Dr Muhammad Imran Ansari-ICU insights Pakistan

Dr Muhammad Imran Ansari-ICU insights Pakistan Critical care insights from Pakistan

NICVD critical care department
11/09/2026

NICVD critical care department

08/09/2026

Patient: 56-year-old female with known DM, HTN, DCMP with EF 30%, CKD baseline Cr 2.4

Presentation:
Admitted on 23/08/26 with acute SOB and diagnosed as Acute Pulmonary Edema secondary to AKI on CKD. Required emergent intubation.

Course:
• Successfully extubated on 25/08/26
• Re-intubated on 27/08/26 due to witnessed aspiration + persistent hypoxia despite 100% FiO2 and PEEP. Required prone positioning.
• Underwent 2 therapeutic bronchoscopies on 28/08 and 01/09 for copious secretions and mucus plugging.
• 5 sessions of dialysis and 2 units PCV transfused during ICU stay.
• Microbiology: 1st BAL = MDR Acinetobacter, 2nd BAL = Mold. Blood cultures from CVP/DL growing GNR, ?Enterococcus, final awaited.
• Currently: Successfully extubated 02/09/26, now on CPAP 8 cmH2O, shifted out of ICU.@

2026 Publications Update Alhamdulillah, grateful to share 4 new research publications this year focusing on Critical Car...
01/09/2026

2026 Publications Update

Alhamdulillah, grateful to share 4 new research publications this year focusing on Critical Care and Cardiovascular Medicine:

1. Acute Kidney Injury in Mechanically Ventilated CICU Patients - Clinical characteristics, RRT and outcomes
2. Long-term impact of frailty on mortality and QOL in AMI patients post PCI
3. Recurrent Pulmonary Embolism after pulmonary endarterectomy - a case report
4.Comparison of T-Piece and Pressure Support
Ventilation During Spontaneous Breathing Trials
in Weaning-Ready STEMI Patients Undergoing
Primary PCI

Humbled to work with an amazing team. Research in ICU/Critical Care is key to improving patient outcomes in Pakistan.
Grateful to all co-authors and mentors.

27/08/2026

CASE SUMMARY

Name: ABC Age/Sex: 47 years / Male Occupation: Truck Driver Date: @19/08/2026

Chief Complaints:
Syncope and Altered Level of Consciousness

Past Medical History:
Known Hypertensive

Presenting Illness:
47-year-old male, truck driver, presented with sudden syncope and ALOC. Initial ECG showed junctional bradycardia with 3rd degree AV block, HR 44, and ST changes in inferior leads. Trop I was markedly elevated at 50,000.
Cath study showed non-dominant RCA with 50% LAD lesion.
He was shifted to CCU-3 .

Course in CCU was complicated by severe hypoxemic respiratory failure. He required high ventilatory support: FiO2 70% PEEP 10 with initial P/F ratio 120. He underwent one session of prone positioning after which oxygenation improved. P/F ratio progressively improved: 120 → 100 → 180 → 190 → 220.

Hemodynamically he had evidence of impaired tissue oxygen delivery: initial ScvO2 54% with Pcv-aCO2 gap 12 mmHg. Milrinone was initiated with improvement in ScvO2 to 67%. Pcv-aCO2 gap remained ∼10 mmHg.

Key Investigations:

1. Labs:
• CBC: TLC 14.1
• RFTs: Cr 2.0
• LFTs: SGPT 1991, SGOT 1863, T.B 0.8
• Coags: INR 1.2
• Inflammatory markers: CRP 12.8, Procalcitonin 1.3

2. ABGs on ventilator:
• Initial: 7.31/36/84.1/18.1 on FiO2 70 PEEP 10
• Improved: 7.46/28/83/19 on FiO2 55 PEEP 10
• Latest: 7.48/28/86/20 on FiO2 40 PEEP 10
• VBG: 7.41/41/28.5/54

3. ECG: 3rd degree AV block, ventricular rate 44, non-specific lateral ST depression

4. Coronary Angiogram: Non-dominant RCA, non obstructive coronary

5. TTE 19/08/2026:
• LV: Normal size, normal systolic function. EF 55-60%. Atypical septal motion.
• RV: Dilated 45mm with depressed systolic function. TAPSE 11mm
• RA: Dilated 44mm
• Valves: Severe TR with poorly coapting leaflets. MV and AV structurally normal
• Impression: Dilated RV with depressed systolic function, Severe TR, Normal LV EF

6. CT Chest/Video:
Attached

Question:
What is the likely cause of hypoxemia in this patient??

Today I got my copy from one of the three authors!Jazakallah!
25/08/2026

Today I got my copy from one of the three authors!
Jazakallah!

Proud moment for our CCM Team! 🎉Our colleagues have published "ICU NOTES" – the critical care handbook we all wished we ...
21/08/2026

Proud moment for our CCM Team! 🎉

Our colleagues have published "ICU NOTES" – the critical care handbook we all wished we had during fellowship prep.

✅ High-yield content
✅ System-wise approach
✅ Exam + Bedside oriented
✅ Guidelines & Landmark Trials included

Written by: Dr. Abdul Rehman, Dr. Bashir Ahmad, Dr. Aqeel
Available at winco books!

Alhamdolillah! We have published three years follow up study of moderate to severe frailty patient at discharge who requ...
05/08/2026

Alhamdolillah! We have published three years follow up study of moderate to severe frailty patient at discharge who required Mechanical ventilation post PCI.

🤪
24/07/2026

🤪

Some people come as students, grow into colleagues, and leave as family. Today we say goodbye to one of the most honest...
21/07/2026

Some people come as students, grow into colleagues, and leave as family.
Today we say goodbye to one of the most honest, hardworking, and humble doctors I’ve had the honor to train with and work alongside.

From our fellow → cleared exit with us → became faculty with me → and now faculty at another prestigious institution.

The ICU won’t be the same without you.
Go shine. We’re all cheering for you. 🙌❤️Shah Fahd

Clot congress!
13/07/2026

Clot congress!

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