Mohd Saif Khan

King Hamad University Hospital | KHUH · Critical Care Medicine

This study challenged the standard fasting protocol for tracheal extubation by investigating the role of gastric ultrasound in critically ill patients. Among 60 patients, 40% had at-risk stomachs, with no significant difference between fasted and non fasted groups. Gastric volumes were also similar.

Introduction: Fluid administration is a commonly practiced intervention in the intensive care unit (ICU) with normal saline being the preferred fluid. We sought to understand the current practice of fluid administration and choice of fluids in Indian ICUs and its effect on renal outcomes. Materials and methods: The Indian Society of Critical Care...

Background The pathogenesis of COVID-19 includes an integrated immune-inflammatory response. Modulation of host immune responses against the SARS-CoV-2 virus might be effective therapeutic management. Various Unani formulations have an immunomodulatory effect. Objective To explore the immunomodulatory effect and safety of Unani polyherbal drug (Ti...

Background Peripheral venous access may become sometimes challenging in critically ill patients due to various reasons. Cannulation of deep upper limb veins using a long peripheral venous catheter (L-PVC) may be feasible under ultrasound (USG) guidance in such patients. Aim: To test the efficacy and safety of L-PVC. The main objective of this study...

Background In the COVID-STEROID 2 trial there was suggestion of heterogeneity of treatment effects (HTE) between patients enrolled from Europe vs. India on the primary outcome. Whether there was HTE for the remaining patient-centred outcomes is unclear. Methods In this post hoc analysis of the COVID-STEROID 2 trial, which compared 12 mg vs. 6 mg d...

Background Echocardiography has become an integral part of the management of critically ill patients. It helps to diagnose and treat various conditions. COVID-19 patients can develop cardiac dysfunction. We planned to study the echocardiographic parameters in COVID-19 patients. Methods We conducted a prospective observational multicenter study aft...

A 36-year-old male was brought to the emergency department after he was found hanging from a ceiling fan, with one leg on a stool and the other hanging free. The duration of the hanging was not known, but the time to hospital presentation was about 90 min. He was a known case of depression. On arrival, he was drowsy, restless, with saliva drooling...

Background Emergency authorization and approval were given for the coronavirus disease-19 (COVID-19) vaccines. The efficacy reported after phase III trials were 70.4% and 78% for Covishield and Covaxin, respectively. In this study, we aim to analyze the risk factors, which were associated with mortality in critically ill COVID-19-vaccinated patient...

Inosine pranobex (IP), an immunomodulatory agent, is used in the treatment of various viral infections. The results of a phase 3 randomized controlled trial are reported, evaluating the efficacy and safety of IP in the treatment of mild to moderate COVID‐19. It includes 416 symptomatic patients with confirmed SARS‐CoV‐2 infection. In addition to a...

The domain of critical care is gradually expanding its horizon associating many specialties and sub/super�specialties from medicine and surgical fields. The content of this book has been divided into various sections, with a focus on the main theme which remains clinically cohesive. The various sections include General Critical Care, Respiratory Cr...

Background: Coronavirus disease-2019 (COVID-19) is prone to acute hypoxemic respiratory failure (AHRF). Because tracheal intubation is associated with a higher risk of death in these patients, AHRF employs high-flow nasal oxygen therapy (HFNOT). The goal of this study was to assess the effect of HFNOT on oxygenation status as well as different pre...

Purpose: We assessed long-term outcomes of dexamethasone 12 mg versus 6 mg given daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia. Methods: We assessed 180-day mortality and health-related quality of life (HRQoL) using EuroQoL (EQ)-5D-5L index values and EQ visual analogue scale (VAS) in the inte...

Aim and background Pre-extubation fasting and the evacuation of gastric contents using a nasogastric (NG) tube is often practiced in critically ill patients to protect the lungs from the risk of aspiration. Gastric ultrasound (GUS) is an excellent bedside modality to assess the gastric volume and content before planned tracheal extubation and may p...

and written informed consent, a prospective observational study was performed over a period of 3 months at the COVID intensive care unit of a government institute-hospital in east India. Adult patients (aged >18 years) with confirmed COVID-positive status (SARS-CoV-2 detected in nasopharyngeal swab by real-time reverse transcription-polymerase chai...

