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A BI_MONTHLY N EWSLET T E R O F I N D I A N S O C I E T Y O F C R I T I C
ALCAREMEDICINE
www.isccm.org
COMMUNICATIONS
Critical Care
Editorial officE
dr. Yatin Mehta
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INDIAN SOCIETY OF CRITICAL CARE MEDICINE
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Contents ISCCM News HeAdlINeS
1 ISCCM News Headlines
2 Editorial
2 Editorial Board 2017-2018
3 President's Desk
3 New Oice Bearers of ISCCM
Branches
4 General Secretary's Desk
4 Delhi Critical Care Symposium -
15th Annual Conference of SCCM
Delhi NCR and 3rd North Zone
Critical Care Conference
5 World Sepsis Day 2017
5 AIIMS Neurological Life Support
Course
6 The 8th FMRI - ISCCM Hands on
Workshop - Bronchoscopy in ICU
6 CRITIC 2017
7 Battle of the Brains
7 South Zone Critical Care 2018
8 GUIDELINES / PRACTICE CORNER
- ESC Guidelines on the Diagnosis
and Management of Acute
Pulmonary Embolism
10 Journal Scan
13 Welcome New Members to the
ISCCM family
15 CRITICARE 2018
WSD 2017 – Webinar IAMM-ISCCM Delhi -Day marked with countrywide
activities NZCC Report Events Reports – ANLS, Bronchoscopy in ICU
Upcoming Events – SZCC , Critic Hyderabad QUIZ Guidelines Image
Section Presidents Message Editorial Desk Secretary Message
CRITICARE 2018
Volume 12.4 SePTemBeR-oCToBeR 2017
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Editorial Board 2017-2018
ediTor in Chief
Dr. Yatin Mehta, Delhi
presidentelect@isccm.org
Editorial
Dr. Yatin Mehta
editor in Chief,
The Critical Care Communications
President-elect, isCCm
presidentelect@isccm.org
www.isccm.org
dePuTy ediTors
Dr. Yash Javeri, Delhi Dr. Rajesh Mishra, AhmeDAbAD
dryashjaveri@yahoo.com mishr.c@gmail.com
ediTors
Dr. Samir Jog, Pune Dr. Sachin Gupta, Delhi Dr. Pradeep Bhatia, JoDhPur Dr.
R. Senthil Kumar, ChennAi Dr. Suresh Ramasubban, KolKAtA
drjogs@gmail.com dr_sachin78@yahoo.co.in editor@theiaforum.org
rskumaricu@gmail.com drsuresh@hotmail.com
Quiz seCTion
Dr. Yatin Mehta, Delhi Dr. Yash Javeri, Delhi
presidentelect@isccm.org dryashjaveri@yahoo.com
Journal sCan
Dr. Srinivas Samavedan Dr. Prashant Kumar
srinivas3271@gmail.com homeprashant@yahoo.com
images seCTion
Dr. Abhinav Gupta Dr. Tapas Kumar Sahoo
abhi.icudoc@gmail.com tapask.sahoo@gmail.com
Dear Readers,
Season’s Greetings
We are presenting you with a new issue of critical care newsleter.
We saw a lot of academic activities in last two months. Branches and zones
conducted excellent conferences. World Sepsis Day and ISCCM Foundation
day was marked with academic activities and webinars.
The newsleter has become a platform for exchange of information on all aspects
of critical care. Future scope of the newsleter is open to your suggestions. I
would like to encourage you to submit original research for Criticare 2018
at Varanasi. Please encourage your colleagues to join us at Varanasi. The
newsleter is going to keep you informed on upcoming events and give you
inside stories on the development strategies and directions.
Please feel free to share your feedback.
Happy Reading
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian
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President's Desk
Dear All,
Season’s Greetings!
We are happy to share this
issue of critical care newsleter.
We saw great conferences and workshops
being organised by various branches.
The academic content of ISCCM courses
is g eting ric her and ric her.
ISCCM Day activities were marked with
great zeal and enthusiasm. Members
across the nation participated in ISCCM
Day.
The theme for ISCCM Day was "Organ
Donation: A G ift fo r L ife"
The w ebcast d rew hug e aud ience.
Many city branches organised public
and ac ademic m eetings.
Dr. Kapil Zirpe
President, isCCm
kapilzirpe@gmail.com
I will like to invite you all to the holiest
of holy cities of World – Varanasi.
We are happy to share that we have
decided to keep separate registration for
Annual conference and workshop. We
request you all kindly note and register
for yourself.
Come and rejuvenate your mind and
soul.
May The Divine And Spiritual Light.
Of This Holy Festival,
Brighten Up Your Life With Health And
Joy.
Happy Diwali
New Office
Bearers of
ISCCM Branches
Ludhiana
Chairman
Dr Vinay Singhal
seCreTary
Dr Gurpreet Singh
Treasurer
Dr Guncha Paul
exeCuTive CommiTTee memBers
Dr Dinesh Garg
Dr Shikha Gupta
Dr Vikas Bansal
Dr Sushil Gupta
Wishing You &
Your Family Members,
a Very Happy Diwali &
Prosperous, Healthy Wealthy
New Year
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer 4 of indian
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Dr. Subhal Dixit
general secretary, isCCm
Dear Friends,
Greetings from Secretary’s Desk!
We are happy to share yet another issue of critical care
newsleter with our members.
These two months saw lot of academic activities across the country.
Many city branches hosted workshops and conferences in their
cities.
NZCC and SZCC was academic extravaganza.
We had ISCCM Foundation day meeting organised by various city
branches and centre.
ISCCM ilm on organ donation was highly appreciated by members
and other specialties.
General Secretary's
Desk
ISCCM
Jalandhar Event
Members and branches participated with lot of enthusiasm.
ISCCM has bid for World congress
A lot of new examiners enrolled for IDCCM and post MBBS and
fellowship exam
CRITICARE 2018 preparations are in full swing.
I on behalf of Organizing Commitee, invite you all to Varanasi
Criticare 2018.
Please encourage your colleagues to submit abstracts and get
registered.
Happy Diwali
Delhi Critical Care Symposium
15th Annual Conference of SCCM Delhi NCR
and 3rd North Zone Critical Care Conference
16th-17th September 2017 • The Leela Ambience, Gurugram
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Introduction to sepsis was given by Dr. C Watal. Dr Yash Javeri
spoke on Sepsis emergency: Who cares?
Bacterial & Fungal sepsis was discussed by Dr. Pallab Ray
Dr B K Rao elaborated on early recognition and common mistakes
in clinical management of sepsis.
Dr Senthur reviewed the therapeutic options for sepsis.
