Browsing by Author "Nikhil Sarangdhar"

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Indian Guidelines on Nebulization Therapy
(Tuberculosis Association of India, 2022) S.K. Katiyar; S.N. Gaur; R.N. Solanki; Nikhil Sarangdhar; J.C. Suri; Raj Kumar; G.C. Khilnani; Dhruva Chaudhary; Rupak Singla; Parvaiz A. Koul; Ashok A. Mahashur; A.G. Ghoshal; D. Behera; D.J. Christopher; Deepak Talwar; Dhiman Ganguly; H. Paramesh; K.B. Gupta; Mohan Kumar T; P.D. Motiani; P.S. Shankar; Rajesh Chawla; Randeep Guleria; S.K. Jindal; S.K. Luhadia; V.K. Arora; V.K. Vijayan; Abhishek Faye; Aditya Jindal; Amit K. Murar; Anand Jaiswal; Arunachalam M; A.K. Janmeja; Brijesh Prajapat; C. Ravindran; Debajyoti Bhattacharyya; George D'Souza; Inderpaul Singh Sehgal; J.K. Samaria; Jogesh Sarma; Lalit Singh; M.K. Sen; Mahendra K. Bainara; Mansi Gupta; Nilkanth T. Awad; Narayan Mishra; Naveed N. Shah; Neetu Jain; Prasanta R. Mohapatra; Parul Mrigpuri; Pawan Tiwari; R. Narasimhan; R. Vijai Kumar; Rajendra Prasad; Rajesh Swarnakar; Rakesh K. Chawla; Rohit Kumar; S. Chakrabarti; Sandeep Katiyar; Saurabh Mittal; Sonam Spalgais; Subhadeep Saha; Surya Kant; V.K. Singh; Vijay Hadda; Vikas Kumar; Virendra Singh; Vishal Chopra; Visweswaran B
Inhalational therapy, today, happens to be the mainstay of treatment in obstructive airway diseases (OADs), such as asthma, chronic obstructive pulmonary disease (COPD), and is also in the present, used in a variety of other pulmonary and even non-pulmonary disorders. Hand-held inhalation devices may often be difficult to use, particularly for children, elderly, debilitated or distressed patients. Nebulization therapy emerges as a good option in these cases besides being useful in the home care, emergency room and critical care settings. With so many advancements taking place in nebulizer technology; availability of a plethora of drug formulations for its use, and the widening scope of this therapy; medical practitioners, respiratory therapists, and other health care personnel face the challenge of choosing appropriate inhalation devices and drug formulations, besides their rational application and use in different clinical situations. Adequate maintenance of nebulizer equipment including their disinfection and storage are the other relevant issues requiring guidance. Injudicious and improper use of nebulizers and their poor maintenance can sometimes lead to serious health hazards, nosocomial infections, transmission of infection, and other adverse outcomes. Thus, it is imperative to have a proper national guideline on nebulization practices to bridge the knowledge gaps amongst various health care personnel involved in this practice. It will also serve as an educational and scientific resource for healthcare professionals, as well as promote future research by identifying neglected and ignored areas in this field. Such comprehensive guidelines on this subject have not been available in the country and the only available proper international guidelines were released in 1997 which have not been updated for a noticeably long period of over two decades, though many changes and advancements have taken place in this technology in the recent past. Much of nebulization practices in the present may not be evidence-based and even some of these, the way they are currently used, may be ineffective or even harmful. Recognizing the knowledge deficit and paucity of guidelines on the usage of nebulizers in various settings such as inpatient, out-patient, emergency room, critical care, and domiciliary use in India in a wide variety of indications to standardize nebulization practices and to address many other related issues; National College of Chest Physicians (India), commissioned a National task force consisting of eminent experts in the field of Pulmonary Medicine from different backgrounds and different parts of the country to review the available evidence from the medical literature on the scientific principles and clinical practices of nebulization therapy and to formulate evidence-based guidelines on it. The guideline is based on all possible literature that could be explored with the best available evidence and incorporating expert opinions. To support the guideline with high-quality evidence, a systematic search of the electronic databases was performed to identify the relevant studies, position papers, consensus reports, and recommendations published. Rating of the level of the quality of evidence and the strength of recommendation was done using the GRADE system. Six topics were identified, each given to one group of experts comprising of advisors, chairpersons, convenor and members, and such six groups (A-F) were formed and the consensus recommendations of each group was included as a section in the guidelines (Sections I to VI). The topics included were: A. Introduction, basic principles and technical aspects of nebulization, types of equipment, their choice, use, and maintenance B. Nebulization therapy in obstructive airway diseases C. Nebulization therapy in the intensive care unit D. Use of various drugs (other than bronchodilators and inhaled corticosteroids) by nebulized route and miscellaneous uses of nebulization therapy E. Domiciliary/Home/Maintenance nebulization therapy; public & health care workers education, and F. Nebulization therapy in COVID-19 pandemic and in patients of other contagious viral respiratory infections (included later considering the crisis created due to COVID-19 pandemic). Various issues in different sections have been discussed in the form of questions, followed by point-wise evidence statements based on the existing knowledge, and recommendations have been formulated. © 2022 Tuberculosis Association of India
