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C O M M U N I C A T I O N SCritical Care

Editorial officE

dr. Yatin Mehta272 Espace, Nirvana Country, Gurgaon 122001Mobile : +91 9971698149 emails : [email protected]

Published By :

IndIan SocIety of crItIcal care MedIcIneFor Free Circulation Amongst Medical ProfessionalsUnit 6, First Floor, Hind Service Industries Premises Co-operative Society, Near Chaitya Bhoomi, Off Veer Savarkar Marg, Dadar, Mumbai – 400028 Tel. 022-24444737 • Telefax :022-24460348 • email : [email protected]

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ISCCM News HeadlIneS ISCCM day – Multiple events across the country

Criticare 2018 agenda

ISCCM Go Green campaign

ISCCM MOVIe Return Gif t gets first prize at aarogya Film festival in Pune.

MCI has awarded 22 CMe hours to CRITICaRe 2018

Thematic conferences by various city branches

Volume 12.5 NoVemBeR-DeCemBeR 2017

1 ISCCM news Headlines

2 editorial

3 President's desk

3 editorial Board 2017-2018

4 General Secretary's desk

5 ISCCM day Celebration 2017

9 ISCCM Branch activities

10 Journal Scan

11 Battle of the Brains

11 Image Section

12 GUIdelIneS / PRaCTICe CORneR - newer Oral anticoagulants

15 Welcome new Members to the ISCCM family

16 new Office Bearers of ISCCM Branches

17 CRITICaRe 2018 Scientific Program

25 CRITICaRe 2018

C O N T E N T S

The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine2

HAPPY NEW YEAR

HAPPY NEW YEAR

Editorial...

dr. yatin MehtaEditor in Chief, The Critical Care CommunicationsPresident-Elect, [email protected]

www.isccm.org

Dear Readers,

Season’s Greetings

The year is ending and we have had a very fruitful and academic

2017. The Varanasi Team under Dr. D. K. Singh has been burning

mid night Diyas (Oil) to make our Annual Conference a great success.

The Scientific programme under the guidance of the President

Dr. Zirpe has turned out very nice and we all are looking forward to it.

I would urge everyone to register and join the pilgrimage! Long Live

ISCCM and CCC! Happy New Year to you all and BIG THANK YOU to

my editorial team!

BeST WISHeS FOR all !

The CriTiCal Care CommuniCaTions a Bi-monThly newsleTTer of indian soCieTy of CriTiCal Care mediCine 3

HAPPY NEW YEAR

President's Desk...

Dear All,

2017 has been a great year for ISCCM. We had big achievements for the society. ISCCM Day was celebrated in full spirit across the country. I am happy to share that we (ISCCM) has won the 1st prize and Beat Short film award at the 7yh Aarogya film festival. The short movie “ Return Gift'' on organ donation was well appreciated at the festival in Pune.

ISCCM is dedicated to environment protection. We have launched a Go Green campaign. Most of our publications are already only in soft copy.

I am also happy to inform all members that Criticare 2018 has been credited with 20 CME hours by MCI. We received record number of abstracts for the conference.

The organising team is keen to welcome you all to Varanasi. In 2018 I wish that may you not only change the date of the calendar, but also your focus, commitments and actions for a more fruitful year ahead.

dr. Kapil ZirpePresident, [email protected]

Editorial Board 2017-2018

EdITor In ChIEfDr. Yatin Mehta, Delhi

[email protected]

dEPuTy EdITorS

Dr. Yash Javeri, Delhi Dr. Rajesh Mishra, AhmeDAbAD

[email protected] [email protected]

EdITorS

Dr. Samir Jog, Pune Dr. Sachin Gupta, Delhi Dr. Pradeep Bhatia, JoDhPur Dr. R. Senthil Kumar, ChennAi Dr. Suresh Ramasubban, KolKAtA

[email protected] [email protected] [email protected] [email protected] [email protected]

QuIz SECTIon

Dr. Yatin Mehta, Delhi Dr. Yash Javeri, Delhi

[email protected] [email protected]

Journal SCan

Dr. Srinivas Samavedan Dr. Prashant [email protected] [email protected]

IMagES SECTIon

Dr. Abhinav Gupta Dr. Tapas Kumar [email protected] [email protected]

www.isccm.org


dr. Subhal dixitgeneral Secretary, ISCCM

Greetings from ISCCM HQ

ISCCM is growing day by day and

increasing its pillars of strength as it

enters the silver jubilee year at the

strike of midnight on 31 december!

It has got a lot of new members and

branch to percolate in india !

Internationally Isccm is playing the role

of a big brother In SARCC region and

now has a very good prominence in

Europe, USA and the world federation!

Dr Kapil Zirpe was nominated by isccm

to represent isccm in world federation.

He was elected to world council during

its meeting in Rio 2017 November.

With education been its strength

always isccm has streamlined its

exams with its 2018 educational

calander out on its website !

Come January 2018 isccm is

going completely go green and all

application for students,institutions

and membership will be online

through the student and institute

management systems.

Members can now also download its

ID cards and membership certificates

online by login!

Many regional meetings, webinar’s

were held across india and are very

well appreciated! I congratulate and

thank all organisers for this !

Isccm day was celebrated with a high

success and lots of creative posters

were received on this theme ! I

sincerely thank all those who have put

in all their efforts in this !

webinar’s were held which got great

appreciation at international level!

General Secretary's Desk

‘‘Internationally

Isccm is playing

the role of a big

brother In sARcc

region and now

has a very good

prominence in

Europe, UsA

and the world

federation!

’’

The film on organ donation “THE

RETURN GIFT” was the show stopper

of the isccm day which has been

well appreciated and has been

nominated for award in the short film

category! Soon after the censorship

board approves this film isccm will

be showing this film across india in

theatres for public viewing.

Isccm is also taking care of its

members by joining hands with new

india insurance and secure safe by

implementing a professional indemnity

policy which will be available to all its

members at concessional rates.

The much awaited Criticare Varanasi

at the holy city is knocking its doors

and awaiting you all from 7-11

March 2018, and the preparation for

this is in full swing ! Many eminent

national and international faculty have

confirmed and the scientific program

is out on website.

Adhar card now has been made

mandatory by government and

hence forth all new applicants for

membership, students, teachers

will have to submit their adhar card

copy along with application! All old

members can update their adhar

card details at: http://www.isccm.org/

UpdateAadharDetails.aspx

Kindly update your adhar details by

31/3/2018!

Finally I welcome you all to the holy

city of Varanasi for Criticare 2018 and

wish you and your family a very happy

new year!

Cheers and thank you !!!