This exclusive training course was organized with the
aim to help physicians, surgeons and intensivists to act
prudently in critical hours while dealing with neurological
emergencies. During the course, a standard protocol-based
approach was taught with hands-on training. The highlights of
World Sepsis Day 2017
Webcast was relayed from SGRH,PGIMER- Chandigarh and Apollo
Hospital- Chennai
The webinar was jointly organised by
IAMM-Delhi and ISCCM Delhi-NCR
AIIMS Neurological Life Support Course
6-7 October 2017 at JPNATC
Organised by
Dept. of Neuroanaesthesiology & Critical Care, All India Institute of Medical
Sciences (AIIMS)
with ISCCM,Delhi at JPN Apex Trauma Centre, AIIMS, New Delhi
Dr. Jaswinder Kaur Oberoi elaborated on diagnosis of fungal
infections and sepsis biomarkers.
The webinar was followed by question answer session.
The webinar was atended by 2400 delegates worldwide.
The webinar is available on you tube.
this training course included didactic lectures and audio-visual
presentations followed by hands-on skill stations.
Dr Keshav Goyal was the Organizing Secretary for the course. The
course was atended by 30 delegates from across the country.
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The 8th FMRI - ISCCM
Hands on Workshop - Bronchoscopy in ICU
8th October 2017 • Fortis, Gurgaon
Organised by SCCM Delhi and Fortis Memorial Research Institute
Under the aegis of ISCCM, Delhi
by Dr. Manoj Goel and Dr Yash Javeri
The highlights of this training course was live cases of
Bronchoscopy, Hands on Training, CD of the course
material and videos, Precise and accurate time management
of programme schedule, CD of Atlas of Bronchoscopy, Real time
Bronchoscopy Simulation etc.
Total 87 candidates were enrolled in this workshop and received
completion certiicate after the course.
The aim of organizing this course was to provide a rich lare
of scientiic material and practical approach of performing
bronchoscopy and percutaneoous tracheostomy in critical care
setings. This training course was specially designed for specialist
and post graduate trainees in critical care medicine, emergency
medicine, respiratory medicine, general medicine and anaesthesia.
Conference Dates: 9th and 10th Dec 2017
Venue: Lecture Gallery, Apollo Medical College,
Jubilee Hills, Hyderabad
Challenging Current Practices Based On Emerging
Evidence
Lateral Thinking
Fostering Innovations
Workshop Date: 8th Dec 2017
Topic: Research Methodology
Venue: Basavatarakam Indo- American Hospital
Auditorium, Banjara Hills, Hyderabad
Organizing Chairperson:
Dr. Palepu B Gopal
Scientific Committee Chairperson:
Dr. Srinivas Samavedam
Organizing Secretary:
Dr. Venkat Raman Kola
Treasurer:
Dr. Subba Reddy K
Individualize Current Protocols
The foundations of scientific innovation and progress lie in curiosity, suspicion
and
enquiry. The art of practicing critical care medicine dwells in ability to integrate
and
individualize the current protocols. There is considerable overlap and conflict
between
these two fundamental elements.
Critically analyzing and challenging established practices can be achieved only
through
periodically debating and discussing these strategies. Though disciplined
implementation
of protocols and guidelines offer safe practice of clinical medicine, these should
not
become restrictive to free thinking and lateralization of clinical paradigms.
Randomized trials and clinical data have been questioned many a time to be
lagging to
“collective experiences” and novel therapies. Emerging evidences that challenge
the
current guidelines, deconstruction of current algorithms and innovative
technologies will
be the tools of engagement in CRITIC 2017.
This conceptual event CRITIC 2017 will enable critical care physicians in
understanding
such technical innovations, novel therapies and those concepts challenging
existing
clinical practices with defensible rationale. Modus operandi would be to stimulate
thinking and perhaps throw light towards new directions with a potential for more
productive research and creating environment for such conceptual modification in
clinical
practice.
Analytical and critical knowledge admirers of critical care medicine will lead us in
understanding the controversies and fallacies in ongoing practices like a
‘Manthan” of
minds, at the ‘ConfeRence on Innovative Thinking in Intensive Care’ - CRITIC
2017.
Conference Pre-Registration Fee:
• ISCCM members Rs. 3,000
• Non ISCCM members Rs. 3,500
Spot Registration Fee: Rs. 4,000
Workshop Registration Fee: Rs. 1,500
Venue:
Lecture Gallery, Apollo
Medical College, Jubilee Hills,
Hyderabad
Venue:
Basavatarakam Indo- American
Hospital Auditorium, Banjara Hills,
Hyderabad
Payment Process:
Cheque/DD: Issued in favour of: ‘SOC OF CRITICAL CARE MEDICINE’ –
payable at Hyderabad, Telangana.
To be received by courier atleast 5 days before the conference dates at this
address:
‘Dr. Venkat Raman Kola, Organizing Secretary - CRITIC 2017, Room no:
217, 2nd Floor, CARE Hospital Banjara
Hills, Rd. No. 1, Hyderabad, Telangana, ISCCM Office Secretary: +91 91778
56352’
Online Transfer: A/c Name: ‘SOC OF CRITICAL CARE MEDICINE’, A/c No:
52023382758, SBH Gunfoundry
Branch, Hyderabad, IFSC Code: SBHY0020066
Please email the proof/transaction id along with your name and mobile no. to:
‘drksreddy77@yahoo.co.in’
Contact for Payment Queries:
Dr. Subba Reddy (Treasurer): +91 99893 85110 e-mail:
drksreddy77@yahoo.co.in
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Battle of the Brains
Dr. Yatin Mehta and Dr. Yash Javeri
Please mail the answers at the earliest to
dryashjaveri@yahoo.com
Correct answers with the name of irst two correct entries
will be published in next issue
Q1. For legal purposes death is:
a. Cessation of all brain activity
b. Cessation of brain stem activity
c. Cessation of cardiac activity
d. Cardio-pulmonary arrest
Q2. Consent for retrieval of organs or
tissue from the deceased is not valid
if obtained from:
a. From the deceased before death
b. From a nominated representative
of the deceased
c. From a person in a qualifying
relationship
d. From the doctor atending the
deceased at the time of death
Q3. Which of the following statements
about living organ donation is
incorrect?
a. It can be directed to a speciic
recipient
b. It may be commercialised in
necessary circumstances
c. It can be for non-directed
altruistic donor chains
d. It can be altruistic non-directed
donation
Q4. How high is the rate of survival in the
irst year for a kidney transplant?
a. 69% b. 87% c. 94% d. 100%
Q5. In what year was the irst successful
organ transplant?
a. 1943 b. 1954 c. 1961 d. 1975
Q6. Up to how many people can one
person help by donating organs?
a. 2 b. 4 c. 5 d.9
Q7. You are more likely to need a
transplant than become a donor?
True or False
Q8. Which of the following apply to
a presumed consent system for
posthumous organ donation:
a. Persons must register their
objections to posthumous
donation.
b. Relatives may have the right
to veto organ removal in the
absence of registered objections.
c. Organ donation can proceed
irrespective of relatives' views if
there are no registered objections
d. All of the options are correct
Q9. Fill in the blanks - Legal position on
Organ Donation?
