AR Advanced Respiratory HUBDr. Ranjit Singh is a Pulmonologist with specialized expertise in Sleep Apnea, NIV and ILD procedures and has an experience of 18 years in this field. Having laid the foundation of his career in 2001, Dr. Singh has come a long way in terms of professional experience. His present centres of consultation are RTIICS (Kolkata) and Advanced Respiratory Centre (Jharkhand) where one may visit with a prior appointment.. He completed MBBS from Ranchi University in 1996, DM - Pulmonary Medicine from SMS Medical College, Jaipur in 2001 and MRCP from Royal Colleges of Physicians, Uk in 2008. Faculty at CMC Vellore. Trained in interventional Bronchology from France Marsille. MRCP examiner since 2012. Some of the services provided by the doctor are Video Bronchoscopy, Endobronchial Ultrasound (EBUS) and Thoracoscopy, Cryo biopsy in ILD, Debulking of the Tumor, Management of central airways Tumor, Ultrasound chest etc. Diseases like Interstitial lung diseases, Lung cancer, severe COPD, Severe Uncontrolled Asthma.
COPD patients significant effects on survival have been shown for several interventions , including. high-frequency neuromuscular electrical stimulation should initiated as the main training modality during his Pulmonary rehabilitation programme, weight gain in underweight patients , non-invasive positive pressure ventilation in chronic hypercapnic patients and lung volume reduction surgery or endobronchial valve treatment in patients with upper-lobe predominant emphysema and poor exercise capacity
An Official American Thoracic Society/European Society of Intensive
Care Medicine/Society of Critical Care Medicine Clinical Practice
Guideline: Mechanical Ventilation in Adult Patients with Acute
Respiratory Distress Syndrome
For all patients with ARDS, the recommendation is strong for
mechanical ventilation using lower tidal volumes (4–8 ml/kg predicted
body weight) and lower inspiratory pressures (plateau pressure , 30 cm
H2O) (moderate confidence in effect estimates). For patients with severe
ARDS, the recommendation is strong for prone positioning for more
than 12 h/d (moderate confidence in effect estimates). For patients with
moderate or severeARDS, the recommendation is strong against routine
use of high-frequency oscillatory ventilation (high confidence in effect
estimates) and conditional for higher positive end-expiratory pressure
(moderate confidence in effect estimates) and recruitment maneuvers
(low confidence in effect estimates). Additional evidence is necessary to
make a definitive recommendation for or against the use of
extracorporeal membrane oxygenation in patients with severe ARDS.
Diagnosis of asthma–COPD overlap: the five commandments
1) A patient with asthma may develop non-fully reversible airflow obstruction but this is not COPD, not even ACO; it is obstructive asthma.
2) A patient with asthma who smokes may also develop non-fully reversible airflow obstruction, which differs from obstructive asthma and from “pure” COPD. This is the most frequent type of patient with ACO.
3) Some patients who smoke and develop COPD may have a genetic Th2 background (even in the absence of a previous history of asthma) and can be identified by high eosinophil counts in peripheral blood.These individuals could be included under the umbrella term of ACO.
4) A patient with COPD and a positive bronchodilator test (>200 mL and >12% FEV1 change) has reversible COPD but is not an asthmatic, or even ACO.
5) A patient with COPD and a very positive bronchodilator test (>400 mL FEV1 change) is more likely to have some features of asthma and could also be classified as ACO.
COPD-OSA Overlap Syndrome
The recognition of co-existing OSA in COPD patients has important clinical relevance as the management of patients with overlap syndrome is different from COPDalone, and the survival of overlap patients not treated with nocturnal positive airway
pressure is significantly inferior to those overlap patients appropriately treated.
Postoperative Pulmonary Complications
Br J Anaesth. 2017;118(3):317-334.
Changes to the respiratory system occur immediately on induction of general anaesthesia: respiratory drive and muscle function are altered, lung volumes reduced, and atelectasis develops in > 75% of patients receiving a neuromuscular blocking drug..The respiratory system may take 6 weeks to return to its preoperative state after general anaesthesia for major surgery.
clinicians should be aware of non-modifiable and modifiable factors in order to recognize those at risk and optimize their care.Preventative measures include preoperative optimization of co-morbidities, smoking cessation, and correction of anaemia, in addition to intraoperative protective ventilation strategies and appropriate management of neuromuscular blocking drugs. Protective ventilation includes low tidal volumes, which must be calculated according to the patient's ideal body weight.
the most beneficial level of PEEP is required,
COPD (Chronic obstructive pulmonary diseases or chronic bronchitis)
Assessment of the risk of death in this patients depend on their BODE Index B stand for BMI, O- Obstruction depending on FEV1, D - Shortness of breath OR dyspnea using MMRC scale , E - Exercise capacity, measured by 6 minutes walk test 6MWT.This index calculated using a scale of 0 to 3 for each parameter, depending on severity. except BMI scale different < 21 is 0 and more than >21 is 1. BODE score of 7 to 10 falls in the higher chance of mortality.
Other factors have also been associated with increased moribidity and mortality in COPD , For example : acute exacerbation of COPD, Hospitalization, cardiac comorbidities
Survival benefit are smoking cessation and lung volume reduction surgery in selected patients .Oxygen is beneficial who are hypoxemic on room air. None of the medications consistently demonstrated to prolong life.
2000 classification of idiopathic interstitial lung diseases
The 2000 classification consists of seven entities of idiopathic interstitial diseases which are defined on clinical, radiological and pathological criteria: idiopathic pulmonary fibrosis, non-specific interstitial pneumonia, cryptogenic organizing pneumonia, acute interstitial pneumonia, respiratory bronchiolitis associated interstitial lung disease, desquamative interstitial pneumonia and lymphoid interstitial pneumonia. The most frequent is Idiopathic Pulmonary Fibrosis, which has a poor prognosis.
Multicentre evaluation of multidisciplinary team meeting agreement on diagnosis in diffuse parenchymal lung disease: a case-cohort study
Agreement between MDTMs for diagnosis in diffuse lung disease is acceptable and good for a diagnosis of IPF, as validated by the non-significant greater prognostic separation of an IPF diagnosis made by MDTMs than the separation of a diagnosis made by individual clinicians or radiologists. Furthermore, MDTMs made the diagnosis of IPF with higher confidence and more frequently than did clinicians or radiologists. This difference is of particular importance, because accurate and consistent diagnoses of IPF are needed if clinical outcomes are to be optimised. Inter-multidisciplinary team agreement for a diagnosis of hypersensitivity pneumonitis is low, highlighting an urgent need for standardised diagnostic guidelines for this disease.