ISCCM Day Celebration 2017Delhi

Raipur

ISCCM Day Celebration

13th October 2017

ISCCM Day Celebration was held on 13th October 2017 At Dharamshila Narayana Superspeciality Hospital. Chief Guest of the program was Dr. Anup Kumar was the, Nodal Officer-NOTTO and Professor & Head of the Department of Urology & Kidney Transplant, VMMC & Safdurjung Hospital. Dr. Deepak Govil and Dr. Anil Gurnani was the Guest of honor of the program.

Dr Tarique presented on care of a brain dead patient.

The program was organized by Dr. Ashutosh Bhardwaj, Clinical lead & Senior consultant Department of Critical Care.

After the introduction and opening remarks by

Dr Deepak Govil, lamp lighting was done by all the dignitaries. Topics on Organ Donation Awareness, Brain Death testing, Brain Death donor maintenance were discussed. A short film on organ donation was also run during the program. After the program quiz for fellows & post Graduates on organ donation was also conducted by Dr Yash Javeri.

Program was well attended by more than 75 participants.

Organ Donation Camp

14th October 2017

Organ Donation Camp was organized at Dwarka for public to create awareness for donating organs. Program was well attended around 30 local resident of the society. The camp was organized by Dr Yash Javeri. Professor Alka Chandra,Head of Department,Anesthesia – Hindu Rao Hospital addressed the gathering on need of organ donation.

Society of critical care medicine, Raipur chapter celebrated ISCCM foundation day on 12th October and theme was “Organ Transplant”, on which society’s president Dr Mahesh Sinha and secretory Dr Surya Prakash Sahu spoke on importance of organ donation.


Raipur

Pune

Society for Critical Care Medicine, Raipur Chapter celebrate ISCCM Foundation day that was covered in city’s reputed Daily Hindi newspaper ‘Pioneer”

THEME : ‘‘RETURN GIFT’’ - ORGAN DONATION

Dates: 09th October 2017

Venue: 1st floor Auditorium Patrakar Bhavan, Ganjve Chowk, Pune

ISCCM Pune Branch is Organized the Program, awereness on organ donation, Well appriciated by media.

Very good Response from local public 190 people has attended the prgram. It is Celebrated to encourage People to donate organ.

PrOgraM

06:00 to 06:10 PMIntroduction of Topic & Role of ISCCMDr Subhal Dixit

06:10 to 06:25 PMOrgan Donation Film “Return Gift” release Felicitation of film production teamDr Marathe

06:25 to 07:05 PM Expert Panel Discussion/ interaction with Audience

Moderator: Dr. Kapil ZirpePanelist : Dr Shirish Prayag,Dr Kaynoosh Kadapatti,Dr Prasad Rajhanse, Dr Subhal DixitMrs Arati Ghokhale, Mr Rajesh Shetti

07:05 to 07:35 PM SKIT “ Sanjeevan : A Gift of life” Purva Shah & Team


The Discussion Between public and experts

Lots of questions & Myths about organ dona-tion - Organs that can be donated are: Kidney, Eye, Lungs, Heart, Liver, Pancreas, Cornea, Small Intestine, Skin tissues, Bone tissues, Heart valves and Veins.

Organ donation has proved to be a miracle for the society. Organs such as kidneys, heart, eyes, liver, small intestine, bone tissues, skin tissues and veins are donated for the purpose of transplantation. The donor gives a new life to the recipient by the way of this noble act

Dr Kapil Zirpe has discussed the Gap between Demand and Supply The demand for organs is considerably higher than the number of donors around the world. Each year several patients die waiting for donors. Statistics re-veal that in India against an average annual demand for 200,000 kidneys, only 6,000 are received. Similarly, the average annual de-mand for hearts is 50,000 while as low as 15 of them are available.

Who pays for Surgery of an organ Donor??? Your family pays for your medical care and fu-neral costs, but not for organ donation. Costs related to donation are paid by the recipient, Hospitals.

Dr Kayanoosh Kadapatti has explained Or-gans that can be donated after death are the heart, liver, kidneys, lungs, pancreas and small intestines. Tissues include corneas, skin, veins, heart valves, tendons,ligaments and bones.

Organ and tissue donation involves removing organs and tissues from someone who has died (a donor) and transplanting them into someone who, in many cases, is very ill or dying (a recipient). Organs that can be trans-planted include the heart, lungs, liver, kid-neys, intestine and pancreas.

Dr Subhal Dixit has explained Organ and Tis-sue Donation after Cardiac Death. Typically when a person suffers a cardiac death, the heart stops beating. The vital organs quickly become unusable for transplantation. But their tissues – such as bone, skin, heart valves and corneas – can be donated within the first 24 hours of death.

Mrs. Arti Gokhale has explain the role of ZTCC on organ donation ,

Dr Balasaheb Bande has explained Individu-als in their 80s and 90s have successfully donated organs including liver and kidneys to save the lives of others. You must be 18 years of age to register through the state's Donate life Registry. People of any age wishing to be-come organ and tissue donors should inform their families that they wish to donate.

190 people had attended the program

Dance & Skit Represented by Purvi ShahAbout organ donation

SKIT “Sanjeevan : A Gift of life”Purva Shah & Team

TEAM BEHIND THE SUCCESSFUL PROGRAM ON ORGAN DONATION


Nagpur

Goa

Ahmedabad

As a part of SCCM annual day celebrations public awareness programme on organ donation was organised by SCCM Nagpur Branch chapter 2017-2019at city hotel centre point on Sunday 15 th october. This SCCM day was celebrated by all 67 branches of ISCCM across the country.

Programme was started with welcome address by Dr Nikhil Balankhe sir speaking on the importance of organ donation. He said "people need to realize that nothing more charitable and selfless than Organ donation can ever occurs in person’s life as you can save 8 live by doing so"

He welcomed with floral bouquet chief guest Dr Vibha Dani who is president of ZTCC followed by Dr Ravi Wankhede he is secretary of ZTCC.

After welcome address dr Ravi Wankhede gave talk on Organ donation. He said "lack of awareness and motivation, religious taboos are few reasons so as peoples are hesitant to donate organs" but people don't understand that every religion rightfully allowed organ

donation" he also said that "you get a great feeling because you brighten someone's life after yours life is over"

Following the talk two Skits were presented first by team of Dr Acharya sir on organ donation after demises of loved one to the unknown donor. Second skit was presented by Team SCCM DR Anant Rajput , Dr Sanjeev Bais, Dr Ajay, dr Shahnawaz Saddique, and dr Kaustub Upadhye, on how to manage burn patients, how Skin donation will help to improve outcomes of patients, and creating more awareness on skin donation. Programme was ended with panel discussion with the panelists Dr Vibha Dani, Dr Ravi Wankhede, Dr Nirmal Jaiswal, Dr Anand Dongare, Dr Bhuche,

dr Deepak Jeswani, Dr acharya, Dr Sameer Jahagirdar. The session was moderated by dr Nikhil balankhe who cleared the doubts on organ donation and successfully answered the question of audience.