Organ Transplantation and Donation
is permited by law, and covered
under the "Transplantation of Human
Organs Act ....", which has allowed
organ donation by live & Brain-stem
Dead donors. In ...., amendment of
the Act also brought in donation of
human tissues, there by calling the
Amended Act "Transplantation of
Human Organs & Tissues Act ...."
Q10. Is the police department involved in
any way for the declaration of brainstem
death?
Answers of May-June 2017 Issue
1. Cefoxitin: Cefoxitin efects routine measurement of
serum creatinine, resulting in falsely elevated levels
of renal function. Cefoxitin is a second generation
wide spectrum cephalosporin. Other medications
which can interfere includes methyldopa and
levodopa
2. Quinolone (Ciproloxacin/levoloxacin) - Coumadin
interaction
3. All fo hte aobve
4. A. Amikacin
5. Prothrombin complex concentrates (PCC) are
derived from human plasma and contain the vitamin
K dependent coagulation factors II, VII, IX, and X
at varying concentrations. Several international
guidelines as well as American College of Chest
Physicians, now recommends PCC for warfarin
reversal in p atients with serious bleeding.
6. Scale used to assess individuals after a closed head
injury, including traumatic brain injury, based on
cognitive and behavioral presentations as they
emerge from coma.
7. A. Boit’s rsepiration
8. Etomidate has an unique characteristics for patients
with traumatic brain injury, as it decreases intracranial
pressure without droppnig normal raterial prsesure.
9. Hypertension
10. Gas Gangrene
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ESC Guidelines on the Diagnosis and
Management of Acute Pulmonary Embolism
European Heart Journal (2014) 35, 3033–3080
GUIDELINES / PRACTICE CORNER
Clinical Classiication of Pulmonary embolism severity
Estimated PE-related early mortality risk deined by in-hospital
or 30-day mortality
This stratiication has important implications both for the diagnostic
and therapeutic strategies
• High Risk – Suspected or conirmed PE in presence of arterial
hypotension
• Not high risk – absence of shock or arterial hypotension
Diagnosis
Clinical presentation
• Dyspnea, chest pain, syncope, cough, shock
Clinical probability
• Well’s criteria and Revised Geneva criteria
D-Dimer testing
• D-dimer levels are elevated in plasma in the presence of
acute thrombosis
• The negative predictive value of D-dimer testing is high
and a normal D-dimer level renders acute PE or DVT unlikely
CT Pulmonary Angiogram
• method of choice for imaging the pulmonary vasculature in
suspected PE
Ventilation-perfusion scintigraphy
• The test is based on the intravenous injection of technetium
(Tc)-99m-labelled macroaggregated albumin particles,
which block a small fraction of the pulmonary capillaries
and thereby enable scintigraphic assessment of lung perfusion.
• Perfusion scans are combined with ventilation studies
• Indications are: outpatients with low clinical probability
and a normal chest X-ray, in young (particularly female)
patients, in pregnancy, in patients with history of contrast
medium-induced anaphylaxis and strong allergic history,
in severe renal failure, and in patients with myeloma and
paraproteinaemia
Echocardiography
• Acute PE may lead to RV pressure overload and dysfunction,
which can be detected by echocardiography
• Disturbed RV ejection patern (so-called ‘60–60 sign’) or on
depressed contractility of the RV free wall compared with
the RV apex (‘McConnell sign’), tricuspid annulus plane
systolic excursion (TAPSE)
• not recommended in haemodynamically stable, normotensive
patients with suspected (not high-risk) PE
Compression Venous Ultrasound
• CUS can be limited to a simple four point examination
(groin and popliteal fossa)
• The only validated diagnostic criterion for DVT is incomplete
compressibility of the vein
Recommendation for PE with shock or hypotension
Emergent CT angiography or bedside Transthoracic echocardiography
is recommended (Grade I C)
Patients with RV dysfunction and who are unstable to shift to
CTPA should undergo CUS to look for DVT (Grade IIb C)
Recommendation for PE without Shock
Diagnostic strategy should be based on clinical probability
(Grade I A)
Plasma D-Dimer should be done in outpatients with low or
intermediate clinical probability (Grade I A)
Normal D-dimer in low probability patients excluded PE
(Grade I A)
Normal CT angiography rules out PE in low or intermediate
patients (Grade I A)
Normal VQ scanning rules out PE (Grade I A)
Treatment of Acute Phase
Hemodynamic and respiratory support
• Titrated Fluid challenge
• Norepinephrine if need for vasopressor arises
• Hypoxemia and hypocapnia can be managed by ventilator
support
Thrombolytic therapy
• Accelerated regimens over 2 hours are recommended
• Agents approved are rTPA, Reteplase, Desmoteplase, Tenecteplase
Surgical Embolectomy
• Indications: high-risk PE, for selected patients with interThe
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mediate-high-risk PE, particularly if thrombolysis is contraindicated
or has failed
Anticoagulation
• anticoagulation is recommended, with the objective of preventing
both early death and recurrent symptomatic or fatal
VTE
• The standard duration of anticoagulation should cover at
least 3 months
• Regimen is started by giving unfractionated heparin for 3-5
days and overlapped with VKA agents or newer oral anticoagulants
Venous ilters
• Venous ilters are usually placed in the infrarenal portion of
the inferior vena cava
• Indicated in patients with acute PE who have absolute contraindications
to anticoagulant drugs, and in patients with
objectively conirmed recurrent PE despite adequate anticoagulation
treatment
• Non-permanent IVC ilters are classiied as temporary or
retrievable devices. Temporary ilters must be removed
within few days, while retrievable ilters can be left in place
for longer periods
Recommendation for PE with shock or hypotension
Thrombolytic therapy is indicated (Grade I B)
Intravenous anticoagulation therapy should be initiated without
delay (Grade I C)
Surgical embolectomy in patients with failed thrombolysis or
contraindication to thrombolysis (Grade I C)
Recommendation for PE without Shock
Anticoagulation to be initiated without delay in low or intermediate
group (Grade I C)
LMWH or Fondaparinux is the drug of choice (Grade I A)
Parallel treatment with oral VKA with INR target 2.5 (Grade I
B)
Alternative to VKA agent, rivaroxaban or apixaban can be initiated
(Grade I B)
Routine use of systemic thrombolytic therapy is not recommended
(Grade III B)
Recommendation for Venous Filters
Should be considered in patient with acute PE and absolute
contraindications to thrombolysis (Grade IIa C)
Duration of anticoagulation – Recommendation
For unprovoked PE, oral anticoagulation for atleast 3 months
(Grade I A)
For patients with transient causes of PE, oral anticoagulation
to be given for 3 months (Grade I B)
Treatment strategies for PE
Shock / hypotension?
