Search

Background Simulation is an educational method that utilizes scenarios and simulators that aide to replicate real clinical situations. This research was undertaken to evaluate the effectiveness of simulation and satisfaction following the use of high-fidelity simulation among nursing students studying at undergraduate level. Materials and Methods This is a quasi-experimental research study which was conducted in the simulation laboratory of Mangaluru, Karnataka. This study involves simulation-based learning to improve clinical competency among 100 B.Sc. nursing students. The presimulation self-efficacy was assessed by giving a questionnaire to the students. After the pretest, the researchers gave a brief introduction to the simulation scenario and explained the facilities available in the simulation laboratory. Learning objectives were explained and the samples were divided into small groups. The simulation was given using clinical scenarios and computer-assisted Human Patient Simulator for 45 minutes in the simulation laboratory. Postassessment of self-efficacy as well as student satisfaction assessment were performed using a questionnaire. Results The findings showed that the simulation is a productive learning strategy and builds confidence. After the simulation, 79% of students strongly agreed that their self-efficacy improved in the management of patients with respiratory emergencies. The results showed positive correlation between the variables which indicates higher level of self-efficacy improves satisfaction among learners. The present study results also revealed that 98% of students had good satisfaction and found debriefing very useful. Conclusion The high-fidelity simulation had a great influence on improving self-efficacy and satisfaction. Hence, simulation needs to be incorporated into the curriculum to enrich skills. [ABSTRACT FROM AUTHOR]

Background: With the provision of a small positive end-expiratory pressure (PEEP) effect, high-flow nasal oxygen (HFNO) therapy carries a risk of stomach distension. The present study was conducted to find out the air leak in the gastric antrum leading to gastric distension in adult patients with acute respiratory failure receiving HFNO therapy. Materials and methods: Adult patients with early hypoxemic respiratory failure requiring HFNO therapy were enrolled in this trial. Before initiation of HFNO therapy, baseline gastric volume (GV) and the average number of peristaltic contractions over one minute were measured using ultrasound. Once the patient was stabilized on HFNO therapy, a 2nd, 3rd, and 4th ultrasound scans were acquired at 10, 20, and 30 minutes respectively. Vitals and blood gas values were recorded at the baseline and after 30 min of initiation of HFNO therapy. Patient comfort, duration of HFNO therapy, and outcome were also recorded. Results: The GV at 10, 20, and 30 minutes were significantly larger (p < 0.001) compared to baseline. This increase in GV was associated with a significantly increased number of peristaltic contractions and had a significant positive correlation with the HFNO flow (r = 0.541; p < 0.001). The HFNO therapy was well tolerated by most of the patients and led to a significant improvement in the vitals and blood gas parameters at 30 minutes after initiation of HFNO therapy. Conclusion: In adult patients with hypoxemic respiratory failure, the use of HFNO therapy produces gas leaks into the stomach leading to increased gastric volume. The gastric distension increases the peristaltic contraction and higher flows result in more distension. [ABSTRACT FROM AUTHOR]

Background: Snakebite is an important occupational hazard in India as it is always been a land of poisonous snakes. The isssue which the physician confronts while treating a snake bite patient is assesment of degree of envenomation and requirement of ASV dose. Aims and Objectives: This study was taken to evaluate the optimum dose of anti-snake venom (ASV) required based on the severity of envenomation. Materials and Methods: Patients with a history of snakebite brought to the Department of General Medicine, Hassan, were included in this study. The study was conducted during the period from December 2014 to June 2016. The sample size of 80 patients was included in the study after fulfilling the inclusion criteria. Results: A total of 80 patients were included in the study. The majority of the victims were males (70%), age between 21 and 40 years (47.5%), and agriculture was the main occupation (67.3%). 51.25% did not identify the snake. The most poisonous were viper and cobra types which were 36.5% and 12.5%, respectively. A delay in lag time of 8.99±8.2 h was observed in severe envenomation. Overall, 51 cases (63.75%) had cellulitis, and 3 (3.75%) in the severe group required fasciotomy. Twenty percent had hematologic derangements. Ten percent of patients had developed renal failure and one required dialysis. 8.75% of patients developed respiratory failure and all required mechanical ventilation. The average dose of ASV vials used in mild, moderate, and severe envenomation was 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively. The overall mortality rate was 5%. Conclusions: The optimum dose of ASV required in mild, moderate, and severe envenomation is 9.04±3.51 vials, 18.5±5.27 vials, and 28.6±7.30 vials, respectively to neutralize the circulating venom and lower the risk of development of serious complications. [ABSTRACT FROM AUTHOR]

Introduction: Snakebites pose a significant public health challenge globally, with India hosting over 250 venomous snake species. This study focuses on four major venomous land snakes, including the saw-scaled viper, responsible for numerous incidents worldwide. Snakebites result in millions of cases annually, with India reporting a substantial number, though the actual incidence and mortality rates may be underestimated due to traditional treatments in rural areas. Objective: The research aims to evaluate clinical parameters in patients with poisonous snakebites, emphasizing clinical predictors of mortality. Methodology: Conducted at a Medical College and Hospital from January to November 2023, the study involved 432 snakebite patients, with 260 exhibiting envenomation signs. Clinical criteria and treatments were standardized, and patient outcomes were monitored. Statistical analysis utilized SPSS version 26.0. Results: Among 260 patients, 58 did not survive, resulting in a mortality rate of 22.3%. No significant age or gender differences were observed between survivors and non-survivors. Rural areas accounted for a higher incidence, and September had the peak admission of patients. Lower limbs were predominantly affected (75.8%). Local pain and swelling were common symptoms. Bleeding tendencies, respiratory failure, and shock were associated with higher mortality. Discussion: Mortality rates varied, and factors like delayed hospital arrival, respiratory failure, acute renal failure, severe coagulopathy, and shock were identified as contributors to death. The study highlighted the correlation between mortality and complications such as bleeding tendencies and respiratory failure. Conclusion: The study concludes that predicting mortality in snakebite patients is feasible using straightforward variables like bleeding tendencies, respiratory failure, and shock. These findings can aid healthcare practitioners in directing high-risk cases to advanced facilities promptly. Availability of Anti-snake venom at Primary Health Centers and raising awareness about prompt hospitalization can improve outcomes. [ABSTRACT FROM AUTHOR]

Battlefield injuries result in acute and severe uncontrolled pain, which can be reduced with the early use of analgesia. Apart from pain, battlefield injuries may also cause significant morbidity and a prolonged period of absence from active duty. Traditionally available opioids are known to cause various undesirable side effects such as respiratory depression that may worsen the condition of an already injured combatant. Nalbuphine is an opioid agonist-antagonist and has been increasingly used for postoperative analgesia over the last decade. In India, it is the only opioid analgesic that does not come under the Controlled Substances Act at the time of this publication. In today's world, where nalbuphine is being recommended for acute pain worldwide, its use in the Indian combat scenario needs to be conceptualized at the medical officer level (primary caregiver). This conceptualization will be discussed in detail in this review article. [ABSTRACT FROM AUTHOR]

