Pub Date : 2023-03-14DOI: 10.5005/jp-journals-11010-1006
M. Ozkarafakili, A. Melekoğlu, E. Altınbilek
Background: Coronavirus disease 2019 (COVID-19) has been a challenging viral respiratory tract infection since 2019 and may contribute to higher mortality in patients with chronic obstructive pulmonary disease (COPD). Methods: We analyzed the clinical data of 98 patients hospitalized with a diagnosis of COVID-19 and who had a previous diagnosis of COPD. They are grouped regarding GOLD ABCD stages, reported as follows whether in pandemic wards or intensive care units (ICU). The clinical outcomes were noted as a live hospital discharge or inhospital mortality. Results: A total of 76 patients (77.6%) were in the pandemic wards, 22 (22.4%) were in the ICU. Around 81 (82.7%) patients survived, 17 (17.3%) were deceased. We grouped them as GOLD A and GOLD B and GLOD C, and GOLD D. Procalcitonin (PCT) level was higher and arterial oxygen partial pressure (PaO2 in mm Hg) to fractional inspired oxygen (PaO2/FiO2) level was lower in the group of GOLD C and GOLD D than in GOLD A and GOLD B (p < 0.005). There was no statistically significant difference in inhospital mortality between these two groups (p = 0.098). While in the univariate model, hemoglobin (Hgb), urea, troponin, PCT, PaO2/FiO2, saturation%, and respiratory rate was observed to be significantly different; in the multivariate model, only a significant independent (p < 0.05) effect of PaO₂/FiO2 were observed in distinguishing patients who survived or deceased. Conclusion: Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD groups are staging COPD patients in favor of predicting hospitalization and mortality. However, when COPD patients are hospitalized with COVID-19 pneumonia, different clinical factors and indices should be considered due to the heterogeneity and complexity of COPD. Keywords: Chronic obstructive pulmonary disease, Coronavirus disease 2019, Mortality. Indian Journal of Respiratory Care (2023): 10.5005/jp-journals-11010-1006
{"title":"Clinical Evaluation of Chronic Obstructive Pulmonary Disease Patients Hospitalized with COVID-19 Pneumonia","authors":"M. Ozkarafakili, A. Melekoğlu, E. Altınbilek","doi":"10.5005/jp-journals-11010-1006","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-1006","url":null,"abstract":"Background: Coronavirus disease 2019 (COVID-19) has been a challenging viral respiratory tract infection since 2019 and may contribute to higher mortality in patients with chronic obstructive pulmonary disease (COPD). Methods: We analyzed the clinical data of 98 patients hospitalized with a diagnosis of COVID-19 and who had a previous diagnosis of COPD. They are grouped regarding GOLD ABCD stages, reported as follows whether in pandemic wards or intensive care units (ICU). The clinical outcomes were noted as a live hospital discharge or inhospital mortality. Results: A total of 76 patients (77.6%) were in the pandemic wards, 22 (22.4%) were in the ICU. Around 81 (82.7%) patients survived, 17 (17.3%) were deceased. We grouped them as GOLD A and GOLD B and GLOD C, and GOLD D. Procalcitonin (PCT) level was higher and arterial oxygen partial pressure (PaO2 in mm Hg) to fractional inspired oxygen (PaO2/FiO2) level was lower in the group of GOLD C and GOLD D than in GOLD A and GOLD B (p < 0.005). There was no statistically significant difference in inhospital mortality between these two groups (p = 0.098). While in the univariate model, hemoglobin (Hgb), urea, troponin, PCT, PaO2/FiO2, saturation%, and respiratory rate was observed to be significantly different; in the multivariate model, only a significant independent (p < 0.05) effect of PaO₂/FiO2 were observed in distinguishing patients who survived or deceased. Conclusion: Global Initiative for Chronic Obstructive Lung Disease (GOLD) ABCD groups are staging COPD patients in favor of predicting hospitalization and mortality. However, when COPD patients are hospitalized with COVID-19 pneumonia, different clinical factors and indices should be considered due to the heterogeneity and complexity of COPD. Keywords: Chronic obstructive pulmonary disease, Coronavirus disease 2019, Mortality. Indian Journal of Respiratory Care (2023): 10.5005/jp-journals-11010-1006","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45033627","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-14DOI: 10.5005/jp-journals-11010-1026
S. Majumder, H. Maheshwarappa
The probability value (p-value) is used in hypothesis testing to assist in determining if the null hypothesis should be rejected. In a practical setting, the p-value helps to determine if an experiment is conducted and then compares the outcomes to what random chance may yield. In order to do it, researchers state a “null hypothesis” that they want to disapprove. Many researchers consider the p-value to be the essential summary of statistical analysis of their research data. Although it is undeniable that p-values are a very useful method for summarizing study results, it is also undeniable that p-values are frequently misused and misunderstood. Therefore p-value must be carefully interpreted based on the study design, sample size, comparability of study groups, and appropriateness of statistical tests. The statistically significant p-value should not be the sole criterion for accepting or rejecting the conclusions of any report or publication. Proper critical appreciation of research publications is a mandatory requirement before making clinical decisions based on them