Clinical suspicion of PE
Diagnostic algorithm
as in Figure 3
Diagnostic algorithm
as in Figure 4
Assess clinical risk
(PESI or sPESI)
RV function (echo or CT)a
Laboratory testingb
Intermediate risk
Intermediate–low risk Low riskc High risk Intermediate–high risk
A/C; hospitalizatione
A/C; consider early
discharge and home
treatment, if feasiblef
Primary reperfusion
A/C; monitoring;
consider rescue
reperfusiond
No
PE confirmed
PESI class III–IV
or sPESI 1
Consider further
risk stratification
Both positive One positive
or both negative
PESI class I–II
or sPESI = 0
PE confirmed
Yes
Suspected PE without shock or hypotension
Assess clinical probability of PE
Clinical judgment or prediction rulea
D-dimer
CT angiography
positive
CT angiography
negative
Low/intermediate clinical probability
or PE unlikely
no PE PE confirmedc no PE PE confirmedc
High clinical probability
or PE likely
No treatmentb Treatmentb No treatmentb
or investigate furtherd Treatmentb
Suspected PE with shock or hypotension
CT angiography immediately available
Echocardiography
RV overloadb
Noa Yes
No
Search for other causes
of haemodynamic instability
PE-specific treatment:
primary reperfusionc
Search for other causes
of haemodynamic instability
Yes
No other test availableb
or patient unstable
positive negative
CT angiography
CT angiography
available
and
patient stabilized
Diagnostic Strategies protocol
Anticoagulation treatment for indeinite period in cases with
second episode of unprovoked PE (Grade I B)
For patients with PE and cancer, weight adjusted LMWH
should be given for 3-6 months (Grade IIa B). Beyond 6 months,
extended anticoagulation is continued indeinitely or till cancer
is cured (Grade IIa C)
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Dr. Srinivas Samavedam
md, dnB, frCP, fnB, ediC, fiCCm
diploma in health Care Quality management,
diploma in medical law and ethics,
head, Critical Care unit, virinchi hospitals, hyderabad
mobile: +919866343632
e-mail: srinivas3271@gmail.com
Dr. Prashant Kumar
md, idCCm, fnB (Critical Care), ediC,
PgdPha, doa
editor 'Critical Care waarticles'
senior Consultant Critical Care,
medanta The medicity, global health Private ltd,
sector - 38, gurgaon 122001, haryana, india
mobile: +919899302959
e-mail: homeprashant@yahoo.com
JOURNAL SCAN
Quantifying the Efects of Prior Acetyl-
Salicylic Acid on Sepsis-Related Deaths:
An Individual Patient Data Meta-Analysis
Using Propensity Matching
Objective: The primary objective was to
conduct a meta-analysis on published
observational cohort data describing the
association between acetyl-salicylic acid
(aspirin) use prior to the onset of sepsis and
mortality in hsopitalized patients.
Study Selection: Studies that reported
mortality in patients on aspirin with sepsis
with a comparison group of patients with
sepsis not on prior aspirin therapy were
included.
Data Sources: Fifteen studies described
hospital-based cohorts (n = 17,065), whereas
one was a large insurance-based database
(n = 683,421). Individual-level patient data
were incorporated from all selected studies.
Data Extraction: Propensity analyses with
1:1 propensity score matching at the study
level were performed, using the most
consistently available covariates judged to
be associated with aspirin. Meta-analyses
were performed to estimate the pooled
average treatment efect of aspirin on sepsisrelated
mortality.
Data Synthesis: Use of aspirin was
associated with a 7% (95% CI, 2-12%; p
= 0.005) reduction in the risk of death as
shown by meta-analysis with considerable
statistical heterogeneity (I2 = 61.6%).
Conclusions: These results are consistent
with efects ranging from a 2% to 12%
reduction in mortality risk in patients
taking aspirin prior to sepsis onset. This
association anticipates results of deinitive
studies of the use of low-dose aspirin as a
strategy for reduction of deaths in patients
with sepsis( (Crit Care Med August 2017).
Our View: Prostaglandins are potent
vasoactive faty acids that is ubiquitously
distributed throughout the body. Platelets
have pathogenic roles in the multiorgan
dysfunction. Indomethacin has been proven
to have therapeutic efects in the sepsis
models in animals. We do not disbelieve the
ray of hope provided in this Meta-Analysis
except for the clinical question of what is the
most appropriate dose for this indication.
Heat and moisture exchangers versus
heated humidiiers for mechanically
ventilated adults and children
Review question: Are heat and moisture
exchangers or heated humidiiers more
efective in preventing complications such
as airway blockages and pneumonia in
adults, children or infants who receive
invasive mechanical ventilation.
Background: When mechanical ventilation
is used to keep critically ill people
breathing efectively, the upper airway
must be humidiied by artiicial means.
Heat and moisture exchangers and heated
humidiiers are the most commonly used
methods of artiicial humidiication.
Both have been associated with speciic
advantages and disadvantages; for
example, heat and moisture exchangers are
thought to be more likely to cause airway
obstruction while heated humidiiers have
been associated with an increased risk of
pneumonia (swelling (inlammation) of the
tissue in one or both lungs).
Study characteristics: We searched for
studies up to May 2017. We included 34
trials in the review, with 2848 participants
from 12 countries. The majority of trials
(27) were set in an intensive care unit with
one in a neonatal intensive care unit. The
remaining seven studies were done in an
operating department. Participants were
infants in three studies with adults (average
age of 40 to 69 years) in the remainder.
Key results: There was no overall diference
in the rates of airway blockage, pneumonia
or death in adults who were ventilated
through heat and moisture exchangers
compared to adults ventilated through
a heated humidiier. There was some
evidence that the occurrence of pneumonia
may be lowered by using heat and moisture
exchangers that capture less moisture. There
was not enough information to make any
conclusions about either of these methods
in children or infants (Cochrane database of
Systemic Reviews Sept 2017).
Our View: This topic has been debated
over and over several times in the past.
Nonetheless this Cochrane review is very
important since it is of our concern for each
patient who is on ventilator. We prefer HME
for most of the routine usage, still there is a
place for heated humidiiers where HME is
contraindicated.
Comparison of diagnostic accuracy in
sepsis between presepsin, procalcitonin,
and C-reactive protein: a systematic review
and meta-analysis
Background: The soluble cluster of
diferentiation 14 (or presepsin) is a free
fragment of glycoprotein expressed on
monocytes and macrophages. Although
many studies have been conducted
recently, the diagnostic performance of
presepsin for sepsis remains debated. We
performed a systematic review and metaanalysis
of the available literature to assess
the accuracy of presepsin for the diagnosis
of sepsis in adult patients and compared the
performance between presepsin, C-reactive
protein (CRP), and procalcitonin (PCT).
