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  • 89

Opinion

AMIKINHAL – Inhaled Amikacin to prevent VAP

Dr Swapnil Pawar February 27, 2024

https://traffic.libsyn.com/ecritcarepodcast/AMIKINHAL_trial.mp3   Blog written by Dr Jose Chacko   Research question The question addressed by the AMIKINHAL trial was: does a 3-day course of nebulized amikacin reduce the incidence of ventilator-associated pneumonia? Population and design The AMIKINHAL trial was conducted between July 2017 and March 2021, across 19 ICUs in France. The study population included patients who had undergone at least 72 hours of invasive ventilation. Excluded   More than 96 hours had elapsed since commencement of invasive ventilation Suspected or confirmed ventilator-associated pneumonia (VAP) Severe acute kidney injury, not on renal replacement therapy Chronic kidney disease (glomerular filtration rate […]

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Evidence

NICO Trial – Intubation in Acute Drug Overdose – Does Intubation Matter?

Dr Swapnil Pawar December 23, 2023

play_arrow NICO Trial – Intubation in Acute Drug Overdose – Does Intubation Matter? Dr Swapnil Pawar   Blog Written by Dr Jose Chacko  Effect of Noninvasive Airway Management of Comatose Patients with Acute Poisoning: A Randomized Clinical Trial (Freund et al. JAMA. 2023;330(23):2267-2274. doi:10.1001/jama.2023.24391) Clinical question Assessment of the neurological status using the Glasgow coma scale (GCS) was introduced by Jennett and Teasdale to guide the early management of patients with acute brain injury. However, it is widely employed to decide upon the necessity for airway protection by endotracheal intubation in various clinical situations. The NICO randomized controlled addressed the […]

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  • 106

Featured

IV Thyroxine in Brain Dead Organ Donors

Dr Swapnil Pawar December 17, 2023

play_arrow IV Thyroxine in Brain Dead Organ Donors Dr Swapnil Pawar   Blog Written by Dr Jose Chacko Intravenous levothyroxine for unstable brain-dead heart donors. Dhar R, Marklin GF, Klinkenberg WD, et al. N Engl J Med 2023;389:2029-38. Background Neurohormonal insufficiency, especially thyroid deficiency, is thought to occur following brain death, leading to depletion of myocardial energy reserves, and shock (1).  Observational studies suggest that the rate of heart and total organ transplants may be higher among donors who receive thyroid hormone, with improved graft function in recipients (2). Based on this hypothesis, hormonal resuscitation is considered a crucial aspect […]

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  • 167

Evidence

ELAN trial – Early vs late anticoagulation in Post-ischaemic stroke with AF

Dr Swapnil Pawar October 4, 2023

play_arrow ELAN trial – Early vs late anticoagulation in Post-ischaemic stroke with AF Dr Swapnil Pawar   Blog written by – Dr Jose Chacko Early versus Later Anticoagulation for Stroke with Atrial Fibrillation (Fischer U, Koga M, Strbian D, et al; ELAN Investigators. Early versus Later Anticoagulation for Stroke with Atrial Fibrillation. N Engl J Med. 2023 Jun 29;388(26):2411-2421) Background Considering the lack of high-quality evidence, guideline recommendations vary regarding the timing of initiation of anticoagulation following ischemic stroke. The European Stroke Organization and the American Heart Association/American Stroke Association currently recommend delaying anticoagulation after ischemic stroke for more than […]

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  • 359

Podcasting

Steroids in Community Acquired Pneumonia

Dr Swapnil Pawar August 21, 2023

play_arrow Steroids in Community Acquired Pneumonia Dr Swapnil Pawar In this episode, we discuss the controversy surrounding the usage of steroids in Community-acquired pneumonia. This controversy arose after the CAPE-COD trial was published recently in NEJM. We discuss the pros and cons of administering steroids as a blanket treatment. We recommend caution and suggest considering the external validity of this trial before changing your practices.    

