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Article: Pain Assessment in Intensive Care Unit: A Forgotten Entity or a Quality Indicator?

Havaldar, Amarja A

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2022 Volume 26, Issue 4, Page(s) 419–420

Abstract: How to cite this article: ...

Abstract	How to cite this article:
Language	English
Publishing date	2022-04-08
Publishing country	India
Document type	Editorial
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-24191
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Vital Role of Ultrasound in the Era of COVID-19: Arriving at the Right Diagnosis Real Time.

Havaldar, Amarja A

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2020 Volume 24, Issue 7, Page(s) 563–564

Abstract: ... patients with respiratory distress.: How to cite this article: Havaldar AA. Vital Role of Ultrasound ...

Abstract	Ultrasound has become an integral part for assessment of critically ill patients. It has helped in diagnosing and treating critically ill patients. The added advantage of ultrasonography is that it is a fantastic diagnostic tool that is easily available at the bedside, repeatable, more objective, and has a steep learning curve. It has become fifth vital assessment along with inspection, palpation, percussion, and auscultation. In the current scenario of COVID-19 pandemic, the disease caused by virus ranges from mild influenza-like illness to severe acute respiratory illness (SARI). Among the patients developing SARI, few require hospitalization and might need intensive care management. As a critical care specialist, we need to keep our antenna up to look for other causes for SARI due to non-COVID etiology as well. This article describes algorithmic approach and vital role of ultrasonography while managing patients with respiratory distress. How to cite this article: Havaldar AA. Vital Role of Ultrasound in the Era of COVID-19: Arriving at the Right Diagnosis Real Time. Indian J Crit Care Med 2020;24(7):563-564.
Keywords	covid19
Language	English
Publishing date	2020-09-18
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-23490
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Article: Vital Role of Ultrasound in the Era of COVID-19: Arriving at the Right Diagnosis Real Time

Havaldar, Amarja A

Indian J Crit Care Med

Abstract: ... patients with respiratory distress. How to cite this article: Havaldar AA. Vital Role of Ultrasound ...

Abstract	Ultrasound has become an integral part for assessment of critically ill patients. It has helped in diagnosing and treating critically ill patients. The added advantage of ultrasonography is that it is a fantastic diagnostic tool that is easily available at the bedside, repeatable, more objective, and has a steep learning curve. It has become fifth vital assessment along with inspection, palpation, percussion, and auscultation. In the current scenario of COVID-19 pandemic, the disease caused by virus ranges from mild influenza-like illness to severe acute respiratory illness (SARI). Among the patients developing SARI, few require hospitalization and might need intensive care management. As a critical care specialist, we need to keep our antenna up to look for other causes for SARI due to non-COVID etiology as well. This article describes algorithmic approach and vital role of ultrasonography while managing patients with respiratory distress. How to cite this article: Havaldar AA. Vital Role of Ultrasound in the Era of COVID-19: Arriving at the Right Diagnosis Real Time. Indian J Crit Care Med 2020;24(7):563-564.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #749202
Database	COVID19

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Article: A rare case of persistent air leak: beware of all the tubes.

Havaldar, Amarja Ashok / Fazal, Abdul Rahim / Chennabasappa, Abhilash

International journal of emergency medicine

2021 Volume 14, Issue 1, Page(s) 58

Abstract: Background: Patients with acute respiratory failure, impaired consciousness, and impaired airway reflexes will require invasive mechanical ventilation. Monitoring of such patients is important. The use of ventilator scalars and loops help in monitoring, ...

Abstract	Background: Patients with acute respiratory failure, impaired consciousness, and impaired airway reflexes will require invasive mechanical ventilation. Monitoring of such patients is important. The use of ventilator scalars and loops help in monitoring, diagnosing the abnormality, and treating the patients effectively. We report a rare cause one should suspect in a case of persistent and fixed air leak in a patient requiring mechanical ventilation. Case presentation: We describe a 28-year-old young patient requiring ventilator support due to neuromuscular weakness. His neuromuscular weakness was rapidly progressing involving the respiratory muscles. The patient was intubated and put on mechanical ventilator support. He was transferred from another health care center to our hospital. On evaluation, the patient was intubated with ETT no 8. The patient had persistent air leak as observed on the ventilator graphics. We checked for ETT cuff malfunction, ventilator circuit, catheter mount, and HME for any disconnection causing the leak. The air leak which we observed in our patient was due to the malpositioned Ryle's tube. Conclusions: Vigilant monitoring of patients requiring mechanical ventilation is necessary. For the evaluation of the cause of air leak, algorithmic approach will help in correctly identifying the abnormality.
Language	English
Publishing date	2021-09-22
Publishing country	England
Document type	Journal Article
ZDB-ID	2411462-5
ISSN	1865-1380 ; 1865-1372
ISSN (online)	1865-1380
ISSN	1865-1372
DOI	10.1186/s12245-021-00381-6
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Article: Epidemiology and ventilation characteristics of confirmed cases of severe COVID-19 pneumonia admitted in intensive care unit (EPIC19): A multicentre observational study.

