Sir Ganga Ram Hospital, New Delhi, India

Institute of Critical Care Medicine

Department Overview:

Critical Care Medicine (CCM) is a specialty that involves the management of patients with life threatening, frequently complex medical and surgical illnesses in a specialized Intensive Care Unit (ICU) or similar facility. A modern ICU represents the pinnacle of any hospital’s approach to highly technological & sophisticated in-patient care. The CCM physician, also called an Intensivist in some parts of the world, has expertise in the evaluation and management of these critically ill patients.

These critically ill patients may have dysfunction or failure of one or more organ systems, including the cardiac, pulmonary, neurologic, liver, kidney or gastrointestinal systems. In the ICU procedures used to support and identify the cause of the critical illness include endotracheal intubation, central venous catheterization, arterial cannulation, pulmonary artery catheterization, bronchoscopy, lumbar puncture, thoracocentesis, paracentesis, chest tube thoracostomy and percutaneous tracheostomy. Specialists from anaesthesia, general medicine, pulmonology and surgery can undergo further training in critical care medicine to become a CCM physician.

The department of Critical Care and Emergency Medicine at Sir Ganga Ram Hospital is recognized both nationally and internationally as a leader in patient care, research and training. Today the Dept. of Critical Care & Emergency Medicine is amongst the largest in private hospitals. The department provides critical care services on 56 beds in three medical/surgical critical care units and 6 beds in a High Dependency Unit (HDU) and also provides resuscitation services in Floor beds and Emergency Rooms. The main state of art 34 bedded ICU, built over 13000 sq ft, is located on the IVthfloor of the new Research and Super Specialty block. The patient area is divided into 4 pods. Each pod has an open bed area and a reverse ventilation isolation area. All beds are equipped with GE Multichannel physiological monitoring systems allowing close monitoring of patients both from the bedside and the central nursing station. The patient beds are totally motorized for enhanced patient comfort and care. Organ support systems like ventilators including High Frequency Oscillatory Ventilator and Nitric Oxide delivery system; Conventional ve ntilators with latest ventilatory modes and respiratory mechanics analysis facilities, Hemodialysis and CRRT machines; ECMO and MARS machine are available at the bedside. Flexible Fiberoptic Bronchosco py, Ultrasonography and Echocardiography are housed in the ICU and are used routinely for both diagnostic and therapeutic purpose.

Patients from across the country are transported via ground and air ambulance services which are fully equipped with life support systems, ventilators and monitors; a trained doctor and technician accompanies the patient during transportation.

A regular teaching schedule in the form of seminars, case presentations and journal discussions is held for the 16 trainee fellows (NBE, 2 year and ISCCM, 1 and 2 year courses). Few candidates on short 3 or 6 month observation courses are provided introductory critical care orientation.

Quarterly Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) training (American Heart Association certified) is conducted in hospital premises. Monthly data collection and yearly audit is performed as aquality improvementprocess that seeks to improve patient care and outcomes through systematic review of care against established global benchmarks.

ECMO Programme :

Programme Director: Dr. B.K. Rao
Co-Director: Dr. Vinod K. Singh
Programme Coordinator: Dr. Sanjeev Mittal

The Department started offering ECMO to suitable patients in 2014
The team associated with the Extra Corporeal Membrane Oxygenation (ECMO) program has the experience of carrying out both forms of ECMO, Veno Arterial(VA) and  Veno Venous(VV).
The indications for both types are different and depend on the target organ support.
Till now, the team has done over 20 cases of both modalities and is well versed with the intricacies of both.
We regularly share our data with Extracorporeal Life Support Organization (ELSO), the umbrella organization for ECMO worldwide. The data sharing is both ways between ELSO and our institute as a part of the academic programme.
We conduct regular training programmes in ECMO.
Our Team members are Part of committee of ECMO society of India and we are in process of launching a fellowship program in ECMO under the aegis of ECMO Society of India
Our ECMO success rates have been comparable to international centers, both for VA and VV ECMO.
We take pride in offering highest quality ECMO treatment at affordable cost.
With continued improvement in skills and training at international centers, the team aspires to further improve upon its successes. 

International Training Center of American Heart Association:

Sir Ganga Ram Hospital was earlier training Layman and medical professionals in Basic Life and Advanced Cardiac life Support Provider program as a satellite center of American Heart association through St Johns Medical College and Manipal Hospital Bangalore.
Since we already had a good infrastructure and a highly experienced set of instructors we have signed an agreement with AHA and are now recognized as an Independent ITC of AHA for all adult training Programs.
We take pride in training over a thousand of Medical professionals in last ten years as BLS and ACLS providers.
We continue to emphasize highest training and educational standards within the parameters of AHA.
We conduct all adult training courses including Instructor Courses.
The training is conducted at a very affordable fee structure (on a cost only basis).

Important Milestones:

  • 1980 : Critical care unit functioning under the dept. of Anesthesia.
  • 1999 : Department of Critical Care & Emergency Medicine (CCEM) established in SGRH.
  • 2003 : Department of Critical Care & Emergency Medicine (CCEM) got recognized as a center for Fellowship by National Board of Education.
  • 2004 : State of the Art Intensive Care Unit in the new Super Specialty Research Block inaugurated by Dr APJ Abdul Kalam, then President of India.
  • 2004 : IDCC fellowship started under ISCCM
  • 2005 : Affiliated City Hospital ICU management taken over by the Dept of CCEM.
  • 2006 : High dependency Unit (HDU) and ICU for poor patients started in separate ward locations.
  • 2006 : Recognized as Satellite Training Center for BLS and ACLS training courses.
  • 2006 : First Annual Certificate Course for Critical Care Nurses (now held every year).
  • 2009 : One thousand Percutaneous Tracheostomies successfully completed by the Dept of CCEM.
  • 2011 : HFOV and Nitric Oxide delivery system installed.
  • 2012 : Doppler Ultrasound acquired by ICU.
  • 2012 : Conventional ICU bed side X-Rays replaced by Digital X-Rays.
  • 2012 : 25 Advanced Cardiovascular Life Support (ACLS) courses completed successfully by American Heart Association (AHA) certified ACLS instructors
  • 2012 : Two year post MBBS certificate course started under ISCCM
  • 2015 : Started offering ECMO as a treatment modality in suitable cases. 4 cases initiated in 2015 for indications airway obstruction due to malignancy, aluminium phosphide poisoning and ARDS.
  • 2017 : Registered with ELSO as Adult Respiratory and Adult Cardiac ECMO center.
  • 2018 : Recognized as International Training Center of American Heart Association for BLS/ACLS Provider and Instructor Courses.

