Opinion

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]

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 […]