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Biomedical subjects

K K Guntupalli

Publications and source records attributed to K K Guntupalli.

At least 19 recordsLinked to original sources
PubMed2006

Predictors of development and outcome in patients with acute respiratory distress syndrome due to tuberculosis.

OBJECTIVE: To study the predictors of development and determinants of outcome in patients with acute respiratory distress syndrome (ARDS) due to tuberculosis (TB). METHODS: Retrospective case-control study of demographic, clinical and laboratory data of hospitalised adult patients with active TB. RESULTS: Of 2733 TB patients treated during 1980-2003, 29 (1.06%; 1.21 patients/year; mean age 31.6 +/- 10.9 years; 16 males) developed ARDS (cases). Seven had pulmonary TB and 22 had miliary TB (MTB); 298 (mean age 32.0 +/- 14.2 years; 110 males) who did not develop ARDS constituted controls. Presence of MTB (OR 4.6, 95%CI 1.2-17.8; P = 0.02), duration of illness beyond 30 days at presentation (OR 177.9, 95%CI 39-811.7; P < 0.001), absolute lymphocyte count < 1625/ mm3 (OR 4.5, 95%CI 1.1-19.3; P = 0.04) and serum ALT > 100 IU (OR 15.7, 95%CI 3.0-81.1, P < 0.001) were independent predictors of ARDS development. Twelve cases died (41.4%). Patients with APACHE II score >18; those with APACHE II score <18 in the presence of hyponatraemia and PaO2/FIO2 ratio <108.5 were likely to die. CONCLUSIONS: In patients with TB, prolonged illness, MTB, absolute lymphocytopaenia and elevated ALT are independently associated with ARDS development. APACHE II score, serum sodium and PaO2/FIO2 ratio are determinants of outcome.

Adult↗
PubMed2005

Effect of airway pressure display on interobserver agreement in the assessment of vascular pressures in patients with acute lung injury and acute respiratory distress syndrome.

BACKGROUND: Previous investigations have identified significant interobserver variability in the measurements of central venous pressure and pulmonary artery occlusion pressure in critically ill patients. Large interobserver variability in the measurement of vascular pressures could potentially lead to inappropriate treatment decisions. OBJECTIVE: We postulated that adding an airway pressure signal (Paw) to pressure tracings of central venous pressure and pulmonary artery occlusion pressure would improve interobserver agreement by facilitating identification of end-expiration. DESIGN: To test this hypothesis, six independent experts used a standard protocol to interpret strip-chart recordings of central venous pressure and pulmonary artery occlusion pressure with or without Paw. Two observers were said to agree if their measurements were within 2 mm Hg of each other. SETTING/SUBJECTS/INTERVENTIONS: A total of 459 strip-chart recordings (303 without Paw and 156 with Paw) were obtained from 121 patients enrolled in the ARDSnet Fluids and Catheters Treatment Trial (FACTT) in 16 different hospitals. RESULTS: Agreement within 2 mm Hg between two measurements was 79% for central venous pressure strips without Paw vs. 86% with Paw. For pulmonary artery occlusion pressure, agreement increased from 71% without Paw to 83% with Paw. The increase in agreement with the addition of Paw was greater for strips demonstrating >8 mm Hg phasic respiratory variation compared with strips demonstrating less phasic respiratory variation. CONCLUSION: Paw display is a simple, inexpensive method to facilitate the identification of end-expiration that can significantly improve interobserver agreement.

Airway Resistance↗
PubMed1999

Heat-related illnesses.

The majority of clinicians will encounter patients with heat-related illness in one form or the other. Early recognition and management are important to prevent morbidity and mortality. In children and elderly, the clinical signs may be subtle and in such situations a sound knowledge of heat-related illnesses is crucial. Besides diagnosing and treating heat-related illnesses, it is equally important to know how to prevent them as they are easily preventable.

Acclimatization↗
PubMed1998

Ventilation of patients with asthma and obstructive lung disease.

Mechanical ventilation in a patient with obstructive airway disease may be a lifesaving measure; however, it may also be associated with significant morbidity and mortality. It is important for a physician to be familiar with the potential complications of mechanical ventilation in this group of patients and to know how to avoid them by carefully applying safe ventilator strategies. The cornerstone of such strategies is to minimize minute ventilation, maximize time for expiration, and avoid hyperinflation of the lung. Several bedside parameters (iPEEP, VEI, Pplat) that reflect presence of gas trapping and potential hyperinflation may be measured. In addition to mechanical ventilation, management should include inhaled bronchodilators and systemic corticosteroid therapies. In the event controlled hypoventilation is necessary, sedation with or without the use of muscle relaxants may be required. Unconventional therapies such as the use of Heliox, magnesium sulfate, ketamine, and inhalational anesthetics may be attempted in severe cases that do not respond to conventional management. With appropriate use of ventilator strategies, a reduction in the mortality and morbidity of patients with obstructive airway disease requiring mechanical ventilation has recently been noted.