The programme was ended with special thanks given to Mr N.K Garg who is chairman of DIFFUSION Engineers PVt. Ltd. Who donated some amount to SCCM for this noble cause.

ISCCM Goa branch celebrated the 24th foundation day on 8 th October 2017 at hotel Double Tree Neptune, Panjim Goa, meeting was in association with ISA Goa branch.

Dr Seetaram Korgaonkar Chairman Goa branch welcomed the august gathering and told purpose of having foundation day celebration. ISCCM Goa is also completed one year since it was founded in Nov 2016.

Audience was given information about the aims of ISCCM and what it has achieved in last 24 years. The theme for this year was "Organ Donation the return Gift for Life". Dr Seetaram Korgaonkar Chairman, elaborated on the purpose of having this theme this year.

CME on Organ Donation started with screening of film "Organ Donation" developed by ISCCM headquarters.

Local TV channel prime TV has covered event and telecasted it in Goa which boosted the awareness program at general public level.(attaching link of telecast ).. Please find the link of the program - https://youtu.be/FvD6QKEMPiA

Photographs of meeting are also attached herewith.

Thanks

Dr. Seetaram KorgaonkarChairman, Goa Branch

Which was followed by talk on 'Organ Donation awareness' by Dr shital Lengde, Nephrologist.

Second talk was on 'brain death testing' given by Prof S ponraj, Head of department of Neurosurgery at Goa medical college. Doctors actively participated in discussion on Organ Donation. Meeting ended with vote of thanks by Secretary ISCCM Dr Hemchand Maenkar and Dr. Milind Naik which was followed by dinner.

Meeting was attended by many specialists and some general public.

ISCCM Foundation Day webinar

Monday, 9th October 2017, 7.00 to 9.30 pm Crowne Plaza, Ahmedabad

ISCCM Foundation Day webinar was organised on 9th October at Ahmedabad by Dr Rajesh Mishra. The topics covered were off day to day interest for intensivist. The webinar was attended by 900 plus world wide audience. The link is available for a month which can be accessed by ISCCM web site.

PrOgraM

7.00-7.15 pm ISCCM Organ Donation Video - Return Gift

7.15-7.35 pm Communication, Convincing and Social aspects of organ donation in India - Mrs. Sujata Ashtekar

7.35-7.55 pm Medicolegal aspects in organ donation in India - Mr. Mahendra Kumar Bajpai

7.55-8.15 pm Brain Death diagnosis Indian Perspective - Dr. Srinivas Samavedam

8.15-8.35 pm Before you ask for organ retrieval you need to know!! - Dr. Rahul Pandit

10 minutes Discussion and question answer

8.45-9.30 pm Managing brain death donor in ICU

Moderator: Dr. Rajesh Mishra

Panelist: Dr. Srinivas Samavedam, Dr. Rahul Pandit, Dr. Pratibha Dileep, Dr. Anuj Clark, Dr. Chirag Matrawadia

Weblink: http://estv.in/isccmday


ISCCM Branch ActivitiesDelhi

Pondicherry

November 2017

International Speaker Program

advanced Mechanical Ventilation with Electrical Impedance Tomography (EIT)

Speaker: Dr Diederik Gommers, Professor Intensive Care Medicine at Erasmus MC, Rotterdam, The Netherlands

Cordinator: Dr Yash Javeri, Secretary - SCCM Delhi NCR, Director- Apex Healthcare Consortium

Panelist: Dr R K Mani, Group CEO, Chairman Critical Care and Pulmonology, Nayati Medicity

Dr J V Divatia, Professor and Head, Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Mumbai

Dr Sandeep Dewan, Director and HOD (Critical care) Fortis Memorial Research Institute, Gurugram

The meeting was organised under aegis of SCCM Delhi at Leela Ambience, Gurugram

December 2017

One Day Workshop on rational Use of Intravenous Fluid

10 December 2017, radisson Blu Hotel, Faridabad

Organized by Dr Supradip Ghosh

A workshop on Rational Use of Intravenous fluid was organized on 10th December 2017 at Hotel Radisson Blu, Faridabad. workshop program designed for audience intensivists, anesthesiologists, internsists and surgeons. Highlights of the workshop was critical appraisal of various commercially, available

fluids, bedside utilization of these principles, in various clinical scenarios and interactive session. Sessions on topics like ambasic concepts – physiology and more with the lectures includes on dynamics fluid and difference fluid were held. Various lectures were given by eminent local faculty and international faculty Dr Roop Kishen. At the last case based panel discussion was held for 2 hours. Workshop was thoroughly attended by more than 70 participants.

First State Level ISCCM Conference which held in October 7th & 8th 2017 at Indragandhi Government General Hospital, Pondicherry.

Dr G.Sreenivaasan ISCCM, Secretary, Pondicherry

Job opportunities Advertisement on isCCm Website

You can advertise Job opportunities in your Hospital/ Institute on ISCCM website and attract best talent. ISCCM has more than 9,500 members working in field of Critical Care in India.

Rates of Job Opportunities advertisement on ISCCM website are as follows:

Hospitals/ Institutes (India) Rs. 20,000 for 30 days

Hospitals/ Institutes (Foreign countries) US$ 500 for 30 days

For any further details required, please contact

Mr. Vimal Merchant

ISCCM Mumbai Office

Phone: 022-24444737/24460348 • Email: [email protected]


dr. Srinivas SamavedamMd, dnB, frCP, fnB, EdIC, fICCMdiploma in health Care Quality Management,diploma in Medical law and Ethics,head, Critical Care unit, Virinchi hospitals, hyderabadMobile: +919866343632e-mail: [email protected]

dr. Prashant KumarMd, IdCCM, fnB (Critical Care), EdIC, PgdPha, doaEditor 'Critical Care Waarticles'Senior Consultant Critical Care, Medanta The Medicity, global health Private ltd, Sector - 38, gurgaon 122001, haryana, IndiaMobile: +919899302959 e-mail: [email protected]

JOUR

NAL SCAN

The compilers would like to wish all members

an advance HAPPY NEW YEAR

Quite a few interesting publications came

out in the last quarter of the year. We look at

some of them

Tissue Doppler assessment of diastolic

function and relationship with mortality

in critically ill septic patients: a

systematic review and meta-analysis

San Filippo F et al ; British Journal of

Anaesthesia, 119 (4): 583–94 (2017)

Diastolic dysfunction is increasingly being

studied and reported in non-cardiac

conditions, especially those associated with a

SIRS response. San Filippo et al carried out a

systematic review of all data that evaluated the

role of tissue Doppler assessment in identifying

diastolic dysfunction among critically ill septic

patients. The primary analyses involved the

relationship o e’ and E/e’ ration with mortality

among critically ill septic patients. A total of 17

patients with about 1300 patients qualified

for the meta-analysis. A significant correlation

was found between lower e’ and higher E/e’

ratio with higher mortality. This implies that

LV diastolic dysfunction is an important cause

for mortality among septic patients. The e’

velocity does not seem to be correlate to the

pre-load status of the LV. This correlation was

more apparent among those patients who

were screened early in the course of sepsis.