Methods: A comprehensive systemic search
was conducted in PubMed, EMBASE, and
Google Scholar for studies that evaluated
the diagnostic accuracy of presepsin for
sepsis until January 2017. The hierarchical
summary receiver operating characteristic
method was used to pool individual
sensitivity, speciicity, diagnostic odds
ratio (DOR), positive likelihood ratio (PLR),
negative likelihood ratio (NLR), and area
under the receiver operating characteristic
curve (AUC).
Results: Eighteen studies, comprising 3470
patients, met our inclusion criteria. The
pooled diagnosis sensitivity and speciicity
of presepsin for sepsis were 0.84 (95% CI
0.80–0.87) and 0.76 (95% CI 0.67–0.82),
respectively. Furthermore, the pooled
DOR, PLR, NLR, and AUC were 16 (95%
CI 10–25), 3.4 (95% CI 2.5–4.6), 0.22 (95%
CI 0.17–0.27), and 0.88 (95% CI 0.85–0.90),
respectively. Signiicant heterogeneity
was found in both sensitivities (Cochrane
Q = 137.43, p < 0.001, I 2 = 87.63%) and
speciicities (Cochrane Q = 180.76, p < 0.001,
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian
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I 2 = 90.60%). Additionally, we found no
signiicant diference between presepsin
and PCT (AUC 0.87 vs. 0.86) or CRP
(AUC 0.85 vs. 0.85). However, for studies
conducted in ICU, the pooled sensitivity
of presepsin was found to be higher than
PCT (0.88, 95% CI 0.82–0.92 vs. 0.75, 95% CI
0.68–0.81), while the pooled speciicity of
presepsin was lower than PCT (0.58, 95% CI
0.42–0.73 vs. 0.75, 95% CI 0.65–0.83).
Conclusion: Based on the results of our
meta-analysis, presepsin is a promising
marker for diagnosis of sepsis as PCT or
CRP, but its results should be interpreted
more carefully and cautiously since too few
studies were included and those studies
had high heterogeneity between them. In
addition, continuing re-evaluation during
the course of sepsis is advisable (Ann
Intensive Care. 2017 eSp 6; 7(1):91.
Our View: Sepsis being amongst the
largest killers in ICUs, any strategy against
it is a bonanza for the Intensivists. We do
not have facilities for presepsin analysis in
our labs. Presepsin has a higher sensitivity
and speciicity in the diagnosis of sepsis
as a new biomarker, and is a predictor for
the prognosis of sepsis. More importantly,
presepsin seems to play a crucial role as a
supplemental method in the early diagnosis
of sepsis.
Statin and Its Association With Delirium
in the Medical ICU*
Objectives: To examine the association
between statin use and the risk of delirium
in hospitalized patients with an admission
to the medical ICU.
Design: Retrospective propensity-matched
cohort analysis with accrual from September
1, 2012, t o September 30, 2015.
Seting: Hartford Hospital, Hartford, CT.
Patients: An initial population of patients
with an admission to a medical ICU totaling
10,216 visits were screened for delirium
by means of the Confusion Assessment
Method. After exclusions, a population of
6,664 was used to match statin users and
nonstatin users. The propensity-matched
cohort resulted in a sample of 1,475 patients
receiving statin matched 1:1 with control
patients not using statin.
Interventions: None.
Measurements and Main Results: Delirium
deined as a positive Confusion Assessment
Method assessment was the primary end
point. The prevalence of delirium was
22.3% in the unmatched cohort and 22.8%
in the propensity-matched cohort. Statin
use was associated with a signiicant
decrease in the risk of delirium (odds
ratio, 0.47; 95% CI, 0.38–0.56). Considering
the type of statin used, atorvastatin (0.51;
0.41–0.64), pravastatin (0.40; 0.28–0.58),
and simvastatin (0.33; 0.21–0.52) were all
signiicantly associated with a reduced
frequency of delirium.
Conclusions: The use of statins was
independently associated with a reduction in
the risk of delirium in hospitalized patients.
When considering types of statins used, this
reduction was signiicant in patients using
atorvastatin, pravastatin, and simvastatin.
Randomized trials of various statin types
in hospitalized patients prone to delirium
should validate their use in protection from
delirium (Critical Care Medicine: Sept 2017;
45(9): 1515–1522).
Our View: We shall ask the readers
whether they would like to start statin for
this indications as a preventive strategy for
delirium. We have never started. Yes our
perception supports the indings of this
study being based on a large numbers of
subjects base.
Balanced versus isotonic saline
resuscitation—a systematic review and
meta-analysis of randomized controlled
trials in operation rooms and intensive
care units
Background: Fluid resuscitation is the
cornerstone in treatment of shock, and
intravenous luid administration is the
most frequent intervention in operation
rooms and intensive care units (ICUs).
The composition of luids used for luid
resuscitation gained interest over the past
decade, with recent focus on whether
balanced solutions should be preferred over
isotonic saline.
Methods: Systematic review and metaanalysis
of randomized controlled trials
(RCTs) comparing luid resuscitation with a
balanced solution versus isotonic saline in
adult patients in operation room or ICUs.
Primary outcome was in-hospital mortality,
secondary outcomes included occurrence
of acute kidney injury (AKI) and need for
renal replacement therapy (RRT).
Results: The search identiied 11 RCTs
involving 2,703 patients; 8 trials were
conducted in operation room and 3 in
ICU. In-hospital mortality, as well as
the occurrence of AKI and need for RRT
was not diferent between resuscitation
with balanced solutions versus isotonic
saline, neither in operation room nor in
ICU patients. Serum chloride levels, but
not arterial pH, were signiicantly lower
in patients resuscitated with balanced
solutions.
Conclusions: Currently evidence
insuiciently supports the use of balanced
over isotonic saline for luid resuscitation
to improve outcome of operation room
and ICU patients (Annals of Translational
Medicine Aug 2017; 5(16).
Our View: Recently a sea change has taken
place in favor of balanced salt solutions.
While we introspect we do not ind much
favor towards balanced salt solutions in
resuscitation practices.
Antiarrhythmics in Cardiac Arrest: A
Systematic Review and Meta-Analysis
Introduction: It is widely accepted
that antiarrhythmics play a role in
cardiopulmonary resuscitation (CPR)
universally, but the absolute beneit
of antiarrhythmic use and the drug of
choice in advanced life support remains
controversial.
Aim: To perform a thorough, in-depth
review and analysis of current literature
to assess the eicacy of antiarrhythmics in
advanced life uspport.
Material and Methods: Two authors
systematically searched through multiple
bibliographic databases including
CINAHL, SCOPUS, PubMed, Web of
Science, Medline(Ovid) and the Cochrane
Clinical Trials Registry. To be included
studies had to compare an antiarrhythmic
to either a control group, placebo or
another antiarrhythmic in adult cardiac
arrests. These studies were independently
screened for outcomes in cardiac arrest
assessing the efect of antiarrhythmics on
return of spontaneous circulation (ROSC),
survival and neurological outcomes. Data
was extracted independently, compared
for homogeneity and level of evidence
was evaluated using the Cochrane
Collaboration’s tool for assessing the risk of
bias. The Mantel-Haenszel (M-H) random
efects model was used and heterogeneity
was asessed uisng ht e 2I tsatistic.