Background: Organophosphorous (OP) compound poisoning is a common toxological emergency in agricultural country like India, as it is easily available. Cardiac Marker (CPKMB &Trop-I) level were frequently elevated in OPC poisoning and ECG changes were observed. Fatality is mostly due to cardiovascular and respiratory failure. Aim & Objective: To study clinical severity and it's correlation to myocardial injury in respect to Troponine-I, CPK-MB and ECG changes. Material and Methods: A prospective observational study conducted among 97 patients admitted in Medicine Department, VIMSAR, Burla with history of OPC poisoning during the period of Dec 2019 to Dec 2021 after approval from institutional Ethical Committee. Changes in ECG, Serum CPK-MB, Trop-I level were estimated by IFCC and ELISA method, respectively and observed at admission, after 3 days and at discharge. Results: Mostly Chlorpyriphos (23.7%) was consumed followed by Phorate (22.7%). The most common clinical symptoms was bradycardia (49.5%) followed by hypotension (26.8%), and tachycardia (21.6%). Acetylcholine esterase level decreased (<25000IU) in 75.3 % patients. ECG showed Sinus bradycardia (44.3%), followed by QT prolongation (33%). On day3, significantly elevated Trop-I (27.80 %) and CPK-MB(29.89%) were found. Conclusion: Majority of the patients were in the age group of 45-60 with males more than females. Occurrence of cardiotoxicity was related to the type of compounds ingested. Elevated CPK-MB and Trop-I indicates severity of OPC poisoning requiring longer ICU stay and also statistically significant to predict the prognosis of poisoning. [ABSTRACT FROM AUTHOR]

In conventional endoscopic retrograde cholangiopancreatography (ERCP), the patient lies prone or in a semi-prone position under deep sedation and maintains spontaneous ventilation. Sedative-induced respiratory depression and unprotected airway compromise patients' safety. The gastro-laryngeal tube (G-LT) is a novel reusable supraglottic airway device with two separate ports for endoscopy and ventilation. This study attempts to evaluate the performance characteristic of G-LT. One hundred and forty patients undergoing ERCP were enrolled and randomized. In Group G, patients underwent ERCP with G-LT, whereas Group S patients underwent ERCP conventionally. G-LT insertion attempts, esophageal visualization times, vital parameters, propofol consumption, endoscopists' and anesthesiologists' satisfaction scores, time to achieve Modified Aldrete Score of ≥ 9, and complications were recorded. Both groups showed similar demographic parameters and 100% procedure completion rates. G-LT group showed shortened esophageal visualization times (4.71 ± 1.687 s vs 7.37 ± 1.515 s) and increased propofol consumption (423.14 ± 106.982 mg vs 178.00 ± 100.125 mg). Group G showed better endoscopic maneuvrability and lesser hemodynamic variability. Sore throat, dysphagia, and mucosal trauma were higher in the G-LT group. G-LT provides less intra-procedural hemodynamic changes, quicker esophageal visualization, and better scope maneuvrability at the cost of higher propofol consumption, sore throat, dysphagia, and mucosal trauma. Clinical Trial Registry of India CTRI/2021/06/034212 (Registered on: 14/06/2021) [ABSTRACT FROM AUTHOR]

Background: To investigate venous thromboembolism (VTE) in hospitalized patients with severe high altitude pulmonary edema (HAPE), we performed a single center retrospective study to evaluate its clinical characteristics, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center in plateau regions. Methods: We studied a total of 18 patients with severe HAPE from January 1, 2012 to December 31, 2021. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities and cardiac ultrasound, and computed tomographic pulmonary angiography (CTPA) variables were obtained, and comparisons were made between groups with and without VTE. Results: Of the 18 patients hospitalized with severe HAPE (age 43 (range, 34–54) years, 14 [77.8%] men), 7 patients developed VTE (38.9%), including 5 with deep vein thrombosis (DVT) and pulmonary embolism (PE), 2 of whom had DVT only. Eighteen patients are all firstly rapid ascent to high altitudes which the mean altitude was 3700 m (3656–4050 m). Compared with patients who did not have VTE, patients with VTE had a longer time in hospital (13 [11, 19] versus 9 [7, 12]; P = 0.027), respiratory failure (6 [85.7%] versus 2 [18.2%]; P = 0.013), the shortened APTT (21.50 [19.00, 27.50] versus 26.30 [24.80, 30.10]; P = 0.044) and the higher level of D-dimer (7.81 [4.62, 9.60] versus 2.90 [1.75, 3.37]; P = 0.003). The proportion of thromboprophylaxis is too low in our cohort which 2 of 18 (11.1%) patients were given VTE prophylaxis. There was no statistically significant difference between the VTE and non-VTE groups (0 [0.0%] versus 2 [18.2%]; P = 0.497). Conclusions: The prevalence of VTE is high in hospitalized patients with severe high altitude pulmonary edema (HAPE). Prophylaxis for venous thromboembolism may be protective in severe HAPE patients after admission. Our data seem to suggest that VTE is probably an additional prognostic factors in patients with severe HAPE. [ABSTRACT FROM AUTHOR]

Background: Noninvasive ventilation (NIV) is an established first-line treatment of acute respiratory failure both in emergency departments (ED) and intensive care unit (ICU) settings. It is however not always successful. Materials and methods: Prospective, observational study was done among patients above 18 years presenting with acute respiratory failure initiated on NIV. Patients were placed in one of two groups covering successful NIV treatment and NIV failure. Two groups were compared on four variables: initial respiratory rate (RR), initial high-sensitivity C-reactive protein (hs-CRP), PaO2/FiO2 ratio (p/f ratio), and heart rate, acidosis, consciousness, oxygenation, and respiratory rate (HACOR) score at the end of 1 hour of initiation of NIV. Results: A total of 104 patients fulfilling the inclusion criteria were included in the study, of which 55 (52.88%) were exclusively treated with NIV (NIV success group), and 49 (47.11%) required endotracheal intubation and mechanical ventilation (NIV failure group). Noninvasive ventilation failure group had a higher mean initial RR compared with NIV success group (40.65 ± 3.88 vs 31.98 ± 3.15, p <0.001). Mean initial PaO2/FiO2 ratio was also significantly lower in the NIV failure group (184.57 ± 50.33 vs 277.29 ± 34.70, p <0.001). Odds ratio for successful NIV treatment with a high initial RR was 0.503 (95% confidence interval (CI), 0.390-0.649) and with a higher initial PaO2/FiO2 ratio was 1.053 (95% CI: 1.032-1.071 and with a HACOR score of >5 at the end of 1 hour of initiation of NIV was highly associated with NIV failure (p <0.001). A high initial level of hs-CRP was 0.949 (95% CI: 0.927-0.970). Conclusion: Noninvasive ventilation failure could be predicted with information available at presentation in ED, and unnecessary delay in endotracheal intubation could possibly be prevented. [ABSTRACT FROM AUTHOR]

