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Invitation for ISCCM Day Poster Competition

Dear ISCCM members,Greetings from ISCCM office.We have been celebrating ISCCM

Day every year with a theme. The theme of ISCCM Day for this year is "Patient Safety in the ICU"Poster display is a good method for making doctors and lay people aware of Patient safety in the ICU. Taking the opportunity of the ISCCM day celebration, we are announcing a Poster competition on "Patient Safety in the ICU"Top 2 posters will receive a citation from society and prize of Rs.10,000 and Rs.7,500 respectively.Instructions for submission of poster on

"Patient Safety in the ICU"1. Ensure that poster is catered to the Indian

Setup.2. It should be original and not copied from

somewhere else.3. Should be in poster format.4. Words allowed - up to 100 maximum.5. Should be in English.Last day for submission is 10th September 2016 and it should be emailed to Dr. Vijaya Patil, Secretary ISCCM and Chairman, ISCCM Day Committee, ISCCM at [email protected] welcome any other suggestion from our members.With warm regards,

Dr. Kapil ZirpePresident-Elect,

ISCCM

Dr. Vijaya PatilSecretary, ISCCM &

Chairman, ISCCM Day Committee

Dr. Pradip Kumar BhattacharyaGeneral Secretary,

ISCCM

Dr. Atul KulkarniPresident, ISCCM

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

TM

w w w . i s c c m . o r g

A B I - M O N T H LY N E W S L E T 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 A L C A R E M E D I C I N E

Editorial officE

dr. Kapil ZirpeDirector & HOD Neuro-Trauma Unit, Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India.Mobile : +91 9822844212 • 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]

We request our esteemed readers to send their valued feedback,

suggestions & views at [email protected]

Contents ISCCM News HeadlIneS1 ISCCM News Headlines

1 Invitation for ISCCM Day Poster

Competition

2 Editorial

2 Editorial Board 2016-2017

3 President's Desk

3 MAHACRITICON 2016 Nagpur

3 New Office Bearers of ISCCM

Branches

4 General Secretary's Desk

4 Quiz Third Edition

5 Organ Donation

5 Heart Transplant - The Final Frontier

6 Govt Draft Bill "Care of Terminally Ill

Patients" "Suggestions from ISCCM"

7 ELICIT Public Meeting on 12th July

"Perspectives on Death & Dying"

9 Critical Care Nursing : Empowering

Nurses - through Continuing Nursing

Education

9 Winners of Critiquiz 2016-2017 “Battle

of the Brains” - Episode 2

10-13 The 4th Annual “BEST OF BRUSSELS”

Symposium on Intensive care &

Emergency Medicine 2016

14 DCCS 2016

14 Gujarat Criticon 2016

14 2nd Mumbai Criticon 2016

14 2nd International Conference on

Imaging in Critical Care Medicine

15-16 CRITICARE 2017 Kochi

Best of Brussels 2016, Pune…..huge hit Brief Report : Annual Critical Care Congress at Kochi 2017. The Ministry of Health and Family Welfare has prepared a draft bill for care of terminally ill

patients Minutes of the public meeting held by the ELICIT task force to discuss perspectives on death

and dying ISCCM Day Poster Competition. Organ Donation Day on 13th August 2016

Volume 11.4JulY-AuGuST, 2016

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

Editorial Board 2016-2017

EDItor In ChIEfDr. Kapil Zirpe, Pune

[email protected]

EditorialDear Colleagues,

GREETINGS! It has been my great pleasure working with my team. Since I took over as the Editor-in-Chief in March 2016, we have

successfully made the smooth transition, thanks to everyone who have helped me during this process. This July, we had a wonderful Best of Brussels meeting. I wish to express sincere thanks as an organizing secretory, to all of you for attending "Best of Brussels" symposium at Pune, India.

The ELICIT Task Force was held at the town hall meeting in Delhi, on the 10th of July 2016, with participation from intensive care specialists, neurologists, palliative care specialists, lawyers , laypersons and many others. The meeting was held as a series of panel discussions. We must appreciate continuous efforts of ISCCM team involved in this task. Please find detail report on page….THIS YEAR,Elections for election of members to the Executive council for 2017-18 has been smooth affaire. Since last year, a few key changes have been made in the election process to facilitate ease of voting and to increase the member voter base. We as an Intensive Care Community in India have to realize our potential in contributing towards Brain Death Donors often called as 'Cadaveric Organ Donation Program'. There is huge MISMATCH in demand & availability of organs. Let everyone of us start taking a lead in organ donation process, identify patients and then successfully declare a patient brain death.

This year theme of ISCCM day is "Patients Safety in ICU ". I appeal everyone to celebrate our ISCCM day at their respective places with awareness programs. ISCCM is preparing slide kit & program material which will be distributed to your city branch office soon. Also request all of you to encourage your nursing staff as well juniors in participating in the Poster competition for ISCCM day.

Last but not least please share your valuable opinions or do send glimpses of your local activities to us.

Dr. Kapil ZirpeEditor in Chief,

the Critical Care CommunicationsPresident-Elect, [email protected]

www.isccm.org

DEPuty EDItorS

Dr. Rahul Pandit, MuMbai Dr. Subhal Dixit, PuNE

[email protected] [email protected]

EDItorS

Dr. Susruta Bandyopadhyay, KolKata Dr. Tushar Patel, ahMEdabad Dr. Yash Zaveri, NEw dElhi Dr. Srinivas Samavedam, hydErabad Dr. Sanjay Dhanuka, iNdorE

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

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

President's Desk

Dear ISCCM members

Greetings from Mumbai! Hope you are enjoying the vigorous

monsoon very much. As expected we had a wonderful Best of Brussels meeting. The workshops preceding the conference were of the highest quality which we have come to expect from the Pune branch. The Lavani (a Marathi dance style) program in the evening was very entertaining. During the conference we had a meeting with Dr Daniel De Backer and Dr Massimo Antonelli, current President and President Elect of the European Society of Intensive Care Medicine. We have come to an agreement on many points and I will be shortly signing the agreement of behalf of ISCCM with European Society of Intensive Care Medicine. We are hoping to start a fellowship program in European centers so that our members can go and do an observership there and if possible actually work in European ICUs.

I recently attended the second conference of Association of South Asian Region Critical Care societies in Colombo. We are in the process of finalizing the constitution of this

organization. The aim of the association is to exchange knowledge, carry out collaborative research across the countries in our region (since we have similar health problems across SAARC countries) and enthuse young minds to take up critical care and educate them as per the latest evidence in the field of critical care medicine. The

Dr. Atul P. KulkarniPresident, ISCCM

[email protected]

third conference of Association of South Asian Region Critical Care Societies will be held at Varanasi along with our National Conference of ISCCM. In Varanasi, Dr Kapil Zirpe who is will take over from me as ASARCCS president, currently he being the president elect.

Please tryout the ISCCM app, Download it from Google playstore and give us your feedback. Last but not the least, the preparation for Criticare 2017 is well underway. We expect to finalize the scientific program for Criticare 2017 by the end of this month.

By the time you get the newsletter the results for the members of the national executive committee elections will be decided. Unfortunately many members will have been prevented from voting because their electronic contact details (mobile nos. and e-mail addresses) were not updated. I once again urge the members to update these details by filling the update form available on the website. The festive season is coming up. I wish all of you a happy and prosperous year ahead. See you in Cochin!

TM

Conference on Critical Care Medicine& Pre-Conference Workshops

24th - 27th November 2016 • Hotel Centre Point, Nagpur

Organised by Society of Critical Care Medicine, Nagpur.MMC CREDIT POINTS APPLIED

FOR REGISTRATION PLEASE CONTACT

Dr. Nirmal JaiswalOrganising Chairman

Suretech Hospital & Research Centre, Nagpur13-A, Banerjee Marg, Dhantoli, Nagpur - 12 Maharashtra, INDIA

9890955055 • [email protected]

Dr. Rajan BarokarOrganising Secretary

4th ,5th & 6th Floor, Aditya Enclave, 20, Central Bazar Road,Opp. Somalwar High School, Ramdaspeth, Nagpur - 440 010.

