Dr Nithin Goutham THESIS

THESIS

FACTORS INFLUENCING RECOVERY OUTCOMES IN PATIENTS WITH RESPIRATORY FAILURE 

INTRODUCTION: 

The respiratory system allows gas exchange between the environment and the body, facilitating the process of aerobic metabolism. Specifically, the respiratory system provides oxygen and removes carbon dioxide from the body. The inability of the respiratory system to perform either or both of these tasks results in respiratory failure. Type 1 respiratory failure occurs when the respiratory system cannot adequately provide oxygen to the body, leading to hypoxemia. Type 2 respiratory failure occurs when the respiratory system cannot sufficiently remove carbon dioxide from the body, leading to hypercapnia.

Respiratory failure can be classified based on chronicity (i.e., acute, chronic, and acute on chronic). A thorough understanding of respiratory failure is crucial to managing this disorder. If either type of respiratory failure is not identified and addressed early, it will become life-threatening and lead to respiratory arrest, coma, and death. 1

Acute respiratory failure due to acute respiratory distress syndrome (ARDS) ranges in incidence from 10-80/100,000/y based on where it is recorded worldwide. This is partly due t different practices and thresholds for intubation in these cases and the use of different definitions of ARDs. According to one report, it is estimated that 10% of all patients admitted to ICU and 23% of mechanically ventilated patients meet ARDS criteria.(2)

Acute respiratory failure related to Coronavirus (COVID-19): It is estimated early in the COVID-19 pandemic that up to 79% of hospitalized patients developed respiratory failure requiring invasive mechanical ventilation.(3)

Acute exacerbation of COPD (AECOPD) is the third most common etiology in patients hospitalized because of acute respiratory failure.(4)

PROBLEM STATEMENT 

      Respiratory failure is a leading cause of mortality and morbidity and in recent times the pandemic of covid has heightened awareness around this problem where there has been increased numbers of ECMO, lung transplants and while many were justified there were many instances where the necessary care was suboptimal.

Understanding factors influencing outcomes in patients with Respiratory Failure is important to optimize better care for such patients.

AIM

TO ASSESS  THE VARIOUS FACTORS INFLUENCING RECOVERY OUTCOMES IN PATIENTS WITH RESPIRATORY FAILURE SPECTRUM SEEN IN THE MEDICINE DEPARTMENT.

OBJECTIVES 

1) To identify the spectrum of respiratory failure patients coming to general medicine department.

2)To study the clinical, radiological and laboratory profile of the spectrum of respiratory failure patients coming to general medicine department 

3)To assess the various factors influencing the causation and recovery of respiratory failure in those patients. 

STUDY DESIGN :

Prospective study design with analysis of factors influencing the outcome of the patients with Respiratory Failure.

INCLUSION CRITERIA

1) Patients above the age of 18 years.

2) Patients with Common causes of respiratory failure like pneumonia, pulmonary edema, pulmonary embolism, acute respiratory distress syndrome, atelectasis, asthma, COPD, neuromuscular and chest wall disorders, inadequate post-operative analgesia, smoking, obesity,  shock, heart failure, cardiac arrhythmia and lung cancer.

EXCLUSION CRITERIA

1) Patients under the age of 18 years

2) Patients/Patients attendants who are not willing for study or not giving consent for the purpose of study

3) Patients without any factors or conditions influencing respiratory failure.

PATIENTS AND METHODOLOGY 

PLACE OF STUDY: Department of General medicine, Kamineni institute of medical sciences, Narketpally.

STUDY PERIOD: April 2023- March 2025

STUDY DESIGN : Prospective Observational Qualitative study.

SAMPLE SIZE: Proposed No. of cases to be studied = 50

CASE PROFORMA

Serial number

Name

Age

Sex

Occupation

OP/IP number

Education

Socioeconomic Status

Phone number

Residence

Complaints :

Shortness of breath                               

Fever

Chest pain

Cough

Sputum

Evening rise of temperature

Pedal edema

Facial puffiness

Oliguria

Anuria

Muscle weakness

Traumatic 

Headache

Hoarseness of voice

Swellings in the neck or chest

Hemoptysis

Weight loss

Decreased appetite

Wheeze

PERSONAL HISTORY 

Alcohol history: 

Smoking history :

Appetite :

Bladder and bowel habits:

PAST HISTORY: 

         family history of similar illness

         HIV status                                     

 H.o Diabetes mellitus

 H/o coronary artery disease                                                            

 Hypertension 

 H/o blood transfusions                                                                    

Chronic kidney disease 

Tuberculosis   

GENERAL EXAMINATION 

 Pallor                                                       

 Icterus

 Lymphadenopathy                    

 Clubbing                               

 Cyanosis                                                                    

 Chest AP and Transverse diameters                        

 Elevated JVP

 Facial Puffiness

 Pedal Edema

RESPIRATORY EXAMINATION:

Movements of chest:

Percussion:

Air entry:

Breath sounds:

CARDIOVASCULAR SYSTEM: 

Heart sounds:

 JVP:

 Added sounds:

GASTROINTESTINAL SYSTEM: 

Inspection: Palpation:

Shape of abdomen organomegaly

Umbilicus liver span

Percussion : Auscultation:

Shifting dullness Bowel sounds 

                                           

CENTRAL NERVOUS EXAMINATION :

Higher mental functions:

Motor and sensory system:

Cerebellar functions:

Meningeal signs:

INVESTIGATIONS : 

CBP

CHEST XRAY PA VIEW

RFT

LFT

ECG 

ECHOCARDIOGRAM

ABG

ULTRASOUND

CT 

MRI

GRAMS STAIN

SPUTUM FOR CBNAAT

OUTCOMES :

1)  Asymptomatic

2) Morbidity-symptomatically better or worse (complications for being bed ridden for longer periods such as bedsores, weakness and wasting of limbs, malnutrition, hospital acquired infections, DVT)

3) Mortality

CONSENT : 

I/WE, relative of the patient have read and understood the information provided in the patient information sheet and have been informed the purpose of the evaluation in the language I understand.

I am aware of the fact that I may not derive any benefit from the evaluation and that I deserve the right to opt out of the study at any point of time.

I willingly agree to participate in this study

Patients sign/thumb impression:                             witness sign/thumb impression

Name:                                                                            name:

Date:                                                                               date:

 

Residents sign:

Resident name:

date:

References : 

1) Shebl E, Mirabile VS, Sankari A, et al. Respiratory Failure. [Updated 2023 Feb 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526127/

2) Vallabhajosyula S, Kashani K, Dunlay SM, Vallabhajosyula S, Vallabhajosyula S, Sundaragiri PR, Gersh BJ, Jaffe AS, Barsness GW. Acute respiratory failure and mechanical ventilation in cardiogenic shock complicating acute myocardial infarction in the USA, 2000-2014. Ann Intensive Care. 2019 Aug 28;9(1):96. [PMC free article] 

3) Cummings MJ, Baldwin MR, Abrams D, Jacobson SD, Meyer BJ, Balough EM, Aaron JG, Claassen J, Rabbani LE, Hastie J, Hochman BR, Salazar-Schicchi J, Yip NH, Brodie D, O'Donnell MR. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet. 2020 Jun 06;395(10239):1763-1770. [PMC free article]

4) Ozsancak Ugurlu A, Habesoglu MA. Epidemiology of NIV for Acute Respiratory Failure in COPD Patients: Results from the International Surveys vs. the "Real World". COPD. 2017 Aug;14(4):429-438.