Objective: To determine whether high-flow nasal oxygen (HFNO) or noninvasive ventilator (NIV) can avoid invasive mechanical ventilation (IMV) in COVID-19-related acute respiratory distress syndrome (ADRS), and the outcome predictors of these modalities. Design: Multicenter retrospective study conducted in 12 ICUs in Pune, India. Patients: Patients with COVID-19 pneumonia who had PaO2/FiO2 ratio <150 and were treated with HFNO and/or NIV. Intervention: HFNO and/or NIV. Measurements: The primary outcome was to assess the need of IMV. Secondary outcomes were death at Day 28 and mortality rates in different treatment groups. Main results: Among 1,201 patients who met the inclusion criteria, 35.9% (431/1,201) were treated successfully with HFNO and/or NIV and did not require IMV. About 59.5% (714/1,201) patients needed IMV for the failure of HFNO and/or NIV. About 48.3, 61.6, and 63.6% of patients who were treated with HFNO, NIV, or both, respectively, needed IMV. The need of IMV was significantly lower in the HFNO group (p <0.001). The 28-day mortality was 44.9, 59.9, and 59.6% in the patients treated with HFNO, NIV, or both, respectively (p <0.001). On multivariate regression analysis, presence of any comorbidity, SpO2 <90%, and presence of nonrespiratory organ dysfunction were independent and significant determinants of mortality (p <0.05). Conclusions: During COVID-19 pandemic surge, HFNO and/or NIV could successfully avoid IMV in 35.5% individuals with PO2/FiO2 ratio <150. Those who needed IMV due to failure of HFNO or NIV had high (87.5%) mortality. [ABSTRACT FROM AUTHOR]

Background: Chronic obstructive pulmonary disease (COPD) is one of the common causes of morbidity as well as mortality particularly in developing countries including India. Acute exacerbations of COPD remain one of the common causes of intensive care unit admissions worldwide and respiratory failure remains one of the common life-threatening complications of such an acute exacerbation. In patients with respiratory failure invasive as well as noninvasive ventilation (NIV) may be used. Many studies have shown that NIV is effective in managing these patients with an advantage over invasive ventilation which may associated with complications associated with endotracheal intubation. Aims and Objectives: (i) To assess the effectiveness of NIV in patients coming with type 2 respiratory failure. (ii) To find out the duration of NIV required for clinical improvement with the end point being normalization of arterial pH. Materials and Methods: This was an observational and retrospective study conducted in the Department of Pulmonary Medicine Seth GS Medical College and KEM Hospital, Mumbai. The duration of study was 2 years. Forty-four patients of acute exacerbation of chronic obstructive airway disease were included in this study on the basis of a predefined inclusion and exclusion criteria. The computerized record of all the patients who had been given NIV for acute exacerbations of chronic airway disease was analyzed. The data analysis included comparing the arterial blood gas pH and the use of NIV. The improvement in the pH value was correlated with the use of NIV. Other comorbidities were included in the data and correlated with the pH values. Results: In our study, the most of the patients belonged to the age group of 51–60 years (31.8%) followed by 41–50 years (29.5%) and 61–70 years (20.5%). Improvement in pH was observed in 42 out of 43 studied cases. It was observed that the average number of hours of NIV per patient was 10–15 h (20.5%) followed by 16–20 h (15.9%) of the study population. Conclusion: NIV is safe and effective form of managing patients of acute exacerbation of chronic obstructive airway disease. [ABSTRACT FROM AUTHOR]

Introduction  Respiratory extracorporeal membrane oxygenation (ECMO) is well established and its popularity has increased during coronavirus disease 2019 (COVID-19) time. The efficacy of ECMO has been proved in refractory respiratory failure with varied etiology. More than 85,000 respiratory ECMO cases (neonatal, pediatric, adult) registered as per Extracorporeal Life support Organization (ELSO) statistics April 2022 report, with survived to discharge or transfer ranging from 58 to 73%. Early initiation of ECMO is usually associated with shorter ECMO run and better outcome. Many patient factors have been associated with mortality while on ECMO. Pre-ECMO patient pH and arterial partial pressure of carbon dioxide (paCO2) have been associated with poor outcome. We designed a retrospective study from a single tertiary care center and analyzed our data of all respiratory ECMO (neonatal, pediatric, and adult) to understand the effect of pre ECMO, paCO2, and arterial pH to ECMO outcome. Methods  It is a retrospective analysis of data collected of patients with acute respiratory failure managed on ECMO from January 2010 to December 2021. Pre-ECMO (1–6 hours before initiation), paCO2, and arterial pH level were noted and analyzed with primary and secondary outcome. Primary outcome goal was survivor and discharged home versus nonsurvivor, while secondary goal was the number of ECMO days and incidence of neurological complications. The statistical analysis was done for primary outcome and incidences of neurological complications and p -value obtained by using chi-squared method. Meta-analysis was done by classifying the respiratory ECMO cases in three major category—COVID-19, H1N1 non-COVID-19, and H1N1 respiratory failure. Results  The total 256 patients of respiratory failure were treated with ECMO during specified period by Riddhi Vinayak Multispecialty Hospital ECMO team. Data analysis of 251 patients (5 patients were transferred for lung transplant, hence been not included in study) done. Patients were divided on the basis of pH level less than 7.2 and more than 7.2 and analyzed for primary and secondary outcome. Similarly, patients were divided on the basis of paCO2 level of less than 45 and more than 45. Patient with pre-ECMO pH level more than 7.2 has statistically better survived extracorporeal life support (ECLS) (p -value: 0.008) and survival to discharge home (p -value: 0.038) chances. Pre-ECMO paCO2 level of less than 45 also showed better survival chance of survived ECLS (46.67 vs. 36.02) and survived to discharge home (42.22 vs. 31.06) but not statistically significant (p -value: 0.15 and 0.18, respectively). There was no significant difference in average number of ECMO days in patient survived to discharge home with paCO2 less than 45 and more than 45 (15.7 vs. 11.1 days), and also in pH more than 7.2 and pH less than 7.2 (15.8 vs. 11.6). The incidence of neurological complications was also found lower in patient with pH more than 7.2 (7.5 vs. 17.3%, p -value: 0.034) and in paCO2 level of less than 45 (4.4 vs. 12.65, p -value: 0.15). Conclusion  Pre-ECMO arterial pH of more than 7.2 (statistically significant) and paCO2 of less than 45 (statistically not significant) have definitely better survival chances and have lesser incidences of neurological complications. There was no significance difference in the number of ECMO days in either group. Authors recommends early initiation of ECMO for mortality and morbidity benefits. [ABSTRACT FROM AUTHOR]

Background: OP compound poisoning is an important indication for emergency admission in most hospitals throughout India. WHO estimates that approximately 3 million pesticide poisoning occur worldwide and causing more than 2,20,000 deaths. Peradeniya Organophosphorus poisoning scale grades the severity of OP poisoning and assess the prognosis of patients. The present study aims to correlate serum cholinesterase level and the clinical criteria score described by the POP scale at initial presentation and the severity of poisoning with need for ventilation and outcome. Methods: A hospital based cross sectional observational study was conducted over period from october 2017 to october 2019 at tertiary care hospital, Ahmedabad. Total of 75 patients were evaluated for POP scale and serum cholinesterase levels for assessment of severity of poisoning. POP scale was studied to predict the need for ventilatory support, duration of hospital stay and outcome. Conclusion: In our study males were most commonly involved (61%). Most commonly affected age group was between 25 to 40 years. 72% had mild, 25.33% had moderate, 2.77% had severe op poisoning according to POP score. Respiratory failure was more common in moderate and severe op poisoning, 68.42% and 100% respectively. Prolonged icu stay(more than 5 days) was required in moderate and severe group of op posisoning, 63% and 50% respectively as compared to mild group(16.67%). 100% mortality was noted in severe group, 47.36% was noted in moderate group. [ABSTRACT FROM AUTHOR]