Reviewer’s comments: This study emphasises

the role of assessment of diastolic function

while prognosticating a septic patient and

also reiterates the necessity of learning the

skills of echocardiography.

Continuous Versus Intermittent

Subglottic Secretion Drainage

to Prevent Ventilator-associated

Pneumonia: a Systematic review

Zunjia W et al; Critical Care Nurse. 2017;

37[5]:e10-e17)

Ventilator associated pneumonia is a problem

faced by most intensive care units. Ideas to

prevent the condition are constantly emerging.

One of the interventions which is considered

to be of some benefit is use of endotracheal

tubes with subglottic suction channels.

Manufacturers recommend continuous

suction through the channel for optimum

benefit. This however presents some logistic

difficulties. Zunjia et al carried out a systematic

review of studies comparing intermittent

subglottic suction with continuous suction.

They included studies which had VAP rates as

well as length of stay as indices of outcome.

After rigorous methodological screening eight

studies involving 1070 patients were selected

for the meta-analysis. The incidence of VAP as

well as the time to VAP onset was comparable

in the two types of subglottic suction. Mucosal

injury appeared to be more common with

continuous suction. No mortality difference

was found. The authors recommended a

larger RCT to elucidate this question.

Reviewer’s comments: It may not be a wrong

practice to use intermittent subglottic suction

to prevent VAP, till bigger RCTs come out with

more definite evidence

Lung recruitment Maneuvers for adult Patients with acute respiratory Distress Syndrome -a Systematic review and Meta-analysis

Goligher EC et al; Ann Am Thorac Soc Vol 14,

Supplement 4, pp S304–S311, Oct 2017

Lung recruitment maneuvers have been

in practice for more than a decade. As the

understanding of pathophysiology of ARDS

improves and consequences of mechanical

ventilation realised, alveolar recruitment

maneuvers have come under greater scrutiny.

Goligher et al carried out a systematic review

of mechanical ventilation strategies with and

without lung recruitment maneuvers. The

aim of the review was to evaluate whether

mechanical ventilation strategies with

recruitment measures, decrease the mortality

when compared to strategies not employing

lung recruitment. For the purpose of this review,

recruitment maneuvers were defined as any

type of transient elevation in mean airway

pressure undertaken to reduce atelectasis.

Six trials enrolling close to 1400 patients

qualified for the review. Significant benefit was

noted in 28 day mortality and oxygenation

when recruitment strategies were part of the

ventilator management. Similarly, incidence

of barotrauma was not higher with the use

of recruitment maneuvers. This study also did

not report increased hemodynamic instability

when recruitment maneuvers were applied.

The authors concluded that recruitment

maneuvers improve oxygenation, particularly

when combined with higher PEEP, and reduce

the requirement for rescue therapy. LRMs are

safe and well tolerated. LRMs may improve

survival in patients with ARDS, but further

research is required to definitively assess the

role of LRMs in the routine management of

mechanical ventilation in patients with ARDS

Reviewer’s comments: Recruitment

maneuvers, when applied in selected group of

moderate to severe ARDS patients probably

have some beneficial effects and are safe.

But selection of patient seems to be the

crucial issue

The influence of esmolol on septic

shock and sepsis: a meta-analysis of

randomized controlled studies

Liu P et al; Am J Emerg Med 2017 Nov 8

Sepsis and septic shock have a varied

outcome determined by a host of factors. One

of the implicated confounders is a myocardial

dysfunction which could be triggered by

a persistent tachycardia. Control of this

tachycardia with beta blockers is an attractive

hypothesis, which is always tempered by

concerns about the effect of the beta blockers

on hemodynamics. Liu et al carried out a

meta-analysis of RCTs evaluating the effect of

the betablocker, esmolol, on the outcomes of

patients with sepsis and septic shock. Only 5

RCTs withstood the methodological scrutiny.

Survival benefit appeared to be significant with

the use of esmolol. Cardiac injury markers

like troponin I were also favourably altered by

esmolol. However, there was no influence of

beta blockade on MAP, CVP or SCVO2. The

authors concluded that Esmolol treatment

may be able to improve survival rate, and

reduce heart rate and TnI.

Reviewer’s comments: In situations where

the SIRS response is severe and persistent,

this study reassures that beta-blockade with

esmolol may not be detrimental. It might have

a favourable effect on myocardial injury.


Image Section

26 year old male presented to the ER with a history of difficulty breathing

Answer to lAst imAge section

Chest X-ray shows the implantable pulse generator with its leadsDeep brain stimulation is used in a variety of clinical settings, predominantly in patients with poorly controlled movement disorders.

Battle of the Brainsdr. yatin Mehta and dr. yash Javeri

Please mail the answers at the earliest to [email protected]

Correct answers with the name of first two correct entries will be published in next issue

Q1. What is Maastricht classification?

Q2. What is FeMg?

Q3. What is Nasogastric tube syndrome?

Q4. Expand OPSS

Q5. Fill in the blanks.

An outbreak called '......... .....' started in March 1990 and spread rapidly all over Bombay and adjoining area. A concomitant and steady increase in ..... ..... ...... ....... ....... isolation was observed.

answers of September-October 2017 Issue

1. For legal purposes death is: Cardio-pulmonary arrest

2. Consent for retrieval of organs or tissue from the deceased is not valid if obtained from: From the doctor attending the deceased at the time of death

3. Incorrect-It may be commercialised in necessary circumstances

4. 94%

5. 1954

6. 9

7. True

8. All of the options are correct

9. Organ Transplantation and Donation is permitted by law, and covered under the "Transplantation of Human Organs Act 1994", which has allowed organ donation by live & Brain-stem Dead donors. In 2011, amendment of the Act also brought in donation of human tissues, there by calling the Amended Act "Transplantation of Human Organs & Tissues Act 2011"

10. The police department has to be informed that a patient is brain dead if it is a medicolegal case, but the declaration of brain-stem death is only done by a panel of doctors.

Q6. What unit is used to measure EAA?

Q7. Which section of IPC deals with death caused by a negligent act.

Q8. Identify the drug

Q9. What is mechanism of action of Giapreza?

Q10. What is line listing?

Use of the Fluid Challenge in Critically Ill adult Patients: a Systematic review.

Messina et al Anesth Analg 2017; 125:1532–

43

Fluid therapy is one of the most common

interventions in hospital and ICU practice.

This is also the intervention with maximum

variability and individual preferences. Messina

et al carried out a systematic review to identify

the pattern and trends of fluid prescriptions.