{"title":"Interpretation of p-value: The Correct Way!","authors":"S. Majumder, H. Maheshwarappa","doi":"10.5005/jp-journals-11010-1026","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-1026","url":null,"abstract":"The probability value (p-value) is used in hypothesis testing to assist in determining if the null hypothesis should be rejected. In a practical setting, the p-value helps to determine if an experiment is conducted and then compares the outcomes to what random chance may yield. In order to do it, researchers state a “null hypothesis” that they want to disapprove. Many researchers consider the p-value to be the essential summary of statistical analysis of their research data. Although it is undeniable that p-values are a very useful method for summarizing study results, it is also undeniable that p-values are frequently misused and misunderstood. Therefore p-value must be carefully interpreted based on the study design, sample size, comparability of study groups, and appropriateness of statistical tests. The statistically significant p-value should not be the sole criterion for accepting or rejecting the conclusions of any report or publication. Proper critical appreciation of research publications is a mandatory requirement before making clinical decisions based on them","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43151530","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spontaneous subcutaneous emphysema (SCE), pneumomediastinum, and pneumothorax in nonventilated COVID-19 patients are being increasingly recognized as complications of COVID-19 pneumonia. We report a case of a young man with no predisposing risk factors for pneumothorax who was diagnosed with a severe acute respiratory syndrome-COV2 pneumonitis revealed by extensive SCE with fatal outcome. Computed tomography of the thorax, abdomen, and pelvis revealed a diffuse lung injury, a pneumothorax, and pneumomediastinum. These complications of COVID-19 pneumonia may be associated with poor prognosis.
{"title":"SARS-COV2 Pneumonia Revealed by Extensive Subcutaneous Emphysema","authors":"Youssef Motiaa, Siham Alaoui Rachidi, mael Labib, Hicham Sbai","doi":"10.5005/jp-journals-11010-1008","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-1008","url":null,"abstract":"Spontaneous subcutaneous emphysema (SCE), pneumomediastinum, and pneumothorax in nonventilated COVID-19 patients are being increasingly recognized as complications of COVID-19 pneumonia. We report a case of a young man with no predisposing risk factors for pneumothorax who was diagnosed with a severe acute respiratory syndrome-COV2 pneumonitis revealed by extensive SCE with fatal outcome. Computed tomography of the thorax, abdomen, and pelvis revealed a diffuse lung injury, a pneumothorax, and pneumomediastinum. These complications of COVID-19 pneumonia may be associated with poor prognosis.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135837805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-13DOI: 10.5005/jp-journals-11010-05206
Ashrita Shetty, A. Shenoy
Introduction: Estimation of weight is important in the intensive care unit but most ICUs do not have a weighing machine for these patients who are unable to stand up. Aim: To compare the accuracy of estimation of weight by the physician, weight estimated using anthropological formulae with actual weight of the patient. Methods: This was a prospective, observational, single centre study. A hundred adult patients, 18-60 years of age, of either gender, waiting for elective surgery in the preoperative waiting area, who were conscious and able to stand were enrolled for the study. The patient's actual weight and height were measured. Experienced anaesthesia consultant unaware of patient's actual weight, was asked to visually estimate the weight of the patient. The patient's height when supine, abdominal girth and length of tibia were measured. Patient's weight was calculated using various anthropological formulae Results: The mean±SD age of the patients was 44.07±14.06 years. 49 were women and 51 were men. There was good correlation between weight estimated by the physician and as calculated by linear regression irrespective of their BMI. Calculated weight was close to actual weight only in patients with normal build but not with low or high BMI. Conclusion: Estimation of patient body weight by an experienced clinician can be fairly reliable. For more objective estimations, linear regression using abdominal and thigh circumference can be used. Anthropometric formulae such as Miller's, Devine's, Robinson's and weight measured using tibial length overestimate weight at low BMI levels and underestimate when BMI is high.