Achievements:

  • 44 ACLS provider courses have been conducted till date by the Dept. of Critical Care & Emergency Medicine including outstation courses in Aligarh, Bareily, Jaipur, Guwahati and ISCCM National Conference.
  • International TraumaCare 2010 held at Indian Habitat Center, New Delhi was jointly organized by Dept. of Critical Care &Emergency Medicine and International Trauma Anesthesia and Critical Care Society(ITACCS) US.
  • DCCS 2012 conference held at Hotel le meridian, New Delhi was organized by Dept. of Critical Care &Emergency Medicine, Sir Ganga Ram Hospital.
  • DCCS 2011 conference held at Hotel Le meridian, New Delhi was organized by Dept of Critical Care Medicine, Sir Ganga Ram Hospital
  • 7 Annual Nursing Training Workshops (2006-2012) have been organized till date to train the nurses in Critical Care Nursing, 
  • Dr. Prakash Shastri has been elected as Secretary, Indian Society of Critical Care Medicine of the year 2011-2013. 
  • Dr. SC Sharma has been elected as an Executive member, Indian Society of Critical Care Medicine, Delhi Branch of the year 2012-2013. 
  • Dr. Vinod K Singh has been elected as Chairman, Indian Society of Critical Care Medicine (Delhi & NCR) for the year 2013-2014
  • Dr. Debashis Dhar has been elected as Chairman, Indian Society of Critical Care Medicine (Delhi & NCR) for the year 2016-18.
  • Dr. Saurabh Taneja has been elected as Executive Member, Indian Society of Critical Care Medicine (Delhi & NCR) for the year 2016-18.
  • 2017 : Dr. Vinod Singh Elected as Joint Secretary, ECMO Society of India.
  • 2017 : Dr. Sanjeev Mittal Elected as Zonal Head North ECMO Society ofIndia.
  • 2018 : Dr Vinod Singh elected as Vice-President ECMO Society of India
  • 2018 : Dr Sanjeev Mittal elected as Zonal head North ECMO society of India
  • 2018 : Dr Sanjeev Mittal, Training Centre Coordinator of International Training Center of American Heart Association

Annual Conference-cum-Workshop

The department conducts an annual academic festival inviting delegates and faculty from all over the country from the year 2013. The theme focuses on the latest practices in the field of critical care every year.

  • 2013 - ECMO- Present & Future
  • 2014 - Complex Issues : Right Steps
  • 2015 - Redefining ICU Basics: A Step Further
  • 2016 - Moving Towards Patient Centered Care
  • 2017 - Ultradynamics – Simplifying Critical Care

Consultants and Staff:

  • Dr. B. K. Rao (Chairman, HOD)
  • Dr. Prakash Shastri (Vice-Chairman)
  • Dr. Vinod Kumar Singh (Teaching co-ordinator)
  • Dr. Debashis Dhar (Casulaty and Infection control monitoring Co-ordinator)
  • Dr. S. C. Sharma (Cadaveric organ donation program Co-ordinator)
  • Dr. Ashok Anand ("Acute Bedside Care Service" Co-ordinator)
  • Dr. Sanjeev Mittal (ITC AHA Co-ordinator, NABH Coordinator, Medical Audit Co-ordinator)
  • Dr. Ashutosh Taneja (Quality and Safety Co-ordinator)
  • Dr. Niraj Tyagi (Nursing Training Co-ordinator, Infection Control Coordinator)
  • Dr. Saurabh Taneja (Acute bedside care Co-ordinator, Audit Coordinator)
  • Dr. Rahul Kumar (Acute Bedside Care Co-ordinator)

Current DNB Fellows:

2017-2019:

  • Dr. Vishal Khandelwal
  • Dr. Neelmani Ahuja
  • Dr. Rishi Shankar
  • Dr. Prabhajan Singh

2018-2020:

  • Dr. Nilanjan Umesh
  • Dr. Shubhlesh Kumar
  • Dr. Devender Kumar Singh
  • Dr. Gynendra Kumar Gautham

Current IDCCM Candidates:

  • Dr. Sandeep Choudhary
  • Dr. Anuraj Dubey
  • Dr. Ansul Goyal
  • Dr. Shubham Agarwal
  • Dr. Arun Gangadhar
  • Dr. Aman Varshney

Nursing staff:

The ICU is staffed in a nurse to patient ratio of 1:1. All these ICUnurses are given introductory training in critical care nursing and undergo regular teaching programs conducted or arranged by the Deptt. of Critical Care &Emergency Medicine, to promote critical nursing care skills and knowledge throughout their stay in the ICU.

Medical / Surgical ICU Technicians:

  • Mr. Sudhanshu Pathak
  • Mr. Gulfan Singh Yadav
  • Mr. Ramesh Kumar Rana
  • Mr. Mukesh Kumar
  • Mr. Ravi Kumar Rana
  • Mr. Shubham Thakur (ICU Trainee)
  • Mr. Akash Yadav (ICU Trainee)

Medical / Surgical ICU Secretary:

  • Mr. Kameshwar Grover

Medical Data Operators:

  • Ms. Renu

ICU Counselor:

  • Ms. Akansha

Academic & Research

Department of CCEM has a basic introductory as well a very detailed academic program for the rotating residents of other departments and its own residents and fellows respectively. The program includes lectures, symposium, journal club, case discussion, adverse event outcome discussions, audit, equipment training and bedside teaching.