Algorithms↗
PubMed1998

Acute respiratory distress syndrome. Inhaled nitric oxide.

There is enough evidence to support the short-term beneficial effects and safety of administering inhaled NO to ARDS patients. This effect may be potentiated when inhaled NO is administered in conjunction with other therapies. The full spectrum of effects of inhaled NO remains to be elucidated. Long-term benefit in terms of mortality and duration of mechanical ventilation has not been demonstrated; more randomized trials probing these effects are needed.

Administration, Inhalation↗
PubMed1997

Angioedema: the role of ACE inhibitors and factors associated with poor clinical outcome.

OBJECTIVE: We sought to study the prevalence of angiotensin-converting enzyme (ACE) inhibitors, a cause of angioedema, and investigate any association between clinical findings at the time of presentation and clinical outcome. DESIGN AND SETTING: Retrospective review of the charts of all patients presenting with angioedema to the emergency department at our tertiary referral teaching hospital or clinics over a 4-year period. The charts were reviewed for documentation of chief complaint(s), physical findings, medical treatment, need for laryngoscopy and/or endotracheal intubation, triage, and probable etiology. RESULTS: Of the 40 patients presenting with angioedema in this study, 15 cases were caused by ACE inhibitors. They were the most common cause of angioedema, accounting for 38% of all cases. The incidence of ACE inhibitor-induced angioedema is estimated to be 0.14%. More patients with angioedema secondary to ACE inhibitors had complaints of odynophagia (p < 0.02), whereas only patients with non-ACE inhibitor causes of angioedema presented with pruritus (p < 0.02). Furthermore, patients presenting with an acute reaction within 24 h of exposure to the causative agent were more likely to require inpatient monitoring (p < 0.05). Both odynophagia and edema of the tongue were significant predictors for undergoing laryngoscopy (p < 0.001 and p < 0.02, respectively) and admission to the hospital (p < 0.05). CONCLUSION: ACE inhibitors are the number one cause of acute angioedema in this tertiary referral teaching hospital. Odynophagia and tongue swelling at the time of presentation had significant implications for diagnostic intervention and admission to the hospital.

Acute Disease↗
PubMed1997

Critical care in India.

India is a vast democracy of nearly one billion people. Before the British rule ended in 1947, the life span of an Indian was a mere 21 years. Within a short span of 50 years, it increased to an impressive 63 years, largely due to public health measures initiated by the government. This created a pool of more than 300 million middle class Indians who could afford the benefits of modern and specialized care when needed. Critical care medicine, as practiced in the West, is still confined to large Metropolitan areas. A large pool of expatriate Indian physicians from all over the world are helping bridge the resource gap between the West and India by transfer of technology and providing appropriate training to physicians and paramedical personnel. This article describes the history and current status of development of critical care medicine in India.

Critical Care↗
PubMed1997

Acute respiratory distress syndrome.

Acute Respiratory Distress Syndrome (ARDS) occurs in a wide range of adult and pediatric critical care settings. This article provides an overview of ARDS including the controversies in definition, a summary of pathophysiology, diagnosis, clinical presentation, and management options. The article also attempts to emphasize new management options in the management of ARDS, and highlights differences between adults and children.

Adrenal Cortex Hormones↗
PubMed1997

Detection of Pneumocystis carinii in tracheal aspirates of intubated patients using calcofluor-white (Fungi-Fluor) and immunofluorescence antibody (Genetic Systems) stains.

OBJECTIVE: To compare the detection rate of Pneumocystis carinii in endotracheal aspirates with that rate in bronchoalveolar lavage fluid, using calcofluor-white (Fungi-Fluor) and immunofluorescence antibody (Genetic Systems) staining methods. DESIGN: Prospective, consecutive cases. SETTING: Medical intensive care unit at Ben Taub General Hospital. PATIENTS: Thirty-one intubated patients admitted with respiratory failure and suspected P. carinii pneumonia. INTERVENTIONS: An endotracheal aspirate specimen was obtained after maximally advancing a closed-system suction catheter, instilling aliquot portions of saline, and suctioning the lavage fluid. This procedure was followed within 30 mins by fiberoptic bronchoscopy and bronchoalveolar lavage. MEASUREMENTS AND MAIN RESULTS: Endotracheal aspirate and bronchoalveolar lavage specimens from each patient were mixed with Saccomano's fixative, blended, and centrifuged. Using a modified method for P. carinii cysts, the sediment was stained with the test calcofluor-white stain Solution A and the test antibody stain. The test antibody stain on the bronchoalveolar lavage specimens was positive for P. carinii for 13 patients and was used as the standard for comparison. In the endotracheal aspirate specimens, the test antibody stain detected 12 (92%) P. carinii-positive patients while the test calcofluor-white stain detected ten (77%) P. carinii-positive patients. CONCLUSIONS: We described a simple method for obtaining, processing, and staining endotracheal aspirate specimens for P. carinii. Obtaining an endotracheal aspirate specimen did not require specially trained personnel or a specialized and more expensive catheter, and was not associated with any complications.

