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Surviving Sepsis Campaign Guidelines

Dr Swapnil Pawar October 22, 2021

https://traffic.libsyn.com/secure/ecritcarepodcast/SSSC_21.mp3 Blog Written by Dr Jose Chacko Screening and early treatment Recommendation against qSOFA The qSOFA screening parameters include a systolic BP <100 mm Hg, respiratory rate >22, and a GCS  <15. The presence of 2 or more criteria denotes a positive qSOFA. The SSG make a strong recommendation against the use of qSOFA as a single screening tool, compared to the National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), or the systemic inflammatory response syndrome (SIRS) considering its poor sensitivity for the diagnosis of sepsis. This recommendation is mainly based on systematic reviews that have shown that […]

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The Role of Hyperventilation in ICP Control

Dr Swapnil Pawar October 8, 2021

play_arrow The Role of Hyperventilation in ICP Control Dr Swapnil Pawar Management of arterial partial pressure of carbon dioxide in the first week after traumatic brain injury: results from the CENTER-TBI study Written by – Dr Jose Chacko & Dr Swapnil Pawar Context –  Recent BTF Guidelines suggested the use of Hyperventilation (HV) to target PaCO2 32–35 mmHg for controlling ICP only as a second-tier treatment. These guidelines did not support lower PaCO2 levels and recommended against routine hyperventilation to PaCO2 below 30 mmHg. However, the practices vary across the globe. Objectives –  to assess, in a real-world context, PaCO2 management and […]

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CNS Physiology
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ICP Monitoring in Traumatic Brain Injury

Dr Swapnil Pawar September 28, 2021

play_arrow ICP Monitoring in Traumatic Brain Injury Dr Swapnil Pawar ICP Monitoring in Traumatic Brain Injury Blog written by Dr Jose Chacko Timely recognition of intracranial hypertension is a crucial component of neurocritical care. In patients who are sedated and mechanically ventilated, sole dependence on the clinical features of raised intracranial pressure (ICP) including pupillary dilatation may lead to inordinate delays in the performance of critical interventions. Hence, continuous, direct measurement of ICP is often performed combined with clinical evaluation and brain imaging to identify deterioration in the neurological status. Non-invasive techniques including ultrasonographic evaluation using the optic nerve sheath […]

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COAST Trial
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ICU Journal Club – Low vs High Oxygenation Targets

Dr Swapnil Pawar September 19, 2021

play_arrow ICU Journal Club – Low vs High Oxygenation Targets Dr Swapnil Pawar Effect of Low-Normal vs High-Normal Oxygenation Targets on Organ Dysfunction in Critically Ill Patients: A Randomized Clinical Trial Harry Gelissen, MD, MBA1; Harm-Jan de Grooth, MD, PhD1,2; Yvo Smulders, MD, PhD3; et al Question  –  Does low-normal oxygenation compared with a high-normal oxygenation target range reduce organ dysfunction in critically ill patients? Population and design The study was conducted in 4 centres in the Netherlands. Adult patients, expected to stay in the ICU for >48 h with 2 or more SIRS criteria were eligible. Excluded were elective surgical patients, patients with pulmonary hypertension, severe ARDS, and […]

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LONG COVID- Long Road for Patients and Health Systems

Dr Swapnil Pawar August 29, 2021

play_arrow LONG COVID- Long Road for Patients and Health Systems Dr Swapnil Pawar The risk of COVID-19 has been largely communicated only in terms of deaths and hospital capacity, with less emphasis on long term sequelae. Around one in three people with symptomatic COVID-19 still, experience debilitating symptoms 12 weeks after onset. Definition– No standardised definition. Some of the case series defined it as persistent symptoms and/or delayed or long-term complications of SARS-CoV-2 infection beyond 4 weeks from the onset of symptoms. Based on recent literature, it is further divided into two categories: (1) subacute or ongoing symptomatic COVID-19, which […]

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Balanced Salt vs Normal Salt in ICU – Just stick to BASICs

Dr Swapnil Pawar August 18, 2021

play_arrow Balanced Salt vs Normal Salt in ICU – Just stick to BASICs Dr Swapnil Pawar Balanced Salt vs Normal Salt in ICU – Just stick to BASICs Blog Written by – Dr Jose Chacko Effect of Intravenous Fluid Treatment With a Balanced Solution vs 0.9% Saline Solution on Mortality in Critically Ill PatientsThe BaSICS Randomized Clinical Trial Introduction The use of normal saline is ubiquitous in clinical practice. The history of saline resuscitation dates back to 1831 when the cholera epidemic swept across Britain leaving a trail of devastation. Out of sheer desperation, Thomas Latta, a young physician from […]

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Remdesivir & Tocilizumab in COVID-19 – Have we gone too far? Detach
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Remdesivir & Tocilizumab in COVID-19 – Have we gone too far?

