In India, while death due to critical illness is highly prevalent, there has also been magnificent advances in the field of critical care medicine in the past few decades. This article summarises the 4 Indian studies set to improve critical care medicine in the country.

Physicians can administer dopamine without the fear of major complications in critically ill patients

Results from a new interventional trial indicate that physicians can administer dopamine without the fear of major complications in critically ill patients as Dopamine infusion does not adversely affect insulin secretion and sensitivity according to this study recently published in IJCCM.

In this study, patients who received dopamine infusion had lower insulin, C-peptide and norepinephrine levels when compared to the control group.

However, the insulin sensitivity index was not statistically different in both the groups which indicate that dopamine does not adversely impact insulin sensitivity.

The trial tells us that dopamine infusion does not have a significant impact on insulin secretion or sensitivity. It is known that a reduction in insulin secretion during dopamine infusion following hyperglycemic clamp would lead to hyperglycemia especially in during stress and circulatory collapse in the ICU. This would have a negative impact on patient outcomes.

One minor drawback of the study is that it was done on a very small sample of patients (n=16). So, more such studies should be done in a larger cohort to find a reliable relationship between dopamine and insulin secretion.

Article: The impact of dopamine on insulin secretion in healthy controls. Underland LJ, Mark ER, Katikaneni R, Heptulla R. Indian Journal of Critical Care Medicine. 2018

Non-invasive ventilation is feasible in managing acute respiratory failure due to non-cystic fibrosis bronchiectasis

Recent findings from a retrospective study found that acute respiratory failure (ARF) due to non-cystic fibrosis bronchiectasis can be conveniently managed with non-invasive ventilation (NIV).

Non-invasive ventilation is the standard of care for managing acute respiratory failure due to chronic obstructive pulmonary disease which is like bronchiectasis. But, limited data has been available to assess the feasibility of NIV in managing ARF due to bronchiectasis.

The study was conducted in 99 patients with ARF (due to bronchiectasis), out of which 81 were given ventilatory support with NIV. In 53 patients, NIV succeeded in managing acute respiratory failure, and failed in 28 patients who later required endotracheal intubation. The duration of hospital stays, the rate of correction of arterial blood gases and mortality rate were comparable between NIV and IMV groups.

The results imply that physicians can opt for NIV to manage acute respiratory failure due to bronchiectasis rather than endotracheal intubation and mechanical ventilation which are associated with high mortality and morbidity rate.

Article: Noninvasive ventilation for acute respiratory failure due to noncystic fibrosis bronchiectasis. Hadda V, Chawla G, Tiwari P, Madan K, Khan MA, Mohan A, Khilnani GC, Guleria R. Indian Journal of Critical Care Medicine. 2018

Methylene blue can help manage vasoplegic syndrome (VS) following cardiac surgery

A recent study done on patients who underwent cardiopulmonary bypass (CPB) indicated that methylene blue (MB) helps in managing vasoplegic syndrome, a common complication of cardiac surgery, and that involves hemodynamic instability.

The study involved 28 patients who received MB for vasoplegia post-CPB were compared with 28 matched (historical) controls.

Individuals in the MB group had recovered rapidly to achieve stable hemodynamics, had less ICU mortality rate, less incidence of renal failure, shorter length of stay, and shorter duration of vasopressor infusion.

Article: Methylene blue for vasoplegic syndrome postcardiac surgery. Habib AM, Elsherbeny AG, Almehizia RA. Indian Journal of Critical Care Medicine. 2018

High-flow nasal cannula is effective in managing respiratory distress in children

This randomised control study found that failure rates of high-flow nasal cannula (HFNC) were significantly lower than that of oxygen therapy.

HFNC therapy is highly beneficial in the treatment of respiratory distress in children. The randomised control study was done with an aim to determine the efficacy of HFNC in comparison to conventional oxygen therapy in children experiencing respiratory distress. Apart from failure rates of HFNC being significantly lower than that of oxygen therapy, patients in the HFNC group also showed a noticeable improvement in respiratory score, respiratory rate, and heart rate.

Another study also demonstrated that early HFNC therapy reduces the intubation rate. Physicians can consider HFNC therapy over conventional oxygen therapy in treating respiratory distress considering its clinical efficiency.

Article: High-flow nasal cannula versus conventional oxygen therapy in children with respiratory distress. Sitthikarnkha P, Samransamruajkit R, Prapphal N, Deerojanawong J, Sritippayawan S. Indian Journal of Critical Care Medicine. 2018

Each of the studies listed above have the potential to improve critical care medicine. However, updates from these studies should be replicated in larger samples to give more results that can eventually be applied to a wider group of patients.