's Deskdr. atul P Kulkarni

General Secretary, ISCCm

Greetings to all new and old members of ISCCM and a wish for a great and successful new year! This issue contains the result of the electronic elections held

from 1st to 7th August 2012. I congratulate those elected to the National Executive body and wish them luck. It is unfortunate that we had correct contact data (e-mail addresses and mobile phone numbers) for only around 3800 life members out of over 5500 members and out of these 400 e-mails bounced. I urge all members to ensure that their e-mail addresses and mobile phone nos. are correctly registered at the head office. We have put up a list of members whose data with us is incomplete on the website. If you happen to be on that list please contact our office and we will send you an update form.

Dr RK Mani will soon take over as the editor of the IJCCM from Dr Shirish Prayag, who did an admirable job for our journal.

The “ICU Protocol Book” edited by Dr Chawla and Dr Todi has been a great success and is very popular. This is available at the head office. Please contact us by e-mail if you want to purchase the book. Similarly the DVDs of first series of

Webinars is also available at the office.

We shall soon send you the proposed amendments of the constitution to make the functioning of the society better. Please send in your suggestions to head office by e-mail. These will be discussed in the AGBM at Kolkata Congress.

The preparations for Criticare 2013 at Kolkata are in full swing and I am sure we will enjoy a wonderful scientific feast there at the beginning of March 2013.

With warm regards

CRITICARE 20131-6 March, 2013 • Science City, Kolkata

Block Your Dates for

BOOKREVIEW: The Checklist Manifesto

Dr Gawande is a Professor of Surgery at Harvard Medical School and also a staff writer for the New Yorker magazine. He has

written three New York Times bestselling books: Complications, Better and most recently The Checklist Manifesto.

The main aim of this book is to drive home the effectiveness of the checklist for preventing mishaps in medicine. We face complex problems in our field of work; the use of checklist can help us tackle them fairly comfortably. Dr Gawande proves his point regarding the usefulness of checklist with not only examples in the field of medicine but

also from aviation industry; which pioneered the use of checklist, the hotel industry, the construction business and capital industry. These cases from different fields make an interesting reading especially the emergency landing on the Hudson River being my personal favourite. In today’s world it is not enough to know everything but also to apply it at the right place and in the right order.

In medicine alone; in spite of being an era of superspecialities; simple tasks may be accidently missed or forgotten because of the work pressure and high work load; leading to an increased risk to the patient’s life. This can be avoided by a simple task – Use of a Checklist. In this book Dr Gawande has cited several benefits of using the checklist with supporting data; be it decreasing in line infections, decreasing complications by using the surgical checklists and tackling complex cases of drowning. Dr Gawande ends the book by citing cases where the checklist has made a difference to his practice as a surgeon after the implementation of WHO Surgical Checklist at his hospital.

Notably missing is the mention of the disadvantages of using checklist and the instances where checklist would be detrimental to use. Medicine is a complex arena; the use of checklist at all junctures is not always possible. Each patient is different and may present with many co-existing problems and hence will need treatment tailored to his or her condition. The checklist is rigid and will fail in such circumstances. It is important to give people the freedom to try and invent and to take responsibility which forms an important part of development of self. Sticking to protocols or checklist will kill the initiation and invention of new therapies.

On the whole; the book is mentally stimulating and gives perspectives on how checklist can make a difference to patient care and outcome in our practice. The lesson learnt is that by using simple checklists, we can get the basics right in many areas of our work. The hurdle is how to make effective use of checklists without losing efficiency and too much time.

dr. reshma ambulkar1

dr. atul Kulkarni2

1Associate Professor, 2Professor, Department of Anaesthesiology, Critical Care & Pain, tata memorial Hospital, mumbai.


CollegeNews

dr. n. ramakrishnan AB (Int med), AB (Crit Care), mmm, FACP, FCCP, FCCm, FICCmSecretary, Indian College of Critical Care medicine

2012 was a very special year for all of us as Critical Care Medicine was recognized by Medical Council of India as a superspecialty and DM Courses were started. While rejoicing this, our society also reiterated the commitment to education and training by taking a giant leap and creating Indian College of Critical Care Medicine. We are indeed proud that we are one of the few professional societies which such a designated body focusing on education.

As we reflect on the past year, I would like to summarize the activities of the College and thank everyone for making 2012 a very ‘educative’ year

• The first Convocation Ceremony held during Criticare 2012 at Pune when distinguished peers were honored with fellowship for their commitment and contributions to our society

• The much awaited Post MBBS Course was launched thanks to efforts from our President Dr. N. Rungta & Dr. Yatin Mehta who developed the curriculum and accepted to be the Coordinator for the course

• Efforts were initiated to plan a training program for Critical Care Nurses. Dr. Prakash Shastri has taken the lead to create the curriculum and this program is expected to be started soon.

• We are now proud to have a book from India for India and the rest of the world – Dr. Rajesh Chawla and Dr. Subhash Todi edited a book entitled “ICU Protocols – A stepwise approach” published by Springer. Several thousand copies of the book have already been sold and there have also been several online download of chapters through the Springer website.

• Based on the ICU Protocols book, we are soon planning a two day “Comprehensive Critical Care Course” and the first of these courses would be offered during Criticare 2013 at Kolkata. We are confident that such a program designed to suit our local needs would be a great value addition.

• The use of technology has certainly helped reach more intensivists through our webinars that were well received and attended. Selected lectures have also been released in a DVD format that is available for purchase from ISCCM head office. We are initiating the second webinar series from February 2013.

• IDCCM & IFCCM Courses continue to remain popular. A special thanks to Dr.

Dhruva Chaudhry, our Accreditation Coordinator who has hastened the process of accreditation. Several new institutions were accredited and we now have over 100 institutions across the country offering our training programs

o 182 candidates registered for IDCCM in 2012 of whom 107 were successful

o 14 candidates appeared for IFCCM in April 2012 and five of them were successful. Of note, candidates from ‘alternative pathway’ appeared for the first time this year

None of these could have been accomplished without the commitment of the College Board under the leadership of Dr. J. V. Divatia (Chancellor) and Dr. Rajesh Chawla (Vice Chancellor) and the entire Executive Committee under the leadership of Dr. N. Rungta. Needless to say that the enthusiasm & requests from our members has been a great source of inspiration to do more.We look forward to enhancing educational offerings even more in 2013 and would greatly appreciate any suggestions from members of our society.

We congratulate the toppers in 2012 who will be receiving the following awards during the Convocation Ceremony to be held on March 1, 2013 during Criticare 2013 at Kolkata

1. Dr. Vijayalakshmi Kamat Award for topper in IDCCM – Dr. G. Sathyamurthy (Sundaram Medical Foundation Hospital, Chennai)

2. Anand Memorial Award for topper in IDCCM – Dr. Pritesh John Korula (Christian Medical College, Vellore)

3. Anand Memorial Award for topper in IFCCM – Dr. Prashant Walse (P D Hinduja Hospital, Mumbai)

IDCCM & IFCCM Awards

JAIpuR

GaNGtoK

FCCS Courses at Jaipur & Gangtok

Reported by

dr. Manish Munjal, Jaipur

Indian Society of Critical Care Medicine, Jai-pur Chapter organized the 85th Fundamental Critical Care Course (FCCS) in India at Jee-van Rekha Critical Care & Trauma Hospital, Jaipur on 12th and 13th of January 2013.

Reported by

arindam Kar, east Zone member ISCCm

Fundamental Critical Care support (FCCS) Course was held on 29-30th September 2012 at

lighting of lamp. What followed were two days of interesting and useful discussions, teaching and most importantly hands on experience. The course was conducted under able guidance of Dr Manish Munjal, National Course Director of FCCS, and with blessings from Dr Narendra Rungta, President of executive body of ISCCM.

The Course was supported by funds from Medical Council of India, Sikkim Manipal University, and Industry (Alere, Micro-Labs, Lupin Maxter, and United)

Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim. This is was the 70th FCCS course in India, and first in the North-Eastern region.

The course lectures and skill stations were conducted in the CRH Building of the institute. There were a total of 40 provider and two instructor candidates who attended the course. The course participants were from Sikkim, North Bengal, Meghalaya, Orissa, Jharkhand, Madhya Pradesh and Maharashtra. A total of nine faculty members covered 17 lectures and eight skill stations over two full days. The course faculty included intensivists, anesthesiologists and internists across the country.

The course was inaugurated by Brig SN Mishra, Vice chancellor, Sikkim Manipal University, Dr RN Salhan Dean SMIMS and Pro VC Sikkim Manipal University, Dr Kundan Mittal, National consultant PFCCS Program, and Dr Arindam Kar, Zonal Member East ISCCM executive council, by


"The Chennai Declaration" Recommendations of "A roadmap- to tackle the challenge of antimicrobial resistance" - A joint meeting of medical societies of IndiaGhafur a1, Mathai d2, Muruganathan a3, Jayalal Ja4, Kant r5, chaudhary d6, Prabhash K7, abraham oc8, Gopalakrishnan r9, ramasubramanian V10, Shah Sn11, Pardeshi r12, Huilgol a13, Kapil a14, Gill JPS15, Singh S16, rissam HS17, todi S18, Hegde BM19, Parikh P20

1 Coordinator, Road map meeting and Antibiotic Stewardship Committee 6&18 Representatives, Indian Society of Critical Care medicine

Indian J Cancer [Epub ahead of print] [cited 2012 Dec 28]. Full document available from : http://www.indianjcancer.com/preprintarticle.asp?id=104065

Abstract“A Roadmap to Tackle the Challenge of Antimicrobial Resistance - A Joint meeting of Medical Societies in India” was organized as a pre-conference symposium of the 2nd annual conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai on 24th August. This was the first ever meeting of medical societies in India on issue of tackling resistance, with a plan to formulate a road map to tackle the global challenge of antimicrobial resistance from the Indian perspective. We had representatives from most medical societies in India, eminent policy makers from both central and state governments, representatives of World Health Organization, National Accreditation Board of Hospitals, Medical Council of India, Drug Controller General of India, and Indian Council of Medical Research along with well-known dignitaries in the Indian medical field. The meeting was attended by a large gathering of health care professionals. The meeting consisted of plenary and interactive discussion sessions designed to seek experience and views from a large range of health care professionals and included six international experts who shared action plans in their respective regions. The intention was to gain a broad consensus and range of opinions to guide formation of the road map. The ethos of the meeting was very much not to look back but rather to look forward and make joint efforts to tackle the menace of antibiotic resistance. The Chennai Declaration will be submitted to all stake holders.

Background and Current Indian ScenarioAntimicrobial resistance is a serious global challenge, with the menace of antibiotic resistant “super bugs”, with posiible return to the pre-antibiotic era. There is a dramatic increase in the prevalence of superbugs, and there is an equal drop in the number of new antibiotics available. The pipeline of antibiotic research and development is nearly dry, especially when it comes to antibiotics active against Gram-negative bacteria. Research and development of any antibiotic is a huge investment for pharmaceutical industry.3 There is currently no functioning national antibiotic policy or a national policy to contain antimicrobial resistance in India. The policy published in 2011 has been put on hold due to non implementability

of major recommendations.4-5 There is no restriction on Over The Counter (OTC) dispensing of antibiotics without prescription. Indian hospitals have reported very high Gram-negative resistance (ESBL producers) and carbapenem resistance rates. Increasing carbapenem resistance will invariably result in increased usage of colistin, currently the last line of defence, with a potential for colistin-resistant and Pan Drug Resistantth bacterial infections.8-10 There is paucity of published data on the existence of an antibiotic policy in the majority of Indian hospitals or on their compliance with existing policies. 11-14 There are major international efforts to tackle the challenge of antimicrobial resistance. 17-20 The Indian medical community is seriously concerned about the high resistance rate in our country and would like to partner with Indian authorities in tackling the issue and joining the global fight against antimicrobial resistance.

Development of Road Map“A Roadmap to Tackle the Challenge of Antimicrobial Resistance - A Joint meeting of Medical Societies in India” was organized as a pre-conference symposium of the 2nd annual conference of the Clinical Infectious Disease Society (CIDSCON 2012) at Chennai on 24th August. This was the first ever meeting of medical societies in India on issue of tackling resistance, with a plan to formulate a road map to tackle the global challenge of antimicrobial resistance from the Indian perspective. We had representatives from most medical societies in India, eminent policy makers from both central and state governments, representatives of World Health Organization, National Accreditation Board of Hospitals, Medical Council of India, Drug Controller General of India, and Indian Council of Medical Research along with well-known dignitaries in the Indian medical field. The meeting was attended by a large gathering of health care professionals. The meeting consisted of plenary and interactive discussion sessions designed to seek experience and views from a large range of health care professionals and included six international experts who shared action plans in their respective regions. The intention was to gain a broad consensus and range of opinions to guide formation of the road map. The ethos of the meeting was very much not to look back but rather to look forward and make joint efforts to tackle the menace of antibiotic resistance. The Chennai Declaration

will be submitted to all stake holders.

Aim of the ‘Road map meeting’ and ‘Chennai Declaration’Aim of the “Road map meeting” and “Chennai Declaration” was to initiate efforts to formulate a national policy to control the rising trend of antimicrobial resistance (AMR), after consultation with all relevant stake holders and to take all possible measures to implement the strategy.

Executive summary1. Increasing antimicrobial resistance is a

serious global and regional challenge. There is an urgent need to initiate measures to tackle the scenario and join international efforts to control this menace.

2. The Indian Ministry of Health (MOH) will need to take urgent initiatives to formulate a national policy to control the rising trend of antimicrobial resistance, after consultation with all relevant stake holders and then take all possible measures to implement the policy.

3. The Drugs Controller General of India (DCGI) will need to formulate and implement a policy on rationalizing antibiotic usage in the country, both in hospitals and over the counters, after consultation with stake holders and experts in the field.

4. State Departments of Health will need to take initiatives to improve infection control standards and facilities in hospitals and encourage implementation of regional antibiotic policies, pending formulation and publication of a national policy. Once a national policy is formulated, whole hearted support for this policy by the state DOH is needed for implementation.

5. The Medical Council of India will need to make necessary curriculum changes so as to include a structured training on antibiotic usage and infection control at the undergraduate and post-graduate level.

6. An Infection Control Team (ICT) must be made mandatory in all hospitals. Regulatory authorities and accreditation agencies (NABH, ISO) must insist on a functioning ICT, during the licensing and accreditation process.


7. State Department of Health (DOH) should take initiatives in organizing regional and state infection control committees to supervise the functioning of hospital ICT.

8. A National Task Force should be set up to guide and supervise the regional and state infection control committees.

9. The National Accreditation Board of Hospitals (NABH) is required to insist on strict implementation of hospital antibiotic and infection control policy, during hospital accreditation and re-accreditation processes. Hospitals without compliance with the policy should not be given accreditation.