Havaldar, Amarja A / Kumar, M Vinay / Vijayan, Balaji / Prakash, Jay / Kartik, Munta / Sangale, Atul

Indian journal of anaesthesia

2022 Volume 66, Issue 10, Page(s) 724–733

Abstract: Background and aims: Coronavirus disease (COVID)-19 has spread across the globe. For a country like India with limited resources and a high population, it is worth knowing how these patients were managed. This prospective study was aimed to evaluate the ...

Abstract	Background and aims: Coronavirus disease (COVID)-19 has spread across the globe. For a country like India with limited resources and a high population, it is worth knowing how these patients were managed. This prospective study was aimed to evaluate the patient characteristics and risk factors associated with mortality. Methods: The study was conducted from 15 June 2020 to 31 December 2020 in four centres across India. Patients above 18 years of age admitted in the intensive care unit (ICU) with severe COVID-19 pneumonia were included. Details of oxygen therapy and ventilator characteristics were collected for seven days. Results: Of 667 patients included in the study, the average age was 57 (standard deviation (SD) = 15) years and 70.46% were male. The ICU mortality was 60%. Acute physiology, age and chronic health evaluation (APACHE II) score was 29.8 (SD = 6.1). Among various significant risk factors, the need for invasive ventilator support on day 1 [odds ratio (OR): 3.11, 95% confidence interval (CI) (1.91-5.08)] and the development of arrhythmia [OR 3.85 CI (1.69,8.77) confidence interval (CI) (1.69, 8.77)] had higher odds of mortality. PF ratio [partial pressure of arterial oxygen/fraction of inspired oxygen] was 109.31 (77.79-187.26), maximum positive end-expiratory pressure was 10.29 (3.5) cmH Conclusion: In this cohort of patients, ICU mortality was 60%. The reason for higher mortality could be the severity of illness as suggested by day 1 PF ratio and APACHE II score.
Language	English
Publishing date	2022-10-19
Publishing country	India
Document type	Journal Article
ZDB-ID	412570-8
ISSN	0019-5049
ISSN	0019-5049
DOI	10.4103/ija.ija_179_22
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Article: Simulation Training in Hemodynamic Monitoring and Mechanical Ventilation: An Assessment of Physician's Performance.

Havaldar, Amarja A / Krishna, Bhuvana / Sampath, Sriram / Paramasivam, Saravana K

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2020 Volume 24, Issue 6, Page(s) 423–428

Abstract: ... to cite this article: Havaldar AA, Krishna B, Sampath S, Paramasivam SK. Simulation Training ...

Abstract	Background: Simulation is to imitate or replicate real-life scenarios in order to improve cognitive, diagnostic and therapeutic skills. An ideal model should be good enough to output realistic clinical scenarios and respond to interventions done by trainees in real time. Use of simulation-based training has been tried in various fields of medicine. The aim of our study was to prospectively evaluate the effectiveness of simulation model "CRITICA"™ (MEDUPLAY systems) in training critical care physicians. Materials and methods: The advanced intensive care unit (ICU) simulator "CRITICA"™ (MEDUPLAY systems) was developed as a joint collaboration between the Indian Institute of Science, Bengaluru and St John's Medical College, Bengaluru. Two-day workshop was conducted. Intensive didactic and case-based scenarios were simulated to formally teach principles of advanced ICU scenarios. The physicians were tested on clinical scenarios in hemodynamic monitoring and mechanical ventilation displayed on the simulator. Assessment of the analytical thinking and pattern recognition ability was carried out before and after the display of the scenarios. Pre- and posttest scores were collected. Results: The postsimulation test scores were higher than pretest scores and were statistically significant in hemodynamic monitoring and mechanical ventilation module. [Hemodynamic monitoring pre- and posttest scores 4.41 (2.06) vs 5.23 (2.22) Conclusion: Simulator-based training in hemodynamic monitoring and mechanical ventilation was effective. Comparison of routine classroom teaching and simulator-based training needs to be evaluated prospectively. How to cite this article: Havaldar AA, Krishna B, Sampath S, Paramasivam SK. Simulation Training in Hemodynamic Monitoring and Mechanical Ventilation: An Assessment of Physician's Performance. Indian J Crit Care Med 2020;24(6):423-428.
Keywords	covid19
Language	English
Publishing date	2020-01-17
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-23458
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Wean to Win.

