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.
1980: Critical care unit functioning under the dept. of Anaesthesia.
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
- 39th 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 Conferen ce.
- 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.
Consultants and Staff:
Dr. B. K. Rao (Chairman, HOD)
Dr. Sumit Ray (Vice-Chairman)
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 (Audit Co-ordinator, ACLS course Co-ordinator)
Dr. Dinesh Kumar Rawat ("Acute Bedside Care Service" Co-ordinator)
Dr. Ashutosh Taneja (Quality and Safety Co-ordinator)
Dr. Niraj Tyagi (Nursing Training Co-ordinator)
Dr. Saurabh Taneja (Acute bedside care Co-ordinator)
Current DNB Fellows:
- Dr. Prasoon Gupta
- Dr. Sunny Kumar
- Dr. Gaurav Arya
- Dr. Arijit Samanta
- Dr. Monica Jindal
- Dr. Vitrag H. Shah
- Dr. Sudhanshu Shekhar
Current IDCCM Candidates:
- Dr. Anand Kr. Jain
- Dr. Saurav Sutradhar
- Dr. Yatendra Kumar Gupta
- Dr. Mayank Gaur
- Dr. Abhinav Arora
- Dr. Sagar Varshney
- Dr. Dharamveer Chandrakar
- Dr. Rijusree Sharma
Current IFCCM Candidates:
- Dr. Alok Kumar
- Dr. Samir Malik
Medical/Surgical ICU Head-Nurse:
Mrs. Moly Cherian (Diploma in General Nursing, Diploma in Midwifery)
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
Medical / Surgical ICU Secretary:
Mr. Kamleshwar Grover
Medical Data Operators:
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 (3 seats biannually)
b. Indian Fellowship in Critical Care (3 seats annually)
c. Two year post MBBS Critical Care Medicine Certificate cours (3 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 27 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
- Implementation of early goal-directed therapy and the surviving sepsis campaign resuscitation bundle in Asia. Sungwon Na,Win Sen Kuan,Malcolm Mahadevan,Chih-Huang Li, Pinak Shrikhande,Sumit Ray,Michael Batech,H. Bryant Nguyen,andfor the ATLAS Investigators. Int J Qual Health Care(2012)24(5):452-462.
- The prognostic value of hypocholesterolemia in sepsis. Sabari Das, Seema Bhargava, Anjali Manocha, Mamta Kankra, Sumit Ray and Lalit Mohan Srivastava. Asian J Pharm Biol Res. Jan-Mar 2011, Vol. 1(1):41-46.
- A controlled study to analyze psychological aspects and psychiatric morbidity amongst people who attempt suicide. Grover Ridhima, Wadhawan J.M., Anand Arti, Rao B.K. Delhi Psychiatry Journal 2011; 14(1):9-18.
- Do biochemical markers predict mortality in severe sepsis or septic shock? Saurabh Taneja, Dhiraj Ambastha, Kumar Ankur, Sauren Panja, Niraj Tyagi, Sumit Ray. The Ganga Ram Journal 2011; 1:53–56.
- Outcome effectiveness of the severe sepsis resuscitation bundle with addition of lactate clearance as a bundle item: a multi-national evaluation. H Bryant Nguyen, Win Sen Kuan, Michael Batech, Pinak Shrikhande, Malcolm Mahadevan, Chih-Huang Li, Sumit Ray and Anna Dengel. Critical Care 2011, 15:R229.
- Percutaneous Dilatational Tracheostomy (PDT). Vinod K. Singh, S.C. Sharma, Ashok Anand, Ashutosh Taneja, Sumit Ray, B.K. Rao. The Ganga Ram Journal 2011; 1:349-352
- ‘Diurnal variation in hand hygiene compliance in a tertiary level multidisciplinary intensive care unit’. Sandeep Sahay, Sauren Panja, Sumit Ray, B.K. Rao. AJIC: American Journal of Infection Control Volume 38, Issue 7, Pages 535-539, September 2010.
- ‘Percutaneous Tracheostomy in patients with coagulopathy’. S.C. Sharma*, V.K. Singh, A. Anand, B.K. Rao. Intensive Care Medicine, 9-13 October 2010. P – S163.
a) Risk factors and related outcomes of intravascular insert-related infections in Intensive Care Unit. Dr. Prakash Shastri. ECAB Clinical Update: Critical Care. Elsevier. Pg 25-34.
Ongoing Research Projects
- Acute febrile illness in adult intensive care unit: The disease spectrum and outcome – an experience from a tertiary care hospital in north India
- Elucidation of the diagnostic and prognostic role of Procalcitonin (PCT), High sensitivity C reactive protein (hs-CRP) and Interleukin 6 (IL-6) in patients with sepsis and their correlative relationship.
- Anti-inflammatory Response versus Pro-inflammatory Response in sepsis patients: Looking at the Cytokines
- Microbes and antibiotic resistance pattern in community acquired infections
Forthcoming Events and Conferences (Events Calendar):
- ACLS Provider Courses 2015 (Aug 27-28, 2015)
- 3rd Annual Critical Care Conference; Dec. 18-20, 2015
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
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.
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: email@example.com for academic/ administrative/ ACLS/ Nursing Course
Emergency: Call 42251098, 42251099
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:
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
Intra aortic balloon pump
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
CVP and DBP
C. Advanced Diagnostics:
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.
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
- Peritoneal dialysis
- CRRT (24 hours available)
- Pain relief
- Arterial blood sampling
- Nasogastric tube placement
- Nasojejunal tube placement
- Lumbar puncture
- Abdominal paracentesis
- 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.
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.
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.
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.
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.
A total of 2201 patients were admitted in the ICU in 2014. Their admissions according to diagnosis and another chart showing incidence of ICU associated infection is as follows:
- ICU, Intensive Care Unit
- Critical Care Medicine
- Intensive Care medicine
- Emergency Medicine
- Nitric Oxide
- HFOV, High Frequency Oscillatory Ventilation
- PCT, Percutaneous Tracheostomy
- USG in ICU, Ultrasound in ICU
- ACLS, Advanced Cardiac Life Support;BLS, Basic Life Support
- ECHO IN ICU, Echocardiography in ICU
- Air Ambulance
- Certificate Course in Nursing
- DNB Fellowship
- ISCCM Diploma
- ISCCM fellowship
- Emergency Care
- Cadaveric Donor
- Ciaglia, Griggs
- CRRT, Continuous Renal Replacement Therapy
- Bronchoscopy in ICU