Dheeraj Gupta

Postgraduate Institute of Medical Education and Research | PGIMER · Department of Pulmonary Medicine

Methods: This is a prospective study of 27 sarcoidosis patients treated with systemic corticosteroids. Patients underwent two serial PET/CT scans: one before initiating therapy and the follow up scan at end of therapy. The metabolic response on PET scan was classified as: (a) complete metabolic response (CMR); (b) partial metabolic response (PMR);...

Background: It is not clear how well sarcoidosis-associated fatigue improves with definitive therapy. Objective: To evaluate improvement in fatigue in patients of sarcoidosis receiving oral corticosteroid therapy, and correlate it with clinical recovery and change in health-related quality of life (HRQL). Methods: We studied 51 newly diagnosed...

Background & objectives: Several patients with cancer in India are not aware of their diagnosis. We evaluated the impact of awareness of cancer diagnosis on health-related quality of life (HRQL) in newly diagnosed patients with lung cancer. Methods: A total of 391 treatment-naïve patients with lung cancer, seen at the Lung Cancer Clinic of a tertia...

Purpose: There is currently no single modality for accurate characterization of enlarged mediastinal lymph nodes into benign or malignant. Recently (18)F-fluorothymidine (FLT) has been used as a proliferation marker. In this prospective study, we examined the role of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography/computed tomogr...

The role of interferon-gamma release assays (IGRAs), although established for identifying latent tuberculosis, is still evolving in diagnosis of active extrapulmonary tuberculosis. We systematically evaluated the diagnostic performance of blood and pleural fluid based IGRAs in tuberculous pleural effusion (TPE). We searched PubMed and EmBase databa...

Abstract Background: A case-control study was conducted to study three VDR gene polymorphism, FokI, BsmI and TaqI, with Tuberculosis (TB)-susceptibility, treatment outcome, bacillary load and site of extrapulmonary TB. Methods: Three hundred and fifty seven TB patients and 392 healthy unrelated controls with no clinical symptoms or family history o...

Foreign body aspiration is an uncommon entity in adults. Herein, we describe our experience with flexible bronchoscopy in the removal of tracheobronchial foreign bodies in adults. We also conducted a systematic review of the literature on the topic of foreign body inhalation in adults managed with flexible bronchoscopy. The bronchoscopy database (f...

Due to its easy maneuverability, patient comfort and documented safety as an outpatient procedure, flexible bronchoscopy (FB) has replaced rigid bronchoscopy for routine diagnostic use. Herein, we report our 34-year experience with outpatient performance of FB. This was a retrospective analysis of all FB procedures performed between September 1979...

To assess the role of digital tomosynthesis (DTS) and dual energy subtraction digital radiography (DES-DR) in detection of parenchymal lesions in active pulmonary tuberculosis (TB) and to compare them with digital radiography (DR). This prospective study was approved by our institutional review committee. DTS and DES-DR were performed in 62 patient...

Endobronchial ultrasound (EBUS) is the preferred minimally invasive technique for the evaluation of intrathoracic lymphadenopathy. Enlarged lymph nodes on computed tomography (CT) are defined as those 1 cm or larger in short-axis diameter. Whether there is agreement between the measurements of lymph node size on CT and EBUS remains unknown. This wa...

Asthma is defined as a chronic inflammatory disorder of the airways which manifests itself as recurrent episodes of wheezing, breathlessness, chest tightness and cough. It is characterized by bronchial hyper-responsiveness and variable airflow obstruction, that is often reversible either spontaneously or with treatment. The prevalence of asthma in...

Medical thoracoscopy (MT) performed either with rigid or the semirigid thoracoscope has been shown to have diagnostic accuracy superior to closed-blind pleural biopsy (CBPB) in exudative pleural effusions (EPE), which remain undiagnosed after thoracentesis. However, in resource-constrained settings, CBPB continues to be performed. In this study, we...

The optimal concentration of lignocaine to be used during flexible bronchoscopy (FB) remains unknown. This randomized controlled trial compared the efficacy and safety of 1% and 2% lignocaine solution for topical anesthesia during FB. Consecutive patients were randomized to receive either 1% or 2% lignocaine solution through the bronchoscope by "sp...