10. The Indian Council of Medical Research should broaden the antimicrobial resistance surveillance network, incorporating hospitals from both the government and private sector. ICMR will need to provide funds for research on antimicrobial resistance, drug development, and vaccines.

11. The Indian division of the World Health Organization should step up interaction with the government on issues related to drug resistance, antibiotic policy, and infection control.

12. There is an urgent need to standardize Microbiology laboratories in India. Hospitals must have good quality Microbiology laboratory or should be willing to outsource specimens, in the absence of a standardized laboratory.

13. Medical societies to take active interest in initiating infection control and antibiotic stewardship awareness activities among the society members, utilizing the extensive network of local branches of all societies.

14. Medical journals should make deliberate attempts to educate readers on infection control and national antibiotic policy-related issues.

15. Electronic and print mass media should take initiatives on public awareness campaigns on the dangers of misuse of antibiotics.

16. Non-Governmental Organizations (NGOs) - national and international- have played a pivotal role in disseminating public information and funding research in diseases like cancer and cardiac diseases. They should come forward with similar enthusiasm to tackle antibiotic resistance issue, with the same vigor.

17. There is a need to evaluate the extent and to regulate the usage of antibiotics in veterinary practice.

Objectives

Regulate over the counter sale of antibiotics It is obvious that ban of 'Over the Counter' (OTC) sale of all antibiotics without prescription will be the ideal step, but whether

such a strict policy could be implemented is questionable. It is debatable whether we have enough drug inspectors and infrastructure to monitor OTC dispensing of all antibiotics. A practical approach will be to formulate a list of antibiotics with strict monitoring on the dispensing of these drugs. Step- by- step introduction of other drugs to the restricted list could be tried later. [Table 1]. The following strategies can be considered:Strategy 1: Complete ban on OTC sale of antibiotics without prescription throughout the country.Strategy 2: Complete ban of OTC sale of antibiotics without prescription in metros and larger cities with a more liberal approach in smaller cities and villages.Strategy 3: A liberal approach throughout the country to start with, with an initial list of antibiotics under restriction and addition of other drugs to the list in a phased manner.

In-hospital antibiotic usage monitoringSurveillance on the usage of all antibiotics will be the ideal way to achieve this aim. This may be an impossible task in the current Indian context, considering the lack of resources in many hospitals. Monitoring higher-end antibiotics will be a more practical and implementable strategy. Monitoring should be more vigilant for third line antibiotics active against Gram-negative bacteria.Strict monitoring on the usage of colistin, must be implemented on an urgent basis. Colistin prescription should be in duplicate, with a copy to be sent to the pharmacy. The prescription must be countersigned by a consultant in 24 hours. In addition, a second opinion by an antibiotic steward within 48-72 hours must be made compulsory. This will allow any doctor to use this life-saving drug in emergencies and at the same time, misuse will be prevented by the compulsory rule of getting a second opinion. Carbapenem and tigecycline (the other higher-end antibiotics with Gram-negative spectrum) usage should be subjected to similar stringent supervision [Table 2].A similar approach would be ideal in the case of higher-end antibiotics with Gram-positive spectrum as well, but may be difficult to implement.The hospital infection control committee should monitor compliance to the surgical prophylaxis policy.

Audit and feedbackPharmacist should keep track on the usage of higher-end antibiotics and should provide a daily list to the infection control team. The infection control team should follow-up the cases on a daily basis, discuss with the antibiotic steward, and give feedback to the primary consultant.

Table 1: Rationalizing OTC sale of antibiotics- Step by Step Approach

Antibiotics that need a prescription (*duplicate) of a registered medical practitioner prior to dispensing

No need of Prescription Many or may not need prescription *need consensus

• All injectable Antibiotics• Oral antibiotics • Linezolid • Forepenem • Newer Quionolones-levofloxacin, moxifloxacin, sparfloxacin,

pazufloxacin etc, • Chloramphenicol • 3rd generation cephalosporin- Cefdinir, cefpodoxime, cefixime*Pharmacy to retain the duplicate prescription

• Ampicillin, Amoxicillin, co-amoxiclav

• Erythromycin, clindamycin

• Nitrofurantoin• Doxycycline• Ciprofloxacin

• First & second generation cephalosporins cefadroxil, cephalexin, cefaclor

• Cefuroxime• Cotrimoxazole• Azithromycin, clarithromycin

Initiate measures to step up microbiology laboratory facilitiesAvailability of standardized microbiology laboratories is limited to bigger hospitals and major cities. Measures should be initiated to expand the network of accredited laboratories. In order to overcome the problem of financial constraints in a resource-limited setting, low-cost diagnostic methods and rapid bedside diagnostics should be explored.

National antimicrobial resistance surveillance system Department of Health and Indian council of Medical Research (ICMR) should establish a national antibiotic resistance surveillance system with representation from all regions in the country. Periodic publication of collated data in a key national journal will serve as a benchmark for antibiotic usage and resistance load in hospitals.

Role of ministry of healthMinistry of Health should take urgent initiative to formulate a national policy in order to control the rising trend of antimicrobial resistance, after consultation with all relevant stake holders and take all possible measures to implement the strategy. National Antibiotic Policy must have generic domains of agreement but should be subject to local adaptation depending on resistance patterns and resources. Department of Health (DOH) to make regulations to reinforce infection control measures in all hospitals.DOH to support, through the development of a national network, surveillance of AMR (Antimicrobial Resistance) and consumption and quality of prescribing. DOH to conduct public awareness campaigns through media and encourage private

Table 2: In-hospital higher-end antibiotic usage monitoring

• Colistin, carbapenem, and tigecycline needs strict monitoring.

• Usage needs to be endorsed by another consultant within 72 hours.

• Higher-end antibiotics with Gram-positive spectrum (teicoplanin, vancomycin, daptomycin, linezolid).

• Need monitoring (strict regulation may not be practical).

• Need to complete an antibiotic monitoring sheet.

• Prescription in duplicate. Copy to be sent to the pharmacy.

• Pharmacist to maintain records on higher-end antibiotic usage.

• Infection control committee will monitor the data at least every three months.


organizations to conduct similar campaigns. Encourage research to develop new antibiotics and vaccines. DOH working in close collaboration with the insurance industry, represented by Federation of Indian Chamber of Commerce and Industry (FICCI), to lay down standard treatment guidelines for diseases after consulting with national experts (including proper antibiotic use), which will be linked to third party payment for the hospitalized patients.

Role of Drugs Controller General of India (DCGI)Urgent measures are needed to regulate over the counter sale of antibiotics (OTC) and rationalize in-hospital antibiotic usage, especially higher-end antibiotics. DCGI has a significant role to play in the initiation of the OTC regulation. Though this is a major challenge, there should not be any delay in initiation of serious efforts.

Hospital Infection Control Committee (HICC)All hospitals must have an infection control committee and an antibiotic policy and should initiate or augment efforts towards implementation.Those hospitals with an existing ICC and an antibiotic policy should augment efforts to increase compliance to the policy. ICC should define an annual target for achievement.

Figure 1: Hierarchy of infection control committee

Hospital accreditation agencies can assess the compliance to the policy. All hospitals must have an infection control team, under the leadership of an infection control consultant, who can be an infectious diseases specialist, a microbiologist with training in infection control or a physician of any specialty with training in infection control. Wholehearted support of the hospital management is essential for the effective functioning of ICT.

Antibiotic steward An antibiotic steward is a physician who is trained in infectious diseases and infection control or a microbiologist with training in infection control and antibiotic stewardship. In hospitals without an ID physician or microbiologist, any clinician with special interest in infection control and antibiotic stewardship can function as an antibiotic steward. Antibiotic steward should be responsible for giving a second opinion on higher-end antibiotic usage. Availability of more than one antibiotic steward in any one hospital will provide flexibility and choice.

Regional (District) Infection Control and Antibiotic Stewardship CommitteesRegional infection control committees could be established to assist and supervise the infection control activities in the region. All hospitals

in the region, both government and private, should be under the guidance of the regional committee.

Central Task ForceA central task force should be formed to supervise the infection control and antibiotic stewardship activities at a national level. The task force should include representatives of all major stake holders; regional and national.Presence of state task forces can bridge the activities of the regional committees with the central task force.

Role of Microbiology LaboratoriesLack of standardization of microbiology laboratories is a serious issue, which needs urgent attention of the policy makers. Microbiology labs should issue hospital antibiogram at pre-defined intervals. Those hospitals without good laboratory support should be willing to outsource samples to better laboratories. Multidrug-resistant bacteria, especially pan-drug-resistant bacteria, must be considered as a notifiable entity. Such a reporting system should complement national antimicrobial resistance surveillance studies. Indian Microbiologists should expand their role from the conventional microbiologist working in a laboratory to an active player in directing interventions in the prevention of HAIs, deciding antibiotic policy and authorizing use of reserve antibiotics, planning and strengthening of diagnostic facility, choosing rapid, sensitive, and specific diagnostic tests, and monitoring antimicrobial resistance [Table 3].Hospital microbiology laboratories should follow standard protocols for susceptibility testing.Hospitals to send Antimicrobial Susceptibility Testing (AST) to standardized labs to avoid erroneous reporting of organisms and their susceptibility pattern.

Role of National Accreditation Board of Hospitals (NABH)National accreditation board of hospitals can play a very significant role in implementing infection control and antibiotic stewardship policy in Indian hospitals. There is no published data on the level of compliance of NABH accredited hospitals to the antibiotic policy and infection control guidelines. NABH should formulate more efficient ways of assessing the compliance to the guidelines. NABH to insist on strict implementation of hospital antibiotic and infection control policy, during hospital accreditation and re-accreditation processes.

Role of medical council of IndiaOne of the main reasons for the inappropriate antibiotic usage by Indian doctors is the lack of adequate training on the subject during undergraduate and post-graduate courses.

Curriculum changeStructured training in antibiotic usage and infection control should be introduced in both UG and PG curriculum. Post-MD/DNB (Internal Medicine) sub-specialization in Infectious Diseases, (leading to DM/DNB) should be introduced in all post-graduate centers that offer sub-specialty training. MD microbiology: Compulsory training in infection control and antibiotic stewardship. Antibiotic stewardship and infection control one week rotation-3 rd , 4 th , and final year MBBS.

Role of medical teachersTeachers should be role models to their students in wise and appropriate antibiotic

Central Task ForceRepresentatives of all medical societies

DOH, DCGI, MCI, NABH, ICMR, WHO representatives

Infection Control nurses

Can have meetings over teleconferencing

Task force must have a communication / media plan so that all its decision are conveyed to media

Regional (District) and State Infection Control Committees

To monitor infection control standards To conduct awareness activitiesTo audit hospital higher end antibiotic usage.Members from all relevant fields, drugs controller / representative, representatives from government hospitals.Representatives from private hospitals, Physicians, Microbiologists, Intensivist, Gynaecologist, Surgeons, Oncologist, etc.Infection control nurses, Pharmacists, Hospital administrators

Composition of Hospital ICTInfection control consultant

Infectious diseases consultant / Microbiologist / Physician interested in infection control.

Infection control nurse, Hospital Medical Superintendent, Chief Executive Officer, and Medical director.

Housekeeping supervisor, Operation theatre in charge.

Representatives of all major departments [Minimum 3 clinicians - a surgeon, a physician and at least one other]

To meet at predefined intervals (Eg. 3 monthly) and evaluate infection control practices


usage,infection control practices and as rational prescribers.

Role of director of medical education (DME)State Department of Health and the Directorate of Medical education should take very active initiatives in implementing the national antibiotic policy and the curriculum change recommended by the MCI. DME should support establishment of infection control committee in all medical college hospitals and consduct regular CMEs on proper antibiotic usage.

Role of directorate of public health (DPH) and medical services (DMS)DPH and DMS will have pivotal role in implementing infection control and antibiotic stewardship policies in government hospitals, and organizing fund for antibiotic stewardship training.

Role of World Health Organization (WHO) WHO should co-ordinate initiatives in various countries, provide technical support, and organize awareness activities. High quality infection control set-ups in developed countries

may not be fruitful unless countries with high resistance rates and less stringent infection control facilities take serious measures to control resistance. WHO can play significant role in helping countries who lack. Indian division of the WHO should be proactive in tackling resistance initiatives and interact with the Indian government. WHO should take initiatives in establishing an international fund to tackle resistance to help resource-limited countries, provide technical and monetary help in tackling AMR initiatives.

Role of medical societies in implementing antibiotic stewardship‘Road map meeting’ and the ‘Chennai Declaration’ are the typical examples of the willingness of medical societies to work together for a common cause. Medical societies in India always took active interest in public health issues and have made significant contributions in all initiatives. Even though the issue of antibiotic resistance existed for long time, serious discussion on the subject started only in recent years. Medical societies should disseminate policy decisions to all society members and public through professional and public and social networking media.

Action plan of all societies for the coming year - Spreading message on rational usage of antibiotics and infection control.Encourage members of the society to attend short courses to qualify to be an antibiotic steward. Dedicated sessions on infection control, antibiotic stewardship in society conferences and workshops for tackling resistance.

Role of medical journalsJournals must make deliberate attempt to educate readers on infection control and national antibiotic policy-related issues and publish more articles on the subject of antibiotic stewardship and infection control. A joint meeting of journal editors to implement this agenda should be explored.

Role of mass mediaInternational media have played a significant role in the success of public awareness activities on the danger of overuse of antibiotics. Indian media should follow similar examples .Media should take initiatives in public awareness regarding “Bad bugs, no drugs” concept.

Veterinary antibiotic usageVeterinary antibiotic usage as a growth promoter or for prophylactic and therapeutic indications is a major contribution to the resistance scenario, which might be passed from animals to humans directly or indirectly via food, environment, or during animal husbandry practices The magnitude of veterinary antibiotic usage is not well-studied in India. There is need to evaluate the extent of antibiotic usage in the veterinary practice, its indications of use and regulate the same. There is also urgent need for regular monitoring of residues of antibiotics in food of animal origin and study their role. Formulation and implementation of regulations for withholding periods between the use of antibiotics and animal slaughter or milking have to be evolved.

National antibiotic awareness dayA designated “National Antibiotic Awareness Day” will help in propagating the importance of tackling antibiotic resistance among health care workers and the public, giving opportunity

to all stake holders to appraise their previous work and plan future activities.

Where does the road map head?“Road map meeting” decisions - The “Chennai declaration” will be submitted to all sectors of the relevant governmental and non-governmental bodies, medical societies, and all major stake holders. The road map should form the template for regional and local framework for combating AMR. Progress with the implementation of the Road map will be assessed annually by a joint committee during the annual conference of one of the participating medical societies. Road map committee of medical societies will communicate with all stake holders to collect data on the progress. The central task force can categorise the recommendations into major and minor on priority basis, assess the progress of implementation and the compliance by all stake holders. The road map will be a dynamic process, subject to further adaptation with time, experience, and maturity.

