Indian Journal of Critical Care Medicine

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2020 | November | Volume 24 | Issue S5

EDITORIAL

Dhruva Chaudhry, Pawan K Singh, Manjunath B Govindagoudar

COVID-19: Winter is COMING!

[Year:2020] [Month:November] [Volume:24] [Number:S5] [Pages:2] [Pages No:S223 - S224]

Keywords: COVID-19, Critically ill adults, Intensive care

PDF  |  DOI: 10.5005/jp-journals-10071-23642  |  Open Access | 

Abstract

Coronavirus disease-2019 (COVID-19) pandemic has battered the healthcare system of India recently. Though the mortality rate is low but the mortality itself is high. In this issue, dedicated to COVID-19, the authors have presented a concise and directed look at the pieces of evidence for COVID-19. Today, there is a plethora of information available on COVID-19 but the same does not translate into true knowledge. This issue serves as the one-point reference for pieces of evidence on various critical aspects of COVID-19. As winters are approaching and air pollution will again be bothering the healthcare system, these times are vital for preparing ourselves and resources for a long and exhaustive battle.

GUIDELINES

Dhruva Chaudhry, OC Abraham, Jose Chacko, Jigeeshu Divatia, Bharat Jagiasi, Arindam Kar, GC Khilnani, RK Mani, BK Rao, Pawan K Singh, Sanjeev Singh, Pavan Tiwary, Chand Wattal, Deepak Govil, Subhal Dixit

Critical Care for COVID-19 Affected Patients: Updated Position Statement of the Indian Society of Critical Care Medicine

[Year:2020] [Month:November] [Volume:24] [Number:S5] [Pages:6] [Pages No:S225 - S230]

Keywords: Convalescent plasma, COVID-19, SARS-CoV-2

PDF  |  DOI: 10.5005/jp-journals-10071-23621  |  Open Access | 

Abstract

The management of coronavirus disease-2019 (COVID-19) is witnessing a change as we learn more about the pathophysiology and the severity of the disease. Several randomized controlled trials (RCTs) and meta-analysis have been published over the last few months. Several interventions and therapies which showed promise in the initial days of the pandemic have subsequently failed to show benefit in well-designed trials. Understanding of the methods of oxygen delivery and ventilation have also evolved over the past few months. The Indian Society of Critical Care Medicine (ISCCM) has reviewed the evidence that has emerged since the publication of its position statement in May and has put together an addendum of updated evidence.

GUIDELINES

G Praveen Kumar, Deepak Govil, Subhal B Dixit, Dhruva Chaudhry, Kapil G Zirpe, Palepu BN Gopal, Arindam Kar

Reprint: Airway Management and Related Procedures in Critically Ill COVID-19 Patients: Position Statement of the Indian Society of Critical Care Medicine

[Year:2020] [Month:November] [Volume:24] [Number:S5] [Pages:13] [Pages No:S231 - S243]

Keywords: Intubation, Nebulization, Tracheostomy,Aerosol, Videolaryngoscopy, Airway, COVID-19, Droplets, Extubation

PDF  |  DOI: 10.5005/jp-journals-10071-23471  |  Open Access | 

Abstract

The coronavirus disease (COVID-19) pandemic has affected nearly all nations globally. The highly contagious nature of the disease puts the healthcare workers at high risk of acquiring infection, especially while handling airway and performing aerosol-generating procedures. The Indian Society of Critical Care Medicine, through this position paper, aims to provide guidance for safe airway management to all healthcare workers dealing with airway in COVID-19 patients.

GUIDELINES

Deven Juneja, Raymond D Savio, Shrikanth Srinivasan, Suresh Ramasubban, Pavan K Reddy, Manoj Singh, Palepu BN Gopal, Dhruva Chaudhry, Deepak Govil, Shubhal Dixit

Basic Critical Care for Management of COVID-19 Patients: Position Paper of Indian Society of Critical Care Medicine, Part-I

[Year:2020] [Month:November] [Volume:24] [Number:S5] [Pages:10] [Pages No:S244 - S253]

Keywords: Intensive care, SARS-CoV-2,Antivirals, Corticosteroids, COVID-19, Critical care

PDF  |  DOI: 10.5005/jp-journals-10071-23601  |  Open Access | 

Abstract

With more than 23 million infections and more than 814,000 deaths worldwide, the coronavirus disease-2019 (COVID-19) pandemic is still far from over. Several classes of drugs including antivirals, antiretrovirals, anti-inflammatory, immunomodulatory, and antibiotics have been tried with varying levels of success. Still, there is lack of any specific therapy to deal with this infection. Although less than 30% of these patients require intensive care unit admission, morbidity and mortality in this subgroup of patients remain high. Hence, it becomes imperative to have general principles to guide intensivists managing these patients. However, as the literature emerges, these recommendations may change and hence, frequent updates may be required.

GUIDELINES

Deven Juneja, Raymond D Savio, Shrikanth Srinivasan, Suresh Ramasubban, Pavan K Reddy, Manoj K Singh, Palepu BN Gopal, Dhruva Chaudhry, Deepak Govil, Subhal B Dixit

Basic Critical Care for Management of COVID-19 Patients: Position Paper of the Indian Society of Critical Care Medicine, Part II

[Year:2020] [Month:November] [Volume:24] [Number:S5] [Pages:9] [Pages No:S254 - S262]

Keywords: Thromboprophylaxis, Venous thromboembolic,Acute respiratory distress syndrome, Antibiotics, COVID-19, Critical care, SARS-CoV-2, Sepsis

PDF  |  DOI: 10.5005/jp-journals-10071-23593  |  Open Access | 

Abstract

In a resource-limited country like India, rationing of scarce critical care resources might be required to ensure appropriate delivery of care to the critically ill patients suffering from COVID-19 infection. Most of these patients require critical care support because of respiratory failure or presence of multiorgan dysfunction syndrome. As there is no pharmacological therapy available, respiratory support in the form of supplemental oxygen, noninvasive ventilation, and invasive mechanical ventilation remains mainstay of care in intensive care units. As there is still dearth of direct evidence, most of the data are extrapolated from the experience gained from the management of general critical care patients.

