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  Most popular articles (Since May 15, 2017)

 
 
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REVIEW ARTICLES
Tracheostomy tube displacement: An update on emergency airway management
Rajkumar Rajendram, Muhammad Faisal Khan, Alex Joseph
July-December 2017, 6(2):800-806
DOI:10.4103/ijrc.ijrc_12_17  
The formation of tracheal stomas and insertion of tracheostomy tubes is increasing in frequency. Although tracheostomy tube displacement is uncommon, the associated mortality is high. This is because rapid intervention is required, management is often difficult and even specialists in airway management often have limited experience with tracheostomized patients. Anyone caring for a patient with a tracheostomy should be aware of the clinical presentation of tracheostomy tube displacement and be able to manage it rapidly. This review describes the application of fundamental principles of airway management to tracheostomy tube displacement to reinforce its similarity to most other airway emergencies. The first and most important question is: Does the airway need to be re-secured? If so can the tracheostomy be reinserted easily? Assessment of the patient's upper airway must determine whether translaryngeal oxygenation and endotracheal intubation are possible. Information about the other factors that influence management can be obtained from the medical records about the formation of the tracheal stoma. Even airway specialists find it challenging to acquire and process this information to formulate an appropriate management plan, off the cuff, in the heat of the moment. Hence, multidisciplinary guidelines for the management of tracheostomy and laryngectomy airway emergencies recommend that this information be displayed on posters at the bedside. This poster should also be accompanied by a written plan for emergency orotracheal intubation or tracheostomy replacement in the event of an airway emergency. All the equipment required to execute these plans should be immediately available at the bedside.
  4,263 342 -
Role of physiotherapy in weaning of patients from mechanical ventilation in the Intensive Care Unit
Anup Bhat, Lenny T Vasanthan, Abraham Samuel Babu
July-December 2017, 6(2):813-819
DOI:10.4103/ijrc.ijrc_8_17  
Admission to an Intensive Care Unit (ICU) initiates an interprofessional and interdisciplinary approach to bring the patient back to health with normal or near normal function. Physiotherapists play a vital role in restoring function to the patient. The role of physiotherapy (PT) in the ICU has moved from primarily being one of only respiratory care to one that also encompasses early rehabilitation and exercise training. Early mobilization in the ICU has gained prominence in the recent years and is becoming standard practice across many centers. However, the impact on weaning with these interventions is not known. This review highlights the dysfunctions from an ICU admission and the rationale for instituting early PT in the ICU. In addition, evidence from systematic reviews and meta-analysis is reviewed to determine the impact of PT interventions on weaning. Evidence suggests the benefit of active mobilization and inspiratory muscle training in facilitating weaning. In addition, these interventions along with neuromuscular electrical stimulation further improve physical function and reduce the risk of critical illness polyneuromyopathy. Therefore, early PT does have significant functional benefits to ICU patients. However, more studies are required to determine how various interventions and intensities of exercise training improve weaning outcomes.
  3,406 594 -
Infection control in intensive care units
Chiranjay Mukhopadhyay
January-June 2018, 7(1):14-21
DOI:10.4103/ijrc.ijrc_9_17  
Infections acquired in the hospitals, especially in the intensive care unit (ICU) settings, ranging between 15% and 20%, may further lead to complications in >40% in critically ill patients. The order of incidence may vary in different settings, but the most usual causes are ventilator-associated pneumonia, intravascular catheter-associated bloodstream infection, catheter-associated urinary tract infection, posttraumatic intra-abdominal infection, and surgical site infection. These can be prevented by adequate and appropriate application of preventive strategies, which can be implemented strictly at the bedside. The basic norms for surveillance strategies, general preventive measures such as standard and isolation precautions and monitoring of antibiotic use should be followed without fail. Specific practical measures for ICU-related infections should be in place, and the monitoring of activities should be documented regularly as “bundle-care” in view of standardizing the practice, irrespective of place or person. Adequate attention, unfortunately, has not been paid for infection control measures in India for years. It is now mandatory that the essential practices are prioritized and integrated fully into regular hospital administrative procedure as a continuous process for improving quality health care.
  3,363 567 1
Driving pressure: Clinical applications and implications in the intensive care units
Jithin K Sreedharan, Jaber Saud Alqahtani
July-December 2018, 7(2):62-66
DOI:10.4103/ijrc.ijrc_12_18  
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.