9823083037 • [email protected]

[email protected]

For Online Registration visit our Website

www.isccmnagpur.com

Plenary sessions, Mahacriticon Orations, How do I do it ?

Thematic Sessions, Debates & Quiz Case base learning from the members

Infectious Diseases (CAI & HAI)

Obstetric Critical Care

Sepsis & Shock

Endocrine emergencies

Surgical Critical Care Poisoning Metabolic & Electrolyte

disorders in ICU ICU Development &

Ethics

Nutrition Neuro Critical Care Trauma Resuscitation

Hands on Wokshops useful for every IntensivistACLS Mechanical Ventilation BASIC Hemodynamic Monitoring Critical Care Nursing

Highlights of Conference

New Office Bearers of ISCCM Branches

Surat KolkataChaIrMan

Dr. Yogesh Desai

SECrEtary

Dr. Samir Gami

trEaSurEr

Dr. Ronak Nagoria

ExECutIvE CoMMIttEE MEMbErS

Dr. Rajesh PrajapatiDr. Suchay Parikh

Dr. Karsan NandaniyaDr. Hardik Patel

Dr. Alok ShahDr. Hardip Maniyar

ChaIrMan

Dr. Ajoy Sarkar

SECrEtary

Dr. Souren Panja

trEaSurEr

Dr. Rajarshi Roy

ExECutIvE CoMMIttEE MEMbErS

Dr. Bibhu Kalyani DasDr. Chandrasis Chakraborty

Dr. Mohit KharbandaDr. Amitabha Saha

Dr. Partha Sarathi GoswamiDr. Ahsan Ahmed


Dr. Pradip Kumar BhattacharyaGeneral Secretary, ISCCM

Dear Members

We are near midway of this term year. I always fear that time is moving very fast and too many things are to be

done. But rightly said by Earl Nightingale “Don't let the fear of the time it will take to accomplish something stand in the way of your doing it. The time will pass anyway; we might just as well put that passing time to the best possible use”. ISCCM is working very hard to improve in the field of academics, educations and research and some of the examples which happened recently are; We launched CCIDC Course with a huge success, we made a new guideline for conducting good workshops at National Level, We signed a successful MOU with ESICM to promote our educational and academic activities, We have contributed to a large extent in the India’s Draft Bill on Passive Euthanasia with “End Of Life

General Secretary's Desk

Car issues” and many others. ISCCM App has been launched with great success and it will solve many purposes of ISCCM in future. CHITRA Study is in full swing and more than 2000 patients have been enrolled by now. Many new hospitals have joined with our ISCCM Course, To promote the Nursing Course a revised registration charges has been implemented so that more nursing students can join and take the advantage of the course, Very soon new guidelines are also going to come up. Preparation for ISCCM day celebrations are in full swing, and I request students to prepare and send their posters at the earliest. Elections have started and I request all the members of ISCCM to contribute with their valuable votes so that a strong Central Body with good future commitments can be formed.

With All Good Wishes

Quiz Third Edition1. Spot on 6. A 20 year-old male arrives in the ED

90 minutes after being crushed by a truck. He has hypovolaemic shock and is coagulopathic, requiring 6,000 ml of crystalloid and 8U of RBCs for resuscitation. The coagulopathy in this patient is unlikely to be due to:

a. Acidosis

b. Dilution

c. Hypocalcaemia

d. Hypothermia

7. 50 y.o male, 60% TBSA burns of chest, arms and legs is admitted to the ED. Burns are circumferential and appear full-thickness. Fluid resuscitation is in progress, intubated and mechanically ventilated (minute ventilation of 16 L). Carboxyhemoglobin level is 15%. ABG: PaO2 140 mmHg, PaCO2 65 mmHg, pH 7.25, BD –8.

Appropriate immediate management at this time is to:

8. What is common to these drugs Trastuzumab, Doxorubicin,Paclitaxel & Cisplatin

9. Who Am I? – Identify the device

Answers to Second Episode1. Trypsinogen is proposed serum

biomarker for Acute Pancreatitis

2. DAMP expansion Danger associated molecular pattern

3. DBO( Diazobicyclooctanone)

Non beta lactum based beta lactamase inhibitor

FDA approved: AVIBACTUM

FDA approved indications: cUTI & cIAI

(complicated urinary tract infection and vomplicated intra abdominal infection)

4. Term used in aviation industry to replete oxygen reserves by jumping from seat to seat. Oxygen from mask is deeply inhaled.

5. 1 gram / kg

6. 2011

7. Customized, Health in Intensive care, Trainable Research & Analysis Tool (CHITRA)

8. Swan Ganz9. No cover piece placed over floor

cleaner.10. Frictional NJ tube Features innovative flaps or barbs

which allow peristalsis to gently drag the catheter into the jejunum

Dr. yash Zaverinew [email protected]

2. Expansion of DEBONEL

3. 32 year old female is admitted to ICU after cardio-pulmonary collapse secondary to Hanta Virus infection. What is the treatment of Hanta Virus Cardio-Pulmonary syndrome (HCPS)?

4. This year in history When was Penicillin invented?

5. In trauma care the acronym MIST stands for:

10.


Organ Donation

Writing on the eve of the World Organ Donation Day on 13th August 2016, I often wonder if we as an Intensive

Care Community in India have realized our potential in contributing towards Brain Death Donors Often called as (Cadaveric Organ Donation Program).India is ranked approximately 40th in terms of organ donation rates in the world. With Spain leading the world at around 34 Brain Death Donors to a million populations, we in India are at 0.05 Donors per million populations. This is despite having out Transplant of Human Organ ACT – TOHA in place since 1994 and having had some amendments in 2008 and 2011 respectively, with some new rules introduced in 2014. Few states like Tamil Nadu have adopted the amendments and are leading the path in the country with approximately 1.9 Donors per million Populations. Though not reflective on waiting list, it is widely believed that there is a need for approximately 150,000 Kidneys, 50,000 Livers and perhaps similar number of Hearts in India. In compared to above, brain death donors per year are minuscule and unless the numbers increase the gap between need and availability of Organs will keep on increasing.The only place where brain death donors are likely to be identified and declared brain stem death is Intensive Care Unit. The TOHA act 1994 and its amendments clearly mention that an Intensivist/Neurologist/Neurosurgeon are the 3 main clinicians, registered hospital

Dr. rahul PanditSenior Consultantfortis hospital, MulundMumbai

Heart Transplant- The Final Frontier Dr. rahul Pandit

Senior Consultantfortis hospital, MulundMumbai

and appropriate authorities will permit to declare brain death. Along with 2 separate set of test done 6 hours apart by one of the above 3 clinicians, head of hospital administration and the primary consultant under who patient is admitted are also a part of the brain death declaring team.This clearly reflects the responsibility we as Intensivist carry on our shoulders in this process of Brain Death Donations. The ground reality is that we are way behind in identifying this as a priority in our day-to-day clinical practice. There are obviously several reasons for this, shortage of trained Intensivist across the country, ever growing patients and their complex management needs and increasingly difficult life an intensivist lives trying to balance between patients, hospital, family and continued professional development. All this has left organ donation to be one of the many jobs an Intensivist is supposed to do. Quite obviously with the process been time consuming, requiring complex communication skills and often dealing with variably emotionally labile families, it does take a toll on the person involved in the process.Having said that we as the Torch Bearers of Intensive Care Units have a responsibility just similar to what we perceive to be for example ventilating a patient. Every Intensivist should take a lead in organ donation process, identify patients and then successfully declare a patient brain dead. This will comply with the government initiative of declaring patient

brain death and reporting the deaths. The next question comes of obtaining the consent. It is very well identified that the consent improves when there is a dedicated organ donor coordinator involved in the process. All hospitals registered to be Retrieval and Transplant centers are mandated to have organ donor transplant coordinators. This has definitely improved the consent rates and helped in more organs been available for transplantation.Few of us may have a potential situation where there may be a perceived conflict of interest. This is seen in large transplant centres where the donor and recipient may be in the same ICU. Fortunately in these big units there is often a second intensivist who could help in manage either the donor or recipient and thus avoid conflict of interest. The second question asked is what if family refuses consent. In such an scenario if the patient has been declared dead then, withdrawal or ventilator or Inotropes will not amount to any violation of our law as the patient is legally dead and there is no legal obligation to continue treatment. However individual hospitals need to develop local policies, which will support the doctors in an eventuality of any litigation.I wish to sign off by requesting all my colleagues to consider organ donation on same pedestal as we consider other ICU priorities to be.