The focus specifically was to look at the triggers,

targets and end points of fluid challenge. For

purposes of this study the authors defined

fluid challenge as the infusion of a definite

quantity of fluid of a specific quality in a fixed

time (expressed as either span or infusion

rate), and defined the outcome of the FC as

a change in a defined hemodynamic variable

for a predetermined threshold. A total of 71

studies enrolling 3617 patients were selected

for the review. The average amount of fluid

given was about 500 ml (7ml/kg). Colloids

were the most commonly used fluids while

starches were used in 6.7% of patients.

Fluid was administered over 30 minutes in

more than 40 % of the studies. Increase

in cardiac output or cardiac index were the

most common targets and a little more than

50% of patients were fluid responders. The

percentage change in CO or CI varied between

10-15%. The authors concluded that the Fluid

Challenge is not well standardized and lacks

of consistency among the published studies.

Reviewer’s comments: Despite lot of

published evidence and guidelines, one of

the most common and crucial interventions in

ICU has lot of variabilities and inconsistencies

in practice.

Continuous versus intermittent

neuromuscular blockade in patients

during targeted temperature

management

Mathias Stöckl et al; Resuscitation Volume

120, November 2017, Pages 14-19

Targeted temperature management is the

current standard of care for patients surviving

a cardiac arrest. Prevention of shivering is an

essential step to avoid hyperthermia. Stockl

et al carried out an RCT comparing continuous

infusion of rocuronium with intermittent doses

of the same drug. The primary outcomes of

interest were shivering episodes. Secondary

outcomes of interest were survival and one

year neurological outcome. The number of

shivering episodes were significantly less

in the continuous infusion group. Doses of

sedatives were also less in the continuous

infusion group. Patients who received

continuous infusion woke up earlier and for a

shorter time in the ICU. However, no difference

in ICU survival or one year neurological status

were noted.

Reviewer’s comments: Continuous

neuromuscular blockade seems to provide

a smoother course during TTM. However,

mortality and neurological status maybe

governed by several other factors and may not

be determined by one intervention alone. The

sample size is too small to make a statement,

but it does raise a valid hypothesis.


Newer Oral AnticoagulantsGUIDELINES / PRACTICE CORNER

NEWEr OraL aNTICOagULaNTS

Two classes are available: the oral direct thrombin inhibitors (DTIs; e.g. dabigatran) and oral direct factor Xa inhibitors (e.g. rivaroxaban, apixaban, and edoxaban {not vailable in India})

DABIGATRAN (Available as Pradaxa)

FDa aPPrOVED INDICaTIONS DOSagE rEgIMES

• Reduce the risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation

• For the treatment of deep venous thrombosis (DVT) and pulmonary embolism (PE) in patients who have been treated with a parenteral anticoagulant for 5-10 days

• To reduce the risk of recurrence of DVT and PE in patients who have been previously treated

Non-valvular Atrial Fibrillation

• 150 mg BID for CrCl >30mL/min

• 75 mg BID for CrCl 15-30mL/min

• If CrCl 30 to 50 mL/min and concomitant use of dronedarone or ketoconazole, consider 75 mg twice daily

• Contraindicated in patients with CrCl <15 mL/min

Treatment and Reduction in the Risk of

Recurrence of DVT and PE:

• For patients with CrCl >30 mL/min: 150 mg orally, twice daily after 5-10 days of parenteral anticoagulation

• No dosing recommendations available for patients with CrCl<30 mL/min or on dialysis

RIVAROXABAN (Available as Xarelto)


• To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation

• For treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and for the reduction in the risk of recurrence of DVT and of PE

• For prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery

Reduction in risk of stroke in nonvalvular atrial fibrillation

• 20 mg once daily with the evening meal for patients with CrCl >50 mL/min

• 15 mg once daily with the evening meal for patients with CrCl 15 to 50 mL/min

• Contraindicated in patients with CrCl<15 mL/min or moderate to severe hepatic impairment (ChildPugh B or C)

Treatment of DVT/PE

• 15 mg twice daily with food, for first 21 days.

• After 21 days, transition to 20 mg once daily with food, for remaining treatment

• Contraindicated in patients with CrCl<30 mL/min or moderate to severe hepatic impairment (ChildPugh B or C)

Prophylaxis of DVT following hip or knee

replacement surgery

• Hip replacement: 10 mg once daily for 35 days

• Knee replacement: 10 mg once daily for 12 days

APIXABAN (Available as Eliquis)


• To reduce the risk of stroke and systemic embolism in patients with nonvalvular atrial fibrillation

• For treatment of deep vein thrombosis (DVT), pulmonary embolism (PE), and for the reduction in the risk of recurrence of DVT and of PE

• For prophylaxis of DVT, which may lead to PE in patients undergoing knee or hip replacement surgery

Reduction in risk of stroke in nonvalvular

atrial fibrillation and prophylaxis of DVT

• 5 mg twice daily for patients with CrCl >50 mL/min

• 2.5 mg once daily for patients with CrCl 15 to 50 mL/min, age > 80 years, weight < 60kg

BaSIC CHaraCTErISTICS BETWEEN WarFarIN aND NOaC

WarFarIN NOaCOnset Slow Rapid Dosing Variable Fixed Food effect Yes Rivaroxaban should be taken with largest meal of the day,

otherwise no known food effects for OACsMedication interactions Many Few Monitoring required Yes No

Offset Long Shorter


SAFETY, EFFICACY AND PHARMACOLOGY OF NOAC

Warfarin rivaroxaban apixaban DabigatranAdministration Once daily with or

without foodOnce or twicedaily with largestmeal of day3

Twice daily withor without food

- Twice daily with or without food- Must be kept in original packaging- Can’t be crushed

Safety in nonvalvularatrialfibrillation

Higher risk ofintracranialhemorrhagecompared toOACs

Higher risk of GIbleedingcompared towarfarin

Lower risk ofmajor bleedingcompared towarfarin

- Higher risk of GI bleeding compared to warfarin- Small increase in risk of MI compared to warfarin

Efficacy in non-valvularatrialfibrillation

Non-inferior towarfarin

Reduced all causemortality

- Lower risk of Ischemic stroke (150mg dose only)- Trend towards reduced all-cause mortality

Bio availability 100% 60-80% 60% 6%

Time to peakeffect

4-5 days 2-4 hours 1-2 hours 1-3 hours

Half-life 40 hours 7-11 hours 12 hours 8-15 hours

Renal clearance None 33% 25% 80%


INDIAN SOCIETY OF CRITICAL CARE MEDICINE

HAPPY NEW YEAR

BeST WISHeS FOR all !