Havaldar, Amarja Ashok / Krishna, Bhuvana

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2023 Volume 27, Issue 10, Page(s) 695–696

Abstract: How to cite this article: ...

Abstract	How to cite this article:
Language	English
Publishing date	2023-10-01
Publishing country	India
Document type	Editorial
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-24556
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Estimation of the effect of vaccination in critically ill COVID-19 patients, analysis using propensity score matching.

Havaldar, Amarja Ashok / Selvam, Sumithra

Annals of intensive care

2024 Volume 14, Issue 1, Page(s) 24

Abstract: Background: Vaccination helped in reducing mortality and disease severity due to COVID-19. Some patients can develop breakthrough infections. The effect of vaccination in critically ill patients admitted with breakthrough infections is not well studied. ...

Abstract	Background: Vaccination helped in reducing mortality and disease severity due to COVID-19. Some patients can develop breakthrough infections. The effect of vaccination in critically ill patients admitted with breakthrough infections is not well studied. We designed a study to estimate the effect of vaccination on ICU mortality in critically ill COVID-19 patients by using propensity score matching. Methods: We included patients from 15th June 2020 to 31st December 2021. Inclusion criteria were unvaccinated and vaccinated COVID-19 patients requiring intensive care unit (ICU) admission. The institutional ethics committee approval was obtained (institutional ethics committee, IEC 08/2023, Clinical trial registry, India CTRI/2023/01/049142). The primary outcome was ICU mortality. The secondary outcomes were the length of ICU stay and duration of mechanical ventilation. We used multivariable logistic regression (MLR) and propensity score matching (PSM) for the statistical analysis. Results: Total of 667 patients (79.31%) were unvaccinated and 174 (20.68%) vaccinated. The mean age was 57.11 [standard deviation (SD) 15.13], and 70.27% were males. The ICU mortality was 56.60% [95% confidence interval (CI) 53.24-60%]. The results of MLR and PSM method showed that vaccinated patients were less likely to be associated with mortality [adjusted odds ratio (AOR), 95% CI using logistic regression: 0.52 (0.29, 0.94), and by propensity score matching: 0.83 (0.77, 0.91)]. Conclusion: The findings of this study support COVID-19 vaccination as an effective method for reducing case fatality not only in the general population but also in critically ill patients, and it has important public health implications.
Language	English
Publishing date	2024-02-12
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2617094-2
ISSN	2110-5820
ISSN	2110-5820
DOI	10.1186/s13613-024-01257-7
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Echocardiographic parameters in COVID-19 patients and their association with ICU mortality: a prospective multicenter observational study.

Havaldar, Amarja Ashok / Kumar, Merugu Vinay / Kumar, Raman / Yarramalle, Surya Prakash / Khan, Mohammad Saif / Misra, Krushna Chandra / Kamble, Shubhangi / Sangale, Atul / Prakash, Jay / Kartik, Munta / Selvam, Sumithra

The ultrasound journal

2023 Volume 15, Issue 1, Page(s) 38

Abstract: Background: Echocardiography has become an integral part of the management of critically ill patients. It helps to diagnose and treat various conditions. COVID-19 patients can develop cardiac dysfunction. We planned to study the echocardiographic ... ...