The heart transplant program for a hospital is the epitome of demonstration of quality care been delivered to patients.

Though it is a program, which involves several disciplines – Cardiac surgery, Cardiology, Intensive Care, Anesthesiology, Infectious Diseases, Psychiatry, Blood Bank, Laboratory, Social workers, Nursing, Physiotherapy etc. It is the Intensive Care where the action takes place the most, after operating room and also longest as it continues for few days.The stakes are high as there is a life at stake and unlike other organ transplants; Orthotopic heart transplant (removing recipients own heart and replacing with donors) is the norm as opposed to a very rare Heterotopic (where both hearts are connected to effectively form a double heart). Hence the desire to succeed is very high as we have removed the recipient’s own heart and any small error can lead to disastrous complications including death.The preparedness of any heart transplant intensive care unit is time consuming and a laborious process. Though it may be possible to overnight prepare the ICU for a one off heart transplant, to make the program sustainable and successful there are robust processes

and competent trained man power which are needed. It would be righteous to say that it is often driven by passion of few key players and the rest of them help and play along with them.For a hospital and their ICU to think of starting a Heart Transplant program there are certain pre requisites, which they need to full fill, though no rule book says so it is only fair to assume that without these pre requisites the program would not succeed.The first and foremost is to have a fully equipped tertiary care Intensive Care Unit managed by full time Intensivist. The ICU should be managing complex cases both medical and surgical. The complexities of cases should be such that protocols are in place and implemented to manage diverse cases, emergencies and ICU procedures not only by the consultant Intensivist but also by the junior doctors of ICU. Complete physiological monitoring of heart, including invasive monitoring, advance mode of ventilation should be effectively in use by the ICU doctors ,The modern life sustaining procedures like Intra Aortic Balloon Pump, ECMO, CRRT should be preformed as a matter of routine

before venturing for heart transplant. The nurses when managing such complex patients are automatically trained to achieve excellence because without them success is not possible. Once the ICU has reached that level where all the equipment and manpower is geared to manage various aspects of Intensive Care then the next leap is considered.Without demonstrating willingness in process of Organ Donation, no ICU can achieve any success in a Transplant medicine. The Organ Donation program is the one, which need to be developed within the hospital. This is not necessarily to procure organs for our own patients, but to understand the complexities of Brain Death, diagnosis, declaration and donor maintenance. Seldom you would have a heart been allocated by the government agency like (ZTCC) to your own hospital, but in this case of rarity it is ethically important to have two (2) separate teams in place one each for donor and recipient, so that conflict of interest does not arise.The next crucial step is to identify the correct recipient. This is usually a multi disciplinary task with the Cardiac Surgeon, Cardiologist and Intensivist playing an important role in


investigating the recipient and only listing those patients who need a transplant and are likely to benefit from the surgery. The patients who may be refused are who still have a reasonable native heart function to give them a reasonable quality of life, patients who have multi organ failure and people who may need a heart lung transplant (which is usually the next step). The potential recipients are investigated, including panel reactive antibody to identify the one with high risk of rejection. A cardiac Catheterization to understand all the pressures, including the most important pulmonary pressures is undertaken. The next phase is of optimization of patient until he receives a new heart. This process is often heart and importantly variable for each patient as the availability of donor could be of different blood groups and varying weight and body structure which may not be suitable to the next in waiting recipient. Some recipients may be in hospital on Vasopressors or Inotropes, some have to be supported with ECMO of Left Ventricular Assist Device just to bridge them for transplant. Ambulatory milrinone therapy has been successfully used in a large group of patients who stay at home or do some work with an ongoing milrinone infusion. Having

endeavored such diverse problems when a recipient is informed of a likely transplant it is like imagining a re birth for him or her.The actual day of transplant is like an adventure and a story in itself; each so different from other that it is difficult to write a uniform process. What does remain unchanged is the Operation and Postoperative care in ICU. The first few hours are race against time. If the initial part is to for the donor hospital/ICU to maintain donor to the best of physiology, the recipient team; once the heart is allocated is working towards planning the transplant, need for periprocedure supports, like nitric oxide etc for the recipient. The coordinated effort of retrieving the organs and then racing to the recipient, more so if it’s a inter city/state transport requires a lot of support, coordination and a ton of permissions from government authorities, forming green corridor, police, hospital coordination etc. With all this organized chaos the doctors strive hard to complete the transplant within 4 hours of donation and the patient is ultimately shifted to ICU.In intensive care along with the marvel of changing physiology on the monitor,

managing the nitric oxide and vaso active drugs the intensivist is busy in keeping the Right Ventricle happy. It is the right heart, which is most vulnerable to the pressures in recipient’s pulmonary vasculature. The right heart failure is one of common cause of transplants not doing well and hence the entire effort is centered on making the heart reservoir work well. The other daunting challenge is of managing the Immunosupression. Thankfully the wheel does not need to be invented there as there is good evidence towards Immunosupression management. Even in our Indian population with increasing experience across the country, we have a good precedence of how to manage Immunosupression. Over next few days the patient is weaned off mechanical supports and then shifted out of intensive care unit.Needless to say the entire process tests every aspect of ICU care and it is only fair to call it as the final frontier. With just over 3500 transplants done across the world and majority of them happening in USA, India is doing close to 100 per year and that’s a commendable achievement. In coming years more and more hospitals will take this challenge and complete a successful journey.

Govt Draft Bill "Care of Terminally Ill Patients""Suggestions from ISCCm"

The Ministry of Health and Family Welfare has prepared a draft bill for care of terminally ill patients - http://www.

mohfw.nic.in/showfile.php?lid=3863 and invited comments from all interested parties. ISCCM wrote the following response to the MOHFW and is in the process of preparing an alternate draft bill through ELICIT to be submitted to the MOHFW.Letter submitted by ISCCM to MOHFWThe draft bill is a laudable initiative by the MoHFW touching upon an issue that has far reaching consequences to the individual and the society. However, it has serious shortcomings that , if not addressed fully would pose impediments to the care of the terminally ill.Doctors are important stakeholders in the issue of terminal care, because in modern times it is primarily their lot to care for the dying. While traditionally physicians are trained to save lives, the role has expanded to deliver compassionate care for those who are beyond the ambit of curable conditions and are facing the end of their lives. The professional standards of caring for the terminally ill have evolved greatly in the world in the last 3 decades and together with it, the ethical and legal framework. In our country, too, there needs to be in place such guidelines. Without it we as individuals are at risk to suffer greatly through avoidable physical and financial burdens and collectively through wastage of resources. As medical professionals we are unable to deliver care according to the highest prevailing standards in the world. This has resulted in loss of self esteem and increased vulnerability to misunderstandings and litigation. The following are our reservations and misgivings about the draft bill on “Medical Treatment of Terminally ill (for the protection of Medical Practitioners” in its present form:1. The context of the Bill on terminal illness

should be the problems unique to the dying and their solutions rather than issues around euthanasia. So emphasis

on various forms of euthanasia should be discarded. The world has moved away from the expression “ passive euthanasia” as its connotation is mercy killing. There is no killing in care giving as we understand in the medical profession, only ensuring humane care. The expression in modern medical world is “ end of life care”. The emphasis is on caring and avoidance of needless burdens of futile medical interventions and the enormous financial burdens that come with it.

