{"title":"Self working water-based instrument for positive expiratory pressure by resistance device and its effectiveness in improving oxygenation in acute pulmonary edema, during the COVID 19 pandemic: A pilot study","authors":"A. Paul, S. Mathew","doi":"10.4103/jalh.jalh_26_21","DOIUrl":"https://doi.org/10.4103/jalh.jalh_26_21","url":null,"abstract":"Background: About 20% to 67% of COVID 19 infected patients who are admitted to the hospitals and 100% of mechanically ventilated patients suffer from acute respiratory distress syndrome. Extrinsic positive expiratory pressure (PEP) can improve oxygenation by direct and indirect mechanisms, thus reducing the need of medical oxygen. But high-budget and sophisticated machines are required to provide this positive airway pressure, adding on to the treatment cost of the patient and investment expenditure by the health-care facilities. We have designed a simple self-working device called self-working water-based instrument for positive expiratory pressure by resistance (SWIPER) device which can provide a PEP. The objective of this study was to assess the effectiveness of this device in improving oxygenation in patients with acute pulmonary edema, which was quantified using pulse oximetry. Methods: Patients who were admitted to the medical intensive care unit during the study period, with an acute pulmonary edema-a diagnosis which was made clinico-radiologically, were chosen as the subjects for the study. Once the patients were critically stabilized by the already existing treatment protocols, the SWIPER device was applied. Results: The device was introduced on 15 patients who were selected after applying the inclusion-exclusion criteria of the study. The mean age of the study group was 65 years (men-64 years, Women-66 years). Eight of them had cardiogenic pulmonary edema whereas seven of them had nephrogenic pulmonary edema. The median baseline SpO2level was 90% (86%, 94%) and the median plateau SpO2level after using the SWIPER device was 94% (91%, 99%) (*P < 0.001). The mean rise in SpO2on using the device was 6% (1.89) which was clinically significant. Conclusion: SWIPER device is effective in significantly increasing the SpO2 in patients with acute pulmonary edema by providing a PEP. This device is not a replacement for the existing positive airway pressure-providing electrical devices. However, SWIPER devices will definitely come in handy in resource-limited settings in providing better treatment and care till the standard therapeutic measures are obtained. It will also help in significantly reducing the medical oxygen consumption in managing such patients.","PeriodicalId":402083,"journal":{"name":"Journal of Advanced Lung Health","volume":"319 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116381971","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}
{"title":"An unusual site for chest wall trauma","authors":"R. Chetambath, N. Sneha, T. Maneesha","doi":"10.4103/jalh.jalh_3_22","DOIUrl":"https://doi.org/10.4103/jalh.jalh_3_22","url":null,"abstract":"Blunt chest trauma can injure ribs, vertebra, or sternum and, in turn, lead to lung injury of various severities. However, trauma to the scapula is very rare and it suggests heavy impact on the chest wall during fall. Here, we discuss a case of a traffic accident where multiple ribs and scapula on the right side are fractured. This, in turn, precipitated contusion of the lung.","PeriodicalId":402083,"journal":{"name":"Journal of Advanced Lung Health","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134408158","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}
{"title":"Innovations help when there is unexpected demand","authors":"R. Chetambath","doi":"10.4103/jalh.jalh_22_22","DOIUrl":"https://doi.org/10.4103/jalh.jalh_22_22","url":null,"abstract":"","PeriodicalId":402083,"journal":{"name":"Journal of Advanced Lung Health","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133906497","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}
{"title":"Evaluation of anaphylaxis: A simplified approach","authors":"Vidushi Rathi, P. Ish","doi":"10.4103/jalh.jalh_21_22","DOIUrl":"https://doi.org/10.4103/jalh.jalh_21_22","url":null,"abstract":"Anaphylaxis has been defined as a serious allergic reaction that can even amount to death. However, the approach to the patient remains grossly individualized. Treatment aims at rapid intervention to prevent mortality. This review gives a detailed yet simplified approach to anaphylaxis, its diagnosis, and management.","PeriodicalId":402083,"journal":{"name":"Journal of Advanced Lung Health","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114623892","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}
{"title":"Smoker with unilateral enlarged breast","authors":"Vishnu Sharma","doi":"10.4103/jalh.jalh_16_21","DOIUrl":"https://doi.org/10.4103/jalh.jalh_16_21","url":null,"abstract":"Intrathoracic tumors can present with paraneoplastic manifestations. We discuss a paraneoplastic manifestation as an interactive discussion. We have focused the discussion on clinical approach to the case.","PeriodicalId":402083,"journal":{"name":"Journal of Advanced Lung Health","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124884218","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}