Dr Swapnil Pawar August 1, 2021

play_arrow Remdesivir & Tocilizumab in COVID-19 – Have we gone too far? Dr Swapnil Pawar Blog written by – Dr Jose Chacko & Dr Swapnil Pawar Remdesivir in COVID-19 Key problems with evidence – National task force (ANZ) Living guidelines –  Consider using remdesivir for adults hospitalised with moderate to severe COVID-19 who do not require ventilation. Do not start remdesivir in adults hospitalised with COVID-19 who require ventilation. WHO recommendation – WHO determined that there was a lack of evidence demonstrating an improvement in patient-relevant outcomes when using remdesivir, such as mortality, need for mechanical ventilation, and time to […]

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Stopping Nasogastric feeds in ICU – Time for a CHANGE
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Stopping Nasogastric feeds in ICU – Time for a CHANGE

Dr Swapnil Pawar July 14, 2021

play_arrow Stopping Nasogastric feeds in ICU – Time for a CHANGE Dr Swapnil Pawar Malnutrition in critically ill patients in the intensive care unit (ICU) has been associated with increased infectious morbidity, increased length of ICU and hospital stay, increased rate of infections, increased number of ventilator days, and impaired wound healing. EN supports gut integrity and decreases the risk of systemic infection from an immunologic standpoint. When gut integrity is compromised, intestinal permeability is increased, which can lead to systemic infections from normal gut bacteria. And there is no argument about feeding ICU patients early or as soon as […]

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Mechanical Power – Paradigm Shift in Mechanical Ventilation in ARDS
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Mechanical Power – Paradigm Shift in Mechanical Ventilation in ARDS

Dr Swapnil Pawar July 4, 2021

play_arrow Mechanical Power – Paradigm Shift in Mechanical Ventilation in ARDS Dr Swapnil Pawar Mechanical Power Blog Written by – Dr Jose Chacko Although a life-supporting intervention, mechanical ventilation is associated with its own perils. Improved gas exchange and amelioration of the work of breathing occurs at the expense of potential damage to the lung, described as ventilator-induced lung injury (VILI). Over the past few decades, we have become increasingly familiar with the propagators of VILI; the benchmark ARDSnet trial conclusively established the safety of low tidal volume ventilation with limitation of plateau pressure (Pplat).1 Subsequently, the driving pressure (Δp) […]

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TTM 2 Trial
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TTM 2 Trial

Dr Swapnil Pawar June 22, 2021

play_arrow TTM 2 Trial Dr Swapnil Pawar TTM 2 Trial  Background  ILCOR guidelines strongly recommend targeted temperature management with a constant target between 32 C and 36 C however, the overall evidence behind this recommendation is of low certainty. Hypothesis  At 6 months, the incidence of death would be lower in the hypothermia group than in the normothermia group. Methods  Population: An international multicenter study involving 14 countries, 61 study sites. Adult patients who suffered out of hospital cardiac arrest due to cardiac or unknown cause, irrespective of the rhythm. Patients were more than 20 minutes of spontaneous circulation after […]

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Driving Pressure & Elastance – New Drivers in ARDS
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Driving Pressure & Elastance – New Drivers in ARDS

Dr Swapnil Pawar June 14, 2021

play_arrow Driving Pressure & Elastance – New Drivers in ARDS Dr Swapnil Pawar Driving Pressure and Elastance – New Drivers in ARDS The respiratory system driving pressure or distending pressure is a crucial respiratory mechanical concept that represents how much pressure is transmitted in the respiratory system during tidal ventilation. The elastance is the change is pressure over the change in volume. The normal value being < 1cmH2O/ml/kg. It remains unknown whether the benefit of lowering VT differs between patients with high elastance (and high driving pressure) and patients with low elastance (and low driving pressure). Gallagher et al undertook […]

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COAST Trial
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COAST Trial

Dr Swapnil Pawar June 7, 2021

play_arrow COAST Trial Dr Swapnil Pawar COAST Trial  Written by – Dr Jose Chacko The Children’s Oxygen Administration Strategies Trial (COAST) trial is a multicentre, open, fractional-factorial RCT conducted in 4 Ugandan and 2 Kenyan hospitals. Children aged 28 days to 12 years, hospitalised with a history of respiratory illness and any one of 2013 WHO clinical definitions of severe pneumonia plus hypoxaemia (SpO2 <92%) were enrolled into either Stratum A (severe hypoxaemia SpO2<80%) Stratum B (SpO2 80-91%) Excluded Uncorrected cyanotic heart disease Chronic lung disease (excluding asthma) Treated with oxygen given at another facility (or >3 hours at the […]