Benzenesulfonates↗
PubMed1996

Aerosolized surfactant in adults with sepsis-induced acute respiratory distress syndrome. Exosurf Acute Respiratory Distress Syndrome Sepsis Study Group.

BACKGROUND: Patients with acute respiratory distress syndrome (ARDS) have a deficiency of surfactant. Surfactant replacement improves physiologic function in such patients, and preliminary data suggest that it may improve survival. METHODS: We conducted a prospective, multicenter, double-blind, randomized, placebo-controlled trial involving 725 patients with sepsis-induced ARDS. Patients were stratified according to the risk of death at base line (indicated by their score on the Acute Physiological and Chronic Health Evaluation [APACHE III] index) and randomly assigned to receive either continuously administered synthetic surfactant (13.5 mg of dipalmitoylphosphatidylcholine per milliliter, 364 patients) or placebo (o.45 percent saline; 361 patients) in aerosolized form for up to five days. RESULTS: The demographic and physiologic characteristics of the two treatment groups were similar at base line. The mean (+/- SD) age was 50 +/- 17 years in the surfactant group and 53 +/- 18 years in the placebo group, and the mean APACHE III scores at randomization were 70.4 +/- 25 and 70.5 +/- 25, respectively. Hemodynamic measures, measures of oxygenation, duration of mechanical ventilation, and length of stay in intensive care unit did not differ significantly in the two groups. Survival at 30 days was 60 percent for both groups. Survival was similar in the groups when analyzed according to APACHE III score, cause of death, time of onset and severity of ARDS, presence or absence of documented sepsis, underlying disease, whether or not there was a do-not-resuscitate order, and medical center. Increased secretions were significantly more frequent in the surfactant group; the rates of other complications were similar in the two groups. CONCLUSIONS: The continuous administration of aerosolized synthetic surfactant to patients with sepsis-induced ARDS had no significant effect on 30-day survival, length of stay in the intensive care unit, duration of mechanical ventilation, or physiologic function.

Administration, Inhalation↗
PubMed1996

Burnout in the internist--intensivist.

OBJECTIVES: Caring for acutely ill patients imposes significant demands on physicians. The environment and stresses of the ICU may lead to the burnout syndrome. The purpose of this study was to evaluate the prevalence of burnout among internal medicine intensivists and the contributing factors present in ICU practice. DESIGN: Mailed survey utilizing the Maslach Burnout Inventory (MBI). Increasing burnout has been shown to be associated with low levels on personal achievement and high scores on depersonalization and emotional exhaustion. SUBJECTS: Random sample of members of the Internal Medicine Section of the Society of Critical Care Medicine. MEASUREMENTS AND MAIN RESULTS: 248 people responded: 220 (88.7%) males and 28 females. Mean age of all respondents was 41.6 +/- 6.7 years. The majority (58.1%) worked in large hospitals (> 400 beds); 55.6% devoted more than 50% of their time to critical care. The emotional exhaustion subscale of the MBI averaged 22.2 +/- 9.5, with a third of respondents scoring in the high range. The depersonalization score averaged 7.1 +/- 5.1%, with 20.4% of respondents scoring in the high range. Similarly personal achievement subscores were poor, with a mean value of 30.9 +/- 6.4%, with 59% scoring in the low range. High levels of emotional exhaustion were associated with anticipating leaving critical care before retirement. CONCLUSIONS: Burnout as measured by the MBI appears to be common in internal medicine intensivists. High levels of emotional exhaustion and depersonalization are related not only to patient care issues but also to a poor support system.

Adult↗
PubMed1996

A rapid and inexpensive method for processing induced sputum for detection of Pneumocystis carinii.

