MESSAGES Intensive care had its beginning during the Polio epidemic of 1952 at Copenhagen when patients were shifted to a common location for purpose of ventilation. Since Dr. NALLA G PALANISWAMI then we have come a long way. However Intensive care management of Pulmonary Chairman problems still occupies an important position in the management of Critically ill patients. Keeping this in mind, the department of Critical Care Medicine is organising an update in Pulmonary Critical Care on the November 8th & 9th, 2014. During the Programme, various common pulmonary problems requiring intensive care management will be discussed and current lines of management as well as recent advances will be deliberated. I wish the organizing committee all the very best in order to make this endeavor a grand success. Greetings It’s my pleasure to invite you all for the 9th ICU Update. We had an overwhelming response and very good feedback from participants of previous CME’s, which kept our enthusiasm to conduct regular CMEs for past 8 years. Critically ill patients are admitted with Pulmonary problems (or) develop major Pulmonary problems like pneumonia, Pulmonary Embolism and ARDS during their ICU stay. Keeping this in mind we have kept Pulmonary Critical Care as theme for this year ICU Update. November 8th we have a CME & Workshop for Paramedics focusing on how to take care of patients on Mechanical Ventilation. It focuses on various basic issues like Basic Ventilator Dr M N SIVAKUMAR Organising Secretary settings, Monitoring of patients on Mechanical Ventilation, Suctioning, Humidification, Aerosol therapy, Nutrition and Weaning. November 9th we have a CME Programme on Pulmonary Critical Care. Course objective is to review Critical Care subjects of major Clinical importance together with current approach to diagnosis and management. The topics include, Interpretation of Chest X-Ray, Arterial Blood Gas analysis, Respiratory Failure, COPD, ARDS, Pulmonary Embolism, Ventilator Associated Pneumonia and difficult weaning. Evidence based presentations are designed to inform and inspire participants to improve the newly acquired knowledge into their daily practice. It will be very useful to Intensivists, Pulmonologists, Anesthesiologists, Post Graduates and Paramedics. Looking forward to see at the ICU Update 2014. ORGANISING TEAM From left to right Dr Gopinathan T, Dr Sureshkumar T, Dr Sivakumar M N, Dr Pattabiraman V R, Dr Selvarajan N, Dr Arjun srinivasan, Dr Senthil Kumar R S, Dr Mahadevan S, Dr Nandhakumar V Dr Kumaran V Dr Murugan A N Dean Medical Director MEMBERS OF ORGANISING COMMITTEE Dr Nandakumar P DA, DNB, IDCCM., Dr Lakshmikanth Charan S MD,IDCCM., Senior ICU Registrar, KMCH, CBE Senior ICU Registrar, KMCH, CBE Dr Selvakumar M MBBS, DNB.,PDFICM., Dr Yuvaraj S DA,IDCCM, Senior ICU Registrar, KMCH, CBE Senior ICU Registrar, KMCH, CBE Dr Saraswathi T DA, EDIC., Dr Parvathy Narayanan M MD, IDCCM., Senior ICU Registrar, KMCH, CBE Senior ICU Registrar, KMCH, CBE Dr Nandhini T MBBS,PDCCM., Dr Saravin S N ICU Registrar, KMCH, CBE ICU Registrar, KMCH, CBE Dr Chaitanya J S K MBBS, DNB., Dr Murugaraj S MBBS, DNB., ICU Registrar, KMCH, CBE ICU Registrar, KMCH, CBE MD., SUPPORTIVE STAFF Nurses - Thamarai Selvi, Shanmuga Priya, Lakshmi, Yuvaraj & Chitra Devi Respiratory Therapist - Radhakrishnan, Vijay Saravanaraj, Satheesh, Kannan, Muthu & Jayakumar Clinical Pharmacist - Mohamed Hisham Secretary - Revathy, Lalitha, Shanmuga Priya & Saroja DAY - 1 November 8th 2014 SESSION I 1. Basics of Mechanical Ventilation a) Indications for Mechanical Ventilation b) What modes to choose? c) Initial Settings of Mechanical Ventilation 2. Monitoring of Patients on Mechanical Ventilation a) Hemodynamic Monitoring b) Respiratory - Spo2, ETCo2, CXR & ABG c) Ventilator Graphics 3. Troubleshooting of Patients on Mechanical Ventilation a) High or Low Peak Airway Pressure b) Low Tidal Volume c) What to accept & When to React? 