The doctors in training in the department are individually taught the techniques of difficult airway management, optimal mechanical ventlation, weaning from mechanical ventilation, noninvasive techniques of mechanical ventilatory support and central venous and arterial line placements. The training related to intubations, central line placements are taught to them initially in a dummy so that they can practice repeatedly. We have a computer simulator for Arrhythmia detection and management for teaching purposes. They are also taught the philosophy of modern intensive care practice, the attitude of "DONOHARM" in intensive care management, the importance of refined diagnosis in critically ill patients to achieve successful outcomes and the advantage of using noninvasive monitoring and measurements wherever possible.

This department presents some of the best award-winning clinical research papers at National Conference of Critical Care Medicine &Pulmonology. Last year the department has presented papers/delivered lectures in 47 conferences. We have also published 20 articles in the last two years.

DNB (Post Doctorate Fellowship) in Critical Care Medicine

Critical Care and Emergency Medicine Department holds a two-year post-doctorate DNB course in Critical Care Medicine. Theree candiates are taken every year. The candidate rotates through all the intensive care units and faculty drawn from the Department of Critical Care and Emergency Medicine Department, Pulmonology, Internal Medicine, Surgery, Nephrology, Paediatrics, Cardiology, Gastroenterology, Neurology and Neurosurgery conducts a well structured teaching program for him.

IDCC &IFCC (Fellowship in Critical Care under ISCCM)

The department of Critical Care and Emergency Medicine conducts:

  • a. Indian Diploma in Critical Care (4 seats biannually)
  • b. Indian Fellowship in Critical Care (4 seats annually)
  • c. Two year post MBBS Critical Care Medicine Certificate cours (4 seats)

Critical Care Training Course for Nurses

The Dept. of Critical Care &Emergency medicine is conducting a 6 months long modular training Course for critical care nurses. Each module consists of a day long programme with didactic lectures & hands on teaching at various skills stations.

This porgramme follow a modular format in which there is a contact day for one day every month. In each module, there are didactic lectures, interactive sessions and workshops for various topics of importance in day-to-day management of critically ill patients.

After each module, the nurses are given a project to complete during the intervening period. Assessment (MCQ based) is done in the last module and two candidates are awarded certification for their excellent performance. Besides the Main ICU nurses from other Critical Care areas as well as from other Hospitals of Delhi have participated and benefited by the course.

Advanced Cardiac Life Support (ACLS) Provider Course

Sir Ganga Ram Hospital (SGRH) is a certified center by American Heart Association (AHA) for conducting Basic Life Support (BLS) Provider Course and Advanced Cardiac Life Support (ACLS) Provider Course. The team of AHA certified ACLS instructors from SGRH ICU have successfully conducted 44 ACLS course both in the hospital (held quarterly) and in various hospitals outside Delhi. Courses have been held along various national critical care conferences.

Library & Teaching aids

The department of Critical Care & Emergency Medicine has a dedicated library situated in the doctor’s lounge, which contains all major books, journals related to critical care, SCCM publications, guidelines, monographs and audiovisual material in the form of videocassettes, CD-ROMs. The department has 4 dedicated computers with printing facility and Internet with round the clock access to database like MDConsult. The hospital subscribes to most of the major international journals available online. The Critical Care and Emergency Medicine Department has developed its own data management software, which is used in the Medical/ Surgical ICU and has its own projection facilities in the form of OHP and Multimedia. A hand on training on mannequins/simulators is provided by the department to the residents and nursing staff.

Major Publications & Presentations:
 

Publications – Year 2017

Articles:

  1. Convergence of minds: For better patient outcome in intensive care unit infections. Wattal C, Javeri Y, Goel N, Dhar D, Saxena S, Singh S, Oberoi JK, Rao BK, Mathur P, Manchanda V, Nangia V, Kapil A, Rattan A, Ghosh S, Singh O, Singh V, Kaur I, Datta S, Gupta SS. Indian J Crit Care Med. 2017;21(3):154-159.
  2. Association of high mortality with extended–spectrum β- lactamase (ESBL) positive cultures in community acquired infections. Sumit Ray, Dimple Anand, Sankalp Purwar, Arijit Samanta, Kaustubh V. Upadhye, Prasoon Gupta, Debashis Dhar. Journal of Critical Care Journal of Critical Care 44 (2018) 255-260. doi:10.1016/j.jcrc.2017.10.036
  3. Tropical fevers in Indian intensive care units: A prospective multicenter study. Singhi S, Rungta N, Nallasamy K, Bhalla A, Peter J V, Chaudhary D, Mishra R, Shastri P, Bhagchandani R, Chugh T D, for Indian Society of Critical Care Medicine Research Group. Indian J Crit Care Med 2017;21:811-8.
  4. Comparative efficacy of clonidine versus magnesium sulfate as an adjunct to lignocaine in intravenous regional anesthesia for postoperative analgesia: A prospective, randomized, double-blind study. Kaur P, Kundra TS, Sood D. J Anaesthesiol Clin Pharmacol 2017;33:387-90.

Chapters:

  1. Severity of illness scoring systems and their clinical relevance. Rao BK. Year Book of Anaesthesiology-6, Year 2017. Sehgal R, Trikha A. Jaypee, 2017;53-67.
  2. Coagulopathy in liver disease. Dr. Sumit Ray, Dr. Arijit Samanta. Critical Care Update 2017. Dr. Subhash Todi, Dr. Atul P Kulkarni, Dr. Kapil Zirpe. Jaypee, 2017;165-170.
  3. Attributable cost of hospital-acquired infection. Dr. Prakash Shastri. Critical Care Update 2017. Dr. Subhash Todi, Dr. Atul P Kulkarni, Dr. Kapil Zirpe. Jaypee, 2017;437-438.
  4. ICU Nursing – How is it different? Dr. Prakash Shastri. ICU Manual for Nurses. Editor - Dr. Prakash Shastri. Jaypee, 2017;3-5.
  5. Airway management. Dr. Debashis Dhar. ICU Manual for Nurses. Editor - Dr. Prakash Shastri. Jaypee, 2017;9-14.
  6. Basics of mechanical ventilation. Dr. Vinod K. Singh, Dr. Vitrag Shah. ICU Manual for Nurses. Editor - Dr. Prakash Shastri. Jaypee, 2017;73-81.
  7. Noninvasive ventilation. Dr. Vinod K. Singh. ICU Manual for Nurses. Editor - Dr. Prakash Shastri. Jaypee, 2017;82-84.

