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eCPR in Out of Hospital Cardiac Arrest

Dr Swapnil Pawar April 18, 2022

play_arrow eCPR in Out of Hospital Cardiac Arrest Dr Swapnil Pawar Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac ArrestA Randomized Clinical Trial Blog written by Dr Jose Chacko Design and setting The study was conducted over a 7.5-year period between 2013 to 2020 in the Prague region A single-centre randomized controlled trial Eligible subjects included adults aged 18 to 65 years receiving ongoing resuscitation for witnessed OHCA of presumed cardiac etiology Minimum of 5 minutes of advanced cardiac life support without attaining ROSC ECPR team was […]

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Noradrenaline Vs Adrenaline in OHCA Patients

Dr Swapnil Pawar March 17, 2022

play_arrow Noradrenaline Vs Adrenaline in OHCA Patients Dr Swapnil Pawar Epinephrine versus norepinephrine in cardiac arrest patients with post-resuscitation shock (Bougouin et al. Intensive Care Med. 2022 Mar;48(3):300-310) Blog Written by – Dr Jose Chacko Study population and design: In this registry-based observational study, the authors identified patients admitted alive after OHCA to five university hospitals in France over a 7-y period between May 2011 and May 2018. Patients were in post resuscitation shock: the need for vasopressors for more than 6 h in spite of adequate fluid resuscitation while targeting a MAP >65 mm Hg. Excluded: non-cardiac cause of […]

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NIV in COVID-19

Dr Swapnil Pawar March 3, 2022

play_arrow NIV in COVID-19 Dr Swapnil Pawar NIV In COVID-19 Written by Dr Jose Chacko and Dr Swapnil Pawar Current Guidelines –  Available Evidence –  RECOVERY-RS Trial  Does CPAP or HFNO, compared with conventional oxygen therapy, reduce the need for tracheal intubation or mortality within 30 days in COVID-19-related acute respiratory failure? Design The RECOVERY-RS trial was a 3-group, randomized clinical trial. The trial was conducted across 48 acute care hospitals in the UK and Jersey. In effect, RECOVERY-RS represents two separate trials that compare CPAP and HFNO with a common control group of conventional oxygen therapy. Allowed the hospital […]

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Long Term Outcomes in COVID-19

Dr Swapnil Pawar February 22, 2022

play_arrow Long Term Outcomes in COVID-19 Dr Swapnil Pawar Clinical Outcomes Among Patients With 1-Year Survival Following Intensive Care Unit Treatment for COVID-19 Heesakkers H, van der Hoeven JG, Corsten S, et al. JAMA. 2022 Feb 8;327(6):559-565. doi: 10.1001/jama.2022.0040. Blog Written by Dr Jose Chacko Design and study population This prospective cohort study is part of the MONITOR IC study on ICU survivors. ICU patients who underwent treatment for COVID-19 were recruited from 11 hospitals in the Netherlands. Patients admitted during the first wave between March 1, 2020, and July 1, 2020, were eligible for inclusion and were recruited before […]

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PLUS Study

Dr Swapnil Pawar February 8, 2022

play_arrow PLUS Study Dr Swapnil Pawar Join us for our 90th episode of the eCritCare podcast, where Jose Chacko & I discuss the recently published landmark trial PLUS. This trial demonstrated no significant difference in 90-day mortality between the saline group and the plasmalyte-148 group. It raises the question – Does the choice of IV fluid in ICU really matter? Should we stop worrying about the choice of fluid and focus on not giving so-called “maintenance fluids” to critically ill patients? The key message is “anything in excess is bad, don’t give something that patient doesn’t need.”

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MICHELLE Trial – Rivaroxaban in COVID-19

Dr Swapnil Pawar January 30, 2022

play_arrow MICHELLE Trial – Rivaroxaban in COVID-19 Dr Swapnil Pawar Rivaroxaban versus no anticoagulation for post-discharge thromboprophylaxis after hospitalisation for COVID-19 (MICHELLE): an open-label, multicentre, randomised, controlled trial Blog Written by – Dr Jose Chacko Question: In patients hospitalized with COVID-19, does prophylaxis with rivaroxaban 10 mg/day for 35 days after discharge improve clinical outcomes, including major and fatal thromboembolic events? Setting, population, design: 14 hospitals in Brazil. This is a 1:1 randomized controlled trial. Thromboprophylaxis with rivaroxaban 10 mg/day or no anticoagulation for 35 days post discharge. Open label study, in permuted blocks of variable size, using a central, […]