{"title":"Pulmonary alveolar microlithiasis: Lungs of stone!","authors":"N. Neenu, K. Utpat, U. Desai, Gautam Sarawade","doi":"10.4103/jalh.jalh_15_22","DOIUrl":"https://doi.org/10.4103/jalh.jalh_15_22","url":null,"abstract":"Pulmonary alveolar microlithiasis (PAM) is a rare autosomal recessive disorder characterized by diffuse bilateral deposition of calcispherites in lung alveoli due to mutations in the SLC34A2 gene. Here, we presented a case of PAM in a young male who had been referred to our center to rule out miliary tuberculosis due to his chest radiography findings of bilateral extensive reticulonodular opacities. Possibility of PAM was considered here due to clinicoradiological dissociation and was confirmed with high-resolution computed tomography of the chest, which showed findings of Stage 2 PAM. Even though PAM has pathognomonic unique chest radiographic findings, it always poses a diagnostic challenge for physicians as it closely resembles other diseases including miliary tuberculosis, pneumoconiosis, and sarcoidosis. This case shows the need for thorough knowledge about PAM that physicians should have to reach at early prompt diagnosis and to avoid unnecessary need for invasive procedures.","PeriodicalId":402083,"journal":{"name":"Journal of Advanced Lung Health","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127665240","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}
{"title":"Chest radiology in a COVID patient with hypoxia","authors":"M. Sharma, Joan Jacob","doi":"10.4103/jalh.jalh_22_21","DOIUrl":"https://doi.org/10.4103/jalh.jalh_22_21","url":null,"abstract":"","PeriodicalId":402083,"journal":{"name":"Journal of Advanced Lung Health","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132087856","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}
{"title":"A retrospective observational study of utility of nonrebreathing mask in moderate to severe hypoxemic COVID-19 pneumonia","authors":"Trinath Dash, Karthik Tipparapu, S. Singh, K. Roy","doi":"10.4103/jalh.jalh_20_21","DOIUrl":"https://doi.org/10.4103/jalh.jalh_20_21","url":null,"abstract":"Introduction: The pulmonary manifestations of covid-19 disease may range from mild pneumonia to severe acute respiratory distress syndrome (ARDS) complicated by shock or multiorgan failure. Proper selection and utilization of oxygen delivery system is the key factor in treating the hypoxemic respiratory failure in severe covid-19 disease. Here by, we present a retrospective observational study of utility of NRBM (Non Rebreathing Mask) in 1876 moderate to severe hypoxemic Covid-19 pneumonia patients in a single centre and its outcome. Objectives: To study the utility of NRBM in moderate to severe hypoxemic COVID-19 pneumonia Patients. Material and Methods: This was a single centre retrospective observational study. Out of 5024 microbiologically confirmed (by Rapid antigen test/RTPCR/TRUENAT) covid-19 pneumonia patients admitted since September, 2020 to May 2021,1876 patients of age >14 years admitted in the department of Respiratory medicine with moderate to severe hypoxemia (SpO2 <90%) and respiratory rate <30/min who were provided supplemental oxygen by NRBM with or without associated Co-morbidities were included in the study. These patients were provided oxygen Supplementation by NRBM according to their SpO2 levels (<90 %) by starting with a minimum flow rate of 10 L/ min to maximum of 15 L/min. Results: Out of 5024 microbiologically confirmed covid-19 patients who were admitted in respiratory ICU and ward,1876 patients were provided supplemental oxygen by NRBM. Patients were distributed according to their duration of onset of symptoms, mode of oxygen delivery, number of days of supplemental oxygen and number of patients expired accordingly and results were observed and analyzed. Majority of the patients belongs to the age group 45 to 60 yrs. The average duration of presentation to ER with worsened symptoms for oxygen requirement was 6.4 days from the onset of symptoms. 1703 (90.77%) patients recovered well without any further deterioration with NRBM. The average duration of days for weaning from NRBM to simple face mask or nasal prongs were 4.5 days based on their respective SpO2 >90% (corresponds to Pao2 >60 mmhg), respiratory rate (<16/min) and heart rate <100 bpm. About 9.3% of the patients (173) who were provided NRBM support who further deteriorated or showed poor response even after maximum period of 7 days were provided with NIV support (130 patients i.e. 6.92%), HFNC support (14 patients i.e. 0.74%) and invasive mechanical ventilation (29 patients i.e. 1.54%).66 patients who were initially provided NRBM support, recovered and 107 patients (2.129%) succumbed to their illness. smoking (table-4)has been observed to be the major risk factor in majority of the patients (43.7%). As per the data of this study there is significant correlation between the utilization of NRBM and advanced age, early initiation of NRBM rather than directly initiating NIV/HFNC/Invasive mechanical ventilation and duration of presentation to the hospital with sympto","PeriodicalId":402083,"journal":{"name":"Journal of Advanced Lung Health","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123618031","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}
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