Editor Vineet Nayyar MD FRACP FJFICM
Staff Specialist ICU Westmead Hospital
Westmead NSW 2145 Australia
Jitendar P Vij
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Critical Care Update 2004
© 2005, Vineet Nayyar
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition : 2005
9788180615054
Typeset at JPBMP typesetting unit
Printed at Lordson Publishers (P) Ltd., C 5/19 RP Bagh, Delhi-110007
5List of Contributors
- Bala Venkatesh md ffarcs fficanzca
- Associate Professor of Critical Care Medicine
- University of Queensland
- Princess Alexandra and Wesley Hospitals
- Brisbane QLD 4102 (Australia)
- Darren Roberts
- South Asian Toxicology Research Collaboration
- (SATRC Northwest Provinces in Sri Lanka)
- Medical School
- Australian National University (Australia)
- David Martin md
- Department of Internal Medicine
- Division of Renal Diseases and Hypertension
- University of Texas Medical School
- Houston TX 77030 (USA)
- Frank Liu md
- Division of Nephrology
- Department of Medicine
- University of California at San Diego
- San Diego CA 92103 (USA)
- GS Umamaheshwara Rao md
- Professor of Neuroanaesthesia
- National Institute of Mental Health and Neurosciences
- Bangalore 560029 (India)
- Hayden White fcp(sa)
- Fellow in Intensive Care
- Princess Alexandra Hospital
- Woolloongabba QLD 4102 (Australia)
- Hrishikesh M
- Department of Neurosurgery
- Christian Medical College
- Vellore 6320004 (India)
- Jayarama Guntupalli md
- Department of Internal Medicine
- Division of Renal Diseases and Hypertension
- University of Texas Medical School
- Houston TX 77030 (USA)
- John A Kellum md facp fccm fccp
- Associate Professor of Critical Care Medicine
- University of Pittsburgh School of Medicine
- Pittsburgh PA 15261 (USA)
- John L Moran fracp fanzca
- Senior Staff Specialist ICU
- Queen Elizabeth Hospital
- Woodville SA 5011 (Australia)
- John Victor Peter md dnb
- Intensive Care Unit
- Queen Elizabeth Hospital
- Woodville SA 5011 (Australia)
- Jose Chacko md edic
- Consultant and Head, Critical Care Medicine
- Manipal Hospital
- Bangalore 560017 (India)
- Kalpalatha Guntupalli md
- Department of Medicine
- Pulmonary and Critical Care Section
- Baylor College of Medicine
- Houston TX 77030 (USA)
- Khusrav Bajan md edic
- Consultant in Emergency Medicine
- PD Hinduja Hospital
- Mumbai 400 016 (India)
- Manoj Singh md
- Fellow in Intensive Care
- Manipal Hospital
- Bangalore 560017 (India)
- Mathew Joseph ms
- Professor of Neurosurgery
- Christian Medical College Hospital
- Vellore 632004 (India)
- Michael Eddleston
- South Asian Toxicology Research Collaboration
- University of Colombo, Sri Lanka
- Centre for Tropical Diseases
- Nuffield Department of Clinical Medicine
- University of Oxford, Oxford (UK)
- Paul M Dark phd frcs
- Clinical Scientist, Cardiovascular Medicine
- University of Manchester
- Hon Consultant in Intensive Care
- Hope Hospital, Salford (UK)
- Praveen K Jain md
- Hon Director, Critical Care
- Malabar Institute of Medical Sciences, Calicut
- Chief of Intensive Care Services
- Sir HN Hospital, Mumbai (India)
- RK Mani md mrcp
- Visiting Consultant
- Pulmonology, Critical Care and Sleep Medicine
- Indraprastha Apollo Hospital
- New Delhi 110053 (India)
- Ram E Rajagopalan abim (med) abim (crit care)
- Consultant and Head
- Department of Critical Care Medicine
- Sundaram Medical Foundation
- Chennai 600 040 (India)
- Ramesh Venkataraman md
- Associate Professor of Critical Care Medicine
- University of Pittsburgh School of Medicine
- Pittsburgh PA 15261 (USA)
- Ravindra L Mehta md facp
- Director, Division of Nephrology
- Department of Medicine
- University of California at San Diego
- San Diego CA 92103 (USA)
- Roop Kishen md frca
- Consultant in Intensive Care and Anaesthetics
- Clinical Lecturer University of Manchester
- Hope Hospital, Salford (UK)
- Sriram Sampath md
- Associate Professor in Medicine
- St John's Medical College
- Bangalore 560034 (India)
- Sunil Karanth md fnb
- Consultant, Critical Care Medicine
- Manipal Hospital
- Bangalore 560017 (India)
- Vijaylakshmi Kamat md
- Medical Director SRMC
- Professor of Anaesthesiology/Critical Care
- Sri Ramachandra Medical College
- Porur, Chennai 600 116 (India)
- Vineet Nayyar md fracp fjficm
- Staff Specialist ICU
- Westmead Hospital
- Westmead NSW 2145 (Australia)
Critical Care Update is an annual publication at the end of each calendar year. Now in its fourth year of production, “The Update” has grown in all dimensions. The process involved in its planning has been extended and the depth of its coverage has also improved. To support further growth and evolution of this publication, I had hoped to constitute an editorial board last year, but events in my personal life interrupted the process. The year gone by has been eventful in more ways than one. The Science of ICU Medicine has evolved rapidly with a number of publications last year appearing in mainstream journals like the New England Journal of Medicine and JAMA. The growth of scientific interest in the specialty of Critical Care augurs well for the future.
In accordance to the pattern established last year, the first section of this book carries a series of articles that define a theme. This year, I have chosen to focus upon Critical Care Education for its relevance to the current scenario in India. As a whole, medical education stands at a difficult crossroads in India today. For although it seems easier for an individual to gain entry into a medical college, the quality of education and standards of evaluating competence have all been diluted beyond recognition. Unrestrained demand and commercial interests have driven the process into a downward spiral. Doctors, as important stakeholders of their own professional standards have either been disenfranchised or sucked into the chaos out of their own craving for personal gain. At a crucial time such as this, it appears appropriate to turn our attention to the building blocks of the future. Critical Care Education is one such element that is still luckily in the hands of professionals who can determine the course it takes in the future.
Some of you may have noticed that the editorial base of the Update has shifted from Bangalore in India to Sydney in Australia. This shift has afforded me more time to plan and edit the contents. It has also given me an opportunity to contact a large number of new contributors from around the world. At the same time, it has also posed a challenge for me to try and keep a balance between what is relevant in India and what is available in the West. All along, I have endeavored to make the contents of this book pertinent to the practice in India by inviting a major contribution from Intensivist authors in India. I have, so far, received a lot of support. This year, I have included contributions from some overseas authors that I have never even met! I am especially thankful to those who readily agreed to write for this book.
Over the last few years, the publishers M/s Jaypee Brothers Medical Publishers (P) Ltd.have provided me with extraordinary support and I sincerely hope that I am able to sustain this fruitful relationship into the future. Finally, to you the reader, I hope this update meets your expectations.
Vineet Nayyar
Sydney (Australia)
Dec 2004