Results and Discussion: The search of the
literature yielded 30 studies, including
39,914 patients. Eight antiarrhythmic
agents were identiied. Amiodarone and
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer 12 of indian
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Image
Section
65 years male has had a recent
neurosurgery.
Identify the device
AnSWER tO
lASt IMAgE SECtIOn
Right upper lobe Aspergilloma
Air crescent sign
lidocaine, the two most commonly used
agents, showed no signiicant efect on any
outcome either against placebo or each
other. Small low quality studies showed
beneits in isolated outcomes with esmolol
and bretylium against placebo. The only
signiicant beneit of one antiarrhythmic
over another was demonstrated with
nifekalant over lidocaine for survival
to admission (p = 0.003). On sensitivity
analysis of a small number of high quality
level one RCTs, both amiodarone and
lidocaine had a signiicant increase in
survival to admission, with no efect on
survival to discharge.
Conclusions: This systematic review
and meta-analysis suggests that, based
on current literature and data, there has
been no conclusive evidence that any
antiarrhythmic agents improve rates of
ROSC, survival to admission, survival to
discharge or neurological outcomes. Given
the side efects of some of these agents,
we recommend further research into
their utility in current cardiopulmonary
resuscitation guidelines (Heart Lung
and Circulation. DOI: htp://dx.doi.
org/10.1016/j.hlc.2017.07.004).
Our View: Antiarrhythmics use is an
established practice in ACLS protocols,
which are widely practiced. After second
cycle of CPR, if there is persistent VF or VT
use of antiarrhythmics is recommended.
We are unable to comment on this
study because the indings need more
conirmation frmo laregr tsudies.
Antimicrobial resistance in the next
30 years, humankind, bugs and drugs: a
visionary approach
Purpose: To describe the current standards
of care and major recent advances with
regard to antimicrobial resistance (AMR)
and to give a prospective overview for the
next 30 years in this ield.
Methods: Review of medical literature
and expert opinion were used in the
development of ht is review.
Results: There is undoubtedly a large
clinical and public health burden associated
with AMR in ICU, but it is challenging to
quantify the associated excess morbidity
and mortality. In the last decade, antibiotic
stewardship and infection prevention and
control have been unable to prevent the
rapid spread of resistant Gram-negative
bacteria (GNB), in particular carbapenemresistant
Pseudomonas aeruginosa (and other
non-fermenting GNB), extended-spectrum
β-lactamase (ESBL)-producing and
carbapenem-resistant Enterobacteriaceae
(CRE). The situation appears more
optimistic currently for Gram-positive,
where Staphylococcus aureus, and
particularly methicillin-resistant S.
aureus (MRSA), remains a cardinal
cause of healthcare-associated infections
worldwide. Recent advancements in
laboratory techniques allow for a rapid
identiication of the infecting pathogen
and antibiotic susceptibility testing. Their
impact can be particularly relevant in
setings with prevalence of MDR, since
they may guide ine-tuning of empirically
selected regimen, facilitate de-escalation of
unnecessary antimicrobials, and support
infection control decisions.
Currently, antibiotics are the primary
anti-infective solution for patients with
known or suspected MDR bacteria in
intensive care. Numerous incentives have
been provided to encourage researchers to
work on alternative strategies to reverse
this trend and to provide a means to
treat these pathogens. Although some
promising antibiotics currently in phase 2
and 3 of development will soon be licensed
and utilized in ICU, the continuous
development of an alternative generation
of compounds is extremely important.
There are currently several promising
avenues available to ight antibiotic
resistance, such as faecal microbiota, and
phage therapy (Intensive Care Medicine
Oct 2017; (43)10.
Our View: Diicult bugs are the greatest
challenge to the medical community at
large. No patient in the community or in the
hospital are free from this threat. Optimal
use of the available drugs, inventions of
new drugs and the alternatives to drugs,
are needed to handle it.
Hemodynamic Assessment of Patients
With Septic Shock Using transpulmonary
thermodilution and Critical Care
Echocardiography - A Comparative Study
Purpose: To assess the agreement between
transpulmonary thermodilution (TPT) and
critical care echocardiography (CCE) in
ventilated patients with septic shock.
Methods: Prospective descriptive
multicenter study; Patients were assessed
successively using TPT and CCE in random
order.
Results: A total of 137 patients were studied
(71 men; age, 61 _ 15 years; Simpliied
Acute Physiologic Score, Sequential
Organ Failure Assessment. TPT and CCE
interpretations at bedside were concordant
in 87/132 patients (66%) without acute cor
pulmonale (ACP), resulting in a moderate
agreement (kappa, 0.48; 95% CI, 0.37-0.60).
Experts’ adjudications were concordant
in 100/129 patients without ACP (77.5%),
resulting in a good inter technique
agreement (kappa, 0.66; 95% CI, 0.55-0.77).
In addition to ACP (n = 8), CCE depicted a
potential source of TPT inaccuracy in 8/29
patients (28%). Lactate clearance at H6 was
similar irrespective of the concordance of
online interpretations of TPT and CCE
(55/84 [65%] vs 32/45 [71%], P = .55). ICU
and day 28 mortality rates were similar
between patients with concordant and
discordant interpretations (29/87 [36%]
vs 13/45 [29%], P = .60; and 31/87 [36%] vs
16/45 [36%], P = .99, preecstively).
