Bhupinder S Natt

Interests

Research

Airway ManagementInterstitial Lung DiseaseExtracorporeal Membrane Oxygenation

Teaching

Airway ManagementInterstitial Lung Disease

Courses

No activities entered.

Scholarly Contributions

Journals/Publications

• Bime, C., Malo, J., Mosier, J. M., Natt, B., & Insel, M. (2018). The Association of Non-Cardiac ECMO With Influenza Incidence: A Time Series Analysis.. Respiratory Care.
• Goel, K., Bailey, M., Borgstrom, M., Parthasarathy, S., Natt, B., Berry, C., & Bime, C. (2018). Trends in COPD Hospitalization and In-Hospital Deaths in the United States by Sex: 2005-2014. Annals of the American Thoracic Society.
• Insel, M., Natt, B., Mosier, J., Malo, J., & Bime, C. (2018). The Association of Non-Cardiac ECMO With Influenza Incidence: A Time Series Analysis. Respiratory care.
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  The 2009 H1N1 influenza epidemic saw a rise in the use of extracorporeal membrane oxygenation (ECMO) as a supportive therapy for refractory ARDS. We sought to determine whether ECMO utilization follows a seasonal pattern that matches the influenza season, and whether it can further be explained by the incidence of each influenza subtype.
• Bime, C., Natt, B., Desai, H., Poongkunran, C., & Borgstrom, M. (2017). Reply: Racial Disparities in Acute Respiratory Distress Syndrome Mortality. Annals of the American Thoracic Society, 14(2), 300-301.
• Natt, B., Desai, H., Bime, C., Dill, J., Dalen, J. E., & Alpert, J. S. (2017). The Reply. The American journal of medicine, 130(4), e165.
• Natt, B., Hypes, C., Basekn, R., Malo, J., Kazui, T., & Mosier, J. M. (2017). The use of extracorporeal membrane oxygenation in the bronchoscopic management of critical upper airway obstruction. Journal of Extra Corporeal Technology, 49(1), 54-58.
• Natt, B., Hypes, C., Basken, R., Malo, J., Kazui, T., & Mosier, J. (2017). Suspected Heparin-Induced Thrombocytopenia in Patients Receiving Extracorporeal Membrane Oxygenation. The journal of extra-corporeal technology, 49(1), 54-58.
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  Heparin-induced thrombocytopenia (HIT) is an immune reaction usually secondary to unfractionated heparin. Anticoagulation management is critical in patients while on extracorporeal membrane oxygenation (ECMO) to prevent thromboembolism and for the optimal functioning of the circuit. We identified five patients with respiratory failure at our hospital managed with ECMO in the last 2 years that were treated for HIT. A brief clinical course and their management are discussed. We also briefly review the literature for best evidence for management of such patients.
• Natt, B., Natt, B., Knepler, J. L., Knepler, J. L., Kazui, T., Kazui, T., Mosier, J. M., & Mosier, J. M. (2017). The use of extracorporeal membrane oxygenation in the bronchoscopic management of critical upper airway obstruction. J Bronchology Interv Pulmonol, 24(1), e12-e14.
• Bime, C., Poongkunran, C., Borgstrom, M., Natt, B., Desai, H., Parthasarathy, S., & Garcia, J. G. (2016). Racial Differences in Mortality from Severe Acute Respiratory Failure in the United States, 2008-2012. Annals of the American Thoracic Society, 13(12), 2184-2189.
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  Racial disparities in health and healthcare in the United States are well documented and are increasingly recognized in acute critical illnesses such as sepsis and acute respiratory failure.
• Desai, H., Desai, H., Natt, B., Natt, B., Kim, S. S., Kim, S. S., Bime, C., & Bime, C. (2016). Decreased In-hospital Mortality after Lobectomy Using Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy.. Annals of American Thoracic Society.
• Desai, H., Natt, B., Bime, C., Dill, J., Dalen, J. E., & Alpert, J. S. (2017). Pulmonary Embolism with Right Ventricular Dysfunction: Who Should Receive Thrombolytic Agents?. The American journal of medicine, 130(1), 93.e29-93.e32.
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  Appropriate management of pulmonary embolism patients with right ventricular dysfunction is uncertain. Recent guidelines have stressed the need for more data on the use of thrombolytic agents in the stable pulmonary embolism patient with right ventricular dysfunction. The objective of this study is to investigate the hypothesis that thrombolytic therapy in hemodynamically stable pulmonary embolism patients with right ventricular dysfunction is not associated with improved mortality.
• Desai, H., Natt, B., Kim, S., & Bime, C. (2016). Decreased In-hospital Mortality after Lobectomy Using Video-Assisted Thoracoscopic Surgery Compared to Open Thoracotomy. Annals of the American Thoracic Society.