NCCP-ICS joint consensus-based clinical practice guidelines on medical thoracoscopy
(Wolters Kluwer Medknow Publications, 2024) Rakesh K. Chawla; Mahendra Kumar; Arun Madan; Raja Dhar; Richa Gupta; Dipti Gothi; Unnati Desai; Manoj Goel; Rajesh Swarankar; Amita Nene; Radha Munje; Dhruv Chaudhary; Randeep Guleria; Vijay Hadda; Vivek Nangia; Girish Sindhwani; Rajesh Chawla; Naveen Dutt; Yuvarajan; Sonia Dalal; Shailendra Nath Gaur; Subodh Katiyar; Jai Kumar Samaria; K.B. Gupta; Parvaiz A. Koul; Suryakant; D.J. Christopher; Dhrubajyoti Roy; Basant Hazarika; Shanti Kumar Luhadia; Anand Jaiswal; Karan Madan; Prem Parkash Gupta; B.N.B.M. Prashad; Nasser Yusuf; Prince James; Amit Dhamija; Veerotam Tomar; Ujjwal Parakh; Ajmal Khan; Rakesh Garg; Sheetu Singh; Vinod Joshi; Nikhil Sarangdhar; Sushmita Roy Chaudhary; Sandeep Nayar; Anand Patel; Mansi Gupta; Rama Kant Dixit; Sushil Jain; Pratibha Gogia; Manish Agarwal; Sandeep Katiyar; Aditya Chawla; Hari Kishan Gonuguntala; Ravi Dosi; Vijya Chinnamchetty; Apar Jindal; Shubham Sharma; Vaibhav Chachra; Utsav Samaria; Avinash Nair; Shruti Mohan; Gargi Maitra; Ashish Sinha; Rishabh Kochar; Ajit Yadav; Gaurav Choudhary; M. Arunachalam; Amith Rangarajan; Ganesh Sanjan
Medical Thoracoscopy (MT) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. The aim of the study was to provide evidence-based information regarding all aspects of MT, both as a diagnostic tool and therapeutic aid for pulmonologists across India. The consensus-based guidelines were formulated based on a multistep process using a set of 31 questions. A systematic search of published randomized controlled clinical trials, open labelled studies, case reports and guidelines from electronic databases, like PubMed, EmBase and Cochrane, was performed. The modified grade system was used (1, 2, 3 or usual practice point) to classify the quality of available evidence. Then, a multitude of factors were taken into account, such as volume of evidence, applicability and practicality for implementation to the target population and then strength of recommendation was finalized. MT helps to improve diagnosis and patient management, with reduced risk of post procedure complications. Trainees should perform at least 20 medical thoracoscopy procedures. The diagnostic yield of both rigid and semirigid techniques is comparable. Sterile-graded talc is the ideal agent for chemical pleurodesis. The consensus statement will help pulmonologists to adopt best evidence-based practices during MT for diagnostic and therapeutic purposes. © 2024 Indian Chest Society.
Pleural effusion guidelines from ICS and NCCP Section 1: Basic principles, laboratory tests and pleural procedures
(Wolters Kluwer Medknow Publications, 2024) Devasahayam J. Christopher; Richa Gupta; Balamugesh Thangakunam; Jefferson Daniel; Surinder K. Jindal; Surya Kant; Prashant N. Chhajed; K.B. Gupta; Sahajal Dhooria; Sudhir Chaudhri; Dhruva Chaudhry; Dharmesh Patel; Ravindra Mehta; Rakesh K. Chawla; Arjun Srinivasan; Arvind Kumar; Shakti K. Bal; Prince James; Jebin S Roger; Avinash A. Nair; S.K. Katiyar; Ritesh Agarwal; Raja Dhar; Ashutosh N. Aggarwal; J.K. Samaria; Digambar Behera; Karan Madan; Raj B Singh; S.K. Luhadia; Nikhil Sarangdhar; George D' Souza; Amita Nene; Akhil Paul; Vimi Varghese; T.V. Rajagopal; M. Arun; Shraddha Nair; Dhivya A Roy; Benjamin E. Williams; Shona A. Christopher; Dhanawade V. Subodh; Nishant Sinha; Barney Isaac; Ashwin A. Oliver; N. Priya; Jedidiah Deva; Sujith T. Chandy; Richu Bob Kurien
Pleural effusion is a common problem in our country, and most of these patients need invasive tests as they can't be evaluated by blood tests alone. The simplest of them is diagnostic pleural aspiration, and diagnostic techniques such as medical thoracoscopy are being performed more frequently than ever before. However, most physicians in India treat pleural effusion empirically, leading to delays in diagnosis, misdiagnosis and complications from wrong treatments. This situation must change, and the adoption of evidence-based protocols is urgently needed. Furthermore, the spectrum of pleural disease in India is different from that in the West, and yet Western guidelines and algorithms are used by Indian physicians. Therefore, India-specific consensus guidelines are needed. To fulfil this need, the Indian Chest Society and the National College of Chest Physicians; the premier societies for pulmonary physicians came together to create this National guideline. This document aims to provide evidence based recommendations on basic principles, initial assessment, diagnostic modalities and management of pleural effusions. © The Author(s) 2024.