So far, 5 sets of guidelines have been published in last 2 decades time. It all started in 2004, when Surviving sepsis campaign published the guidelines for the management of severe sepsis and septic shock. In 2008 second came, in 2012 3rd in 2016 4th and now we have the latest 5th version of it. Every time, it was improved, refined and crystallize...

Background and aim The management of the worldwide spreading COVID-19 consists of amelioration of its symptoms but no cure is yet available. Herbal medicines supplemented with the Western medicine have been applied for COVID-19 treatment in India, China, Iran, and other countries. This systematic review and meta-analysis of RCTs evaluates the effec...

With the expansion of a growing number of dedicated, state of the art oncology centres across the world, we have seen parallel enthusiasm in cutting edge critical care services provided to oncology patients. This has led to the birth of a new subspecialty of medicine termed as “Onco-critical care”. Being a relatively new subspecialty, onco-critical...

PurposeWe compared dexamethasone 12 versus 6 mg daily for up to 10 days in patients with coronavirus disease 2019 (COVID-19) and severe hypoxaemia in the international, randomised, blinded COVID STEROID 2 trial. In the primary, conventional analyses, the predefined statistical significance thresholds were not reached. We conducted a pre-planned Bay...

Background Global pandemic of COVID 19 has affected many countries. The initial epicenter was in China with gradual spread to various countries including India. For a developing country like India with limited resources and high population, it is worthwhile to know how these patients requiring intensive care admission were managed and the outcome o...

Importance: A daily dose with 6 mg of dexamethasone is recommended for up to 10 days in patients with severe and critical COVID-19, but a higher dose may benefit those with more severe disease. Objective: To assess the effects of 12 mg/d vs 6 mg/d of dexamethasone in patients with COVID-19 and severe hypoxemia. Design, setting, and participants...

As you all are aware of the fact that Invasive arterial pressure monitoring (IABP), using arterial catheterization, is one of the commonly performed bedside procedures in the ICU during shock, when noninvasive blood pressure monitoring becomes unreliable. Today, I will describe various techniques of cannulation specially the ultrasound technique w...

For an intensive care specialist this topic may be easy to explain for many but for beginners, this could be still confusion to differentiate the two…Preload and preload responsiveness. Classically, preload has been defined as the maximum degree of myocardial fiber stretch or tension before the start of ventricular contraction, and is determined by...

This presentation was part of a workshop on Mechanical ventilation organized by the Department of Anesthesiology, Institute of Medical Sciences, Banaras Hindu Universityat the conference titled (UPISACON-2021).

Tracheostomy decannulation is a fundamental step towards making patients free from mechanical ventilation. However, regardless of its apparent significance, there is no generally acknowledged convention for this essential change. We report the use of HFNC in the decannulation of a tracheostomized patient whose weaning was difficult.

Background: Acute hypoxemic respiratory failure (AHRF) is common in COVID-19. Tracheal intubation in such patients is fraught with higher mortality, therefore, high flow nasal oxygen therapy (HFNOT) is being used in AHRF. In this study, we aimed to determine the impact of HFNOT on oxygenation status and also various predictors of HFNOT failure. Met...

Epidemiology and outcome of trauma victims admitted in trauma centers of tertiary care hospitals – A multicentric study in India: A comment

Background Coronavirus disease 2019 (COVID‐19) can lead to severe hypoxic respiratory failure and death. Corticosteroids decrease mortality in severely or critically ill patients with COVID‐19. However, the optimal dose remains unresolved. The ongoing randomised COVID STEROID 2 trial investigates the effects of higher vs. lower doses of dexamethaso...

Background The coronavirus disease 2019 (COVID‐19) pandemic has resulted in millions of deaths and overburdened healthcare systems worldwide. Systemic low‐dose corticosteroids have proven clinical benefit in patients with severe COVID‐19. Higher doses of corticosteroids are used in other inflammatory lung diseases and may offer additional clinical...