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Monoclonal Antibodies in COVID-19
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Monoclonal Antibodies in COVID-19

Dr Swapnil Pawar May 25, 2021

play_arrow Monoclonal Antibodies in COVID-19 Dr Swapnil Pawar Monoclonal Antibodies in COVID-19 Blog Written by – Dr Jose Chacko The COVID-19 pandemic continues to rage unabated in many parts of the world. India is by far the worst affected, with uncontrolled transmission across the country. Mutant variants have been implicated in the second wave that has ravaged most of the states. The quest for therapeutic options continues; monoclonal antibodies have been the focus of interest, particularly as a therapeutic option in mild to moderate disease, with the potential to prevent progression to severe disease. How do monoclonal antibodies work, and […]

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Thromboprophylaxis in COVID-19
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Thromboprophylaxis in COVID-19

Dr Swapnil Pawar May 16, 2021

play_arrow Thromboprophylaxis in COVID-19 Dr Swapnil Pawar Blog Written by – Dr Jose Chacko Thrombo-inflammation in COVID-19 The SARS-COV-2 virus invades endothelial cells leading to microvascular inflammation, which in turn, triggers an intense prothrombotic state, termed thrombo-inflammation. The levels of coagulation factors, including fibrinogen and factor VIII, are often elevated in COVID-19. Circulating thrombotic microparticles and hyperviscosity also contribute to the prothrombotic state. The prothrombotic state in COVID-19 appears to be distinctly different from disseminated intravascular coagulation (DIC). Thrombocytopenia and low levels of fibrinogen are typically present in DIC; however, the prothrombotic state in COVID-19 is usually characterized by normal […]

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VITT – Vaccine Induced Immune Thrombotic Thrombocytopenia
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VITT – Vaccine Induced Immune Thrombotic Thrombocytopenia

Dr Swapnil Pawar May 5, 2021

play_arrow VITT – Vaccine Induced Immune Thrombotic Thrombocytopenia Dr Swapnil Pawar Blog Written by – Dr Jose Chacko ChAdOx1 nCov-19-associated vaccine-induced immune thrombotic thrombocytopenia (VITT) From February 2021 onwards, there are several reports of unusual thrombotic phenomena associated with thrombocytopenia among subjects who received the ChAdOx1 nCov-19 vaccine. These reports led to a temporary pause in ChAdOx1 nCov-19 administration across several European countries, pending further investigation regarding a possible link. Subsequently, the agency emphasized that on balance, the protective effect of the vaccine against COVID-19 infection far exceeded the possible risk. Two reports have hence been published in The New […]

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ULTRA Trial – Tranexamic Acid in SAH
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ULTRA Trial – Tranexamic Acid in SAH

Dr Swapnil Pawar April 25, 2021

play_arrow ULTRA Trial – Tranexamic Acid in SAH Dr Swapnil Pawar   Ultra-early tranexamic acid after subarachnoid haemorrhage (ULTRA): a randomised controlled trial Question Does the use of early, short-duration fibrinolytic agents improve clinical outcomes in subarachnoid hemorrhage? Design, setting Randomized controlled trial from 8 centres in the Netherlands Population Inclusion Adult patients (age ≥18 years) with CT-confirmed subarachnoid hemorrhage Signs and symptoms suggestive of SAH for less than 24 h Non-contrast CT-confirmed subarachnoid hemorrhage Exclusion The peri-mesencephalic bleeding pattern on CT with Glasgow Coma Scale score of 13–15, without loss of consciousness soon after the event or absence of […]

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Neuromuscular Blockade in Intensive Care – To Be or Not To Be
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Neuromuscular Blockade in Intensive Care – To Be or Not To Be

Dr Swapnil Pawar April 9, 2021

play_arrow Neuromuscular Blockade in Intensive Care – To Be or Not To Be Dr Swapnil Pawar   Blog Slides by – Dr Swapnil Pawar Indications for NMB use in ICU – NMB Agents – NMB Monitoring – Evidence – ARDS –   Status Asthmaticus – Raised ICP/Severe TBI – Therapeutic hypothermia – Complications associated with the use of NMB in ICU – Supportive Care – Summary –

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Transfusion Thresholds in Intensive Care
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Transfusion Thresholds in Intensive Care

