Introduction: Prolonged mechanical ventilation may be associated with various complications. Checklists and protocols have been made to increase the success of weaning from ventilation and reduce the complications; however, adherence to same and outcomes are not well documented in resource-limited, high burden settings. This study was conducted to assess the current weaning practices and impact of implementation of evidence-based weaning protocol in a high-burden tertiary care ICU setting. Materials and methods: A quasi experimental (pre-test, post-test design) study was carried out in the medical ICU of a tertiary care centre between January 2016 and June 2017.The study was done in three phases, in which 50 patients were recruited in phase one and phase three. Phase two involved training and education of residents in protocol-based weaning. The compliance to various steps of the protocol-based weaning was assessed and outcome parameters were assessed and compared between phases one and three. Results: The baseline demographic profile and comorbidities of the patients in both the groups were comparable. The compliance to weaning protocol was low in various steps. There was a significant improvement assessment of readiness criteria, post-SBT assessment and pre-extubation screening in the post-intervention as compared to the pre-intervention phase. There was an increase in the proportion of patients who were successfully extubated from 50% to 66% (p=0.10). There was no significant difference in duration of mechanical ventilation (10 days vs 7.3 days, p= 0.61), ICU stay (9.2 vs 8.2 days, p= 0.57), as well as hospital stay between the two groups (16.1 vs 17.1 days, p= 0.45).Frequency of re-intubations decreased from 14% to 6% and ventilator associated pneumonia decreased from 34% to 18%. Conclusion: The study revealed low compliance to various parameters assessed as a part of weaning; however, training of resident doctors was successful in improving compliance with protocol-based weaning.

The global outbreak of Coronavirus disease 2019 (COVID-19), caused by the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2/2019-nCoV) has put forth a serious threat to the international public health and has ruined the global economy. Till date, no drugs have been approved for Coronavirus Disease-2019 (COVID-19), although use of some drugs in trial phase has been attempted. The drugs being used for management of COVID-19 disease include chloroquine (CQ), hydroxychloroquine (HCQ), and remdesivir. In this article, we have aimed to review existing literature and mechanism by which CQ and HCQ have an effect on COVID-19, most importantly by interfering with autophagy, lysosomal activity, receptor binding and membrane fusion. We have systematically searched the PubMed database upto April, 2020 and analysed all the articles published on CQ, HCQ and COVID-19. The available data provides insights into the immunomodulatory potency of HCQ, along with the molecular mechanism of action of the drug on the SARS-CoV-2.

COVID-19 is characterized by fever, cough, shortness of breath, myalgia, and headache. The disease also takes a more severe form with life-threatening manifestations of acute respiratory distress syndrome (ARDS), acute cardiac injury, acute kidney injury, disseminated intravascular coagulopathy, and cytokine storm. It has been elucidated that like its predecessor, the SARS CoV, the SARS CoV-2 utilizes the ACE2 receptor to enter cells. This knowledge brought into speculation the effects of a dysregulated Renin-Angiotensin system (RAS) in the pathogenesis of COVID-19. It has been proposed that the effects of a dysregulated RAS would lead to an inflammatory cascade and contribute to the cytokine storm that is central to the disease. This paper looks at the RAS pathway and the hypothesizes the possibility of a positive RAS feedback loop in the pathogenesis of COVID-19. We also propose possible drug targets for the treatment of COVID-19.