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Dheeraj Gupta

Publications and source records attributed to Dheeraj Gupta.

At least 19 recordsLinked to original sources
PubMed2006

Is there a role for noninvasive ventilation in acute respiratory distress syndrome? A meta-analysis.

The role of noninvasive ventilation (NIV) in the management of acute respiratory distress syndrome (ARDS) is controversial. The aim of this study was to assess the effect of NIV on the rate of endotracheal intubation and intensive care unit (ICU) mortality in patients with ARDS. We searched the MEDLINE database for relevant studies published from 1980 to September 2005, and included studies if (a) the design was a randomized controlled trial; (b) patients had ARDS irrespective of the underlying etiology; (c) the interventions compared NIV and medical therapy with medical therapy alone; and (d) outcomes included need for endotracheal intubation and/or ICU survival. The addition of NIV to standard care in the setting of ARDS did not reduce the rate of endotracheal intubation (absolute risk reduction (RR) 13.5%, 95% confidence interval (CI) -5.2% to 31.3%), and had no effect on ICU survival (absolute RR 4.8%, 95% CI -12.8% to 22.1%). However, the trial results were significantly heterogeneous. Thus, current evidence suggests that patients with ARDS are unlikely to have any significant benefits on outcome when NIV is added to standard therapy. However, this analysis is limited by the presence of significant heterogeneity; hence large randomized controlled trials are required to settle this issue.

Critical Care↗
PubMed2006

Efficacy and safety of iodopovidone in chemical pleurodesis: a meta-analysis of observational studies.

The search for an 'ideal' agent for pleurodesis continues. Iodopovidone is a topical antiseptic and has been shown to be safe and effective in many studies. The aim of this study was to evaluate the efficacy and safety of iodopovidone as an agent for chemical pleurodesis. We performed a systematic review of all the observational trials which have used iodopovidone for chemical pleurodesis. Six studies including 265 patients who had undergone chemical pleurodesis with iodopovidone were included for this analysis. Iodopovidone was used for variety of indications, which included pleural effusion (157 patients), and pneumothorax (108 patients). Pleurodesis was performed through tube thoracostomy in 144 patients and through thoracoscopy in 121 patients. The success rate of pleurodesis varied from 64.2% to 100%, and summary success rate of all the studies was 90.6% (95% confidence intervals [CI], 86.4-93.8). The success rate was independent for the procedure (tube thoracostomy [126/144; 87.5%, 95% CI 80.9-92.4] or thoracoscopy [114/121; 94.2%, 95% CI 88.4-97.6]) used for performing pleurodesis or for the indication (pleural effusion [139/157; 88.5%, 95% CI 82.5-93.1] or pneumothorax [101/108; 93.5%, 95% CI 87.1-97.4]). The only significant complication reported was chest pain of varying degree. Systemic hypotension was reported in three patients in only one study. There were no deaths related to chemical pleurodesis with iodopovidone. Overall, this review supports the safety and efficacy of iodopovidone as an agent for chemical pleurodesis in cases of recurrent pleural effusions and pneumothoraces regardless of their etiology.

Anti-Infective Agents, Local↗
PubMed2006

Elapid snakebite as a cause of severe hypertension.

Snakebite is a common medical emergency in tropical countries, however, autonomic dysfunction is an uncommon manifestation of snakebite. The authors present an unusual manifestation of severe neurotoxic snake envenomation: severe hypertension requiring intravenous antihypertensives. A review of the literature on autonomic dysfunction in neurotoxic snake envenomation is also presented.

Adult↗
PubMed2006

Efficacy and safety of iodopovidone pleurodesis through tube thoracostomy.

OBJECTIVE: To evaluate the efficacy and safety of iodopovidone as an agent for pleurodesis through tube thoracostomy in patients with recurrent pleural effusions and pneumothorax. METHODS: This was a prospective study in which pleurodesis was performed with a solution of 20 mL 10% iodopovidone and 80 mL normal saline solution infused through a tube thoracostomy and left in the pleural cavity for 4 h. RESULTS: A total of 64 patients (34 men) with a mean (+/-SD) age of 47.1 +/- 15.4 years were included. There were 37 cases of pleural effusion and 27 of pneumothorax. A complete response (neither reaccumulation of fluid nor recurrence of pneumothorax) was obtained in 32 (86.5%) patients with pleural effusion and 25 (92.6%) patients with pneumothorax. A second procedure (i.e. repeated pleurodesis) was attempted successfully in four patients in the pleural effusion group. All patients experienced chest pain to a varying degree as recorded on a Visual Analogue Scale (median 50.5, range 10-95). Seven patients developed fever and one immunocompromised patient developed empyema following the procedure. There were no recurrences at a median follow up of 5 months (range 3-15 months) in the pleural effusion group, and 13 months (range 6-24 months) in the pneumothorax group. CONCLUSIONS: Iodopovidone can be used as an effective and safe agent for (chemical) pleurodesis (through tube thoracostomy), which is inexpensive and readily available.