Books Authored:

  1. ICU Manual for Nurses. (under the aegis of Indian Society of Critical Care Medicine). Editor - Dr. Prakash Shastri. Jaypee, 2017.

Paper presentation/Poster Presentation/Oral presentation/Abstract:

  1. Predictors of mortality in adult severe Chikungunya patients from 2016 epidemic in India: comorbid conditions and organ failure not stable hemodynamic status on presentation, defines outcome. Dr. Niraj Tyagi. ESICM Annual Congress organized by European Society of Intensive Care Medicine at Vienna, Sept 25, 2017.
  2. A prospective 3 years study of epidemiology, spectrum and outcome of dengue fever in ICU from tertiary care hospital in north India. Dr. Prasoon Gupta, Dr. Rahul Kumar, Dr. Prakash Shastri. Conference Proceedings of CRITICARE 2017, Kochi. 23rd Annual Conference of Indian Society of Critical Care Medicine at Kochi, 1-5 February 2017.

Publications – Year 2016

Chapters:

  1. Severity of Illness Scoring Systems and Their Clinical Relevance. Rao BK. Year Book of Anaesthesiology-6, Year 2016. Editors-Sehgal R, Trikha A. Jaypee, 2016;53-67
  2. Approach to Acid-Base Disorders. Dr. Vitrag Shah, Dr. Arijit Samanta, Dr. Sumit Ray. Anaesthesia Update Book 2016 (with conference proceedings), 64th ISACON 2016 conference, Ludhiana, Nov 25-29, 2016. Jaypee, Pg 591-599

Journal Scan:

  1. Age of transfused blood in critically ill  adults. Lacroix J, Hébert PC, Fergusson DA, Tinmouth A, Cook DJ, Marshall JC, Clayton L, McIntyre L, Callum J,Turgeon AF, Blajchman MA, Walsh TS, Stanworth SJ, Campbell H, Capellier G, Tiberghien P, Bardiaux L, van de Watering L, van der Meer NJ, Sabri E, Vo D; ABLE Investigators and The Canadian Critical Care Trials Group. N Engl J Med. 2015 Apr 9;372(15):1410-8.

Dr. Prakash Shastri- Yearbook of Anesthesiology-5, Editors- Sehgal R, Trikha A, Jaypee, 2016;299-302

Paper presentation/Poster Presentation/Oral presentation/Abstract:

  1. Characteristics and outcome in severe H1N1 & ARDS. Dr. Rahul Kumar.  Conference Proceedings of CRITICARE 2016 - 22nd Annual Conference of Indian Society of Critical Care Medicine and International Sepsis Forum at Agra, 3-7 February 2016.
  2. Case series of prolonged proning in patients with refractory hypoxemia. Dr. Ruchi Gupta, Dr. Vinod K. Singh, Dr. Debashis Dhar, Dr. Sanjeev Mittal, Dr. Ashutosh Taneja, Dr. Dinesh Rawat, Dr. Niraj Tyagi, Dr. Saurabh Taneja, Dr. Rahul Kumar, Dr. B.K. Rao. Conference Proceedings of CRITICARE 2016 - 22nd Annual Conference of Indian Society of Critical Care Medicine and International Sepsis Forum at Agra, 3-7 February 2016.
  3. Challenges in management of severe dengue. Dr. Sameer Malik, Dr. Rahul Kumar, Dr. Prakash Shastri. Conference Proceedings of CRITICARE 2016 - 22nd Annual Conference of Indian Society of Critical Care Medicine and International Sepsis Forum at Agra, 3-7 February 2016.
  4. ARDS – an atypical presentation of tropical diseases with outcome analysis. Dr. Prasoon Gupta, Dr. Rahul Kumar, Dr. Vinod K. Singh, Dr. B.K. Rao. Conference Proceedings of CRITICARE 2016 - 22nd Annual Conference of Indian Society of Critical Care Medicine and International Sepsis Forum at Agra, 3-7 February 2016.
  5. Survival benefit of prone ventilation and feasibility of prolonged (>20 hours) prone positioning in severe H1N1 ARDS: experience from India. (A tertiary care teaching hospital and ECMO center). N. Tyagi, R.K. Rajput, S. Taneja, V.K. Singh, S.C. Sharma, S. Mittal, B.K. Rao. Intensive Care Medicine Experimental 2016, 4(Suppl 1):30, A542.

Publications – Year 2015

Chapters:

  1. Intra-abdominal sepsis and abdominal compartment syndrome. Dr. Prakash Shastri. Textbook of Critical Care, Jaypee, Editor-Dr. Yatin Mehta, Pg 495-500
  2. Hepatorenal syndrome. Dr. Saurabh Taneja, Dr. Sumit Ray. Textbook of Critical Care, Jaypee, Editor-Dr. Yatin Mehta, Pg 483-488.
  3. Simplified algorithm for ABG interpretation. Dr. Sumit Ray. Medicine Update 2016-2, Volume 26, 2016, Jaypee, Editor-Dr. Gurpreet S Wander, Dr. K.K. Pareek, Pg 1595-1599.

Journal Scan:

Incidence of and risk factors for severe cardiovascular collapse after endotracheal intubation in the ICU: A multicenter observational study. Perbet S, De Jong A, Delmas J, Futier E, Pereira B, Jaber S, Constantin JM. Crit Care. 2015;19:257.

