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Respiratory Physiology -Part 2 Dr Swapnil Pawar
COVID-19 Vaccine – The Mystery of Hope Dr Swapnil Pawar
Spontaneous Bacterial Peritonitis Dr Swapnil Pawar
Post-Operative Fluid Management Dr Swapnil Pawar

Opinion

Background

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eCritCare Podcast

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COVID-19 Vaccine – The Mystery of Hope

Dr Swapnil Pawar December 24, 2020

COVID -19 Vaccine Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine Population Inclusion: Healthy adults or those with stable medical conditions including human immunodeficiency virus (HIV), hepatitis B virus, or hepatitis C virus infection were eligible. United States, 130 sites; Argentina, 1; Brazil, 2; South Africa, 4; Germany, 6; and Turkey, 9 Exclusion: Previous history of Covid-19, treatment with immuno-suppressive therapy, or diagnosis with an immunocompromising condition. Design Randomized controlled trial using an interactive Web-based system Intervention 30 μg of BNT162b2 (0.3 ml volume per dose) into the deltoid muscle. Two 30 mcg doses of the vaccine administered 21 […]

Lactate in Sepsis

eCritCare Podcast

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Lactate in Sepsis

Dr Swapnil Pawar December 14, 2020

Blog Written by – Dr Jose Chacko Lactic acidosis commonly occurs in critically ill patients, especially among those in shock of varying etiology. High lactate levels are uniformly associated with poor clinical outcomes, including mortality.1 However, there is considerable interest and conflict of opinion regarding the clinical value of using lactate levels to guide resuscitation in critically ill patients. Although generally considered to be a marker of tissue hypoxia, the etiology of hyperlactatemia in the critically ill may be multifactorial. Lactate production and metabolism Lactate is generated at the rate of 0.8 mmol/kg/hour (1300 mmol/day) and the normal plasma level […]

Respiratory Physiology Part 1

ICU Primary Prepcast

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Respiratory Physiology Part 1

Dr Swapnil Pawar December 9, 2020

RESPIRATORY PHYSIOLOGY Written by – Dr Madhuri Anupindi Describe the anatomy of the trachea and bronchial tree to the level of the segmental bronchi The trachea is a fibrocartilaginous tube which typically has an inner diameter of about 2.5cm and a length of about 10 – 16cm. It begins at the lowest border of the larynx around the level of C6, and ends by bifurcating into the right and left main bronchi around T5-7. The trachea is D shaped in cross section and consists of curved cartilage rings anteriorly and a flat, longitudinal muscle called the trachealis posteriorly. The […]

intensive-care-emergency-room-with-hemodialysis-machine-hemofiltration-procedure-patient-critical-stance_133994-599

eCritCare Podcast

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RICH Trial – Regional Citrate vs Systemic Heparin Anticoagulation for CRRT

Dr Swapnil Pawar November 26, 2020

Effect of Regional Citrate Anticoagulation vs Systemic Heparin Anticoagulation During Continuous Kidney Replacement Therapy on Dialysis Filter Life Span and Mortality Among Critically Ill Patients With Acute Kidney InjuryA Randomized Clinical Trial The blog is written by Dr Jose Chacko Design The study was performed against the background of the KDIGO (2012) guidelines that recommended the use of regional citrate anticoagulation instead of heparin during renal replacement therapy in acute kidney injury in patients who have no impairment of coagulation, no increase in bleeding risk, and not receiving systemic anticoagulation for comorbid conditions. The RICH trial was a randomized, multicenter, […]

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eCritCare Podcast

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Critical Appraisal of Surviving Sepsis Guidelines

Dr Swapnil Pawar November 18, 2020

Written by – Dr Jose Chacko “Bundled” care in sepsis The 2018 surviving sepsis guidelines combined the previous 3- and 6-h bundles into a single 1-h bundle that included Estimation of lactate levels; repeat if level > 2 mmol/l (weak recommendation; low-quality evidence) Blood culture, followed by broad-spectrum antibiotics (best practice statement) Intravenous crystalloid at 30 ml/kg for hypotension or lactate ≥ 4 mmol/l (strong recommendation; low-quality evidence) Vasopressors if the patient remains hypotensive during or after fluid resuscitation for MAP ≥ 65 mm Hg (strong recommendation; moderate-quality) Bundled vs. physician-judgement based approach Kaukonen et al. showed that mortality with […]