Objective: Digital tomosynthesis (DT) and dual-energy subtraction digital radiography (DES-DR) are known to perform better than conventional radiography in the detection of pulmonary nodules. Yet the comparative diagnostic performances of DT, DES-DR and digital radiography (DR) is not known. The present study compares the diagnostic performances o...

We read with interest the review by Rintoul et al1 wherein the authors have summarised the usefulness of linear endobronchial ultrasound (EBUS) in a lucid manner. In the section on ‘Investigation of Suspected Sarcoidosis’, the authors state that the diagnostic yield to detect granulomas using endosonography (80%) is … [Full text of this article]

Pneumothorax (PTX) following flexible bronchoscopy (FB) and transbronchial lung biopsy (TBLB) occurs in 1% to 6% of cases. Chest radiography (CXR) is therefore routinely requested to detect PTX following TBLB. The objective of this study was to prospectively evaluate the accuracy of ultrasound (US) in the detection of post-TBLB PTX. Consecutive pat...

The use of endoscopic ultrasound with bronchoscope-guided fine-needle aspiration (EUS-B-FNA) has been described in the evaluation of mediastinal lymphadenopathy. Herein, we conduct a meta-analysis to estimate the overall diagnostic yield and safety of EUS-B-FNA combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBN...

Recent population prevalence estimates of pulmonary tuberculosis (PTB) are not available for several areas in India. We conducted a field-based population survey at a north Indian district to estimate point prevalence of bacteriologically positive PTB. A stratified cluster sampling design was used to conduct the survey in both urban and rural areas...

Several studies have reported the performance of combining endoscopic ultrasound fine-needle aspiration with an echobronchoscope (EUS-B-FNA), with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), for the diagnosis of mediastinal lymphadenopathy. Herein we report our initial experience with this technique. In this retros...

Bronchial asthma is an important public health problem in India with significant morbidity. Several international guidelines for diagnosis and management of asthma are available, however there is a need for country-specific guidelines due to vast differences in availability and affordability of health-care facilities across the globe. The Indian Ch...

The baseline clinical and demographic parameters are shown in Table 2. The pattern of FDG uptake in various lymph node groups of the body, percentage of patients with pulmonary parenchymal FDG positivity (sarcoidosis, 52.3%; TB, 44.8%), and patterns of FDG uptake in the lung parenchyma and by extrapulmonary organs (sarcoidosis, 40.9%; TB, 41.3%) we...

We compared levels of Th1/Th2/Th17 cytokines and T-regulatory cells in active and remitting granulomatosis with polyangiitis (GPA). Twenty-one cases of GPA in active state as well as in remitting state and 20 healthy controls (HC) were enrolled in the study. Cytokines were detected in culture supernatants of PBMCs after stimulation with proteinase-...

Introduction. Goodpasture's syndrome is a rare clinical entity and is characterized by circulating autoantibodies which are principally directed against the glomerular/alveolar basement membrane. The etiology of Goodpasture's syndrome is still unknown. Lung involvement occurs as a result of lung injury and the exposure of new epitopes to the immune...

AimThe present study is a proteomic approach to find differentially expressed proteins in sera of limited and systemic subsets of active disease versus their remitting state in patients with granulomatosis with polyangiitis (GPA) and their correlation with disease activity.Methods Eighteen patients with GPA in active as well as in remitting state a...

The need for an accurate, rapid, simple and affordable point-of-care (POC) test for Tuberculosis (TB) that can be implemented in microscopy centers and other peripheral health-care settings in the TB-endemic countries remains unmet. This manuscript describes preliminary results of a new prototype rapid lateral flow TB test based on detection of ant...

Mycobacterium tuberculosis (M. tb), an intracellular pathogen, has the ability to infect alveolar epithelial cells (AEC) also in addition to alveolar macrophages. The virulence of M. tb is attributed to proteins encoded by genomic regions of deletion (RD) and till date 16 such regions (RD1-RD16) have been identified. Culture filtrate protein 21 (CF...