Measurable goals of the road map

First yearFormulation of a national policy to combat antimicrobial resistance.1. Initiation of efforts to implement major

components of the policy.2. Sixty percent compliance rate to major

recommendations by all stake holders.

Second yearCompliance rate to reach 70%.1. Initiation of efforts to implement minor

components of the policy.2. India achieving the status of a country

with a functioning antibiotic policy despite limitations.

Next five years1. More than 90% compliance rate to major

and minor components of the policy.2. India achieving the status of a country with a

functioning antibiotic policy comparable to those countries with high quality infection control and antibiotic policy compliance rates.

ConclusionSerious concern about the rising trend of antimicrobial resistance in the country has prompted medical societies to hold the joint «Road map meeting» in order to seek practical, implementable solutions to the problem. We have considered the Indian scenario on the ground before making the recommendations. We believe that if we have the will and resolve, the «Chennai Declaration» targets can very easily be achieved.

DisclaimerThe opinions expressed in “Chennai Declaration” are those of the authors. The opinions do not reflect in any way to those of the institutions, to which the authors are affiliated. We express our gratitude to the governmental bodies like DCGI, MCI, NABH, ICMR, and World Health Organization for participation in the “Road map meeting,” but the opinions expressed in “Chennai Declaration” do not, in any way, belong to these organizations. We also express our gratitude to the international representatives for their participation in the meeting and sharing their experience.

Abridged by Dr. Palepu Gopal

Table 3: Role of microbiologists and microbiology laboratories

1. Constantly changing spectrum of Multi Drug Resistant (MDR) pathogens and the availability of newer technologies calls for the need of regular communication between the microbiologists and clinicians.

2. Microbiology labs need to be strengthened and be proactive with rapid & molecular diagnostics, early identification of emerging pathogens and detecting resistance accurately.

3. Generating cumulative antibiograms for emerging patterns of resistance.

4. Determining molecular epidemiology of resistant strains.

5. Dissemination of data at frequent and regular intervals.

6. Develop networking of institutes, Govt. and private hospitals/labs.

7. Develop standardized laboratory methods & Quality control protocols, for reliable data.

8. Rapid, sensitive, specific and point of care tests - baterial infections / resistance

9. Taking technology to the field - microarray based, real time PCR based.

10. Mandatory NABL accreditation of the clinical laboratories.

11. Restrictive reporting of antibiotics. Microbiologists should release the sensitivity report on higher - end antibiotics, only if the bacteria are Multi Drug Resistant.

12. government support for capacity building.

13. Identify Institutions in different regions as referal labs which will be responsible for making a repository of bacterial strains of interest / rare resistant markers, undertake genotyping of the resistant isolates and study emergence of new mechanism of resistance.


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dr. Jayant ShelgaonkarDirector, ICu, Aditya Birla Hospital, Pune

Effectiveness of a multidimensional

approach for prevention of ventilator-associated

pneumonia in adult intensive care units from

14 developing countries of four continents: Findings

of the International Nosocomial Infection Control Consortium

Association between systemic corticosteroids

and outcomes of intensive care unit–acquired

pneumonia

Corticosteroids and intensive care unit–

acquired pneumonia*

Rosenthal, Victor D. MD; Rodrigues, Camilla MD; et al. Critical Care Medicine:

December 2012 - Volume 40 - Issue 12 - p 3121–3128

the aim of this study was to analyze the effect of the International Nosocomial Infection Control Consortium’s multidimensional approach on the reduction of ventilator-associated pneumonia in patients hospitalized in intensive care units.

A prospective active surveillance before–after study. the study was divided into two phases. During phase 1, the infection control team at each intensive care unit conducted active prospective surveillance of ventilator-associated pneumonia by applying the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the methodology of International Nosocomial Infection Control Consortium. During phase 2, the multidimensional approach for ventilator-associated pneumonia was implemented at each intensive care unit, in addition to the active surveillance.

Forty-four adult intensive care units in 38 hospitals, members of the International Nosocomial Infection Control Consortium, from 31 cities of the following 14 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, lebanon, macedonia, mexico, morocco, Panama, Peru, and turkey.

A total of 55,507 adult patients admitted to 44 intensive care units in 38 hospitals.

the International Nosocomial Infection Control Consortium ventilator-associated pneumonia multidimensional approach included the following measures: (1) bundle of infection-control interventions; (2) education; (3) outcome surveillance; (4) process surveillance; (5) feedback of ventilator-associated pneumonia rates; and (6) performance feedback of infection-control practices.

the ventilator-associated pneumonia rates obtained in phase 1 were compared with the rates obtained in phase 2. We performed a time-series analysis to analyze the impact of our intervention.

During phase 1, we recorded 10,292 mechanical ventilator days, and during phase 2, with the implementation of the multidimensional approach, we recorded 127,374 mechanical ventilator days. the rate of ventilator-associated pneumonia was 22.0 per 1,000 mechanical ventilator days during phase 1, and 17.2 per 1,000 mechanical ventilator days during phase 2.the adjusted model of linear trend shows a 55.83% reduction in the rate of ventilator-associated pneumonia at the end of the study period; that is, the ventilator-associated pneumonia rate was 55.83% lower than it was at the beginning of the study.

the implementation the International Nosocomial Infection Control Consortium multidimensional approach for ventilator-associated pneumonia was associated with a significant reduction in the

Ranzani, Otavio Tavares MD; Ferrer, Miquel MD, PhD; et al.

Critical Care Medicine: September 2012 - Volume 40 - Issue 9 - p 2552–2561

the use of corticosteroids is frequent in critically-ill patients. However, little information is available on their effects in patients with intensive care unit–acquired pneumonia. We assessed patients’ characteristics, microbial etiology, inflammatory response, and outcomes of previous corticosteroid use in patients with intensive care unit–acquired pneumonia.

Prospective observational study was conducted at Intensive care units of a university teaching hospital.

three hundred sixteen patients with intensive care unit–acquired pneumonia. Patients were divided according to previous systemic steroid use at onset of pneumonia.

Interventions: None.

measurements and main Results: Survival at 28 days was analyzed using Cox regression, with adjustment for the propensity for receiving steroid therapy. One hundred twenty-five (40%) patients were receiving steroids at onset of pneumonia. Despite similar baseline clinical severity, steroid treatment was associated with decreased 28-day survival (adjusted hazard ratio for propensity score and mortality predictors 2.503; 95% confidence interval 1.176–5.330; p = .017) and decreased systemic inflammatory response. In post hoc analyses, steroid treatment had an impact on survival in patients with nonventilator intensive care unit–acquired pneumonia, those with lower baseline severity and organ dysfunction, and those without etiologic diagnosis or bacteremia. the cumulative dosage of corticosteroids had no significant effect on the risk of death, but bacterial burden upon diagnosis was higher in patients receiving steroid therapy.

Conclusions: In critically-ill patients, systemic corticosteroids should be used very cautiously because this treatment is strongly associated with increased risk of death in patients with intensive care unit–acquired pneumonia, particularly in the absence of established indications and in patients with lower baseline severity. Decreased inflammatory response may result in delayed clinical suspicion of intensive care unit–acquired pneumonia and higher bacterial count.

ventilator-associated pneumonia rate in the adult intensive care units setting of developing countries.

of hydrocortisone on pneumococcal pneumonia (1). Patients prescribed corticosteroids in addition to penicillin defervesced more quickly and had less pleuritic pain compared to controls. this study suffered from a weak randomization strategy, incomplete blinding, and the selection of questionable outcomes, but the notion that corticosteroids might help patients with pneumonia by attenuating inflammatory cascades still exercises physicians’ imaginations. A steady flow of investigations have continued to probe the relationship between corticosteroids and pneumonia (2). Recent studies have focused on community-acquired pneumonia of moderate severity, defined as requiring admission to hospital, and community-acquired pneumonia of high severity, defined as requiring admission to an intensive care unit (ICu) (3, 4). the study by Ranzani and colleagues (5) in this issue of Critical Care Medicine extends this field of investigation to ICu-acquired pneumonia.

the authors’ decision to evaluate ICu-acquired pneumonia was reasonable, given the signal from the septic shock literature that corticosteroids probably only benefit the sickest of patients (if any). the divergent results of the trial by Annane et al (6) of hydrocortisone for septic shock, which noted lower mortality rates among corticotropin nonresponders, and the Corticus trial, which found no difference in mortality between hydrocortisone and placebo arms regardless of the corticotropin response, continue to stir controversy. the most tenable explanation for the discrepant results between the two trials is that the trial by Annane et al (6) enrolled sicker patients than Corticus (patients enrolled within 8 vs. 72 hrs of shock onset) (6–8). Patients in the Annane trial had more refractory shock and higher mortality rates overall, thereby raising the possibility that corticosteroids may only benefit the sickest of patients.

And indeed, the literature on corticosteroids and pneumonia also hints that corticosteroids might be most impactful in patients with more severe pneumonia. In a randomized controlled trial of dexamethasone vs. placebo among 304 patients hospitalized with community-acquired pneumonia, patients randomized to dexamethasone had marginally shorter hospital lengths of stay (median 6.5 days vs. 7.5 days, p = .05) but no difference in hospital mortality or hospital readmission rates (3). This trial specifically excluded patients requiring intensive care. Confalonieri and colleagues (4), however, conducted a trial on patients with severe community-acquired pneumonia specifically requiring ICu admission. they randomized 46 patients to a 200-mg hydrocortisone bolus and daily infusions at 10 mg/hr vs. placebo for 7 days. Patients assigned hydrocortisone required fewer days of mechanical ventilation (median 4 days vs. 10 days, p = .007), had shorter hospital lengths of stay (median 13 days vs. 21 days, p = .03), and lower mortality rates (0% vs. 30%, p = .009). Confalonieri and colleagues also reported a subgroup analysis of the study by Annane et al (6) of hydrocortisone for severe septic shock refractory to fluids and vasopressors (4, 6). Septic shock was secondary to community-acquired pneumonia for 101 of the 300 patients in the study by Annane et al (6). the 28-day mortality rate was 45% among the 47 hydrocortisone patients vs. 65% in the 54 placebo patients (odds ratio 0.44, 95% confidence interval 0.20–0.98, p = .04).

the study by Ranzani and colleagues now considers the potentially sickest of pneumonia patients, those with ICu-acquired pneumonia. Ranzani and colleagues analyzed prospective, observational data

Editorial by Klompas, Michael MD, MPH

Critical Care Medicine: September 2012 - Volume 40 - Issue 9 - p 2710–2712

over 50 yrs ago, investigators from Johns Hopkins Hospital published a report describing the impact


Physical restraint in mechanically ventilated ICU patients: a survey of

French practice

Low-dose steroids in adult septic shock: results

of the Surviving Sepsis Campaign

Blind Insertion of Feeding Tubes in Intensive Care

Units : A National Survey

Lung water assessment by lung ultrasonography in

intensive care: a pilot study

as the total number of B-lines detectable in an anterolateral luS examination.

Good correlations were found between the B-line score and lung weight (r = 0.75, p < 0.05) and density (r = 0.82, p < 0.01), that only marginally increased when the lung density of the first 10 mm of subpleural lung tissue was evaluated (r = 0.83, p < 0.01). moreover, values of subpleural lung density were not significantly different from values of the whole lung density (0.34 ± 0.11 vs. 0.37 ± 0.16 g/ml, p = ns). Very good correlations were found between the B-line score and both the weight (r = 0.85, p < 0.01) and the density (r = 0.88, p < 0.01) of the upper lobes. the weight of the lower lobes was not correlated with the B-line score (r = 0.14, p = ns).

Conclusions

lung ultrasound B-lines are correlated with lung weight and density determined by Ct. luS may provide a reliable, simple and radiation-free lung densitometry in the intensive care setting.

on 316 patients with ICu-acquired pneumonia. they divided the population into steroid-exposed and unexposed groups. Steroid exposure was defined as ≥20mg of methylprednisolone or equivalent within the 2 days preceding pneumonia onset. the primary outcome was 28-day survival on Cox regression. they attempted to adjust for confounding by indication using propensity-to-treat-with-steroid scores constructed from 33 clinical variables including age, gender, comorbidities, admission diagnosis, ICu admission, Acute Physiology and Chronic Health evaluation II and Sequential organ Failure Assessment scores, and presence or absence of shock at pneumonia diagnosis. they found that steroid-exposed patients had a higher 28-day mortality compared to steroid-unexposed patients (adjusted hazard ratio 2.5, 95% confidence interval 1.2–5.3, p = .017). the study’s strengths included prospective data collection, a large number of pneumonia cases, and the use of propensity scores to adjust for confounding by indication.

the study by Ranzani and colleagues ostensibly contradicts the hints from previous work that corticosteroids may improve survival for patients with the severest of pneumonias. on closer examination, however, this study’s limitations preclude a definitive answer. Key concerns include the variable indications and timing of steroid exposures, the strong possibility that many patients actually did not have pneumonia, a relatively low proportion of severely ill patients, and some omissions from the propensity scores that raise the possibility of persistent confounding by indication.

most notably, corticosteroids in this study were not necessarily prescribed as adjuncts for the treatment of pneumonia. the indications for corticosteroids included exacerbation of respiratory disease (33% of the steroid group), neurological disorders (27%), septic shock (14%), and long-term use of corticosteroids (10%). these conditions vary in both their morbidity and responsiveness to corticosteroids independent of pneumonia (9–13). In addition, patients were classified as steroid exposed as long as they were on corticosteroids within the 2 days prior to pneumonia onset. this leaves open the possibility of significant variability in the duration and dose of steroid exposure prior and subsequent to pneumonia onset. High doses of corticosteroids for long periods prior to pneumonia may have rendered some patients immunologically compromised at pneumonia onset; conversely, corticosteroids may have been abruptly stopped immediately after pneumonia onset in other patients, thereby attenuating the possibility of beneficial suppression of the acute inflammatory effects of a severe pneumonia. Pneumonia was considered present in this study if patients met a clinical definition or had a simplified clinical pulmonary infection score ≥6. The positive predictive value of both these criteria for histological pneumonia is only about 60%, making it possible that almost half the patients in this study did not have pneumonia at all (14). only about a third of patients (98/316) had shock at the time of pneumonia diagnosis, the patient subset theoretically most likely to benefit from corticosteroids. Finally, the propensity scores incorporated Acute Physiology and Chronic Health evaluation II and Sequential organ Failure Assessment scores from ICu admission rather than the time of steroid initiation, possibly compromising the adequacy of adjustment for confounding by indication and severity of illness.

the net message of this study is that patients treated with corticosteroids have high morbidity and mortality, but the factors described above, most of which are unavoidable consequences of observational data, leave us wondering whether corticosteroids are markers or drivers for poor outcomes. the possibility that patients with the severest of pneumonias may yet benefit from corticosteroids still stands. In addition, these

observational data should not stop clinicians from using corticosteroids for ICu diagnoses for which randomized, controlled trial data do suggest possible benefit such as early acute respiratory distress syndrome, chronic obstructive pulmonary disease flares, and acute spinal cord injuries (6, 9, 10, 13). We continue to need careful, randomized, controlled trials and better pneumonia diagnostics to determine whether severe pneumonias merit corticosteroids and to determine whether the risk-to-benefit ratio of corticosteroids shifts when patients with other indications for corticosteroids develop pneumonia.