2. It is all about the fundamental rights of a patient’s as a citizen. The imperative of consent before any medical intervention implicitly allows for refusal. Therefore all life saving interventions in principle can be refused/ declined by the patient. So withdrawal and withholding of life supporting interventions can be refused if unwanted. If the context is terminal illness then the doctor can medically agree with such decisions. This can scarcely be confused with euthanasia or its variants as the agency causing the patient’s death is the terminal illness not the decision to withdraw or withhold. It is a decision not to struggle or not to prolong a process already started. Hence there is no confusion with suicide and its abetment.

3. Since the right to refuse or accept treatment is universal irrespective of the competency of the patient, this right is sustained into the phase when the patient loses competency. This cannot be relinquished but is to be represented by his/ her family. The physician safeguards this patient’s right through the principle of “ best interest”. The physician is duty bound by current bioethical principles to respect patient Autonomy, act with beneficence and non malfeasance and in keeping with social justice. So a Bill that does not recognize Advance Will as an instrument of patient’s autonomy to be expressed when he becomes incompetent will seriously impede our ability to deliver care according

to the highest professional standards. The draft bill dismisses the validity of Advance Will for reason of misuse. This ruling would, in effect deny a basic right for the incompetent patient and doctors a reliable way to assess his/her wishes. The benefits have been ignored without weighing the benefits and exploring safeguards.

4. Critical care units are the likely places where the urban citizen would usually die. Usually in the last days he/she is subjected to highly technological and expensive medical interventions even if futile. In the present day world, withdrawal and withholding decisions are made in critical illness are the norm in 70-90% of ICU deaths as clinical judgment is exercised to make interventional decisions judiciously. The call in critical care today is humane care when the end is inevitable, saving the patient unbearable burdens and the family enormous emotional stress and financial burdens. An appropriate legal framework would, therefore improve the quality of care of the dying and reduce the cost of critical care.

5. The Bill stipulates court validation of end of life decisions for incompetent patients. This is unworkable in practice as most decisions in critical care units have to be made within hours or days. The already burdened family can scarcely go through a lengthy court procedure. With already enormous pendency in courts, expeditious processes can hardly be expected. Nor does such ruling have precedence anywhere else in the world- such provisions only being present for dispute resolution in the form of Court declarations.

6. End of life decisions are essentially medical decisions. In the Aruna Shanbaug case the Amicus Curiae termed appropriate withholding and withdrawal decisions as “ ordinary medical decisions, not judicial decisions that can be taken even without legislation”. These observations should be integrated into this Bill.


7. All medical decisions are to be according to standards set by professional bodies. The Indian Society of Critical Care Medicine (ISCCM) has framed ethical position statements regarding treatment withdrawal and withholding in terminal illness. They are constructed through consensus and in keeping with practices round the world. Legal framework should enable best medical practices providing protection to doctors and patients through pragmatic safeguards.

The Bill must take into consideration the guidelines framed by the ISCCM (latest version in 2012) and jointly with Indian Association of Palliative Care (IAPC) (in 2014). These are carefully researched documents based on worldwide consensus of the best standards of the care of the dying. As the foremost stakeholders Medical opinion is to be integral to the development of a Bill for our Nation.ELICIT task force meeting for draft billEnd of Life Care in India Task Force (ELICIT), a joint initiative of the ISCCM, the IAPC and

the IAN engaged the services of a legal firm DSK legal to prepare an alternate draft bill on Care of the Terminally ill patients. After multiple alterations on email the final draft was discussed at an ELICIT meeting in New Delhi on 11th July. DSK legal is now giving final touches to this draft bill, which will then be submitted, to MOHFW. The meeting was attended by Dr. Mani, Dr. Divatia, Dr. Iyer on behalf of ISCCM. Dr. Atul Kulkarni, Dr. Pradip Bhattacharya could unfortunately not attend this meeting.

ELICIT Public Meeting on 12th July"Perspectives on Death & Dying"

The Elicit Task force consists of (alphabetical order) Dr Jigi Divatia, Dr Vinay Goyal, Ms Harmala Gupta,

Dr Roop Gursahani, Dr Shivakumar Iyer, Dr Stanley Macaden, Dr Raj K Mani, Dr U Meenakshisundaram, Dr MM Mehndiratta, Dr Mary Ann Muckaden, Dr Apoorva Pauranik, Dr Naveen Salins, Dr Nagesh Simha, Dr Gagandeep Singh and Dr Nirmal Surya.The ELICIT Task Force held the town hall meeting in Delhi, on the 10th of July 2016, with participation from intensive care specialists, neurologists, palliative care specialists, lawyers and laypersons including volunteers from cancer support groups, relatives of patients who had passed away, members of the press and many others.Patient and Care-Giver's Perspective as TitleThe meeting was held as a series of panel discussions. Several open ended questions were asked to members of the panels and a lively interaction with the audience followed. Dr.Roop Gursahani, one of the members of the executive committee of ELICIT expertly conducted the meeting.The first panel examined questions related to the patient’s and the care-giver’s perspective. The panelists were Harmala Gupta from “CanSupport”, Priya Jain, Dr. Nagesh Simha, a palliative care specialist and an executive committee member of ELICIT and Dr. Ajit Mansingh an ENT surgeon.Dr. Roop started the ball rolling by asking Dr. Mansingh to narrate his experience of having someone close pass away. Dr. Mansingh explained to the audience his experience of caring for his mother who had advanced Parkinson’s disease and later his father who had a disseminated cancer. He explicitly stated that having a method to record the wishes of his parents would have helped him in the difficult decision making especially regarding “do not resuscitate” and “withholding withdrawing” therapy. Amazingly though Dr. Mansingh and his father had not had a detailed discussion about his prognosis, his father however being a medical person knew his diagnosis and probably knew the prognosis. He recalled

the final chance conversation that they had towards the end, that he cherishes in his heart todate.Dr. Simha then narrated his personal experience of being in an ICU when he underwent renal transplantation and related the stages a patient goes through while dealing with the disclosure of a life threatening diagnosis.A lady from the audience narrated her experience of looking after her terminally ill mother after she was discharged from Tata Hospital. Palliative Care team from CanSupport whom she approached, gave proactive advice and support to the family, preparing their minds and their home to care and look after her mother at home without distress. Their continued engagement allowed conversations within the home about her mother’s terminal condition which helped her mother open out to her children and her husband and express her wishes and achieve closure for many unfinished issues .Dr. Simha then explained to the audience about an evidence based approach for breaking bad news to patients and their families. He explained how a semi structured conversational approach (SPIKES) consisting of Setting up an interview, Assessment of patient perspectives, ensuring Invitation for information sharing from the patient, transfer of the information, i.e. Knowledge in an Empathetic manner and Summarising and Strategising for immediate futureDr. Purnima Karandikar narrated her experience with her grandfather, an articulate, independent and a very wise soul. When he was asked about whether he wanted to know his diagnosis, when he developed health issues, he opted not to know and simply said he want to be pain free and did not want to suffer a prolonged ill ness. Another interesting anecdote she revealed was an elderly freedom fighter friend who expressed his wishes when on ventilator for a terminal illness by scribbling down “ Ramayana khatm ho gaya, ab…Ram ko jaane do”Dr. Nandini Vallath (from the audience) said that, it is important for medical professionals

to find out the reasons why the family does not want disclosure to the patients about terminal illness. Once we acknowledge and appreciate the family’s affection for the patient, empathise with their concerns, they feel empowered to understand the advantages of sharing the information with the patient. Most of them understand and support graded disclosure of diagnosis/prognosis to the patient.Dr. Apurva Puranik (from the audience) narrated his personal experience of patients with Creutzfeld Jakob disease with dementia from a single family. The younger family members who were not yet affected, expressed their wish not to know their diagnosis while they were well.Harmala Gupta (CanSupport) then explained the Five Wishes form of the Aging with dignity foundation from US and how we need to translate and adapt it for the Indian Context. It is an advance directive document that is well structured and simple to understand. She emphasized the importance of facilitating the opportunity for the patients to say – I love you, I am sorry, I forgive you and goodbye to the loved ones in their lives, before they make their final exit.The Doctor's PerspectiveThe second panel looked at questions related to the doctor’s perspective. The panelists were Raj Mani (intensive care specialist), Shivakumar Iyer (anaesthesiologist, intensivist) Sushma Bhatnagar (Palliative Care Physician) and Sanjay Nagral (gastroenterology surgeon and ethicist)Roop began by asking Dr. Mani to comment on the process of dying and the common trajectories of dying in terminally ill patients. Dr. Mani described four common scenarios; i) patients with terminal cancer who gradually go downhill, ii) patients with organ system failure like congestive heart failure, liver failure, COPD who go downhill punctuated with episodes of acute worsening, each episode worsening the baseline status, iii) patients with dementia, other neurological disorders who function at a low baseline for a prolonged period and progressively decline or may develop