4. Care of Patients on Mechanical Ventilation Part - 1 a) Humidification b) Suctioning c) Aerosol Therapy CME & WORKSHOP ON CARE OF PATIENTS ON MECHANICAL VENTILATION SESSION 2 5. Care of Patients on Mechanical Ventilation Part -2 a) Ventilator Care Bundle b) Prevention of Ventilator Associated Pneumonia (VAP) c) Nutrition 6. Weaning of Patients on Mechanical Ventilation a) Weaning Modes & Criteria b) Protocolized Weaning c) Difficult weaning 7. Non-Invasive Ventilation a) Indication, Modes b) Settings & Monitoring c) Troubleshooting Workshop Limited Registrations Only DAY - 2 November 9th 2014 CME on PULMONARY CRITICAL CARE SESSION I 1. Respiratory failure - Evaluation & Management a) Physiology, Types b) Bedside Diagnosis c) Evaluation & Management 2. Interpretation of Arterial Blood Gas & Chest X-RAY a) 7 Step approach to ABG b) Interpretation of CXR - Systematic approach c) Are daily Chest X-Ray necessary in ICU? 3. Monitoring of Patient on Mechanical Ventilation a) Hemodynamics b) Spo2, ETCo2, Airway Pressure c) Ventilator Graphics SESSION 2 4. Community Acquired Pneumonia (CAP) a) Etiology - Bacterial, Viral, Fungal & Atypical organisms b) Diagnosis - Role of Biomarkers c) Empirical Therapy 5. Massive Pulmonary Embolism - Diagnosis & Management a) Algorithm for Diagnosis b) Indication for Thrombolysis c) Anticoagulation & IVC Filter 6. Ventilator Associated Pneumonia (VAP) - Diagnosis, Management & Prevention a) Diagnosis - BAL Vs ET Culture, Biomarkers b) Management - Drugs, Combination Therapy, Aerosolized Antibiotics & Duration of Therapy c) Prevention - Subglottic Tubes, Role of Closed Suction, HME Vs Heated Humidifier SESSION 3 7. Acute Severe Asthma & COPD a) Bronchodilator Therapy - Dose, When and What to use? b) Steroids - Dose, route and duration c) Rescue Therapy - Megnesium, Heliox 8. How do you safely ventilate an Asthma & COPD Patients? a) Role of NIV b) Initial Settings - TV, RR, I:E Ratio, PEEP c) How to Monitor & Treat AUTOPEEP, Aerosol Delivery? 9. ARDS Management - What’s New? a) Ventilatory & Non-Ventilatory b) Lung Protective Ventilation - TV, Plateau Pressure, PEEP - How to Choose? c) Prone Ventilation, HFO, ECMO. d) Steroids & Immuno Nutrients - Is it Useful? SESSION 4 10. Supportive Care of Patients on Mechanical Ventilation a) Humidification, Suctioning & Aerosol Therapy b) Sedation, Nutrition, Positioning & Oral Care 11. Approach to Difficult Weaning a) Cause for Difficult Weaning, Evaluation b) Protocolized Approach 12. Non-Invasive Ventilation a) Modes, Settings, Interface selection b) Indications & Contraindications c) Monitoring & Troubleshooting This CME to be Accredited with Dr MGR MEDICAL UNIVERSITY FACULTY Dr. RAM E RAJAGOPALAN Dr. BABU K ABRAHAM Head - Department of Critical Care Medicine Sr. Consultant Critical Care Physician SMF, Chennai. Apollo Hospitals, Chennai. Dr. VIVEK P Dr. BINILA CHACKO Consultant Intensivist & Pulmonologist Associate Professor, Department of Critical Care PRS Hospitals, Thiruvananthapuram. CMC Vellore. Dr. SIVAKUMAR M N Dr. ARJUN SRINIVASAN Head - Department of Critical Care Medicine Consultant Interventional Pulmonologist KMCH, CBE KMCH, CBE Dr. GOPINATHAN T Consultant Intensivist KMCH, CBE ABOUT ICU KMCH ICU being a referral centre to all the ICUs in the region, is one of the busiest ICUs in South India. It has dedicated ICUs to treat