Background: The use of high-flow nasal cannula (HFNC) in Coronavirus disease-2019 (COVID-19) patients is debated due to its uncertain benefits and risks of aerosol dispersion. This retrospective study was aimed to assess the outcome of treatment with HFNC therapy in adult COVID-19 patients with acute hypoxemic respiratory failure (AHRF) admitted in intensive care units (ICU) and to assess the factors affecting outcome. Material and methods: We retrieved electronic medical records of all COVID-19 patients who received HFNC for respiratory support after failure to maintain adequate oxygenation with conventional oxygen devices, between June 1 and August 31, 2020. The data retrieved were statistically analyzed. Results: A total number of 558 COVID-19 patients were admitted to ICUs, out of which 139 patients were identified to be on HFNC and 85 met the inclusion criteria for the study. The success rate of 48.2% with HFNC was observed in these patients. The patients recorded to experience HFNC success were of young age and having higher baseline oxygen saturation compared to those who had its failure. The ROX indices postinitiation were observed to be significantly higher in the success group (p ≤0.001). Awake-prone positioning while receiving HFNC was followed by around more patients in the success group (p <0.001). On multivariate logistic regression analysis, baseline oxygen saturation, awake-prone positioning, and number of days on HFNC were found to be independently affected outcome with HFNC. Conclusion: Almost half of the cases of moderate-to-severe COVID-19 pneumonia can be managed successfully with HFNC, without the need of mechanical ventilation. [ABSTRACT FROM AUTHOR]

Background and purpose: Snake bite is a common but neglected health problem and grave emergency in tropical countries particularly in India. Due to lack of adequate studies, proper demography and epidemiological data, its incidence is poorly estimated. Main reasons for this are lack of proper reporting, difficulty in identification of snake species and treatment by nonmedical persons and traditional healers. Later is also a strong cause of delay in seeking proper medical treatment and high mortality. This highlights the importance of public awareness at very grass root level. Methods: An observational study was conducted to assess the epidemiological profile, presentation, clinical features and outcome in patients presented with neurotoxic snakebites. This study was done among patients with neurotoxic envenomation, admitted to Government Medical College, ANMMCH GAYA from June 2019 to august 2021. Results: A total of 175 cases were evaluated for presentation, clinical features and treatment. 108 were males and rest were females. Time interval between bite and reaching hospital varied from 30 minutes to 30 hours. Bite was mostly over lower limb. Ptosis was the earliest and most common symptom followed by dysphagia pain abdomen and visual abnormalities. All patients received ASVS according to standard guideline. 17 patients developed respiratory failure requiring mechanical ventilation. 9 patients died. 6 of them were brought in gasping condition and already had suffered hypoxic brain insult. Conclusion: patients presenting with snake bite should receive ASVS as early as possible at slightest of the symptom. Public awareness and timely intervention is important and life saving as ASVS is very effective and safe in snake bite management. Main reason for delay in reaching hospital is treatment by traditional healers and remote location of the patients. Lack of awareness, delayed presentation to the hospital, and treatment by nonmedical personnel add to the risk of mortality. [ABSTRACT FROM AUTHOR]

BACKGROUND: Efficacy of high-flow nasal cannula (HFNC) over noninvasive ventilation (NIV) in severe coronavirus disease 2019 (COVID-19) pneumonia is not known. We aimed to assess the incidence of invasive mechanical ventilation in patients with acute hypoxemic respiratory failure due to COVID-19 treated with either HFNC or NIV. METHODS: This was a single-center randomized controlled trial performed in the COVID-19 ICU of a tertiary care teaching hospital in New Delhi, India. One hundred and nine subjects with severe COVID-19 pneumonia presenting with acute hypoxemic respiratory failure were recruited and allocated to either HFNC (n = 55) or NIV (n = 54) arm. Primary outcome was intubation by 48 h. Secondary outcomes were improvement in oxygenation by 48 h, intubation rate at day 7, and in-hospital mortality. RESULTS: Baseline characteristics and PaO2/FIO2 ratio were similar in both the groups. Intubation rate at 48 h was similar between the groups (33% NIV vs 20% HFNC, relative risk 0.6, 95% CI 0.31-1.15, P = .12). Intubation rate at day 7 was lower in the HFNC (27.27%) compared to the NIV group (46.29%) (relative risk 0.59, 95% CI 0.35-0.99, P = .045), and this difference remained significant after adjustment for the incidence of chronic kidney disease and the arterial pH (adjusted OR 0.40, 95% CI 0.17-0.93, P = .03). Hospital mortality was similar between HFNC (29.1%) and NIV (46.2%) group (relative risk 0.6, 95% CI 0.38-1.04, P = .06). CONCLUSIONS: We were not able to demonstrate a statistically significant improvement of oxygenation parameters nor of the intubation rate at 48 h between NIV and HFNC. These findings should be further tested in a larger randomized controlled trial. [ABSTRACT FROM AUTHOR]

Esophageal pressure (Pes) monitoring is performed during polysomnography (PSG) with a thin, water-filled catheter connected to a transducer. The resulting quantitative assessment of respiratory effort can aid in the accurate diagnosis of sleep-related breathing disorders. This was a prospective observational study using Pes in PSG for thirty patients with chronic respiratory failure (CRF) conducted in the Department of Pulmonary, Critical Care and Sleep Medicine at a tertiary care centre of North India. Sleep scoring was done by conventional method and using esophageal manometry and compared polysomnography normal without esophageal manometry recording (PSGN) and polysomnography with esophageal manometry scoring (PSGE). Apnea hypopnea index (AHI) index was similar in both groups. However, respiratory effort related arousals (RERAs) were diagnosed easily using Pes resulting in significant increase in respiratory disturbance index (RDI) and even reclassification in terms of severity of sleep apnea. Besides, Pes was also useful to distinguish obstructive from central hypopnea which cannot be distinguished by routine PSG which can help guide therapy particularly in chronic respiratory failure patients with hypoventilation. Such patients with hypoventilation often require bilevel positive airway pressure as ventilatory support. Central hypopneas and apneas with hypercapnia may require a higher-pressure support, a backup rate or even advanced volume assured modes of ventilation. Thus, it can be concluded that Pes in PSG remains a safe and generally well-tolerated procedure. Use of Pes aids to detect RERA and thereby RDI; a better marker of sleep related breathing disorder rather than AHI. It also helps in differentiating between obstructive and central hypopnea. [ABSTRACT FROM AUTHOR]

Background: Non-invasive respiratory support for neonates using bubble continuous positive airway pressure (bCPAP) delivery systems is now widespread owing to its safety, cost effectiveness and easy applicability. Many innovative solutions have been suggested to deal with the possible shortage in desperate situations like disasters, pandemics and resource-limited settings. Although splitting of invasive ventilation has been reported previously, no attempts to split non-invasive respiratory support have been reported.Objective: The primary objective was to test the feasibility of splitting the bCPAP assembly using a T-piece splitter in a simulation model.Methods: A pilot simulation-based study was done to split a single bCPAP assembly using a T-piece. Other materials consisted of a heated humidification system, an air oxygen blender, corrugated inspiratory and expiratory tubing, nasal interfaces and two intercostal chest tube drainage bags. Two pressure manometers were used simultaneously to measure delivered pressures at different levels of set bCPAPs at the expiratory limb of nasal interfaces.Results: Pressures measured at the expiratory end of two nasal interfaces were 5.1 and 5.2 cm H2O, respectively, at a flow of 6 L/min and a water level of 5 cm H2O in both chest bags. When tested across different levels of set continuous positive airway pressure (3-8 cmH2O) and fractional inspired oxygen concentration (0.30-1.0), measured parameters corresponded to set parameters.Conclusion: bCPAP splitting using a T-piece splitter is a technically simple, feasible and reliable strategy tested in a simulation model. Further testing is needed in a simulated lung model. [ABSTRACT FROM AUTHOR]