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  There is a paucity of data regarding the optimal surgical approach for lung lobectomy. Lobectomy performed by video-assisted thoracoscopic surgery (VATS) has been associated with lower morbidity as compared to thoracotomy. However, no multicenter studies have shown improved mortality with VATS lobectomy compared to open surgical lobectomy.
• Hypes, C. D., Stolz, U., Sakles, J. C., Joshi, R. R., Natt, B., Malo, J., Bloom, J. W., & Mosier, J. M. (2016). Video Laryngoscopy Improves Odds of First-Attempt Success at Intubation in the Intensive Care Unit. A Propensity-matched Analysis. Annals of the American Thoracic Society, 13(3), 382-90.
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  Urgent tracheal intubation is performed frequently in intensive care units and incurs higher risk than when intubation is performed under more controlled circumstances. Video laryngoscopy may improve the chances of successful tracheal intubation on the first attempt; however, existing comparative data on outcomes are limited.
• Hypes, C., Sakles, J., Joshi, R., Greenberg, J., Natt, B., Malo, J., Bloom, J., Chopra, H., & Mosier, J. (2016). Failure to achieve first attempt success at intubation using video laryngoscopy is associated with increased complications. Internal and emergency medicine.
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  The purpose of this investigation was to investigate the association between first attempt success and intubation-related complications in the Intensive Care Unit after the widespread adoption of video laryngoscopy. We further sought to characterize and identify the predictors of complications that occur despite first attempt success. This was a prospective observational study of consecutive intubations performed with video laryngoscopy at an academic medical Intensive Care Unit. Operator, procedural, and complication data were collected. Multivariable logistic regression was used to examine the relationship between the intubation attempts and the occurrence of one or more complications. A total of 905 patients were intubated using a video laryngoscope. First attempt success occurred in 739 (81.7 %), whereas >1 attempt was needed in 166 (18.3 %). One or more complications occurred in 146 (19.8 %) of those intubated on the first attempt versus 107 (64.5 %, p 1 attempt is associated with 6.4 (95 % CI 4.4-9.3) times the adjusted odds of at least one complication. Pre-intubation predictors of at least one complication despite first attempt success include vomit or edema in the airway as well as the presence of hypoxemia or hypotension. There are increased odds of complications with even a second attempt at intubation in the Intensive Care Unit. Complications occur frequently despite a successful first attempt, and as such, the goal of airway management should not be simply first attempt success, but instead first attempt success without complications.
• Natt, B. (2016). Medical image of the week: endobronchial valves. Medical image of the week: endobronchial valves, 13(1), 34-35.
• Natt, B. S., Desai, H., Singh, N., Poongkunran, C., Parthasarathy, S., & Bime, C. (2016). Extracorporeal Membrane Oxygenation for ARDS: National Trends in the United States 2008-2012. Respiratory care, 61(10), 1293-8.
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  Recent advances in technology and protocols have made the use of extracorporeal membrane oxygenation (ECMO) a viable rescue therapy for patients with ARDS who present with refractory hypoxemia. Despite the lack of strong evidence supporting the use of ECMO in ARDS, its use seems to be increasing. We sought to determine recent trends in the use of ECMO for ARDS. We also assessed trends in mortality among patients with ARDS in whom ECMO was used.
• Natt, B. S., Malo, J., Hypes, C. D., Sakles, J. C., & Mosier, J. M. (2016). Strategies to improve first attempt success at intubation in critically ill patients. British journal of anaesthesia, 117 Suppl 1, i60-i68.
