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Chawla G, Abrol N, Kakkar K. Personal Protective Equipment A Pandora's Box. Indian J Crit Care Med 2020;24(5)371-372.How to cite this article Murthy PR, Venkatesha Gupta KV, Ajith Kumar AK. Is Anxiety a Rising Concern during COVID-19 Pandemic among Healthcare Workers? Indian J Crit Care Med 2020;24(5)369-370.

Viral causes of acute respiratory distress syndrome (ARDS) are mostly limited to influenza A; however, adenovirus has been emerging as a cause of fulminant ARDS with a high mortality rate and no consensus on its management. Here we present a series of five patients with confirmed adenovirus infection treated for ARDS at our quaternary referral institution.

All patients were above 18 years old, had confirmed adenovirus infection, and were treated for acute hypoxic respiratory failure requiring mechanical ventilation in our medical intensive care unit (MICU). Demographic and clinical data were collected and analyzed.

Among these patients, the median age was 28 years, median BMI 28 kg/m

median sequential organ failure assessment (SOFA) score 9, and median acute physiology and chronic health evaluation (APACHE) III score 74. All patients received lung-protective mechanical ventilation with high positive end-expiratory pressure and low plateau pressures. Three patients developed severe ARDS, two received pnovirus-associated Acute Respiratory Distress Syndrome Need for a Protocol-based Approach. Indian J Crit Care Med 2020;24(5)367-368.

Vashisht R, Mirzai S, Koval C, Duggal A. Adenovirus-associated Acute Respiratory Distress Syndrome Need for a Protocol-based Approach. Indian J Crit Care Med 2020;24(5)367-368.Amlodipine is a widely prescribed drugs for the management of hypertension. Its toxicity is associated with severe myocardial depression and refractory hypotension. We present a case of a 28-year-old female known case of seizure disorder and depression who got admitted to our hospital with a history of consumption of 80 tablets of 5 mg amlodipine (total 400 mg). Patient presented to our hospital after 23 hours following consumption of the drug. Patient was managed in the intensive care unit (ICU) with mechanical ventilation support and intravenous infusion of noradrenalin, adrenalin, insulin-dextrose, and calcium gluconate. Due to refractory hypotension, venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated on the same day. Patient was successfully managed and discharged home on the 8th day. This report highlights a rare case of a massive amlodipine overdose (400 mg) and ECMO as a rescue therapy.

Sutar A, Venkategowda PM, Murthy A, Chikkaswamy SB. Severe Amlodipine Toxicity A Case Rescued with Extracorporeal Membrane Oxygenation. Indian J Crit Care Med 2020;24(5)365-366.

Sutar A, Venkategowda PM, Murthy A, Chikkaswamy SB. Severe Amlodipine Toxicity A Case Rescued with Extracorporeal Membrane Oxygenation. Tofacitinib in vitro Indian J Crit Care Med 2020;24(5)365-366.A 41-year-old lady who presented with sudden-onset severe headache diagnosed to have ruptured supraclinoid internal carotid artery (ICA) aneurysm. Her cardiac echocardiography showed features of Takotsubo cardiomyopathy. After stabilizing her cardiac condition, she underwent craniotomy and clipping of aneurysm. Both cardiac and neurological catastrophes were managed by the joint team with excellent outcome. This paper emphasizes the need for high-quality combined care.

Tripathy LN, Rana I, Saha A, Dixit R. Takotsubo Cardiomyopathy Secondary to Ruptured Supraclinoid Internal Carotid Artery Aneurysm. Indian J Crit Care Med 2020;24(5)363-364.

Tripathy LN, Rana I, Saha A, Dixit R. Takotsubo Cardiomyopathy Secondary to Ruptured Supraclinoid Internal Carotid Artery Aneurysm. Indian J Crit Care Med 2020;24(5)363-364.Parvovirus B19 has rarely been associated with acute liver failure (ALF), which has a high mortality. Plasma exchange that usually acts as a bridge to liver transplantation removes toxins, antibodies, cytokines, and can correct coagulopathy while maintaining a euvolemic state. Pediatric data regarding its use are scarce. We report a case of 16-year-old girl with acute liver failure in stage 4 encephalopathy with coagulopathy due to parvovirus B19 who was successfully managed with high-volume therapeutic plasma exchange (TPE). We tried to use it as a treatment modality due to nonavailability of in-hospital transplant facilities. Parvovirus B19 may be an underdiagnosed cause of acute viral hepatitis. Therapeutic plasma exchange can act as a bridge to liver transplant (LT) or bridge to recovery especially in self-limiting illnesses such as viral hepatitis.

Singh DP, Agarwal S, Singh R, Nandan D, Gupta A. Therapeutic Plasma Exchange in Parvovirus B19-induced Acute Hepatic Failure. Indian J Crit Care Med 2020;24(5)361-362.

Singh DP, Agarwal S, Singh R, Nandan D, Gupta A. Therapeutic Plasma Exchange in Parvovirus B19-induced Acute Hepatic Failure. Indian J Crit Care Med 2020;24(5)361-362.Every patient in neurocritical care evolves through two phases. Acute pathologies are addressed first. These include trauma, hemorrhagic or ischemic stroke, or neuroinfection. Soon after, the concentration shifts to identifying secondary pathologies like fever, seizures, and ischemia, which may exacerbate the brain injury. Frequent bedside examinations are not sufficient for timely detection and prevention of secondary brain injury (SBI) as per the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care. Multimodality monitoring (MMM) can help in tailoring treatment decisions to prevent such a brain injury. Multimodal neuromonitoring involves data-guided therapeutic interventions by employing various tools and data integration to understand brain physiology. Monitors provide real-time information on cerebral hemodynamics, oxygenation, metabolism, and electrophysiology. The monitors may be invasive/noninvasive and global/regional. We have reviewed such technologies in this write-up. Novel themes like bioinformatics, clinical research, and device development will also be discussed.

Ruhatiya RS, Adukia SA, Manjunath RB, Maheshwarappa HM. Current Status and Recommendations in Multimodal Neuromonitoring. Indian J Crit Care Med 2020;24(5)353-360.

Ruhatiya RS, Adukia SA, Manjunath RB, Maheshwarappa HM. Current Status and Recommendations in Multimodal Neuromonitoring. Indian J Crit Care Med 2020;24(5)353-360.