Using the abbreviated World Health Organization Quality of Life (WHOQOL-Bref) questionnaire, we evaluated the effect of exposure to smoke from wood combustion while cooking on health-related quality of life (HRQL) in 85 women using wood and 85 women using liquefied petroleum gas (LPG) as cooking fuel in India. Age, years of cooking and hours spent...

Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the c...

SETTING Aspergillus complicates the course of healed pulmonary tuberculosis (PTB), causing aspergilloma and chronic pulmonary aspergillosis. Whether Aspergillus also causes allergic sensitisation in PTB-related fibrocavitary disease and bronchiectasis remains unknown. OBJECTIVE To investigate the prevalence of Aspergillus sensitisation in healed fi...

Background: The exact position of routine bronchoscopic sampling techniques in diagnostic workup of sarcoidosis is often debated. Herein, we ascertain the role of transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided TBNA (EBUS-TBNA), transbronchial lung biopsy (TBLB), and endobronchial biopsy (EBB) in diagnosis of sarcoidosis. M...

Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the c...

Background: There is no disease-specific instrument to describe health-related quality of life (HRQoL) in Indian patients with asthma. However, an abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-Bref), a generic Hindi HRQoL measure, has been developed and validated in India. Aims: To evaluate the WHOQOL-Bref in adult...

Adherence to the prescribed Anti-tuberculosis drug (ATD) treatment is crucial for curing patients with active TB. Anti-tuberculosis drug (ATD) induced hepatotoxicity (ATDH) may contribute to ATD’s poor compliance in patients with tuberculosis (TB) as interruption of treatment and the switch to second-line anti-tuberculosis drugs, which is required...

Rigid bronchoscopy is often an indispensable procedure in the therapeutic management of a wide variety of tracheobronchial disorders. However, it is performed at only a few centers in adult patients in India. Herein, we report our initial 1-year experience with this procedure. A prospective observational study on the indications, outcomes, and safe...

Background and Aims: Allergic bronchopulmonary aspergillosis (ABPA) is an immunological disorder caused by hypersensitivity against Aspergillus fumigatus. The pathogenesis of ABPA remains unknown. Few studies have investigated the role of environmental factors in pathogenesis of ABPA. Herein, we investigate the role of environmental factors in ABPA...

Endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) is superior to conventional TBNA (cTBNA) in the staging of lung cancer. However, its efficiency in diagnosis of sarcoidosis when combined with endobronchial (EBB) and transbronchial lung biopsies (TBLB) has not been studied. This randomized controlled trial compares diag...

The differential diagnosis of sarcoidosis and tuberculosis is difficult, especially in countries with a high tuberculosis burden. We hypothesized that sonographic features on endobronchial ultrasonography (EBUS) would help in differentiating tuberculosis from sarcoidosis. In this study, the endosonographic features of tuberculosis and sarcoidosis a...

Tuberculosis (TB) continues to be a major health problem due to lack of accurate, rapid, and cost-effective diagnostic tests. Serodiagnostic tests incorporating highly specific region of difference (RD) antigens (early secretory antigenic target 6 [ESAT-6], culture filtrate protein 10 [CFP-10], culture filtrate protein 21 [CFP-21], and mycobacteria...

Background:There is no disease-specific instrument to describe health-related quality of life (HRQoL) in Indian patients with asthma. However, an abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-Bref), a generic Hindi HRQoL measure, has been developed and validated in India.Aims:To evaluate the WHOQOL-Bref in adult patien...

To the Editor: Wing et al. (July 11 issue)(1) report that significant reductions in cardiovascular risk factors were achieved in the Look AHEAD (Action for Health in Diabetes) trial, yet no significant difference in clinical end points was evident. Table 1 of their article perhaps indicates the reason for this apparent discrepancy. More than 59% of...

Background: Sarcoidosis and tuberculosis closely resemble each other and Mycobacterium tuberculosis has been implicated as a causative agent for sarcoidosis. Herein we explore the socio-demographic features of patients with sarcoidosis vis-a-vis tuberculosis. Methodology: In a prospective case-control design, we studied hundred patients each of...

Letter to the editor.