Aims and objectives: To prospectively evaluate the impact of cardiopulmonary ultrasound (CPUS) on etiological diagnosis and treatment of critically ill acute respiratory failure (ARF) patients. Design: This is a prospective observational study conducted in a general intensive care unit (ICU) of a tertiary care center in India. Patients over 18 years old with presence of one of the objective criteria of ARF. Patients either consecutively admitted for ARF to ICU or already admitted to ICU for a different reason but later developed ARF during their hospital stay. Written informed consent in local language was obtained from next of kin. Interventions: All included patients underwent bedside CPUS including lung ultrasound (US) and transthoracic echocardiography plus targeted venous US by single investigator, blinded to clinical data. The US diagnosis of ARF etiology was shared with treating intensivist. Initial clinical diagnosis (ICD) and treatment plan (made before US) of each patient were compared with post-US clinical diagnosis and treatment plan. The changes in diagnosis and treatment up to 24 hours post-US were considered as impact of US. Results: Mean age of 108 included patients was 45.7 ± 20.4 years (standard deviation). The ICD was correct in 67.5% (73/108) cases, whereas the combined CPUS yielded correct etiological diagnosis in 88% (95/108) cases. Among the 108 included patients, etiological diagnosis of ARF was altered after CPUS in 40 (37%) patients, which included "diagnosis changed" in 18 (17%) and "diagnosis added" in 22 (20%). Treatment plan was changed in 39 (36%) patients after CPUS, which included surgical interventions in 17 (16%), changes in medical therapy in 12 (11%), and changes in ventilation strategy in 4 (3.5%) patients. Conclusion: This study demonstrates that use of combined US approach as an initial test in ARF, improves diagnostic accuracy for identification of underlying etiology, and frequently changes clinical diagnosis and/or treatment. [ABSTRACT FROM AUTHOR]

Background: Myasthenic crisis (MC) is mainly managed by invasive ventilation (IV) which is associated with prolonged intubation and ventilation and respiratory complication.Aim: To report the characteristics of patients who can be managed by noninvasive ventilation (NIV) and also predictors of NIV in myasthenia gravis (MG).Patients and Methods: In a retrospective study at tertiary care hospital in India during 2013-2015, patients with MG were evaluated. MG was diagnosed by clinical, repetitive nerve stimulation, and acetylcholine receptor antibodies. Patients were intubated based on arterial blood gas criteria. Demographic variables, Myasthenia Gravis Foundation of America (MGFA) score, and clinical examination were done. NIV success was defined if patient did not need mechanical ventilation (MV) in the management or for 72 h after extubation and was considered unsuccessful if patients required MV during this period.Results: Twenty three out of 68 MG patients had MC, 16 patients were given NIV, and 16 IV. Median intensive care unit stay was 18 (4-94) days. Predictors of crisis were infection, bulbar weakness, MGFA > 2b, and history of crisis. NIV was the only respiratory support in 7 patients and reintubation was prevented in 3 patients. NIV failed in 9 patients. Comparison of NIV success and failure did not reveal any difference.Conclusion: With NIV, intubation was prevented in 7 and reintubation in 3 patients. NIV has lower incidence of complications. NIV should be tried in patients with impending MC. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19), which started in December 2019 in China, has resulted in a pandemic leading to significant morbidity and mortality across the globe. Although it mainly causes respiratory symptoms, respiratory failure and death due to multiorgan failure, there is evolving evidence to suggest gastrointestinal (GI) and liver involvement by this virus. Owing to this, health-care professionals taking care of GI and liver diseases are also at an increased risk of getting exposed. Hence, there is a need for protocols to be prepared to guide the handling of COVID-19 patients by the GI and liver specialists, as well as to manage the pre-existing GI and liver diseases during the ongoing pandemic. We present here the guidelines prepared jointly by the three Indian professional bodies in the field of GI diseases, namely the Society of Gastrointestinal Endoscopy of India, Indian Society of Gastroenterology, and Indian National Association for the Study of the Liver. [ABSTRACT FROM AUTHOR]

Background: In developing countries, the widespread use of organophosphorus compounds (OPCs) has been accompanied by increasing incidence of poisoning with these agents, both suicidal and accidental. This is attributed mainly to their easy availability, indiscriminate handling, storage and lack of knowledge about the serious consequences of poisoning. Of the various substance used for suicidal attempts in India, OPCs form a significant group. Since the clinical manifestation of OPC poisoning is diverse ranging from mild symptoms to fatal complications in the course of time, we need proper management of the situation. Materials and methods: Present study included 42 patients with Organophosphorus poisoning admitted in B.J. Medical College, and Civil Hospital Ahmedabad. This study was carried out from June 2018 to June 2019. Patients were managed as per standard protocols of O P poisoning. We also checked for various parameters on like cholinesterase level, complete blood counts, renal function test with electrolytes, liver function test. Results: In this study, majority of patients fell in 20-30 years of age group with male predominance. Most common clinical features were vomiting, miosis and giddiness. Majority of the patients belonged to mild grade. The average s.cholinesterase level was low as severity increases. More doses of PAM and atropine were required in severe poisoning. Most common complication was respiratory paralysis. Death was more in severe poisoning. Conclusion: OPC is one of the most common poisoning in India. In patients of OP poisoning presenting symptoms and s.ChE level directly correlated with severity. Therapeutic required dose of PAM and atropine are different in different grade of severity. Survival amongst patients is definitely better if atropine and PAM are being given with Mechanical ventilator support in cases of respiratory insufficiency. [ABSTRACT FROM AUTHOR]

Introduction: Hypoxemic Respiratory Failure (HRF) is severe arterial hypoxemia that is refractory to supplemental oxygen. Oxygen Saturation Index (OSI) can be an alternate method of diagnosing and assessing the severity of HRF as it uses Oxygen Saturation (SpO2) in place of Partial Pressure of Oxygen (PaO2) and may be utilised with reasonable sensitivity and specificity. Aim: To evaluate the correlation between Oxygen Saturation Index (OSI) and Oxygenation Index (OI) in HRF in neonates. Materials and Methods: The prospective observational study was conducted in Kempegowda Institute of Medical Sciences and Hospital, Bengaluru, Karnataka, India, from December 2016 to July 2018. Fifty neonates who were admitted to Neonatal Intensive Care Unit (NICU) and conventionally ventilated in view of HRF were included. Arterial blood gases in the first 24 hours of life and corresponding oxygen saturations and ventilator settings were recorded. OI and OSI was calculated using the standard formula and their correlation was analysed. Results: The neonates were all on first day of life at admission to NICU and were invasively ventilated due to HRF. The mean birth weight was 1.89±0.84 kg. Of the 50 neonates, 22 (44%) were preterm babies (<34 weeks), 17 (34%) belonged to late preterm group (34 weeks to 36 weeks +6days), 9 (18%) were term babies (>37 weeks), 2 neonates were extremely preterm (less than 28 weeks). In this study, OSI and OI significantly associated and correlated (p-value <0.01) with a correlation coefficient r=0.727. Area under the Receiver Operating Characteristic (ROC) curve for OSI was 0.912 which indicates that OSI is an excellent test to assess the severity of HRF. Conclusion: That OSI can be used to diagnose and assess the severity of lung disease in neonates having HRF. [ABSTRACT FROM AUTHOR]

