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.
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,
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.
Pirfenidone Reduces Respiratory-related Hospitalizations in Idiopathic Pulmonary Fibrosis
In a pooled analysis of three phase 3 IPF clinical trials, patients receiving pirfenidone had a lower risk of non-elective respiratory-related hospitalization over 1 year. Among those hospitalized for any reason, pirfenidone was associated with a lower risk of death following hospital admission.
Noninvasive Ventilation in Acute Hypoxemic Nonhypercapnic Respiratory Failure: A Systematic Review and Meta-Analysis
Noninvasive ventilation decreased endotracheal intubation rates and hospital mortality in acute hypoxemia nonhypercapnic respiratory failure excluding chronic obstructive pulmonary disease exacerbation and cardiogenic pulmonary edema patients. There is no sufficient scientific evidence to recommend bilevel positive airway pressure or helmet due to the limited number of trials available.
Bronchoscopic Lung Cryobiopsy Increases Diagnostic Confidence in
the Multidisciplinary Diagnosis of Idiopathic Pulmonary Fibrosis
American Journal of Respiratory and Critical Care Medicine Volume 193 Number 7 | April 1 2016
BLC is a new biopsy method that has a meaningful
impact on diagnostic confidence in the multidisciplinary
diagnosis of interstitial lung disease and may prove useful in the
diagnosis of IPF.
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.
Sleep apnoea and risk of post-operative infection: beyond cardiovascular impact.
the risk of pneumonia or sepsis is more than doubled in patients with a predominance of central, rather than obstructive, respiratory events