Conclusions: Agreement between TPT
and CCE was moderate when interpreted
at bedside and good when adjudicated
oline by experts, but without impact on
lactate clearance and mortality. htp://
dx.doi.org/10.1016/j.chest.2017.08.022
Our view: This observational study
emphasizes the fact that interpretation
of data or images is the most important
aspect of any hemodynamic monitoring
tool. The modality per se does not impact
outcome on its own
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1 Prachi Verma, Jaipur LM-17/V-317
2 Saurabh Chandrakar, Vellore LM-17/C-442
3 Ankit Sharma, Yamuna Nagar LM-17/S-1517
4 BalJeet Kaur, Rudrapur LM-17/K-931
5 Prashant Rajebhosale, Pune LM-17/R-560
6 Umesh Jain, Mumbai LM-17/J-449
7 Ramesh N, Kondapur LM-17/N-278
8 Amit Rastogi, Lucknow LM-17/R-559
9 Raja Gindi, Chennai LM-17/G-691
10 Avadhesh Pratap, Vidisha LM-17/P-859
11 Gaurav Haral, Ahmednagar ALM-17/H-127
12 Suresh Panuganti, Secunderabad LM-17/P-860
13 Saurav Prasad, Gumla LM-17/P-861
14 Anitha Janjanam, Palakkad LM-17/J-451
15 Devender Kumar, Rewari LM-17/K-930
16 Rahul Daga, Nagpur ALM-17/D-547
17 Balaji Rajaraman, Pudukkotai LM-17/R-558
18 Vasudha Singhal, Gurgaon LM-17/S-1477
19 Harsh Sapra, Gurgaon LM-17/S-1516
20 Syed Qadri, Kurnool LM-17/Q-7
21 Anamika Dhanawade, Mumbai ALM-17/D-548
22 Aditya Joshi, Gurgaon LM-17/J-450
23 Anandi Nayak, Bangalore ALM-17/N-280
24 Vinoth PR, Chennai LM-17/P-878
25 Vikasdeep Bansal, Mumbai LM-17/B-680
26 Nitin Tangri, Amritsar LM-17/T-317
27 Smitha jose, Hyderabad LM-17/j-452
28 Hrishikesh Hazarika, Guwahati LM-17/H-128
29 Ashish Deshmukh, Aurangabad LM-17/D-555
30 Somank Gupta, Kota LM-17/G-701
31 Deepak Anand R, Hosur LM-17/A-557
32 Apoorva Tiwari, New Delhi ALM-17/T-323
33 Vatsal Zanzmera, Surat LM-17/Z-21
34 Nanisagana KumanaRajan, Thane ALM-17/K-946
35 Bhanu Muthaiah, Mysore LM-17/M-824
36 Ajal Hussain, Guwahati ALM-17/H-129
37 Sheetal Jayakar, Pune LM-17/J-454
38 Mohammed Ismail Nizami, Hyderabad
LM-17/N-279
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40 Sandeep B, Chitoor LM-17/B-681
41 Rajdeep Chaudhari, Bhandara LM-17/C-443
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70 Ravi Ruhil, Gurgaon LM-17/R-562
71 Mohammed Samir, Bangalore LM-17/S-1522
72 Anil Malik, New Delhi LM-17/M-828
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74 Sonali Kodange, Pune LM-17/K-936
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76 Anirban Das, Kolkata LM-17/D-550
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80 Arijit Sardar, New Delhi LM-17/S-1524
81 Suvendu Laha, Pune LM-17/L-101
82 Abdul Ahad Ryhan Uddin,
Chitagong
LM (SAARC)-
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17/M-829
84 Ujwal Dhundi, New Delhi LM-17/D-551
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88 Ghanshyam Darak, Latur LM-17/D-553
89 Darshan Shah, Ahmedabad LM-17/S-1526
90 Charudat Vaity, Mumbai LM-17/V-314
91 Prabuddha Mukhopadhyay, Kolkata LM-17/M-830
92 Pinank Pandya, Mumbai LM-17/P-865
93 Samik Pramanik , Kolkata LM-17/P-877
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95 Kiran Nallella, Warangal ALM-17/N-285
96 Manoj Kumar, Ranchi LM-17/K-949
97 Hiren Dobariya, Rajkot ALM-17/D-554
98 Chandrakant Chandrakant, Dehradun
ALM-17/C-445
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106 Parag Morad, Ahmedabad ALM-17/M-832
107 Jitendrakumar Patel, Ahmedabad ALM-17/P-869
108 Saba Afreen R, Bangalore ALM-17/A-553
109 Sudhama Sirivella, Chennai ALM-17/S-1529
110 Dhirajkumar Pandey, Mumbai ALM-17/P-870
111 Swathi Gosula, Kadapa ALM-17/G-693
112 Sourabh Gogoi, Guwahati ALM-17/G-694
113 Alakesh Bezbaruah, Dist Sonitpur ALM-17/B-686
114 Hymn Parikh, Amreli LM-17/P-871
115 Koushik Borah, Guwahati LM-17/B-687
116 Sreeraj V, Calicut LM-17/V-315
117 Melwin George, Mala PO LM-17/G-695
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119 Suhana Golandaj, Kolhapur ALM-17/G-696
120 Neelima Karri, Secunderabad LM-17/K-938
121 Naganand K.V, Mysore LM-17/K-939
122 Sowmya Adimulapu, Markapur LM-17/A-554
123 Shyam Jacob, Kotayam LM-17/J-457
124 Robin Thomas, Ernakulam LM-17/T-320
125 Chandreshkumar Sudani, HyderabadLM-17/S-1530
126 Ravinder Malik, Jind LM-17/M-833
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129 Pedditi Reddy, Secunderabad LM-17/R-565
130 Trilok Srivastava, Gorakhpur ALM-17/S-1531
131 Inderpreet Isher, New Delhi LM-17/I-45
132 Abhay Joshi, Jalgaon LM-17/J-458
133 Shivaji Patil, Dahod LM-17/P-872
134 Shankar Duraisamy, Salem LM-17/D-557
135 Mori Laxmanbhai, Surendranagar LM-17/L-100
136 Ravneet Chahal, Malerkotla LM-17/C-447
137 Jumana Haji, Bangalore LM-17/H-131
138 Ruchika Choudhary, Jaipur LM-17/C-448
139 Ram Arun, Erode LM-17/A-555
140 Subhajit Guha, Kolkata LM-17/G-697
141 Deepak Parashar, Nagpur LM-17/P-873
142 Rajib Duarah, Indrapur LM-17/D-558
143 Isha Garg, Chennai LM-17/G-698
144 Kotrasheti Shailaja, Mysore LM-17/S-1532
145 Navratan Navratan, Gurdaspur LM-17/N-282
146 Ajay V, Calicut LM-17/V-316
147 Jayesh Narayanan, Calicut LM-17/N-283
148 Bharath K V, Anand LM-17/K-940
149 Swapnil Sakhala, Nashik LM-17/S-1533
150 Gunaseelan G, Chandigarh LM-17/G-699
151 Laxami Kotgire, Nizamabad LM-17/K-941
152 Pullakandam Kumar, Khammam LM-17/K-942
153 Malathi Subramaniam, Chengappalli LM-17/S-1534
154 Abhilasha Thanvi, Jodhpur LM-17/T-322
155 Vikas Kumar, Patna LM-17/K-943
156 Dinesh Ekambaram, Bangalore LM-17/E-22
157 Mateen Shaikh, Mumbai ALM-17/S-1535
158 Akshay Agarwal, Hyderabad ALM-17/A-556
159 Govind Prakash, Gurgaon ALM-17/P-874
