Prevalence and characteristics of venous thromboembolism in severe exacerbation of chronic obstructive pulmonary disease in a tertiary care hospital in India.

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) carries a high risk of venous thromboembolism (VTE). Pulmonary embolism (PE) and AECOPD increase the mortality and morbidity risk associated with each other. Racial and ethnic differences in VTE risk have been documented in multiple studies. However, there is a dearth of reliable Indian data on the same. This study was planned to find the prevalence of VTE in the setting of severe AECOPD in a tertiary care hospital in India and to identify the clinical, laboratory and radiological characteristics of VTE in severe AECOPD. A total of 156 consecutive patients admitted with severe AECOPD and meeting the specified inclusion and exclusion criteria were recruited. Thorough workup of all patients was done including ABG, serum D dimer, ECG, compression ultrasound of lower limbs and 2-D echocardiography. Patients with high pre-test probability score, or intermediate pre-test probability score at presentation with serum D dimer above the age adjusted cut-off underwent computerised tomography pulmonary angiography (CTPA).  Results were analysed using SPSS version 23.  Sixteen (10.3%) patients had VTE, 15 (93.75%) of them being cases of isolated PE. Female gender, higher cumulative past exposure to corticosteroid, higher alveolar-arterial gradient, right ventricular dysfunction, and higher mean pulmonary artery pressure were associated with increased risk for VTE. The prevalence of VTE in AECOPD in this study among an Indian population is higher than among other Asians, but lower than among the Blacks, the Caucasians and the Middle-East ethnicities. Since a vast majority of VTE presents as PE without DVT in the setting of AECOPD, the absence of deep vein thrombosis of lower limbs does not rule PE in the setting.

Bronchoscopic Cryotherapy for Acute Hypoxemic Respiratory Failure in Three Mechanically Ventilated Patients: A Case Series.

Endobronchial blood clots or mucus plugs can present with minimal symptoms or acute airway obstruction in the intensive care unit (ICU) patients. Acute airway obstruction can lead to rapid worsening of dyspnea owing to poor oxygenation due to collapse of the lung. Prompt recognition and treatment of this condition can translate into a successful outcome by decreasing morbidity and mortality and facilitating successful weaning of these patients. When conventional methods fail to relieve the obstruction, cryoextraction a novel technique, may prove to be a useful alternative for the removal of these clots and mucus plugs. Cryoextraction is best performed with rigid bronchoscopic intubation. However, in certain conditions, it may be used with a flexible fiberoptic bronchoscope (FOB) through an endotracheal tube, especially when bedside procedure is required in ICU patients. In this series, three cases are being discussed where bedside flexible bronchoscopy-guided cryoextraction was done leading to a successful resolution of acute hypoxemic respiratory failure. How to cite this article: Tale S, Meitei SP, Prakash V, Negi A, Mishra M, Sindhwani G. Bronchoscopic Cryotherapy for Acute Hypoxemic Respiratory Failure in Three Mechanically Ventilated Patients: A Case Series. Indian J Crit Care Med 2021;25(1):94-96.