Anti-Infective Agents, Local↗
PubMed2006

Performance of standard severity scoring systems for outcome prediction in patients admitted to a respiratory intensive care unit in North India.

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 (MPM(0) and MPM(24), 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 x 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.

APACHE↗
PubMed2006

Allergic bronchopulmonary aspergillosis: lessons from 126 patients attending a chest clinic in north India.

AIMS AND OBJECTIVES: To describe the experience of screening patients with asthma for allergic bronchopulmonary aspergillosis (ABPA) presenting to a chest clinic. The clinical, serologic, radiologic, and treatment aspects including outcome of ABPA are also described. METHODS: All consecutive patients with asthma presenting to the chest clinic over a period of 2 years were screened with an Aspergillus skin test. Patients who were found to be positive were further investigated for ABPA. Patients were also arbitrarily classified as ABPA-seropositive (ABPA-S), ABPA with central bronchiectasis (ABPA-CB), and ABPA-CB with other radiologic findings (ABPA-CB-ORF) based on the high-resolution CT findings. RESULTS: Five hundred sixty-four patients were screened using an Aspergillus skin test; 223 patients (39.5%) were found to be positive, and ABPA was diagnosed in 126 patients (27.2%). There were 34 patients (27%) with ABPA-S, 42 patients with ABPA-CB, and 50 patients with ABPA-CB-ORF. Fifty-nine patients (46.8%) had received antitubercular therapy in the past. The vast majority of patients had bronchiectasis at presentation to our hospital. High-attenuation mucous impaction was noted in 21 patients (16.7%). There was no significant difference between the stages of ABPA and the duration of illness, the severity of asthma, and the serologic findings (ie, absolute eosinophil count, IgE levels [total] and IgE levels [for Aspergillus fumigatus]). The median duration of follow-up was 13 months (range, 9 to 38 months). All patients went into "remission" at 6 weeks. Twenty-five patients had a "relapse" during the course of their treatment. One hundred nine patients had "complete remission," 17 patients were classified as having "glucocorticoid-dependent ABPA," and 7 patients were classified as having "end-stage ABPA." CONCLUSIONS: There is a high prevalence of ABPA in asthmatic patients presenting at our hospital. The disease entity is still underrecognized in India; the vast majority of patients have bronchiectasis at presentation, and almost half are initially misdiagnosed as having pulmonary tuberculosis. There is a need to redefine the definitions of ABPA and the optimal dose/duration of glucocorticoid therapy. This study reinforces the need for the routine screening of asthmatic patients with an Aspergillus skin test.

Adolescent↗
PubMed2006

Etiology and outcomes of pulmonary and extrapulmonary acute lung injury/ARDS in a respiratory ICU in North India.

OBJECTIVE: Outcomes in patients with ARDS/acute lung injury (ALI) may be dependent on the underlying cause. We describe the case mix, clinical behavior, and outcomes of patients with ALI/ARDS resulting from pulmonary causes (ALI/ARDSp) and extrapulmonary causes (ALI/ARDSexp). DESIGN: Retrospective study conducted between January 2001 and June 2005. SETTING: Respiratory ICU (RICU) of a tertiary care hospital in northern India. PATIENTS: All patients fulfilling the criteria for ALI/ARDS and requiring mechanical ventilation for > 24 h. MEASUREMENTS AND RESULTS: Of the 180 patients (ARDS, 140 patients; ALI, 40 patients), 123 patients had ALI/ARDSp, whereas 57 patients had ALI/ARDSexp. The most common cause of ALI/ARDSp was infective pneumonia, whereas the most common cause of ALI/ARDSexp was sepsis. At ICU admission, although patients with ALI/ARDSexp were sicker than those with ALI/ARDSp, there was no difference between the two groups of patients in the development of new organ dysfunction/failure (Delta sequential organ failure assessment [SOFA] scores) or the time to develop the first organ dysfunction/failure (assessed by SOFA scores). The median length of RICU stay was similar in the two groups (5 days [interquartile range (IQR), 6 days] vs 5 days [IQR, 9.5 days], respectively, in patients with ALI/ARDSp and ALI/ARDSexp; p = 0.4). The hospital mortality rate was 47.8% and was not significantly different between the two groups (ALI/ARDSp group, 43.1%; ALI/ARDSexp group, 57.9%; p = 0.06). Multivariate analysis showed the following risk factors for death in the ICU: female gender (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.25 to 0.94); SOFA scores (OR, 1.18; 95% CI, 1.07 to 1.3); and DeltaSOFA scores (OR, 1.24; 95% CI, 1.09 to 1.41). There was no significant effect of the category of ARDS on outcome (OR, 1.6; 95% CI, 0.8 to 3.2). CONCLUSIONS: Although patients with ALI/ARDSexp are sicker on ICU admission, the underlying cause of ARDS does not affect the length of ICU stay or hospital survival time.

Acute Disease↗
PubMed2006

The relationship between FEV1 and peak expiratory flow in patients with airways obstruction is poor.