Dr. Roop Gursahani and the members of first panel

Members of the ELICIT Task Force Members of the second panel including Dr. Iyer and Dr. Mani


acute complication; or iv) patients who were otherwise in good health, who develop multi-organ failure due to devastating conditions such as trauma or septic shock or other acute critical illnesses that deteriorate despite full treatment, and reach a point of no return. Dr. Roop added that there are also patients who die suddenly. Roop then asked if it is possible to identify the trajectory individual patients might take and whether it would be possible to predict this. Dr. Mani replied that it is increasingly becoming possible to anticipate a poor prognosis in such conditions and change goals of care accordingly, although not with accuracy in terms of time.. Dr. Iyer responded by saying that it was easier to predict probabilities using the self-administered “surprise question” i.e. ‘would I be surprised, if this patient were die in the next few weeks or months’ as recommended by the Gold standard Framework, UK.Roop then asked Dr. Sushma Bhatnagar to describe what she would consider a good death. Dr. Sushma stated that a death in which suffering is minimized by good symptom control, where unnecessary interventions are avoided and the patient is informed as per his choice and is able to achieve closeness and care in the company of her/his near and dear ones may be described as a good death.Dr. Iyer when asked about different approaches to decision making that patients choose, at the End-of-life, quoted results of a study that examined decision making styles of patients with terminal illness. It showed that patients may be divided into those who like to decide for themselves and those who like others to decide for them. Those who like to decide for themselves are described as autonomists when they are people who like to retain control for their life as long as possible and as altruists when they like to decide for themselves because they wouldn’t like to burden others with their decision-making. Those who don’t like to decide for themselves can further be characterized as authorizers who would like to specify whom they want to decide for them, or as absolute trusters when they are generally trusting and wouldn’t mind if anybody in their family or their doctor decide for them. Avoiders are those who feel powerless and therefore avoid decision-making till the very end and allow decision making happen by default (or by God) as they feel completely helpless. Each of these decision making styles could be benefited by an individualized approach to end-of-life decision-making.Sanjay Nagral explained about brain death in response to a question by Roop. He explained how in India, a utilitarian perspective of harvesting organs has led to ironic situation, where the doctor can declare brain death as death if organ harvesting was being considered but not otherwise. Dr. Mani then said that we should have the unified concept of death including circulatory and brain death, as is the case in the developed world. In fact the “Transplantation of Human Organs Act” has clearly defined the deceased person as one who has had either circulatory or brain death. Despite this there is a perceived dichotomy arising from the wordings of the Act with regard to brain death, that should be corrected and we should be able to declare death as brain death irrespective of organ donation.The next question Roop posed was to Dr. Sushma regarding the simple things that can be done at home for terminally ill patients. Dr. Sushma explained about caring for terminally ill patients at home and how in their unit they train patient’s families to provide care at home after the discharge.

Dr. Nandini then added that the ethical aspects of CPR, especially ‘when to reconsider starting a CPR’, should be part of the training in all Basic and advanced life support courses. It was generally agreed that, clash of best interests as perceived by the doctor who may focus on beneficence of a particular organ function, versus that perceived by the patient/family who wants to see the benefit reflected on general wellbeing, along with questions on patient autonomy are the usual sources of conflict in End Of Life Decision making.In response to a question regarding ‘euthanasia’ Dr. Mani then explained how the term euthanasia is no longer used in current medical practice or is used only to signify “active shortening of the dying process on the explicit request of the patient/ surrogate(s)” He further stated that withholding or withdrawing therapy in the clinical context of terminally ill patients has nothing to do with euthanasia, but only with respect to futile interventions towards the end of life. Dr. Roop then concluded the session by saying that one euthanizes animals in the appropriate context and not sentient human beings who can decide for themselves.EOLC as a Public CampaignThe third panel discussed End of life Care as a Public Campaign. The panelists included Nandini Vallath (Trivendrum Institute of Palliative Sciences), Anita Anand (ComFirst India Pvt Ltd), Apoorva Pauranik (neurologist), and Vinita Singh (Independent Consultant, Ethical Trade; Trustee, WeThePeople).Dr. Roop began this panel discussion by asking Dr. Nandini Vallath about how Kerala became a shining spot in the otherwise dismal rating that India received in the Quality of End of Life Care survey of the “Economic Intelligence Unit”.Dr. Nandini explained how concerned deliberations amongst three friends, Dr Rajagopal, Dr Suresh Kumar and Mr Ashok in a pain clinic in Calicut medical College in the late 1980s, went on to development of Pain and Palliative Care Society, which provided palliative care services and training, and later extended their work to the community with the help of satisfied family carers, volunteers and with sustained media support (Malayalam Manorama), television. The committed movement within community garnered government support and finally facilitated the State Palliative Care policy for Kerala after two decades of work. Through his policy, the government of Kerala commits to access and availability of palliative care to its citizens through its network of healthcare services. She went on to say that although palliative care was well established in the community, there are significant gaps in care especially for non-cancer patients, acute illnesses and for patients in multi-specialty hospital settings. She narrated an anecdote of a patient in Kerala with COPD, who wished that he had cancer rather than COPD so that he could receive some palliative care. She emphasized through two patient scenarios, how ongoing conversations between the patient/family empowered with clarity no what is going on, and the doctor, enables honest communications and clarity on what an intervention can and cannot do. She pronounced this to be ‘the cru to appropriate care planning, and for dignified end of life care.Vinita Singh narrated her experience in taking the Constitution to the people and said that it was important to appreciate the directive principles enshrined in our constitution and how they can become a starting point for our dialogue with people regarding end of life care. The constitution provides for the unity in

diversity in our country. She was full of praise for the Indian constitution as an extraordinary document that acknowledges the vastness and diversity of this ancient country, and yet has retained it’s soul, the oneness that ties us all together, at it’s very core. It’s structure and contents have strengthened our ethical and legal framework. Anita Anand was asked by Roop “How can we get a media and communication strategy for this issue?” Anita answered by saying it is not just about living wills but also about the individual’s perspective regarding life and death. All of us are going to die, acceptance is the key, of death as a part of the life cycle. She added that the Hindu view about rebirth and reincarnation helped in the campaign for abortion as a strategy. The fear of death, of suffering, of ending is an emotional issue and getting the media to buy in is always a challenge. She further emphasized the significance of thoughtful planning and strategizing a campaign for awareness on the ‘living will’, that is sensitive to literacy and the cultural diversity of the land.Dr. Apoorva Puranik answered in response to question by Roop that the core messages of the campaign would be Living wills, disproportionate treatment, brain death and it’s connotations in the language of the common man. He touched briefly upon methods for the same : print and digital, the need for contents to be broad, varied and need-based, wide range and the need for methods to reach ‘ saturation level’, like smorgasbord or cafeteria approach. Essays on the topic and narratives by patients and relatives through mass media could be considered for campaign. Dr. Apoorva furher mentioned the work of Muskaan, a NGO in Indore that has done excellent work on creating awareness on what actually brain death means and the opportunity for organ donation.Chaarvi Murari, a youngster from the audience spoke of the importance of reaching out to the youth through the right media, e.g. facebook.Dr. Iyer added that workshops for both care-givers and professional care providers are very important. ISCCM/IAPC already have designed structured workshops for care providers, and a suitable workshop can be prepared for care-givers.Anita said that it is important to understand the psyche of the people we are addressing, when planning strategies. Dr. Nandini related from her experience with dying patients, that people more often harbour fears of the process leading to death of “how I will die, will I suffer” etc. rather than the fear of death itself. For doctors it was more often fears of litigation that prevent them from reaching appropriate EOLC decisions for critically ill patients. Dr Mani added that religion or cultural diversity has not been a factor in his decision making in EOLC, because the underlying common experience is that of suffering during the dying process.Vinita Singh underscored the importance of public awareness about the issue and the possibility of enabling this through Citizen cafes and discussions on EOLC issues in a matter of fact manner. Dr. Nandini described the unanticipated massive response from the public and success of a program that their NGO, Pallium India, held in Kerala in 2013, called “Let’s talk about death over a Tea”. She also mentioned the importance of having a good number of non-doctors in the panel in such meetings so that the audience relate to the speaker’sperspectives better. Dr. Poornima Karandikar suggested “Mrityunjaya” as a possible catchy title for such programs. Dr Sushma Bhatnagar lauded the innate intelligence of an average Indian,


