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How to cite this article: Srinivasan S, Kumar PG, Govil D, Gupta S, Kumar V, Pichamuthu K, et al. Competencies for Point-of-care Ultrasonography in ICU: An ISCCM Expert Panel Practice Recommendation. Indian J Crit Care Med 2022;26(S2):S7-S12.
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How to cite this article: Govil D, Kumar GP. Early CT in COVID-19: Should I or Should I Not? Indian J Crit Care Med 2021;25(3):251-252.
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Although the pathophysiology of pulmonary disease caused by coronavirus disease-2019 (COVID-19) is not yet fully understood, successful extracorporeal membrane oxygenation (ECMO) use has been reported for COVID-19-related severe acute respiratory distress syndrome (ARDS). We report a case series of 12 patients who received long venovenous ECMO (VV ECMO) runs for refractory hypoxia (median PF ratio of 71.8, interquartile range (IQR) 53.5-78.5) from COVID-19-related ARDS. A majority (75%) of the patients were males with a median age of 44 (IQR 37-53.5). Overall, six (50%) patients survived to hospital discharge with five of them (83.3%) noted to be cerebral performance category 1 or 2 at the time of discharge. Survivors consistently showed an improvement in sequential organ failure assessment scores within 72 hours of ECMO initiation. The median ECMO duration was 28 days (IQR 13.5-50). Despite using standard anticoagulation strategy, six (50%) of our patients had one or more major bleeding episodes, which proved to be directly fatal in four (25%) patients. Although the overall outcomes of our cohort were acceptable, our patients had much longer ECMO runs (mean 38 days in survivors) and with much higher, often fatal bleeding complications. We compare our data with other published COVID-19 VV ECMO series. HOW TO CITE THIS ARTICLE: Kakar V, North A, Bajwa G, Raposo N, Kumar PG. Long Runs and Higher Incidence of Bleeding Complications in COVID-19 Patients Requiring Venovenous Extracorporeal Membrane Oxygenation: A Case Series from the United Arab Emirates. Indian J Crit Care Med 2021;25(12):1452-1458.
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The use of ultrasound to enhance the regeneration of zeolite 13X for efficient utilization of thermal energy was investigated as a substitute to conventional heating methods. The effects of ultrasonic power and frequency on the desorption of water from zeolite 13X were analyzed to optimize the desorption efficiency. To determine and justify the effectiveness of incorporating ultrasound from an energy-savings point of view, an approach of constant overall input power of 20 or 25 W was adopted. To measure the extent of the effectiveness of using ultrasound, the ultrasonic-power-to-total power ratios of 0.2, 0.25, 0.4 and 0.5 were investigated and the results compared with those of no-ultrasound (heat only) at the same total power. To analyze the effect of ultrasonic frequency, identical experiments were performed at three nominal ultrasonic frequencies of ~28, 40 and 80 kHz. The experimental results showed that using ultrasound enhances the regeneration of zeolite 13X at all the aforementioned power ratios and frequencies without increasing the total input power. With regard to energy consumption, the highest energy-savings power ratio (0.25) resulted in a 24% reduction in required input energy and with an increase in ultrasonic power, i.e. an increase in acoustic-to-total power ratio, the effectiveness of applying ultrasound decreased drastically. At a power ratio of 0.2, the time required for regeneration was reduced by 23.8% compared to the heat-only process under the same experimental conditions. In terms of ultrasonic frequency, lower frequencies resulted in higher efficiency and energy savings, and it was concluded that the effect of ultrasonic radiation becomes more significant at lower ultrasonic frequencies. The observed inverse proportionality between the frequency and ultrasound-assisted desorption enhancement suggests that acoustic dissipation is not a significant mechanism to enhance mass transfer, but rather other mechanisms must be considered.