Suveer Singh

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Verified

Suveer verified their affiliation via an institutional email.

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• BSc,MBBS,PhD,EDIC,DICM,FHEA,FFICM,FRCP
• Professor at Imperial College London

Background Artificial intelligence (AI) systems have been implemented to improve the diagnostic yield and operators’ skills within endoscopy. Similar AI systems are now emerging in bronchoscopy. Our objective was to identify and describe AI systems in bronchoscopy. Methods A systematic review was performed using MEDLINE, Embase and Scopus database...

Objectives Bronchoscopy in the mechanically ventilated patient is an important skill for critical-care physicians. However, training opportunity is heterogenous and limited by infrequent caseload or inadequate instructor feedback for satisfactory competencies. A new artificial intelligence (AI) navigational system using augmented reality – the Ambu...

INHALE investigated the impact of seeking pathogens by PCR on antibiotic stewardship and clinical outcomes in hospital-acquired and ventilator-associated pneumonia (HAP and VAP). This pragmatic multicentre, open-label RCT enrolled adults and children with suspected HAP and VAP at 14 ICUs. Patients were randomly allocated to standard of care, or rap...

Objectives Intensive care unit (ICU) clinicians stop antibiotics more often, with a negative infection: point-of-care test (PCR-POCT). Simulated cases of diagnostic uncertainty regarding infection resolution led clinicians to choose options such as procalcitonin (PCT) and/or PCR-POCTs +/− de-escalation to aid stop decisions. We hypothesised that a...

This study investigated the clinical and physiological response to use of the BEACON Caresystem, a bedside open-loop decision support system providing advice to guide clinicians when weaning patients from invasive mechanical ventilation. Multicenter prospective study conducted in five adult intensive care units in the UK. Following screening and as...

Introduction: Simulation-based training has proven effective for learning flexible bronchoscopy. However, no studies have tested the efficacy of training toward established proficiency criteria, i.e., mastery learning (ML). We wish to test the effectiveness of ML compared to directed self-regulated learning (DSRL) on novice bronchoscopists' end-of...

Rationale Flexible bronchoscopy is an operator dependent procedure. An automatic bronchial identification system based on artificial intelligence (AI) could help bronchoscopists to perform more complete and structured procedures through automatic guidance. Methods 101 participants were included from six different continents at the European Respira...

Background: Lymphoma patients may require intensive care (ICU) due to disease- or treatment-related complications. The lymphoma-HIV interaction complicates management, but whether outcomes are worse in these patients, when critically ill, is unclear. A retrospective observational cohort study reviewed outcomes of patients admitted to ICU, subseque...

Background and objective High-dose intravenous pulsed glucocorticosteroids (GCS) are not part of the standard treatment in acute respiratory distress syndrome (ARDS), and the evidence supporting their use is conflicting. In clinical practice, however, they are used in specialist settings when clinico-patho-radiological features suggest a potentiall...

Background Burn inhalation injury (BII) is a major cause of burn-related mortality and morbidity. Despite published practice guidelines, no consensus exists for the best strategies regarding diagnosis and management of BII. A modified DELPHI study using the RAND/UCLA (University of California, Los Angeles) Appropriateness Method (RAM) systematicall...

Objectives Point-of-care tests (POCTs) for infection offer accurate rapid diagnostics but do not consistently improve antibiotic stewardship (ASP) of suspected ventilator-associated pneumonia. We aimed to measure the effect of a negative PCR-POCT result on intensive care unit (ICU) clinicians’ antibiotic decisions and the additional effects of pati...

Background Molecular diagnostic tests may improve antibiotic prescribing by enabling earlier tailoring of antimicrobial therapy. However, clinicians’ trust and acceptance of these tests will determine their application in practice. Objectives To examine ICU prescribers’ views on the application of molecular diagnostics in patients with suspected h...

Respiratory critical care is central to modern intensive care medicine. A working knowledge of specific lung conditions and syndromes, their pathophysiological basis, and up-to-date management strategies define effective multi-disciplinary support. The Oxford Textbook of Respiratory Critical Care provides the reader with evidence-based, contemporar...

Respiratory critical care is central to modern intensive care medicine. A working knowledge of specific lung conditions and syndromes, their pathophysiological basis, and up-to-date management strategies define effective multi-disciplinary support. The Oxford Textbook of Respiratory Critical Care provides the reader with evidence-based, contemporar...

Respiratory critical care is central to modern intensive care medicine. A working knowledge of specific lung conditions and syndromes, their pathophysiological basis, and up-to-date management strategies define effective multi-disciplinary support. The Oxford Textbook of Respiratory Critical Care provides the reader with evidence-based, contemporar...