Bernard De Jonghe, Jean-Michel Constantin, et al.

Volume 39, Issue 1 / January , 2013, Pages 31 – 37

to characterize the perceived utilization of physical restraint (PR) in mechanically ventilated intensive care unit (ICu) patients and to identify clinical and structural factors influencing PR use.

A questionnaire was personally handed to one intensivist in 130 ICus in France then collected on-site 2 weeks later.

the questionnaire was returned by 121 ICus (response rate, 93 %), 66 % of which were medical-surgical ICus. median patient-to-nurse ratio was 2.8 (2.5–3.0). In 82 % of ICus, PR is used at least once during mechanical ventilation in more than 50 % of patients. In 65 % of ICus, PR, when used, is applied for more than 50 % of mechanical ventilation duration. Physical restraint is often used during awakening from sedation and when agitation occurs and is less commonly used in patients receiving deep sedation or neuromuscular blockers or having severe tetraparesis. In 29 % of ICus, PR is used in more than 50 % of awake, calm and co-operative patients. PR is started without written medical order in more than 50 % of patients in 68 % of ICus, and removed without written medical order in more than 50 % of patients in 77 % of ICus. only 21 % of ICus have a written local procedure for PR use.

this survey in a country with a relatively high patient-to-nurse ratio shows that PR is frequently used in patients receiving mechanical ventilation, with wide variations according to patient condition. the common absence of medical orders for starting or removing PR indicates that these decisions are mostly made by the nurses.

Brian Casserly, Herwig Gerlach, Gary S. Phillips, et al.

Volume 38, Issue 12 / December , 2012, Pages 1946 – 1954

the Surviving Sepsis Campaign (SSC) developed guidelines and treatment bundles for the administration of steroids in adult septic shock. However, it is not clear how this has affected clinical practice or patient outcome.

the SSC has developed an extensive database to assess the overall effect of its guidelines on clinical practice and patient outcome. this analysis focuses on one particular element of the SSC’s management bundle, namely, the administration of low-dose steroids in adult septic shock. this analysis was conducted on data submitted from January 2005 through march 2010 including 27,836 subjects at 218 sites.

A total of 17,847 (of the total 27,836) patients in the database required vasopressor therapy despite fluid resuscitation and therefore met the eligibility criteria for receiving low-dose steroids. A total of 8,992 patients (50.4 %) received low-dose steroids for their septic shock. Patients in europe (59.4 %) and South America (51.9 %) were more likely to be prescribed low-dose steroids compared to their counterparts in North America (46.2 %, p < 0.001). The adjusted hospital mortality was significantly higher (oR 1.18, 95 % CI 1.09–1.23, p < 0.001) in patients who received low-dose steroids compared to those who did not. there was still an association with increased adjusted hospital mortality with low-dose steroids even if they were prescribed within 8 h (oR 1.23, 95 % CI 1.13–1.34, p < 0.001).

Steroids were commonly administered in the treatment of septic shock in this subset analysis of the Surviving Sepsis Campaign database. However, this was associated with an increase in adjusted hospital mortality.

Giacomo Baldi, Luna Gargani, Antonio Abramo, et al.

Volume 39, Issue 1 / January , 2013, Pages 74 - 84

to investigate the accuracy of lung ultrasonography (LUS) in the quantification of lung water in critically ill patients by using quantitative computed tomography (Ct) as the gold standard for the determination of lung weight.

twenty consecutive patients admitted to an intensive care unit who underwent chest Ct as a step in their clinical management were evaluated within 4 h by luS. lung weight, lung volume, and physical lung density were calculated from the Ct scans using ad hoc software. Semiquantitative ultrasound assessment of lung water was performed by determining the ultrasound B-line score, defined

Norma A. Metheny, RN, PhD, Barbara J. Stewart, PhD and Andrew C. Mills, RN, PhD

Am J Crit Care September 2012 vol. 21 no. 5 352-360

Although most critically ill patients experience at least 1 blind insertion of a feeding tube during their


Randomized Controlled Trial of Chlorhexidine Dressing and Highly

Adhesive Dressing for Preventing Catheter-related Infections in Critically Ill Adults

Ventilator-Associated Pneumonia Is

Characterized by Excessive Release of

Neutrophil Proteases in the Lung

stay in an intensive care unit, little is known about the types of health care personnel who perform these insertions or about methods used to determine proper positioning of the tubes.

to describe results from a national survey of critical care nurses about feeding tube practices in their adult intensive care units. the questions asked included who performs blind insertions of feeding tubes and what methods are used to determine if the tubes are properly positioned.

Data were collected from members of the American Association of Critical-Care Nurses via pencil-and-paper and online surveys. Results from both forms were combined for data analysis and were compared with practice recommendations of national-level organizations.

A total of 2298 responses were obtained. Physicians perform more blind insertions of styleted feeding tubes than do nurses; in contrast, nurses place more nonstyleted tubes. Radiographic confirmation of correct position is mandated more often for blindly inserted styleted tubes (92.3%) than for nonstyleted tubes (57.5%). the 3 most commonly used bedside methods to determine tube location are auscultation for air injected via the tube, appearance of feeding tube aspirate, and observation for indications of respiratory distress.

Recommendations from multiple national-level organizations to obtain radiographic confirmation that each blindly inserted feeding tube is correctly positioned before the first use of the tube are not adequately implemented. Auscultation is widely used despite recommendations to the contrary.

Thomas S. Wilkinson, PhD; Andrew Conway Morris.CHEST. December 2012;142(6):1425-1432. Et al.

Background: Ventilator-associated pneumonia (VAP) is characterized by neutrophils infiltrating the alveolar space. VAP is associated with high mortality, and accurate diagnosis remains difficult. We hypothesized that proteolytic enzymes from neutrophils would be significantly increased and locally produced inhibitors of human neutrophil elastase (HNe) would be decreased in BAl fluid (BALF) from patients with confirmed VAP. We postulated that in suspected VAP, neutrophil proteases in BAlF may help identify “true” VAP.

Methods: BAl was performed in 55 patients with suspected VAP and in 18 control subjects. Isolation of a pathogen(s) at > 104 colony-forming units/ml of BAlF dichotomized patients into VAP (n = 12) and non-VAP (n = 43) groups. matrix metalloproteinases (mmPs), HNe, inhibitors of HNe, and tissue inhibitors of matrix metalloproteinases (TIMPs) were quantified. Plasminogen activator (PA) activity was estimated by sodium dodecyl sulfate polyacrylamide gel electrophoresis and zymography.

Results: Neutrophil-derived proteases HNe, mmP-8, and MMP-9 were significantly increased in cell-free BAlF from patients with VAP as compared with those without VAP (median values: HNe, 2,708 ng/ml vs 294 ng/ml, P < .01; mmP-8, 184 ng/ml vs 5 ng/ml, P < .01; mmP-9, 310 ng/ml vs 11 ng/ml, P < .01). HNE activity was also significantly increased in VAP (0.45 vs 0.01 arbitrary units; P < .05). In contrast, no significant differences were observed for protease inhibitors, tImPs, or PAs. HNe in BAlF, at a cutoff of 670 ng/mL, identified VAP with a sensitivity of 93% and specificity of 79%.

Conclusions: Neutrophil proteases are significantly elevated in the alveolar space in VAP and may contribute to pathogenesis. Neutrophil proteases appear to have potential in suspected VAP for distinguishing true cases from “non–VAP” cases.

Rationale: most vascular catheter-related infections (CRIs) occur extraluminally in patients in the intensive care unit (ICu). Chlorhexidine-impregnated and strongly adherent dressings may decrease catheter colonization and CRI rates.

Objectives: to determine if chlorhexidine-impregnated and strongly adherent dressings decrease catheter colonization and CRI rates.

Methods: In a 2:1:1 assessor-masked randomized trial in patients with vascular catheters inserted for an expected duration of 48 hours or more in 12 French ICus, we compared chlorhexidine dressings, highly adhesive dressings, and standard dressings from may 2010 to July 2011. Coprimary endpoints were major CRI with or without catheter-related bloodstream infection (CR-BSI) with chlorhexidine versus nonchlorhexidine dressings and catheter colonization rate with highly adhesive nonchlorhexidine versus standard nonchlorhexidine dressings. Catheter-colonization, CR-BSIs, and skin reactions were secondary endpoints.

Measurements and Main Results: A total of 1,879 patients (4,163 catheters and 34,339 catheter-days) were evaluated. With chlorhexidine dressings, the major-CRI rate was 67% lower (0.7 per 1,000 vs. 2.1 per 1,000 catheter-days; hazard ratio [HR], 0.328; 95% confidence interval [CI], 0.174–0.619; P = 0.0006) and the CR-BSI rate 60% lower (0.5 per 1,000 vs. 1.3 per 1,000 catheter-days; HR, 0.402; 95% CI, 0.186–0.868; P = 0.02) than with nonchlorhexidine dressings; decreases were noted in catheter colonization and skin colonization rates at catheter removal. the contact dermatitis rate was 1.1% with and 0.29% without chlorhexidine. Highly adhesive dressings decreased the detachment rate to 64.3% versus 71.9% (P < 0.0001) and the number of dressings per catheter to two (one to four) versus three (one to five) (P < 0.0001) but increased skin colonization (P < 0.0001) and catheter colonization (HR, 1.650; 95% CI, 1.21–2.26; P = 0.0016) without influencing CRI or CR-BSI rates.

Conclusions: A large randomized trial demonstrated that chlorhexidine-gel–impregnated dressings decreased the CRI rate in patients in the ICu with intravascular catheters. Highly adhesive dressings decreased dressing detachment but increased skin and catheter colonization.

Jean-François Timsit, Olivier Mimoz, et al

Am. J. Respir. Crit. Care Med. December 15, 2012 vol. 186

New Branches Approved Bhavnagar Branch Patiala Branch Shillong BranchexeCutIVe CommIttee

CHAIRmAN SeCRetARY

Dr. J F Rana Dr. Gyanendra Lal Gupta

tReASuReR

Dr Vipul P Parekh

exeCutIVe CommIttee memBeRS

Dr. M R Kanani Dr. Dipshikha TripathiDr. Naresh D Suchak Dr. P L Vaghela

Dr. P L Sachapara Dr. Harsh Patel

exeCutIVe CommIttee

CHAIRmAN SeCRetARY

Dr. R S Bedi Dr. Dalbir Dhanda

tReASuReR

Dr. Yadvarinder Singh


Dr. Vishal Chopra Dr. Hemant TulliDr. Guneet Singh Dr. Rakesh Arora

Dr. Akshay Jain Dr. Satwant Sachdeva

exeCutIVe CommIttee

CHAIRmAN

Dr. Himjyoti Das

SeCRetARY

Dr. P Bhattacharyya

tReASuReR

Dr. Md. Yunus


Dr. Nari M Lyngdoh Dr. V HmarDr. M Lanleila


Madurai

Cochin Bhopal

A REPORT ISCCM Day Celebrations9Th OCTObER, 2012

Theme: Hand Hygiene

On 9th-Oct ISCCM Day celebration was

observd at the Apollo Specialty Hospital

Madurai. On the Theme of " Hand Hygiene" we

had awareness programs for the Health Care

Workers,patient's and their relatives. We made

it as a Hand Hygiene awareness week from 9th

- 15th the Global Hand Washing Day.

Dr Mohamed Ibrahim M.D.

ISCCM Day Hand Hygiene Madurai

ISCCM Day Hand Hygiene Madurai Staff

ISCCM Day Hand Hygiene Madurai RangoliISCCM Day Hand Hygiene Madurai Quiz

ISCCM Day Hand Hygiene Madurai Poster

Sir,

Lectures and posture presentations were

done at various hospitals in Cochin. Senior

colleagues arranged hand hygiene awareness

programmes in their respective hospitals. In

our hospital (*Lakeshore Hospital, Cochin*) we

had an afternoon meeting at our auditorium

where *Dr. Nita George M.D Anaesthesia,

EDIC, Intensivist* spoke about the importance

of hand hygiene followed by a half an hour

video presentation.About 200 people attended

including both nurses and paramedical staff.

Dr. Mallie George

Secretary, ISCCM Cochin City Branch

Dr. Pradip Bhattacharya from Bhopal reports

Respected sir,

Namasthe! I am herewith sending the particulars of I.S.C.C.M. Day celebrations, organised by our branch. The particulars are given below.

Branch : KAKINADA CITY BRANCH

Date : 9 th October 2012

Time : 12 noon to 2 p.m

Venue : Anaesthesia Seminar room, Govt.General Hospital, Kakinada

Programme Details : We conducted a special meeting to celebrate I.S.C.C.M Day on 9th October i.e today. Prof. A.S. Kameswara Rao, Chairman of the branch chaired the meeting and welcomed the gathering. He also spoke

on - "Critical Care in semi urban areas". Dr. B.V. Mahesh Babu, Secretary of the branch highlighted the importance of I.S.C.C.M. Day and he spoke on the theme - "Wash Hands & Save Lives". Senior members - Prof B. Soubhagya Lakshmi, Dr. S.S.C. Chakra Rao and Dr. S.V. Lakshminarayana. Also shared their opinions regarding I.S.C.C.M. activities and gave suggestions regarding the future projects. The meeting was adjourned for Lunch after a formal vote of thanks by Dr. Atchutharamaiah, Treasurer of the branch.

In the evening Dr. M. Santhisree, Asst.Professor of Anaesthesia and Critical Care conducted an Awareness campaign among the Nursing students and Anaesthesia Technicians regarding the importance of HAND HYGIENE.

Contact Person : Dr. B.V. Mahesh Babu; Contact no: 9848160327.

Thanking you,

With warm regards,

Dr. B.V. Mahesh Babu


KakinadaJaipur

Surat

Agra

Indian Society of Critical Care Medicine, Jai-pur Chapter is organizing the 85th Fundamen-tal Critical Care Course (FCCS) in India at Je-evan Rekha Critical Care & Trauma Hospital, Jaipur on 12th and 13th of January 2013. It is a two-day comprehensive course addressing ‘funda-mental management principles for the first 24 hours of critical care’ of Society of Critical Care medicine, USA. The registration will be restricted to 40 delegates (for provider course) and 5 delegates (for instructor course) on first-come first-serve basis. The registration fee is Rs 5500- (including course material) for provider course and 12000 for instructor course which has to be sent by cheque/ bank draft/ cash in favor of “Indian So-ciety of Critical Care Medicine, Jaipur Chapter” and mailed to organizing secretary.