{"title":"Accuracy of patient weight estimated by physician and anthropological formulae – a comparison with actual measurement","authors":"Ashrita Shetty, A. Shenoy","doi":"10.5005/jp-journals-11010-05206","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-05206","url":null,"abstract":"Introduction: Estimation of weight is important in the intensive care unit but most ICUs do not have a weighing machine for these patients who are unable to stand up. Aim: To compare the accuracy of estimation of weight by the physician, weight estimated using anthropological formulae with actual weight of the patient. Methods: This was a prospective, observational, single centre study. A hundred adult patients, 18-60 years of age, of either gender, waiting for elective surgery in the preoperative waiting area, who were conscious and able to stand were enrolled for the study. The patient's actual weight and height were measured. Experienced anaesthesia consultant unaware of patient's actual weight, was asked to visually estimate the weight of the patient. The patient's height when supine, abdominal girth and length of tibia were measured. Patient's weight was calculated using various anthropological formulae Results: The mean±SD age of the patients was 44.07±14.06 years. 49 were women and 51 were men. There was good correlation between weight estimated by the physician and as calculated by linear regression irrespective of their BMI. Calculated weight was close to actual weight only in patients with normal build but not with low or high BMI. Conclusion: Estimation of patient body weight by an experienced clinician can be fairly reliable. For more objective estimations, linear regression using abdominal and thigh circumference can be used. Anthropometric formulae such as Miller's, Devine's, Robinson's and weight measured using tibial length overestimate weight at low BMI levels and underestimate when BMI is high.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42873628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-13DOI: 10.5005/jp-journals-11010-05207
Saumy Johnshon, A. Nileshwar
Introduction: Cardiopulmonary resuscitation can be termed successful only if the victim survives to hospital discharge and returns to a reasonable quality of life. Aim: The aim of this study was to determine long term survival and quality of life of patients who sustained in-hospital cardiac arrest. Patients and Methods: This was a prospective interventional study of 1955 patients who sustained in- hospital cardiac arrest at a tertiary hospital in India. Adult patients who sustained cardiac arrest in the hospital were included in the study and patients who were < 18 years of age, cardiac arrest in operation theatre and patients who were brought in ‘near death’ state to the hospital were excluded. Parameters were collected during two periods, before and after introduction of Modified Early Warning Score (MEWS). Results: In the PreMEWS period, 228 out of 1135 (20%) patients had return of spontaneous circulation (ROSC), of whom 59 survived to discharge (5.19%), 51 patients (4.49%) were alive at 6 months and 45 patients (3.96%) were independent at activities of daily living (ADL). In the PostMEWS period, 202 out of 820 patients (24.6%) had ROSC, of whom 138 patients (16.82%) survived to discharge, 110 were alive at 6 months (13.41%) and 99 (12.07%) were independent at ADL. Conclusion: The rate of return of spontaneous circulation, survival to discharge rate, 6 month survival and independence at activities of daily living are all better with the use of modified early warning score.