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eCritCare Podcast

257

Evidence Based Medicine – Guidelines and GRADE methodology

Dr Swapnil Pawar October 25, 2020

Guidelines and GRADE Methodology Guidelines are recommendations intended to assist providers and recipients of health care and other stakeholders to make informed decisions. Recommendations may relate to clinical interventions, public health activities, or government policies. ( WHO 2003,2007) Before forming guidelines, consider – Who is the target user of the guideline Who it applies to What is covered? – Eg diagnosis and treatment of diabetic retinopathy Develop key questions Key Steps – Group Composition & consultation process Managing conflicts of interests Formulate Question Select Outcomes Rate Importance Create Evidence Profile using GRADE-PRO Rate quality of evidence for each Outcome Downgrade […]

eCritCare Podcast

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Evidence Based Medicine – How to interpret a Meta-Analysis

Dr Swapnil Pawar October 17, 2020

How to Interpret a Meta-Analysis Blog Written by Dr Jose Chacko What is a meta-analysis and why do we need to perform a meta-analysis? We live in the era of evidence-based medicine Some important clinical questions remain unanswered despite several studies e.g., corticosteroids in sepsis; small studies may not be powered; blood sugar control differing conclusions Put together studies systematically, attempt to come to a more definitive conclusion A meta-analysis provides a single, overall measure of the treatment effect, enhancing the clinical interpretation of findings across several studies. You get results as “effect size” How meta-analysis is performed Ask the […]

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ICU Primary Prepcast

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Physics & Monitoring in ICU – Part 1

Dr Swapnil Pawar October 5, 2020

Physics and Monitoring in ICU – Part 1 Written by – Dr Madhuri Anupindi Describe the physical principles of ultrasound Ultrasound is sound whose frequency is above the range of human hearing. Sound is a mechanical wave produced by vibration of the medium and can be represented by a sinusoidal wave. The wavelength is the distance between two consecutive points of the same phase, the amplitude is the maximal distance covered by each particle during an oscillation and the frequency is the number of cycles occurring in 1 second measured in hertz. Medical ultrasound uses high frequency sound ranging from […]

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Educator's Podcast

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technology, MedEd and COVID-19

Dr Swapnil Pawar October 4, 2020

In this podcast, we discuss the upsurge of the use of technology in Medical education space during COVID-19 pandemic. Dr Eric Gantwerker from Chicago talks about the pros and cons of the different technological solutions emerged during this pandemic. Further reading –

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eCritCare Podcast

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Evidence-Based Medicine Part 1- How to Interpret an RCT

Dr Swapnil Pawar October 4, 2020

Interpreting an RCT Blog written by – Dr Jose Chacko & Dr Swapnil Pawar 3 Key areas – the validity of the trial methodology; the magnitude and precision of the treatment effect; the applicability of the results to your patient or population. Questions to consider when assessing an RCT Did the study ask a clearly focused question? Was the study an RCT and was it appropriately so? Were participants appropriately allocated to intervention and control groups? Were participants, staff, and study personnel blind to participants’ study groups? Were all the participants who entered the trial accounted for at its conclusion? […]

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eCritCare Podcast

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Steroid Story in COVID-19

Dr Swapnil Pawar September 21, 2020

Steroids in COVID-19 The role of corticosteroids in treating severe infections has been debatable for some time. During the coronavirus disease 2019 (COVID-19) pandemic, rigorous data on the efficacy of corticosteroids have been limited. As of July 24, 2020, 55 studies of corticosteroids for the treatment of COVID-19 have been registered on ClinicalTrials.gov. In early July, The Randomized Evaluation ofCOVID-19 Therapy (RECOVERY) trial reported its findings from 6425 patients randomized to 6mg/d of dexamethasone or usual care. Overall, dexamethasone resulted in an absolute reduction in mortality of 2.8 %( 22.9%vs 25.7%for usual care; age-adjusted rate ratio, 0.83 [95%CI, 0.75- 0.93]). […]