Please find attached registration & course in-formation on attached document

You are requested to confirm your seat before sending registration fee as we have a limited seats and registration is on first-come first-serve basis.

For registration and details, kindly contact.

Course CoordinatorDr Manish MunjalJeevan Rekha Critical Care & Trauma Hospital, Mahal Yojna, Jagatpura, Jaipur - 302025 (India) • Off.: +91 141 515 50 50 (50 Lines) • Direct +91 515 50 75 • Cell. No.: +91 98290 62550

ISCCM Day Hand Hygiene Surat

In Surat, we arranged awareness program on hand hygiene in different hospitals on ISCCM day. Our aim was to encourage nursing staff & other para medical staff about importance of hand hygiene.We all took similar classes based on WHO recommendation.

BAPS Pramukh swami Hospital : Dr. Mitul Chavda

Adventist Hospital : Dr. Chetan Mehta

Nirmal Hospital : Dr. Gaurish Gadbail

Apple Hospital : Dr Alpesh Parmar.

Dr. Mitul Chavda

ISCCM Day was celebrated with lots of

enthusiasm here in the city of Taj--Agra.

8 Oct--16hrs--Press conference was organised

about the aim of the day and to spread

awareness amongst people.

9 Oct-13hrs--Presentation for the Nursing

staff,paramedics on Hand Hygiene by Dr

Diptimala Agarwal at Pushpanjali Hospital

Agra

9Oct--20hrs-Program for the doctors at

Pushpanjali Hospital Agra.

1. Prevention of Catheter related Blood

Stream Infection : Dr Ranvir S Tyagi

2. Prevention of Catheter related Urinary

Tract Infection : Dr Neha Agarwal

3. Prevention of Ventilator Associated

Pneumonia : Dr Rakesh Tyagi

Dr. Diptimala Agarwal

We conducted a special meeting to celebrate

I.S.C.C.M Day on 9th October i.e today. Prof. A.S.

Kameswararao, Chairman of the branch chaired

the meeting and welcomed the gathering. He

also spoke on -" Critical Care in semi urban

areas." Dr. B.V. Mahesh Babu, Secretary of the

branch highlighted the importance of I.S.C.C.M

Day and he spoke on the theme -"Wash Hands

& Save Lives". Senior members - Prof B.

Soubhagya Lakshmi, Dr. S.S.C. Chakra Rao and

Dr. S.V. Lakshminarayana, also shared their

opinions regarding I.S.C.C.M activities and

gave suggestions regarding the future projects.

The meeting was adjourned for lunch after a

formal vote of thanks by Dr. Atchutharamaiah,

Treasurer of the branch.

In the evening Dr. M. Santhisree,Asst.Professor

of Anaesthesia and Critical Care conducted

an awareness campaign among the nursing

students and anaesthesia technicians regarding

the importance of Hand Hygiene.

Dr Mahesh Babu


Pune

ISCCM Day Hand Hygiene Rosenthal Sahyadri Hospital Pune

ISCCM Day Hand Hygiene Pledge Sahyadri Hospital Pune

ISCCM Day Hand Hygiene Poster Pune

ISCCM day on hand hygiene was celebrated at various hospitals in Pune by the respective ISCCM members in those hospitals.

Dr. Subhal Dixit

Calender of EventsJanuary 2013

January 2nd to 6th, 2013 1st central province Criticon 2013, Nagpur, India [email protected]

January 19th, 2013 ISCCM, Banglore Chapter CME, Bangalore www.isccm.org

January 19th to 23rd, 2013 42nd critical care congress, San Juan, Puerto Rico www.sccm.org

February 2013

February 10th, 2013 ISCCM Mumbai Branch Clinical Meeting, “Criticare Update 2013” ISCCM Mumbai branch

March 2013

March 1st to 6th, 2013 19th Annual Congress ISCCM , Criticare 2013, Kolkata, India www.criticare2013kolkata.com

March 19th to 22nd, 2013 33rd International symposium on Intensive care and Emergency Medicine, Brussels

www.intensive.org

June 2013

June 8th to 9th, 2013 Basic support and support in Intensive care (BASIC), Columbiaasia Referral Hospital, Bangalore

Contact : Dr. Pradeep Rangappa, Secretary, ISCCM - Bangalore. email : [email protected]

June 12th to 15th, 2013 24th Annual meeting of European society of Paediatric and Neonatal Intensive care, Netherland

www.kenes.com/espnic

July 2013

July 9th and 10th, 2013 ISCCM Pune , Intensive Care Review Course, Pune Contact : Ms Vidula- 09011026332; Dr Subhal Dixit- 9822050240

July 11th and 12th, 2013 ISCCM Pune, Workshops on hemodynamic monitoring, Mechanical Ventilation and Ultrasound, ECHO in ICU, Pune

Contact : Ms Vidula- 09011026332; Dr Subhal Dixit- 9822050240

July 13th and 14th, 2013 Best of Brussels Conference (Top 50 lectures), ISCCM, Pune Contact : Dr Subhal Dixit- 9822050240, Dr Kapil Zirpe- 9822844212

July 12th to 14th, 2013 Intensive Care in Asia- Oppurtunities and Challenges, Singapore. www.sg-anzics.com

August 2013

August 17th 2013 USG and ECHO workshop, Manipal Hospital, Bangalore Contact : Dr. Pradeep Rangappa, Secretary, ISCCM-Bangalore. email: [email protected]

Aug 28th to 1st September, 2013

First WFSICCM Congress, Durban, Africa. www.criticalcare2013.com

September 2013

September 20th to 22nd, 2013 THEMATICC 2013 and International Conference on Shock, Hemodynamic Monitoring and Therapy

Contact person : Dr. Vijaya Patil (09819883535) or Dr. Atul Kulkarni (09869077526)

October 2013

Oct 5th to 9th, 2013 ESICM LIVES 2013, Paris, France www.esicm.org

November 2013

November 9th 2013 Mechanical Ventilation workshop, Narayana Hrudayalaya, Bangalore

Contact : Dr Pradeep Rangappa, Secretary, ISCCM, Bangalore email : [email protected]

Bangalore

Bangalore ISCCM Chapter commemorated

the ISCCM Day on 10 October at Hotel Le

Meridian. We were privileged in having Victor

Rosenthal who is an ID specialist and pioneer

in extensive research work in Infection Control

give talk on "Effective interventions to prevent

Nosocomial Infections" which was followed

by talk on "hand hygiene" by Dr Ajith Kumar,

President, Bangalore Chapter ISCCM.

Dr. Pradeep Rangappa


CRITICARE 201319th annual Congress of the Indian Society of Critical Care Medicine &

International Critical Care Congress 2013Scientific Congress 1-3 March, 2013 • Workshop 4-6 March, 2013 • Science City, Kolkata

SCIENTIFIC PROGRAM DAY – 17:30 onwards Registration8:15-8:25 AM Welcome address

PLENARY SESSION -1(HALL – A)8:30 -9:30 am Chairpersons: Narendra Rungta, & Subrata Moitra8:30 – 8:50 am Intensive care: Beyond Technology (1) Speaker: F. Udwadia8:50–9:10 am Making ICU care Affordable (2) Speaker: Ram E. Rajagopalan9:10 – 9:30 am Menace of tropical fever in India-Management strategy in ICU (3) Speaker: Dhruv Chowdhury

PLENARY SESSION -2 (HALL –A)9:40-10:40 am Chairpersons: Shirish Prayag & Anjan Dutta9:40– 10:00am Antimicrobial therapy of septic shock - Speed is Life (4) Speaker: Anand Kumar10:00 – 10:20 am Biomarkers of sepsis (5) Speaker: Konrad Reinhardt10:20– 10:40 am Combating Acinetobacter (6) Speaker: Jeff Lipmann10:50 – 12:00 Parallel Session

HALL - A HALL – B HALL – C HALL - D HALL – E HALL – FTHEMATIC FUNGAL

SEPSISTHEMATIC ARDS NEW GUIDELINES THEMATIC FLUIDS WHATS NEW

MONITORINGChairpersons: Prithwish Bhattacharya & Sugato Dasgupta

Chairpersons: Pawan Agarwal & Rajesh Pande

Chairpersons:S K Biswas, Diptimala Agarwal

Chairpersons: Jose Chacko & Prakash Shashtri

Chairpersons: Sandhya Talekar & Dr Mitra Mustafi

10:50 – 11:10 am Candida sepsis: Time is tissue (7) - Anand Kumar

Can ARDS be prevented(10) - Daniel Talmor

ISCCM Guideline on ICU Design (13) - Ashutosh Ghosh

Are colloids down andout: lessons learnt from recent trials (16)- Konrad Reinhardt

10.40 – 11.40 Ancillary Session

Glucose Monitoring techniques in ICU: New technology (19) - P.Gopal

11:10 – 11:30 am Aspergillus and Mucor in ICU: a growing threat (8) - Sameer Sahu

Immunomodulation in ARDS: does it work (11) - Pravin Amin

Acute spinal cord injury guidelines (14) - Mohan Matthews

Albumin resuscitation: Is it staging a come back (17) - Sumit Rai

Therapeutic drug monitoring of antibiotics in ICU: The way forward (20) - Jeff Lipmann

11:30 – 11:50 am Candida in Respiratory secretions – Harmless resident or not? (9) - Vivek Nangia

ARDS; Rescue therapies in severe hypoxemia (12) - Suresh Ramasubban

Therapeutic hypothermia: current guidelines (15) - Manoj Goel

Is chloride resuscitation harmful: ideal resuscitation fluid for 2013 (18) - George John

Neuromonitoring: Newer technology (21) - J.K. Murthy

Q&A 12:00Parallel Session

12:05 – 1:15 pm HALL - A HALL – B HALL – C HALL - D HALL – E HALL – FTHEMATIC

PANCREATITISYEAR IN REVIEW: 2012 PANEL DISCUSSION THEMATIC ANTIBIOTIC THEMATIC GLUCOSE/

EndocrineChairpersons: Ananda Bagchi & Sheila Myatra

Chairperson: Sujoy Mukherjee & Ranvir Tyagi

Chairpersons: Pradeep Bhattacharjee & Basab Bijoy Sarkar

Chairpersons: Subhankar chowdhry & Sujoy Ghosh

12:05 – 12:25pm Acute Pancreatitis: Atlanta classification Revisited 2012 (25) - Sriram sampat

Cardiology/resuscitation/he modynamics (33) - Mahua Bhattacharya

12:05 12:35 Ethical issues in ICU (28)Moderator: R.K. ManiPanelist: Manimala Rao,Ram Rajagopalan,Krishnenedu Mukherjee, P Deka,

Optimal use of colistin: recent data (30) - Jeff Lipmann

Hypoglycemia in ICU: New insights (22) - Farhad Kapadia

12:25 – 12:45pm Nutrition therapy inacute pancreatitis (26) - K.sriram

Respiratory critical care and mechanical ventilation (34) - Charles Gommersall

Sulbactam: how it should be used (31) - A. Baronia

Gonadal Steroids in Intensive care (23) - Binayak Sinha

12:45– 1:05 pm Surgical options in Acute Severe Pancreatitis - J.D. Sunavala (27)

Infection/Sepsis (35) - Robert Balk

12:40-1:10Legal issues in ICU (29)Moderator: Manish MunjalPanelist: Subroto Moitra,B.K.Rao, Shirish Prayag,Asit Sil

Gram positive sepsis: current management strategies (32) - Rajiv Suman

Thyroid disease in intensive care (24) – J.V. Peter

Q&A 1:151:15 – 2:00 pm Lunch/ Exhibit Break2:00- 4:00 pm Executive committee meeting (ITC- BOARD ROOM)2:00- 3:10 Parallel Session

HALL - A HALL – B HALL - C HALL - D HALL – E HALL – FTHEMATIC

TRANSPLANTATIONTHEMATIC SEDATION THEMATIC INFECTION THEMATIC SEPSIS/ HOW I DO IT

VENTILATIONChairpersons: Rahul Pandit & Sourabh Kole

Chairpersons: Tapas Chakraborty & Bibhu Kalyani Das

Chairpersons: Vivek Nangia & Rajiv Suman

Chairpersons: Abhijit Bhattacharya & D P Chakraborty

Chairpersons: Ajoy sirkar & Sumit Sengupta

2:00- 2:20 pm Brain death certification and cadaveric organ transplant: current status in India - P.Gopal (36)

Implementing Analgesia, and sedation protocols in ICU (39)- Carol Thompson

Chennai Declaration- (42) Abdul ghafur

Optimizing antimicrobial therapy in Septic Shock: Ahammer helps too. (45) - Anand Kumar

Utilize Ventilator Graphics at the bedside (48)- Daniel Talmor

2:20- 2:40 pm Managing brain dead organ donor in ICU - Subhash Arora - (37)

Analgosedation in ICU: Choosing the right agent - Srinivasa Samavedam (40)

VAT – should it be treated - Robert Balk (43)

Rapid diagnosis of sepsis (46) - K. Reinhardt

Perform Recruitment Manouevers - Edgar jiminez (49)

2:40-3:00 pm Organizing your ICU for organ transplant - Ramesh Venkatraman (38)

Sedation in ventilated patient: can we do without it (41) - Ravindra Mehta

Management of HIV infected critically ill patients (44) - Bibhuti Saha

Adjunctive therapies in sepsis (47) - R. K. Mani

Titrate PEEP - Farhad Kapadia (50)

Q&A 3:10 pm3:15- 4:25 pm Parallel Session

HALL - A HALL – B HALL - C HALL - D HALL – E HALL – FTHEMATIC

NEPHROLOGYWHATS NEW

HEMODYNAMICSHOW I DO IT PROCEDURES

THEMATIC NEUROLOGY CONTROVERSIES RESUSCITATION

Chairpersons: Jayanta Bose & Arup dutta

Chairpersons:Anil Mishra & Rajnish Joshi

Chairpersons: Arijit Bose & Sandip Kantor

Chairpersons:Arunabha Choudhry &Amna Goswami

Chairpersons: A.Sobhana & Emanuel Rupert

3:15-3:35 pm SLED /CRRT/IHD: who wins the race (51) - Claudio Ronco

Assessing hemodynamic: New Tools (54) - Jean Louis Teboul

Rapid fluid infusion techniques (57) - M.C Mishra

Acute Stroke- Role of Intensivist (60) -Shiva iyer

Early Goal directed therapy: controversies and newer trials (63) - Anand Kumar

3: 35- 3:55 pm Strategies to prevent AKI (52) - Arghya Majumdar

Assessing Tissue perfusion: beyond lactate (55) - Jean Louis Vincent

Perform Tracheostomyin ICU (58) - Abhiram Mullick

ICP Management: Current Status (61)Bibhu Kalyani Das

Fluid resuscitation: Dry or Wet (64) - Ram Rajagopalan

3:55- 4:15 pm Drug Dosing in renal failure: Lessons learnt from DALI (53) - Jeff Lipmann