Respiratory critical care is central to modern intensive care medicine. A working knowledge of specific lung conditions and syndromes, their pathophysiological basis, and up-to-date management strategies define effective multi-disciplinary support. The Oxford Textbook of Respiratory Critical Care provides the reader with evidence-based, contemporar...

Respiratory critical care is central to modern intensive care medicine. A working knowledge of specific lung conditions and syndromes, their pathophysiological basis, and up-to-date management strategies define effective multi-disciplinary support. The Oxford Textbook of Respiratory Critical Care provides the reader with evidence-based, contemporar...

Acute lung injury in COVID-19 results in diffuse alveolar damage with disruption of the alveolar-capillary barrier, coagulation activation, alveolar fibrin deposition and pulmonary capillary thrombi. Nebulized recombinant tissue plasminogen activator (rt-PA) has the potential to facilitate localized thrombolysis in the alveolar compartment and impr...

Background Point of Care Tests (POCTs) offer accurate rapid diagnostics for infections but have not improved antibiotic-free-days. This has been attributed to clinician prescribing behaviour rather than test performance. Hypothesising experience to influence prescribing behaviour, we compared the effect of POCT-use on antibiotic decision-making amo...

DOI: 10.1111/tct.13657

Nebulized thrombolysis offers locally targeted therapy with potentially lower bleeding risk than systemic administration for coronavirus disease 2019 (COVID-19) respiratory failure. In a proof-of-concept safety study, adult patients with COVID-19-induced respiratory failure and a <300mmHg PaO2/FiO2 (P/F) ratio, requiring invasive mechanical ventila...

Objectives: Early studies of venovenous extracorporeal membrane oxygenation (ECMO) in COVID-19 have revealed similar outcomes to historical cohorts. Changes in the disease and treatments have led to differences in the patients supported on venovenous ECMO in the first and second waves. We aimed to compare these two groups in both the acute and fol...

A 30-year-old woman was admitted with fever, lethargy, diarrhoeal illness, arthromyalgia, rash and weight loss over a few weeks. Laboratory results showed pancytopenia (neutrophils 0.4×10 9 , Hb 80, Plt 82), LDH 2500, creatine kinase 2800, ferritin >17 000, ESR >50, positive anti-dsDNA, anti-Ro, anti-La and low serum complement (C3 and C4). Systemi...

Background Bronchoscopy is a challenging technical procedure, and assessment of competence currently relies on expert raters. Human rating is time consuming and prone to rater bias. The aim of this study was to evaluate if a bronchial segment identification system based on artificial intelligence (AI) could automatically, instantly, and objectively...

In situ pulmonary arterial thrombosis in COVID-19 is not visible on CTPA. However, the presence of CT-measured right heart and pulmonary artery dilatation in COVID-19 is likely attributable to this process and may be a possible surrogate for its detection. https://bit.ly/3g7z5TV.

Background The FilmArray Pneumonia Panel (bioMérieux) is a rapid multiplex PCR aiming to increase speed and sensitivity in the microbiological diagnosis of pneumonia. This offers potential for improved antimicrobial stewardship and evidence-based antibiotic prescribing. Whether such gains can be realised in practise is uncertain, thus, we conducted...

Background Patients presenting with acute hypercapnic respiratory failure due to exacerbations of chronic obstructive pulmonary disease (AECOPD) are typically managed with non-invasive ventilation (NIV). The impact of low-flow extracorporeal carbon dioxide removal (ECCO 2 R) on outcome in these patients has not been explored in randomised trials....

Interstitial lung disease and associated fibrosis occur in a proportion of individuals who have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection through unknown mechanisms. We studied individuals with severe coronavirus disease 2019 (COVID-19) after recovery from acute illness. Individuals with evidence of inter...

Background: Antimicrobial overuse causes increased antimicrobial resistance in ICUs; antimicrobial stewardship programmes (ASPs) aim to optimize usage. Following an MDR Acinetobacter baumannii (MRAb) outbreak in 2008, an ASP was implemented at a London ICU, and then continued as a long-term programme. This study aimed to determine long-term change...

A novel iodine perfusion score correlates with breathlessness and D LCO in patients post-#COVID19 without obvious interstitial disease on CT, suggesting that lung perfusion assessment may be useful in patients without another cause of dyspnoea https://bit.ly/3U6E2f5.

A 30-year-old woman was admitted with fever, lethargy, diarrhoeal illness, arthromyalgia, rash and weight loss over a few weeks. Laboratory results showed pancytopenia (neutrophils 0.4×10 9 , Hb 80, Plt 82), LDH 2500, creatine kinase 2800, ferritin >17 000, ESR >50, positive anti-dsDNA, anti-Ro, anti-La and low serum complement (C3 and C4). Systemi...