Dr. Prakash Shastri- Yearbook of Anesthesiology-5, Jaypee, Editors-Dr. Raminder Sehgal, Dr. Anjan Trikha, Pg 318-320

Abstract:

  1. Fourteen-year experience of over 1900 percutaneous dilatational tracheostomies (PDT) in a multidisciplinary intensive care unit (ICU) of a developing country. Champanerkar SR, Singh V, Sharma SC, Anand A, Raawat D, Tyagi N, Taneja S, Rahul, Gafoor I, Upadhye K, Gupta R. Indian J Crit Care Med 2015;19(13):S61.
  2. Clinical spectrum, outcome and challenges in refractory hypoxemic patient. Mishra G, Gupta R, Rao BK, Shastri P, Mittal S, Taneja A, Taneja S, Gafoor I, Upadye K, Champanerkar S. Indian J Crit Care Med 2015;19(13):S38.

Publications – Year 2014

Articles:

  1. Ecology of blood stream infection and antibiotic resistance in intensive care unit at a tertiary care hospital in North India. Wattal C, Raveendran R, Goel N,  Oberoi JK,  Rao BK. Braz J Infect Dis. 2014;18(3):245-251
  2. Inhaled nitric oxide as a salvage therapy in patients with severe ARDS. Mehra S, Garg A, Dalvi PB, Taneja S, Nindra P, Ray S. Current Medicine Research and Practice. 2014;4(2):51-55.
  3. Procalcitonin as a rapid diagnostic biomarker to differentiate between culture-negative bacterial sepsis and systemic inflammatory response syndrome: A prospective, observational, cohort study. Anand D, Das S, Bhargava S, Srivastava LM, Garg A, Tyagi N, Taneja S, Ray S. J Crit Care (2014), http://dx.doi.org/10.1016/j.jcrc.2014.08.017.

Abstract:

  1. Rapidly progressive respiratory failure due to cyclophosphamide toxicity. Dr. Shreekant Champanerkar. ‘DCCS 2014’  - 12th Annual Conference of Society of Critical Care Medicine – Delhi (A Delhi & NCR branch of ISCCM) at New Delhi on September 4-7, 2014
  2. A case of fulminant meningococcemia. Dr. Shreekant Champanerkar. ‘DCCS 2014’  - 12th Annual Conference of Society of Critical Care Medicine – Delhi (A Delhi & NCR branch of ISCCM) at New Delhi on September 4-7, 2014
  3. A case of tracheo bronchial rupture: how an urgent but systemic management can save a life. Dr. Garima Mishra. ‘DCCS 2014’  - 12th Annual Conference of Society of Critical Care Medicine – Delhi (A Delhi & NCR branch of ISCCM) at New Delhi on September 4-7, 2014
  4. Survival after in-hospital cardiac arrest in a developing country: retrospective study over 4 years period. Dr. Niraj Tyagi. ESICM 2014 Congress organized by European Society of Intensive Care Medicine at Barcelona, Spain on September 28-October 1, 2014.

CME Articles:

Insulin Infusion Protocol (Human Insulin/Insugen). Ray S. Current Medicine Research and Practice. 2014;4(4):186–187. http://dx.doi.org/10.1016/j.cmrp.2014.08.007.

Case Reports:

  1. Acute right heart syndrome: Rescue treatment with inhaled nitric oxide. Garg A, Vignesh C, Singh VK, Ray S. Indian J Crit Care Med 2014;18:40-2.
  2. Severe suicidal digoxin and propranolol toxicity with insulin overdose.  Garg A, Panda S, Dalvi P, Mehra S, Ray S, Singh VK. Indian J Crit Care Med 2014;18:173-5.

Chapters:

  1. Monitoring of High-Risk Areas: Intensive Care Units. Dr. B.K. Rao. Hospital Infection Prevention: Principles & Practices, Springer, Pg 123-126

Publications Year 2013

Articles:

  1. Interrelationship Between Procalcitonin and Organ Failure in Sepsis. Dimple Anand, Sabri Das, Sumit Ray, Seema Bhargava & Lalit Mohan Srivastava. Ind J Clin Biochem. DOI 10.1007/s12291-013-0326-z. April 2013.
  2. Ultrasound-guided central venous catheter insertion. Vinod K. Singh, Saurabh Mehra, Saurabh Taneja, Ashish Garg, Pradip Dalvi. The Ganga Ram Journal Vol. 3, No. 4, 2013; Pg 221-226.

Abstracts:

  1. A case of acute right heart syndrome – role of inhaled nitric oxide. Ashish Garg, C Vignesh, Vinod K Singh, Sumit Ray. Criticare 2013, 19th Annual conference of Indian Society of Critical Care Medicine, Kolkata, March 2013. Pg29.
  2. A single-center 12-year experience with Percutaneous dilatational tracheostomy in intensive care unit. R. Kumar, V.K. Singh, S.C. Sharma, D. Dhar, B.K. Rao. Criticare 2013, 19th Annual conference of Indian Society of Critical Care Medicine, Kolkata, March 2013. Pg36.

Chapters:

Trauma The current scenario and need for relook at strategies to prevent mortality and morbidity. Dr. Prakash Shastri. Updates on Anaesthesia CME 2013. Pg 40-44

Approach to managing a febrile patient in intensive care unit. Dr. Prakash Shastri. ECAB Clinical Update.  Pg 3-20

 

Forthcoming Events and Conferences (Events Calendar):

  • ACLS Provider Course October 24-25. 2018
  • 6th Annual Critical Care Conference: Dec 22-23, 2018

Downloads:

  • ISCCM IDCC Application Form (www.isccm.org)
  • ISCCM IFCC Application Form (www.isccm.org)
  • ISCCM 2 year post MBBS certificate course in critical care Application Form (www.isccm.org)
  • ICU Observership Application Form
  • Nursing Training Course Application Form (write to the department)
  • ACLS Provider Course Application Form

F.A.Q. s

1. What is meant by Intensive Care Units (ICU)?

Intensive care units (ICU), also called critical care or intensive therapy departments, are sections within a hospital that look after patients whose conditions are life-threatening and need constant, close monitoring and support from equipment and medication to keep normal body functions going..