  3,257 602 -
EDITORIAL
Cardiopulmonary resuscitation in adult patients in prone position
Pawan Nanjangud, Anitha Nileshwar
July-December 2017, 6(2):791-792
DOI:10.4103/ijrc.ijrc_3_17  
  3,432 424 -
REVIEW ARTICLES
Temperature monitoring in the intensive care unit
Binila Chacko, John Victor Peter
January-June 2018, 7(1):28-32
DOI:10.4103/ijrc.ijrc_13_17  
Close monitoring and management of temperature abnormalities are crucial in the critically ill to minimize the physiological and biochemical ill effects of extremes of temperature. In the intensive care unit, core temperature monitoring using either urinary, nasopharyngeal, or esophageal temperatures is recommended. One needs to be aware of the pitfalls and fallacies of other commonly used sites.
  2,500 308 1
Strategies to prevent ventilator-associated lung injury in critically Ill patients
Alex Joseph, Muhammad Faisal Khan, Rajkumar Rajendram
January-June 2018, 7(1):4-13
DOI:10.4103/ijrc.ijrc_6_17  
Life-saving mechanical ventilation (MV) induces or exacerbates a range of pulmonary pathologies, collectively known as ventilator-induced lung injury if there is evidence of direct causation (i.e., in the research laboratory). However, in clinical practice, the term ventilator-associated lung injury (VALI) is more appropriate. While several factors are involved, the main drivers of the pathogenesis are regional overdistention and clinical atelectasis. This understanding has led to search for strategies to attenuate VALI and improve survival. The current approaches focus on reduction of lung stress and strain by limitation of alveolar–plateau pressure and tidal volume. Recent data suggest that control of driving pressure (plateau pressure–positive end-expiratory pressure) and mechanical power applied during ventilation may also be beneficial. More exciting are the various new techniques for MV (e.g., airway pressure release ventilation and neurally adjusted ventilatory assist), emerging alternative modalities for gas exchange (e.g., extracorporeal membrane oxygenation), and novel biological therapies (e.g., anti-inflammatory stem cells) that promise to revolutionize the management of respiratory failure and relegate VALI to the ash heap of history. However, there are currently insufficient data to recommend their use in routine clinical practice.
  1,933 466 -
Strategies in patients with right ventricular failure on mechanical ventilation
Nitin Tanajirao Patil
January-June 2018, 7(1):22-27
DOI:10.4103/ijrc.ijrc_22_17  
Right ventricular failure is a complex clinical syndrome, and is a challenge for the intensivist to diagnose in critically ill patients, more so in patients receiving mechanical ventilation. Acute RV failure is a sudden deterioration of RV function and an inability of the RV to pump adequate cardiac output to the pulmonary circulation, thereby leading to inadequate cardiac output to the systemic circulation. The most common causes of acute RV failure are acute RV myocardial infarction, massive pulmonary embolism, congenital heart diseases, and severe pulmonary arterial hypertension. Over the years, RV has been considered a passive chamber of the heart and has received less focus about the way it functions and how efficiently the RV dysfunction can be managed. The National Heart Lung and Blood Institute in 2006 convened a working group to better understand the mechanisms of right ventricular dysfunction and the various ways and means to diagnose and manage right ventricular dysfunction.
  1,760 341 -
Advanced cardiovascular support in refractory shock
Ashwin Neelavar Udupa, Rajesh Mohan Shetty
July-December 2018, 7(2):67-72
DOI:10.4103/ijrc.ijrc_2_17  
“Shock” is a term that is used to signify inadequate tissue perfusion and cellular oxygenation. The basic principle of treating shock is restoring tissue perfusion and adequate cellular oxygenation. Resuscitation from shock is achieved using a combination of fluid therapy, inotropes, and vasopressors. Refractory shock has been defined as requirement of noradrenaline infusion of >0.5 μg/kg/min despite adequate volume resuscitation. Inability to use oxygen damages the cellular machinery and if not restored in time, shock can become irreversible. Mortality in these patients is very high, and the assessment and management of these patients requires a much more aggressive approach for survival. This article will focus on the management of refractory shock.
