Evidence Based Core Topics in CRITICAL CARE MEDICINE 2019
Evidence Based Core Topics in CRITICAL CARE MEDICINE 2019
Ross Callum Freebairn BHB MBChB Dip Obst FANZCA FRCP FJFICM FCICM
President, Asia Pacific Association of Critical Care Medicine (APACCM) Consultant, Intensive Care Services, Hawke's Bay Hospital, Hastings, New Zealand
Associate Dean (Hawke's Bay) University of Otago, Wellington, New Zealand
Adjunct Associate Professor, Chinese University of Hong Kong, Hong Kong
Atul Prabhakar Kulkarni MD (Anesthesiology) PGDHHM FISCCM FICCM ecretary General, Asia Pacific Association of Critical Care Medicine (APACCM)
Professor and Head Division of Critical Care Medicine Tata Memorial Hospital Homi Bhabha National Institute Mumbai, Maharashtra, India

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Evidence Based Core Topics in Critical Care Medicine 2019
First Edition: 2019
9789352709069
Printed at
All the hardworking, caring, and sincere souls who provide compassionate care to the critically ill in the Asia Pacific Region selflessly.
- Abdullah Al Shimemeri MBChB MD FRCPC
- Consultant
- Department of Pulmonary and Critical Care Medicine
- Professor, College of Medicine
- King Saud bin Abdulaziz University for Health Sciences
- Riyadh, Saudi Arabia
- Ajmer Singh MD
- Director, Cardiac Anesthesia
- Medanta Institute of Critical Care and Anesthesiology
- Gurugram, Haryana, India
- Alexis Kate Ford LLB (Hons) GDLP MBBS FRACGP
- Medical Officer
- Australian Defence Force
- Australia
- Alexis Tabah MD FCICM
- Staff Specialist
- Department of Intensive Care
- Caboolture and Redcliffe Hospitals
- Senior Lecturer, Department of Medicine
- The University of Queensland
- Brisbane, Queensland, Australia
- Amarja Ashok Havaldar
- MD (Anaesthesiology) FNB (Critical Care Medicine)
- DM (Critical Care Medicine) EDIC
- Assistant Professor
- Department of Critical Care Medicine
- St John's Medical College Hospital
- Bengaluru, Karnataka, India
- Amartya Mukhopadhyay MBBS MD MRCP FRCP EDIC MPH
- Division of Respiratory and Critical Care
- University Medicine Cluster
- Department of Medicine
- National University Health System and
- National University of Singapore
- Singapore
- Amit Kansal MBBS MD (Anesthesia) FCICM
- Consultant
- Department of Intensive Care Medicine
- Ng Teng Fong General Hospital
- Singapore
- Amit Madhukar Narkhede
- MD DNB DM (Critical Care Medicine)
- Specialist Senior Registrar
- Division of Critical Care Medicine
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Amol Kothekar MD IDCC
- Associate Professor
- Division of Critical Care Medicine
- Department of Anesthesiology, Critical Care and Pain
- Tata Memorial Hospital
- Homi Bhabha National Institute
- Mumbai, Maharashtra, India
- Andrew Li MBBS MRCP (UK) DFD (CAW)
- Division of Respiratory and Critical Care
- University Medicine Cluster
- Department of Medicine
- National University Health System and
- National University of Singapore
- Singapore
- Anthony David Holley
- BSc MBBCh DipPaeds DipDHM FACEM FCiCM
- Senior Staff Specialist
- Department of Intensive Care Medicine
- Royal Brisbane and Women's Hospital
- Brisbane, Queensland, Australia
- Anthony S McLean MBBS MD FRACP FCICM FCSANZ
- Professor and Head
- Department of Intensive Care Medicine
- Nepean Hospital
- University of Sydney
- Australia
- Atul Prabhakar Kulkarni
- MD (Anesthesiology) PGDHHM FISCCM FICCM
- Secretary General
- Asia Pacific Association of Critical Care Medicine (APACCM)
- Professor and Head, Division of Critical Care Medicine
- Tata Memorial Hospital
