Institute of Critical Care Medicine

Contact Information

+91-11-42254000 gangaram@sgrh.com

Specialists

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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 Instt. of Critical Care Medicine at Sir Ganga Ram Hospital is recognized both nationally and internationally as a leader in patient care, research and training. Today the Instt. of Critical Care Medicine is amongst the largest in private hospitals. The department has 80 critical care beds including 12 beds in the Executive block. The department also provides resuscitation and critical care services to High Dependency Units (HDU), floor beds and Emergency department.The Instt. of Critical Care Medicine at Sir Ganga Ram Hospital is recognized both nationally and internationally as a leader in patient care, research and training. Today the Instt. of Critical Care Medicine is amongst the largest in private hospitals. The department has 80 critical care beds including 12 beds in the Executive block. The department also provides resuscitation and critical care services to High Dependency Units (HDU), floor beds and Emergency department. 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 24 trainee fellows (NBE: 3-year and ISCCM: 1-year course). 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
2018: Dr. B.K. Rao, Chairman – National Accreditation Board for Hospital & Healthcare Providers (NABH)
2019: Dr. Vinod K. Singh elected as President, ECMO Society of India
2022: Dr. Vinod K. Singh elected as Zonal Member ISCCM
2022: Dr. Vinod K. Singh elected as Editor-in-Chief, IJECMO Journal
2023: Dr. Sanjeev Mittal – Selected as Chairman of New Delhi Committee ECMO India Foundation (ECMO SOCIETY OF INDIA) for the year 2023–2025

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
2018- Ultradynamics : Advances in Critical Care
2019- Ultradynamics : Bench to Bedside
2023- Acute Neuro Care (ANC) – Focused Approach on Neuro-Emergencies
2023- Obstetrical Emergencies and Critical Care Conference (OECC)
2023- Symposium on Extracorporeal Therapies in Intensive Care Unit (ECT-i)
2023- Intensive Care Oncology 2023
2024- Obstetrical Emergencies and Critical Care Conference 2024 (OECC)

Consultants and Staff:

Dr. B. K. Rao (Emeritus Consultant & Advisor)
Dr. Prakash Shastri (Chairperson)
Dr. Vinod Kumar Singh (Co-Chairperson)
Dr. Debashis Dhar (Vice-Chairperson 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 (Teaching Coordinator, Acute bedside care Co-ordinator, Audit Coordinator)
Dr. Rahul Kumar (Acute Bedside Care Co-ordinator)
Dr. Prasoon Gupta
Dr. Asish Kumar Sahoo

Current DNB Fellows:

2021-2024:

Dr.Arun Kumar K.M.
Dr. Bokinala Naveen
Dr. Deepanshu
Dr. Dileep N.
Dr. Pallavi B.
Dr. S. Maniraj
Dr. Srinivasan M.

2022-2025:

Dr. Aman Kaur Saini
Dr. Diksha Gaur
Dr. Kaushal Kumar
Dr. Khushboo
Dr. Neeraj Gautam
Dr. Somalin Satapathy

2023-2026:

Dr. Anitesh Kumar Gupta
Dr. Deepali Shukla
Dr. Manish Kumar
Dr. Pramod Kumar
Dr. Zil Bardolia Pravinkumar

Current IDCCM Candidates:

Dr. Surbhi
Dr. Aakrati Bansal
Dr. Shivam Upadhyay
Dr. Anand Kaneria
Dr. Ayushi Saxena
Dr. Samarth Agarwal
Dr. Isha Jain

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 Chand Rana
Mr. Ravi Kumar Rana
Mr. Mukesh Kumar Verma
Mr. Shubham Thakur
Mr. Akash Yadav
Mr. Kunal Sharma
Mr. Amit Kumar
Mr. Manish Kumar
Mr. Suresh Kumar Yadav

Medical / Surgical ICU Secretary:

Mr. Kameshwar Grover

Medical Data Operators:

Ms. Aditi

ICU Counselor:

Ms. Akansha

Academic & Research

Instt. of Critical Care Medicine 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 Instt. of Critical Care Medicine &Pulmonology.