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eCritCare Podcast

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Prone Positioning in ARDS

Dr Swapnil Pawar September 13, 2020

play_arrow Prone Positioning in ARDS Dr Swapnil Pawar Prone Positioning in ARDS Written by – Dr Jose Chacko Edited By – Dr Swapnil Pawar Prone positioning was first proposed in the 1970s as a method to improve gas exchange in ARDS. Subsequent observations of dramatic improvement in oxygenation with simple patient rotation motivated the next several decades of research. During COVID -19 pandemic, the debate on the utility of proning has been resurfaced. Ventilation heterogeneity In ARDS, widespread edema occurs leading to an increase in the weight of the lung. The dependent areas of the lung are compressed by the […]

Men holding placards and loudspeakers and protesting against racism, inequality. Black lives matter concept.

Educator's Podcast

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Social Determinants of Health in Medical Education

Dr Swapnil Pawar September 6, 2020

Understanding of social determinants of health is important not only for budding medical professionals but also for medical educators. In this podcast, Dr Mobola Campbell-Yesufu from Northwestern university talks about the need to include this topic in all medical curricula across the globe. play_arrow Social Determinants of Health in Medical Education Dr Swapnil Pawar This social determinants of health curriculum provide a broad overview of issues of health equity affecting our patients. The curriculum of social determinants of health consists of three modules (social determinants of health, health disparities and social justice). This curriculum teaches residents how to identify […]

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eCritCare Podcast

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STARRT-AKI Trial

Dr Swapnil Pawar August 22, 2020

Timing of Initiation of Renal-Replacement Therapy in Acute Kidney Injury The STARRT-AKI Investigators for the Canadian Critical Care Trials Group, the Australian and New Zealand Intensive Care Society Clinical Trials Group, the United Kingdom Critical Care Research Group, the Canadian Nephrology Trials Network, and the Irish Critical Care Trials Group* play_arrow STARRT-AKI Trial Dr Swapnil Pawar Acute kidney injury occurs in up to 50% of critically ill patients and is associated with high morbidity and mortality. Renal replacement therapy (RRT) can rapidly correct life-threatening complications associated with acute kidney injuries, such as severe hyperkalemia, metabolic acidosis, or pulmonary edema due […]

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eCritCare Podcast

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Top 10 Practice Changing Trials in Intensive Care

Dr Swapnil Pawar August 15, 2020

play_arrow Top 10 Practice Changing Trials in Intensive Care Dr Swapnil Pawar Dr Swapnil Pawar & Dr Jose Chacko The ARDS-net low tidal volume (ARMA) study In this multicentric randomized controlled trial (RCT), patients with acute lung injury and acute respiratory distress syndrome (ARDS), (based on pre-Berlin definitions) were enrolled. The study was conducted across 10 university hospitals in the USA for a 3-year period between 1996-99. Patients were ventilated with a tidal volume of 12 ml/kg predicted body weight at a plateau pressure of 50 cm H2O or less, and compared with 6 ml/kg predicted body weight at a […]

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Educator's Podcast

149

Anthropology to Explore the Culture in Medicine

Dr Swapnil Pawar August 3, 2020

Join Dr. Eve Purdy from Canada to learn how to dissect the culture of your working environment through the lens of Anthropology. In this podcast, she describes simulation as a means to create moments of cultural compression and how that can be beneficial to evaluate and thus potentially modify the culture of the place. References – Connecting simulation and quality improvement: how can healthcare simulation really improve patient care? V Brazil, EI Purdy, K Bajaj. BMJ quality & safety 28 (11), 862-865 Identifying and transmitting the culture of emergency medicine through simulation E Purdy, C Alexander, M Caughley, S […]