只有当患者存活到出院并恢复到合理的生活质量时，心肺复苏才能被称为成功。目的:本研究的目的是确定住院心脏骤停患者的长期生存和生活质量。患者和方法:这是一项前瞻性介入研究，研究对象为1955名在印度一家三级医院住院的心脏骤停患者。在医院发生心脏骤停的成年患者被纳入研究，小于18岁的患者、在手术室发生心脏骤停的患者和在“濒死”状态下被送到医院的患者被排除在外。在引入修正预警评分(Modified Early Warning Score, MEWS)之前和之后两个时间段收集参数。结果:在PreMEWS期间，1135例患者中有228例(20%)出现了自然循环恢复(ROSC)，其中59例(5.19%)存活至出院，51例(4.49%)存活至6个月，45例(3.96%)患者能够独立进行日常生活活动(ADL)。在mews后期间，820例患者中有202例(24.6%)发生ROSC，其中138例(16.82%)存活至出院，6个月存活110例(13.41%)，ADL独立存活99例(12.07%)。结论:采用改良预警评分法，患者的自然循环恢复率、生存至出院率、6个月生存率和日常生活活动的独立性均有提高。
{"title":"Long term survival in patients who sustained in-hospital cardiac arrest","authors":"Saumy Johnshon, A. Nileshwar","doi":"10.5005/jp-journals-11010-05207","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-05207","url":null,"abstract":"Introduction: Cardiopulmonary resuscitation can be termed successful only if the victim survives to hospital discharge and returns to a reasonable quality of life. Aim: The aim of this study was to determine long term survival and quality of life of patients who sustained in-hospital cardiac arrest. Patients and Methods: This was a prospective interventional study of 1955 patients who sustained in- hospital cardiac arrest at a tertiary hospital in India. Adult patients who sustained cardiac arrest in the hospital were included in the study and patients who were < 18 years of age, cardiac arrest in operation theatre and patients who were brought in ‘near death’ state to the hospital were excluded. Parameters were collected during two periods, before and after introduction of Modified Early Warning Score (MEWS). Results: In the PreMEWS period, 228 out of 1135 (20%) patients had return of spontaneous circulation (ROSC), of whom 59 survived to discharge (5.19%), 51 patients (4.49%) were alive at 6 months and 45 patients (3.96%) were independent at activities of daily living (ADL). In the PostMEWS period, 202 out of 820 patients (24.6%) had ROSC, of whom 138 patients (16.82%) survived to discharge, 110 were alive at 6 months (13.41%) and 99 (12.07%) were independent at ADL. Conclusion: The rate of return of spontaneous circulation, survival to discharge rate, 6 month survival and independence at activities of daily living are all better with the use of modified early warning score.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42382349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-13DOI: 10.5005/jp-journals-11010-05205
A. Ramzi, A. Nileshwar, L. Shenoy, Siri Kandavar
Introduction: Vocal cord assessment after thyroidectomy, routinely performed by anaesthesiologist by direct laryngoscopy in the immediate postoperative period is associated with significant haemodynamic changes and patient discomfort. Aim: Comparison of patient comfort, haemodynamic response and accuracy of assessment of vocal cord mobility between Airtraq and Macintosh laryngoscope. Methodology: In a prospective, randomised controlled study, 82 euthyroid patients, ASA PS 1-2, aged 20-60 years, of either gender undergoing thyroidectomy under general anaesthesia were randomised to one of two groups, Group M and Group A. Anaesthesia was induced with propofol and fentanyl, maintained with morphine, vecuronium, nitrous oxide and isoflurane in oxygen to maintain a MAC of 1-1.3%. At the end of surgery, patients were extubated after complete reversal of neuromuscular blockade and when fully awake. Vocal cord movement and haemodynamic changes were assessed three minutes later using either Airtraq (Group A) or Macintosh laryngoscope (Group M). Patient reactivity score (Favourable - No grimace or facial grimace; Unfavourable – Any head, neck and limb movements or cough). Vocal cord movements were again assessed by an ENT surgeon 48 hours later. Results: Demographic data, type and duration of surgery were similar in both groups. 63.4% of patients in Group A had favourable scores compared to 29.3% in Group M even though duration of laryngoscopy was longer in Group A. There was no significant difference in haemodynamic changes between the groups. Conclusion: Patients are more comfortable during vocal cord assessment with Airtraq laryngoscopy even though duration of laryngoscopy is longer when compared to Macintosh laryngoscope.
