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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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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 […]

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Vitamin D3 in Critically Ill Patients
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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. […]

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Neuromuscular Blockade in ARDS
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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 […]

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Convalescent Plasma in COVID-19
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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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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 […]

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ANZICS Meet The Experts
ANZICS Meet The Experts
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Podcasting

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.

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ANZICS Meet The Experts
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Podcasting

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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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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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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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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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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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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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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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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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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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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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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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 […]

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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 […]

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Permissive Hypercapnia in ARDS

Dr Swapnil Pawar February 3, 2020

Lung protective ventilation has become the cornerstone of the management of ARDS patient. As a consequence, hypercapnia is inevitable. However, permissive hypercapnia is not without its own problems. In this podcast, we discuss this dogma and challenge traditional practices.  What is permissive hypercapnia? Permissive hypercapnia is a ventilation strategy that allows an unphysiologically high partial pressure of carbon dioxide (PCO2) to permit lung protective ventilation with low tidal volumes. The term “permissive hypercapnia” was coined by Hickling and associates in the early 1990s in their seminal descriptions of improved survival in ARDS in which plateau pressures and tidal volumes were limited. […]

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Shame Resilience in Medical Education

Dr Swapnil Pawar February 2, 2020

Shame is highly complex, individualised and contextualised construct and should not be used as a pedagogical intervention to facilitate learning. in this podcast, Will Bynum from Duke university shares his thoughts and research on this complex concept. Author’s Bio Will Bynum, M.D Assistant Professor of Family Medicine, Duke University School of Medicine Will Bynum is currently an assistant professor of family medicine in the Duke University School of Medicine and associate program director in the Duke University Family Medicine Residency.  After graduating in 2005 from the University of North Carolina in Chapel Hill with a degree in Biology, he completed […]

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PEPTIC Study

Dr Swapnil Pawar January 29, 2020

Effect of Stress Ulcer Prophylaxis With Proton Pump Inhibitors vs Histamine-2 Receptor Blockers on In-Hospital Mortality Among ICU Patients Receiving Invasive Mechanical Ventilation Design This was a multi-centre cluster randomised trial involving 50 ICUs in Australia, New Zealand, Canada, Ireland, and the UK.  The units were randomised (as opposed to individual patient randomization) to one type of stress ulcer prophylaxis for 6 months and then switched over to the other medication. Study Population Included: The study population included adult patients 18 years and older who underwent invasive mechanical ventilation in the first 24 hours of ICU admission. Not included: Patients […]

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Driving Pressure Vs Tidal Volume in ARDS

Dr Swapnil Pawar January 20, 2020

Recently there has been a growing interest in driving pressure as a significant parameter for titration in mechanical ventilation for ARDS patients. It has challenged our dogma of 6-8 mls/kg tidal volume ventilation. In this podcast, we discuss the current evidence and future of mechanical ventilation in ARDS.  Our understanding of mechanical ventilation in ARDS has evolved significantly since the year 2000. The key concepts that have been accepted in practice include low tidal volumes, low plateau pressure, lower driving pressures and reduced frequency of injurious strain cycles. The main focus is to avoid ventilator-associated lung injury. With the recent […]

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EFFORT Trial

Dr Swapnil Pawar January 13, 2020

Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) trial Anorexia arises as a physiological response to acute illness and predisposes hospital inpatients to serious caloric and protein deficits. In combination with immobilisation and pronounced inflammatory and endocrine stress response, these nutritional deficits contribute to muscle wasting and progressive deterioration of metabolic and functional status, particularly in medical patients with multiple morbidities. Hospitals don’t provide the best possible food and often patients complain about the quality of the food.  More than 30% of medical inpatients are at increased risk of malnutrition, a […]

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Thrombolysis in Submassive PE

Dr Swapnil Pawar December 31, 2019

The role of thrombolysis in submassive PE remains controversial to date. In this podcast, Dr Chacko & I dive deeper to explore the current evidence on this topic. What is Submassive PE and what are the key differences between Submissive and Massive PE The terms massive, submassive, and low-risk PE have been coined to risk stratify PE based on the likelihood of mortality. Massive PE is characterized by sustained hypotension with a systolic pressure of < 90 mm for >15 minutes or the requirement for vasopressor support. A submassive PE does not cause hypotension but causes right heart strain, dilation, […]