- Homi Bhabha National Institute
- Mumbai, Maharashtra, India
- B Craig Ellis
- MBChB FACEM Dip IMC (RCSEd) DipObs
- Specialist Emergency Physician
- St John New Zealand
- Deputy Medical Director
- Mount Wellington, Auckland, New Zealand
- Bhuvana Krishna
- MD (General Medicine) IDCCM IFCCM
- Professor
- Department of Critical Care Medicine
- St John's Medical College and Hospital
- Bengaluru, Karnataka, India
- Brigitte Hollander
- MBChB (Otago) PGDipOMG (Otago)
- Senior Registrar
- Intensive Care Services
- Hawke's Bay Hospital
- Hastings New Zealand
- Carol D'silva
- MD (Anesthesiology) FNB (Critical Care Medicine)
- Assistant Professor
- Department of Critical Care Medicine
- St John's Medical College Hospital
- Bengaluru, Karnataka, India
- Catherine L Tacon
- BSc (Med) MBBS FCICM MPH&TM PostGradCertAeromedRetrieval
- Intensive Care Specialist
- Cairns Hospital
- Cairns, Queensland, Australia
- Charudatt Vaity
- MD (Med) DNB (Med) MRCP (UK) EDIC MFICM (UK)
- Senior Consultant
- Department of Critical Care
- Fortis Hospital
- Mumbai, Maharashtra, India
- Chulananda Dias Goonasekera
- MBBS FCAI FRCP (UK) PhD MPhil MD (Anesthesiology) DCH MRCPCH
- Consultant Anesthetics
- Department of Anesthesia
- King's College Hospital, NHS Trust
- London, England
- Dhanvijay Shekhar Yadavrao
- MBBS MD (Anesthesia) FCICM
- Consultant
- Department of Intensive care Medicine
- Ng Teng Fong General Hospital
- Singapore
- Dhruva Chaudhry
- MD (Med) DNB (Med) DM (PCCM)
- Senior Professor and Head
- Department of Pulmonary and Critical Care Medicine
- Pt. BD Sharma PGIMS
- Rohtak, Haryana, India
- Elizabeth Jane Bennett MBBS FANZCA FCICM MPH
- TM (Masters public health and tropical Medicine)
- Coordinator
- Department of Anesthesia and Intensive Care
- School of Medical Science
- College of Medicine, Nursing and Health Sciences
- Fiji National University
- Suva, Fiji Islands
- Elizabeth Louise Trent FCICM FANZCA BHB MBChB DipObs
- Intensivist
- Department of Intensive Care Unit
- Hawke's Bay Intensive Care Unit
- Hawkes Bay District Health Board
- Hastings, Hawke's Bay, New Zealand
- Ganshyam Jagathkar MD FNB
- Head
- Department of Critical Care
- Maxcure Hospital
- Hyderabad, Telangana, India
- Gentle Sunder Shrestha MD FACC EDIC FCCP
- Assistant Professor
- Department of Anesthesiology
- Tribhuvan University Teaching Hospital
- Maharajgunj, Kathmandu, Nepal
- Hao Zheng Wong MBBS
- ICU Senior registrar
- Department of Intensive Care Unit
- Royal Adelaide Hospital
- Adelaide, Australia
- Harish MM
- MBBS MD DNB IDCCM DM (Critical Care Medicine) EDIC
- Consultant and Incharge
- Department of Critical Care Medicine
- Narayana Hrudayalaya
- Bengaluru, Karnataka, India
- Jaikrit Bhutani
- MD (Med) DNB (Med) DM (PCCM) PGMed 2nd year Intern
- Internal Medicine
- Pt BDS PGIMS
- Rohtak, Haryana, India
- Jane O'Donnell MN RN
- Senior Research Scientist
- Department of Respiratory and Acute Care
- Fisher and Paykel Healthcare
- Auckland, New Zealand
- Jeffrey Lipman
- MBBCh DA FFA FFA (Crit Care) FCICM MD (Research)
- Senior Specialist, Department of Intensive Care Services
- Royal Brisbane and Women's Hospital
- Professor and Head
- Department of Anesthesiology and Critical Care
- The University of Queensland
- Brisbane, Queensland, Australia
- John Botha MBChB MMed FCP(SA) FCICM
- Adjunct Clinical Professor
- Monash University
- Melbourne, Victoria, Australia
- Juhi Chandwani
- MD (Anesthesiology) DNB FFARCSI EDIC
- Consultant
- Department of Anesthesia and Intensive Care Unit
- Royal Hospital
- Muscat, Oman
- Kate Barnett MBChB (Hon) MRCP (UK) FACEM FCICM