  1,609 318 -
Six-Minute walk test as a guide for walking prescription for patients with chronic obstructive pulmonary diseases
Baskaran Chandrasekaran, Kalyan Chakravarthy Reddy
July-December 2018, 7(2):73-76
DOI:10.4103/ijrc.ijrc_19_17  
Exercise training in chronic respiratory disorders such as chronic obstructive pulmonary disease (COPD) is an essential component of pulmonary rehabilitation, but physical activity for maintenance of benefits in COPD after outpatient/inpatient rehabilitation is a neglected one. The dosage of walking is not “prescribed” properly by health-care providers for maintenance of muscle mass and improving quality of life. If the ground or treadmill walking is appropriately dosed and prescribed based on 6-min walk test (6MWT), the unsupervised ground walking may be a useful alternative to supervised aerobic fitness programs for achieving fitness benefits. This article provides an overview of dosing and measuring the walking program (either ground or treadmill) objectively to novice therapists and primary care physicians based on the 6MWT to COPD patients.
  1,471 261 -
CASE REPORTS
Skin rash and mild bruising: Is montelukast a safe drug?
Deep Inder, Seema Manak, Faiz Akram, Pawan Kumar
July-December 2018, 7(2):105-107
DOI:10.4103/ijrc.ijrc_3_18  
Montelukast is one of the commonly used drugs in asthma patients. It is prescribed along with inhalational corticosteroids. Although a relatively safe drug, there is a probability of occurrence of skin rashes and skin bruising. Authors present a case report of a 64-year-old chronic asthmatic woman, reporting widespread erythematous eruptions with mild skin bruising and generalized pruritus mostly affecting her lower abdomen and upper extremities. The rash appeared 28 days after introduction of montelukast (10 mg OD). The physician excluded other attributable factors such as trauma, autoimmune disorders such as Churg-Strauss syndrome, and food allergy. Reappearance of rashes after montelukast introduction and complete resolution of the skin rashes after discontinuing it confirms montelukast as offending drug. Naranjo causality assessment score also revealed a “certain/definite” relationship to the montelukast. Long-term safety of montelukast needs to be reviewed by prescribing physicians to prevent adverse reaction.
  1,519 71 -
REVIEW ARTICLES
Emergency front of neck access
Martin Ince, Venkata Krishnakar Melachuri
July-December 2017, 6(2):793-799
DOI:10.4103/ijrc.ijrc_7_17  
The “Can't Intubate, Can't Oxygenate” (CICO) situation, while rare, is one of the most emergent and stressful scenarios ever faced by airway practitioners. Failure to provide adequate oxygenation can rapidly result in hypoxic brain injury and death. Emergency front of neck access provides a last resort, lifesaving route for the invasive oxygenation of patients. Adequate forward planning as well as recognition of at-risk patients is critical to avoidance of CICO situations. Multiple strategies exist for performing emergency front of neck access, and much debate exist as to which strategy is superior. All airway practitioners should be trained in at least one method of emergency front of neck access, as it may be required in unfamiliar environments at any time. A thorough understanding of the anatomy involved is important to avoid complications, and regular training has been shown to be vital to the maintenance of the skill. It is often the case that front of neck access is performed too late and a great emphasis has been placed on promoting a timely performance of the procedure.
  1,390 146 -
Liver support devices: Bridge to transplant or recovery
Nandhini Anamthuruthil Joseph, Lakshmi Krishna Kumar
July-December 2017, 6(2):807-812
DOI:10.4103/ijrc.ijrc_11_17  
Liver failure, whether acute or acute on chronic, is a devastating disease with a very high mortality and morbidity. The recent therapeutic advances, especially liver transplant, have given reason for optimism to the ever-rising population affected by this disease. However, scarcity of organs and lack of resources make this an option that only few can afford. The hunt for an artificial device to assist or replace the functions of the liver has been on the rise since the past 40 years. These devices are classified into artificial and bioartificial liver (BAL) assist devices. Artificial liver devices such as molecular adsorbent recirculating system, Prometheus, single-pass albumin dialysis, and selective plasma filtration therapy are mostly aimed at taking over the blood purification systems of the liver. BAL-assisted devices incorporate hepatic cell lines to obtain a more comprehensive coverage of the complex functions of the liver. These include extracorporeal liver assist device, modular extracorporeal liver support, HepatAssist, and Amsterdam Medical Centre-BAL. Development of an ideal liver assist device has been difficult due to the complexity of the functions of the organ. The initial studies on these devices are promising but inconclusive. Therapeutic plasma exchange seems to have a very favorable profile in the treatment of these patients and has been successfully used in a large number of patients. To arrive at a more definitive conclusion of the usefulness of these devices in the management of liver failure, large randomized multicentric studies with more objective end points need to be carried out. A literature review was performed using PubMed and library searches to collect the recent studies in this regard. This review aims to provide a myopic view of the advances that have been made in the development and usefulness of these liver assist devices.
