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The coronavirus disease-2019 (COVID-19) pandemic has affected millions of people worldwide. As our understanding of the disease is evolving, our approach to the patient management is also changing swiftly. Available new evidence is helping us take radical decisions in COVID-19 management. We searched for inclusion of the published literature on treatment of COVID-19 from around the globe. All relevant evidences available till the time of submission of this article were briefly discussed. Once advised as blanket therapy for all patients, recent reports of hydroxychloroquine with or without azithromycin indicated no potential benefit and use of such combination may increase the risk of arrhythmias. Clinical evidence with newer antivirals such as remdesivir and favipiravir is promising that can hasten the patient recovery and reduce the mortality. With steroids, evidence is much clear in that it should be used in low dose and for short period not extending beyond 7 days in moderate to severe hospitalized patientCrit Care Med 2020;24(9)838-846.
To develop a device that can reduce the exposure of aerosols to healthcare workers (HCWs) who are working in coronavirus disease-2019 (COVID-19) critical units.
Barrier enclosure has recently been proposed for use during intubations where the risk of aerosolization is high. In COVID-19 outbreak, use of noninvasive respiratory support is increasing. But at the same time, it is associated with high risk of aerosol generation, leading to infections among HCWs. We have made a modification in the intubation box and hence expanded its use with an aim to reduce COVID-19 exposure.
Vacuum suction tubing was attached to wall mount, and the other end of tubing was fixed, using adhesive surgical tapes, to the inside of the roof of barrier enclosure. Keeping the vacuum suction switched-on inside the box created a negative pressure while overall air flow is into the box from outside. This led us to believe that aerosols if generated are not contaminating patient's vicinity. Currently, we are using barrier enclosure boxes on all patients who are on noninvasive support (noninvasive ventilation or high-flow oxygen therapy).
We believe that adding barrier enclosure with the above-mentioned negative-pressure modification will provide an opportunity to use noninvasive support widely, while at the same time, HCW's exposure to aerosols will be reduced.
Kumar P, Chaudhry D, Lalwani LK, Singh PK. Modified Barrier Enclosure for Noninvasive Respiratory Support in COVID-19 Outbreak. Indian J Crit Care Med 2020;24(9)835-837.
Kumar P, Chaudhry D, Lalwani LK, Singh PK. Modified Barrier Enclosure for Noninvasive Respiratory Support in COVID-19 Outbreak. Indian J Crit Care Med 2020;24(9)835-837.
Coronavirus disease-2019 (COVID-19) pandemic has inundated healthcare systems globally especially resources in intensive care units (ICUs). Tracheostomy may be required in critically ill COVID-19 patients to facilitate weaning and to optimize resources like ventilator and ICU beds. Percutaneous tracheostomy (PCT) has become the standard of care globally in ICUs; however, it is considered a high-risk procedure in COVID-19 patients because of the inherent risk of aerosol generation.
Patients with severe COVID-19 who were on mechanical ventilation because of respiratory failure for ≥10 days were evaluated for PCT. We developed a four-step approach from patient selection and timing, preparation, performance, and postprocedure for PCT in these patients.
We evaluated our four-step protocol in four patients. One of them was non-COVID patient and rest three were COVID patients. The procedure was uneventful in all of the patients with median time of procedure and apnea is 10 minutes 30 seconds and 2 minutes 20 seconds, respectively. The tracheostomy was decannulated in two of these patients and one patient is still on ventilator.
We believe our four-step protocol for PCT in critically ill COVID-19 patient is simple, safe, and easily adapted in any setting with limited training and available resources. We recommend further studies to evaluate this approach in selected critically ill COVID-19 patients who need tracheostomy.
Nasa P, Singh A, Ali A, Patidar S, Georgian A. Percutaneous Tracheostomy in COVID-19 Patients A Four-step Safe Protocol. Indian J Crit Care Med 2020;24(9)832-834.
Nasa P, Singh A, Ali A, Patidar S, Georgian A. Percutaneous Tracheostomy in COVID-19 Patients A Four-step Safe Protocol. learn more Indian J Crit Care Med 2020;24(9)832-834.
Renal replacement therapy (RRT) is utilized for patients admitted with acute kidney injury and is becoming indispensable for the treatment of critically ill patients. In low middle income and developing country like India, the epidemiological date about the practices of RRT in various hospitals setups in India are lacking. Renal replacement therapy although is being widely practiced in India, however, is not uniform or standardized. Moreover, the use of RRT beyond traditional indications has not only increased but has shifted from the ambit of the nephrologist and has come under the charge of intensivists.
The goal of the study was to record perceptions and current practices in RRT management among intensivists across Indian intensive care units (ICUs).
A questionnaire including questions about hospital and ICU settings, availability of RRT, manpower availability, and RRT management in critically ill patients was formed by an expert panel of ICU physicians. The questionnaire was circulated online to Indian Society of Critical Care Medicine (ISCCM) members in October 2019.
The facilities in government setups are scarce and undersupplied as compared to private or corporate setups in terms of ICU bed strength and availability of RRT. High cost of continuous renal replacement therapy (CRRT) makes their use restricted.
Resources of RRT in our country are limited, more in government setup. Improvement of the existing resources, training of personnel, and making RRT affordable are the challenges that need to be overcome to judiciously utilize these services to benefit critically ill patients.