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Omicron Variant – Facts and Challenges

Dr Swapnil Pawar January 12, 2022

play_arrow Omicron Variant – Facts and Challenges Dr Swapnil Pawar In this episode, we discuss the challenges faced by healthcare systems and the patterns emerging from the current COVID-19 pandemic wave caused by the Omicron variant. Blog Written by – Dr Jose Chacko The World Health Organization reported on omicron (B.1.529), the fifth SARS-CoV-2 variant of concern, on 25th November 2021.1 The first report of the omicron variant was from Botswana, followed by a case from Hong Kong. A steep rise in cases was observed in South Africa, especially from the Gauteng province in the ensuing days. The omicron variant […]

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ICU Journal Club- COVID HighFlow

Dr Swapnil Pawar December 28, 2021

play_arrow ICU Journal Club- COVID HighFlow Dr Swapnil Pawar Effect of High-Flow Oxygen Therapy vs Conventional Oxygen Therapy on Invasive Mechanical Ventilation and Clinical Recovery in Patients With Severe COVID-19A Randomized Clinical Trial Blog written by Dr Jose Chacko Design and setting Randomized controlled trial conducted across three centers in Columbia over 5 months from August 2020 to January 2021. Patients were randomized 1:1 to high flow nasal cannula (HFNC) or conventional oxygen. It was an unblinded trial, the main investigators were unaware of study group outcomes until unlocking of the database. Web-based randomization, stratified by study site. Included Adult […]

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Glycemic Control in ICU

Dr Swapnil Pawar November 30, 2021

play_arrow Glycemic Control in ICU Dr Swapnil Pawar Blog Written by Dr Jose Chacko Uncontrolled hyperglycemia may adversely impact critically ill patients through diverse mechanisms. High glucose levels may impair the innate immune response, with abnormal glycosylation of immunoglobulins.1 Neutrophil migration is inhibited with suppression of phagocytic activity; complement fixation and bacterial opsonization are also disrupted.2 Animal models have suggested that targeting normoglycemia may attenuate hyperglycemia-induced inhibition of bacterial opsonization.3 Furthermore, insulin may exert an anti-inflammatory effect that may ameliorate organ dysfunction in critical illness.4 However, aiming for tightly controlled blood glucose levels may lead to episodes of hypoglycemia that may adversely affect outcomes. […]

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ICU Journal Club – CONTROLING Study

Dr Swapnil Pawar November 23, 2021

play_arrow ICU Journal Club – CONTROLING Study Dr Swapnil Pawar Individualised versus conventional glucose control in critically ill patients: the CONTROLING study—a randomized clinical trial Blog written by Dr Jose Chacko Background –  Hyperglycaemia is an adaptive response to stress and is commonly seen in critically ill patients. Individualising hyperglycaemia management similar to blood pressure management, by targeting the patient’s pre-admission usual glycaemic, is a novel concept and has not been explored before in large RCT. Setting and design The CONROLING study is a multicentric, double-blind, RCT conducted in 12 centres in France. The study included patients from medical, surgical, […]

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Early Vs Delayed RRT in ICU

Dr Swapnil Pawar November 8, 2021

play_arrow Early Vs Delayed RRT in ICU Dr Swapnil Pawar Blog Written by Dr Jose Chacko Intensive care physicians often face the conundrum of deciding when to consider renal replacement therapy (RRT) in acute kidney injury (AKI). RRT may be commenced for the early correction of metabolic complications and prevention of volume overload. However, an early strategy may entail unnecessary therapy for some patients who might recover renal function otherwise. Even more concerning is the perpetuation of damage that may occur due to the hemodynamic instability that often accompanies RRT. The proximal tubules located at the corticomedullary junction are particularly […]

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ICU Journal Club- COVID STEROID 2 Trial

Dr Swapnil Pawar October 26, 2021

play_arrow ICU Journal Club- COVID STEROID 2 Trial Dr Swapnil Pawar Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe HypoxemiaThe COVID STEROID 2 Randomized Trial Question –  What is the effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support at 28 days inpatients with COVID-19 and severe hypoxemia? Setting and design The COVID-STEROID-2 randomized controlled trial was conducted between August 27, 2020, and May 20, 2021, including 11 centres in Denmark, 12 in India, two […]

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Surviving Sepsis Campaign Guidelines

Dr Swapnil Pawar October 22, 2021

play_arrow Surviving Sepsis Campaign Guidelines Dr Swapnil Pawar 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 […]

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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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