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  • 556

Featured

ICU Journal Club – MERCY Trial

Dr Swapnil Pawar August 8, 2023

play_arrow ICU Journal Club – MERCY Trial Dr Swapnil Pawar Continuous vs. intermittent dosing of Meropenem – The MERCY trial Monti G, Bradic N, Marzaroli M, Konkayev A, Fominskiy E, Kotani Y, et al. Continuous vs Intermittent Meropenem Administration in Critically Ill Patients With Sepsis: The MERCY Randomized Clinical Trial. JAMA. 2023 Jul 11;330(2):141–51. Blog Written by Dr Jose Chacko Background The efficacy of beta-lactam antibiotics is related to the duration for which drug levels remain above the minimum inhibitory concentration (MIC) (1). However, they are generally administered as intermittent doses. Intermittent dosing leads to peaks and troughs in drug […]

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  • 186

Evidence

PATCH Trial – Pre-hospital TXA in Severe Trauma

Dr Swapnil Pawar July 17, 2023

play_arrow PATCH Trial – Pre-hospital TXA in Severe Trauma Dr Swapnil Pawar   Prehospital Tranexamic Acid for Severe Trauma. Gruen RL, Mitra B, Bernard SA, et al. N Engl J Med. 2023 Jun 14.                                                                         Blog written by Dr Jose Chacko Introduction Continued hemorrhage is a leading cause of preventable deaths in patients with severe trauma. Exacerbating the fibrinolytic process in trauma due to tissue […]

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  • 324

Podcasting

ICU Journal Club – Craniotomy vs Decompressive Craniectomy in Acute SDH

Dr Swapnil Pawar June 27, 2023

play_arrow ICU Journal Club – Craniotomy vs Decompressive Craniectomy in Acute SDH Dr Swapnil Pawar   Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma Hutchinson PJ, et al. The RESCUE-ASDH Trial Collaborators. Decompressive Craniectomy versus Craniotomy for Acute Subdural Hematoma. N Engl J Med. 2023 Jun 15;388(24):2219-2229 Blog written by Dr Jose Chacko  Introduction Acute subdural hematomas occur in nearly two-thirds of patients with traumatic brain injury and are associated with poor functional recovery and relatively high mortality (1). An acute subdural hematoma is evacuated through a large craniotomy. The surgeon raises a skull flap to enable access and removal […]

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  • 357

Featured

PACER Trial

Dr Swapnil Pawar June 6, 2023

play_arrow PACER Trial Dr Swapnil Pawar Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia (the PACER trial) Van Baarle FLF, Van De Weerdt EK, Van Der Velden WJFM, Ruiterkamp RA, Tuinman PR, Ypma PF, et al. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. N Engl J Med. 2023 May 25;388(21):1956–65. Blog written by Dr Jose Chacko    Background The risk of major bleeding complications associated with the insertion of central venous catheters (CVC) in thrombocytopenic patients is considered to be low. Variable thresholds are followed for prophylactic platelet transfusion, ranging between 20 –50,000, based on guideline recommendations […]

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  • 75

Opinion

Selective Digestive Decontamination

Dr Swapnil Pawar May 24, 2023

play_arrow Selective Digestive Decontamination Dr Swapnil Pawar In this episode, Prof Ian Seppelt, one of the lead investigators of SuDDICU, shares his insights and talks about the rationale for SDD in ICU. He also explains the reasons behind the failure to change practices despite the evidence of mortality benefit from the recent meta-analysis. He discusses the future of SDD and the strategy for its widespread adaptation. https://jamanetwork.com/journals/jama/fullarticle/2798011  

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  • 824

Featured

CAPE-COD Trial – Hydrocortisone in Community Acquired Pneumonia

Dr Swapnil Pawar April 3, 2023

play_arrow CAPE-COD Trial – Hydrocortisone in Community Acquired Pneumonia Dr Swapnil Pawar Hydrocortisone in Severe Community-Acquired Pneumonia Dequin et al. N Engl J Med. 2023 Mar 21  Blog Written by Dr Jose Chacko Background Corticosteroids exert powerful anti-inflammatory and immunomodulatory properties that may attenuate the consequences of severe community-acquired pneumonia (CAP), and, thereby, improve clinical outcomes. Although many randomized controlled trials (RCTs) have been carried out to evaluate the potential beneficial effect of corticosteroids in CAP, reduced mortality was observed in a lone RCT of 46 patients by Confalonieri et al. nearly two decades ago (1). The findings of meta-analyses […]