Sodhi K, Philips A, Mishra RC, Tyagi N, Dixit SB, Chaudhary D,
Renal Replacement Therapy Practices in India A Nationwide Survey. Indian J Crit Care Med 2020;24(9)823-831.
Sodhi K, Philips A, Mishra RC, Tyagi N, Dixit SB, Chaudhary D, et al. Renal Replacement Therapy Practices in India A Nationwide Survey. Indian J Crit Care Med 2020;24(9)823-831.
Platelets (PLTs) are dynamic blood molecules which perform multiple physiological functions. Platelet derangements are commonly encountered in intensive care units (ICUs). The relationship of PLT indices with all-cause mortality, acute physiology and chronic health evaluation IV (APACHE IV), diabetes mellitus (DM), and length of stay in ICU is debatable and hence this study was undertaken to bridge this gap of knowledge.
Prospective data were collected for 20 months in the ICU of our hospital. Platelet indices were analyzed among survivors and non-survivors. Acute physiology and chronic health evaluation IV scores were used to study the relationship between PLT indices and illness severity. Receiver operating characteristic curves were constructed to compare the performances of PLT indices in predicting mortality, while the effect of DM on PLT indices was evaluated using regression analysis.
A total of 170 out of 345 patients (119 survivors, 51 non-survivors) met the study criteria. Patients with decrea AN, Prabhu VM. Platelet Indices as Predictive Markers of Prognosis in Critically Ill Patients A Prospective Study. Indian J Crit Care Med 2020;24(9)817-822.
Samuel D, Bhat AN, Prabhu VM. Platelet Indices as Predictive Markers of Prognosis in Critically Ill Patients A Prospective Study. Indian J Crit Care Med 2020;24(9)817-822.
Optimal personal protective equipment (PPE) preparedness is key to minimize healthcare workers (HCW) infection with COVID-19. This two-phase survey evaluated PPE preparedness (adherence to Ministry of Health India (MoH) PPE-recommendations; HCW-training; PPE-inventory; PPE-breach management) in Indian intensive care units (ICU).
The phase 1 survey was distributed electronically to intensivists from 481 Indian hospitals between March 25, 2020, and April 06, 2020, as part of a multinational survey. Phase 2 was repeated in 320 Indian hospitals between April 20, 2020, and April 30, 2020.
Response rate was 25% from 22 states. PPE practice varied between states and between private, government, and medical colleges. Between phase 1 and phase 2, all aspects of PPE training improved donning/doffing 43% vs 66%, respectively;
value <0.01); safe waste disposal practices (38% vs 52%;
value = 0.09); intubation training (18% vs 31%;
value = 0.05); and transport (18% vs 31%;
value = 0.05). Perception of , Kumar P, Ramanathan K, Rajamani A. State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic A Nationwide Survey. Indian J Crit Care Med 2020;24(9)809-816.
Haji JY, Subramaniam A, Kumar P, Ramanathan K, Rajamani A. State of Personal Protective Equipment Practice in Indian Intensive Care Units amidst COVID-19 Pandemic A Nationwide Survey. Indian J Crit Care Med 2020;24(9)809-816.
Transplantation of Human Organ Act was passed in India in 1994 to streamline organ donation and transplantation activities. It is time to retrospect ourselves and analyze the method to increase organ donation.
Retrospective observational analysis.
To evaluate the change in organ donation rate and reasons for changes in rates.
Brainstem dead declared patients whose family consented for organ donations in the last 23 years (1997-2019) at Ruby Hall Clinic, Pune, India.
Retrospectively demographic data of the brainstem dead declared donors, the primary diagnoses, comorbidities, and the complete data of their management till organ retrieval was assessed.
One hundred cases in the age group 15-75 years (mean 41.6 ± 15.3 years) of brainstem death consented for organ donation were retrospectively studied. The period was divided into two groups, group I and group II included study duration from 1997 to 2013 and from 2013 to 2019 respectively. During the entire period, though the major cause of donor death rgan donor, and better protocol-based management of the cadaver organ donor.
Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A,
. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital 23 Years of Experience. Indian J Crit Care Med 2020;24(9)804-808.
Zirpe KG, Suryawanshi P, Gurav S, Deshmukh A, Pote P, Tungenwar A, et al. Increase in Cadaver Organ Donation Rate at a Tertiary Care Hospital 23 Years of Experience. Indian J Crit Care Med 2020;24(9)804-808.
Medication error in developed countries is of primary concern when there is a question of adversity to a patient's health, but in developing countries like India, it is just a term and its significance is undervalued. The incidence of medication error is essential to estimate the proper medical care provided in the healthcare system.
The main objective of the study is to determine the incidences of medication error in critical care unit and to evaluate its risk outcomes.
This is a prospective observational study conducted over a period of 6 months in a critical care unit of a tertiary care hospital. Medication chart review method was opted for data collection. The medication errors were mainly classified as prescription, transcription, indenting, dispensing, and administration error. A total of 6,705 charts were reviewed. The NCCMERP risk index was used to evaluate the outcome of errors.
Of the total 6,705 charts, 410 medication errors were found, i.e., 6.11%. The most common error is transcription error that constitutes 44.