{"title":"Comparison of assessment of vocal cord mobility following thyroid surgery using Macintosh Laryngoscope and Airtraq","authors":"A. Ramzi, A. Nileshwar, L. Shenoy, Siri Kandavar","doi":"10.5005/jp-journals-11010-05205","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-05205","url":null,"abstract":"Introduction: Vocal cord assessment after thyroidectomy, routinely performed by anaesthesiologist by direct laryngoscopy in the immediate postoperative period is associated with significant haemodynamic changes and patient discomfort. Aim: Comparison of patient comfort, haemodynamic response and accuracy of assessment of vocal cord mobility between Airtraq and Macintosh laryngoscope. Methodology: In a prospective, randomised controlled study, 82 euthyroid patients, ASA PS 1-2, aged 20-60 years, of either gender undergoing thyroidectomy under general anaesthesia were randomised to one of two groups, Group M and Group A. Anaesthesia was induced with propofol and fentanyl, maintained with morphine, vecuronium, nitrous oxide and isoflurane in oxygen to maintain a MAC of 1-1.3%. At the end of surgery, patients were extubated after complete reversal of neuromuscular blockade and when fully awake. Vocal cord movement and haemodynamic changes were assessed three minutes later using either Airtraq (Group A) or Macintosh laryngoscope (Group M). Patient reactivity score (Favourable - No grimace or facial grimace; Unfavourable – Any head, neck and limb movements or cough). Vocal cord movements were again assessed by an ENT surgeon 48 hours later. Results: Demographic data, type and duration of surgery were similar in both groups. 63.4% of patients in Group A had favourable scores compared to 29.3% in Group M even though duration of laryngoscopy was longer in Group A. There was no significant difference in haemodynamic changes between the groups. Conclusion: Patients are more comfortable during vocal cord assessment with Airtraq laryngoscopy even though duration of laryngoscopy is longer when compared to Macintosh laryngoscope.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44240928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-13DOI: 10.5005/jp-journals-11010-05204
G. G, Jithin K Sree, Harilakshmanan .
Background: Obstructive sleep apnoea (OSA) is a breathing disorder during sleep which leads to life-threatening events. The recommended treatment for moderate to severe OSA is continuous positive pressure therapy (CPAP). Aim: To predict the optimal CPAP level in OSA. Methodology: This was a cross sectional observational study, carried out in pulmonary medicine department at a tertiary referral centre in South India. Twenty patients were recruited in the study over a period of 6 months. All patients in study group underwent CPAP titration with optimal or good titration over a full night polysomnography. Results: We correlated the optimal CPAP level with demographic, anthropometric and polysomnographic variables, which showed a trend of association between body mass index (BMI), neck circumference, apnoea hypopnoea index (AHI), oxygen desaturation index (ODI) and severity of OSA with optimal CPAP level Conclusion: No statistically significant association was observed between demographic, clinical, anthropometric and polysomnographic variables with optimal CPAP level.
{"title":"Predictors of optimum continous positive airway pressure level in obstructive sleep apnoea patients","authors":"G. G, Jithin K Sree, Harilakshmanan .","doi":"10.5005/jp-journals-11010-05204","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-05204","url":null,"abstract":"Background: Obstructive sleep apnoea (OSA) is a breathing disorder during sleep which leads to life-threatening events. The recommended treatment for moderate to severe OSA is continuous positive pressure therapy (CPAP). Aim: To predict the optimal CPAP level in OSA. Methodology: This was a cross sectional observational study, carried out in pulmonary medicine department at a tertiary referral centre in South India. Twenty patients were recruited in the study over a period of 6 months. All patients in study group underwent CPAP titration with optimal or good titration over a full night polysomnography. Results: We correlated the optimal CPAP level with demographic, anthropometric and polysomnographic variables, which showed a trend of association between body mass index (BMI), neck circumference, apnoea hypopnoea index (AHI), oxygen desaturation index (ODI) and severity of OSA with optimal CPAP level Conclusion: No statistically significant association was observed between demographic, clinical, anthropometric and polysomnographic variables with optimal CPAP level.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45008239","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-13DOI: 10.5005/jp-journals-11010-05201
A. Nileshwar
{"title":"Organ transplant – Gift of life!","authors":"A. Nileshwar","doi":"10.5005/jp-journals-11010-05201","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-05201","url":null,"abstract":"","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47901187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-13DOI: 10.5005/jp-journals-11010-05202
A. Shenoy
Organ donation is becoming more common but there is still a large gap between the number of people requiring transplants and the organs donated. There are set criteria for organ donation. When organ donation is considered after brain death, the physician must ensure that the prerequisites for testing are met and proceed to establish brain death using standard guidelines. The pathophysiological changes that occur after brain death must be borne in mind and utmost care should be given to counter those changes that would result in dysfunction of the donated organs. The brain dead patient must be maintained as stable as possible in the ICU. General nursing and medical care must continue. Core temperature must be maintained and infections must be treated. Blood pressure is best maintained with fluids and minimal vasopressors. Low tidal volume ventilation, optimal levels of positive end-expiratory pressures to maintain minimal FIO2, will maintain airways open and reduce extravascular lung water. Maintain euvolaemia. Maintain urine output at 0.5–3 ml/kg/h. Electrolyte abnormalities must be corrected. Maintain blood glucose concentrations between 120-180 mg %. Triple hormonal therapy improves organ function. Organ retrieval is performed in an operation theatre and a well conducted anaesthetic care is essential for the viability of these organs. One brain-dead organ donor can potentially donate ‘lives’ to eight individuals. To enhance or preserve the maximum potential of the donated organs, the anaesthesiologist and intensivist play a vital role in preserving the organs as best as possible.