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Community of Practice in MedEd

Dr Swapnil Pawar December 29, 2019

Learning is a social rather than an individual activity, and much of it occurs at the unconscious level, resulting in the acquisition of a large body of tacit knowledge. In this podcast, Dr Alice Fornari who is Vice President of Faculty Development at Northwell Health System and Associate Dean at the Donald and Barbara Zucker School of Medicine helps budding educators to understand this novel concept. 3 key characteristics for the successful development of Community of Practice – Relationship Building Passion for the topic Sharing of resources Speaker Bio – Dr Fornari is the Associate Dean of Educational Skills Development, […]

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High Wean Trial

Dr Swapnil Pawar December 23, 2019

Liberating high-risk patients from mechanical ventilation poses a unique challenge to all intensive care physicians. The use of high flow has increased over the last decade, however, the combination of high flow nasal oxygen and NIV has not been tested so far. The present study published in JAMA tries to answer this dilemma. Effect of Postextubation High-Flow Nasal Oxygen With Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone on Reintubation Among Patients at High Risk of Extubation Failure: A Randomized Clinical Trial The decision regarding when to liberate patients from mechanical ventilation faces intensive care unit (ICU) clinicians regularly. While this […]

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ICP Monitoring in TBI

Dr Swapnil Pawar December 1, 2019

TBI remains a major cause of death and disability worldwide. Poor outcome is associated in part with the primary insult and importantly from secondary brain injury, which is a complex series of pathologic events triggered in the early phase after TBI that then evolve over time. Apart from treating Primary pathology, modern TBI management focuses on the prevention, identification and management of SBI.  Neuromonitoring is central to SBI management. This includes serial clinical examination, imaging and the use of invasive and non-invasive devices that allow cerebral physiology to be assessed over time. Traditionally neuromonitoring has focussed on ICP monitoring which […]

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CVS Physiology Part 2

Dr Swapnil Pawar December 1, 2019

CARDIOLOGY PHYSIOLOGY Describe the cardiovascular events that occur during ventricular systole and diastole The cardiac cycle is made up of two phases defined by the mechanical activity of cardiac muscles, systole which is ventricular contraction lasting about 300miliseconds and diastole which is ventricular relaxation and lasts about 500miliseconds. The cardiovascular events that occur during these phases can be subdivided into mechanical and electrochemical events: Ventricular Systole: Mechanical Isovolumetric contraction At the beginning of ventricular systole, the atrioventricular valves close, heard as the first heart sound, and the intraventricular pressure rises rapidly. This rise in pressure causes the AV valves to […]

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MicroAggression in Medicine

Dr Swapnil Pawar November 30, 2019

Podcast with Dr Ruth Gotian Microaggression is well recognised but less talked problem in medicine. In this podcast, Dr Ruth Gotian from Weil Cornell Medicine, New York talks about this concept and helps us to understand various strategies to deal with Microaggressions in Medicine. Dr Ruth Gotian is Assistant Dean for Mentoring, Executive Director, Mentoring Academy, Chief Learning Officer in Anesthesiology and Assistant Professor of Education in Anesthesiology at Weill Cornell Medicine

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ANTHARTIC Trial

Dr Swapnil Pawar November 24, 2019

Prevention of Early Ventilator-Associated Pneumonia after Cardiac Arrest CRICS-TRIGGERSEP Network and the ANTHARTIC Study Group Even though controversies persist, targeted temperature management at 32 to 36°C remains recommended in patients with out-of-hospital cardiac arrest. Since it has beneficial effects on morbidity and mortality. However, targeted temperature management is associated with an increased risk of secondary infections and constitutes an independent risk factor for early ventilator-associated pneumonia. What’s known? The key early study suggesting the benefit of single-day administration of cefuroxime in patients with coma was performed more than 20 years ago. Few studies have been conducted since, including one single-centre, […]