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eCritCare Podcast

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Cytokine Storm in COVID-19

Dr Swapnil Pawar August 1, 2020

What really happens in the lung in COVID-19 pneumonia? Although several studies suggest raised levels of inflammatory mediators in COVID-19, it is pertinent to compare levels observed in other types of acute respiratory distress syndrome (ARDS). IL-6 levels may be considerably lower in patients with severe COVID-19 compared with levels that are typically seen in patients with the hyperinflammatory phenotype of ARDS.2 Ackermann et al. evaluated autopsy findings in the lungs from patients who died of COVID-19 and compared it with patients who died of H1N1 pneumonia and those with uninfected lungs. The pulmonary involvement in COVID-19 was characterized […]

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eCritCare Podcast

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Tranexamic Acid in Acute GI Bleeding – HALT-IT Trial

Dr Swapnil Pawar July 24, 2020

Effects of a high-dose 24-h infusion of tranexamic acid on death and thromboembolic events in patients with acute gastrointestinal bleeding (HALT-IT): an international randomised, double-blind, placebo-controlled trial The HALTIT trial was an international, multicentric, randomized, double-blind placebo controlled trial. It was carried out in 164 hospitals across 15 countries (UK, Pakistan, Nigeria, Egypt, Malaysia, Georgia, Romania, Nepal, Sudan, Saudi Arabia, Spain, Ireland, Albania, Papua New Guinea, and Australia). Conducted between July 4, 2013, and June 21, 2019. Inclusion Included patients were >16 years and older or aged 18 years or older (depending on the definition of adult in their respective […]

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eCritCare Podcast

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Hydroxychloroquine Prophylaxis in COVID-19 – Debunking the Myth

Dr Swapnil Pawar July 12, 2020

A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19 The only strategies that worked so far in COVID-19 to mitigate transmission are rapid identification of cases, isolation, contact tracing, and self-quarantine of those exposed. To date, no medication has been shown to prevent SARS-CoV-2 transmission. This trial hypothesized that hydroxychloroquine could potentially be used as postexposure prophylaxis, to prevent symptomatic infection after exposure to Covid-19. Setting The study was conducted in Canada and the US. Methods Multicentre Randomised controlled trial. Inclusion Criteria – subjects who were within 3 days of known high-risk exposure (as self-reported) pending formal testing. […]

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eCritCare Podcast

534

Dexamethasone in COVID-19 – Too Good To Ignore

Dr Swapnil Pawar July 2, 2020

RECOVERY TRIAL The RECOVERY trial is a randomized clinical trial designed to evaluate several treatment modalities in patients with COVID-19 infection. 11,000 patients from 175 hospitals of the National Health Services. Inclusion Criteria – Hospitalized patients who had clinically suspected or laboratory-confirmed COVID-19 infection Exclusion – if dexamethasone was unavailable at the treating hospital or considered to be definitely indicated or contraindicated by the treating physician. The treating staff was not blinded to the study arm. Intervention – Dexamethasone 6 mg once daily IV or orally for a maximum of 10 days using web-based randomization. Patients were assigned in a […]

Vitamin D3 in Critically Ill Patients

eCritCare Podcast

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Vitamin D3 in Critically Ill Patients

Dr Swapnil Pawar June 23, 2020

Early High-Dose Vitamin D3 for Critically Ill, Vitamin D–Deficient Patients The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network Setting: The study was conducted The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network from April 2017 through July 2018 at 44 U.S. hospitals. Design: 1:1 randomized controlled study, Vit D vs. placebo, using a central electronic system, stratified by site Inclusion: Adults were screened for Vitamin D deficiency by the hospital lab or by a POC test; with a lower cut-off level of 25OH <20 ng/mL. These patients were randomized to one of the study groups. […]

Neuromuscular Blockade in ARDS

eCritCare Podcast

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Neuromuscular Blockade in ARDS