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  • 586

Opinion

CLOVERS Trial – Early restrictive vs liberal fluid resuscitation for Septic shock

Dr Swapnil Pawar January 29, 2023

play_arrow CLOVERS Trial – Early restrictive vs liberal fluid resuscitation for Septic shock Dr Swapnil Pawar   Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension (The CLOVERS trial) National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury Clinical Trials Network; Shapiro NI, Douglas IS, Brower RG, et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663. Epub ahead of print. PMID: 36688507. Blog written by Dr Jose Chacko Background Fluid resuscitation is one of the key early interventions in patients with septic shock. However, […]

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  • 184

Respirtory

BOX Trial – Oxygenation targets in OHCA Comatose survivors

Dr Swapnil Pawar January 12, 2023

play_arrow BOX Trial – Oxygenation targets in OHCA Comatose survivors Dr Swapnil Pawar   Oxygen Targets in Comatose Survivors of Cardiac Arrest  Schmidt H, Kjaergaard J, Hassager C, et al. Oxygen Targets in Comatose Survivors of Cardiac Arrest. N Engl J Med. 2022 Oct 20;387(16):1467-1476. doi: 10.1056/NEJMoa2208686. Epub 2022 Aug 27. PMID: 36027567. Blog written by – Dr Jose Chacko   Background Following successful resuscitation from cardiac arrest, reperfusion injury may exacerbate damage to the brain. The appropriate oxygenation target during mechanical ventilation in comatose survivors of out-of-hospital cardiac arrest is unknown. Findings from observational studies and animal models suggest […]

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  • 381

Featured

Double Sequential External Defibrillation – A game-changer

Dr Swapnil Pawar January 1, 2023

play_arrow Double Sequential External Defibrillation – A game-changer Dr Swapnil Pawar   Alternate defibrillation strategies for refractory ventricular fibrillation Cheskes S, Verbeek PR, Drennan IR, et al.  N Engl J Med. 2022 Nov 24;387(21):1947-1956. doi: 10.1056/NEJMoa2207304. Epub 2022 Nov 6. PMID: 36342151.   Blog Written by Dr Jose Chacko Background Double sequential (DSED) and vector change (VC) defibrillation have been in use for many years. Observational studies and case reports have switched to these strategies mainly as a last resort in refractory ventricular fibrillation. Early application of DSED or VC may lead to improved rates of defibrillation and return of […]

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  • 209

Opinion

TEAM Trial – Early Mobilisation in Intensive Care

Dr Swapnil Pawar December 16, 2022

play_arrow TEAM Trial – Early Mobilisation in Intensive Care Dr Swapnil Pawar   Early Active Mobilization during Mechanical Ventilation in the ICU The TEAM Study Investigators and the ANZICS Clinical Trials Group Blog Written by – Dr Jose Chacko  Population and setting The study was held from February 27, 2018, to November 19, 2021, across 49 hospitals in 6 countries, including Australia, New Zealand, Ireland, the UK, Germany, and Brazil. Patients were on mechanical ventilation. Ventilation was expected to continue beyond the calendar day after randomization. Patients were judged to be stable to enable mobilization. Could be on norepinephrine ≤0.2 […]

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  • 434

Neuromuscular

SETPOINT 2 Trial – Early Vs Late Tracheostomy in Stroke patients

Dr Swapnil Pawar November 17, 2022

play_arrow SETPOINT 2 Trial – Early Vs Late Tracheostomy in Stroke patients Dr Swapnil Pawar   Blog Written by – Dr Jose Chacko Effect of Early vs Standard Approach to Tracheostomy on Functional Outcome at 6 Months Among Patients With Severe Stroke Receiving Mechanical Ventilation The SETPOINT2 Randomized Clinical Trial Background In the SETPOINT pilot study, 60 patients with stroke on mechanical ventilation were randomized to tracheostomy within 3 days of intubation or between days 7 and 14 if they remained intubated. The ICU length of stay, the primary endpoint, was similar. However, sedation use, duration of mechanical ventilation, and […]