INTRODUCTION: Rapid Point of Care Tests for infection (POCT) do not consistently improve antibiotic stewardship (ASP) of suspected ICU infection. We measured 1) the effect of a negative PCR-POCT on antibiotic stop decisions, and 2) clinico-behavioural factors that prevent stopping. METHODS: Vignettes of antibiotic treated respiratory infection, wit...

Background Early studies of veno-venous extracorporeal membrane oxygenation (VV-ECMO) in COVID-19 have revealed similar outcomes to historical cohorts. Changes in the disease and treatments has led to differences in the patients supported on VV-ECMO in the 1st and 2nd waves. We aimed to compare these two groups in both the acute and follow-up phase...

Persistent interstitial lung changes with associated symptoms occur in a proportion of individuals that have recovered from severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) infection through unknown mechanisms. We studied individuals with severe COVID-19 longitudinally following recovery from acute illness. Subjects with interstitial lu...

Purpose To describe the incidence of pulmonary artery thrombosis in COVID-19 versus influenza pneumonia using CT angiography and to assess whether it may increase the risk of pulmonary hypertension. Materials and Methods Single and dual energy CT pulmonary angiography of age- and gender-matched patients with influenza and COVID-19 pneumonia, refer...

Introduction Burns inhalation injury (BII) increases the attributable mortality of burns related trauma. However, diagnostic uncertainties around bronchoscopically graded severity, and its effect on outcomes, remain. This study evaluated the impact of different bronchoscopic BII grades on outcomes. Methods A single-centre cohort study of all patie...

Background: Panton-Valentine leukocidin (PVL) is an exotoxin secreted by Staphylococcus aureus (S. aureus), responsible for skin and soft tissue infections. As a cause of severe necrotising pneumonia, it is associated with a high mortality rate. A rare entity, the epidemiology of PVL S. aureus (PVL-SA) pneumonia as a complication of influenza coin...

Background Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians’ endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device...

Aims Right ventricular (RV) strain is a known predictor of outcomes in various heart and lung pathologies but has been considered too technically challenging for routine use in critical care. We examined whether RV strain acquired from the subcostal view, frequently more accessible in the critically ill, is an alternative to conventionally derived...

A significant proportion of patients with COVID-19 develop acute respiratory distress syndrome (ARDS) with high risk of death. The efficacy of veno-venous extra-corporeal membrane oxygenation (VV-ECMO) for COVID-19 on longer term outcomes, unlike in other viral pneumonias, is unknown. In this study we aimed to compare the 6-month mortality of patie...

Abstract Background Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Methods Using a Delphi process, an international pane...

Introduction COVID-19 mortality rates are high, particularly in patients requiring invasive ventilatory support, developing a cytokine storm, or experiencing thromboembolic disease. Our goal was to determine if traffic-light driven, personalised care was associated with improved survival in acute hospital settings. Methods Outcomes were evaluated...

Background: Bronchoscopic sampling of bronchoalveolar fluid (BAL) should be safe and effective. Current sampling practice risks loss of sample to the attached negative flow, aerosolisation, or spillage, due to repeated circuit breaks, when replacing sample containers. Such concerns were highlighted during the recent coronavirus pandemic. Objectiv...

Objectives: Severe coronavirus disease 2019 is associated with an extensive pneumonitis and frequent coagulopathy. We sought the true prevalence of thrombotic complications in critically ill patients with severe coronavirus disease 2019 on the ICU, with or without extracorporeal membrane oxygenation. Design: We undertook a single-center, retrosp...

Veno-Venous Extracorporeal Membrane Oxygenation (VV-ECMO) provides a bridge to recovery in patients with acute respiratory failure due to the acute respiratory distress syndrome (ARDS). Survival in ARDS has improved over 15 years, and VV-ECMO may rescue even the most severe of these patients. Predictors of survival on ICU are based upon the princip...

Abstract Background: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Methods: Using a Delphi process, an international p...

Background Corona Virus Disease 2019 (COVID-19) pneumonitis associated with severe respiratory failure carries a high mortality. Coagulopathy has emerged as a significant contributor to thrombotic complications. Case summary We describe two cases of severe COVID-19 pneumonitis refractory to conventional mechanical ventilation and proning position,...

Background: Leptospirosis is a potentially fatal zoonosis. It can cause a wide range of symptoms, including diffuse alveolar haemorrhage which occurs in a minority of cases but carries a mortality of over 70%. These patients may present with severe acute respiratory failure. The differential diagnosis for diffuse alveolar haemorrhage is broad wher...

Despite advances in the pathophysiology of Chronic Obstructive Pulmonary Disease (COPD), there is a distinct lack of biochemical markers to aid clinical management. Microvesicles (MVs) have been implicated in the pathophysiology of inflammatory diseases including COPD but their association to COPD disease severity remains unknown. We analysed diffe...

