I am very happy to be the section editor of this special edition of our journal released on the occasion of the sixth annual conference CHETMEDICON-2019 conducted by the General medicine department of Chettinad Hospital and Research Institute. The theme of this year’s conference is Recent Advances in the Medical Intensive Care Units (MICU). In addition to the lecture series in the conference we have selected certain important review articles which may enrich and update our collective knowledge in the management of critically ill patients.

ARDS is a life-threatening condition with significant impact on the morbidity and mortality of critical care patients. The use of Non-invasive ventilation (NIV) in ARDS is still controversial as NIV failure is associated with worse prognosis. However there is no classification system that facilitates an optimal prognostication of mortality in ARDS patients. This is a prospective study done in Medicine ICU between June 2018 and May 2019 in which the association of PF ratio at admission and NIV failure in ARDS patients who are put on NIV is studied.

Dermatomyositis is a chronic inflammatory immune mediated disorder of skin and muscles. Patients with classic dermatomyositis typically present with symmetric, proximal muscle weakness, and skin lesions that demonstrate interface dermatitis on histopathology. We report a 39 year old female who presented with painful proximal myopathy with multiple joint pain. She had hyperpigmented rashes over forehead, nasal bridge and anterior wall of chest. On examination there were multiple painful small nodules over joints with restriction of movements. Excision biopsy showed features consistent with angiolipoma. Musle biopsy report favoured diagnosis of dermatomyositis and she was started on injection methotrexate.

Intensive care units are an integral part of any hospital which deals with critically ill patients who are at extremes of physiological dysfunction. Mortality in critically ill patients vary from 18% up to 40% in various studies across the world due to varied clinical practice, ICU design and individual patient factors. Mortality prediction models such as APACHE score and SOFA score and other scoring tools are used commonly in ICU to prognostic patients and to predict mortality but none of the tools have been shown to be superior among various studies conducted. Demographic factors such level of sophistication of ICU, financial status can adversely affect the prognosis of patients and they are especially important in developing countries such as India. Individual clinical characteristics such as patient’s pre-morbid status and co-morbidities, presence of sepsis with shock, acute respiratory distress syndrome have significant effects on the prognosis of critically ill patients. Sepsis is one of the most common disease condition in an ICU setting, although there are limitations to surviving sepsis guidelines, the recommendations are still widely followed in many hospitals. Our understanding of mechanical ventilation has improved tremendously in the past few years with immense data from evidence based studies which has contributed to the decline in ICU mortality and overall hospital mortality.

Metabolic acidosis is a common finding in ICU patients. Metabolic acidosis in ICU patients is not usually a simple acid base disorder but a mixed acid base disorder. Severe metabolic acidosis is said to be present when pH is < 7.2 and it’s found to be associated with very high mortality especially when it occurs rapidly. Clinical Manifestations of severe acidosis are hyperventilation, decreased myocardial contractility, decreased cardiac output, cardiac arrhythmias, systemic vasodilatation, diaphragm dysfunction and CNS depression. For management of metabolic acidosis, understanding its pathophysiology is important. The prognosis of a patient with metabolic acidosis is usually determined by the underlying disorder causing acidosis. Treatment is directed towards the etiological factor causing acidosis and not towards treatment of acidosis. Treating acidosis with intravenous sodium bicarbonate is controversial.

Endocrinopathies may develop in intensive care unit patients and are not uncommon. These disorders pose unique challenges to the attending clinicians as they present non-specifically. Timely diagnosis and appropriate treatment of the endocrine failures can improve the outcome in critically ill patients. In this review article, endocrine disorders involving the thyroid, anterior pituitary and adrenal glands have been discussed.

Atrial fibrillation (AF) is a common arrhythmia in critically ill patients and is associated with significant mortality. The pathophysiology of development of AF is multifactorial.Advanced age is the most common risk factor for development of AF. The initial therapeutic strategy should depend on the identification and correction of underlying modifiable risk factor. Unfortunately there are limited data for therapeutic strategies for AF in critically ill patients. Present review summarizes the risk factors, pathophysiology, management of haemodynamically unstable as well as stable patients and anticoagulation therapy in critically ill patients.

The Intensive Care Unit in every hospital consumes a large number and variety of blood products on a daily basis. Although commonly used, there is no consensus on the trigger and outcomes of usage of packed cells, plasma, platelets and other products. Multiple studies have shown the detrimental effect of the inadvert use of packed cells, thus cautioning against a low threshold for transfusion in most ICU patients. It has been emphasised that transfusion based on patient related factors such as symptoms of hypoxia, lactic acidosis and heart failure should be utilised rather than an arbitrary haemoglobin value.

It was invented by Irish physician Arthur Leared, and refined by George Cammann in 1852. In 1858, Somerville Scott Alison described a stethoscope which had two separate bells, allowing the user to hear and compare sounds derived from two discrete locations. In the early 1960s, David Littmann, a Harvard Medical School professor, and cardiologist patented a new stethoscope which had vastly improved acoustical performance.