Dr Swapnil Pawar March 30, 2021

play_arrow Transfusion Thresholds in Intensive Care Dr Swapnil Pawar Transfusion Thresholds in Intensive Care Blog Written by Dr Jose Chacko Incidence of anemia in the ICU Anemia is all too common among critically ill patients, with 30–50% of patients receiving red cell transfusion. The etiology of anemia in the ICU is multifactorial, contributed by intravenous fluid resuscitation with the resulting hemodilution, repeated blood sampling, low erythropoietin levels induced by inflammatory cytokines, and abnormalities of iron metabolism. A hemoglobin level of 10 gm/dl was proposed by Adam and Lundy among surgical patients in 1942 (1); they averred that “when the concentration […]

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REALITY Trial – Liberal Vs Restrictive Transfusion in MI
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REALITY Trial – Liberal Vs Restrictive Transfusion in MI

Dr Swapnil Pawar March 23, 2021

play_arrow REALITY Trial – Liberal Vs Restrictive Transfusion in MI Dr Swapnil Pawar REALITY Trial  Blog is written by Dr Jose Chacko Setting and design The study conducted in 26 centres in France and 9 centres in Spain Enrolment between March 2016 to September 2019 Patients assigned a 1:1 ratio to the restrictive or a liberal transfusion arm. Web-based, centralized randomization, with blocks of varying size and stratified by centre. MACE assumed to be 11% in the restrictive transfusion group and 15% in the liberal transfusion group. A sample size of 300 patients per group for 80% power to demonstrate […]

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Tocilizumab Fairytale in COVID-19
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Tocilizumab Fairytale in COVID-19

Dr Swapnil Pawar March 15, 2021

play_arrow Tocilizumab Fairytale in COVID-19 Dr Swapnil Pawar Blog Written by – Dr Jose Chacko REMAP-CAP Study population Patients 18 years of age or older, with either clinically suspected or microbiologically confirmed Covid-19, admitted to an intensive care unit (ICU) and receiving respiratory or cardiovascular organ support. Within 24 hours of commencement of organ support Respiratory support Intubation ventilation or NIV High-flow nasal cannulae with flow rates more than 30 liters per minute and the fraction of inspired oxygen more than 0.4 Cardiovascular support Vasopressor or inotrope infusion Excluded Imminent death, limiting of therapy Previously participated in the REMAP-CAP trial […]

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Oxygen Therapy in ICU- The Circle of Uncertainty
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Oxygen Therapy in ICU- The Circle of Uncertainty

Dr Swapnil Pawar March 5, 2021

play_arrow Oxygen Therapy in ICU- The Circle of Uncertainty Dr Swapnil Pawar   Background  Clinical practice guidelines give no recommendation for oxygenation targets in adult patients in the ICU owing to sparse evidence. HOT- ICU Trial Setting: 35 ICUs in Denmark, Switzerland, Finland, the Nether- lands, Norway, the United Kingdom, and Iceland Design: Randomized study in permuted blocks. Stratified by center and the presence or otherwise of COPD and hematological malignancy Study population Inclusion Acute respiratory failure, who were receiving at least 10 litres of oxygen per minute in an open system or who had a FiO2 of at least […]

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COVID-19 Vaccines – Comprehensive Review
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COVID-19 Vaccines – Comprehensive Review

Dr Swapnil Pawar February 28, 2021

play_arrow COVID-19 Vaccines – Comprehensive Review Dr Swapnil Pawar COVID-19 vaccines: Comprehensive Review Written by – Dr Jose Chacko Several vaccines are being employed against COVID-19 following expedited evaluation and manufacturing processes. Currently, more than 50 potential vaccines are undergoing clinical trials in various phases.1 Effective immunization is considered to be an important strategy in the control of the COVID-19 pandemic. Phases of vaccine development The conventional methodology of vaccine development involves several phases. The first step in the process involves preclinical evaluation. During this phase, the vaccine is administered to experimental animals to evaluate immunogenicity and toxicity. Clinical trials […]

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COVID-19 Vaccine – The Mystery of Hope
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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 […]

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Lactate in Sepsis
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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 […]

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Respiratory Physiology Part 1
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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 […]

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RICH Trial – Regional Citrate vs Systemic Heparin Anticoagulation for CRRT
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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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Critical Appraisal of Surviving Sepsis Guidelines
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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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Evidence Based Medicine – Guidelines and GRADE methodology
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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 […]

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Evidence Based Medicine – How to interpret a Meta-Analysis
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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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Physics & Monitoring in ICU – Part 1
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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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Evidence-Based Medicine Part 1- How to Interpret an RCT
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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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Steroid Story in COVID-19
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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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Prone Positioning in ARDS
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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 […]

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Social Determinants of Health in Medical
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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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STARRT-AKI Trial
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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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Top 10 Practice Changing Trials in Intensive Care
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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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Anthropology to Explore the Culture in Medicine
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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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Cytokine Storm in COVID-19
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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Tranexamic Acid in Acute GI Bleeding – HALT-IT Trial
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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