and emphasized that we have to know how to communicate with our patients in these issues and literacy is not an issue. Deepa George from the audience added that if we can understand death, then we would have understood life.Dr. Apoorva Pouranik talked about the importance of addressing and allaying misconceptions among laypersons and legal fraternity that such laws may become a Licence to kill. Swagata Banik a public health care professional related from his US based experience that EOL Care should be seen more as a public health issue. He offered his help for doing collaborative research for bringing out the vast empirical data in EOLC from India. He also made the observation that nursing and faith leaders are missing in our dialogue regarding EOLC. Dr. Roop concluded the panel discussion by stating statistics of the growing single person households, which is currently at 5% in India, 15% in China and 25% in South Korea. This is going to pose significant challenges to the future for care planning especially at the terminal stages.EOLC and the LawThe fourth panel discussed End of life care and the law. The panelists were all lawyers of repute-Girish Gokhale, Vivek Diwan and Nausher Kohli Roop initiated this panel by asking Mr. Girish Gokhale what exactly are laws and lawyers for?Girish wisely defined Law as “codified common sense” and said that regulations were needed for good governance, and are meant to further the rights and stress duties to the citizens. He stated that the EOLC Act would become the law to support the right of the patient to regulate her/his treatment. He examined the gaps in the judgement on the Aruna Shanbagh case that has created a sad confusing situation. The

current draft bill on EOLC of the government is self-contradictory as it is based on both the law commission reports and the judgement in Aruna Shanbagh case. In one place it states the relevance of advance directives, and in another place it declares them void. Dr. Mani commented that there is a lot of confusion about the term euthanasia in the draft bill and this term can not be used at all in the context of withholding / withdrawing artificial life support interventions, as the person is dying due to the underlying dysfunction of vital organs and not because of withdrawal of the distressful artificial intervention.Vivek Diwan was asked about constitutional protection and the rights of patients with regard to end of life care and he replied saying that the constitution is an aspirational document and the fundamental rights have in many ways guided important laws protecting citizen liberty. He stated that the right to life is the right to live with dignity, until the point of death. There is no separate right to autonomy but the right to give consent or refuse it may imply this right to autonomy. To this Dr. Mani remarked that the Preamble to the Constitution of India assures “Liberty, Equality and Fraternity”. Autonomy is implicit in the Right to Liberty.Dr. Roop then asked Nausher about how the ELICIT draft bill was prepared? Nausher then described in detail the preparation of the draft bill by DSK legal team, by studying the prevalent laws of scores of countries and in consultation with Dr. Mani, Dr. Roop and Dr. Simha. This draft was then circulated among the ELICIT members on email and after multiple iterations a final draft was collated and circulated by Dr. Naveen Salins. This reviewed draft was discussed in detail,

in a meeting on 9th July and the final draft bill is now with the legal team, getting ready for submission to the federal government.In the open question answer session that followed, Vinita Singh stressed on separate strategies that focused on creating awareness in the community, the legal fraternity and doctors.Dr. Roop then posed a question about Sallekhana, Santhara and other methods of voluntary choices of death in the Indian tradition, by giving up eating and drinking to allow death to occur gradually. Mr. Prassananshu, a lawyer in Delhi from the Indian law school then elaborated about Sallekhana, santhara, Samadhi, iccha mrityu in the Indian tradition. He explained how respect for autonomy is emphasized in these traditions. Santhara is usually undertaken when end of life is perceived to be near. Starvation and abstinence from food and water is the usual method. The decision is not irrevocable. The sanction of religion exists along with processes to examine the motive for Santhara in individuals. It can be disallowed by the religious leaders if the motive is suspect. A chance of misuse however persists.After this last comment Dr. Roop Gursahani thanked all the panelists and the audience for their active participation and Dr. Mani then thanked Dr. Roop for his expertise in organizing and coordinating the event and the meeting came to a close.Dr. Shivakumar Iyer ([email protected])Dr. Nandini Vallath ([email protected])Dr. Poornima Karandikar ([email protected])

Critical Care Nursing : empowering Nurses - through Continuing Nursing education

“Any intelligent fool can make things bigger, more complex, and more violent. It takes a touch of genius — and a lot of courage to move in the

opposite direction.”- Ernst F. Schumacher

From caring for critically ill patients in the most anarchic situations to implementing Outcome Directed Nursing Interventions with a Human Touch; the Critical Care Nurse has a stupendous task at hand.We must acknowledge the fact that, nursing has evolved from a singular concept of “Care” to a multidimensional & dynamic decision making system, impacting patient outcomes to the core. Critical Care Nursing practice of today has diversified into multiple super-specialities like Cardiac Critical Care, Neurology Critical

Care, Neonatology and so on; which has further multiplied the opportunities in Critical care Nursing to dispense “Intelligent Nursing care” to patients with varied disease processes & care needs. AContinuing Nursing Education (CNE) in Critical care, forms a canopy of enrichment systems for betterment of Critical Care Nursing practices in Healthcare. Understanding this need & urgency of having well–trained Nursing professionals rendering quality care to critical patients in India; a Continuing Nursing education endeavour was initiated by ISCCM, through the “Indian Diploma in Critical Care Nursing” (IDCCN). This was rolled out as a pan India initiative & has grown by leaps and bounds since its inception (in 2013), networking & impacting not only

the urban healthcare setting but also the rural healthcare in India. In accoradnce to attrition of Nurses from India and a huge lacunae of trained Critical Care nurses, the ISCCM, has now cut down on the IDCCN course fees dractically to penerate this CNE to the most remote arenas of healthcare.If Doctors are the “Minds” behind the decision making, Nurses are the “Indispensable channels of Care” and one can never have favourable patient outcomes, without a “Stratified & integrated team approach”.Nursing Empowerment through education and training leads the Critical Care Nurse to “Think”, “Question”, “Research” and “Reform” Critical care practices to positively impact Nurse-led Patient outcomes in the most synergistic manner.

Winners of Critiquiz 2016-2017 “Bat tle of the Brains” - Episode 2

dr. Payel BoseFNB CCM Trainee

Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata

dr. Gunjan chanchalaniMD, FNB, IFCCM (Critical Care Medicine)

Chief Intensivist Nanavati Hospital

Winners of first episode get free registration for First ICCMID Course on 10-11 September, 2016 at Delhi.

