Search

Few incidences of adult patients with rapidly progressing empyema complicated by bronchopleural fistula related to Streptococcus anginosus have been documented. A 53-year-old male with a history of smoking 20 packs/year. He was admitted with 5 days history of worsening cough, respiratory distress, fever, headache, and pleuritic chest pain. Thoracic ultrasound was done, showing septated right-sided pleural effusion, confirming empyema. After decortication, pus culture showed heavy growth of Streptococcus anginosus. The drug susceptibility test revealed susceptibility to penicillin, erythromycin, cephalosporin, and piperacillin/tazobactam. The patient was successfully treated with piperacillin/tazobactam and early open thoracotomy decortication surgery was performed and discharged within 11 days. Although the number of empyema cases infected with Streptococcus anginosus is low, patients should be managed early depending on accurate diagnosis using the right antibiotics, optimal drainage, and surgical intervention if necessary. Further knowledge and research on the clinical presentation and the pathogenesis of thoracic Streptococcus anginosus are needed to have better clinical outcomes in future cases. The specific classification of empyema is suggested using lung ultrasound for the best management options.

Background: A structured respiratory care (RC) program has a greater impact on student's critical thinking and problem-solving. Across India, the RC curricula differ in structure and duration. With the exception of a few well-established central universities and autonomous institutions, many required appropriate educational resources and qualified faculty. The objective of the current study is to determine RT students' perception toward their careers and level of satisfaction with the available learning resources. Materials and Methods: In this cross-sectional survey, 904 respiratory therapy students participated from medical universities and educational institutions across India. Institutional Ethics clearance was obtained from the host institution and students were given basic information regarding the survey. A validated, structured questionnaire was used which consists of 26 questions that cover four domains: Perception (4 items), satisfaction (13 items), curriculum (5 items), and suggestion (4 items). The questions were answered as per the five-point Likert scale. Data analysis was descriptive, and logistic regression was performed to evaluate factors associated with students' satisfaction with the learning resources. Results: The majority of the respondents were female (59%) and belonged (48%) to the age group of

The prehospital use of noninvasive ventilation (NIV) by emergency medical services is increasing. Applying NIV in the prehospital setting began to gain more attention in the late 1990s when the primary form of noninvasive positive pressure ventilation emerged as a substitute to endotracheal intubation. For the last several years, NIV has become the standard of care for acute cardiogenic pulmonary edema and exacerbation of chronic obstructive pulmonary disease patients in the prehospital setting. A remarkable number of studies demonstrate a reduction in mortality and intubation rates in comparison to standard care when NIV is initiated in the prehospital setting, though there is a lack of evidence to strongly recommend the use of prehospital NIV as a first choice. An in-depth understanding of the science and technological background of NIV machines and interfaces can help attending clinicians in the prehospital setting and thus enhance therapeutic effectiveness by maximizing patient comfort, safety, and stability. Selections of the patients, devices, and interfaces, as well as achieving good patient-ventilator synchrony, are the key aspects of a successful outcome.

Respiratory therapy (RT) profession in India is over 25 years old. Although there have been key advancements in the profession, no history and limited evidence are available about its development and transformation. This article provides a viewpoint on the history and development of the RT field, the evolution of RT education in India, its current state, and the way forward. It also describes in brief the establishment of professional organization, scientific journal, and other major events pertinent to the RT profession in India. This article also emphasizes the need to rationalize the sector and to shape its future to suit the needs of over a billion people who utilize the services of related facilities, directly or indirectly in a highly dynamic healthcare environment. Resolutions to address a few challenges have also been considered, which in our view could be a way forward in this profession. A comprehensive review and assessment was conducted through direct communication, personal interviews, and the review of existing documents in professional organization's archives, representative hospitals, academic institutes, and other relevant texts. The data obtained were evaluated for its relevance and grouped on a thematic basis. This is currently the first paper about the comprehensive history and development of the RT profession in India over the last 25 years.

Acute respiratory distress syndrome (ARDS) is considered a frequent and serious lung disease that is continuously linked with an increase in both morbidity and mortality. Mechanical ventilation (MV) is considered as the gold standard therapy in the management of ARDS; although MV support is lifesaving, it is also associated with potentially harmful threats such as ventilator-induced lung injury (VILI). It is understood from the physiological background itself that VILI has a considerable impact on the prognosis of a patient. Therefore, the current studies show that focusing on key therapeutic elements causing over-distension of the available lung units is more imperative for indicating further damage than how much pressure is used to ventilate. In the past two decades, there has been an increasing trend toward using driving pressure (DP) in the management of ARDS patients in intensive care units (ICUs). Recent studies propose that measuring DP in ARDS patients, in addition to the other respiratory mechanics measurements, may support selecting and customizing appropriate ventilator parameters, which, in turn, improves patient outcomes and decreases mortality rate. Therefore, this review is intended to outline the physiological meaning of DP, the clinical measurement and application of DP and factors limiting DP. Furthermore, measuring DP in non-ARDS patients and recent clinical evidence for the use of DP in the ICUs will be discussed in detail.