The authors describe a method to process induced sputum specimens for detection of Pneumocystis carinii which is simple, rapid and inexpensive. Induced sputum and bronchoalveolar lavage (BAL) were obtained within a 24-hour period from 41 patients who were HIV-positive and had pulmonary symptoms suspicious for P carinii pneumonia. Induced sputum or BAL fluid was placed into Saccomanno's fixative, blended, and centrifuged. The sediment was stained for P carinii cysts by a modified method with Fungi-Fluor Solution A (Polysciences, Warington, PA) and the Genetic Systems Pneumocystis carinii Immunofluorescence Antibody (Genetic Systems, Seattle, WA). The Genetic Systems stain on the BAL specimen was positive in 35 patients and was the standard for comparison. With a single induced sputum, the Genetic Systems stain detected 31 (89%) positive patients, whereas the Fungi-Fluor stain detected 21 (60%). The sensitivity for detecting P carinii cysts in induced sputum was significantly greater (P < 0.05) for the Genetic Systems stain.

AIDS-Related Opportunistic Infections↗
PubMed1996

Clinical aspects of asthma.

Asthma, one of the most common medical conditions during pregnancy, provides health care workers with an opportunity to diagnose, educate, and treat these patients. With proper fetal and maternal monitoring, outcome is good both for the mother and the baby. Elderly patients constitute a special group for whom asthma is underdiagnosed and undertreated. Exercise is a common trigger for asthma. The three factors determining exercise-induced asthma are minute ventilation, climatic conditions, and bronchial hyperreactivity. In vocal cord dysfunction, abnormal adduction of vocal cords causes airway obstruction. Vocal cord dysfunction can occur by itself or along with asthma and can be mistaken for asthma.

Adolescent↗
PubMed1995

Isoniazid overdose: four case reports and review of the literature.

OBJECTIVES: To review the pathophysiology, presentation and treatment of isoniazid (INH) intoxication. DATA SOURCES: Human, animal and modeling studies published since 1940 identified through MEDLINE and a review of the bibliographies of relevant articles. STUDY SELECTION AND DATA EXTRACTION: The studies identified were reviewed with emphasis on the most recent. Earlier studies were selected for their historical value and relevance to the clinical setting. DATA SYNTHESIS: Isoniazid overdose is a potentially fatal intoxication. The incidence of tuberculosis has recently increased in the United States and therefore the frequency of INH overdose may also increase. Patients with INH overdose may present with nausea, vomiting, ataxia, symptoms reminiscent of atropine intoxication, coma and grand mal seizures. Lactic acidosis is revealed by laboratory evaluation. Treatment requires admission to the ICU for ventilatory support, and management of seizures and acid-base abnormalities. Pyridoxine, in a dose equivalent to the amount of INH ingested, is the only effective antidote. CONCLUSIONS: INH overdose should be suspected in any patient presenting with seizures and metabolic acidosis. Prognosis is good when treatment is instituted early.

Acidosis↗
PubMed1995

Comparison of the effect of intermittent administration and continuous infusion of famotidine on gastric pH in critically ill patients: results of a prospective, randomized, crossover study.

OBJECTIVES: To compare the effects of intermittent intravenous administration and continuous intravenous infusion of famotidine on gastric pH in critically ill patients. DESIGN: A prospective, randomized, crossover study of continuous infusion and bolus administration of famotidine in critically ill patients. SETTING: A 14-bed medical intensive care unit (ICU) of a 500-bed county hospital. PATIENTS: Medical ICU patients requiring stress ulcer prophylaxis. INTERVENTIONS: Patients were randomized to receive an equivalent dose of famotidine by continuous infusion or intravenous bolus for 24 hrs, and then were crossed over to the other arm of the study. MEASUREMENTS AND MAIN RESULTS: Critically ill patients who met the inclusion criteria were randomly assigned to receive famotidine 20 mg i.v. over 10 mins, every 12 hrs or a continuous infusion of 1.7 mg/hr for 24 hrs. After a 16-hr washout period, patients crossed over to the other arm of the study. Gastric pH was monitored continuously for 24 hrs. A total of 710 gastric pH measurements were obtained for each phase of the study. The mean area under the pH-time curve for a 24-hr period was higher for continuous infusion than bolus administration (p = .05). Continuous infusion of famotidine maintained a gastric pH of > or = 4 over a longer time period than bolus administration (20.8 hrs vs. 12.6 hrs, respectively; p < .01). Onset of therapeutic gastric pH for continuous infusion was slightly delayed as compared with bolus administration. CONCLUSIONS: Continuous infusion of famotidine is more effective than an equivalent dose given by intermittent bolus in maintaining the appropriate gastric pH necessary for prevention of stress ulceration. Delayed onset of effect may warrant a priming dose when famotidine is given by continuous infusion.

Adult↗