Dr. Khusrav BajanCritical Care Consultant & head of Emergency Departmenthinduja hospital, Mumbai


2015, PUNE - INDIA2015, PUNE - INDIA

The 4th Annual “BeST oF BRuSSelS” Symposium on Intensive care & emergency medicine 2016

3th - 10th July 2016 Pune, INDIA

Jointly Organized by ISCCm, Pune Branch &

the Department of Intensive Care, erasme university Hospital, Brussels

7 Pre-conference hands on workshops were held from 3th– 7th July 2016

2016, PUNE - INDIA

Course: 14th Annual Review Course on Intensive Care3th, 4th & 5th July 2016 5th Floor, Ruby Hall Clinic & Mock Test at Tehmi Grant Nursing SchoolDelegates: 150 • Course Director: Dr Balasaheb Pawar

Co-Directors: Dr Sunitha Binu Varghese & Dr Sushma Patil Gurav

This year at the review course one day was dedicated for Mock examination designed to prepare trainees for practical & theory exit examination in critical care medicine. The objectives were to expose them to an exam environment, understanding the pattern of examination, what is expected, give a feed back after each interaction of what was good and what was missing and most importantly to be examined by ISCCM examiners. The pattern selected has consists of a mixture of written MQC, Cases discussions, didactic lectures and table viva to give a comprehensive exposure to all components of examination

Workshop / Course: 3rd Annual Advanced Strategies in Mechanical Ventilation6th & 7th July 2016 • Hyatt Regency, Pune

Delegates: 52 • Course Director: Dr Sandhya Talekar • Co Director: Dr B D Bande

This workshop was an advanced mechanical ventilation workshop covering new emerging technologies in Mechanical Ventilation and Gas Exchange.Some of the topics that were discussed were Electrical Impedance Therapy –ASV, EIT, ECMO, ECCO2R, ASV, HFO, Trans Pulmonary Pressure, and Newer Modes of Ventilation. The new experiment of the "advanced strategies" showed a lot of promise and exclusiveness

Workshop / Course: 20th Annual Fundamentals in Mechanical Ventilation6th & 7th July 2016 • Hyatt Regency, PuneDelegates: 131 • Course Director: Dr Sandhya Talekar • Co Director: Dr B D Bande

This Mechanical Ventilation Workshop focused on the fundamental aspects of Mechanical Ventilation. Some of the topics that were covered at this workshop included Modes of Ventilation, Trouble Shooting, Airway Management, NIV, Ventilation in COPD, ARDS

Workshop / Course: Hemodynamic Monitoring6th & 7th July 2016 • Hyatt Regency, PuneDelegates: 83 • Course Directors: Dr Kayanoosh Kadapatti Course Coordinator: Dr Jyoti Shendge

The only Hemodynamic Monitoring workshop in the country to have 5 international Faculty, During this workshop various invasive and non invasive techniques of hemodynamic monitoring and Cardiac output measurement like CVP, Arterial pressure and PA pressure monitoring, Pulse Contour Analysis, Echo-cardiography & Doppler were discussed

Lectures & Workstation Presentations & Mock Test held at the Review Course on Intensive Care Workshop

Plenary Lectures at the Fundamentals in Mechanical

Ventilation Workshop

Workstations at the Fundamentals in Mechanical Ventilation Workshop

Plenary Lectures at the Advanced Strategies in Mechanical Ventilation Workshop

Workstations at the Advanced Strategies in Mechanical Ventilation Workshop

Hemodynamics Monitoring Workstations in process

Hemodynamic Monitoring Lectures


Workshop / Course: Ultrasound & 2D Echocardiography Life Support Basic Level 1 Provider Course6th & 7th July 2016 • KEM Hospital & Research Center

Delegates: 80 • Course Director: Dr Pradeep D’costa& Co Director: Prof Luka Neri • Course Co Coordinator: Dr Jayant Shelgaonkar

A joint venture Training Program of ISCCM & WINFOCUS

A joint venture training program of ISCCM Pune Branch & WINFOCUS, delegates were trained in using Ultrasound according to 'ABCDE' and 'Head to-toes' priority pathways in order to enhance rapid and effective decision making, diagnosing, treating, and monitoring

acute and critical ill patients. The course covered general principles of ultrasound, how to interpret the ultrasound patterns of the major acute syndromes, and the technique of the major invasive procedures. The delegates also had hands on practice sessions so as to

make them comfortable to use ultrasound in critical care. This well structured workshop helped delegates to use of USG & 2DEcho in septic shock, ARDS, pulmonary embolism, acute decompensation of Heart Failure and many more complex scenarios.

WORKSHOP / COURSE: Clinical Nutrition6th July 2016 • Hyatt Regency, PuneDelegates: 73 • Course Director: Dr Subhal Dixit

This workshop aimed to develop a strategy for team work for the Intensivist, dietician & nurse. Delegates were able to understand Principles of nutritional support in ICU, monitor nutrition in ICU, Practical aspects of enteral /parenteral nutrition and trouble shooting. Disease specific nutrition Immunonutrition, organizational aspects of nutrition support, nutritional products and delivery system, the participants also got an opportunity to interact with experts during the hands on session. This workshop was aimed to develop a real sense of team work in the ICU and this team of the intensivist, dietician & nursing staff has a true awareness about the importance of nutrition in the critically ill.

Our brand new JAMA Session in BOB 2016This year we had planned an exclusive new JAMA Session simply means -Just Ask Me Anything which was held on 8th July 2016.It was truly interactive open live forum with all 12 faculty members on the dais. There were No presentations, No talks, No debates; just an hour-long Q& A session with world renowned professors. Delegates could just ask any questing to the faculty and they got the best possible answers from these SMARTYDOZEN!!

The Fourth Annual “BEST OF BRUSSELS” Symposium on Intensive Care & Emergency Medicine held in Pune, India8th to 10th July 2016 • Hyatt Regency, PuneISCCM, Pune Branch under the chairmanship of Dr Shirish Prayag & Prof Jean L Vincent has successfully conducted the Fourth Annual “BEST

OF BRUSSELS” symposiumin PUNE, India from the 8th to the 10th July 2016 at the Hyatt Regency, Pune.

The traditional Lamp lighting ceremony

WORKSHOP / COURSE: Straight Talk7th July 2016 • Hyatt Regency, PuneDelegates: 66 • Course Director: Dr Kapil Zirpe, Dr Ashit Hegde & Dr Sushrut Bandopadhyay

Lectures & Workstation Presentations held at the Clinical Nutrition Workshop

Presentations at the Stroke Workshop

Day 1- 8.27am –The Full Hall Dr Shirish Prayag giving the welcome address

8.30 am ON TIME … Everytime

Prof Jean L Vincent

For the first time a new workshop ‘’Straight Talk” which was linked to antibiotic resistant &addressed factors including economic impact, intrinsic and acquired drug resistance, morbidity and mortality rates, and causes of infections were taken into account. Synchronously with the waxing of bacterial resistance there has been waning antibiotic development. The approaches that ID specialist are employing in the pursuit of new antibacterial agents were briefly described .The attendees got an overview of current scenario of infections, important bug,preventive strategies, the antibiotics –, mechanisms of action and resistance, spectrum of activity, and preeminent members of each class are discussed

Twelve International Faculty on the dias - Jama Session


International Faculty from Belgium, Australia, Netherland, France, Italy & SwitzerlandThe brain storming Scientific Sessions: The Brilliant Dozen……………………………in process……….