Objective: There is a high rate of death due to burns and wound infections in India. Innovators and manufacturers of wound and burn dressings need to keep themselves abreast of the most current rules governing medical devices. The concept of advanced dressings is emerging in India. However, local manufacturing is hindered by an absence of clear regulatory guidelines. The lack of advanced wound and burn dressings on the market critically affects patient survival rates, while imports from other countries make dressings unaffordable and beyond the reach of most patients. This article presents the details of an approval procedure for advanced dressings and provides manufacturers, innovators and investors with a better understanding of the classification rules, import, export and marketing approval processes. We also discus the reasons for high levels of imports and costs, as well as suggestions on how to address this. Method: A critical analysis was conducted of 54 research and review articles, including regulatory guidelines to control the marketing of wound and burn care dressings recommended by international regulatory agencies. Conclusion: India is highly dependent on imports of advanced dressings. Due to lack of clear, quality regulatory guidelines, innovators and manufacturers are facing issues while showcasing their product in the Indian market. Thus development of clear quality regulatory guidelines is crucial. Therefore, this article may guide and encourage manufacturers to develop advanced dressings in India [ABSTRACT FROM AUTHOR]

Context: The Indian Society of Critical Care Medicine (ISCCM), had taken an initiative to enable all Indian ICUs (Intensive Care Unit) to capture and store relevant data in a systematic manner in an electronic database: "CHITRA" (Customized Health in Intensive Care Trainable Research and Analysis tool). Aims: This study was aimed at capturing, and summarising longitudinal epidemiological data from a single tertiary care hospital ICU (Intensive Care Unit), based on a pre-existing database and the CHITRA (Customized Health in Intensive Care Trainable Research and Analysis tool) system. Settings and design: Prospective Observational Methods and material: Data was extracted from two databases, a pre-existing database, arbitrarily named pre-CHITRA (January 2006 to April 2014), and the CHITRATM database (October 2015 to January 2018). Diagnoses of the patients admitted were tabulated using the ICD10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) coding format. The outcomes were summarised and cross tabulated. Statistical analysis used: Cross tabulations were used to display summarized data, analysis of outcomes were done using t test and regression analyses, and correspondence analysis was used to explore associations of descriptors. Results: A total of 18940 patients were admitted, with a male preponderance, and the median age was fifty-two years. Most of admissions were from emergency (62%). The age (0.3, p = 0.000, CI (0.2 - 0.38)) and mean APACHE II score of patients had increased over the years (0.18, p = 0.000 CI (0.12-0.25). The ICU mortality had decreased significantly over the years (-0.04, p = 0.000, CI (-0.05 to -0.03)). The most common admission diagnosis in the pre-CHITRA database was general symptoms and signs (ICD10 R50-R69), and in the CHITRA database was Type1 Respiratory failure (ICD 10 J96.90). Conclusion: This study has shown the utility of the CHITRA system in capturing epidemiological data from a single centre. [ABSTRACT FROM AUTHOR]

Modified heart rate, acidosis, consciousness, oxygenation and respiratory rate (HACOR) score takes into consideration pneumonia, cardiogenic pulmonary edema, pulmonary acute respiratory distress syndrome (ARDS), immunosuppression, septic shock, and the sequential organ failure assessment (SOFA) score prior to non-invasive mechanical ventilation (NIV) that would impact the success of NIV and are commonly seen in patients presenting to the emergency. Propensity score matching could have been done for similar distribution of baseline characteristics. Specific objective criteria are needed to define respiratory failure requiring intubation. [ABSTRACT FROM AUTHOR]

Aims: To obtain information on organizational aspects, case mix and practices in Indian Intensive Care Units (ICUs). Patients and Methods: An observational, 4‑day point prevalence study was performed between 2010 and 2011 in 4209 patients from 124 ICUs. ICU and patient characteristics, and interventions were recorded for 24 h of the study day, and outcomes till 30 days after the study day. Data were analyzed for 4038 adult patients from 120 ICUs. Results: On the study day, mean age, Acute Physiology and Chronic Health Evaluation (APACHE II) and sequential organ failure assessment (SOFA) scores were 54.1 ± 17.1 years, 17.4 ± 9.2 and 3.8 ± 3.6, respectively. About 46.4% patients had ≥1 organ failure. Nearly, 37% and 22.2% patients received mechanical ventilation (MV) and vasopressors or inotropes, respectively. Nearly, 12.2% patients developed an infection in the ICU. About 28.3% patients had severe sepsis or septic shock (SvSpSS) during their ICU stay. About 60.7% patients without infection received antibiotics. There were 546 deaths and 183 terminal discharges (TDs) from ICU (including left against medical advice or discharged on request), with ICU mortality 729/4038 (18.1%). In 1627 patients admitted within 24 h of the study day, the standardized mortality ratio was 0.67. The APACHE II and SOFA scores, public hospital ICUs, medical ICUs, inadequately equipped ICUs, medical admission, self‑paying patient, presence of SvSpSS, acute respiratory failure or cancer, need for a fluid bolus, and MV were independent predictors of mortality. Conclusions: The high proportion of TDs and the association of public hospitals, self‑paying patients, and inadequately equipped hospitals with mortality has important implications for critical care in India. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to develop and validate a predictor score for assessing the requirement of mechanical ventilation (MV) in patients with Guillain-Barre syndrome (GBS). Study design: The study was conducted in patients admitted with GBS in neurointensive care unit in a tertiary care hospital. The demographic, clinical factors, electrophysiological, and spirometric data of all consecutive patients were prospectively collected. The study was undertaken in 2 stages. In the first stage, data were collected for development of a predictor score. In the second stage, the score developed was validated on a separate set of patient data. Results: The data collected were compared between the 2 groups (ventilated vs nonventilated). On univariate analysis, time taken to reach maximum deficit, neck weakness, bulbar weakness, facial weakness, single breath count (SBC), forced vital capacity, and phrenic nerve latency predicted the need for MV. On multivariate analysis, only neck weakness, bulbar weakness, SBC, and forced vital capacity were independent predictors of MV. There was a good correlation between SBC and the spirometric tests and phrenic nerve distal motor latency, as reflected in receiver operating characteristics curve. The predictor score developed using the regression coefficient of independent predictors showed that the best cutoff score for prediction of ventilation was 60 (sensitivity, 0.95; 1 - specificity, 0.065). Internal cross validation of the neck weakness, SBC, and bulbar palsy (NSB) score showed good correlation (Pearson R = 0.76; P = .00). There was no statistically significant difference between predicted and observed outcomes (sensitivity, 95%; specificity, 93%). Conclusion: Several independent risk factors were found to predict the requirement for MV in patients with GBS at admission. However, after scoring and analyzing them, it was found that combining a few of them was more useful to predict the need for MV. A model using NSB score, developed using clinical variables, accurately predicted the requirement of MV. In addition, among the NSB score parameters, simple bedside SBC could adequately assess the adequacy of vital capacity. [ABSTRACT FROM AUTHOR]

