Seminar

Exchanging Ideas at Guidelines

Guidelines 2008 conference showcased the importance of guidelines in intensive care practice

Dr Kirti Pawar, Consultant Intensivist, Bhote Hospital, Baramati

Dr A Rajasekaran, President of National Board of Examination, Ministry of Health and Family Welfare, Government of India

Dr BK Rao, Chairperson-Department of Critical Care Medicine and Chairman- Sir Gangaram Hospital

The two-day national conference 'Guidelines 2008' organised by the Department of Intensive Care Medicine at Deenanath Mangeshkar Hospital, Pune, presented the best and latest evidence-based practicing guidelines on various topics of daily concern in intensive care practice. This conference was all about an effort in discussing standardised medical care, used internationally for critically-ill patients. Dr A Rajasekaran, President of National Board of Examination, Ministry of Health and Family Welfare, Government of India inaugurated the conference and presented a keynote address highlighting the fact that there is a dire need of recognising centre of excellences to provide education and training opportunities within the country to prevent the brain drain.

Guidelines-2008 discussed topics in critical care and it was an effort to disseminate knowledge about standardised protocols amongst doctors. The conference featured talks by renowned faculties who are experts in their fields, delivered the lectures on pertinent subjects. More than 300 delegates attended this conference and highlighted most critical issues in their presentation.

Speaking on the management of spontaneous Intracerebral Haemorrhage (ICH) in adults and acute Ischemic stroke Dr Subhash Kaul, Professor and Head of Department of Neurology, Nizam Institute, Hyderabad said, "Stroke disease in India is a growing problem which then leads to paralysis. It is caused through high-blood pressure, diabetics, cholestrol and smoking and therefore, all have to make an effort to prevent this condition better by controlling these diseases. If all these diseases are controlled then the stroke chances are minimised. When it occurs, patients should be immediately taken to the hospital so that they get proper treatment and it is also important for the doctors to know in which state surgery will help, therefore research is going on this." He emphasises that identifying the stroke and controlling the disease plays an important role here to minimise the chances of strokes.

Dr Kaul further added, “Stroke patients should immediately brought to the hospital to get proper drugs and supportive treatment which can treat the clot in the brain. Intracranial bleeding is another type of brain hemorrhage, which leads to bleeding inside the brain, which is again due to high blood pressure. 90 per cent of the problem of haemorrhage will be solved when it is controlled as once it occurs then the treatment is not self-sustained.”

Dr Kirti Pawar, Consultant Intensivist, Bhote Hospital, Baramati presented on Oximes in OPP says, "High dosage can work more than conventional dosage of atropine in pesticides poisoning. Adequate doses of pralidoxine over adequate period in OPP, judicious use of atropine, meticulous ventilatory management, good nutritional care, will definitely help to save each precious life poisoned with organo-phosphate." Dr BK Rao, Chairperson-Department of Critical Care Medicine and Chairman- Sir Gangaram Hospital, discussed practicing guidelines on managing severe traumatic brain injury. "Monitoring and assessment of blood-pressure and oxygenation, intracranial pressure monitoring and limits, cerebral perfusion thresholds and brain-oxygen monitoring, treatment on the basis of pharmacological and non-pharmacological treatment, prophylaxis, nutrition and Intracranial Pressure (ICP) monitoring technology are the important guidelines, which calculate and manage the issue related to traumatic brain injury," said Dr Rao.

"When we would actually put an effort in understanding and following these guidelines then we will be able to treat our patients with lesser mortality," he added. Dr Sugam Kale, Consultant Anaesthetist, National University Hospital, Singapore spoke on management of sedation, analgesia and neuromuscular blockade in intensive care unit and transport of critically-ill patients. Dr Kale said, "Problems in Indian context are multifold. Not many ICUs have local guidelines for using and assessing sedation, even within the hospital. Different ICU doctors have personal favorite drugs and their own methods of dosage. What you get on a particular day is not dependent on what is 'right' but more so on who is the doctor doing the rounds that day." He stressed over the fact that the importance of reviewing the effects of sedation and muscle paralysis among ICU patients is often not realised and then the consequences can be dire for the patient and expensive for the hospital. Added Dr Kale, "New developments are happening and we must base our practice on the results of well designed scientific studies." The event was organised for the first time, and considering the exciting response it received this year, Guidelines would now be an annual event henceforth.

EH News Bureau