- Consultant
- Intensive Care Services
- Hawke's Bay Hospital
- Hastings, New Zealand
- Khalid Ismail Khatib MD (Medicine)
- Professor
- Department of Medicine
- SKN Medical College
- Pune, Maharashtra, India
- Lakshman Karalliedde DA FCA
- Former Consultant
- Department of Anesthesiology and Toxicology
- Guy's and St Thomas’ NHS Foundation Trust
- London, England
- Lalita Gouri Mitra DA MD DNB MNAMS
- Associate Professor
- Department of Critical Care
- Institute of Liver and Biliary Sciences
- New Delhi, India
- Lata Bhattacharya MD (Anesthesiology)
- Senior Consultant and Head
- Department of Anesthesiology
- Jawaharlal Nehru Cancer Hospital and Research Centre
- Bhopal, Madhya Pradesh, India
- Lounja Bouikhsaine
- Diploma (Fine Arts) BSc (Psychology)
- MSc (Neuropsychology & Speech and Language Therapy)
- Medical Illustrator
- Department of Pediatric Recovery
- King's College Hospital, NHS Foundation Trust
- London, England
- Lyndal Russell MBBS FCICM FRACP
- Consultant
- Department of Intensive Care
- Townsville Hospital
- Townsville, Queensland, Australia
- Madiha Hashmi FFARCSI
- Assistant Professor
- Department of Anesthesiology
- Aga Khan University
- Karachi, Pakistan
- Maika Vuli Seru MBBS PGDA
- Senior Registrar
- Department of Anesthesia
- Colonial War Memorial Hospital
- Suva, Fiji, Islands
- Matthew Edward Cove
- MBChB BSc (Hons) FAMS FCCP
- Senior Resident
- Department of Respiratory and Critical Care Medicine
- National University Hospital
- Singapore
- Michael AJ Park MBChB MRCP (UK) FCICM
- Medical Director, Acute Medical Services
- Intensive Care Services
- Hawke's Bay Hospital
- Hastings, New Zealand
- Michael J O'Leary MD FRCA FCICM
- Senior Staff Specialist
- Department of Intensive Care Service
- Royal Prince Alfred Hospital
- Camperdown, Sydney, Australia
- Co-State Medical Director-Organ and Tissue Donation Service
- Michael Toolis MBBS BSc (Hons) GCertClinUS
- Intensive Care Unit
- Frankston Hospital
- Melbourne, Victoria, Australia
- Monika Gulati Kansal MBBS MD (Anesthesia) FCICM
- Consultant
- Department of Intensive Care Medicine
- Ng Teng Fong General Hospital
- Singapore
- Muhammad Habibullah Rana MBBS MRCP EDIC
- Resident Physician
- Department of Intensive Care Medicine
- Ng Teng Fong General Hospital
- Singapore
- Nattachai Srisawat
- MD MSc EDIC (European Diploma Intensive Care Medicine)
- Assistant Professor
- Department of Medicine
- Chulalongkorn University
- Bangkok, Thailand
- Nimita Deora MSc (Microbiology)
- Clinical Research Coordinator
- Department of Anesthesiology
- Chirayu Medical College and Hospital
- Bhopal, Madhya Pradesh, India
- Nishanth Baliga DM (Critical Care Medicine)
- Senior Resident
- Department of Anesthesia, Critical Care and Pain
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Niteen D Karnik MD FICP
- Professor and Head
- Department of Medicine
- LTMMC and LTMGH (Sion Hospital)
- Mumbai, Maharashtra, India
- Nupur N Karnik MD
- Senior Resident
- Department of Pathology
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Nuttha Lumlertgul MD MSc
- Instructor
- Department of Medicine
- Chulalongkorn University
- Bangkok, Thailand
- Pradip Kumar Bhattacharya
- MD (Anesthesiology) FICCM FCCCM MS
- Director
- Critical Care and Emergency Services
- Head and Professor
- Department of Anesthesiology
- Chirayu Medical College and Hospital
- Bhopal, Madhya Pradesh, India
- Pradnya Atul Kulkarni MBBS DPB
- Blood Transfusion Officer
- Department of Pathology (Blood Bank)
- KJ Somaiya Hospital and Research Center
- Mumbai, Maharashtra, India