Thoracoscopic pleural biopsy increases the diagnostic yield of pleural effusions undiagnosed after thoracentesis, and is superior to closed pleural biopsy. Medical thoracoscopy can be performed using the rigid thoracoscope or the semirigid thoracoscope (pleuroscope). In this randomized trial, we compare the efficacy and safety of the two thoracosco...

Background: The exact position of routine bronchoscopic sampling techniques in diagnostic workup of sarcoidosis is often debated. Herein, we ascertain the role of transbronchial needle aspiration (TBNA), endobronchial ultrasound-guided TBNA (EBUS-TBNA), transbronchial lung biopsy (TBLB), and endobronchial biopsy (EBB) in diagnosis of sarcoidosis....

Background and objectiveLow tidal volume ventilation has been shown to improve survival in acute respiratory distress syndrome (ARDS). Adaptive support ventilation (ASV), a closed-loop ventilatory mode, can minimize the work of breathing, and thus potentially improve the outcomes in ARDS. The aim of this pilot, randomized clinical trial was to comp...

The utility of semirigid thoracoscopy in undiagnosed exudative pleural effusions (EPE) has been variably reported in different studies. Herein, we perform a systematic review and meta-analysis to estimate the overall diagnostic yield and safety of semirigid thoracoscopy in EPE. We searched the PubMed and EmBase databases for studies reporting the o...

During intracellular residence in macrophages, mycobacterial lipids, namely phosphatidylinositol mannosides (PIM) and lipoarabinomannans, are expelled in the lung milieu to interact with host cells. PIM include a group of essential lipid components of Mycobacterium tuberculosis (M. tb) cell wall. Given that PIM function as mycobacterial adhesins fo...

Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus, manifesting with poorly controlled asthma, recurrent pulmonary infiltrates and bronchiectasis. There are estimated to be in excess of four million patients affected world-wide. The importance of recognizing ABPA...

Newly diagnosed pulmonary tuberculosis (PTB) patients starting treatment under the Revised National Tuberculosis Control Programme (RNTCP) in a North Indian city. To quantify impairment in health-related quality of life (HRQoL) of PTB patients at the time of diagnosis and during treatment, and to assess the utility of these assessments as a measure...

Chronic obstructive pulmonary disease (COPD) is a major public health problem in India. Although several International guidelines for diagnosis and management of COPD are available, yet there are lot of gaps in recognition and management of COPD in India due to vast differences in availability and affordability of healthcare facilities across the c...

The efficiency of various investigations and diagnostic criteria used in diagnosis of allergic bronchopulmonary aspergillosis (ABPA) remain unknown, primarily because of the lack of a gold standard. Latent class analysis (LCA) can provide estimates of sensitivity and specificity in absence of gold standard. Herein, we report the performance of vari...

Tables S1–S4. (DOC)

: Treatment options for central airway tumors include surgery, radiotherapy, and in those with inoperable or emergent airway obstruction, therapeutic bronchoscopy. Herein, we report our experience with the exclusive use of rigid bronchoscope in the management of central airway tumors. : Retrospective review of charts of patients who underwent rigid...

Fever is of grave concern in the management of patients with neutropenia with early detection of a focus of infection being the major goal. As lungs are the most common focus, chest imaging is of vital importance. This Institute Review Board approved prospective study was undertaken to assess the usefulness of high resolution computed tomography (H...

Patients with aspergilloma can be safely managed with supportive therapy in absence of massive haemoptysis. We hypothesised that chronic cavitary pulmonary aspergillosis (CCPA) could also be managed on similar grounds. The aim of this prospective, randomised controlled trial was to evaluate the efficacy and safety of itraconazole in CCPA. Consecuti...

Background Multidrug resistant (MDR) and extensively-drug resistant (XDR) tuberculosis (TB) are a serious threat to the national TB control programs of developing countries, and the situation is further worsened by the human immunodeficiency virus (HIV) pandemic. The literature regarding MDR/XDR-TB is, however, scanty from most parts of India. We c...

Eight operational locations for the Revised National Tuberculosis Control Programme in six Indian states. To assess the 6-month efficacy of an intermittent thrice-weekly directly observed treatment (DOT) regimen for tuberculous peripheral adenopathy and the need for prolongation of treatment to 9 months for non-resolution of lymphadenopathy. Patien...

