Browsing by Author "Karki, Bipin"
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Publication Clinical Characteristics and Outcomes of Patients Managed with Percutaneous Dilatational Tracheostomy in the Intensive Care Unit: A Retrospective Observational Study(Nepal Medical Association, 2025) Pradhan, Utsav; Karki, Bipin; Paneru, Hem Raj; Shrestha, Pramesh Sunder; Shrestha, Gentle Sunder; Acharya, Subhash PrasadAbstract Introduction: Percutaneous dilatational tracheostomy has emerged as a preferred minimally invasive alternative to surgical tracheostomy for critically ill patients requiring prolonged mechanical ventilation, though comprehensive data from Nepal remains limited. This study aimed to evaluate the practice of percutaneous dilatational tracheostomy and analyze clinical outcomes in a tertiary level ICU in Nepal. Methods: A retrospective observational study was conducted at Level III ICUs Nepal from April 14, 2021 to April 12, 2024. All patients aged 18 and older who underwent percutaneous dilatational tracheostomy during ICU stay in the study duration were included. Ethical approval for the study was obtained from the institutional review committee [Ref. 583. (6-11) E2]. Data on clinical characteristics, procedural techniques, complications, and outcomes were collected from electronic records and individual file records from hospital record department. Results: The study population comprised predominantly males 53 (63.86%) with a median age of 49 (IQR: 30-62) years. Neurological disorders, particularly intracranial haemorrhage, were the most common admission diagnosis 53 (63.86%). The mean duration from mechanical ventilation to PDT was 16 (IQR: 11-20) days and the main indication was prolonged mechanical ventilation 62 (74.7%). Grigg’s guidewire dilator forceps technique was used 77 (92.77%) of the time. Immediate complications occurred in 12 (14.46%) of cases. The hospital survival rate was 42 (50.6%) with 69 % of survivors achieving decannulation before discharge. Conclusions:Percutaneous dilatational tracheostomy safe bedside procedure for critically ill patients needing prolonged ventilation, with only minor, non-life-threatening complications observed in our tertiary care setting.Publication Massive Middle Cerebral Artery Ischemic Stroke Associated with Severe Acute Respiratory Distress Syndrome in H1N1 Influenza: A Case Report Authors(Nepal Medical Association, 2022) Bhattarai, Suju; Karki, Bipin; Pokhrel, Shweta; Regmi, Sachit; Shrestha, Bibek; Shrestha, Pramesh SunderAbstract: Influenza has a common occurrence during its peak seasons. It usually causes disease of the respiratory tract including severe acute respiratory distress syndrome. However, it may also cause disease and complication of other organ systems. We present a rare complication of influenza in which a patient secondary to influenza developed massive middle cerebral artery ischemic stroke. The patient however survived following recovery of both severe acute respiratory distress syndrome and ischemic stroke after decompressive craniectomy and a prolonged intensive care unit stay. This case report is to highlight the importance of influenza related complications besides the pulmonary infliction which can lead to morbidity and even mortality if not managed on time.Publication Retained bronchial foreign body diagnosed after 29 years of penetrating chest trauma(Nepalese Respiratory Society, 2022) Rimal, Ankit; Pun, Bishika; Karki, Bipin; Paudel, Ashmita; Pradhan, Utsav Lal; Shrestha, Pramesh SunderAbstract: This is a case of retained bronchial foreign body identified by Computed Tomography (CT) scan after 29 years of initial penetrating chest trauma. The patient had a long-standing history of shortness of breath which was diagnosed and treated as recurrent pulmonary infections. The case report is an attempt towards eliciting the importance of CT scan in identifying such foreign bodies. Interpretation & diagnosis of long standing organic foreign bodies may present with occasional diagnostic dilemma. However, prompt and accurate diagnosis is necessary to prevent complications that can be serious and, as in our case, potentially fatal.