Dr Swapnil Pawar June 17, 2020

Introduction – Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by intense lung inflammation, consolidation, and progressive microatelectasis with refractory acute hypoxemia [1, 2]. Despite advances in technology and sophistication of mechanical ventilators, the mortality of ARDS is still high [3–5]. A multimodal strategy involving non-pharmacologic interventions and pharmacologic interventions is recommended for the management of ARDS. Non-pharmacologic interventions include protective lung ventilation strategies, including low tidal volume and higher positive end-expiratory pressure (PEEP) along with prone positioning. These strategies are accepted because of their beneficial effects on patient outcomes in ARDS [2, 5, 6]. However, the benefit […]

Convalescent Plasma in COVID-19

eCritCare Podcast

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Convalescent Plasma in COVID-19

Dr Swapnil Pawar June 13, 2020

Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomised Clinical Trial Setting: Seven medical centres in China in the Hubei province. Design: February 14, 2020, to April 1, 2020. Patients were randomly assigned via computer-generated random numbering (1:1) to receive standard treatment combined with convalescent plasma transfusion or standard treatment alone. Randomisation was stratified based on whether the infection was “severe” or “life-threatening”. Patients: Included: Patients with COVID-19 diagnosis based on nasopharyngeal polymerase chain reaction (PCR) testing. Patients were randomised within 72 hours of testing positive; pneumonia confirmed by chest […]

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eCritCare Podcast

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Remdesivir in COVID-19 – ACCT Trial

Dr Swapnil Pawar June 1, 2020

Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 — Preliminary Report. New England Journal of Medicine doi:10.1056/NEJMoa2007764 Setting: 73 sites including United States (45), Denmark (8), the United Kingdom (5), Greece (4), Germany (3), Korea (2), Mexico (2), Spain (2), Japan (1), and Singapore (1). Enrollment between February 21, 2020, and April 19, 2020. 844/1059 patients (79.8%) of patients were enrolled at sites in North America. [15.3% in Europe, and 4.9% in Asia). Overall, 53.2% of the patients were white, 20.6% were black, 12.6% were Asian, and 13.6% were designated as other or […]

ANZICS Meet The Experts

ANZICS Meet The Experts

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Professor Dale Needham: Episode 16- Rehab in ICU during COVID-19

Dr Swapnil Pawar May 25, 2020

In this podcast, Professor Dale Needham from John Hopkins hospital shares his insights into ICU rehab experiences during COVID-19 pandemic. He talks about the challenges associated with prolonged ICU length of stay and advises on how to optimise the recovery of COVID-19 patients.

ANZICS Meet The Experts

ANZICS Meet The Experts

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Professor Maurizio Cecconi: Episode 15 – Post COVID-19 Pandemic Challenges in Italy

Dr Swapnil Pawar May 25, 2020

In this podcast, Professor Maurizio Cecconi talks about Italian experiences of the COVID-19 pandemic and outlines the challenges specific to intensive care in the post-pandemic phase. He discusses various issues including prolonged ICU length of stay, slow weaning, and the impact of the pandemic on staff well-being.

ANZICS Meet The Experts

ANZICS Meet The Experts

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Professor Lucciano Gattinoni : Episode 12 – mechanical Ventilation in COVID-19

Dr Swapnil Pawar May 25, 2020

COVID -19 has a very unique pattern and it has challenged the dogmatic approach of mechanical ventilation described for ARDS patients. In this podcast, Prof Luciano Gattinoni talks in-depth about the pathophysiology of the disease and how we should ventilate these patients. His key messages are monitor closely, identify the right phenotype, be patient and do not apply blanket protocols for mechanical ventilation. For Full podcast –

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eCritCare Podcast

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Chloroquine, Hydroxychloroquine & Macrolides in COVID-19 -> Beginning of the End

Dr Swapnil Pawar May 25, 2020

Hydroxychloroquine or chloroquine with or without a macrolide for treatment of COVID-19: a multinational registry analysis Design: Multinational registry analysis including 671 hospitals in North America, South America, Europe, Africa, Asia, and Australia. Subjects: Patients hospitalized between Dec 20, 2019, and April 14, 2020, and tested positive for SARS-CoV-2. Data abstracted from Surgical Outcomes Collaborative (Surgisphere Corporation, Chicago, IL, USA) database. Treatment group: Patients who received either HCQ or CQ either alone or in combination with a macrolide. There were four groups of patients: 1. HCQ, 2. HCQ+macrolide 3. CQ 4. CQ+macrolide Excluded: Patients who received treatment after 48 h […]