Abstract	Background: Echocardiography has become an integral part of the management of critically ill patients. It helps to diagnose and treat various conditions. COVID-19 patients can develop cardiac dysfunction. We planned to study the echocardiographic parameters in COVID-19 patients. Methods: We conducted a prospective observational multicenter study after institutional ethical committee approval. COVID-19 pneumonia patients admitted to the intensive care unit (ICU) were enrolled. The echocardiographic evaluation was done within 24-48 hours of admission. Assessment of the left and right heart with systolic and left ventricular diastolic function evaluation was done. The primary outcome was ICU mortality. The secondary outcomes were the length of ICU stay and duration of mechanical ventilation. Results: Among 573 patients mean age was 57.17 (14.67) with 68.60% being males. On day 1 of ICU, invasive mechanical ventilation was used in 257 (45%) patients. One hundred and forty-eight (25.83%) patients were on vasopressors when echocardiography was performed. Severe left ventricle (LV) systolic dysfunction was seen in 8.7% of patients and had higher odds of mortality [2.48(1.058-5.807), p = 0.037] followed by E and e' with odds ratio of [0.984(0.971-0.998), p = 0.021] and 0.897 (0.805-0.998), p = 0.046], respectively. E/e' indicative of filling pressure of the LV was not found to be significant. Troponin I, E/A, and RV dilatation were similar among survivors and non-survivors. Conclusion: Echocardiographic evaluation in COVID-19 patients showed severe LV systolic dysfunction was associated with ICU mortality. E/e' was not found to be significant but lower e' was associated with higher mortality. Trial registration IEC 131/2020, CTRI/2020/06/025858 date 13th June 2020.
Language	English
Publishing date	2023-09-13
Publishing country	Italy
Document type	Journal Article
ZDB-ID	2965029-X
ISSN	2524-8987 ; 2036-3176
ISSN (online)	2524-8987
ISSN	2036-3176
DOI	10.1186/s13089-023-00336-3
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Article: Demographics and Clinical Characteristics of COVID-19-vaccinated Patients Admitted to ICU: A Multicenter Cohort Study from India (PostCoVac Study-COVID Group).

Havaldar, Amarja Ashok / Prakash, Jay / Kumar, Sanjeev / Sheshala, Kaladhar / Chennabasappa, Abhilash / Thomas, Ria Rachel / Sushmitha, Ea Chinny / Khan, Mohd Saif / Kumar, Raman / Kindo, Srishti / Singh, Ritu / Kartik, Munta / Swamy, Akshay Hiruyur Manjunatha / Raj, John Michael / Thomas, Tinku / Selvam, Sumithra

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine

2022 Volume 26, Issue 11, Page(s) 1184–1191

Abstract: ... How to cite this article: Havaldar AA, Prakash J, Kumar S, Sheshala K, Chennabasappa A, Thomas RR et ...

Abstract	Background: Emergency authorization and approval were given for the coronavirus disease-19 (COVID-19) vaccines. The efficacy reported after phase III trials were 70.4% and 78% for Covishield and Covaxin, respectively.In this study, we aim to analyze the risk factors, which were associated with mortality in critically ill COVID-19-vaccinated patients admitted into intensive care unit (ICU). Materials and methods: This study was conducted from April 1, 2021 to December 31, 2021 across five centers in India. Patients who had received either one or two doses of any of the COVID vaccines and developed COVID-19 were included. The ICU mortality was a primary outcome. Results: A total of 174 patients with COVID-19 illness were included in the study. The mean age was 57 years standard deviation (SD 15). Acute physiology, age and chronic health evaluation (APACHE II) score and the sequential organ failure assessment (SOFA) score were 14 (8-24.5) and 6 (4-8), respectively. Multiple variable logistic regression showed patients who have received a single dose [odds ratio (OR): 2.89, confidence interval (CI): 1.18, 7.08], neutrophil:lymphocyte (NL) ratio (OR: 1.07, CI: 1.02,1.11), and SOFA score (OR: 1.18, CI: 1.03,1.36) were associated with higher mortality. Conclusion: The mortality in the vaccinated patients admitted to the ICU was 43.68% due to COVID illness. The mortality was lower in patients who had received two doses. How to cite this article: Havaldar AA, Prakash J, Kumar S, Sheshala K, Chennabasappa A, Thomas RR et al
Language	English
Publishing date	2022-10-30
Publishing country	India
Document type	Journal Article
ZDB-ID	2121263-6
ISSN	1998-359X ; 0972-5229
ISSN (online)	1998-359X
ISSN	0972-5229
DOI	10.5005/jp-journals-10071-24349
Database	MEDical Literature Analysis and Retrieval System OnLINE

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