The Department of Critical Care Medicine (CCM) is the newest department at Maharajgunj Medical Campus, Institute of Medicine, established on 19th Poush 2078. Prior to becoming a separate department, all activities, including academic programs, were conducted under the leadership of the Department of Anesthesiology. The department is committed to providing excellent clinical service, education, training, and research in all its endeavors. The department follows a multidisciplinary approach to patient management, coordinating with other specialty departments to leverage their expertise and enhance patient outcomes.
The department has 6 faculty members and 6 DM Critical Care Medicine (CCM) Residents.
Faculties:
- Prof. Dr. Subhash Prasad Acharya, Professor and Head of the Department
- Dr. Gentle Sunder Shrestha, Associate Professor
- Dr. Pramesh Sunder Shrestha, Associate Professor
- Dr. Hem Raj Paneru, Lecturer
- Dr. Sachit Sharma, Lecturer
- Dr. Sunil Pathak, Lecturer
DM CCM Residents:
- Dr. Ashmita Paudel, DM Year 3
- Dr. Bipin Karki, DM Year 3
- Dr. Sadikshya Regmi, DM Year 2
- Dr. Utsav Lal Pradhan, DM Year 2
- Dr. Suson Ghimire, DM Year 1
- Dr. Raveesh Mishra, DM Year 1
General Medical and Surgical ICU Services
TUTH ICU serves patients from all across the country, including the most remote parts. Currently, faculties from the Department of Critical Care Medicine do regular rounds in ICU A, ICU B, Liver Transplant ICU (LT-ICU), Medical ICU (MICU), and Post-operative ward (POW). ICU A and ICU B are level III mixed medical and surgical ICUs with the facility of all bedside organ support measures including mechanical ventilation and hemodialysis. ICU A has 10 beds, each being a cubicle with the facility of negative pressure isolation. Similarly, ICU B has 12 beds, each being a cubicle with negative pressure isolation. The Department of CCM also does regular rounds and provides advice pertaining to critical care management of patients admitted to MICU, which is primarily looked after by the Department of Internal Medicine. Similarly, the Department of CCM also does regular rounds in the POW, which is a 12-bedded unit hosting primarily post-surgical patients. Sick patients who require critical care support are subsequently transferred to level III ICUs for further management and care.
Liver Transplant ICU Service
LT-ICU is a specially designed unit dedicated to the postoperative care of patients undergoing liver transplantation. The unit has two functional beds with the facility of positive pressure isolation. To date, the unit has successfully served 15 liver transplant patients. When there are no transplant cases, the unit is used to treat other regular patients.
Critical Care Consultation Services
The department also provides consultations and advice regarding patient management whenever called for by other departments.
Operations
The department has been working in collaboration with the Department of ENT for the management of patients who undergo tracheostomy. A significant number of bedside Percutaneous tracheostomy (66 in the year 2080 BS) was performed by the Department of CCM.
Procedures
Procedures are an integral part of critical care management which can be outcome-changing and life-saving in critically ill patients. The Department of CCM has been performing procedures like bronchoscopy, Point of Care Ultrasound (POCUS), Central Venous Catheterization, Chest drain insertion, Arterial line insertion, Electrocardiography, Electroencephalography (EEG), and Intracranial pressure monitoring on a regular basis for patients who have indications for them. We perform state-of-the-art organ support measures at the bedside including advanced mechanical ventilation, advanced cardiac output monitoring, plasma exchange, hemodialysis, and extracorporeal membrane oxygenation (ECMO).
Nursing Services and Activities
Regular Patient Care, Monitoring, and Procedures
Critical care nursing has been the backbone of the clinical services provided at the bedside. Nurses in the department are trained not only to take care of general medical-surgical patients but also the ones undergoing complex surgeries like renal and liver transplantation. We independently perform, monitor, and manage the organ support measures like advanced hemodynamic monitoring, vasopressor infusions, EEG, physiotherapy and patient mobilization, Plasma Exchange, and Hemodialysis in coordination with and support from the intensivists.
Staff Support Activities
Critical Care Nurses Group (CCNG): We have formed CCNG with the aim to empower nurses and enhance the extracurricular activities in ICU. CCNG is organizing various programs to develop the multidisciplinary activities within and outside the unit. The most notable activity emerging out of this group is the Continuous Nursing Education session every Tuesday where one nurse delivers a talk on a topic in critical care nursing.
Mindfulness Programs: We have been organizing meditation sessions for the healthcare workers working in the ICU every week on Monday (Art of Living). It has been quite helpful in reducing ICU burnout and enhancing the spiritual well-being of the staff.
ICU Refreshment Program: We have been organizing a quarterly refreshment program with the aim to socialize and perform entertainment activities.
List of Hospital Services Provided and Patient Enrollment
Following is the data of patients served in ICU in the year 2080:
- Total Patient Admission: 1199 patients with a survival rate of 74.64%
- From OT: 38.36%
- From ER: 26.77%
- Others: 34.90%
- Mechanical Ventilation: 56.6% of total admissions
Distribution of Patients by Specialty
- Surgical Patients: 56% of total admissions, with the majority being neurosurgical patients (30.19% of total admissions)
- Medical Patients: 44%, with 11.09% being patients with respiratory diseases.