Welcome New Members to the ISCCM family1 Sanjeev Kumar, Palakkad LM-17/K-958

2 Balakrishna Palnati, Guntur LM-17/P-894

3 Rupali Lahoria, Chandigarh LM-17/L-103

4 Dhiraj Pol, Nipani LM-17/P-889

5 Abdul Parey, Jammu ALM-17/P-916

6 Megha Brahmavar, Bangalore ALM-17/B-699

7 Shilpa Autkar, Nagpur ALM-17/A-575

8 Sunil Krishnappa, Bangalore LM-17/K-953

9 Kamlesh Shekhawat, Udaipur LM-17/S-1562

10 Veereswara S K, Chennai LM-17/S-1557

11 Pawan Jain, Raipur LM-17/J-466

12 Pratik Jain, bhilai LM-17/J-464

13 Dewan Roshan Singh, Bangalore LM-17/S-1564

14 Faizur Rahman, Dehradun LM-17/R-570

15 Kushal Parikh, Nadiad ALM-17/P-910

16 Ravindran V, bellandur LM-17/V-330

17 Ravichandran R.P, Pudukkottai LM-17/R-576

18 Akash Shah, Ahmedabad LM-17/S-1552

19 Atiranjan Kumar, Ranchi ALM-17/K-963

20 Vamsi Anupa, Tirupathi LM-17/A-566

21 Prachee Makashir, Pune LM-17/M-855

22 Anil Gupta, Jaipur LM-17/G-719

23 Karthik Arigela, Nellore LM-17/A-572

24 Ankit Kumar, Kanpur nagar LM-17/K-961

25 Sandeep Gundu, godavarikhani LM-17/G-721

26 Karan Gagneja, Faridabad LM-17/G-708

27 Sudarshan Lakhe, Gulbarga LM-17/L-104

28 A Hari Prasad, Berhampur LM-17/P-883

29 Aditi Takale, Miraj LM-17/T-329

30 Geo John, Kuttappuzha LM-17/J-462

31 Sireesha Maddukuri, Hyderabad LM-17/M-839

32 Himanshu Jangid, Alwar LM-17/J-463

33 Deepthi Papineni, S.R.Nagar ALM-17/P-884

34 Manyam Sridhar, Somaikot LM-17/S-1549

35 Raju Ganesan, Chennai LM-17/G-706

36 Utpal Sarma, New Delhi LM-17/S-1550

37 Shivangi Mishra, Bangalore LM-17/M-840

38 Kunal Talreja, Jalgaon LM-17/T-330

39 Mahesh Patil, Osmanabad LM-17/P-885

40 Haider Abbas, Lucknow LM-17/A-560

41 Poonam Chaudhari, Chinchwad ALM-17/C-450

42 Vijaya Muthayala, Nellore LM-17/M-849

43 Jyothi Hattiholi, Belgaum LM-17/H-132

44 Gynendra Gautam, Kanpur LM-17/G-728

45 Santosh Boppidi, Hyderabad LM-17/B-703

46 Anitha Sanapala, Visakhapatnam LM-17/S-1567

47 Chinmaya Panda, Raipur LM-17/P-906

48 Vibhavari Naik, Hyderabad LM-17/N-288

49 Padma Priya Vemulapalli, Vijayawada LM-17/V-323

50 Neha Pareek, Jaipur LM-17/P-886

51 Poornachand Anne, Hyderabad LM-17/A-561

52 Nagaraju Munagala, Hyderabad LM-17/M-841

53 Harshilkumar Gandhi, Ahmedabad LM-17/G-707

54 Masood Mohammed, Hyderabad LM-17/M-842

55 Jithendra C, Bangalore LM-17/C-451

56 Shyam Prasad M S, Hyderabad LM-17/M-843

57 Praveen Kodisharapu, Kondapur LM-17/K-951

58 M.Asiel Christopher, Hyderabad LM-17/C-452

59 Priya Nayak, Hyderabad LM-17/N-289

60 Rajesh Baranwal, Gorakhpur LM-17/B-691

61 Shivam Puniyani, Nagpur LM-17/P-887

62 Prashant Mandilwar, Ranchi LM-17/M-844

63 Mitesh Patel, Gondiya LM-17/P-888

64 Sudhanshu Singhraul, Raipur LM-17/S-1551

65 Senthil Ramasamy, Dindigul LM-17/R-569

66 Ankit Mangla, New Delhi LM-17/M-845

67 Debatra Bose, Hooghly LM-17/B-692

68 Nisarg Oza, Vadodara LM-17/O-21

69 Nitesh Singh, Ghazipur LM-17/S-1553

70 MD Rehan Alam, Aligarh LM-17/A-562

71 Sudhakar Ghattamaneni, Vijayawada LM-17/G-709

72 Prashant Akulwar, Nanded LM-17/A-563

73 Deepak Chandra, Howrah LM-17/C-453

74 Shriswaroop Kulkarni, Kolhapur LM-17/K-952

75 Naresh V, Secunderabad LM-17/V-324

76 Sandeep Devulapally, Warangal LM-17/D-561

77 Mohan Narava, Visakhapatnam LM-17/N-290

78 Lokesh Gutta, Godavari LM-17/G-710

79 Sumanth M.V, Hyderabad LM-17/M-846

80 Mahender Voruganti, Karimnagar LM-17/V-325

81 Suman Nandi, Kamrup Rural LM-17/N-291

82 Shreyas Bhor, Ahmednagar LM-17/B-693

83 Chetan Mahajan, Jalgaon LM-17/M-847

84 Vivek Durai, Hosur LM-17/D-562

85 Aejaz Ahmad Ansari, Dhule ALM-17/A-564

86 Pavan Gautam, Raipur ALM-17/G-711

87 Sumita Sumita, Jaipur LM-17/S-1554

88 Shuvranu Ghosh, Tripura LM-17/G-712

89 Shailesh Gaikwad, Akluj LM-17/G-713

90 Jithin Jose, Shillong LM-17/J-465

91 Raju Shakya, Shillong LM-17/S-1555

92 Dhruva Sharma, Hathras LM-17/S-1556

93 Sony Vyas, New Delhi LM-17/V-326

94 Anwar Hassain, Thrikkakara LM-17/H-133

95 Madhur Joshi, Jaipur LM-17/J-467

96 Abhishek Kotalwar, Nanded LM-17/K-954

97 Pankaj Roy, Patna LM-17/R-571

98 Pavan Rahangdale, Bhopal LM-17/R-572

99 Sanjeev Yadav, Agra LM-17/Y-63

100 Tanmayee Tailam, Hyderabad LM-17/T-331

101 Supriya Pusapati, Hyderabad LM-17/P-890

102 Anurag Chavan, Miraj LM-17/C-454

103 Abhishek Singh, Nagpur LM-17/S-1558

104 Rakesh Mamilla, Hyderabad LM-17/M-848

105 Varun Gutti, Hyderabad LM-17/G-714

106 Kulesh Patir, Faridabad LM-17/P-891

107 Sanjay Kumar, Ranchi LM-17/K-955

108 Dheeraj Dumir, Panchkula LM-17/D-563

109 Deepa Agarwal, Kota LM-17/A-565