Extracorporeal Cardiorespiratory Support: Coming to bedside - Sameer Jog (56) -

Bronchoscopy in ICU (59)- Mrinal Sircar

Early mobilsation: key to success (62) - Carol Thompson

Do we need to treat sinus tachycardia in ICU (65) - Sumit Ray

Q&A 4:254:30-5:40 pm Parallel Session

HALL - A HALL – B HALL - C HALL – D HALL – E HALL – FTHEMATIC

VASOPRESSORPRO: CON THEMATIC TRAUMA/

DISASTERTHEMATIC

TRANSFUSIONChairpersons: Dr Iqbal & Samir Sahu

Chairpersons: Jayanta Dutta & Indranil Ghosh

Chairpersons: Sumit Podder & Ansu Choudhry

Chairpersons:Vandana Agarwal & Maitreyii Bhattachaya


11:10 – 11:30 am Volumetric capnography (94) - Sheila Myatra

Early vs Late parenteral nutrition (91) - Shyam Sunder

Pulmonary edema: is it cardiogenic (97) - Jean Louis Teboul

11:30 – 11:50 pm Lung imaging in ventilated patient at the bedside (95) - Daniel Talmor

11:20-11:50Antifungal Use in ICU(87)Moderator: Shirish PrayagPanelist: Rajesh Chawla, Jean Louis Vincent, Arunaloke Chakraborty, Arindam Kar

11:20-11:50 Infection: (89) Case Study2:Chairperson: Yatin MehtaSpeaker: Ravindra MehtaPanelist: V Ramasubramanian, Indranil Roy,

Optimizing energy and protein delivery to the individual patient (92)- K.Sriram

The forgotten ventricle in sepsis (98)- Susruta Bandyopadhyay

Q&A 12:00Change (5 minutes)

12:05 – 1:15 pm Parallel SessionHALL - A HALL – B HALL – C HALL - D HALL – E HALL – F

THEMATIC NIV THEMATIC CPR THEMATIC: SURGERY PANEL DISCUSSION THEMATIC: INTRA-ABDOMINAL PRESSURE

Chairpersons: Ravindra Mehta & Ajoy Sirkar

Chairpersons: Saureen Panja & Mahuya Bhattacharya

Chairpersons: Arunava chakraborty & Shaibal chakraborty

Chairpersons:Rajesh Mishra & Chandrashish Chakravarty

12:05 – 12:25 pm NIV: Use in hypoxemicfailure: what’s the evidence (99) - G.C.Khilnani

CPR: Role of thrombolysis and PCI (102) - Khusrav Bajan

Bariatric surgery: Post op ICU care (105) - Mayur Patel

12:00-12:30 Critical Research in India (111)Moderator: J.V.Divatia Panelist: Anand Kumar, Dilip karnad, Farhad Kapadia, Kalpalatha Guntapalli

Measuring Intraabdominal Pressure: Techniques and limitation (107) - Yash Javeri

12:25 – 12:45 pm NIV: Tips to make it work (100) - Rajesh Chawla

Post resuscitation bundle (103) - Anuj Clerk

Reducing postoperative infection (110) - Sandip Dewan

Intraabdominal hypertension: current management (108) - Deepak Jaduvanshi

SCIENTIFIC PROGRAM DAY – 2HALL - B HALL – C HALL - D HALL – E HALL – F

7:30 – 8:15 amMeet the Expert(Breakfastsession)

Topic: Hemodynamics/resuscitation - (76)Moderator: Ram RajagopalanExpert: Jean Louis Teboul,Farhad Kapadia

Topic: Trauma (77) Moderator: Arijit Bose Expert : Michael Parr, M.C.Mishra

Topic: Sepsis (78)Moderator: Ramesh VenkatramanExpert: Jeff Lipmann, Dr Gopalkrishnan

Topic: Nephrology (79) - Moderator: Dr Lalit Agarwal Expert: Claudio Ronco, Jose Chacko

8:30-9:30 PLENARY SESSIONS – 1 (HALL A)Chairpersons: Ram E. Rajagopalan & Yatin Mehta

8:30–8:50am Presidential address : Taking Critical Care to Places (156) - Speaker: Narendra Rungta8:50– 9:10 am Fluid resuscitation in resource limited setting - Speaker: J. Divatia (81)9:10 –9:30am ARDS: Berlin definition - Speaker: Marco Ranieri (82)9:40 – 10:40 PLENARY SESSION -2 (HALL A)

Chairpersons: Pravin Amin & J.Divatia9:40-10:00 am Glucose variability: missing link - Speaker: Jean Louis Vincent (83)10:00-10:20 am Weaning failure of cardiac origin - Speaker: Jean Louis Teboul (84)10:20-10:40 am Fluid management in AKI: the 5B approach - Speaker: Claudio Ronco (85)10:50– 12:00 pm Parallel Session

HALL – A HALL – B HALL – C HALL - D HALL – E HALL – FTHEMATIC

RESPIRATORY MONITORING

PANEL DISCUSSION CASE DISCUSSION (AIM) THEMATIC NUTRITION THEMATIC CARDIOLOGY

Chairpersons: R.K.Mani & Partha S Bhattacharya

Chairpersons: Dalia Chatterjee & Dr Khatima

Chairpersons: Pradeep D Costa & Suvanon Roy

10:50 – 11:10 am Bedside monitoring of lung mechanics during mechanical ventilation (93) - Marco Ranieri

10:50- 11:20 Antibiotic Use in ICU (86)Moderator: S K Todi Panelist: Jean Louis Vincent, Ram Gopal Krishnan, Animesh Gupta, Camilla Rodrigues

10:50- 11:20 Infection: (88) Case study 1:Chairperson: JD SonavalaSpeaker: Vivek NangiaPanelist: A. Baronia, Rajeev Soman, Khushrav Bajan

Nutrition protocol inICU (90)- N.Ramakrishnan

10.40 – 11.40 Ancillary Session

Acute coronary syndrome: Role of intensivist (96) - Y.P.Singh

4:30-4:50 pm PREPARATION FOR CONVOCATION

Vasopressin and analogs: current status (73) - Pravin Amin

5:30-6:00 pm Antibiotic Original molecule: Hemant Tiwari vs. Generic Brands: Sumit Ray (69)

Critical care during an epidemic (70) - Dr. Saurabh kole

Guidelines for emorrhagic Shock - Prasad Rajhans (66)

4:50- 5:10 pm PREPARATION FOR CONVOCATION

Norepinephrine revisited(74) - Jean Louis teboul

Organizing a trauma team and trauma protocol (71) - M.C. Mishra (AIIMS)

Blood component transfusion strategies in ICU (67) - Rajan Barokar

5:10-5:30 pm PREPARATION FOR CONVOCATION

Is Dopamine out (75) - Jean Louis Vincent

6:00 – 6:30 pmSelective decontamination of digestive tract (SDD/SOD) for preventing nosocomial sepsis: is it an option in IndiaPRO: Dilip karnadCON: Camilla Rodriguez70

Disaster planning in ICU: Checklist (72) - Dr Brajendra Lahkar

Hemoglobin target in different ICU population: current status (68) - Rajib Paul

5:30 pm -6.30 pm Convocation of Indian College of Critical Care Medicine & Past President’s Oration7.00 pm -7.30 pm INAUGURATION7:30 pm -onwards Cultural Program Followed by Dinner

12:45 – 1:05 pm NIV: When to call quits and reach for the tube (101) - Randip Guleria

Rapid response team and cardiac arrest team: Are they worth the effort (104) - Jose Chacko

Perioperative care of high risk surgery (106) - R K Singh

12:30-1:00 pm Administrative issues in ICU (112) Moderator: N.ramakrishnan Panelist: B Ray, N. Rungta, Yatin Mehta, Surabh Ghosh

2-4 pm Industries meet Poly compartment syndrome (109)- Sandip Kantor

Q&A 1:151:00 – 2:00 pm Lunch Break2:00-3:15 pm PLENARY SESSIONS (HALL A)

Chairpersons: Shiva Iyer & Sheila Myatra2:00 – 2:20 pm Reporting ICU performance: Accountability Speaker: N. Ramakrishnan (113)2:20 – 2:40 pm What have we learnt from mega epidemiological studies in sepsis Speaker: Jean Louis Vincent (114)2:40 – 3:10 pm ISCCM Oration (115) Speaker: Banambar Ray

Parallel SessionHALL A (free paper) HALL – B (free paper) HALL – C (free paper) HALL – D (free paper) HALL – E HALL – F (free paper)

3:15 – 4:05 pm Chairpersons: Arindam Kar & B.D.Bande 116

Chairpersons: Sriram Sampat & Palepu Gopal 117

Chairpersons: Rahul Pandit & Rajan Barokar 118

Chairpersons: Ashutosh Ghosh & Rajesh Pandey 119

Chairpersons: Dipankar Sarkar & S.S. Arora 120

CHANGE 5 Mins4:10 – 5:00 pm Parallel Session

HALL - A HALL – B HALL – C HALL - D HALL – E HALL – FTHEMATIC SURVIVING

SEPSIS CAMPAIGNTHEMATIC VOLUME

RESPONSIVENESSTHEMATIC INFECTION THEMATIC HEMATO/

ONCOLOGYPANEL DISCUSSION

Chairpersons: C P Thakur (Patna), Amit Sinha (Patna)

Chairpersons: Yashish Palliwall & Tanmoy Das

Chairpersons: Shaibal Ghosh, Amitabha Saha

Chairpersons: Y.P.singh & Sumit Poddar

4-6 pm GB Meet

4:10 – 4:25 pm Surviving sepsis campaign: Has it worked (121) - Edgar ziminez

Preload, Volume status and Volume responsiveness:not the same (124) - Mervyn Singer

Infection control myths in ICU (127) - Camilla Rodriguez

Trial of ICU care in oncology patient (130) - J.V. Divatia

4:00-4:30Economic issues in ICU (133) Moderator: Ram Rajagopalan Panelist: B.Ray, Mohan Mathews, Hospital Administrator

SCIENTIFIC PROGRAM DAY – 1 (Contd.)


SCIENTIFIC PROGRAM DAY – 3MEET THE EXPERT Session

Timing HALL – B HALL - C HALL – D HALL – E HALL – F7:30- 8:15 am Topic: Airway (149)

Moderator: Atul Kulkarni Expert: Abhiram Mullick, Tapas Chakraborty

Topic: Ventilator /Respiratory (150)Moderator: Rajesh ChawlaExpert: Daniel Talmor,Shirish Prayag

Topic: Sepsis (151) Moderator: R.K.Mani Expert: Mervyn Singer, Sunavala J. D.

Topic: Nutrition (152) Moderator: N.ramakrishnan Expert: K. Sriram, P. Amin

8:30-9:30 PLENARY SESSIONS 1 (HALL A)Chairpersons: Sukumar Mukherjee, Sunit singhi

8:30-8:50 am Making ICU care accessible (153) Speaker: Subroto Maitra8:50-9:10 am Nursing in ICU: the better half (154) Speaker: Carol Thompson9:10 – 9:30 am Viral Sepsis – when to suspect it. (155) Speaker: Pravin Amin9:40-10 40 am PLENARY SESSIONS 2 (HALL A) Chair persons: Manimala Rao & G.C. khilnai9:40-10:00 am Surviving Sepsis Guidelines , what is new in 2012 (156) Speaker: Rajesh Chawla10:00 – 10:20 am A new Frontier in Critical Care: Saving the injured Brain: Wes Ely (157)10:20 –10:40 am Open vs. Closed vs. transitional: Practical model of ICU care in India (158) Speaker: Shrish Prayag

Best Poster/Floor presentation awardCHANGE (10 mins)

10:50 – 12:00 pm Parallel SessionHALL – B HALL – C HALL - D HALL – E HALL – F

WHATS NEWAIRWAY & VENTILATION

THEMATICVENTILATOR INDUCED

INJURY

BASICS PANEL DISCUSSION HOW I DO IT: INFECTION CONTROL

Chairpersons: Deepak Govil & Rajarshi Roy

Chairpersons:C.K. Jani & Asok Sengupta

Chairpersons: Sriram sampat & Ram Rajagopalan

Chairpersons: Amit sinha & Mohit Kharbanda

10:50 – 11:10 am Newer technology in airway management in ICU (159) - Atul Kulkarni

Preventing VILI (162) - Ajoy Sirkar

Guytonian concept of circulation (165) - Mervyn Singer

11:00-11:30Critical care in SAARC countries (168) - Moderator: Dr N.RungtaPanel: Dr Shiva Iyer, Javed Hussain, Maheda Hashmi, Nepal, Srilanka (Rep)

(173) Infection control in an open ICU - N.Jaiswal

4:25 – 4:40 pm Implementing surviving sepsis guideline in resource limited setting (122) - Shirish Prayag

Assessing volume responsiveness in non ventilated patient (125) - Jean Louis Teboul

Use of procalcitonin in starting and stopping antibiotics in ICU (128) - Robert Balk

Graft versus host disease for the intensivist (131) - Subhal dixit


4:40– 4:55 Surviving Sepsis campaign: whats the future (123)- Marco Ranieri

Assessing volume responsiveness in ventilated patient (126) - Atul Kulkarni

Necrotizing skin and softtissue infection (129) - Sanjay dhanuka

Thromboelastogram: Use in ICU (132) - Deven Juneja

4:30 -5:00 Training in ICU (134) Moderator: N.RungtaPanel: J. C. Suri, A. Baronia, Charles Gommersall, N. Ramakrishnan

Q&A 5:00CHANGE 5 Mins

5:10– 6:00 pm Parallel SessionHALL – B HALL – C HALL - D HALL – E HALL – F

PRO/CON THEMATICGASTROENTEROLOGY

NEW GUIDELINES NEUROLOGY

HOT TOPICS THEMATIC VENOUSTHROMBOEMBOLISM

Chairpersons:Pravin Amin & Sibabrata banerjee

Chairpersons:Mahesh Goenka & Dinesh Singh

Chairpersons:S. S. Nandi & S. Iyer

Chairpersons: AnjanDutta & Diptimala Agarwal

Chairpersons:Randip Guleria & Rajiv Goyal

5:10 – 5:25 pm 5:00-5:30Minimally Invasive hemodynamic monitoring is necessary in managing shock (135)PRO: Mervyn SingerCON: Rahul Pandit

Gut dysmotility in ICU (137) - Arindam kar

Status Epilepticus (140)-Kapil zirpe

Use of internet in Critical Care (143) - Manish Munjal

DVT prophylaxis in ICU: what have we learnt from recent trials (146) - D K Singh

5:25 – 5:40 pm Post Pyloric feeding: selecting the right patientand the right technique (138)- Abhiram Mallik