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eCritCare Podcast

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Preventing Transmission of COVID-19 in Intensive Care

Dr Swapnil Pawar May 17, 2020

Tracheostomy – Tracheotomy in ventilated patients with COVID-19: Guidelines from the COVID-19 Tracheotomy Task Force, a Working Group of the Airway SafetyCommittee of the University of Pennsylvania Health System, published in Annals of Surgery Indication – Tracheotomy may be considered in patients with prolonged periods of intubation, defined as greater than 21 days, who are otherwise without significant comorbidities and would be expected to have a good prognosis if recovery is achieved. Pre-Procedure – Rule out whether the patient is still positive or negative by performing PCR and/or CT chest. Informed consent must be obtained from NOK. LocationThe procedure should […]

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Educator's Podcast

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Translational Simulation on Steroids in COVID-19

Dr Swapnil Pawar May 9, 2020

Professor Victoria Brazil & Dr Swapnil Pawar What is Translational Simulation? It is a terminology which refers to a subset of simulation activities that are directly focused on a patient or institutional level outcomes and focusing on those outcomes through at least two ways. One is through diagnosing system issues at the individual team or system level and then also seeking to address those issues through simulation. It involves testing new systems or embedding new systems or re-evaluating existing systems. Steroids are a two-edged sword, and we have to think before commencing any patient on steroids carefully. Similarly, translational simulation […]

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eCritCare Podcast

233

Remdesivir in COVID-19- new Cure or Illusion

Jose Chacko May 9, 2020

Remdesivir (also GS-5734) is a monophosphoramidate prodrug of an adenosine analogue that has a broad antiviral spectrum including filoviruses, paramyxoviruses, pneumoviruses, and coronaviruses. In vitro, remdesivir inhibits all human and animal coronaviruses tested to date, including SARS-CoV-2. Intravenous remdesivir was studied for treatment of Ebola virus disease, in which it was adequately tolerated but less effective than several monoclonal antibody therapeutics,and has been used on the basis of individual compassionate use over the past several months in patients with COVID-19 in some countries. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial Strengths – Only RCT on this […]

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eCritCare Podcast

192

Connecting Dots in COVID-19

Dr Swapnil Pawar April 27, 2020

The literature published from various countries has helped us to understand the disease pattern in COVID-19 pandemic. The New York experience Richardson et al. evaluated a large case series of 5,700 patients admitted to 12 hospitals under Northwell Health, the biggest health care provider in New York (1). They analyzed the clinical characteristics and outcomes of patients hospitalized over a 35-day period between March 1, 2020, and April 4, 2020. All patients tested positive for SARS-CoV-2 by RT-PCR on the nasopharyngeal sample. Patients were followed up until they were discharged alive or dead, or until the study endpoint. On April 4, […]

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eCritCare Podcast

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Novel Therapies and Diagnostic Tools in COVID-19

Dr Swapnil Pawar April 18, 2020

Remdesivir The nucleotide analog remdesivir has in vitro activity against SARS-CoV-2. It was used on a compassionate basis in 61 patients with COVID-19 who had an oxygen saturation of less than 94% on room air or required supplemental oxygen. Remdesivir was administered intravenously in a dose of 200 mg on day 1, followed by 100 mg per day for 9 days. Clinical outcomes of 53 of the 61 patients were analyzed. At baseline, 30 patients (57%) were invasively ventilated and four patients were on extracorporeal membrane oxygenation (ECMO). The median follow-up period was 18 days. The level of the oxygen […]

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eCritCare Podcast

349

COVID-19 Controversies

Dr Swapnil Pawar April 5, 2020

Many novel therapies have been proposed in our battle against this deadly pandemic. In this podcast, we summarise the literature available to date and present our views so you can make an informed decision while treating your patients with COVID-19. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) in COVID-19 Do ACE inhibitors and ARBs help or harm? It has been shown that COVID-19 uses the ACE2 receptor to gain access into cells . This has led to the hypothesis ACE inhibitors and ARBs may upregulate ACE2 expression, leading to increased predisposition to COVID-19 infection. However, according to Perico […]