- Pravin Amin MD FCCM
- Head
- Department of Critical Care Medicine
- Bombay Hospital Institute of Medical Sciences
- Mumbai, Maharashtra, India
- Pravina Yande BHMS MBA
- Medical Administrator
- National Burns Centre
- Navi Mumbai, Maharashtra, India
- Priya Bhate MD
- Assistant Professor
- Department of Medicine
- Seth GSMC and KEM Hospital
- Mumbai, Maharashtra, India
- Rahul Pandit
- FCICM FJFICM EDIC FCCP FICCM DA
- Director, Critical Care
- Fortis Hospital
- Mumbai, Maharashtra, India
- Ravi N Mistry MBChB
- Senior Registrar
- Department of Intensive Care
- Wellington Hospital
- New Zealand
- Ravindranath Tiruvoipati
- MBBS MS FRCSEd MCh MSc FCICM EDIC
- Consultant Intensivist and Director
- Intensive Care Research, Intensive Care Medicine
- Frankston Hospital
- Frankston, Victoria, Australia
- Rob Bevan
- MBBS (Lond) BMedSci MRCP (UK) FRACP FCICM
- Intensive Care Specialist
- Critical Care Complex
- Middlemore Hospital
- Auckland, New Zealand
- Ross C Freebairn
- BHB MBChB DipObst FANZCA FRCP FJFICM FCICM
- President
- Asia Pacific Association of Critical Care Medicine (APACCM)
- Consultant, Intensive Care Services
- Hawke's Bay Hospital, Hastings, New Zealand
- Associate Dean (Hawke's Bay)
- University of Otago, Wellington, New Zealand
- Adjunct Associate Professor, Chinese University of Hong Kong,
- Hong Kong
- Ruchira W Khasne
- MBBS DA DNB IDCCM EDAIC EDIC
- Consultant and Head
- Department of Critical Care
- Ashoka Medicover Hospital
- Nashik, Maharashtra, India
- Sadudee Peerapornratana MSc MD
- Instructor
- Department of Medicine
- Chulalongkorn University
- Bangkok, Thailand
- Sandeep Kantor MD (Anesthesiology) FCCP FCCM FCCP
- Consultant
- Department of Anesthesia and Intensive Care Unit
- Royal Hospital
- Muscat, Oman
- Sanya Chaudhry
- MD (Med) DNB (Med) DM (PCCM) PGMed. 2nd year Intern
- Internship
- SGT Medical College
- Gurugram, Haryana, India
- Saurabh Pradhan MD (Anesthesiology) DM
- Critical Care Medicine Resident
- Department of Anesthesiology
- Tribhuvan University Teaching Hospital
- Maharajgunj, Kathmandu, Nepal
- Sheetal Gaikwad MD
- Assistant Professor
- Department of Anesthesia, Critical Care and Pain
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Shruti Dutta MSc PhD
- Senior Research Officer
- Skin Bank and Research
- National Burns Centre
- Navi Mumbai, Maharashtra, India
- Simon Smith MBChB FRACP DTM&H
- Infectious Diseases Specialist
- Department of Medicine, Cairns Hospital
- Cairns, Queensland, Australia
- Sing Chee Tan MBBS, MMed (ClinEpi) BMedSc
- Registrar, Department of Intensive Care Unit
- Austin Health
- Victoria, Australia
- Srinivas Samavedam
- MD DNB FRCP FNB EDIC FICCCM DMLE MHA
- Head, Department of Critical Care
- Virinchi Hospital
- Hyderabad, Telangana, India
- Subhal Bhalchandra Dixit
- MD (Medicine) IDCCM FCCM FICCM
- President-Elect
- Indian society of Critical Care Medicine
- Consultant, Department of Critical Care
- Director, Intensive Care Unit
- Sanjeevan and MJM Hospitals
- Pune, Maharashtra, India
- Subhash Prasad Acharya MD (Anesthesiology)
- Associate Professor
- Department of Anesthesiology
- Tribhuvan University Teaching Hospital
- Maharajgunj, Kathmandu, Nepal
- Sunil M Keswani MS MCh (Plastic Surgery)
- Medical Director
- National Burns Centre
- Navi Mumbai, Maharashtra, India
- Thomas A Doyle BA (Hon) MBBS MRCP (UK) FCICM
- Intensive Care Specialist
- Cairns Hospital
- Cairns, Queensland, Australia
- Timothy Martin Wilkinson MA DPhil (Oxon)
- Professor
- Department of Politics and International Relations
- University of Auckland