Background: Noninvasive mechanical ventilation (NIMV) is the delivery of positive pressure ventilation through an interface to upper airways without using the invasive airway. Use of NIMV is becoming common with the increasing recognition of its benefits. Objectives: This study was done to evaluate the feasibility and outcome of NIMV in tertiary care centres. Materials and Methods: An observational, retrospective study conducted over a period of 18 months in two tertiary level hospitals of north India on 184 consecutive patients who were treated by NIMV, regardless of the indication. NIMV was given in accordance with the arterial blood gas (ABG) parameters defining respiratory failure (Type 1/Type 2). Results: The most common indication of NIMV in our hospitals was acute exacerbation of chronic obstructive pulmonary disease (AE-COPD 80.43%), and 90.54% AE-COPD patients were improved by NIMV. Application of NIMV resulted in significant improvement of pH and blood gases in COPD patients, while non-COPD patients showed significant improvement in partial pressure of oxygen (PaO2) alone. The mean duration of NIMV was 8.35 ± 5.98 days, and patients of interstitial lung disease (ILD) were on NIMV for the maximum duration (17 ± 8.48 days). None of the patients of acute respiratory distress syndrome were cured by NIMV; 13.04% patients on NIMV required intubation and mechanical ventilation. Conclusion: This study demonstrates and encourages the use of NIMV as the first-line ventilatory treatment in AE-COPD patients with respiratory failure. It also supports NIMV usage in other causes of respiratory failure as a promising step toward prevention of mechanical ventilation. [ABSTRACT FROM AUTHOR]

Hereditary surfactant deficiency remains elusive as a definitive diagnosis for full-term newborns presenting with intractable respiratory failure. We present a patient with a novel point mutation resulting in hereditary Surfactant Protein-B (SP-B) deficiency. A term female developed intractable respiratory failure soon after birth and died of respiratory failure at 2 months of age despite aggressive management. Genetic testing for the common mutation for SP-B (121ins2) and ABCA3 gene mutation was negative. Further genetic testing showed a novel mutation in the SP-B gene (c.1032insGCC). Both parents are heterozygous for the same gene mutation, thus confirming an autosomal recessive pattern of inheritance. This mutation has only been seen previously in 2 other infants, also of Indian subcontinent origin. We suggest heightened vigilance and consultation with a reference laboratory in detecting similar mutations in term newborns presenting with unexplained respiratory failure. This will primarily help in the counseling of future pregnancies for the affected families. [ABSTRACT FROM AUTHOR]

Aim We studied the epidemiology and etiology of stridor in our patients along with the role of arterial blood gas (ABG) analysis in their management. We also reviewed their prognostic indices and the clinical outcomes. Materials and methods It was a prospective study in a tertiary referral hospital in which 72 patients presenting with stridor, were independently evaluated by 3 different clinicians and clinically classified into mild, moderate and severe. Based on ABG values (pH, PO2, PCO2), we defined 3 groups of patients viz, those in respiratory failure, impending respiratory failure and those with no evidence of failure. Treatment was directed at the cause of stridor. Clinical outcomes were assessed and results classified as resolved, improved, stable and death. Results Out of 72 patients, kappa coefficient of agreement between the 3 observers were found to be 0.014, indicating poor interobserver reliability for the working clinical classification. However, ABG analysis indicated otherwise, with 6 patients in respiratory failure, 19 progressing to impending failure. Hence we complied by the more objective ABG analysis in planning management. Laryngomalacia in children and hypopharyngeal malignancies in adults were found to be the most common causes of stridor in our study. As compared to other conditions, laryngomalacia in children had a poorer outcome (p = 0.001). Conclusion Early detection of impending respiratory failure was instrumental in achieving better clinical outcomes in our patients presenting with stridor. Thus we inferred that ABG analysis is a valuable tool in the effective management of stridor. [ABSTRACT FROM AUTHOR]

The article highlights a study that aims to define the prevalence, severity, and progression of non-pulmonary organ dysfunction and its effect on outcome in patients with acute respiratory failure (ARF) at the respiratory intensive care unit of a tertiary referral hospital in India. Daily patient data were collected on adult patient with ARF to calculate component and total non-pulmonary sequential organ failure assessment scores. The patient hospital survival was the main outcome measure.

Objective: There are little data on the value of using severity scoring systems developed in western countries to assess critically ill patients in India. The authors evaluated the performance of Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II) and Mortality Probability Models version II at admission and at 24 h (MPM0 and MPM24, respectively) in predicting patient outcomes in their Respiratory Intensive Care Unit. Methods: Data from 459 consecutive adult admissions were collected prospectively. Standardized mortality ratios were computed as an index of the overall model performance. Model calibration was assessed using Lemeshow–Hosmer goodness-of-fit tests and through calibration curves. Model discrimination was assessed through receiver operating curve analysis and by drawing 2 × 2 classification matrices. Results: Overall standardized mortality ratio exceeded 1.5 for all models. All models had modest discrimination (area under receiver-operating-characteristic curves 0.66–0.78) and poor calibration (high Lemeshow–Hosmer C and H statistic values). All models had a tendency to underpredict hospital death in patients with lower mortality probability estimates. There were no major differences between the models with regard to either discrimination or calibration performance. Conclusions: Standard severity scoring systems developed in western countries are poor at predicting patient outcome in critically ill patients admitted to a respiratory intensive care unit in Northern India. Caution must be exercised in using such models in their present form on Indian patients until either they are customized for local use or fresh models are developed from Indian cohorts. [ABSTRACT FROM AUTHOR]

Background: At 140 million, India has the second largest population of old people in the world, as per the 2011 census.1 The covid 19 pandemic has wreaked havoc in millions of lives. Elderly are especially vulnerable to COVID-19 and experience high morbidity and mortality as a result of immunosenescence. Age is independently linked with mortality, but age alone does not adequately capture the robustness of older adults who are a heterogeneous group. The current research was done in a tertiary healthcare hospital in Maharashtra to understand the clinical profile and factors that affected the outcome of elderly during the second wave of the COVID pandemic., Method: This was a single centre retrospective observational study done in a tertiary hospital which was admitting both covid and non-covid patients during the time of this study. All elderly patients admitted with COVID 19 disease in Covid ward and covid ICU (Intensive care unit) were included in the study. Their Demographic details, duration of illness, vital parameters, oxygen saturation, partial pressure of arterial oxygen compared to fraction of inspired oxygen (PaO2-FiO2 ratio) were recorded and also relevant investigations such as complete blood count, kidney function tests, liver function tests, arterial blood gases, chest X-rayand ECG (Electrocardiogram),CT scan of the brain, CSF(cerebrospinal fluid) studies and other tests where relevant were recorded. Inflammatory markers such as C-Reactive Protein (CRP), Ferritin, D-Dimer and Chest CT scan were noted. Clinical profiles and outcomes were noted till discharge or death., Results: Among 231 patients that were included in this study, 81(35%) were female and 150 (65%) were male. Ninety-two patients died (39.8%) while 139 patients (60.2%) survived in our study. Majority of our patients (211;91.3%) presented in category E(pneumonia with respiratory failure) or category F(pneumonia with respiratory failure and multiorgan dysfunction syndrome). Factors which had a major impact on mortality were- a low PaO2-FiO2 ratio on admission, high C-Reactive Protein (CRP) levels, high d-dimer levels, a finding of bilateral ground glass opacities on x-ray, and need for invasive ventilation on admission., Conclusions: Elderly remain vulnerable to severe consequences of COVID-19 infection owing to the increasing comorbidities and immunosenescence in them. Prolonged oxygen therapy and intensive respiratory rehabilitation are the mainstays of effective management. Given the constant threat of mutating virus, masking, maintaining hand sanitization, vaccination and also caring for our elders while still maintaining social distance are our best bet against a fatal third wave., (© Journal of the Association of Physicians of India 2011.)