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  • 680

Featured

WATERFALL Trial – Fluid Resuscitation in Acute Pancreatitis

Dr Swapnil Pawar November 17, 2022

play_arrow WATERFALL Trial – Fluid Resuscitation in Acute Pancreatitis Dr Swapnil Pawar   Written by – Dr Jose Chacko Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis Hypoperfusion and hemoconcentration in acute pancreatitis may lead to necrosis, and adverse clinical outcomes. Population The WATERFALL multicenter, open-label, parallel-group, randomized, controlled, superiority trial, enrolled patients at 18 centres from India, Italy, Mexico, and Spain. Acute pancreatitis was diagnosed according to the revised Atlanta Classification. For inclusion in the study, patients were within 24 hours after pain onset and 8 hours or less since confirmation of diagnosis. Excluded Patients who met the criteria […]

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Opinion

Oxygen Therapy in Intensive Care

Dr Swapnil Pawar September 4, 2022

play_arrow Oxygen Therapy in Intensive Care Dr Swapnil Pawar In our landmark 100th episode, we discuss the controversy around one of the most commonly used drugs in intensive care, i.e. Oxygen. In this episode, we dive deeper into the available evidence and recommend our approach for using oxygen in critically ill patients. In this episode, we discuss the following landmark RCTs- Oxygen ICU ICU-ROX HOT-ICU LOCO2 HYPRESS2 Our recommendation – Oxygen is a drug. In general, conservative use of oxygen therapy is recommended, and hyperoxia must be avoided. However, in certain subgroups of patients, such as septic shock and ARDS, […]

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  • 218

Featured

Targeted Temperature management in TBI

Dr Swapnil Pawar August 27, 2022

play_arrow Targeted Temperature management in TBI Dr Swapnil Pawar In this episode, we discuss the role of therapeutic hypothermia and targeted temperature management in severe TBI. We dive deeper into the available literature on this topic and share our recommendations on this controversy. The key controversies on this topic include – .    1. Selective Brain Cooling versus Whole Body Cooling 2. Target Temperature 3. Duration of Temperature Management Our recommendation – Targeted Temperature Monitoring for severe Traumatic Brain Injury remains the mainstay treatment and avoiding hyperthermia in the acute phase seems more rational than inducing hypothermia. Hypothermia has proven […]

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  • 4834

evidence based medicine

LOVIT trial – Final Nail in the Coffin for Vit C in Septic Shock?

Dr Swapnil Pawar June 25, 2022

play_arrow LOVIT trial – Final Nail in the Coffin for Vit C in Septic Shock? Dr Swapnil Pawar Intravenous Vitamin C in Adults with Sepsis in the Intensive Care Unit Blog Written by Dr Jose Chacko Setting   Thirty-five medical–surgical ICUs in Canada, France, and New Zealand.   Included: Adult patients with infection, receiving vasopressors, who were admitted to the ICU for no longer than 24 hours   Excluded: Patients with contraindications for vitamin C, those who received open-label vitamin C, expected to die, or undergo withdrawal of life-support measures within 48 hours.   Intervention   Vitamin C, 50 mg/kg […]

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  • 132

Podcasting

Resuscitation Targets in Septic Shock

Dr Swapnil Pawar June 10, 2022

play_arrow Resuscitation Targets in Septic Shock Dr Swapnil Pawar In this podcast, we discuss the evidence behind different resuscitation targets used in the treatment of a patient with septic shock Lactate Capillary refill time MAP Echo/USG based measurements. Microcirculation assessment Our strategy – A multimodal approach to resuscitation of a patient with Septic shock. No single parameter is adequate to guide us in the choice of treatment options.

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  • 154

Featured

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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  • 729

Evidence

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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  • 208

Podcasting

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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  • 320

Featured

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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  • 433

Featured

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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  • 280

Evidence

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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  • 326

Opinion

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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  • 653

Featured

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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  • 879

Evidence

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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  • 474

Opinion

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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  • 984

Featured

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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  • 526

evidence based medicine

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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  • 628

Opinion

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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  • 337

Featured

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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  • 890

Featured

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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  • 487

Opinion

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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Respirtory

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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Featured

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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