- Auckland, New Zealand
- Valencia Lim
- MBBS, MRCP
- Senior Resident
- Department of Respiratory and Critical Care Medicine
- National University Hospital
- Singapore
- Vandana Saluja
- MD PDCC Liver Transplant Anesthesia
- Associate Professor
- Department of Critical Care
- Institute of Liver and Biliary Sciences
- New Delhi, India
- Vijaya Patil DA MD
- Professor and Head
- Division of Anesthesiology
- Department of Clinical Anesthesia, Critical Care and Pain
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Vikas Bhagat
- DO MD DM EDIC
- Specialist Senior Resident
- Department of Anesthesia, Critical Care and Pain
- Tata Memorial Hospital
- Mumbai, Maharashtra, India
- Vinay Amin MBBS
- Registrar, Department of Medicine
- Bombay Hospital Institute of Medical Sciences
- Mumbai, Maharashtra, India
- Yatin Mehta
- MD MNAMS FRCA FAMS FIACTA FICCM FTEE
- President
- Indian Society of Critical Care Medicine
- Chairman
- Medanta Institute of Critical Care and Anesthesiology
- Gurugram, Haryana, India
As of Saturday, 5th January 2019, the estimated population of Asia is 4,565,540,460, equivalent to roughly 60% of the total world population.
In contrast to the population, compared to the western intensive care units, critical disease profile, information about the diagnosis, treatment and patient outcome of diseases suffered by patients of that population, the intensive care units in Asia and the Pacific regions reported in scientific journals reports and critical care educational texts are in significant minority. However, the organization of intensive care delivery in Asia Pacific region is rapidly evolving, and within over 50 countries that comprise the “Asia Pacific” region. There is an ever-increasing demand for services for critically ill and an increasing desire to have information relevant to intensive care medicine practice in this region.
This desire led the Asia Pacific Association of Critical Care Medicine (APACCM) to organize and sponsor this publication “Evidence Based Core Topics in Critical Care Medicine 2019” to assist dissemination of the available evidence in the field. The book has been exclusively written by 85 authors, who practice in the Asia Pacific regions intensive care environment, and as such provides a contemporary overview of the practice intensive care medicine in our region. In addition to sections of general assessment and organ support in critically ill, over half of the book is dedicated to organ dysfunction and specific critical illness syndromes (including the infectious diseases) that are prevalent in areas of the region.
We are grateful to many authors for their commitment and their expertise in producing this book, and to the publishers for their consideration and care in its production.
Ross Callum Freebairn
Atul Prabhakar Kulkarni
Acknowledgments
We wish to thank all contributors from all member countries of APACCM (Asia Pacific Association of Critical Care Medicine) for their efforts in contributing the chapters to the first ever book published by Asia Pacific Association of Critical Care Medicine. This book would not have been possible without their hard work, put in, in spite of their busy clinical schedule.
We would also like to extend our appreciation to Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Group President), Ms Chetna Malhotra Vohra (Associate Director–Content Strategy), Ms Prerna Bajaj (Development Editor), and all the staff of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their efforts and input enabling timely publication of the book.