2. How can I admit my patient in Sir Ganga Ram Hospital ICU?

For admission in Sir Ganga Ram Hospital ICU, you can directly contact the consultant on duty in the ICU either through Sir Ganga Ram Hospital extension number (2090) or ICU Consultant number (9811370004). Consultant of your choice can also make bookings for bed in ICU.

3. What are different training programmes conducted by the department?

The department is presently conducting post-doctoral fellowship programme in critical care medicine for doctors. The centre is recognised by both ISCCM and National Board of Examinations. The department also allows Observership for doctors. There are also training programmes for critical care nurses and technicians.

4. How can I join as Sr. Resident in the department?

Any doctor with post-graduation (in Medicine, Anaesthesia, and Chest Medicine) or 5 years of post MBBS experience in critical care & emergency medicine may apply for Senior Residency. Selection is done after interview subject to availability of vacancy. Please contact the HR Department for information on vacant residency posts in ICU.

5. How can I apply for ISCCM/ DNB Fellowship programmes?

The department conducts interview from applicants for ISCCM Fellowship selection. For application, visit URL: http://www.sgrh.com/dept/criticare/critical.htm#Fellowshipform. For DNB Fellowship, the National Board of Examinations conducts entry level exam for selection and candidates are posted according to merit and choice basis. For detailed information, visit URL: www.natboard.nic.in.

Contact us:

  • ICU consultant: Call 9811370004 or 01142252090 (24 hours, 7 days a week)
  • ICU secretary: Call at 01142252404 for any academic or administrative enquiry during 9 am to 5 pm on working days.
  • E-mail: icuoffice@sgrh.com for academic/ administrative/ ACLS/ Nursing Course
  • Emergency: Call 42251098, 42251099

Services:

Equipment

The Medical/ Surgical ICU is equipped with state of art equipment and cutting edge technology to provide basic and advanced life support, monitoring and drug administration etc. The list of equipment is exhaustive and includes the following types and makes-

A. Organ Support:

  • Ventilatory Support
  • Ventilators- Draeger Evita2 Dura, Evita4 and Savina, Oxylog 3000
  • BIPAP devices- Respironics STD 30 and BIPAP S, Sullivan VPAP II
  • HFOV sensormedics 3100B
  • Nitric Oxide Delivery System
  • ECMO
  • Cardiovascular support
  • Intra aortic balloon pump
  • ECMO
  • Renal support
  • IHD
  • CRRT
  • Peritoneal dialysis
  • Liver support
  • MARS

B. Monitoring:

  • Hemodynamic MonitoringNon invasive:
  • Patient Monitors- Wipro GE Dash 4000, Wipro GE Solar 8000 M, Marquette 3000, Marquette 1000, L&T Stellar
  • Central monitoring stations- Wipro GE Sync Master
  • Pulse oximeters- Novamatrix, Simed, Nellcor Puritan Bennett 190, 195
  • Defibrillators- BPL, Wipro GE Cardioserve
  • Invasive
  • CVP and DBP
  • Vigileo, Flotrac
  • PA Catheter
  • IAP

C. Advanced Diagnostics:

  • USG/ ECHO
  • TEE
  • TEG
  • Video Bronchoscope

D. Others:

  • Infusion syringe pumps- Terumo 523, Terumo 527, JMS SP 500, Top 5100
  • Enteral feeding pumps- Compact
  • Bronchoscope- Olympus BF 40 with camera reorder and projection facilities
  • Patient warming system- Snuggle warm SW 3000, Hot line fluid warmer
  • ABG and electrolyte analyzer- Chiron Diagnostics 850
  • Resuscitation & airway Teaching Learning Simulators- CPR trainer Resusci Anne, Laerdal Intubation trainer, Central & peripheral Vascular access trainer- Laerdal IV Torso, Laerdal Heartsim Interactive ACLS training system
  • Airway devices- Laryngoscopes, tube changers, LMA, Proseal, Fastrach, Combitube, Trachlight, cricothyroidotomy sets, Percutaneous tracheostomy sets.

Services

Procedures and Treatments:

  • Resuscitation and outreach services for ward and emergency room round the clock
  • Advanced Airway management   and Percutaneous tracheostomy
  • Invasive vascular procedure - Central venous line placement ,Arterial line placement, Invasive pulmonary artery catheterization , dialysis catheterization, Temporary pacemaker placement 
  • Hemodynamic monitoring including minimally invasive CO monitoring techniques
  • Synchronized cardio version
  • Continuous vasoactive and antiarrhythmic drug infusions
  • Thrombolytic infusion
  • Haemodialysis
  • Peritoneal dialysis
  • CRRT (24 hours available)
  • MARS
  • Bronchoscopy
  • Ultrasonography
  • TPN
  • Pain relief
  • Arterial blood sampling
  • Nasogastric tube placement
  • Nasojejunal tube placement
  • PEG
  • Lumbar puncture
  • Abdominal paracentesis
  • Thoracentesis
  • ICD tube placement
  • Nutritional planning

High Frequency Oscillatory Ventilation (HFOV) -High frequency oscillatory ventilation (HFOV) is a type of mechanical ventilation used as a rescue therapy in patients with failure of conventional ventilation like severe ARDS or in patients with air leak syndromes like pneumothorax and pulmonary interstitial emphysema (PIE). Two HFOV ventilators (3100 B) were installed in 2011 and is frequently used in management of severe ARDS patients. Additionally, fellows are made familiar with the basics and mechanism of this mode.

