Sudhir Chaudhri

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.

Noninvasive mechanical ventilation: An 18-month experience of two tertiary care hospitals in north India

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.

Impact of psychiatric profile and personality trait on directly observed tuberculosis treatment outcome

Background: Psychiatric morbidity in tuberculosis (TB) patients is well-known and its impact on treatment compliance needs to be evaluated. Objectives: To study psychiatric profile, personality trait of TB patients registered on directly observed treatment-short course (DOTS) and to evaluate their impact on treatment completion and default. Materials and Methods: Psychiatric morbidity and personality traits were assessed by Cornell Medical Index and 16PF personality questionnaire, respectively. Patients with psychiatric comorbidity were randomized into two groups. Group A: DOTS with psychiatric intervention and Group B: DOTS alone. They were followed-up till treatment completion. Results: Out of 214 patients registered, 176 (82.2%) had psychiatric comorbidity. 150 (85.2%) had anxiety neurosis, and 26 (14.8%) had depression. On personality assessment, 54.1% were neurotic, 26% introverts, 15.8% extroverts, and 4.1% had other traits. Forty-one (23.3%) patients defaulted. Default rate was low (13.6 vs 33%, P = 0.002) and patient retrieval was good (67 vs 24%, P = 0.01) in group A. Patients with neurotic trait defaulted more ( P = 0.006). On multivariate analysis, smoking (odds ratio (OR) = 3.76, 95% confidence interval (CI): 1.7-8.28); alcoholism (OR = 15.4, CI: 6.67-35.72); and neurotic personality (OR = 3.54, CI: 1.61-7.79) were strongly associated with default whereas age, sex, social class, literacy, and psychiatric morbidity type were not. Conclusion: Pretreatment psychological assessment and intervention reduces default rate.

Hydatid Disease of Pleura: A Rare Cause of Recurrent Pneumothorax

Echinococcosis or hydatid disease is caused by larvae of Echinococcus. The hydatid disease is endemic in some Mediterranean countries, Middle East, South America, South Africa and Oceania. The liver is the most common site of infection followed by the lung in 10% to 30% of cases. Pleural involvement of hydatid disease can occur, and usually follows the rupture of a pulmonary or hepatic hydatid cyst in to the pleural space. When a patient presents with recurrent pneumothorax, zoonotic infections, especially hydatid disease of the lung, should always be considered alongside other common causes of recurrent pneumothorax.

Occurrence of psychiatric disorders in the patients of multi drug resistant tuberculosis under treatment

Background: Tuberculosis (TB) is considered as one of the leading causes of mortality worldwide. Even though fatality of TB is well known, treatment non-adherence is major barrier related to management of TB. Studies have shown that there is strong association between psychiatric disorders and treatment nonadherence to TB. Psychiatric issues present a challenge in the treatment of patients with multi drug-resistant tuberculosis (MDR-TB). Both baseline psychiatric disorders and development of psychiatric complications related to anti-tuberculosis drugs require aggressive management for better management of TB. The objective of the present endeavour was to study the occurrence of psychiatric complications in patients of MDR-TB during treatment Methods: Patients of MDR-TB registered at PMDT centre situated at a tertiary level hospital were screened for psychiatric disorder by using GHQ-12 and assessment was done using structured clinical interview for DSM-IV-TR (SCID-1) research version. Diagnosis of psychiatric disorder was made on the basis of DSM-IV-TR. Results: Psychiatric disorders were already present in 8 (6.15%) patients before the start of MDR-TB treatment and development of psychiatric disorder in 12 (9.23%) patients after initiation of the treatment. Depressive disorder (n=9; 6.9%), anxiety disorder (n=5; 3.8%) and psychosis (n=4; 3.1%) were most frequent psychiatric disorders. Conclusions: GHQ-12 was found to be very useful screening instrument for detection of psychiatric disorders. The regimen IV anti tubercular drugs used for the treatment of MDR-TB drug resistant tuberculosis, significantly increases the risk of development of psychiatric disorders.