  1,312 208 -
ORIGINAL ARTICLES
Predictors of mortality in patients of acute exacerbation of chronic obstructive pulmonary disease: A prospective observational study
Hemant Kumar, Satyadeo Choubey
July-December 2018, 7(2):77-82
DOI:10.4103/ijrc.ijrc_21_17  
Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) result in increased morbidity, mortality and tremendous socioeconomic burden. Predicting inhospital mortality may aid prognostication, planning for the site of care, i.e., ward versus intensive care units, and better individualization of treatment. Aim of Study: This study aims in predicting inhospital mortality in patients of AECOPD based on the parameters measured at the time of admission. Methods: Known COPD patients in acute exacerbations admitted in a tertiary care hospital were interrogated for clinical history and examination. All relevant laboratory tests including arterial blood gas analysis, complete blood count, liver and renal function tests, and random blood sugar were done. Based on outcome, patients were grouped into survivors and nonsurvivors. Parameters recorded were then subjected for univariate analysis to get their statistical significance. All significant variables on univariate analysis were then analyzed further with multivariate analysis. Results: Out of the total 140 patients included in the study, 24 (17%) died during their hospital stay. Of the various acute-phase parameters recorded at the time of the admission, only five qualified to be predictors of inhospital mortality based on univariate and multivariate analyses. These were partial pressure of carbon dioxide in arterial blood (PaCO2) (odds ratio [OR], 95% confidence interval [CI] =1.067, 0.993–1.146), pH (OR, 95% CI = 0.001, 0.001–0.584), serum glutamic pyruvate transaminase (SGPT) (OR, 95% CI = 1.032, 1.006–1.059), sodium (OR, 95% CI = 0.779, 0.689–0.881), and random blood sugar (OR, 95% CI = 1.018, 1.007–1.029). With these five factors combined, area under receiver operating characteristic (ROC) curve was 0.9684, sensitivity 79.18%, specificity 96.55%, positive predictive value 82.61%, negative predictive value 95.73%, and correctly classify acute exacerbation in 93.57%. Good survival can be expected if these parameters are within normal limits. Conclusion: pH, PaCO2, SGPT, serum sodium, and random blood sugar at the time of admission are independent predictors of mortality in patients of AECOPD. These can be helpful in developing a prediction tool of inhospital mortality in such patients.
  1,076 211 -
Comparison of extubation outcomes following T-piece trial versus pressure support/continous positive airway pressure in postsurgical patients
Lakshmi Kumar, AR Meghalakshmi, Anu Vasudevan, Sunil Rajan, Jerry Paul
January-June 2018, 7(1):37-41
DOI:10.4103/ijrc.ijrc_25_17  
Background: Pressure support with continuous positive airway pressure (CPAP) and T-piece trials are the most common spontaneous breathing trial used to test readiness for extubation. Aim: We aimed to compare extubation failures defined by the need for reintubation within 48 h following T-piece trial versus extubation directly from pressure support (PS) ventilation in postoperative patients. Patients and Methods: This was a prospective cross-sectional study conducted in the postsurgical patients. Hemodynamic parameters and respiratory variables were measured before and after weaning trials. Outcomes after extubation, need for noninvasive-assist ventilation following extubation, duration of oxygen therapy, and time of shifting from the Intensive Care Unit (ICU) were also recorded. Results: Fifty patients needed mechanical ventilation postoperatively were recruited for the study. No significant differences were seen in the rate of extubation failures between PS- and T-piece groups. Rapid shallow breathing index recorded at the start of weaning was significantly higher in the T-piece group (P < 0.001). The respiratory rate (RR) and heart rate (HR) were significantly higher (P < 0.001) and saturation lower (P = 0.035) in the group on T-piece trial. The need for respiratory assist devices, oxygenation index, length of ICU stay, duration of oxygen therapy, and mortality were comparable between the two groups. Conclusions: Outcomes of weaning are similar between T piece and CPAP/PS in patients undergoing postoperative mechanical ventilation. Weaning on T piece is associated with higher RR, HR, rapid shallow breathing, and lower saturation than weaning from CPAP/PS but does not affect the length of ICU stay, need for oxygen therapy, or mortality.