Noninvasive monitoring of lung function during mechanical ventilation has been used to study disease processes causing respiratory failure. Pediatric pulmonary function monitoring during mechanical ventilation in the pediatric intensive care unit in patient with respiratory failure is becoming more common in western countries. The article describes a review of principles and methods of respiratory function monitoring in the pediatric age group. It attempts to incorporate experience from original articles previously published as well as the experience in monitoring pulmonary mechanics at our institution. Routine monitoring of pulmonary mechanics in patients being mechanically ventilated may have significant impact on morbidity and/or mortality of pediatric patients with respiratory failure. Key articles pertaining to lung function testing in pediatric age group from past 15 years were used as well as clinical experience encountered by attending pediatric intensivists at Henrico Doctors' Hospital was incorporated. Over the past ten years the use of monitoring of gas exchange and bedside pulmonary mechanics monitoring as a part of respiratory function monitoring has become more common. With better clinical information to precisely document the status of lung function, it may lead to improved methods of ventilator management which may prevent complications and may significantly impact on morbidity and/or mortality of mechanically ventilated pediatric patients. [ABSTRACT FROM AUTHOR]

Paraquat is highly toxic to human and is widely used in agriculture as a contact herbicide. Paraquat poisoning is associated with high mortality varying from 35% to 50%. Six cases of paraquat poisoning were treated in our center. Acute kidney injury developed in all the cases and mortality was 66%. Respiratory and multiorgan failure are the main causes for mortality. [ABSTRACT FROM AUTHOR]

Hemoptysis is a very common symptom in the practice of pulmonary physicians of India. We present a case of uncontrolled hemoptysis managed with bronchial artery embolization. Bronchial artery embolization is an effective treatment for patients with hemoptysis. Serious complications are rare, but may occur if the arterial supply to other structures is compromised. [ABSTRACT FROM AUTHOR]

The article discusses the airway pressure for infants with meconium aspiration syndrome which includes mechanical ventilation and medical care .

The article presents a case study of a 35-year-old woman who was suffering with fever for 1 week and breathlessness for 2 days. She didn't have any history of chest pain, cough with sputum or wheeze. Further diagnosis revealed an ery-thematous lesion with a black necrotic centre (eschar) in the right axilla, and Type 1 respiratory failure. She was given piperacillin/tazobactam and levofloxacin along with mechanical ventilator support.

Introduction: In neurologic practice the common causes of respiratory failure are central (stroke and CNS infections) and peripheral (GBS and Myasthenia). Because of paucity of ICU facility these patients are manually Ambu ventilated but there is no information about the outcome of such patients. Aim: To report the outcome and predictors of good prognosis in the patients subjected to manual ambu ventilation. Methods: A retrospective review of patients undergoing prolong Ambu ventilation >12 hours in a tertiary care teaching hospital in India is presented. Patients needing Ambu ventilation for <12 hours or shifted to another hospital were excluded. The good outcome was defined as discharge from the hospital with spontaneous breathing. We classified the patient into central (CNS infection and stroke) and peripheral (Myasthenia and GBS) cause of respiratory failure. The demographic, clinical profile, associated co morbidities and ventilation related complications were compared between good and poor outcome groups. Results: There were 19 patients aged 48 (range 19 to 75 years and 13 were men. Six patients had good and 13 had poor outcome. G B syndrome (1/1) and CNS infection (3/6) had better outcome than the stroke (1/7) and myasthenia gravis (1/1). Patients having more than 2 co morbidities did not survive. Conclusion: One third patients with prolonged ambu ventilation survive. Patients with CNS infection and G B Syndrome without associated co morbidities have better outcome and should be pursued with Ambu ventilation even if ICU facility is not available. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of early postnatal dexamethasone therapy on severity of hyaline membrane disease., Design: Prospective, randomized, controlled, unblinded study., Setting: Neonatal Intensive Care Unit., Methods: 19 babies who had hyaline membrane disease were included in this study. The inclusion criteria were clinical and radiographic diagnosis of RDS, requiring mechanical ventilation and FiO2 > 0.3. Ten babies received injection dexamethasone 0.5 mg/kg/dose 12 hourly for 3 days starting within 6 hours of birth. The control group did not receive any drug. Babies with active infection, bleeding tendency and congenital malformation were excluded. None of the babies received surfactant. The duration of ventilation and AaDO2 and FiO2 requirements from day one to five were calculated., Results: The initial AaDO2 were similar in both the groups but on day 3, 4, 5 AaDO2 were low in study group (201, 85, 70) compared to control group (236, 209, 162). The initial FiO2 were 0.66 and 0.63 in dexamethasone and control groups, respectively and remained high till day 2 and came down in study group on days 3, 4 and 5 (0.41, 0.27, 0.27) compared to control group (0.53, 0.34, 0.42). The mean duration of ventilation was shorter in dexamethasone group (87 hours) vs control group (120 hours)., Conclusion: Early use of postnatal dexamethasone reduces the disease severity and oxygen requirement in RDS and hence would be useful in the Indian context.

Objectives: To provide the clinical profile and assess the significance of various risk factors contributing to the occurrence of oral candidosis in newborns., Design: Case-control study., Setting: Neonatal Intensive Care Unit (NICU)., Subjects: Twenty newborns with oral candidosis and an equal number of age and weight matched controls., Interventions: All cases of oral candidosis were treated with local application of 1% Clotrimazole., Results: Oral candidosis was documented in 3.2% (20/650) cases in the NICU. Acute pseudomembranous candidosis was the most common presentation. The mean age of onset was 10.5 days. Candida albicans was isolated in 50% cases in addition to C. tropicalis, C. paratropicalis, C. krusei, C. glabrata and C. parapsilosis. On univariate analysis, male sex, birth asphyxia and prolonged antibiotic therapy had a significant correlation with occurence of oral candidosis in neonates. Out of these, birth asphyxia was the only factor significantly associated with oral candidosis (OR 8.09, 95% CI 1.34-48.8, p = 0.0226) on multivariate analysis., Conclusions: C. albicans was the predominant isolate in this series of oral candidosis. Clinical manifestations were evident in the second week of life and birth asphyxia was the most important associated perinatal event.

Sixty four asphyxiated term babies (Apgar score of 6 or less at 5 minutes) and 90 non-asphyxiated term babies (controls) were studied. Of these, 40 cases and 48 controls could be followed up. Mortality and neurodevelopmental outcome were studied in both the cases and controls. Mortality and poor neurodevelopmental outcome correlated inversely with the Apgar scores at 5 and 10 minutes. The outcome of babies with low 5 minute Apgar scores was significantly better than those with the same scores at 10 minutes. Symptomatic neonates when compared to asymptomatic neonates with same Apgar score showed significantly poorer outcome. Babies with Apgar scores of 6 at 5 or 10 minutes behaved like the controls both in terms of mortality and neurodevelopmental outcome.