Subarachnoid hemorrhage(141) - Harsh Jain

Tele ICU: scope in India(144) - Amit Verma

Diagnostic strategy of PE inresource limited setting(147) - Souren Panja

5:40 – 5:55 pm 5:30-6:00Early tracheostomy isbetter (pro-con) PRO; E Rupert CON; Anupam Goswami

Stress ulcer prophylaxis in ICU: is it overused (139) - Prakash Shastri

Plasmapheresis for neurological disorders (142)- Prashant Nasha

Handover in ICU: a neglected art (145) - Rajesh Pande

Management of PE in ICU(148) - S. S. Arora

Q&A 6:006:00- 7:00 pm Annual General Body Meeting7:30 – onwards Banquet

11:10 – 11:30 am Airway humidification, nebulization and high flow oxygen (160) - Jim Fink

Ventilation induced non pulmonary injury (163) - Arun dewan

Heart - Lung Interaction(166) - Edgar Jiminez

Catheter Related Blood Stream Infection-prevention - Dr. Suhasini (174)

11:30 – 11:50 pm Extracorporeal lung support(161) - Marco Ranieri

Improving patient ventilator synchrony (164) - Daniel Talmor

Organ cross talk (167) Charles Gommersal

11:30-12:00Improving safety and Reducing errors in icu (169)Moderator: Pradeep BhattacharyaPanel: B Ray, Yashesh Palliwall,Arpan Guha, A.P.Singh

Environmental cleaningand contact isolation (175)- Sanjay Bhattacharjee

Q&A 12:00

CHANGE 5 mins12:05 – 1:15 pm Parallel Session

HALL - A HALL – B HALL – C HALL - D HALL – E HALL – FTHEMATIC PNEUMONIA THEMATIC THEMATIC PULMONARY THEMATIC BLEEDING HOW I DO ITChairpersons: Sumanta Dasghupta & Anshuman Mukherjee

Chairpersons: Rimita Dey & Souren Panja

Chairpersons: Subhashish Ghosh & Iqbal rahman

Chairpersons:Sharmila Chandra & Ajit deka

Chairpersons: V. Ramasubramaniam & Ritesh Shah

12:05 – 12:25 pm Severe CAP: empiric therapy: deviating from the guidelines (173a)- Sumit Sengupta

Ideal MAP: a moving target (175) - Jean Louis Teboul

Pleural effusion in ICU: When to drain - Sujoy Mukherjee (178)

Managing bleeding due toThrombolysis, anti platelet and anticoagulant therapy(181) - Chandrashish chakravarty

12.00-4.00 pm SAARC meet Empirical antibiotic in community acquired bacterial sepsis (170) - Ashit Hegde

12:25 – 12:45pm Ventilator Associated Pneumonia – Risk factor &Management (174b) - Marin Kollef

Diagnosing cortisol deficiency in ICU (176) - Sudha Kansal

OSA in ICU : (179) -J.C. Suri

Coagulation system: new insights (182) - Mammon Chandy

Finding focus of sepsis in ICU (171) - Anand Kumar

12:45– 1:05 pm Viral pneumonias (175c) - Satish Gupta

Vitamin D in ICU: the rising sun (177) - K.Sriram

Challenging cases – Pulmonary critical care (180) - Robert Balk

Coagulopathy in trauma (183) - Michael Parr

Integrating hemodynamic variables at the bedside (172) - Mervyn Singer

Q&A 1:151:00– 2:00 pm Lunch Break

PLENARY SESSIONS (HALL A)2:00-3:30 pm Chairpersons: Atul Kulkarni & S.2:00–2:20 pm Analgosedation in ICU: Data Driven decisions to improve outcome: Wes Ely (184)2:20–2:40 pm Strategies beyond antibiotics (185) Speaker: Dilip Karnad2:40–3:00 pm Catching them early: Detecting deterioration in hospitalized patients (186) Speaker: Marin Kollef3:00-3:20 pm Hansraj Nayyar Oration

CHANGE 5 Mins3:25 – 4:30 pm Parallel Session


HALL – A HALL – B HALL – C HALL - D HALL – E HALL – FBASICS THEMATIC

NEPHROLOGYPANEL DISCUSSION CONTROVERSIES

SEPSISTHEMATIC SEPSIS

Chairpersons: A.K. Baronia & Indranil Ghosh

Chairpersons: Jayanta Bose, Dr V.V.Laksminarayan

Chairpersons: Rajarshi RoyDeepak Talwar

Chairpersons: Asif Ahmed & Amitava Saha

3:25 – 3:45 pm Biofilm and quorum sensing (187) - Robert Balk

Cardio Renal syndrome (189 a) - Claudio Ronco

3:00-3:30Device related infections(190)Moderator: Prithwish BhattacharyaPanel: Gillian Thompson,carol Thompson, Bhaskar Narayan Choudhry, Partha Goswami

(192) Intravenous immunoglobulin’s & GCSF in sepsis - R K Mani

Hemophagocytic syndrome in ICU: sepsis mimic (195) - Mohit Kharbanda

3:45 – 4:05 pm Purinergic Signaling during inflammation (188)George John

Managing Hyponatremia in ICU: common errors (189 b)Shashwati Sinha

Cooling septic febrile patient: is it useful (193) Avdesh Bansal

Inhaled antibiotics: what’s the evidence (196) -Yashish Palliwal

4:05 – 4:25 pm Mechanisms of antibiotic resistance (189) - Vandana Sinha

Concept of subclinical AKI (189 c) - Claudio Ronco

3:30- 4:00Challenging Cases in Sepsis (191) Moderator: V Ramasubramaniam Panelist: Mervyn Singer, Ashutosh Ghosh, Udas Ghosh, Sugato Dasgupta

C. DIfficile infection: an emerging threat (194)- Marin Kollef

4-6pmIncoming EC meeting

Steroids in sepsis, trauma and surgery: current evidence (197) - Sudhir Khunteta

Q&A 4:30


CHANGE 5 Mins4:35 – 5:25pm Parallel Session

HALL – A HALL – B HALL – C HALL – D HALL-E HALL – FCONTROVERSIES

VENTILATIONTHEMATIC CARDOLOGY HOW I DO IT THEMATIC INFECTION WHATS NEW

Chairpersons: Samir Sahu & Vandana Sinha

Chairpersons: Dr Ahangar, Ajay Banerjee

Chairpersons: Sumit Podder & Samar Ghosh

Chairpersons:Ashit Hegde & H.Bagaria

Chairpersons: Kalpalatha Guntapally & Kiran Sheshadri

4:35 – 4:50 pm Target Tidal Volume or Plateue pressure in mechanical ventilation (201)- Daniel Talmor

Temporary and permanent pacemakers in the Intensive care – Sandhya Talekar (198)

Setting up an ICU in districts - Subrato Maitra (204)

Surveillance cultures in ICU: are they helpful (207)- Shankar Sengupta

Value of Bundles in ICU – Charles Gommersall (210)

4:50 – 5:05 pm Newer modes: are they helpful in weaning (202) - Yatin Mehta

Ventricular assist devices (199) - Dr Ahangar

Manage invasive ventilation at home (205) - Deepak Talwar

What bug rules our ICU’s(208) - R Venkatraman

NIV: Whats new (211) - Edgar Ziminez

5:05 – 5:20 pm Diagnosing VAP: Quantitative or Qualitative culture/ Bronch or Non Bronch techniques (203) - Harjeet Dhumra

Narrow complex tachycardia-approach for the intensivist - Rabin Chakraborty (200)

Manage Poisonous snake bite (206) - Sanjeev bhoi

Probiotic/Prebiotic/Symbiotic: what’s the evidence(209)- Marin Kollef

Paralysis in ARDS: New Data (212) - Wes Ely

Q&A 5:25CHANGE 5 mins

5:30 – 6:30 pm Parallel SessionHALL - A HALL – B HALL – C HALL - D HALL – E HALL – F

THEMATIC NEUROLOGY

THEMATIC HEPATOLOGY

CONTROVERSY THEMATICOBSTETRICS & CRITICAL

CARE

IMAGING IN ICU WHAT’S NEW

Chairpersons: Abhijit Chatterjee & Ambar Chakraborty

Chairpersons:Animesh Gupta & Yashesh Palliwal

Chairpersons: Chandra Sharma & V.K. Thakur

Chairpersons:Ashutosh Ghosh & S N Mitra

Chairpersons: Sukalyan Purkayastha & Dr Saugata Sen

5:30 – 5:45 pm (213) Brain, heart, lungs-who to save in a fight? Shabbar Joad

(222) Intensive care of the cirrhotic patientDeepak govil

(219) Pediatric Controversy (216) Anaphylactoid syndrome of pregnancy Omender Singh

- Lung Ultrasound in ICULuca Neri (226)

5:45 – 6:00 pm Post op Neurosurgical meningitis: Diagnosis and treatment (214) - Rajesh Mishra

(223) Portal hypertension-old problem, new answersM.K. Goenka

(220) End of life care in Indian ICURam E Rajagopalan

(217) Hypertensive emergencies of pregnancy: a new approach to a age oldproblem - D.P. Samaddar

Ultrasound in PolytraumaEnrico Storti(227)

6:00 – 6:15 pm Encephalitic syndromes in ICU: a practical approach(215) - V.Ramsubramanium

(224) Hepatopulmonary Syndrome - Rajesh Pande

Chasing the serum Albumin: is it worthwhile(221)- Dipankar sarkar

(218) Complications of the obese parturient- Vijaya Patil

PET scan in ICU Soumen Roy (228)

Q&A 6:306:30 – 7:00 pm Valedictory Function

CRItICaRE 2013 - WoRKSHoP PRoGRaMWORKSHOP ON CRITICAL CARE TOXICOLOGY

Course Director- Dr.Omender SinghMonday 4TH March 2013

8:00-08:30 Introduction to the Workshop / Pre Test Dr Omender Singh8:30-08:50 Approach to Acute poisoning in Emergency Department-Toxidromes Dr Omender Singh8:50-09:10 ACLS AHA /AHLS Toxicology Dr Yash Javeri9:10-09:30 The ABCDs of Poisoning Dr Omender Singh9:30-09:50 Insecticide Poisioning Organophosphorous/organochlorine and Carbamates Dr J V Peter9:50-10:10 Sedative and Hypnotic Overdose Dr Praveen Bajaj10:10-10:30 Alcohol, Ethanol, and Beyond- Toxic Alcohol Intoxication Dr Senthil Kumaran10:30-11:00 Tea Break11:00-11:20 Corrosives, Hydrocarbons, & Halogenated Hydrocarbons Dr Prashant Nasa11:20-11:40 Poisoning-CLUB and Rave Drugs Dr Omender Singh11:40-12:00 CharcoBicarbaNACaFab-obalamin: I All About the Antidotes - I Dr Prashant Nasa12:00-12:20 Antidotes Part 2 Dr Mohit Kharbanda12:20-12:40 Methaemoglobinemia –Missed Diagnosis Dr Senthil Kumaran12:40-13:00 Paracetamol and Salicylate Overdose Dr Deven Juneja13:00-13:50 LUNCH BREAK13:50-14:10 Plant poisoning Dr Senthil kumaran14:10-14:30 BITE and STINGS- Snake, Scorpion, Spider Envenomations and Bee Bites-Useful Tips H.S Bawaskar14:30-14:50 Tox Lab Dr V V Pillay14:50-15:10 Aluminium Phosphide & Rat Killer Poisoning Dr J V Peter15:10-15:30 Toxic Inhalations Dr Prashant Nasa15:30-15:50 Appraoch to Chemo ,Bio & Radiation Toxicology Dr Yash Javeri15:50-16:10 Extracorporeal Therapy in poisoning Dr Omender Singh16:10-16:30 Tea Break16:30-17:00 Interactive Case Studies Dr J V Peter17:00-17:45 TOX JEOPARDY -WIN ATTRACTIVE PRIZES 17:45 Post Test


WORKSHOP ON INTENSIVE CARE NEPHROLOGY BEYOND BASIC (for Instructor & Provider Course) • 4th & 5th March, 2013Course Director: Dr. Charles Gomersall & Course Co-ordinator: Dr. Shivakumar Iyer

Monday 4th March, 201308:30 Registration08:50 Welcome Charles Gomersall09:00 AKI – definitions and epidemiology Gordon Choi09:30 AKI Charles Gomersall10:00 Chronic kidney disease Hans Flaatten10:30 CRRT part 1 Ross Freebairn11:00 Break11:20 CRRT part 2 Gordon Choi11:50 Peritoneal dialysis Charles Gomersall12:20 IHD & Hybrid techniques Shivakumar Iyer12:50 Drug dosing in renal failure Hans Flaatten13:20 Lunch14:20 Skill stations/tutorials

AKIChronic kidney diseasePeritoneal dialysisCRRTIHD and hybrid techniquesDrug dosing

All instructorsHans FlaattenShivakumar IyerRoss FreebairnGordon ChoiCharles Gomersall

16:35 Lecturing (instructor candidates only) Charles Gomersall17:00 Teaching skill stations (instructor candidates only)

Tuesday 5th March, 201308:30 Rhabdomyolysis Ross Freebairn09:00 Abdominal compartment syndrome Shivakumar Iyer09:30 Break09:50 Skill stations/tutorials

Chronic kidney diseasePeritoneal dialysisCRRTIHD and hybrid techniquesDrug dosing

Hans FlaattenShivakumar IyerRoss FreebairnCharles GomersallGordon Choi

12:05 Post course MCQ12:35 Close

Instructor candidates only13:15 Instructor candidates give allocated lectures with feedback from facilitator All faculty14:15 Instructor candidates teach skill stations with feedback from facilitator All faculty17:15 Close

WORKSHOP ON RESEARCH & PUBLICATION • 4th & 5th March, 2013Course Director: Dr. Sunit Singhi & Course Co-ordinator: Dr. Mahua Bhattacharya

DAY - I • 4th March, 2013HOW TO START

9am – 9:20am Asking right research question and background literature search J V Peter9:20am – 9:40 am Study designs (scope & limitations) Raja Dhar9:40 am – 10:20am Understanding basic statistics Ritesh Agarwal10:20am – 11:00am Writing a research protocol Robert Balk

HANDS ON (Group discussion)11:15 am – 1:00pm Each Group will be given a clinical problem ( New Therapy, Prognosis, Diagnosis )

One Faculty facilitator for each groupGroups will be expected to do the followingIdentify research questionDo literature search, Identify Study design, Identify statistical methods, Write a research protocol One spokesperson from each group will present to all groups about their conclusions.