  1,120 130 -
Screening for obstructive sleep apnea using epworth sleepiness score and berlin questionnaire: Which is better?
Ramakant Dixit, Satyadeep Verma, Kamender Singh Pawar
January-June 2018, 7(1):33-36
DOI:10.4103/ijrc.ijrc_20_17  
Background: Obstructive sleep apnea (OSA) is a highly prevalent, but underdiagnosed and undertreated disorder. There is a need for simple but accurate tool for early detection of patients based on their clinical symptoms and physical findings into high- or low-risk group and give information for urgent polysomnography (PSG) and further treatment to prevent serious consequences. Epworth Sleepiness Score (ESS) and Berlin Questionnaire (BQ) are the most popular and widely acceptable instruments for identification of high-risk patients of OSA. The aim of our study was to compare these two established and well-known sleep questionnaires regarding their ability to find out the probable cases of OSA in Indian scenario. Methods: This cross-sectional study was conducted at a tertiary care center on 72 adult patients with symptoms of sleep-related breathing disorders. All patients were asked to fill both ESS and BQ questionnaires. Subsequently, all patients were subjected to level-1 PSG. For each patient, the Apnea–hypopnoea index was calculated to assess the diagnosis and severity of OSA and to further compare the ESS and BQ questionnaires for their sensitivity (SN) in OSA patients. Results: A total of 14 (19.4%) patients were diagnosed as OSA by ESS while by BQ, 32 (44.4%) patients were diagnosed as having OSA with SN of 31% and 71.11%, respectively (P = 0.00004). The positive predictive value was 82.3% and 88.8% for ESS and BQ, respectively, with a negative predictive value of 43.6% by ESS and 63.8% by BQ questionnaires. Conclusion: ESS is a less sensitive diagnostic tool for early detection of high-risk patients of OSA in general population. BQ is a valid, reliable, and more sensitive parameter to screen patients for OSA and may help in improving the quality of life in such patients with proper OSA management.
  1,088 146 1
CASE REPORTS
Pneumothorax after insertion of nasogastric tube
Muhammad Faisal Khan, Rajkumar Rajendram, Mohammed Ahmed Abdou
July-December 2017, 6(2):832-834
DOI:10.4103/ijrc.ijrc_4_17  
A 65-year-old man was admitted to the Intensive Care Unit (ICU) for invasive mechanical ventilation after a significant intraventricular bleed. When his nasogastric tube (NGT) was accidentally removed, a new NGT was inserted blind. The pH of the thick green aspirate was under five and so enteral feeding was restarted. However, the patient subsequently deteriorated with rapidly worsening respiratory failure and invasive ventilation was required. An X-ray revealed misplacement of the NGT into the right lung with consolidation, pleural effusion, and pneumothorax. This highlights that indirect techniques to check NGT position (e.g., air insufflation and abdominal auscultation, aspirate appearance and pH) are unreliable. Even X-ray only detects misplacement after the event and mistakes have occurred because previous X-rays from the same patient have erroneously been reviewed. Only real-time visualization can prevent bronchopulmonary misplacement and the associated risks of pneumothorax and microbial contamination. The authors' current practice is therefore to use laryngoscopy, endoscopy, or fluoroscopy for insertion of all NGT in patients in ICU with impaired airway protective reflexes.
  999 110 -
ORIGINAL ARTICLES
Perception and knowledge of tuberculosis and its services among slum dwellers in Chhattisgarh
Janmejaya Samal
July-December 2017, 6(2):828-831
DOI:10.4103/ijrc.ijrc_10_17  
Background: The level of knowledge and behavior of tuberculosis (TB) patients and the vulnerable population can affect the control of TB in a particular community. Objective: The main objective of this study was to assess the level of knowledge and behavior regarding TB among slum dwellers in Chhattisgarh, India. Materials and Methods: A total of 100 families were selected from two different slum areas in Durg district of Chhattisgarh through simple random sampling technique. A structured questionnaire was used to collect the information from the slum dwellers. Results: Ninety-five percent of the respondents knew that TB is caused by bacteria, 82% knew that TB is transmissible, 63% were aware of different modes of TB transmission, 97% could tell about the symptoms of TB, and 76% of participants were aware about the curability of TB. Seventy-five percent of the slum dwellers were aware that TB treatment is free of cost at public health facilities; 68% were aware that TB is preventable, and 91% could tell about various preventive measures of TB. It was observed from this study that the slum dwellers have relatively poor knowledge about the modes of TB transmission and its preventability showing that proper health education approaches must be implemented to bring down this knowledge gap. Conclusion: Health education and awareness programs need to be carried out to further improve the knowledge of slum dwellers. This would ensure their seeking proper help at appropriate time and place and take precautionary measures against contracting TB.