Nitric Oxide Delivery System-NOxBOXmobile, Nitric oxide (NO) Delivery system was installed in 2011. This delivers NO gas into the patient breathing circuit with continuous monitoring of the gas concentration. Nitric Oxide selectively dilates blood vessels in only those lung segments that are actively participating in gas exchange (oxygen & carbon dioxide) at the alveolar-capillary level thus improves oxygen levels in the body.

ECMO: The department started offering ECMO as a treatment modality in suitable cases. 4 cases initiated in 2015 for indications airway obstruction due to malignancy, aluminium phosphide poisoning and ARDS.

Percutaneous Tracheostomy (PCT) -Our ICU was one of the first centers in India to perform Percutaneous Tracheostomy (PCT) in 2000. This is a minimally invasive procedure performed at the bedside done under bronchosopic guidance. More than 1500 PCTs have been performed and the same has been presented in many international and national conferences.

Cadaveric Donor Management Program-Sir Ganga Ram Hospital is one of very few centers in the country that has an established state-of-the art facility for transplantation for both, adults and children using cadaveric as well as from living donors. Under the program, a protocolised approach for management of the cadaveric donors is in place in the ICU.

Renal Replacement Therapy (RRT) -Round the clock, in house, Renal Replacement Therapy (RRT) is available in the ICU.

RRT facilities available include Intermittent Hemodialysis (IHD), Continuous Renal Replacement Therapy (CRRT) and Hybrid Therapy like Sustained Low Efficiency Dialysis (SLED).

Ultrasonography (USG)/ Echocardiography (ECHO) -Sonography has evolved to become one of the most versatile modalities for diagnosing and guiding treatment of critically ill patients. It consists of both cardiac (Echocardiography) and non-cardiac (lung, abdominal and vascular) ultrasound. The ability to assess hemodynamics  and volume status non-invasively is immensely useful in the management of critically ill patients.

Point-of-care ultrasound applications such as lung ultrasound are gradually replacing traditional imaging modalities (i.e., chest X-rays), while the use of ultrasound for procedure guidance has been shown to reduce complications and thus to increase patients’ safety.

Sonography is also used in Focussed Assessment with sonography in trauma (FAST) in critically ill trauma patients to detect intra-abdominal injuries.

Bronchoscopy-Flexible Fiberoptic bronchoscopy has become an important diagnostic and therapeutic tool for the management of patients admitted in intensive care unit. Involvement of the respiratory system is common, whatever the underlying cause of disease that precipitates the critical illness. The safety and usefulness of bronchoscopy in well trained hands with appropriate precautions have led to its increasing use even in unstable and mechanically ventilated patients.  

Patient retrieval:

Air Ambulance

This service was first started in 1992 by our ICU consultant Dr SC Sharma and till date more than 300 patients have been transported both nationally and internationally by air ambulance as well as in commercial flights. The air ambulances are fully equipped with life support systems, ventilators and monitors and a trained doctor and technician accompanies the patient during transportation.

Ground Ambulance

The ICU staff undertakes the patient retrieval services round the clock. For this the department has an intensive care/cardiac ambulance fitted with Multichannel Patient Monitor, Bird Avian transport ventilator, medical gases and vacuum, infusion pumps, defibrillator, pacemaker, all emergency drugs and instrumentation. 

Emergency Services:

The hospital runs a fully equipped Emergency Unit runs round the clock.Annually, on an average 50000patients attend the emergency room. With a built up area of 4000 sq feet , the emergency unit has triage, consultation and examination areas, observation ward, minor OT, plaster and dressing rooms, ECG room, resuscitation room and doctors and staff rooms and patient waiting areas. There are13 patient beds cum trolley bay. All patient beds have piped gases, vacuum, Multichannel cardiac monitors from GE. The unit has infusion pumps, defibrillators, pace maker, ICU and transport ventilators, patient and fluid warmers and  trauma management equipment. The emergency is also the nodal point of disaster management of the hospital. It is fully equipped to handle any type of emergency and resuscitation round the clock. Registrars from Medical/ Surgical ICU are posted in emergency by rotation. Consultants of Critical Care and Emergency Medicine Department are available 24 hours, seven days a week in the emergency.

The emergency unit is strategically located near the entrance of the hospital and next to the imaging department.

Keywords:

  1. ICU, Intensive Care Unit
  2. Critical Care Medicine
  3. Intensive Care medicine
  4. Emergency Medicine
  5. Nitric Oxide
  6. HFOV, High Frequency Oscillatory Ventilation
  7. PCT, Percutaneous Tracheostomy
  8. USG in ICU, Ultrasound in ICU
  9. ITC, AHA, BLS ACLS Provider, BLS Instructor, ACLS Instructor,ACLS, Advanced Cardiac Life Support;BLS, Basic Life Support
  10. ECHO IN ICU, Echocardiography in ICU
  11. Air Ambulance
  12. Certificate Course in Nursing
  13. DNB Fellowship
  14. ISCCM Diploma
  15. ISCCM fellowship
  16. Emergency Care
  17. Cadaveric Donor
  18. Ciaglia, Griggs
  19. CRRT, Continuous Renal Replacement Therapy
  20. Bronchoscopy in ICU
  21. V V ECMO, VA ECMO, ECMO unit, ECMO facility, ECMO in Sir Ganga Ram Hospital, Swine flu, H1N1, Alphos poisoning,ECMO

CASES:

A total of 2143 patients were admitted in the ICU in 2017. Their admissions according to diagnosis and another chart showing incidence of ICU associated infection is as follows:

 

 

graph

graph

graph

APACHE-II Score Correlation with Mortality

Objective:

To correlate the APACHE-II scoring system with mortality and length of stay in ICU.

Place and Duration of Study:

The Intensive Care Unit (ICU) of SGRH for the full year.