The " Translational session " which was held on Sunday 10th July, had National & International experts hold discussions on topics of major presentations made during the preceding 2 days of BOB, which was case based and interactive with the audience. This session was aimed to

convert the points at the BOB sessions in to real TAKE HOME Messages related to cases that we see in our ICU’s. This session was rated as the most welcome and useful change by all the delegates as well as International and National faculty

Q & A session with world renowned professors

Dr Shirish Paryag, Dr Kapil Zirpe & Dr Subhal Dixit,

Inaugurating The scientific exhibition at BOB 2016

Hamilton Medical Industry Session

Sanofi Industry Session

Baxter Industry Session

Pro: Daniel De BackerCon: Jean Louis Vincent

Pro: Massimo AntonelliCon: Jan De Waele

Chairperson: Dr Nirmal Jaiswal &

Dr Kapil Zirpe

Chairperson: Dr Pradip Bhattacharya

& Dr Sameer Jog

Industry Session on 8th & 9th July 2016

Biocon Industry Session

Sanofi Industry Session Astra Zeneca Sesssion

Bharat Serum Session

DEBATES – 2DEBATES – 1

2016, PUNE - INDIA

Sanofi Industry Session


The ModeratorsProf J L Vincent &Dr Shirish Prayag

The EXPERTS: Prof Daniel DeBacker &

Dr Pravin Amin

The EXPERTS: Prof Michael Reade &

Dr Amit Gupta

BOB MASTERCHEF: The Food Court

Entertainment programs at the Inaugural Session :The engrossed audience during the Cultural Program, Performed Experience the

real world of Lavani artists

Dr Sunitha Varghese presenting a case on Resistant organisms, long standing ICU

Dr Urvi Shukla presenting a case on

Difficult to wean

The EXPERTS: Prof Davide Chiumello &

Dr Rajesh Chawla

The EXPERTS: Prof Jean Francois Timsit

& Dr Ashit Hegde

Dr Kapil Zirpe presenting a case on Infections in

Organ transplant recipient

Dr Sameer Jog presenting a case on MI with Cardiogenic shock

The EXPERTS: Prof Jean Louis Teboul &

Dr Yatin Mehta

The EXPERTS: Prof Jan DeWeale &

Dr Deepak Govil

Dr Kayanoosh Kadapatti presenting a case on

Stroke

Dr Subhal Dixit presenting a case on

GI Bleed

Our Friends

The Team behind it !!!!!!!!!!!!!!


TM

nd2 Mumbai Criticon 2016 th nd30 September - 2 October

Golden Jubilee Auditorium, Tata Memorial Hospital, Parel

Theme - Updates in Critical Care

ndThe 2 edition of ISCCM Mumbai Criticon aims at providing a platform to share the ideas and practices in the field of Critical care medicine. It marks an important milestone in the roadmap toward increased awareness in the advances in ICU practice. The conference will have pre conference workshops and main conference which will have lecture, presentations and panel discussions. The scientific sessions will consist of a select set of presentations by eminent faculty who are prominent in the field of Critical Care Medicine and have participated in many national and international conferences. Together, we are looking at raising the standard of critical care practice through exchange of knowledge and ideas and we are sure you will find your participation rewarding and look forward to welcoming you.

th 30 September: Pre conference workshopst nd1 & 2 October: Main Conference

CONFERENCE PROGRAM:

For registration & general inquiries: M: +91 8551856993T: +91 22 40046837 / E: [email protected] / www.isccmmumbai.com

Organising ChairmanDr. Rahul Pandit

Organising SecretaryDr. Akshay ChhallaniDr. Sonali Vadi

TreasurersDr. Bharat JagiasiDr. Reshma Ambulkar

Intensivists Physicians Anesthetists Surgeons Nurses Paramedical staff Health professionals

(Intensive care and emergency medicine)

Students Obstetricians

Who Can Attend Executive Committee

Workshops NIV with Ancillary Treatment Critical Care in Obstetrics Neuro Critical Care Nursing CME

Dr. Thomas BleckUSA

Dr. Stefano NavaItaly

International Faculty

Submit case reports for e-poster presentations at [email protected]

TM

4th Gujarat State Level Critical Care Conference

Saving Lives through Critical Care

25th - 27th November 2016 • Hotel Azzaro, Diu, IndiaJointly Organised by

All ISCCM Branches of Gujarat25th November 2016Theme : Medico - Legal aspects of

Clinical Practice Various Acts pertaining to Medical

Practice Pitfalls & Precautions in

Documentation & Keeping Medical Records

Panel Discussion : Medical - Legal aspects of Death Scenarios in Hospital

26th November 2016Theme : Practice PracticalVarious topics related to daily

practice in Emergencies & Critical Care

Banquet and Gala Dinner

27th November 2016Theme : Core Critical Care Myths & Facts in Critical Care

Practice 20 Myth Buster Questions, Its

Practical Solution & Protocols for Daily Practice

Landmark Trials & Recent Research Articles in Journals of Critical Care Medicine

How to Initiate Research & Clinical Trials at Local Level?

For any query please contactDr. Darshan G. Shukla • 9909989404

Dr. Vipul P. Parekh • 8347471212

www.gujaratcriticon.com

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Delhi Critical Care Symposium

14th Annual Conference of SCCM Delhi NCR2nd North Zone Critical Care Conference &

First ICCMID CourseINTENSIVE CARE CLINICAL MICROBIOLOGY & INFECTIOUS DISEASE COURSE

9th & 10th September 2016India Habitat Centre, Lodhi Road, New Delhi 110003

HIGHLIGHTS Multidisciplinary ConferenceThematic CourseCriti Quiz

Open House and Hot Debates Sepsis Forum

ICCMID Course Indianised Course Focus on Severe Life Threatening

Infections Resistance Trends

Perfect Amalgam of Audience and Faculty

Best Critical Care ID Case

Dr. Debasis Dhar Dr. Vinod Singh Organising Chairman Chairman Scientific Program

Dr. Yash Javeri, Organizing Secretary9818716943 • [email protected]

CONFERENCE SECRETARIATSociety of Critical Care Medicine Delhi

(A Branch of Indian Society of Critical Care Medicine)805/59 Shakuntla Tower, Nehru Place, New Delhi 110019

Tel. : 011-41007180 • e-mail : [email protected] Co-ordinator : Ms. Kavita Sharma • 9811895550

www.isccmdelhi.com

Abstract Submission Last Date 15th August 2016Send your abstract to [email protected]

2nd International Conference on Imaging in Critical Care Medicine

Organized by Indian Society of Critical Care Medicine,

Kolkata Branch

17th-20th November 2016 • Novotel, Kolkata

SECRETARIAT

AMRI Hospital, Salt Lake, JC-16 & 17, Sector III, Kolkata 700098

Dr. Dipankar Sarkar • +91 98311 79171

Dr. Amitabha Saha • +91 98301 77784

Dr. Rajarshi Roy • +91 98312 43209

Mr. Kaushik Dhar • +91 80179 84305

email : [email protected] • [email protected]

www.trinayan.net

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Trinayan

The 3rd Eye


International Faculty

Organizing Committee

Venue Images

Prof. MaheshNirmalan

Prof. AndrewArgent

Prof. Antonelli Dr. Peter Spronk

Dr. MaurizioCecconi

Prof. RinaldoBellomo

Prof. Younsuck Dr John Myburgh

Dr Donald B. Chalfin

Le Meridien, KochiCrowne Plaza, Kochi

Dr Mohan A Mathew Organizing Chairman

Dr. Atul KulkarniNational President &

National Scientific Chair person

Dr Suresh G NairOrganising Secretary

Dr Vinodan KScientific Committee

Chairman

Criticare-2017

Dates To Remember

Conference Secretariat

Event Managers

Organising Secretary

Dr Suresh G NairAster MedicitySouth Chittoor

Ernakulam - [email protected]

Mob : 09847040849

Scientific Committee Chairman

Dr Mohan A MathewLakeshore Hospital

MaraduErnakulam - 682040

[email protected] : 09447076652

Organizing Chairman

Dr Vinodan KMedical Trust Hospital

MG RoadErnakulam - 682016

[email protected] : 09846011922

Workshop 1st & 2nd Feb,2017

Presidential Oration 3rd Feb, 2017

Presidential Dinner3rd Feb 2017

Faculty Dinner 1st & 2nd Feb, 2017

Exhibition Opening 2nd Feb, 2017 @ 5.30 PM

Banquet4th Feb, 2017

Conference Inauguration3rd Feb, 2017

Raju Kannampuzha

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Madhu S Kayarat

Travel And Tour Operator

Criticare-2017

Editorial officEdr. Kapil Zirpe

Grant Medical Foundation, Ruby Hall Clinic, Pune, Maharashtra, India.Mobile : +91 9822844212

[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]

23rd Annual Conference ofIndian Society of Critical Care Medicine

1st, 2nd February 2017

Workshop3rd, 4th , 5th February 2017

Conference

Criticare-2017

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