  939 113 -
A clinical audit to assess the adherence of the code blue team to advanced cardiac life support protocol and its effect on the patient outcome in a Tertiary Care Hospital in Kochi, Kerala
Indhu Aynipully Jayasingh, R Athish Peter Margos, Shoba Philip
January-June 2018, 7(1):46-49
DOI:10.4103/ijrc.ijrc_24_17  
Introduction: Cardiopulmonary resuscitation is a sequence of techniques that combines chest compression with artificial ventilation to manually maintain the circulation to preserve intact brain function. The aim is to maintain circulation and breathing in a person who is in cardiac arrest until emergency aid arrives. Effective teamwork by Code Blue team raises chances of a successful outcome. The advanced cardiac life support (ACLS) guidelines were developed by the American Heart Association using the comprehensive review of resuscitation literature performed by the International Liaison Committee on Resuscitation. Aim: To assess adherence of Code Blue team to ACLS protocol, to assess outcome of resuscitation, and to compare outcome between those where ACLS guidelines were followed and those not followed. Patients and Methods: A clinical audit was done between 2014 and 2015 at Lourdes Hospital, Kochi, on inpatients aged between 30 and 80 years, with witnessed cardiac arrests/respiratory arrest. Pregnant and unwilling patients were excluded. Results: The common arrest rhythm was pulseless electrical activity, followed by asystole. ACLS protocol was followed in 58.7%. The most common deviation was usage of inappropriate drugs. Return of spontaneous circulation (ROSC) was attained in 53.3%, of which 28.5% were discharged (P < 0.05), which suggests a significant association between the adherence to ACLS protocol and ROSC. Conclusion: Although Code Blue team is ACLS trained, deviations occurred in nearly half of the resuscitations, which need to be reduced. Outcome was better in those resuscitations where the ACLS protocol was followed.
  917 126 -
EDITORIAL
Scientific writing
Anitha Nileshwar
January-June 2018, 7(1):1-3
DOI:10.4103/ijrc.ijrc_27_17  
  885 154 -
ORIGINAL ARTICLES
Maximal inspiratory and expiratory pressures in men with chronic obstructive pulmonary disease: A cross-sectional study
Veena Kiran Nambiar, Savita Ravindra, B S Nanda Kumar
July-December 2018, 7(2):88-92
DOI:10.4103/ijrc.ijrc_5_18  
Introduction: Respiratory muscle dysfunction is a cardinal feature in chronic obstructive pulmonary disease (COPD) contributing to decreased exercise capacity and pulmonary function test (PFT) limitation with progression of the disease. Maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) are reliable parameters for assessing the respiratory muscle strength. Aims: This study aims to measure maximal inspiratory and expiratory pressures in male COPD patients, to determine their correlates, and to study the relationship between the severity of COPD and respiratory muscle strength. Patients and Methods: This was an observational, cross-sectional study. A total of 100 males, who were known COPD patients and who were clinically stable, were recruited. Both inpatients and outpatients were studied. Spirometric PFT test was done, and MIP and MEP were measured using respiratory pressure meter. Descriptive statistics and Pearson's correlation were used. Results: The mean (± standard deviation) MIP and MEP were 47.73 (±19.6) cm H2O and 60.76 (±11.6) cm H2O, respectively. MIP and MEP showed a highly significant correlation (P < 0.001) with forced expiratory volume at 1 s (FEV1) and forced vital capacity. The correlation of MIP and MEP with FEV1shows a positive linear trend, and the MEP values were higher than MIP values. There was a decrease in MIP and MEP with increasing severity of COPD. Conclusion: MIP decreases with progression of the disease, and thus, inspiratory muscle training should be included in a pulmonary rehabilitation program.