DrNB in Critical Care Medicine

Critical Care Medicine Department holds a three-year DrNB course in Instt. of Critical Care Medicine. Eight candiates are taken every year. The candidate rotates through all the intensive care units and faculty drawn from the Department of Instt. of Critical Care Medicine, 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)

Instt. of Critical Care Medicine conducts:

a. Indian Diploma in Critical Care (4 seats biannually)
b. Indian Fellowship in Critical Care (4 seats annually)

Fellowship under ESOI

The department conducts Extracorporeal Life Support Fellowship Course under ECMO Society of India

Critical Care Training Course for Nurses

Instt. of Critical Care 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 programme 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

Instt. of Critical Care 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. Instt. of Critical Care 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 2024

Articles:

Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS et al. Risk factors, mortality, and predictors of survival in COVID-19-associated pulmonary mucormycosis: a multicenter retrospective study from India. Clin Microbiol Infect. 2024 Mar;30(3):368-374. doi: 10.1016/j.cmi.2023.12.006. Epub 2023 Dec 9. PMID: 38081413.

Publications Year 2023

Articles:

Muthu V, Patel A, Agarwal R, Rudramurthy SM, Shevkani M, Thangaraju,D, Shastri PS, Chakrabarti A. Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India. Emerg Infect Dis. 2023 Jan;29(1):8-19
Mehta Y, Paul R, Ansari AS, Banerjee T, Gunaydin S, Nassiri AA, Pappalardo F, Premužić V, Sathe P, Singh V, Vela ER. Extracorporeal blood purification strategies in sepsis and septic shock: An insight into recent advancements. World J Crit Care Med. 2023 March 9;12(2):71-88. DOI: 10.5492/wjccm.v12.i2.71
Shastri P (2023). Clinical presentation, ICU management and outcome in severe COVID-19 disease – A prospective observational study. Ann Antivir Antiretrovir 7(1): 010-016. DOI: https://dx.doi.org/10.17352/aaa.000017
Muthu V, Agarwal R, Rudramurthy SM, Thangaraju D, Shevkani MR, Patel AK, Shastri PS et al. Risk factors, mortality, and predictors of survival in COVID-19-associated pulmonary mucormycosis: a multicenter retrospective study from India. Clinical Microbiology and Infection. 2023. https://doi.org/10.1016/j.cmi.2023.12.006. (pre-proof)
Kansal A, Latour JM, See KC, Rai S, Cecconi M, Britto C, Conway Morris A, Dominic Savio R, Nadkarni VM, Rao BK, Mishra R. Interventions to promote cost-effectiveness in adult intensive care units: consensus statement and considerations for best practice from a multidisciplinary and multinational eDelphi study. Crit Care. 2023 Dec 11;27(1):487. doi: 10.1186/s13054-023-04766-2. PMID: 38082302; PMCID: PMC10712165.

Book Chapters:

Sabharwal P, Taneja S. Management of heatstroke. Decision Making in Critical Care Medicine, first edition. Editors: AP Kulkarni, SJ Bhosale. Jaypee Brothers Medical Publishers; 2023.p.181.
Rao BK, Sabharwal P. Simulation-based training in ICU. Critical Care Update 2023, 5th edition. Editors: Dr. RC Mishra, Dr. SN Myatra, Dr. Deeapk Govil, Dr. S. Todi. Jaypee Brothers Medical Publishers 2023; 534.
Chakraborty S, Taneja S. Basic Modes of Ventilation. Clinical Keys In Anaesthesiology And Critical Care (under publishing). Jaypee Publishers
Chakraborty S, Taneja S. Management of a patient with severe hypothermia. Decision Making in Critical Care (under publishing). Jaypee Publishers.
Singh VK, Kumar R. Mode selection: Basic modes criteria. Book: Bedside approach to ventilator management. Editors: Dr. Pradeep Bhattacharya, Dr. Rajesh Chandra Mishra, Dr. Jay Prakash. CBS Publishers & Distributors
Singh VK, Kumar R. Transport of critically ill pregnant patients. ISCCM Manual of Obstetric Critical Care. Jaypee Brothers Medical Publishers. Pg 268-271.