{"title":"Care of the brain dead organ donor","authors":"A. Shenoy","doi":"10.5005/jp-journals-11010-05202","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-05202","url":null,"abstract":"Organ donation is becoming more common but there is still a large gap between the number of people requiring transplants and the organs donated. There are set criteria for organ donation. When organ donation is considered after brain death, the physician must ensure that the prerequisites for testing are met and proceed to establish brain death using standard guidelines. The pathophysiological changes that occur after brain death must be borne in mind and utmost care should be given to counter those changes that would result in dysfunction of the donated organs. The brain dead patient must be maintained as stable as possible in the ICU. General nursing and medical care must continue. Core temperature must be maintained and infections must be treated. Blood pressure is best maintained with fluids and minimal vasopressors. Low tidal volume ventilation, optimal levels of positive end-expiratory pressures to maintain minimal FIO2, will maintain airways open and reduce extravascular lung water. Maintain euvolaemia. Maintain urine output at 0.5–3 ml/kg/h. Electrolyte abnormalities must be corrected. Maintain blood glucose concentrations between 120-180 mg %. Triple hormonal therapy improves organ function. Organ retrieval is performed in an operation theatre and a well conducted anaesthetic care is essential for the viability of these organs. One brain-dead organ donor can potentially donate ‘lives’ to eight individuals. To enhance or preserve the maximum potential of the donated organs, the anaesthesiologist and intensivist play a vital role in preserving the organs as best as possible.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41329718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-12-13DOI: 10.5005/jp-journals-11010-05203
U. K. Bylappa,, Abdulgafoor M. Tharayil, N. Shaikh, S. Prabhakaran, S. Rohrig, F. Malmstrom
Adaptive support ventilation (ASV) is a dual control mode of ventilation, which uses a closed loop control technique. This mode delivers controlled, time triggered and time cycled breaths when a patient is not breathing. If the patient has spontaneous breaths, it delivers flow cycled breaths and allows the patient to trigger and breathe spontaneously, either in between the controlled breaths or fully spontaneously. This mode is pressure limited for control, assist control and spontaneous breath. The pressure will vary depending on the target tidal volume and uses autoflow throughout the cycle. IntelliVent(R) is a closed loop mode of ventilation, an advance over the ASV mode where the ventilator automatically adjusts settings and optimises ventilation depending on the target settings and physiological information from the patient.
{"title":"Adaptive Support Ventilation – A way different from traditional ventilation","authors":"U. K. Bylappa,, Abdulgafoor M. Tharayil, N. Shaikh, S. Prabhakaran, S. Rohrig, F. Malmstrom","doi":"10.5005/jp-journals-11010-05203","DOIUrl":"https://doi.org/10.5005/jp-journals-11010-05203","url":null,"abstract":"Adaptive support ventilation (ASV) is a dual control mode of ventilation, which uses a closed loop control technique. This mode delivers controlled, time triggered and time cycled breaths when a patient is not breathing. If the patient has spontaneous breaths, it delivers flow cycled breaths and allows the patient to trigger and breathe spontaneously, either in between the controlled breaths or fully spontaneously. This mode is pressure limited for control, assist control and spontaneous breath. The pressure will vary depending on the target tidal volume and uses autoflow throughout the cycle. IntelliVent(R) is a closed loop mode of ventilation, an advance over the ASV mode where the ventilator automatically adjusts settings and optimises ventilation depending on the target settings and physiological information from the patient.","PeriodicalId":53846,"journal":{"name":"Indian Journal of Respiratory Care","volume":" ","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48022577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：