110 Manoj S, Chennai LM-17/S-1559

111 Usha N.C, Chennai LM-17/N-292

112 Samrat Verma, New Delhi LM-17/V-327

113 Krishan Thakur, Bhopal LM-17/T-332

114 Jais Sasidharan, Chennai LM-17/S-1560

115 Shilpee Kumari, New Delhi LM-17/K-956

116 Smit Bhongade, Yavatmal LM-17/B-694

117 Ankita Rajput, Nagpur LM-17/R-573

118 Sreeroop K.S, Thrissur LM-17/K-957

119 Naimish Chavada, Ahmedabad LM-17/C-455

120 Narasimha B C, Bangalore LM-17/B-695

121 Surendra Agarwala, Guwahati LM-17/A-567

122 Shivaraddi Bhandi, Hubli LM-17/B-696

123 Rahul Patne, Nanded LM-17/P-892

124 Prince Gupta, Gwalior LM-17/G-715

125 Aditi Prabhu, Chennai LM-17/P-893

126 Pallavi Rane, Jalgaon LM-17/R-574

127 Manisha Bhardwaj, Chandigarh LM-17/B-697

128 Jigar Dodiya, Rajkot LM-17/D-564

129 Rushyendra B, Nellore LM-17/B-698

130 Ramesh Agarwal, Faridabad ALM-17/A-568

131 Ginu Mathew, Palakkad LM-17/M-850

132 Naman Jain, New Delhi ALM-17/J-468

133 Nitin Kasana, Ghaziabad ALM-17/K-959

134 Gautam Parmar, Junagadh ALM-17/P-895

135 Tushar Charkha, Akola ALM-17/C-456

136 Anirban Bhattacharya, Haldia ALM-17/B-700

137 ShaikMohd Hidayathullah, Hyderabad ALM-17/H-134

138 Nipun Agrawal, Bareilly ALM-17/A-569

139 Tanu Shree, Bhopal LM-17/S-1561

140 Vashishth Patel, Sabarkantha LM-17/P-896

141 Anjana Gopinath, Kutch LM-17/G-716

142 Arun Bathena, Nellore LM-17/B-701

143 Siddhartha Hanjura, Jammu LM-17/H-135

144 Appu Jose, Idukki LM-17/J-469

145 Kunjesh Rupapara, Rajkot LM-17/R-575

146 Manas Bindra, Chhindwara LM-17/B-702

147 Dilpreet Kaur, Patiala LM-17/K-960

148 Deepti Thudamaladinne, Secunderabad LM-17/T-333

149 ManishKumar Variya, Surat LM-17/V-328

150 Sahil Sood, Faridabad LM-17/S-1563

151 Romi Prasad, Pune LM-17/P-897

152 Chirag Gilitwala, Surat LM-17/G-717

153 Gnaneshwar Arra Bhattu, Balapur LM-17/A-570

154 Thaha Hussain, Coimbatore LM-17/H-136

155 Harsha Makwaana, Ahmedabad LM-17/M-851

156 Apoorva Garhwal, Wani LM-17/G-718

157 Mohd Mustahsin, Pilibhit LM-17/M-857

158 Sanjoy George, Kottayam LM-17/G-720

159 Mohamed Arif S.A, Chennai LM-17/A-571

160 Amit Kothari, Pune LM-17/K-962

161 ArpitKumar Patel, Mehsana LM-17/P-898

162 Dhruv Upadhyay, Ahmedabad LM-17/U-58

163 Rajesh Patil, Jalgaon LM-17/P-900

164 Darshanbhai Satapara, Surendranagar LM-17/S-1565

165 Maharshi Pandya, Ahmedabad LM-17/P-901


New Office Bearers of ISCCM Branches

Delhi NCRChaIrMan

Dr. Yash JaveriSECrETary

Dr. Prashant KumarTrEaSurEr

Dr. Saurabh TanejaExECuTIVE CoMMITTEE MEMBErS

Dr. Ashutosh Bhardwaj

Dr. Deven Juneja

Dr. Himanshu Dewan

Dr. Rajat Gupta

Dr. Suneel Garg

Dr. Vishal Kumar

166 Guruprasad H S, Bangalore LM-17/H-137

167 Sonali Ghosh, Faridabad LM-17/G-722

168 Ghanshyam Chandak, Parbhani LM-17/C-457

169 Krishna Patil, Jalgaon LM-17/P-899

170 Ramu Mulampaka, Visakhapatnam LM-17/M-852

171 Rohini Gulhane, Nagpur LM-17/G-723

172 Sangeeta Basu, New Delhi LM-17/B-704

173 Vibin Vasudevan, New Delhi LM-17/V-329

174 Sandeep Gurugubelli, Srikakulam LM-17/G-724

175 Ankur Ohri, Noida LM-17/O-22

176 Sudipta Joy, New Delhi LM-17/J-470

177 Sourav Dhara, Howrah LM-17/D-565

178 Pankaj Mishra, New Delhi LM-17/M-853

179 Sonal Gajbhiye, Chennai LM-17/G-725

180 Arvind Prakash, New Delhi LM-17/P-902

181 Inderjeet Ahuja, Kanpur LM-17/A-573

182 Latheef P, Karuvissery LM-17/P-903

183 Bhattaram Gopalakrishna, Nellore LM-17/G-726

184 Banoth Naik, Chennai LM-17/N-293

185 Sriharika Chejerla, Nellore LM-17/C-458

186 Dhanraj P, Kannur LM-17/P-904

187 Hemansukumar Patel, Surat LM-17/P-905

188 Prem Gade, Hyderabad LM-17/G-727

189 Naresh Munot, Pune LM-17/M-854

190 Arun Saxena, Jaipur LM-17/S-1566

191 Shijukumar C, Trivandrum LM-17/C-459

192 Gaurav Acharya, bhopal LM-17/A-579

193 Radhika Dash, Chennai LM-17/D-569

194 Vandana Tyagi, Jaipur LM-17/T-334

195 Payal Saxena, Agra LM-17/S-1568

196 Kranthi Gedala, Bhadrachalam LM-17/G-729

197 Priyanka Patel, Surat ALM-17/P-907

198 Mirza Beg, New Delhi ALM-17/B-705

199 Jerestyn Khapoliwala, Mumbai ALM-17/K-964

200 Sana Abedin, Gurgaon ALM-17/A-574

201 R.Jagan Rao, Secunderabad ALM-17/R-577

202 Shamandeep Kaur, Kharar ALM-17/K-965

203 Seethiraju Bhargava, Guntur ALM-17/B-706

204 Vijay Gupta, Jaipur ALM-17/G-730

205 Preeti Chaudhary, Jaipur ALM-17/C-460

206 Anita Jangid, Bhilwara ALM-17/J-471

207 Hassan Khan, Mumbai ALM-17/K-966

208 Ajinkya Patil, Kolhapur ALM-17/P-908

209 Navinkumar Kore, Mumbai ALM-17/K-967

210 Sajida Sultana, Sixmile ALM-17/S-1569

211 Dhrumil Parekh, Navsari ALM-17/P-909