J V PeterSriram SampathRitesh AgarwalJose Chacko

1:00pm – 2:00pm LUNCHRESEARCH RELATED ISSUES

2:00pm – 2:20pm Ethical issues in research Jose Chacko2:20pm – 2:40pm Legal issues in research Ritesh Agarwal2:40pm – 3:00pm Organisational issues in research Joseph L Mathew3:00pm – 3:20pm Economical issues in research Ritesh Agarwal3:20pm – 3:40pm Documentation in clinical research Sriram Sampath

PUBLISHING RESEARCH3:40pm – 4:00pm Writing abstract and manuscript Anand Kumar4:00pm – 4:20pm TEA BREAK4:20pm – 4:40pm Submitting research work for publication Sunit Singhi4:40pm – 5:00pm Conducting meta analysis Anand Kumar5:00pm – :305pm OPEN FORUM MODERATOR : Sunit Singhi

DAY – II • 5th March, 2013LECTURE

9:00am – 9:30am What is Evidence Based Medicine and what it is not Kameswar Prasad9:30am – 10:00am Asking the right clinical question Joseph L Mathew10:00am – 10:30am How to search internet for evidence Medha Joshi10:30am – 10:50am TEA BREAK

CASE BASED DISCUSSION10:50am – 12:50pm Delegates will be divided into groups. Each group will be given a case scenario and they will formulate right questions and search net for

relevant evidence and present to the entire group.Joseph L Mathew Kameswar PrasadMedha Joshi

12:50pm – 1:50pm LUNCHLECTURE

1:50pm – 2:10pm Analysing literature on Diagnosis Kameswar Prasad2:10pm – 2:30 pm Analysing literature on therapy Robert Balk2:30pm – 2:50 pm Analysing literature on Meta analysis Anand Kumar2:50 pm – 3:10pm Analysing literature on prognosis J V Peter3:10pm – 3:30pm Analysing cost effectiveness literature Sriram Sampath

CASE BASED DISCUSSION3:30pm – 4:30pm Delegates will be divided into groups. Each group will be given an article (therapy,diagnosis,metaanalysis) to critique Anand Kumar

Robert BalkJ V PeterKameswar Prasad

4:30pm – 5:00pm OPEN FORUM MODERATOR - Sunit Singhi


WORKSHOP ON COMPREHENSIVE TRAUMA LIFE SUPPORT (CTLS) • 4th & 5th March 2013Course Director & Co-ordinator - Dr. N. Ganapati & Dr. Tanmoy Das

Day – 1 (4th March, 2013) Day – 2 (5th March, 2013)07.30 Registration08.30 Course Overview09.00 Initial Assessment & Primary Survey09.50 Airway Assessment & Management10.40 Break11.00 Workshop: Airway/RSI/Cricothyrotomy12.00 Hemorrhage Assessment & Management12.50 Lunch13.30 Severe Head Injury14.20 Abdominal Trauma15.00 Break15.30 Thoracic Trauma16.20 - 17.30 Workshop: ChestTubes/Interosseous

08.30 Spinal Trauma09.10 Musculoskeletal Trauma10.00 Burns10.40 Break11.00 Trauma in Pregnancy & Children11.50 The Elderly Trauma Patient12.30 Lunch13.30 Definitive Care14.10 Transport of the Critically Injured14.50 Break15.10 Intensive Care: The First 24 hours16.00-17.00 Evaluation & Concluding Session

The course will emphasize on:

1. Sequence of assessment & management

2. Team roles & preparation

3. Primary survey

4. Simultaneous resuscitation & re-evaluation

5. Secondary survey

6. Planning & definitive care management

7. On-going support to optimize outcome

8. Tertiary survey

The CTLS Educational Format provides:

1. Pre-course materials (A must read)

2. A 2 day course that features

- A multi disciplinary approach

- Case audit interactive presentations

- Group Discussions

- Interactive Hands On Skill Stations

- An in course MCQ.

CTLS Faculties

International

• Dr. Michael Parr, Australia

• Dr. Gillian Bishop, Australia

• Dr. Maureen McCunn, USA

• Dr. Jeff Berman, USA

• Dr. Arpan Guha, UK

• Dr. Sashi Kumar, Australia

• Dr. Samir Suri, Australia

National

• Dr. J Balavenkat, Coimbatore

• Dr. T Ramakrishnan, Chennai

• Dr. Manish Merhotra, Lucknow

• Dr. Debasish Roy, Kolkata

• Dr. Arijit Bose, Kolkata

WORKSHOP ON NUTRITION IN CRITICAL CARECourse Director - Dr. N. Ramakrishnan & Co-ordinator – Dr. Lawni Goswami

Monday 4TH March 20138:30 – 9:00 am Registration

9:00 – 9:10 am Welcome, Introduction of faculties, briefing of workshop format

9:10 – 9:30 am Nutrition as adjunctive care or as proactive therapy Dr. N. Ramakrishnan

9:30 – 9:50 am Nutritional screening and assessment Dr. Pravin Amin

9:50 – 10:10 am Current guidelines on enteral nutrition (ASPEN/ISPEN/Canadian) ICU Dr. Mohan Das

10:10 – 10:30 am Current guidelines on parenteral nutrition (ASPEN/ISPEN/Canadian) Dr. Pravin Amin

10:30 – 10:50 am Immunonutrition in critical care Dr. Krishnan Sriram

10:50 – 11:10 am Tea Break (20 mins)

11:10 – 12:10 pm Case based Discussions - - Nutrition in Pancreatitis- Nutrition in Hepatic Failure

Dr. Mahua Bhattacharyya

12:10 – 12:30 pm Perioperative Nutrition optimization Dr. Krisnan Sriram

12:30 – 1:30 pm Lunch

1:30 – 2:30 pm Case based Discussion – - Nutrition in Renal failure- Nutritional issues in EOL care

Dr. N. Ramakrishnan

2:30 – 2:50 pm Monitoring Nutritional Support role of markers and whats new Dr. Mohan Das

2:50 – 3:30 pm Quiz / MCQs

3:30 – 4:00 pm Display of nutritional delivery devices.Nasogastric tubes. Freka Tubes, PEG tubes and their care different pumps and delivery devices

AIRWAY MANAGEMENT WORKSHOP • 4th & 5th March 2013Course Directors : Dr. Atul Kulkarni & Dr. Saikat Sengupta

DAY 1 • 4th March, 20138:00 Registration

8:30 Predicting the difficult airway and their pitfalls in intensive care Dr. Saikat Sengupta

9:00 Airway algorithms and their application critical case scenarios Dr. Pradeep Bhattacharya

9:30 Supraglottic airway devices with special emphasis on the LMA’s Dr. Sheila Nynan Myatra

10:00 Fiberoptic guided intubation in intensive care and other uses of the fiberscope in intensive care Dr. Atul Kulkarni

10:30 - 11:00 Tea Break

11:00 – 13:00 Workstations

13:00 - 13:45 Lunch

13:45 – 15:45 Workstations

Workstations Faculty

1 Bag Mask Ventilation, Intubation with MILS, Oxygen therapy, Humidification Dr D P SamaddarDr Swagata Tripathy

2 Optimizing laryngoscopy – OELM, BURP, Sellicks, Ramp, different laryngoscopy blades, stylets, bougies, airway exchange catheters Dr Prithwis BhattacharyaDr Jayanta MitraDr Palas Kumar

3 Supraglottic Airways – LMA etc Dr Moed AhmedDr Sucharita Chakravarti

4 Needle cricothyrotomy &TTJVSurgical cricothyrotomy

Dr Sheila Nynan MyatraDr Saikat Sengupta


NEURO CRITICAL CARE WORKSHOP • 4th & 5th March 2013Course Directors - Dr. Atul Kulkarni & Dr. Saikat Sengupta

4th March 2013 Venue: Institute Of Neurosciences Kolkata (I-NK)8:30am to 8:40am Introduction Dr. Kapil Zirpe

8:40am to 9.00am ICP: Physiology/ Pathology / Management Dr. J M K Murthy

9:00am to 9:20am Approach to Comatose Patients Dr. Partha Sarathi Goswami

9:20am to 9:40am Myths and Facts in Neuro Critical Care Dr. Bibhukalyani Das

9:40am to 10.00am Blood Presure Management in CVA Dr. Subhash Arora

10:00am to 10:20am Critical Care issues in CNS infection Dr. A Shovana

10:20am to 10:40am Current concepts in Management of Status Epilepticus Dr. Tapas Kumar Banerjee

10:40am to 11.00am Actue Para paresis in ICU Dr. Trinanjan Sarangi

11.00am to 11.30am Delirium in NeuroICU Dr. Alakananda Dutt

11.30am to 11.45am TEA BREAK

11.45am to 12.05 pm What is new in Stroke Management Dr. Jayanta Roy

12.05pm to 12.25pm Recent advances in Neuro radiological interventions for treatment of Intracranial bleed Dr. Sukalyan Purakayastha

12.25pm to 12.45pm Medical management of SAH Dr. JMK.Murthy

12.45pm to 1.30pm LUNCH BREAK

INVESTIGATIONS IN NEURO CRITICAL CARE/ CASE BASE DISCUSSION (Rotation of 4 batches)1.30pm to 2.00pm EEG/ EP Dr.Asish Dutta

2.00pm to 2.30pm Transcranial Doppler(understanding its role in neurocritical care) Dr.Indranil Ghosh

2.30pm to 3.00pm CSF and other lab investigations in NCCU Dr. Hrishikesh Kumar

3.00pm to 3.30pm Neuro Imaging(CT/MRI) Dr.Mona Tiwari

3.30pm to 4.00pm TEA BREAK

4.00pm to 4.30pm Traumatic Brain Injury Dr.Samarendra Nath Ghosh

4.30pm to 5.00pm Therapeutic Hypothermia(when Iwill do it) Dr.Apratim Mukherjee

5.00pm to 5.30 pm Management of Post cardiac arrest Syndrome Dr.Kapil Zirpe

5.30pm to6.00pm Diagnosis of Brain Death and Organ Donation Dr.Subhash Arora

6.00pm VALIDATORY FUNCTION

Indian Society of critical care Medicine

election result 2012

I am happy to announce the list of newly elected office bearers and members of the Executive Committee for 2013 - 2015 that was ratified in the ISCCM executive committee meeting on 4th November 2012

Vice Presidents

dr yatin Mehta dr Khilnani Praveen dr. Kapil Zirpe

secretary

dr. Prakash Shastri

executiVe committee members

dr. Singh yogendra Pal dr. Khunteta Sudhir dr. nikalje anand dr. Sachdev anil

President – elect and chief election commissioner - isccm

dr. Shivakumar Iyer

DAY 2 • 5th March, 20130830 Video laryngoscope: what have you been missing in critical care Dr Moed Ahmed

0900 The subglottic airway – percutaneous tracheostomy: when & how? Dr Sheila Nynan Myatra

0930 Maintaining the airway in critical care. Care of the patient Dr Prithwis Bhattacharya

1000 Extubating the patient with a difficult airway Dr D P Samaddar

1030 – 1100 Tea

1100 – 1300 Workstations

1300 – 1345 Lunch

1345 – 1545 Workstations

Workstation Faculty

1 Videolaryngoscopy – 2 stations Dr Moed AhmedDr Prithwis BhattacharyaDr Jayanta Mitra

2 Fiberscopy – 2 stations Dr Pradeep BhattacharyaDr Palas KumarDr Saikat Sengupta

3 Subglottic airway Dr Atul KulkarniDr Sheila Nynan MyatraDr Swagata Tripathy


Conference Secretariat

Dr. Bibhu Kalyani Das Dr. Subhash Todi Dr. Susruta Bandyopadhyay Dr. Ajoy SarkarChairman, Reception Committee

Mobile : +91-9830006409Organizing Chairman

Mobile : +91-9831202040Organizing Secretary

Mobile : +91-9831079453Treasurer

Mobile : +91-9830006644

CRITICARE 2013KB-25 Building, 2nd Floor, Salt Lake City, Sector - III, Kolkata - 700098, West Bengal, India.

Mobile : +91-9810084342 • +91-8017984305 • e-mail : secretariat@criticare2013kolkata. org • [email protected]

for more Details & Online Registration please visit www.criticare2013kolkata.org

Editorial officEdr. Shivakumar iyer

Karnik Heritage, Flat No 08, 3rd floor, Sadubhau Kelkar Road, Off F. C. Road,Pune - 411004, Maharashtra. Phone : 020-25532320 (from 11 am to 3 pm)

[email protected]

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

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

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

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

FEW

INTE

RNAT

ION

AL

FAC

ULTI

ES

19th Annual Congress of the Indian Society of Critical Care Medicine & International Critical Care Congress

SCIENCE CITY, KOLKATA

SCIENTIFIC CONGRESS: 1st TO 3rd March, 2013 WORKSHOP: 4th TO 5th March, 2013

ORGANIZED BY: ISCCM KOLKATA BRANCH, WEST BENGAL, INDIA

Website : www.criticare2013kolkata.org Email : [email protected] / [email protected] / [email protected]

ACCESSIBLE t ACCOUNTABLE t AFFORDABLE CARE

Anand Kumar (Canada) Charles Gommersall (HONGKONG) Claudio Ronco (Italy) Daniel Talmor (USA) Edgar Jiminez (USA) Enrico Storti (ITALY) Gillian Thompson (USA) Jean Louis Teboul (FRANCE) Jean Louis Vincent (BELGIUM) Jeff Lipmann (AUSTRALIA) Konrad Rein Hardt (GERMANY) Luca Neri (ITALY) Marin Kollef (USA) Mervyn Singer (UK) Michael Parr (AUSTRALIA) Robert Balk (USA) Wes Ely (USA)

Neuro Critical Care Course Nutrition in Critical Care Course Research and Publication Extracorporal Supports (Cardiopulm. & liver) Physical Rehabilitation & Respiratory Therapy Nephro Critical Care Toxicology Comprehensive Critical Care Course Basic Pediatric Intensive Care Course Mechanical Ventilation : Basic and Advanced Pediatric Fundamental Critical Care Support Procedures in PICU (PPICU)

Advanced Cardiac Life Support Course Fundamental Critical Care Support Course Fundamental Disaster Management Comprehensive Trauma Life Support Course Ultrasound in Emergency and Critical Care Unit Mechanical Ventilation Hemodynamic Monitoring Critical Care Nursing Antibiotic Stewardship & Infection Control Airway Management Workshop Learning through Simulations Basic Assessment & Support in Intensive Care

WORKSHOP DETAILS

Conference highlights:

More than 250 lectures

Thematic/Panel/Pro-con/ Guideline/ How I do it / Controversies Sessions

200 National Faculties

30 International Faculties

Twenty-eight Workshops

Adult & Pediatric sessions

CRITICARE 2013

Critical Care - ISCCMcase reports, brief communications, interesting ECG's, X-rays, CT scans, MRI's...

Documents

Transcript of Critical Care - ISCCMcase reports, brief communications, interesting ECG's, X-rays, CT scans, MRI's...