Aims Comprehensive echocardiography assessment of right ventricular (RV) impairment has not been reported in critically ill patients with COVID-19. We detail the specific phenotype and clinical associations of RV impairment in COVID-19 acute respiratory distress syndrome (ARDS). Methods Transthoracic echocardiography (TTE) measures of RV function...

Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression....

Introduction Automated systems for ventilator management to date have been either fully heuristic rule-based systems or based on a combination of simple physiological models and rules. These have been shown to reduce the duration of mechanical ventilation in simple to wean patients. At present, there are no published studies that evaluate the effec...

Studies conducted in people living with HIV (PLHIV) report high rates of sleep disturbance, without a clear explanation as to cause or effect. Therefore, we proposed use of multiple validated questionnaires that would allow a more comprehensive evaluation of sleep quality in PLHIV. We administered eight validated sleep and wellbeing questionnaires,...

Background UK data suggest 6% of COVID-19 hospital admissions are either currently pregnant or immediately post-partum. However, the current literature suggests that if COVID-19 occurs in pregnancy, or post-partum, symptoms are mostly mild. Methods All COVID-19 admissions to one acute London National Health Service Foundation trust were reviewed s...

Rationale: Clinical and epidemiologic data in coronavirus disease (COVID-19) have accrued rapidly since the outbreak, but few address the underlying pathophysiology. Objectives: To ascertain the physiologic, hematologic, and imaging basis of lung injury in severe COVID-19 pneumonia. Methods: Clinical, physiologic, and laboratory data were collated....

Introduction. Several viral respiratory infections - notably influenza - are associated with secondary bacterial infection and additional pathology. The extent to which this applies for COVID-19 is unknown. Accordingly, we aimed to define the bacteria causing secondary pneumonias in COVID-19 ICU patients using the FilmArray Pneumonia Panel, and to...

Outcomes and prognostication of patients with ARDS given immunosuppression as rescue on a Specialist Respiratory Critical Care Unit

Objective To determine whether the trajectories of survivors and non-survivors are different in patients admitted to intensive care in London. Design In this case series of 15 survivors and 16 non-survivors, data from admission to discharge was collected and aligned to lowest PaO2/FiO2 ratio where aggregation and trends were demonstrated. Setting S...

This report highlight the limitations of VV-ECMO, as a bridge to independent recovery. Questions of the role of such technology in a failing physiological system, the ethics and process of withdrawal, a ‘dying with dignity’ framework, and when to involve palliative and psychological care, arise. Challenges of End of life Decision making, the timing...

BACKGROUND: COVID-19 is a global health emergency. Recent data indicate a 50% mortality rate across UK intensive care units. METHODS: A single institution, two-centre retrospective analysis following implementation of a Decision Support tool and real-time data dashboard for early detection of patients requiring personalised enhanced care, focussing...

The severe acute respiratory syndrome coronavirus 2 pandemic is to date affecting more than a million of patients and is challenging healthcare professionals around the world. Coronavirus disease 2019 may present with a wide range of clinical spectrum and severity, including severe interstitial pneumonia with high prevalence of hypoxic respiratory...

These recommendations for physicians who perform bronchoscopy will help to protect those patients (un)-affected by the current COVID-19 pandemic, minimize the risk of transmission, and maintain clinical care for all patients.

Laennec's invention of the stethoscope in 1816, and description of auscultatory sounds for clinical diagnosis remain important today. History and examination are pivotal to accurate diagnosis, helped by confirmatory investigations. The key symptoms of respiratory disease are breathlessness, chest pain, cough with associated sputum production, and w...

Background: Ventilator-associated pneumonia is the most common intensive care unit (ICU)-acquired infection, yet accurate diagnosis remains difficult, leading to overuse of antibiotics. Low concentrations of IL-1β and IL-8 in bronchoalveolar lavage fluid have been validated as effective markers for exclusion of ventilator-associated pneumonia. The...

Background Restrictions on respiratory trainee time and access to procedures reduce the opportunities to acquire necessary skills in bronchoscopy. Simulation, not subject to such impediments, is a useful supplementary aid to teaching bronchoscopic techniques in a safe environment but there is a limited choice of simulators that are sufficiently rea...

Interest in type D personality and negative emotions such as anxiety and hostility has been growing. These factors are associated with health risk behaviors, which could determine the incidence and progression of cardiovascular disease in initially healthy individuals. We sought to evaluate the prevalence of anxiety, hostility and type D personalit...

We have undertaken for the first time a comprehensive evaluation of MVs within BALF/plasma of COPD patients, and demonstrated BALF neutrophil-derived MV numbers correlate with functional and clinically relevant disease severity indices. Our data strongly suggest BALF neutrophil MVs are a novel, clinically relevant biomarker for COPD disease severit...