Hemodialysis catheters are commonly placed in the major central vein for the purpose of dialysis. Coiling or looping of guidewire is a rare but reported complication of a central vascular catheter insertion. We report a case in which we encountered a rare complication of looping of the guidewire used for dialysis catheter placement and how we corre...

Inadvertent fitting of the disposable syringe may damage the injection port of the central venous catheter; effort during flushing might have contributed to the damage and may result in an outflow of medication. There should be a gentle application of syringe in the injection port of the CVC and also we should look for any leakage during drug admin...

To determine the administration of bronchodilators by a metered-dose inhaler with holding chamber is as efficacious as the administration by a nebulizer, although metered-dose inhaler with holding chamber is always superior to a metered-dose inhaler.

Many health care workers are either on duties at corona centre or resting in quarantine period and they are unable to attend the training program. In presentation , I would like to highlight few important aspects of managing COVID-19 patients with severe and critical illness.

A 65-year-old diabetic male patient was admitted to the ICU with a right lobar pneumonia. He was started on appropriate antibiotic therapy. He was receiving oxygen by a mask at 8 L/min and maintaining an SpO 2 of 94%. His blood pressure was being monitored every 10 min using noninvasive blood pressure measurement. By evening his blood pressure star...

Patients treated with catecholamines for shock often develop tachyphylaxis and direct cardiotoxicity. If you are not able to maintain BP in a septic patients, death is eminent. Potent vasopressor Long back identified (1930s) and used (1960)* Unique mechanism of action Recent interest erupted due to unfavorable toxicities of catecholamines Catechola...

Understanding of Molecular pathobiology and immunology of sepsis has evolved in last decade. Sepsis is not just merely hyperimmune response as has been thought over decades, but far more nuanced and complex interplay between the infectious agent and host. Organ and tissue level There is impaired response of microcirculation to local stimulation. En...

Delirium is an acute onset (hours to days) alteration in attention and awareness with simultaneous change in cognition which has a fluctuating pattern (Table 1).1 It is as common as 80% in mechanically ventilated ICU patients, associated with higher mortality, prolonged ICU stay and post-ICU cognitive impairment. Delirium may belong to any of follo...

Introduction: Ultrasound guidance may improve the success rate of vascular cannulation. There is lack of data regarding the utility of USG guided arterial cannulation in critically ill patients in shock. We aim to compare the impact of using real time ultrasound guidance versus palpation method in achieving arterial catheterization in critically il...

Peripheral venous access is a routine procedure in emergency and critical care areas. However, not all procedures are successful due to altered venous anatomy, varied patient characteristics and blind nature of procedure. Sometimes, this seemingly easy procedure may become difficult, time-consuming, and exasperating. Needle punctures in the process...

Introduction Predictive accuracy of severity scoring systems in Indian ICUs does not fit well owing to differences in case mix from the west. We hypothesized that 24 h is too early to predict the outcome and that the predictive accuracy of these scores might be better at 48 h of ICU admission. Objective The aim of this study was to evaluate and com...

Critically ill patients are at increased risk of developing nosocomial infection. Hospitals in developing countries are facing higher incidence of this problem. The aim of this study was to assess the epidemiology of infections in hospital. A retrospective study was conducted at CCU of a tertiary care teaching hospital in South India. All patients...

Background: Mini- Broncho-Alveolar Lavage (m-BAL) is a blind technique which is reported to be as good as Bronchoscopic-BAL (B-BAL) in terms of safety and microbiological yield. The m-BAL catheter is not always available; hence, we devised an alternative technique, the modified m-BAL. Objective of this study was to compare diagnostic yield, duratio...

INTRODUCTION. Limited data is available regarding the assessment of severity of illness scores in Indian patients. OBJECTIVE. To compare the ability of APACHE II, SAPS II, and SOFA scores to predict 28-day mortality. METHODS. This prospective study was conducted in adult ICU patients with expected LOS [48 h and included medical and surgical patient...

Context: Midazolam and propofol are effective sedatives for use in upper gastrointestinal endoscopy (UGIE); however, their utility is limited when used alone. In this regard, dexmedetomidine seems to be a promising sedative. Aims: The aim was to compare the hemodynamic effects and sedation efficacy of these drugs in patients undergoing elective dia...