Surgical, Trauma, Medical, Coronary and Neuro patients with the total bed strength of 100. As Intensive Care Team our primary responsibility is to provide safe, appropriate, high quality care and comfort to all patients with any form of Critical Illness. Standardized and Protocolized care has major impact on outcome measures like mortality, nosocomial infections and length of stay. INFRASTRUCTURE ICUs have got state of the art technology that enables us to give high quality patient care. Equipment’s include Multiparameter monitors, Invasive and Noninvasive Ventilators, Intra Aortic Balloon Pump (IABP), Syringe Pumps, Infusion Pumps, Sequential Compression Devices (SCD), Patient Warming System, Fluid warmers and motorized cot. Portable X-RAY, Ultrasound and ECHO machines are exclusively available for ICU. Hemodialysis can be performed in all the ICUs. Cardiac output monitoring, ICP monitoring, Continuous Renal Replacement Therapy (CRRT) & Extra Corporeal Membranous Oxygenation (ECMO) are some of the recent additions. We also have dedicated transport monitor, Ventilator and well-equipped critical care ambulance for transport of Critically ill. ICUs are fully backed by good Biochemistry, Microbiology, Nutrition and Radiology services round the clock. Intensivists ICU Doctors Team PERSONNEL ICUs are managed by formally trained Intensivists and are well supported by a team of Registrars and Junior Medical Officers. Most of our ICU consultants come from Anesthesia background and subsequently specialized in Critical Care. It has 24 hours consultant backup from other specialities. Other members of the multidisciplinary team include Clinical Pharmacist, Respiratory Therapists, Critical Care Nurses, Nurse Educators, Department Secretaries, Physiotherapists, Nutritionists, Social Workers and Support staffs. RT Team Sr. Nursing Team & Clinical Pharmacist Dept Secretaries PATIENT CARE KMCH ICU has been providing state of the art care for the last 25 years. Tasks are carried out with precision, Synchronization and Co-ordination by a multidisciplinary team in all ICUs with unwavering commitment and teamwork. Nursing care is focussed to meet the Psychological, Physical & Emotional needs of the patient. Cases handled include Acute Coronary Syndrome, Polytrauma, ARDS, Acute Stroke, Poisoning, Envenomation, Acute Kidney Injury & Severe Sepsis. We are one of the referral centres for complex Polytrauma, Sepsis with multi organ failure and ARDS. Hypothermia for Cardiac arrest survivors, Good Primary PCI Programme, Stroke Thrombolysis, ICP Monitoring in severe TBI, Multi organ support in severe sepsis, ECMO and Prone ventilation for ARDS are some of our best practices. EDUCATION AND RESEARCH KMCH ICU has strong emphasis on teaching and Research. Our ICU is a premier training center for Critical Care and Respiratory therapy. Currently we have four Training programmes in Critical Care. 1. One year fellowship by Indian Society of Critical Care Medicine 2. One year fellowship in Critical Care by Dr.M.G.R Medical University 3. BSc Respiratory therapy by Dr.M.G.R Medical University 4. Post Graduate Diploma in Critical Care Nursing by Christian Medical Association As a tertiary referral ICU we provide state of the art care with the help of very good professionals and infrastructure. At the same time we are very cost effective, ethical and evidence based in our management. ICU TEAM Team Work Works For more details please visit www.kmchicu.com KOVAI MEDICAL CENTER AND HOSPITAL Excellence in Healthcare Avanashi Road, Coimbatore – 641014. Ph: 0422 – 4323800, 3083800 Email : [email protected], Webste : www.kmchhospitals.com CIN: L85110TZ1985PLC001659