Nishant Kumar Chauhan

Weaning of mechanically ventilated chronic obstructive pulmonary disease patients by using non-invasive positive pressure ventilation: A prospective study.

Background: Chronic obstructive pulmonary disease (COPD) patients frequently pose difficulty in weaning from invasive mechanical ventilation (MV). Prolonged invasive ventilation brings along various complications. Non-invasive positive pressure ventilation (NIPPV) is proposed to be a useful weaning modality in such cases. Objective: To evaluate the usefulness of NIPPV in weaning COPD patients from invasive MV, and compare it with weaning by conventional pressure support ventilation (PSV). Materials and Methods: For this prospective randomized controlled study, we included 50 COPD patients with type II respiratory failure requiring initial invasive MV. Upon satisfying weaning criteria and failing a t-piece weaning trial, they were randomized into two groups: Group I (25 patients) weaned by NIPPV, and group II (25 patients) weaned by conventional PSV. The groups were similar in terms of disease severity, demographic, clinical and biochemical parameters. They were compared in terms of duration of MV, weaning duration, length of intensive care unit (ICU) stay, occurrence of nosocomial pneumonia and outcome. Results: Statistically significant difference was found between the two groups in terms of duration of MV, weaning duration, length of ICU stay, occurrence of nosocomial pneumonia and outcome. Conclusion: NIPPV appears to be a promising weaning modality for mechanically ventilated COPD patients and should be tried in resource-limited settings especially in developing countries.

Health Related Quality of Life in Adult Obstructive Sleep Apnea

Objective: To review the literature on Obstructive Sleep Apnea (OSA) and Health Related Quality of Life (HRQoL). Method: We conducted systematic review of the literature on HRQoL and OSA. Summary: Our review of published literature on quality of life in adult OSA suggest that there is significant impairment of HRQoL in obstructive sleep apnea but the magnitude of QoL impairment is not proportional to the severity of OSA as determined by AHI. There is paucity of data over effect of treatment on quality of life but the available data suggest that there is improvement in QoL with CPAP treatment at least in moderate and severe OSA patients. Effect of other treatment modalities is unclear yet.

Complications Associated with Invasive Mechanical Ventilation in Obese Patients

Due to increase in the prevalence of obesity, the proportion of obese patients being posted for any surgery or admitted in a critical care unit requiring mechanical ventilation is on the rise. There are specific problems faced while ventilating these subgroups of patients. This chapter attempts to summarise the effects of obesity and related respiratory medical conditions on the lung mechanics and functions, types of problems faced during mechanical ventilation and ways to troubleshoot them.

An Atypical Case of Mounier-Kuhn Syndrome: Time to Change the Diagnostic Approach?

Mounier-Kuhn syndrome (MKS) is a rare disease of unknown etiology characterized by abnormal pathologic dilatation of tracheabronchial tree. The diagnosis of MKS is normally made on CT scan of chest on the basis of enlarged diameters of trachea and main stem bronchi. We are presenting histologically confirmed case of MKS, where the diameter of right main bronchus is below minimum diameter (mean+3 SD) required for the diagnosis. We suggest that the diagnosis of MKS should not be solely based on fixed criteria such as the diameter of airways, but on the basis of the overall clinical, pathologic, and radiologic profile.

Bilateral spontaneous pneumothorax in osteogenic sarcoma due to occult pulmonary metastases

Spontaneous pneumothorax (SPTX) is an uncommon complication of osteogenic sarcoma. Most of these SPTX associated with osteogenic sarcoma are due to detectable pulmonary metastasis. Development of SPTX without any evidence of pulmonary metastasis is extremely rare. Herein, we report a case of a young girl with osteosarcoma of the right femur that developed pneumothorax on both sides following treatment with combination chemotherapy without any obvious pulmonary metastases, bullae, or blebs.

Drug-resistant pulmonary tuberculosis presenting as mass lesion.

A 33-year-old woman presented with a 1-month history of dry cough, fever, reduced appetite and weight loss. She had taken antitubercular therapy about a year prior with partial improvement in symptoms. At initial presentation, a plain chest X-ray followed by a contrast-enhanced chest CT scan was advised. The CT scan image was suggestive of a right upper lobe mass lesion. Since the patient had no sputum production, a diagnostic flexible bronchoscopy was performed. The bronchoalveolar lavage fluid analysis along with ultrasonography-guided lung biopsy was diagnostic of multidrug-resistant tuberculosis.