STUDY OBJECTIVES: To evaluate the correlation between FEV1 and peak expiratory flow (PEF) values expressed as a percentage of their predicted value, and to assess factors influencing differences between the two measurements. DESIGN: Cross-sectional. SETTING: Pulmonary function laboratory at a tertiary-level teaching hospital in northern India. PARTICIPANTS: A total of 6,167 adult patients showing obstructive pattern on spirometry over a 6-year period. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: There was considerable variability between percentage of predicted FEV1 (FEV1%) and percentage of predicted PEF (PEF%). Locally weighted least-square modeling revealed that PEF% underestimated [corrected] FEV1% in patients with less severe obstruction and overestimated [corrected] it in those with more severe obstruction. Using Bland-Altman analysis, PEF% underestimated FEV1% by a mean of only 0.7%; however, limits of agreement were wide (- 27.4 to + 28.8%), indicating that these two measurements cannot be used interchangeably. PEF% and FEV1% were > 5% apart in approximately three fourths and differed by > 10% in approximately one half of the patients. On multivariate analysis, discordance > 5% was significantly influenced by female gender (odds ratio, 1.26; 95% confidence interval [CI], 1.01 to 1.58) and increasing FEV1% (odds ratio, 1.09 for every 10% increase; 95% CI, 1.04 to 1.14) but not by height or age. CONCLUSIONS: FEV1% and PEF% are not equivalent in many patients, especially women and those with less severe airflow limitation. Assumptions of parity between PEF% and FEV1% must be avoided.

Adolescent↗
PubMed2006

Comparison of fixed percentage method and lower confidence limits for defining limits of normality for interpretation of spirometry.

BACKGROUND: The use of the lower 90% confidence limit of the lower limit of normal (LLN(CI)), rather than a fixed percentage of the predicted value (LLN(%)), appears to be statistically more appropriate for interpretation of spirometry results. There has been no comparative assessment of these 2 definitions of the LLN in routine clinical practice. METHODS: We studied results of spirometry interpretations made with these 2 approaches, and assessed various factors that influence discordant classification of spirometry results. Spirometry records from 18,112 consecutive adult patients referred for spirometry were interpreted as normal, obstructive, or restrictive, based on both LLN(CI) and LLN(%). Discordant results were analyzed using multiple logistic regression techniques to identify variables that significantly affected discordant classification of results. RESULTS: Overall, 11.7% of the results were discordant between the 2 methods. Agreement between the 2 methods, calculated using the kappa estimate, was poorer with spirometry values from women and from patients at the extremes of height and age. Age, sex, and height independently influenced discordant classification. Limits of agreement between LLN(CI) and LLN(%) were wide for all the spirometric variables studied--more so in women and in shorter and older patients. CONCLUSIONS: LLN(CI) and LLN(%) yielded different interpretations of spirometry data in several instances, and the 2 methods cannot be used interchangeably. When interpreting spirometry data in routine clinical practice, LLN(CI) should be preferred over LLN(%).

Adolescent↗
PubMed2005

Epidemiology, risk factors and outcome of nosocomial infections in a Respiratory Intensive Care Unit in North India.

OBJECTIVE: To determine the epidemiology, risk factors and outcome of infections in a Respiratory Intensive Care Unit (RICU) of a tertiary care institute in northern India. METHODOLOGY: Prospective, observational clinical study. RESULTS: The study included 201 patients (1285 patient days) admitted to RICU over a period of one-and-a-half years. A total of 77 infections were identified in 67 patients (33.5%). The infections included pneumonia (23%), sepsis of unknown origin (10.5%), bacteremia (7.5%), urinary tract infections (1.5%), catheter related blood stream infections (1%) and Clostridium difficile colitis (1%). The most commonly identified organisms were the Acinetobacter species (34.8%), Pseudomonas aeruginosa (23.9%) and Escherichia coli (15.2%). The median length of stay in patients with and without infection was 13 days (interquartile range, IQR, 28) and 4 days (interquartile range, IQR, 3), respectively (p<0.0001). Multivariate analysis showed the following risk factors for ICU-acquired infection: the admitting diagnosis of infection (odds ratio [OR] 3.3; 95% confidence intervals [CI] 1.06-10.1), length of stay in the RICU (OR, 1.2; 95% confidence intervals [CI] 1.1-1.33); renal failure (OR, 4.7; 95% CI, 1.52-14.41) and institution of parenteral nutrition (OR, 16.9; 95% CI, 1.07-269.03). Multivariate analysis showed the following risk factors for death in ICU: APACHE II scores (OR, 1.06; 95% CI, 1.01-1.11), and endotracheal intubation (OR, 5.07; 95% CI, 1.24-20.65). CONCLUSIONS: This study clearly documents a high prevalence rate of infections in the ICU, and the data suggest that occurrence of infections was associated with a prolonged ICU stay but had no significant effect on the final outcome.

Anti-Bacterial Agents↗
PubMed2005

Cobbled tongue.

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Adult↗