GUIDELINES

Rajesh K Pande, Ashish Bhalla, Sheila N Myatra, Lakshmi N Yaddanpuddi, Sachin Gupta, Tapas K Sahoo, Ravi Prakash, Tarun A Sahu, Akansha Jain, Palepu BN Gopal, Dhruva Chaudhry, Deepak Govil, Shubhal Dixit

Procedures in COVID-19 Patients: Part-I

[Year:2020] [Month:November] [Volume:24] [Number:S5] [Pages:9] [Pages No:S263 - S271]

Keywords: Emergency, Intubation endotracheal,Aerosols, Nebulizers, Airway, SARS-CoV-2, Bronchoscopy, Tracheostomy, Central venous catheter, COVID-19, Diagnostic procedure

PDF  |  DOI: 10.5005/jp-journals-10071-23597  |  Open Access | 

Abstract

The number of cases with novel coronavirus disease-2019 (COVID-19) infection is increasing every day in the world, and India contributes a substantial proportion of this burden. Critical care specialists have accepted the challenges associated with the COVID-19 pandemic and are frontline warriors in this war. They have worked hard in streamlining workflow isolation of positive patients, clinical management of critically ill patients, and infection prevention practices. With no end in sight for this pandemic, intensive care unit (ICU) practitioners, hospital administrators, and policy makers have to join hands to prepare for the surge in critical care bed capacity. In this position article, we offer several suggestions on important interventions to the ICU practitioners for better management of critically ill patients. This position article highlights key interventions for COVID-19 treatment and covers several important issues such as endotracheal intubation and tracheostomy (surgical vs PCT), nebulization, bronchoscopy, and invasive procedures such as central venous catheters, arterial lines, and HD catheters.

GUIDELINES

Rajesh K Pande, Ashish Bhalla, Sheila N Myatra, Lakshmi N Yaddanpuddi, Sachin Gupta, Tapas K Sahoo, Ravi Prakash, Tarun A Sahu, Akansha Jain, Palepu BN Gopal, Dhruva Chaudhry, Deepak Govil, Subhal Dixit

Procedures in COVID-19 Patients: Part-II

[Year:2020] [Month:November] [Volume:24] [Number:S5] [Pages:8] [Pages No:S272 - S279]

Keywords: Continuous renal replacement therapy, COVID-19, CT scan, Hemodialysis, SARS-CoV-2,Acute kidney injury, Ultrasonography interventional, Airway, Ambulance

PDF  |  DOI: 10.5005/jp-journals-10071-23604  |  Open Access | 

Abstract

Critical care in the era of novel coronavirus disease-2019 (COVID-19) infection has multiple challenges including management of the patient, underlying comorbidities, and the complications. With no end in sight to the pandemic, intensive care unit (ICU) practitioners and hospital administrators have to join hands to prepare for the long battle ahead. Critically ill COVID-19 patients need imaging or image-guided interventions in one form or the other including X-rays, ultrasonography (USG), echocardiography (ECHO), and CT scan. These patients often require renal replacement therapy (RRT) for either the preexisting chronic renal insufficiency or acutely developing kidney injury. Another important component of care is transfer of the patient to and fro from the ICU or to higher care centers. Most of the ICUs are equipped with modern facilities but with increasing number of patients a large number of makeshift arrangements are being made for managing these patients. This position paper outlines important tips to formulate protocols and procedures for critically ill patients, who are managed in the ICU.

GUIDELINES

Jeetendra Sharma, Prashant Nasa, Kesavarapu Subba Reddy, Swarna Deepak Kuragayala, Shikha Sahi, Palepu Gopal, Dhruva Chaudhary, Subhal B Dixit

Infection Prevention and Control for ICU during COVID-19 Pandemic: Position Paper of the Indian Society of Critical Care Medicine

[Year:2020] [Month:November] [Volume:24] [Number:S5] [Pages:10] [Pages No:S280 - S289]

Keywords: Decontamination, Disinfection, Healthcare workers, Infection control practices, Intensive-care, Quarantine,Aerosol, Specimen, COVID-19, Sterilization

PDF  |  DOI: 10.5005/jp-journals-10071-23607  |  Open Access | 

Abstract

Coronavirus disease-2019 (COVID-19) has very high rates of hospital-related transmission among healthcare workers (HCWs), mandating the need for careful intensive care unit (ICU) designing, optimization of staff resources, implementation of vigorous infection control practices, environmental disinfection, meticulous sample collection, and criteria for staff quarantine. Most of the ICUs are not designed to deal with airborne viral infections and require redesigning for the safety of HCWs and patients. Infection control practices related to the prevention of spread of COVD-19 are unique and are well described. The training of staff on infection control practices reduces the infection rate among HCWs significantly. Adequate staffing not only helps in infection control but also prevents burnout of the staff. In case of infection to HCW, the staff must be assessed systematically, and institute\'s infection control committee should guide for isolation period as well as return to work based upon standard recommendations. This article focuses on infection control and prevention measures required in ICU during the COVID-19 pandemic.

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