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Stress Ulcer Prophylaxis in ICU

Dr Swapnil Pawar November 17, 2019

Dr Jose Chacko & Dr Swapnil Pawar Stress-induced gastrointestinal ulcers are common among patients admitted to the intensive care unit (ICU). These ulcers impose significant morbidity and mortality, therefore, stress ulcer prophylaxis (SUP) is a common clinical practice among healthcare providers dealing with these critically-ill patients.  A survey of 58 ICUs in North America, mainly in university teaching hospitals, revealed that 84% of patients admitted to the ICUs received SUP, with proton pump inhibitors being the most commonly used agents. Whether SUP is effective and safe, or not, remains a topic of controversy. The data is still conflicting, and the […]

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ICU ROX Trial

Dr Swapnil Pawar November 10, 2019

Conservative Oxygen Therapy during Mechanical Ventilation in the ICU The ICU-ROX Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group Oxygen is a vital element in medical practice and among the most universally used agents for the treatment of critically ill patients. Guidelines for the provision of oxygen give recommendations for target oxygen saturations and for the weaning of oxygen therapy. Despite this, the titration of supplemental oxygen in mechanically ventilated patients is infrequent with resultant hyperoxia being common in the intensive care unit (ICU). Hyperoxia can be defined as a state in which supraphysiological levels […]

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Transfusion Thresholds in ICU

Dr Swapnil Pawar November 3, 2019

Dr. Jose Chacko & Dr. Swapnil Pawar Anaemia is a common condition associated with critically ill patients admitted to an intensive care unit (ICU). The World Health Organization (WHO) defines anaemia as a haemoglobin (Hb) level less than 13 g/dL(milligram per decilitre) in men and less than 12 g/dL in women. Various studies have shown that approximately two-thirds of critical patients admitted to an ICU have a haemoglobin concentration of less than 12 g/dl on the day of admission, and 97% of the patients become anemic after a week in ICU. The cause of anemia in critical illness is complex […]

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The Role of Infographics in Medical Education

Dr Swapnil Pawar October 28, 2019

Dr Ben Symon & Dr Swapnil Pawar There has been a trend of the increasing use of infographics in Medical Education. In this thought-provoking podcast, Dr Ben Symon from Brisbane advises budding educators to use it as an adjunct rather than the primary pedagogy. He talks about the role of infographics in promoting scholarship in MedEd and shares his insights in designing the better infographics.  Resources – Martin L et al. Exploring the Role of Infographics for Summarizing Medical Literature. Health Professions Education 5 (2019) 48–57  Huang, S., Martin, L.J., Yeh, C.H., Chin, A., Murray, H., Sanderson, W.B., Mohindra, R., […]

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CRASH 3 – A Fairy Tale of Victory of Tranexamic acid & Dr Utako Okamoto

Dr Swapnil Pawar October 26, 2019

Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3): a randomised, placebo-controlled trial Intro –  As we know, TRANEXAMIC ACID is a synthetic analogue of the amino acid Lysine. It reduces bleeding by preventing the breakdown of fibrin clots i.e fibrinolysis. The CRASH-2 trial showed that in patients with trauma with major extracranial bleeding, early administration (within 3 h of injury) of tranexamic acid reduces bleeding deaths by a third. Subsequent analyses showed that even a short delay in treatment reduces the benefit of tranexamic acid administration. However, […]

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NIV iN ARDS

Dr Swapnil Pawar October 20, 2019

Dr Swapnil Pawar & Dr Jose Chacko Noninvasive ventilation (NIV) is a well-established treatment for acute respiratory failure, especially in patients with hypercapnia and cardiogenic pulmonary edema.  Conversely, the use of NIV for hypoxemic respiratory failure, including acute respiratory distress syndrome (ARDS), is still controversial. What’s the pathophysiology of ARDS? ARDS is characterized by diffuse alveolar damage and pulmonary capillary endothelial injury. The alveolar-capillary barrier is formed by the microvascular endothelium and the epithelial lining of the alveoli. A variety of insults resulting in damage either to the vascular endothelium or to the alveolar epithelium could result in ARDS. Early ARDS […]

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