212 Pooja Arora, Jaipur ALM-17/A-576

213 Prahalad Kumawat, Nagaur ALM-17/K-968

214 Jaipratap Chouhan, Jaipur ALM-17/C-461

215 Siboprosad Bhattacharjee, ambari ALM-17/B-707

216 Jakir Mansuri, Sanganer ALM-17/M-856

217 Smridhi Gupta, Faridabad ALM-17/G-731

218 Rajesh Das, Kolkata ALM-17/D-566

219 Sravanthi Chaluvadi, Hyderabad ALM-17/C-462

220 Ritu Sen, Bhopal ALM-17/S-1570

221 Avinash Chaudhari, Amravati LM-17/C-464

222 Zehra Bagliwala, Mumbai ALM-17/B-708

223 Nikhilesh Pawaskar, Mumbai ALM-17/P-911

224 Parth Shah, Mumbai ALM-17/S-1571

225 Neha Srivastava, Bangalore LM-17/S-1572

226 Shivali Panwar, New Delhi LM-17/P-912

227 Vishalkumar Vaghani, Surat LM-17/V-331

228 Raj Deokule, Nagpur ALM-17/D-567

229 Sunil Sethi, Karnal LM-17/S-1573

230 Kamal Charaya, Karnal LM-17/C-463

231 Praveen Gupta, Karnal LM-17/G-732

232 Raghu Singh, Karnal LM-17/S-1574

233 Kaushal Gagan, Karnal LM-17/G-733

234 Bhoomika Patel, Surat LM-17/P-913

235 Parul Vadgama, Surat LM-17/V-332

236 Chandrapriya Khobragade, Chennai LM-17/K-969

237 Deepak Dhummansure, Bidar LM-17/D-568

238 Khyati Shamaliya, Surat LM-17/S-1575

239 Gousuddin Arif, Gulbarga LM-17/A-577

240 Kaja Sriramamurthy, Kalaburagi LM-17/S-1576

241 Pratima Patil, Kalaburgi LM-17/P-914

242 Manjunath Patil, Kalaburagi LM-17/P-915

243 Manjula Bapugol, Kalaburgi LM-17/B-709

244 Mohammed Inamdar, Kalaburgi LM-17/I-46

245 Mallikarjuna Holakunde, Kalaburagi LM-17/H-138

246 Paary T.T.S, Hosur LM-17/T-335

247 Kaushal Kumar, Ranchi LM-17/K-970

248 Liyakhath Ali, Gulbarga LM-17/A-578

249 Payal Patel, Valsad LM-17/P-917

250 Jayram Navade, Thane LM-17/N-294

251 Vishnu Gautam, Tonk ALM-17/G-734

252 Greeshma Issac, Kottayam LM-17/I-47

253 Lal Prasad, Noida LM-17/P-918

254 Pratik Tantia, Udaipur LM-17/T-336

255 Surmila Khoirom, Imphal LM-17/K-971

256 Seni Potsangbam, Imphal LM-17/P-919

257 Monika Thokchom, Imphal LM-17/T-337

258 Kangabam Devi, Imphal LM-17/D-570

259 Thuibahenba Singh, Imphal LM-17/S-1577

260 Soibam Meitei, Imphal LM-17/M-858

261 Potsangbam Singh, Imphal LM-17/S-1578

262 Maharabam Binarani, Imphal LM-17/B-710

263 Longjam Eshori, Imphal LM-17/E-23

264 Sinam Devi, Imphal LM-17/D-571

265 Smita Smita, Durg ALM-17/S-1579

266 Shailesh Kalamkar, Navi Mumbai LM-17/K-972

267 Mandar Jamdar, Nagpur LM-17/J-472

268 Rajesh Shah, Mumbai LM-17/S-1580

269 Sadhana Srivastava, Varanasi LM-17/S-1581

270 Pragathesh Palaniappan, Vellore ALM-17/P-920

271 Rinu Kashyap, Saharanpur ALM-17/K-973

272 Jaison Sunny, Kottayam LM-17/S-1582

273 Ajay Kumar, Chittoor LM-17/K-974

274 Loveleen Mangla, Lucknow LM-17/M-859

275 Munesh Maheswari, Jaipur ALM-17/M-860

276 Rishab Priyadarshi, Bangalore ALM-17/P-921

277 Ajay Kumar, New Delhi LM-17/K-975

278 Sathisha Sathisha, Bangalore LM-17/S-1583

279 Rameshkumar Malam, Junagadh LM-17/M-861

280 Arvinder Singh, Amritsar LM-17/S-1584

281 Sirshendu Pal, Siliguri LM-17/P-922

282 Srinivasa M, Mysore LM-17/M-862

283 Baidya Rajak, Ramgarh ALM-17/R-578


CRITICARE 2018 SCIENTIFIC PROGRAM

Wednesday, 7th March 2018



CRITICARE2018

7-11 March, 2018 Varanasi

BlockYour

Dates


Thursday, 8th March 2018



CRITICARE2018

7-11 March, 2018 Varanasi

BlockYour

Dates


Friday, 9th March 2018


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 ZirpenaTIonal PrESIdEnT, ISCCM &

ChaIrMan SCIEnTIfIC CoMMITTEE

movement & has developed into one of the greatest center of learning. It has produced many a great freedom fighters, 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 confident 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 confident 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 scientific 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 officEdr. Yatin Mehta

272 Espace, Nirvana Country, Gurgaon 122001Mobile : +91 9971698149

[email protected]

Published By : IndIan SocIety of crItIcal care MedIcIneFor Free Circulation Amongst Medical Professionals

Unit 6, First Floor, Hind Service Industries Premises Co-operative Society, Near Chaitya Bhoomi, Off Veer Savarkar Marg, Dadar, Mumbai – 400028

Tel.: 022-24444737 • Telefax: 022-24460348 • email: [email protected] • [email protected]

Printed at : urvi compugraphics • 022-2494 5863 • email : [email protected]

7-11 March, 2018 • Varanasi

Venue:Hotel Ramada, The Mall, Cantonment, Mall Rd, Varanasi, Uttar Pradesh 221002

Hotel Clarks, Cantt The Mall, Mall Road, Varanas, Uttar pradesh 221002

www.criticare2018.com

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