  868 95 1
CASE REPORTS
An unusual case of multiple failed extubations in a neurosurgical patient
Gana Boban Thadathil, Jithendra , Mathew George, Jithin K Sree, PJ Binu, Jeevan Lal
January 2014, 3(1):418-420
A 41 year old woman, ASA PS1, an operated case of Chiari type 1 malformation, syringomyelia and syringobulbia, was posted for right syringopleural shunt. After a routine on-table extubation, immediately postoperatively, she lost consciousness, became progressively hypoxaemic requiring emergent reintubation. Blood gases revealed severe respiratory acidosis. The patient was systematically evaluated for likely causes of respiratory failure considering the sites of surgery and her preoperative surgical condition, i.e., brainstem, chest and larynx. She failed three trials of extubation, at different stages of her evaluation. Suspecting an undiagnosed neurological condition, the neurologist's evaluation discovered a three-month history of easy fatiguability, dysphagia and ptosis. Nerve conduction studies also pointed to the diagnosis of myasthaenia gravis. After initiating steroids and neostigmine, the patient made a steady recovery and was successfully weaned off the ventilator.
[ABSTRACT]   Full text not available  [PDF]
  924 26 -
EDITORIAL
What's in a name – Does it matter? scientific notations in respiratory care
Aboo Abdul Rahiman Ramzi, Anitha Nileshwar
July-December 2018, 7(2):59-61
DOI:10.4103/ijrc.ijrc_19_18  
  753 195 -
ORIGINAL ARTICLES
A prospective observational study to evaluate the severity assessment scores in community-acquired pneumonia for adult patients
Akhila Babu, Nybin Jose, Jona Jose
July-December 2017, 6(2):820-823
DOI:10.4103/ijrc.ijrc_16_17  
Introduction: Assessment of severity is the first step for determining whether a patient diagnosed with community-acquired pneumonia (CAP) needs to be admitted to the hospital or can be treated on outpatient basis. Aim: This study compares the ability of three severity scoring systems, systolic blood pressure, multilobar chest radiography involvement, albumin level, respiratory rate, tachycardia, confusion, oxygenation, and arterial pH (SMART-COP), confusion, urea nitrogen, respiratory rate, blood pressure less than 90/60 mm Hg and age over 65 years (CURB-65), and pneumonia severity index (PSI) to predict the need for mechanical ventilation and inotropic support among adult patients admitted to the hospital. Methodology: This was an observational study conducted on patients admitted from March 2016 to July 2016 to the Intensive Care Unit (ICU). Demographic data, severity scores from CURB-65, PSI, and SMART-COP, were documented. Patients were followed up for the need for mechanical ventilatory/inotropic support. The overall mortality of patients with CAP was recorded. Results: A total of eighty patients with CAP were included in this study. Forty-seven (59%) were male. A CURB-65 severity score ≥2 had a sensitivity, specificity, and negative predictive value (NPV) of 85.7%, 47.5%, and 9.7%, respectively, for ICU admission. For a PSI severity score ≥4, the sensitivity, specificity, and NPV were 71.4%, 46.8%, and 18.6%. SMART-COP severity score >3 had a sensitivity, specificity, and NPV of 85.7%, 62.4%, and 20.7%, respectively. In predicting inotropic support, CURB-65 (PSI, SMART-COP) had sensitivity of 85.4% (80.5%, 90.2%), specificity of 64.1% (64.1%, 81.5%) and NPV of 19.4% (24.2%, 28.8%). Conclusions: SMART-COP scoring system is superior to CURB-65 and PSI in predicting the need for mechanical ventilation and inotropic support.
  794 133 -
CASE REPORTS
Weaning in asthmatics: A finely supervised action
Sunil Kumar Garg, Pragya Garg
July-December 2017, 6(2):835-836
DOI:10.4103/ijrc.ijrc_14_17  
Respiratory failure from severe asthma is a potentially reversible, life-threatening condition. Since asthma involves bronchospasm and mucous plugging, it causes increased pressure difference between peak and plateau pressure. The increased pressure difference between the two can be due to ventilatory strategy of asthma itself which involves increased inspiratory flow rate and square flow pattern to increase expiratory time. It is important that clinicians managing such patients understand the use of mechanical ventilation since wrong interpretation may lead to inappropriate decision making during weaning.
  818 89 -