Methodology:

All adult patients who were admitted in the ICU were included. APACHE-II score was calculated with worst values of first 24 hours (at the completion of 24 hours). Patients who were discharged alive from the ICU or died after first 24 hours were noted as the primary outcome measurement. Patients who died or discharged within 24 hours were not included

Observations:

Apache II Score No. Of Patients Survivors Non-Survivors Observed Mortality Predicted Mortality #
3-10 159 152 7 4.40 0
11-20 386 316 70 18.13 15-25
21-30 253 179 74 29.25 40-55
31-40 120 64 56 46.67 75 -85
>40 21 9 12 57.14 85-100

Results:

In the score category 11-20, 316 out of 386 patients (81.8%) were discharged and only 70 (19.2%) died. Out of those 780 patients whose APACHE-II score was found in high category 31 - 40, 56 (46.67%) deaths were observed.

On this parameter our ICU has been doing well for last 6 Years.

Conclusion:

The APACHE-II scoring system was found useful for classifying patients according to their disease severity. There was an relationship between the high score and higher chances of mortality.

#National Center for Emergency Medicine Informatics Data

Correlation of APACHE II, Duration of Stay and Mortality

Apache Scoring Total No. Of Patients Survivor Non-Survivor Observed Mortality Predicted Mortality
  No. Of Patients Average Stay no. of days No. of Patients; Average Stay no. of days No. of Patients Average Stay no. of days    
3-10 159 5.86 152 5.75 7 8.14 4.40 0
11-20 386 8.20 316 8.01 70 9.06 18.13 15-25
21-30 253 8.96 179 8.96 74 8.97 29.25 40-55
31-40 120 7.38 64 7.95 56 6.73 46.67 75-85
>40 21 6.90 9 10.33 12 4.33 57.14 85-100

Majority of patients with APACHE < 20 survived. ALOS in survivors was much less than non-survivors. In case of severely sick patients, i.e. APACHE > 30; the observed mortality was much less than expected mortality.

Correlation of APACHE II, Age and Mortality

Apache Scoring Total No. Of Patients Survivor Non-Survivor Observed Mortality Predicted Mortality
  No. Of Patients Average Age No. of Patients Average Age No. of Patients Average Age    
3-10 159 47.08 152 47.22 7 44.14 4.40 0
11-20 386 54.98 316 55.06 70 54.62 18.13 15-25
21-30 253 56.98 179 57.74 74 55.16 29.25 40-55
31-40 120 58.46 64 58.64 56 58.26 46.67 75 -85
>40 21 59.95 9 50.88 12 66.75 57.14 85-100

Except for APACHE > 40; the average age of was similar in survivors and non-survivors group.

Correlation of APACHE II, Age, Gender and Mortality

Age (In Years) Female
  APACHE Total Patients Non-Survivor Observed Mortality
  Lowest Highest Average      
16-24 4 44 16.61 18 4 22.22
25-35 1 37 15.96 51 7 13.73
36-45 5 36 18.97 38 6 15.79
46-55 5 38 19.78 55 11 20.00
56-65 4 45 21.44 84 23 27.38
66-75 7 48 19.75 48 9 18.75
>76 4 33 18.05 32 7 21.88
Total       326 67 20.55

 

Age (In Years) Male
  APACHE Total Patients Non-Survivor Observed Mortality %
  Lowest Highest Average      
16-24 0 32 14.21 37 2 5.41
25-35 0 46 15.39 66 18 27.27
36-45 2 76 17.51 86 18 20.93
46-55 6 43 20.5 106 31 29.25
56-65 3 47 21.15 143 41 28.67
66-75 5 44 21.92 130 31 23.85
>76 8 46 22.49 59 12 20.34
Total       627 153 24.40

The number of male admissions is almost the double of the number of female admissions. The observed mortality is slightly higher in males (24.4%) as compared to females (20.55%); especially owing to the increased mortality in 25-55 age group.

SAPS-II Score Correlation with Mortality

Objective:

To correlate the SAPS-II score system with mortality in ICU.

Place and Duration of Study:

The Intensive Care Unit (ICU) of SGRH for the full year.

Methodology:

All adult patients who were admitted in the ICU were included. SAPS-II score was calculated with worst values of first 24 hours (at the completion of 24 hours) Patients who were discharged alive from the ICU or died after first 24 hours were noted as the primary outcome measurement. Patients who died or discharged within 24 hours were not included

Observations:

SAPS II Scoring Total no. of patients Survivor Non-Survivor Observed Mortality
3-10 14 14 0 0.00
11-20 107 103 4 3.74
21-30 183 166 17 9.29
31-40 176 143 33 18.75
41-50 158 130 28 17.72
51-60 122 88 34 27.87
61-80 131 64 67 51.15
>80 47 15 32 68.09
Total 938 723 215 22.92

Conclusion:

The SAPS-II scoring system was found useful for classifying patients according to their disease severity. There was a relationship between the high score and higher chances of mortality.

Correlation of SAPS II, Duration of Stay and Mortality

SAPS II Scoring Total no. of patients Survivor Non-Survivor Observed
    Average stay Average stay Mortality
3-10 14 3.5 0 0.00
11-20 107 5.46 7.5 3.74
21-30 183 7.4 4.88 9.29
31-40 176 8.32 12.33 18.75
41-50 158 7.66 10.55 17.72
51-60 122 9.48 9.85 27.87
61-80 131 9.54 7.08 51.15
>80 47 8 4.71 68.09
Total 938 7.73 8.25 22.92

Correlation of SAPS II, Age and Mortality

SAPS II Scoring Total no. of patients Survivor; Non-Survivor Observed Mortality
  No. Of Patients Average Age No. of Patients; Average Age No. of Patients Average Age  
3-10 14 37.5 14 37.5 0 0 0.00
11-20 107 41.28 103 41.37 4 39 3.738
21-30 183 51.45 166 51.71 17 49 9.29
31-40 176 56.96 143 57.47 33 54.75 18.75
41-50 158 58.58 130 58.25 28 60.1 17.72
51-60 122 57.64 88 59.19 34 53.64 27.87
61-80 131 56.79 64 58.71 67 54.95 51.15
>80 47 63.97 15 60.4 32 65.65 68.09
Total 938 54.5 723 53.99 215 56.21 22.92