Recent advances in critical care: Part II.

With the increasing number of critically ill patients being admitted to intensive care units (ICUs), newer techniques and treatment modalities continue to evolve for their adequate management. Thus, it has become imperative to understand existing tools and resources, and utilise or repurpose them to achieve better results that can decrease morbidity and mortality. In this writeup, we chose five areas of interest, including analgosedation, role of colloids, recent advancements in the management of respiratory failure, the role of extracorporeal membrane oxygenation, and newer antimicrobials. The role of analgosedation in the critically ill has gained importance with focus on post-ICU syndromes, and albumin has re-entered the fray as a possible repairer of the injured glycocalyx. The coronavirus disease 2019 (COVID-19) pandemic forced us to relook at various ventilator strategies and mechanical support for the failing circulation has now become more common with clear end-points. Rising microbial antibiotic resistance has opened up the research on newer antibiotics.

Prone cardiopulmonary resuscitation: Relevance in current times.

The most common and recommended position for performing cardiopulmonary resuscitation (CPR) is the supine position. However, clinicians may encounter situations when patients suffer cardiac arrest in prone position. Prone CPR has been described previously in a number of settings, most commonly intraoperative. In the current COVID-19 era, with more patients being nursed in prone position, an increase in the incidence of cardiac arrests requiring prone CPR is expected. Hence most of the resuscitation guidelines have made prone CPR a vital component of their recommendations. To date, most of our health-care workers have limited knowledge about prone resuscitation and the literature surrounding it. Nonetheless, with the current evidence at hand, it seems to be a reliable method of providing resuscitation and all health-care workers should be well versed with it. Thus, the goal of this narrative review is to try and fill the gaps in our knowledge about prone CPR. Literature search was done on PubMed, Medline, EMBASE using keywords 'CPR', 'Resuscitation', 'Prone Position', 'Prone', 'Prone CPR'.

Successful anaesthetic management of a COVID-positive patient with multiple comorbidities: regional anaesthesia to the rescue

The perioperative anaesthetic management of a case of COVID-19 pneumonia with multiple systemic comorbidities, posted for unilateral below knee amputation and debridement of hand, poses a uniquely challenging scenario for the anaesthesiologist. We hereby report such a case which was managed successfully using ultrasound-guided popliteal and wrist block along with perioperative use of high flow nasal cannula, incentive spirometry and awake proning.

Management of pregnant laboring women during COVID-19 pandemic.

Since its first outbreak in December 2019 in Wuhan, China, coronavirus disease 2019 (COVID-19) has become a global public health threat. In the midst of this rapidly evolving pandemic condition, the unique needs of pregnant women should be kept in mind while making treatment policies and preparing response plans. Management of COVID-19 parturients requires a multidisciplinary approach consisting of a team of anesthesiologists, obstetricians, neonatologists, nursing staff, critical care experts, infectious disease, and infection control experts. Labor rooms as well as operating rooms should be in a separate wing isolated from the main wing of the hospital. In the operating room, dedicated equipment and drugs for both neuraxial labor analgesia and cesarean delivery, as well as personal protective equipment, should be readily available. The entire staff must be specifically trained in the procedures of donning, doffing, and in the standard latest guidelines for disposal of biomedical waste of such areas. All protocols for the management of both COVID-19 suspects as well as confirmed patients should be in place. Further, simulation-based rehearsal of the procedures commonly carried out in the labor room and the operation theaters should be ensured.