A tertiary care hospital in North India. To analyse the frequency of mutations associated with resistance to rifampicin (RMP), isoniazid (INH) and streptomycin (SM) in Mycobacterium tuberculosis. M. tuberculosis isolates from 171 pulmonary tuberculosis (TB) patients (newly diagnosed 102, 59.6%; retreated 69, 40.3%) were analysed. Drug susceptibilit...

BACKGROUND: Flexible bronchoscopic procedures are currently the most often employed technique for demonstrating granulomatous inflammation in sarcoidosis. Conventional transbronchial needle aspiration (TBNA) has been used for over 3 decades; however, it remains an underutilized technique, primarily due to the wide variations in the reported success...

Letter to the editor.

Background: Flexible bronchoscopic procedures are currently the most often employed technique for demonstrating granulomatous inflammation in sarcoidosis. Conventional transbronchial needle aspiration (TBNA) has been used for over 3 decades; however, it remains an underutilized technique, primarily due to the wide variations in the reported succes...

Background: There are variable observations in published literature regarding smoking status and stage of lung cancer (LC) with positive, negative and no associations being reported. In particular, data regarding the association of quantified smoking status (QSS) with non-small cell lung cancer (NSCLC) stage at the time of diagnosis is limited. In...

: Postintubation tracheal stenosis (PITS) is a common problem encountered by interventional pulmonologists. The aim of this study was to evaluate the utility of mitomycin C (MMC) as an adjunctive treatment to rigid bronchoscopic dilatation in patients with PITS. : Prospective analysis of data from the interventional pulmonology unit of a large tert...

Hemophagocytic lymphohistiocytosis (HLH) has been reported to complicate fulminant tropical infections but data on severe HLH with multi-organ dysfunction (MODS) are scant. Retrospective review of medical electronic records of our intensive care unit (ICU) over a 2-year period. We describe 10 adult patients with HLH and MODS. Patients had short sym...

SESSION TYPE: Hot Topics in Respiratory & Critical CarePRESENTED ON: Tuesday, October 23, 2012, 2012 at 04:30 PM - 05:45 PMPURPOSE: Smoke from combustion of biomass cooking fuels is a major source of household indoor air pollution in India. Although health hazards related to such exposure are well-recognized, its effect on people's perceived health...

Field sites in 12 districts in different parts of India. To determine the nationwide population prevalence of and risk factors for asthma and chronic bronchitis (CB) in adults. A standardised validated questionnaire based on the International Union Against Tuberculosis and Lung Disease's 1984 questionnaire was used to assess asthma and CB prevalenc...

This study was carried out to evaluate high-resolution melting (HRM) curve analysis assay for detection of mutations in three drug resistance-associated genes of Mycobacterium tuberculosis. Clinical isolates of Myco. tuberculosis phenotypically resistant to rifampicin (n = 29), isoniazid (n = 35) and streptomycin (n = 34) were analysed for mutation...

Ever since sarcoidosis was first described, its relationship with tuberculosis has been debated. Whereas some consider sarcoidosis and tuberculosis as two extremes of the same disease process, other researchers have negated the role of mycobacteria in causation of sarcoidosis. Whether or not linked causally, there are obvious clinical similarities...

To investigate the chest radiographic and high resolution computed tomography (HRCT) chest manifestations in glucocorticoid-naïve allergic bronchopulmonary aspergillosis (ABPA) patients. This is a prospective observational study and includes 60 consecutive glucocorticoid-naïve patients with ABPA who underwent chest radiography and HRCT of the chest...

Drug resistant tuberculosis (TB) is an increasing problem worldwide. We retrospectively identified Mycobacterium tuberculosis isolates from treatment failure pulmonary TB (362), and extrapulmonary TB (338) patients (18-70 years) during a 4 year period (June, 2002-July, 2006). Drug susceptibility testing was carried out for the first line anti-tuber...

The association between allergic bronchopulmonary aspergillosis (ABPA) and aspergilloma has been proposed as a severe form of ABPA. However, this conclusion is based on single-patient case reports. In this study, we describe the clinical details and immunological findings of this association and compare patients of ABPA with aspergilloma and those...