Case Report:

Singh V, Taneja S, Mittal S, Sabharwal P, Rao BK. Venovenous Extracorporeal Membrane Oxygenation Elective Therapy Time to Rethink: A Case Report and Review of Literature. Indian J ECMO 2023;1(1):25-28
Chakraborty S, Sahoo AK, Rao BK, Singh VK. A challenging case of refractory status epilepticus: ICU management. SGRH Newsletter Apr-Jun 2023. Pg 4.

Publications Year 2022

Articles:

Rao BK. Echocardiography in Intensive Care Unit: We Need a Certification Program. J Acute Care. 2022;xx(xx):1–2.
Muthu V, Patel A, Agarwal R, Rudramurthy SM, Shevkani M, Thangaraju,D, Shastri PS, Chakrabarti A. Multicenter Case–Control Study of COVID-19–Associated Mucormycosis Outbreak, India. Emerg Infect Dis. 2023 Jan;29(1):8-19

Book Chapters:

Rao BK. Co-author of guidelines on Guidance on Diagnosis & Management of Carbapenem Resistant Gram-negative Infections by Division of Epidemiology & Communicable Diseases, Indian Council of Medical Research (ICMR), March 2022;1-24
Rao BK, Tyagi N, Sahoo AK. B-type natriuretic peptide interpretation in intensive care unit. Critical Care Update 2022, 4th Edition. Editors – Dr. Deepak Govil, Dr. Rajesh Chandra Mishra, Dr. Dhruva Chaudhry, Dr. Subhash Todi. Jaypee 2022; 234-238.
Sahoo AK, Shastri P. Career path in critical care in India. ISCCM Critical Care Update 2022, 4th Edition. Editors – Dr. Deepak Govil, Dr. Rajesh Chandra Mishra, Dr. Dhruva Chaudhry, Dr. Subhash Todi. Jaypee 2022; 489-491.
Chakraborty S, Dhar D, Richhariya D. Assessment of Volume Status and Hemodynamic Monitoring. Text Book of Emergency Medicine including intensive care & Trauma, 2nd Edition. Editors – Dr. Devendra Richhariya, Dr. Bhawana Sharma. Jaypee 2022.
Taneja S, Ray S. Hepatorenal Syndrome. Textbook of Critical Care. 2nd Edition. Editors - Dr. Yatin Mehta, Dr. Jeetendra Sharma, Dr. Chitra Mehta. Jaypee Publishers 2022.
Shastri P, Taneja S. Intra-abdominal Sepsis and Abdominal Compartment Syndrome. Textbook of Critical Care, 2nd Edition. Editors - Dr. Yatin Mehta, Dr. Jeetendra Sharma, Dr. Chitra Mehta. Jaypee Publishers 2022.
Kishen R, Taneja S. Fluid Therapy in Covid 19: Principles and Practice. Critical Care Update 2022, 4th Edition. Editors – Dr. Deepak Govil, Dr. Rajesh Chandra Mishra, Dr. Dhruva Chaudhry, Dr. Subhash Todi. Publishers: Jaypee Publishers 2022
Gupta P, Rao BK. Trauma resuscitation. Comprehensive Manual of Resuscitation 2022.
Gupta P, Chakroborty S. Severe Soft-tissue Infection. CRITICON 2022 BOOK, Critical Care Medicine: Bench to Bedside.