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  Tracheal intubation in critically ill patients is a high-risk procedure. The risk of complications increases with repeated or prolonged attempts, making expedient first attempt success the goal for airway management in these patients. Patient-related factors often make visualization of the airway and placement of the tracheal tube difficult. Physiologic derangements reduce the patient's tolerance for repeated or prolonged attempts at laryngoscopy and, as a result, hypoxaemia and haemodynamic deterioration are common complications. Operator-related factors such as experience, device selection, and pharmacologic choices affect the odds of a successful intubation on the first attempt. This review will discuss the 'difficult airway' in critically ill patients and highlight recent advances in airway management that have been shown to improve first attempt success and decrease adverse events associated with the intubation of critically ill patients.
• Natt, B., & Knepler, J. L. (2016). Medical image of the week: endobronchial valves. Southwest Journal of Pulmonary and Critical Care, 13(1), 34-35.
• Natt, B., & Knepler, J. L. (2016). Medical image of the week: lung entrapment. Southwest Journal of Pulmonary and Critical Care, 13(1), 36-37.
• Natt, B., Knepler, J., Kazui, T., & Mosier, J. M. (2017). The Use of Extracorporeal Membrane Oxygenation in the Bronchoscopic Management of Critical Upper Airway Obstruction. Journal of bronchology & interventional pulmonology, 24(1), e12-e14.
• Natt, B., Power, E., & Beatty, N. (2016). Medical image of the week: purpura fulminans. Southwest Journal of Pulmonary and Critical Care, 13(6), 307-308.
• Tey, K. R., & Natt, B. (2016). Medical image of the week: mediastinal metastases causing right ventricular outflow obstruction. Southwest Journal of Pulmonary and Critical Care, 12(1), 22-23.
• Baalachandran, R., Hypes, C., Natt, B., & Snyder, L. (2015). Pipe dreams: concealed methamphetamine causing severe toxicity. The American journal of the medical sciences, 349(6), 548-9.
• Desai, H., Bajaj, A., Hanamaikai, K., & Natt, B. (2015). Medical image of the week: acute aortic dissection. Southwest Journal of Pulmonary and Critical Care, 10(6), 348-349.
• El Aini, T., Omar, M., & Natt, B. (2015). Medical image of the week: bilateral symmetrical nephromegaly. Southwest Journal of Pulmonary and Critical Care, 10(2), 93-94.
• Habibi, S., Natt, B., & Jenkins, C. (2015). Medical image of the week: ‘CSFoma’. Southwest Journal of Pulmonary and Critical Care, 11(4), 192.
• Mosier, J. M., Malo, J., Sakles, J. C., Hypes, C. D., Natt, B., Snyder, L., Knepler, J., Bloom, J. W., Joshi, R., & Knox, K. (2015). The impact of a comprehensive airway management training program for pulmonary and critical care medicine fellows. A three-year experience. Annals of the American Thoracic Society, 12(4), 539-48.
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  Airway management in the intensive care unit (ICU) is challenging, as many patients have limited physiologic reserve and are at risk for clinical deterioration if the airway is not quickly secured. In academic medical centers, ICU intubations are often performed by trainees, making airway management education paramount for pulmonary and critical care trainees.
• Natt, B., & Raz, Y. (2015). IMAGES IN CLINICAL MEDICINE. Air Bronchogram. The New England journal of medicine, 373(27), 2663.
• Natt, B., Mazursky, K., & Meinke, L. E. (2015). Medical image of the week: acute amiodarone pulmonary toxicity. Southwest Journal of Pulmonary and Critical Care, 11(4), 189-190.
• Omar, M., El Aini, T., & Natt, B. (2015). Medical image of the week: Westermark sign. Southwest Journal of Pulmonary and Critical Care, 10(3), 125-126.
• Tey, K. R., & Natt, B. (2015). Medical image of the week: empyema necessitans. Southwest Journal of Pulmonary and Critical Care, 11(6), 271-272.
• Natt, B. S., Campion, J. M., & Knox, K. S. (2014). Acute eosinophilic pneumonia associated with ingestion of Ulomoides dermestoides larvae ("Chinese beetles"). Annals of the American Thoracic Society, 11(10), 1667-8.
• Natt, B., & Szerlip, H. M. (2014). The lost art of the history and physical. The American journal of the medical sciences, 348(5), 423-5.
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  The important contribution of the history and physical in making a correct medical diagnosis has been known for centuries. Despite this, these skills are being undermined by technology that many physicians mistakenly believe to be the new gold standard. The authors report 2 cases in which the history and physical trumped technology in making the correct diagnosis. Medical educators need to reemphasize the importance of the history and physical. This will require changes in curriculum and intense faculty development.
• Natt, B., Berry, C. E., Bime, C., & Gerald, J. K. (2014). Tucson critical care journal club: early goal-directed therapy. Southwest Journal of Pulmonary and Critical Care.