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eCritCare Podcast

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COVID-19 – Management of Critically ill Patient

Dr Swapnil Pawar March 27, 2020

“Music: www.bensound.com“

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eCritCare Podcast

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65 Trial

Dr Swapnil Pawar March 15, 2020

Effect of Reduced Exposure to Vasopressors on 90-Day Mortality in Older Critically Ill Patients With Vasodilatory HypotensionA Randomized Clinical Trial François Lamontagne, MD1,2; Alvin Richards-Belle, BSc3; Karen Thomas, MSc3; et al Introduction- Vasopressors are commonly administered to patients in intensive care units (ICUs) to treat in order to prevent hypotension associated myocardial injury, kidney injury, and death. Vasopressors, however, may reduce blood flow in vasoconstricted vascular beds and are associated with effects on cardiac, metabolic, microbiome, and immune function. Balancing risks of hypotension with risks from vasopressors is, therefore, a challenge when managing patients in ICUs. Blood pressure is used to guide the administration of vasopressors. The norm is […]

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eCritCare Podcast

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Hyperoxemia in Intensive Care

Dr Swapnil Pawar March 5, 2020

Oxygen is a vital element and impaired oxygen delivery in critically ill patients is associated with increased mortality. As a consequence, reassuring oxygen delivery has become a cornerstone of many resuscitation protocols and liberal use of supplemental oxygen is common. This is predominantly due to our understanding of physiology. Oxygen is a critical element to fuel oxidative phosphorylation for the generation of ATP by mitochondria. Since ATP is mainly produced by means of oxidative phosphorylation, hypoxemia may impair the production of ATP and thereby lead to cellular ATP depletion. On the contrary, The negative effects of too much oxygen are less clear and many health care professionals […]

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eCritCare Podcast

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NONSEDA Trial

Dr Swapnil Pawar February 28, 2020

Nonsedation or Light Sedation in Critically Ill, Mechanically Ventilated Patients Invasive mechanical ventilation after tracheal intubation is among the most frequently performed procedures in adult patients admitted to the intensive care unit (ICU). Sedation and analgesia are provided at the time of intubation and may be maintained for hours or days. The aim of sedation is to minimize oxygen consumption and facilitate a patient’s ability to remain comfortably connected to a ventilator. Over the past two decades, it has been recognized that prolonged and deep sedation can increase the duration of mechanical ventilation, delay weaning, impair neuromuscular function, produce delirium, […]

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eCritCare Podcast

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De-resuscitation in Intensive Care

Dr Swapnil Pawar February 20, 2020

The accumulation of a positive fluid balance is a frequent occurrence in critically ill patients. As Paracelsus said, ” All things are poisons, nothing is without poison. Only the dose permits something not to be poisonous.” Like other drugs, it is the dose of fluids which makes them poisonous. What is de-resuscitation? Where did this term originate from?The use of intravenous fluid therapy is universal among critically ill patients to optimize tissue perfusion and oxygen delivery. Apart from intravenous fluids administered during initial resuscitation, fluid accumulation occurs from nutrition, maintenance fluids, and diluents used for intravenous drug therapy. An aggressive […]

vitamin-c-colorful-plastic-container-oranges-with-green-leaves-white-background-3d_1284-19244

eCritCare Podcast

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VITAMINS Trial

Dr Swapnil Pawar February 13, 2020

Sir William Osler said that “except on a few occasions, the patient appears to die from the body’s response to infection rather than from the infection” Sepsis is a major problem across the globe. Apart from the enormous financial costs of sepsis, the human toll of this disease is staggering and new interventions that limit the ravages of this disease are urgently required. Despite numerous RCTs, we still have not found the magic bullet to cure sepsis. The role of Vitamin C in Sepsis has been debated a lot recently. Multiple and overlapping effects of hydrocortisone, vitamin C, and thiamine […]