160 Gudabandi Kumar, Visakhapatnam ALM-17/K-944
161 Mounika Junnuthula, Macha BolaramALM-17/J-459
162 Priyanka Salunkhe, Jalgaon ALM-17/S-1536
163 Sajidali Saiyad, Surat ALM-17/S-1537
164 Thota Teja, Kadapa ALM-17/T-324
165 Santosh Raja, Coimbatore LM-17/R-566
166 Karthik Kumaran, Vellore LM-17/K-945
167 Rupali Rupali, Fatehabad LM-17/R-567
168 Murthy Arumilli, Bangalore LM-17/A-558
169 Ruchika Makkar, Jaipur LM-17/M-834
170 Sreenivasan Vadivelu, Chennai LM-17/V-318
171 Prabhakar Pamarthi, Hyderabad LM-17/P-875
172 Malappa Poojari, Bangalore LM-17/P-876
173 Nishant Sharma, New Delhi LM-17/S-1538
174 Hemadri Motamarri, Chirala LM-17/M-835
175 Shrikant Shelkikar, Latur LM-17/S-1539
176 Jabbar Desai, Karad LM-17/D-559
177 Niyas Naseer, Thrissur LM-17/N-284
178 Ronak Jain, Jaipur ALM-17/J-460
179 Sunita Verma, Ghaziabad ALM-17/V-321
180 Kabilan R, Patukotai LM-17/R-568
181 Jenita Singh, Bhubaneshwar LM-17/S-1540
182 Senthilnathan Thiruchengode,
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183 Anil Sathyadas, ThiruvananthapuramLM-17/S-1541
184 Swarup Padhi, Gurgaon LM-17/P-879
185 Josekuty Mathew, Kochi LM-17/M-836
186 Rajnish Singh, New Delhi LM-17/S-1542
187 Sumit Maini, Ludhiana LM-17/M-837
188 Dixit Thakur, New Delhi LM-17/T-326
189 K.Ajit Choudary, Anantapur ALM-17/C-449
190 Hakim Vaghjipurwala, Panchmahal ALM-17/V-319
191 Beiparysa K, Siaha LM-17/K-947
192 Snehal Tanna, Keshod LM-17/T-327
193 Prashant Borle, Jalgaon LM-17/B-688
194 Vinod Kinge, Jalgaon LM-17/K-948
195 Sushil Gurjar, Jalgaon LM-17/G-702
196 Pankaj Badhe, Jalgaon LM-17/B-689
197 Prahlad Mishra, Bawadia Kalan ALM-17/M-838
198 Prashant Nakum, Amreli ALM-17/N-286
199 Jain George, Muvatupuzha LM-17/G-703
200 Prashant Sakhavalkar, Pune LM-17/S-1545
201 Ashish Bansal, Kanpur ALM-17/B-690
202 Anuj Singhal, Gurgaon LM-17/S-1546
203 Hansaj Padh, Mumbai ALM-17/P-880
204 Alka Gondale, Navi Mumbai ALM-17/G-704
205 Bon Sebastian, Trivandrum LM-17/S-1547
206 Bharat Patel, Ahmedabad LM-17/P-881
207 Rajdeep Dhandhukiya, Akola LM-17/D-560
208 Disha Parhi, Kolkata ALM-17/P-882
209 Vijayasree K, Akola ALM-17/K-950
210 Kushagra Gupta, Ghaziabad LM-17/G-705
211 Farhan Ahmed, Mumbai ALM-17/A-559
212 Lakshmi Shobhavat, Mumbai LM-17/S-1548
213 Anusha Nalamothu, Vijayawada LM-17/N-287
214 Veera Babu Vadlani, Guntur LM-17/V-322
215 Boban Varghese, Trivandrum LM-17/V-320
216 Mayank Sachan, New Delhi LM-17/S-1527
217 Ashish Sarode, Jalgaon LM-17/S-1544
218 Piyush Jain, Mumbai LM-17/J-461
219 Khyati Thakkar, Vadodara LM-17/T-328
220 Sandeep Sukhsohale, Amravati LM-17/S-1543
221 Manisha Badhe, Jalgaon ALM-17/B-683
The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian
soCieTy of CriTiCal Care mediCine 15
CRITICARE 2018 7-11 March, 2018 • Varanasi
SWaGatHaM!
Friends,
I am honoured and privileged to assume
the role of Chairperson of the 24th Annual
Congress at Varanasi.
Situated on the bank of River Ganga.
Varanasi is the oldest living city &
considered as the holiest and most sacred
place on this planet. Mark Twain once said,
"Varanasi is older than history, older than
tradition, older even than legend & looks
twice as old as all of them put together." It is
also an important industrial center, famous
for its carpet, silk fabrics, perfumes, ivory
works & sculptures.
Banaras Hindu University is an
internationally reputed temple of learning.
It was founded by the great nationalist
leader, Pt. Madan Mohan Malviya, in 1916.
It played a stellar role in the independence
Dr. Kapil Zirpe
naTional PresidenT, isCCm &
Chairman sCienTifiC CommiTTee
movement & has developed into one of the
greatest center of learning. It has produced
many a great freedom ighters, renowned
scholars, artists, scientists & technologist
all contributing immensely towards the
progress of modern India. We also proud to
be associated with six Bharat Ratna Award.
I am conident that we will be steadfast
in addressing the pressing challenges. On
behalf of all of us, I am most pleased to
welcome Prof. D K Singh who is organizing
secretary of 24 TH Annual Congress of
ISCCM. Over his years of service in BHU,
he has distinguished himself as a person with
dedication, integrity, and professionalism.
We are conident that he and his team will
continue to make outstanding contributions
to ISCCM.
Thus, on the behalf of Organizing
Committee, Varanasi City Branch &
BHU, I invite you all to join this excellent
scientiic feast at Varanasi in 2018. The city
is eager to greet with you with spiritual
music to enlighten your soul with learning
& knowledge.
Dr. Michael S Niederman Dr. Michale Oleary Dr. Rupert Pearse Dr. Vito
Marco Ranieri Dr. Claudio Ronco
Prof. Alain Combes Prof. Dr. Med. Tobias Welte Prof. Giuseppe Citerio Prof.
Jean-Louis Teboul Prof. Paul Wischmeyer
INTERNATIONAL FACULTY
Editorial officE
dr. Yatin Mehta
272 Espace, Nirvana Country, Gurgaon 122001
Mobile : +91 9971698149
newsletter@isccm.org
Published By : INDIAN SOCIETY OF CRITICAL CARE MEDICINE
For Free Circulation Amongst Medical Professionals
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Near Chaitya Bhoomi, Off Veer Savarkar Marg, Dadar, Mumbai – 400028
Tel.: 022-24444737 • Telefax: 022-24460348 • email: isccm1@gmail.com •
isccm1@vsnl.net
Printed at : urvi compugraphics • 022-2494 5863 • email : urvi@urvi.cc
7-11 March, 2018 • Varanasi
Venue:
Hotel Ramada, The Mall, Cantonment, Mall Rd, Varanasi, Utar Pradesh
221002
Hotel Clarks, Cant The Mall, Mall Road, Varanas, Utar pradesh 221002
www.criicare2018.com