ABPA is radiologically classified on the presence or absence of central bronchiectasis (CB) as ABPA-CB and serologic ABPA (ABPA-S) respectively. Few studies have described the follow-up of patients with ABPA-S. The aim of this retrospective study was to describe the outcomes of ABPA-S. Patients were diagnosed as ABPA-S if they met all the following...

Background: Fiberoptic bronchoscopy and lung biopsy are important diagnostic tools in patients with diffuse pulmonary infiltrates. However, these patients often have hypoxemic respiratory failure that makes this procedure hazardous. Noninvasive ventilation (NIV) has been shown to improve oxygenation in hypoxemic patients. Objective: To report th...

Real-time endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for diagnosis of mediastinal lymphadenopathy. Although most studies have reported the utility of EBUS-TBNA in malignancy, its use has been extended to benign conditions including sarcoidosis. Herein, we perform a systematic revie...

Chemical pleurodesis is an accepted therapy for patients with recurrent pleural effusions and pneumothorax. Iodopovidone has been shown to be safe and effective for chemical pleurodesis in several studies. The aim of this systematic review was to update a previously reported meta-analysis on the efficacy and safety of iodopovidone pleurodesis. Two...

There is paucity of data from India on the use of noninvasive ventilation (NIV) in acute respiratory failure (ARF). In this observational study, we report the indications and outcomes of patients requiring NIV in the respiratory ICU of a tertiary care hospital. All patients with ARF requiring NIV were included in the study. NIV was delivered throug...

Objective To study the role of Interferon gamma release assay (IGRA) (QuantiFERON–TB Gold In Tube) in blood in the diagnostic work up of active tuberculosis (TB) in a high TB prevalence region. Design Prospective, comparative group study. Setting Subjects presenting to the services of the Pulmonary Medicine Department of a large tertiary care teach...

Several studies have reported the influence of genetic variations on susceptibility to tuberculosis (TB). Polymorphism in P2X7 gene coding for P2X7 receptor present on macrophages has been linked to TB in different populations. To assess the role of P2X7 gene -762T/C and -1513A/C polymorphisms in TB susceptibility. In a case-control study, polymera...

Benign endobronchial tumors are uncommon. Bronchoscopic removal is the preferred modality of treatment although surgery may be required in some cases. Rigid bronchoscopy is usually recommended in the management of these tumors. However, flexible bronchoscopy is also used in many centers. We present a case of endobronchial lipoma, where an unusual c...

Mannose-binding lectin (MBL) plays an important role in innate immunity. The effect of low MBL levels producing variants of MBL2 gene on tuberculosis (TB) has been controversial with some studies reporting it to confer protection against the disease, whereas others estimating a susceptibility relation. Other than conducting a case-control study to...

Currently, there is not a uniform consensus regarding the number of criteria or specific cut-off values for the variety of tests that are used to diagnose allergic bronchopulmonary aspergillosis (ABPA). Traditionally, an eosinophil count >1000 cells/μl is considered an important criterion in the diagnosis of ABPA. The goal of this study was to deli...

Summary  There is a biological plausibility on the link between cystic fibrosis transmembrane conductance regulator (CFTR) mutations and allergic bronchopulmonary aspergillosis (ABPA). The aim of the systematic review was to investigate this link by determining the frequency of CFTR mutations in ABPA. We searched the PubMed and EmBase databases for...

Allergic bronchopulmonary aspergillosis (ABPA) is the best-known allergic manifestation of Aspergillus-related hypersensitivity pulmonary disorders. Most patients present with poorly controlled asthma, and the diagnosis can be made on the basis of a combination of clinical, immunological, and radiological findings. The chest radiographic findings a...

PURPOSE: Fiberoptic bronchoscopy (FOB) and lung biopsy is an important diagnostic tool in patients with diffuse pulmonary infiltrates. However, these patients often have hypoxemic respiratory failure which makes the procedure risky. Noninvasive positive pressure ventilation (NIPPV) improves oxygenation in hypoxemic patients. We report the efficacy...