Case Reports:

Kumar A, Sabharwal P, Gupta P, Singh VK, Rao BK. A Fatal Case of Acute Disseminated Encephalomyelitis: A Diagnosis to Ponder in Pandemic. Indian J Crit Care Med. 2022;26(4):518-520

Services

Equipment

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

A. Organ Support

Ventilatory Support
Ventilators - Drager Evita2 Dura, Evita4, and Savina
Oxylog 3000
Hamilton G5
Drager Infinity 500
BIPAP Devices, BIPAP S9, BIPAP III Resmed, BIPAP ST, Stellar 150
HFOV Sensormedics 3100B
ECMO
Cardiovascular Support
HFNC
Renal Support
IHD
CRRT, SLED
Peritoneal Dialysis
Liver Support MARS

B. Monitoring

odynamic Monitoring Non invasive:
Patient Monitors - Intellivue MX 550, EFFICIA CM 10 (Phillips)
Central Monitoring Stations - P II C IX Central Station (Phillips)
Defibrillators - Wipro GE Cardioserve
Invasive
CVP and IBP
IAP

C. Advanced Diagnostics

USG / TTE / TEE
TEG
Video Bronchoscope, Ambuscope
ROTEM
TCD
Cardiac Output Monitoring

D. Others

Infusion Syringe Pumps - Fresenius Kabi (Agilia), B Braun, BD - Alaris
Bronchoscope - Olympus BF 40 with Camera Reorder and Projection Facilities
Therma Patient Warming System, Hot Line Fluid Warmer
ABG and Electrolyte Analyzer
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
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 retrival:

Air Ambulance

This service was first started in 1992 by our ICU flights. The at been transported both natiour air ambulances are fully equipped doctor and technician accompanies the patient consultant Dr SC Sharma and til dates well as in comm ICU od intemationally by air ambulance willis and a trained with life support systems, ventilators and monitors and a during transportation.

Ground Ambulance

The ICU staff undertakes the patient retrieval services round the clock. For this the department has lato Intensive care/cardiac ambulance fitted with fultichannel 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 50000 patients 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 are 13 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 emergericy 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

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
ITC, AHA, BLS ACLS Provider, BLS Instructor, ACLS Instructor, ACLS, Advanced Cardiac Life
ECHO IN ICU, Echocardiography in ICU Support; BLS, Basic Life Support
Air Ambulance
Certificate Course in Nursing Sir Ganga Ram Hospital - Institute of Critical Care Medicine
DNB Fellowship
ISCCM Diploma
ISCCM fellowship
Emergency Care
Cadaveric Donor
Ciaglia, Griggs
CRRT, Continuous Renal Replacement Therapy
Bronchoscopy in ICU
V V ECMO, VA ECMO, ECMO unit, ECMO facility, ECMO in Sir Ganga Ram Hospital, Swine flu, H1N1, Alphos poisoning, ECMO

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- Drager Evita2 Dura, Evita4 and Savina, Oxylog 3000, Hamilton G5, Drager Infinity 500
BIPAP devices- BIPAP S9, BIPAP III Resmed, BIPAP ST, Stellar 150
HFOV sensormedics 3100B
ECMO
Cardiovascular support
HFNC
Renal support
IHD
CRRT, SLED
Peritoneal dialysis
Liver support
MARS

B. Monitoring:

Hemodynamic Monitoring Non invasive
Patient Monitors- Intellivue MX 550, EFFICIA CM 10 (Phillips)
Central monitoring stations- P II C IX Central station (Phillips)
Defibrillators- Wipro GE Cardioserve
Invasive
CVP and IBP
IAP

C. Advanced Diagnostics:

USG/ TTE/ TEE
TEG
Video Bronchoscope, Ambuscope
ROTEM
TCD
Cardiac output monitoring

D. Others:

Infusion syringe pumps- Fresenius Kabi (Agilia), B Braun, BD - Alaris
Bronchoscope- Olympus BF 40 with camera reorder and projection facilities
Therma Patient warming system, Hot line fluid warmer
ABG and electrolyte analyser
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.

Summary of Audit-2023:

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:

Results:

The observed mortality is lesser then predicted mortality in all age groups.

SMR Weighted is 0.6-0.8 in both operated and non operated categories On this parameter our ICU has been doing well for last 10 Years.

Conclusion:

The APACHE-II scoring system was found useful for classifying patients according to their disease severity.

There was relationship between the high score and mortality.

Correlation of APACHE II, Duration of Stay and Mortality

The Length of Stay (LOS) in APACHE II <20 was less in survivors than non-survivors

The Length of Stay (LOS) in APACHE II >20 was more in non-survivors than survivors.