Background: Indian Society of Critical Care Medicine (ISCCM) guidelines on Planning and Designing Intensive care (ICU) were first developed in 2001 and later updated in 2007. These guidelines were adopted in India, many developing Nations and major Institutions including NABH. Various international professional bodies in critical care have their own position papers and guidelines on planning and designing of ICUs; being the professional body of intensivists in India ISCCM therefore addresses the subject in contemporary context relevant to our clinical practice, its variability according to specialty and subspecialty, quality, resource limitation, size and location of the institution. Aim: To have a consensus document reflecting the philosophy of ISCCM to deliver safe & quality Critical Care in India, taking into consideration the requirement of regulatory agencies (national & international) and need of people at large, including promotion of training, education and skill upgradation. It also aiming to promote leadership and development and managerial skill among the critical care team. Material and Methods: Extensive review of literature including search of databases in English language, resources of regulatory bodies, guidelines and recommendations of international critical care societies. National Survey of ISCCM members and experts to understand their viewpoints on respective issues. Visiting of different types and levels of ICUs by team members to understand prevailing practices, aspiration and Challenges. Several face to face meetings of the expert committee members in big and small groups with extensive discussions, presentations, brain storming and development of initial consensus draft. Discussion on draft through video conferencing, phone calls, Emails circulations, one to one discussion Result: Based upon extensive review, survey and input of experts' ICUs were categorized in to three levels suitable in Indian setting. Level III ICUs further divided into sub category A and B. Recommendations were grouped in to structure, equipment and services of ICU with consideration of variation in level of ICU of different category of hospitals. Conclusion: This paper summarizes consensus statement of various aspect of ICU planning and design. Defined mandatory and desirable standards of all level of ICUs and made recommendations regarding structure and layout of ICUs. Definition of intensive care and intensivist, planning for strength of ICU and requirement of manpower were also described.
Guillain-Barré syndrome, known for its diverse, atypical and heterogeneous range of presentations, can rarely present in an apparent comatose state with absent brainstem reflexes. Two patients presented in an unresponsive state with flaccid quadriplegia, total areflexia with no response to cephalic or peripheral painful stimuli. Pupils were mid-dilated with absent direct and consensual light reflex. All cranial nerve reflexes were absent. Preliminary laboratory investigations and complementary tests were normal. Cerebrospinal fluid evaluation showed albumincytological dissociation. Brain magnetic resonance imaging and electroencephalogram were normal. Both were diagnosed as fulminant Guillain-Barré syndrome. Despite an absence of brainstem reflexes neither patient fulfilled diagnostic criteria for brain death.
Aim: Currently there are no guidelines regarding the content of the clinical notes needed for transfer of patients from one centre to another. This problem is manifold in developing countries where intensive care is a developing specialty. This study was conducted to analyse the patient's clinical information provided by the referral summary at the time of ICU admission.Settings: Twelve bedded intensive care unit (ICU) of a 900 bedded tertiary care referral centre.Observations: Over a period of 1 year, we had 310 intensive care admissions. One hundred and twenty-four patients out of these were out of hospital admissions. Ninty-six patients out of 124 patients had a prior hospitalisation of more than 24 hours. Patient information regarding the clinical details, source of referral, severity of illness, course in the previous hospital and management were analysed at time of admission.There were 62 (64%) male and 34 (36%) female patients. Mean admission APACHE-II (Acute physiological and chronic health evaluation) of referred patients was 15.89 ± 2.89 and mean SOFA (Sequential organ failure assessment) was 8.2083 ± 1.86.Authors found that majority of referral notes did not provide information regarding the presenting complaints, progression of signs and symptoms, progression of the organ failures, neurological assessment, airway and intubation details, ventilator settings on the blood gases, trends of vital parameters, nutrition, DVT prophylaxis and clinical status at time of discharge.
Conclusion:Guidelines should be developed for the content of referral summaries to maintain continuity of care and avoid delay in institution of life saving therapies.
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