Presentations

• Bull, D. A., Lick, S. D., Hypes, C., Natt, B., Mosier, J. M., Malo, J., & Hsu, C. (2019, May/). Duration and Outcomes of Veno-Venous Extracorporeal Membrane Oxygenation Support in Acute Respiratory Distress Syndrome: Results from ELSO database. American association for thoracic surgery 99th annual meeting. Toronto: American association for thoracic surgery.

Poster Presentations

• Natt, B. (2018, February). Right ventricular dysfunction in acute respiratory distress syndrome. SCCM. San Antonio, TX: SCCM.
• Hypes, C., Sakles, J. C., Mosier, J. M., Natt, B., Greenberg, J., Morrissette, K., & Cristan, E. (2017, Feb). Rethinking NIV: when it works, it works. When it doesn't, it really doesn't. Society of Critical Care Medicine Annual Congress. Honolulu, HI.: Society of Critical Care Medicine.
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  22. Greenberg J, Mosier J, Natt B, Morrissette K, Cristan C, Sakles J, Hypes C; Rethinking NIV: when it works, it works. When it doesn't, it really doesn't [Poster]; Society of Critical Care Medicine Annual Congress; February 2017; Honolulu, HI.
• Desai, H., Natt, B., & Bime, C. (2016, May/Spring). Decreased in-hospital mortality after lobectomy using video-assisted thoracoscopic surgery compared to open thoracotomy. ATS International Conference. San Francisco, CA.
• Hypes, C., Sakles, J. C., Nararro, T., Greenberg, J., Natt, B., Chopra, H., & Mosier, J. M. (2016, Sept). Failure to achieve first attempt success is associated with a higher odds of adverse events during intubation in the Intensive Care Unit using a video laryngoscope. Society for Airway Management. Atlanta.
• Key, T., Natt, B., Pederson, K. R., Meinel, M. K., & Carr, G. E. (2015, May/Spring). Implementing an Inpatient Chain of Survival at an Academic Medical Center. American College of Physicians National Meeting. Washington, DC.
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  (National winner)
• Nararro, T., Mosier, J. M., Sakles, J. C., Greenberg, J., Natt, B., Chopra, H., & Hypes, C. (2016, Sept). Predictors of complications of Intensive Care Unit airway management despite first attempt success using video laryngoscopy. Society for Airway Management.
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  This submission won the SAM travel award for Dr. Navarro to present it at the conference. I mentored Dr. Navarro in this activity.
• Natt, B., Malo, J., Hypes, C., Kazui, T., Basken, R., & Mosier, J. M. (2016, August). Outcomes of Patients with Severe Influenza Treated at the Banner-University Medical Center During the 2015-16 Influenza Season. Options IX for the Control of Influenza. Chicago.
• Natt, B., Malo, J., Hypes, C., Kazui, T., Basken, R., & Mosier, J. M. (2016, August/Summer). Outcomes of Patients with Severe Influenza Treated at the Banner-University Medical Center During the 2015-16 Influenza Season. Options IX for the Control of Influenza. Chicago, IL.
• Natt, B., Malo, J., Hypes, C., Kazui, T., Basken, R., & Mosier, J. M. (2016, Summer). Outcomes of Patients with Severe Influenza Treated at the Banner-University Medical Center During the 2015-16 Influenza Season. Options IX for the Control of Influenza. Chicago, IL.
• Natt, B., Rodriguez, ., Knox, K. S., & Carr, G. E. (2016, May/Spring). Concurrent Myasthenia Gravis and autoimmune featured interstitial lung disease: a case report. ATS International Conference. San Francisco, CA.
• Key, T., Natt, B., Pederson, K. R., Meinel, M. K., & Carr, G. E. (2015, November/Fall). Implementing an Inpatient Chain of Survival at an Academic Medical Center. American College of Physicians Arizona Meet. Tucson, AZ.
• Natt, B., Desai, H., Poongkunran, C., & Bime, C. (2015, October/Fall). Extracorporeal Membrane Oxygenator Use in ARDS. CHEST Annual Meeting. Montreal, Québec, Canada.
• Natt, B., Desai, H., Singh, N., Poongkunran, C., & Bime, C. (2015, October/Fall). ARDS Prevalence and Survival Trends in the United States; 2008-2012. CHEST Annual Meeting. Montreal, Québec, Canada.
• Natt, B., Malo, J., Snyder, L. S., Knepler, J. L., Knox, K. S., & Mosier, J. M. (2015, May/Spring). Advanced Airway Management in Critical Care Fellowship Training. ATS International Conference. Denver, CO.
• Singh, N., Natt, B., Ainapurapu, B. B., & Trowers, E. A. (2015, November/Fall). Hereditary Spherocytosis Leading to Pulmonary Hypertension. American College of Physicians Arizona Meet. Tucson, AZ.

Case Studies

• Campion, J. M., & Natt, B. (2017. ICU CXR(p. 1).
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  Image of the week