Objective : To determine mechanical ventilation discontinuation (weaning) practices in Bangladesh as there is currently no data available on this issue. Method : Analyzing the Survey on Bangladeshi respondents using questionnaire developed by and used by a pan Asian study where Bangladesh critical care physicians participated. Result : 40 physicians from 10 ICUs of Bangladesh participated. Majority of our participating doctors (62.5%) came from private for profit hospital. 19 out of 40 respondents were certified in critical care medicine. In our study spontaneous breathing trial (SBT) was liberally used with pressure support being used by 30% respondents. Most of the extubation trial took place during day. As criteria for extubation, respondents mainly considered consciousness and cooperation and along with gag reflex, cough strength, suction frequency and cuff leak at different times. Noninvasive ventilation (NIV) was commonly used for early extubation in cases of COPD, cardiogenic pulmonary edema, neuromuscular disorders, post-operative cases and obesity. Slightly less than half of respondents did not follow any sedation protocol and 42.5% followed weaning protocol. Protocolized weaning by nurses are not known to be practiced in Bangladesh. Conclusion : Weaning practices are diverse in Bangladeshi ICUs. Protoclized weaning is rarely practiced in Bangladesh. Bangladesh Crit Care J March 2021; 9(1): 4-11

Methemoglobinemia is a potentially fatal condition at a level of more than 70%. It occurs when the ferrous iron inHaemoglobin is oxidized to ferric iron, forming methemoglobin (MetHb), causing decreased capability of hemoglobinto bind and deliver oxygen to tissues. Methemoglobinemia has been linked to a wide array of substances, includingfungicides and industrial chemicals. We describe a patient who developed a high MetHb level of 70.7%, afterdeliberately consuming a fungicide, namely Mancozeb. The "oxygen saturation gap" is the difference between thecalculated oxygen saturation from a standard blood gas machine and the reading from a pulse oximeter. If it is greaterthan 5%, the patient's hemoglobin may be abnormal, representing carbon monoxide poisoning, methemoglobinemia,or sulfhemoglobinemia. Disproportionate cyanosis not responding to supplemental oxygen, chocolate brown blood,and saturation gap of >5% raised the suspicion of methemoglobinemia secondary to ingestion of fungicide. Analternative approach to treatment including intravenous ascorbic acid, NAC, and multiple blood transfusions wasgiven due to the unavailability of methylene blue. A high index of suspicion, early recognition, and an alternativeapproach to management resulted in a favorable outcome. Bangladesh Crit Care J March 2023; 11 (1): 46-50

A 36 -year-old female developed refractory cardiac and respiratory failure after self-declared ingestion of unknown amount of propranolol, benzodiazepine and few other unknown drugs in unknown dose. She also had vomiting followed by aspiration pneumonia. Despite giving adequate I/V fluid, antibiotics, activated charcoal, lipid emulsion, intravenous sodium bicarbonate and inotropic support, she became hypotensive and developed acute heart failure with pulmonary edema. This patient was managed with extracorporeal membrane oxygenation (ECMO) for 72 h, she survived without any deficit. This records country’s first ever use of extracorporeal membrane oxygenation in any patient. In this particular case when traditional antidotes were insufficient to prevent collapse, ECMO was introduced in the form of extracorporeal life support (ECLS) to maintain perfusion, reduce vasopressor requirements, and maintain oxygenation and carbon dioxide removal from blood. With increasing expertise and availability, extracorporeal membrane oxygenation should be considered in patients who develop cardiac or respiratory failure due to any cause, refractory to conventional therapy. Bangladesh Crit Care J September 2022; 10(2): 142-145

Lithium Carbonate is the first line treatment for bipolar depressive disorder. It also has beneficial effects on prophylactic use in Acute manic episodes to prevent recurrence and reduces rate of suicide associated with affective disorder. Low therapeutic index of Lithium (0.8-1.2meq/l) mandates regular and frequent measurement of Serum lithium level in patients taking this drug. Here we present a 59 years Indian male who is a known diabetic, chronic alcoholic and a case of bipolar disorder. He was on Lithium tablet off and on for last 4 years and was also on oral antidiabetic agent. He was admitted in ICU through emergency with complaints of altered level of consciousness for 2 days with H/O recurrent hypoglycemia associated with nausea, reduced food intake, vertigo, tremor of all four limbs with weakness of both lower limbs for approximately last 2 months. Admission serum lithium level was 2.24meq/l. Hemodialysis was started. Neurological symptoms improved and serum Lithium level returned to normal (0.79meq/l) after 2 session of hemodialysis. Bangladesh Crit Care J March 2021; 9(1): 46-48

not available Bangladesh Crit Care J March 2022; 10 (1): 78-79