Large Airway Complications Following Lung Transplantation
Airway complications following lung transplantation are common and may be associated with significant morbidity and mortality. Although there are multiple risk factors, anastomotic ischemia is the major factor for the development of airway complications. Most of the complications can be managed with bronchoscopic interventions. However, some may require surgical intervention even retransplantation. In recent years, a universally accepted definition and grading system have been published by the International Society for Heart and Lung Transplantation (ISHLT). Common airway complications include anastomotic dehiscence, anast...
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
Hemothorax: A Review of the Literature
Hemothorax is a collection of blood in the pleural cavity usually from traumatic injury. A chest x-ray has historically been the imaging modality of choice upon arrival to the hospital. The sensitivity and specificity of point-of-care ultrasound, specifically through the Extended Focal Assessment with Sonography in Trauma (eFAST) protocol has been significant enough to warrant inclusion in most Level 1 trauma centers as an adjunct to radiographs. If the size or severity of a hemothorax warrants intervention, tube thoracostomy has been and still remains the treatment of choice. Most cases of hemothorax will resolve with tub...
Source: Clinical Pulmonary Medicine - January 1, 2020 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Biomarkers in Pulmonary Infections: Erratum
No abstract available (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Erratum Source Type: research
Can C-reactive Protein Testing Help Guide Antibiotic Therapy for Outpatients With COPD Exacerbations?
Synopsis: C-reactive protein may be a useful point-of-care tool to assist in antibiotic guidance in outpatients with an acute COPD exacerbation. This multicenter, randomized controlled trial demonstrated that CRP guided prescribing results in lower antibiotic use with no effect on quality of life.
Source: Butler CC, Gillespie D, White P, et al. C-reactive protein testing to guide antibiotic prescribing for COPD exacerbations. N Engl J Med. 2019;381:111–120. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
Corticosteroids in Community-acquired Pneumonia: To Give or Not To Give?
Synopsis: Several randomized controlled trials (RCTs) and meta-analyses have shown improved outcomes when using corticosteroids in community-acquired pneumonia (CAP), including shorter length of stay, reduced treatment failure, and even lower mortality rates in severe disease. In this reviewed study, a bundled intervention including corticosteroids did not improve outcomes and suggested that corticosteroids may even cause harm.
Source: Lloyd M, Karahalios A, Janus E, et al. Effectiveness of a bundled intervention including corticosteroids on outcomes of hospitalized patients with community-acquired pneumonia. JAMA Intern ...
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
When the Lesion Should Be There, But Isn’t …
Diagnostic imaging plays a prominent role in the evaluation of numerous medical conditions, ranging from suspected infections to assessment of the acutely injured patient to staging malignancies and numerous other conditions, both common and rare. Imaging can be a very powerful tool in the diagnosis of medical disorders and plays a major role in the assessment of therapeutic response as well. It is common in practice for imaging studies to provide findings that may corroborate the clinical or laboratory impression of a disorder, allowing a presumptive diagnosis and institution of therapy, often circumventing the morbidity ...
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Medical Malpractice and Bronchoscopy: Why Do Physicians Face Litigation?
Despite bronchoscopy’s minimally invasive approach, it is not without errors and complications. When such errors do occur, patients may seek legal redress. The aim of the study was to describe the setting, contributing characteristics, and outcomes of litigation targeting bronchoscopic procedures. Westlaw (Thompson Reuters), an online legal research data set, was queried for all medical malpractice cases reported in the United States from 1983 to 2018 wherein bronchoscopy was performed. A total of 87 cases were included. Pulmonology was the most common specialty named in the cases (n=42, 48%). The most common alleged rea...
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Diffuse Alveolar Hemorrhage in the Setting of an Acute Exacerbation of Chronic Hypersensitivity Pneumonitis Due to Drug Rash With Eosinophilia and Systemic Symptoms: A Case Report
Drug rash with eosinophilia and systemic symptoms (DRESS) is a well-recognized phenomenon that is considered to be a hyperinflammatory reaction in response to the administration of a drug. It is typical to have systemic signs of inflammation, and the most commonly reported pulmonary manifestations include pneumonitis, interstitial lung disease, and acute respiratory distress syndrome. Here, we present a 62-year-old woman with a history of chronic hypersensitivity pneumonitis who presented in respiratory distress with a new progressive rash. Bronchoscopy demonstrated diffuse alveolar hemorrhage (DAH), and a clinical diagnos...
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care/Interstitial and Inflammatory Lung Disease Source Type: research
The Safety and Efficacy of General Anesthesia Bronchoscopy in Patients With Metastatic Brain Lesions
Conclusion:
These results confirm that the rate of serious complications in patients with space-occupying brain lesions who undergo bronchoscopy with general anesthesia is similar to that in patients without brain lesions, indicating that bronchoscopy can be performed safely in this patient population. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
Poncet Disease: A Case-based Review of an Uncommon Extrapulmonary Manifestation of Tuberculosis
Discussion:
This case of an immunocompromised woman with fevers, lymphadenopathy, polyarthritis, and erythema nodosum demonstrates a unique presentation of TB. PD is defined as reactive arthritis due to infection with TB elsewhere in the body. Although PD was first described in 1897, it stills remains a disputed and lesser-known entity. This case highlights the importance of recognizing this unique manifestation of TB to prevent misdiagnosis and delay. It also demonstrates the diagnostic challenge in distinguishing the overlapping features of sarcoidosis manifesting as Lofgren syndrome and PD. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2019 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Inhaled Tranexamic Acid: A Therapeutic Option For Hemoptysis
Synopsis: A prospective randomized, double-blinded, placebo-controlled trial in patients with nonmassive hemoptysis demonstrated that inhaled tranexamic acid significantly reduced the volume of expectorated blood with a higher rate of hemoptysis resolution, decreased the need for invasive procedures, shortened the length of hospital stay, and reduced the recurrence rate at 1-year follow-up, compared with placebo. However, its role in patients with massive hemoptysis remains an open question.
Source: Wand O, Guber E, Guber A, et al. Inhaled tranexamic acid for hemoptysis treatment, a randomized controlled trial. Chest. 201...
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Does Aspirin Use Influence Exacerbations and Morbidity of Chronic Obstructive Pulmonary Disease?
Synopsis: Aspirin use has led to an improvement in mortality rate in coronary artery disease (CAD) patients, but there are not many studies showing mortality benefit in chronic obstructive pulmonary disease (COPD) patients. A recent observational cohort study assessed its influence on acute exacerbation of COPD, respiratory morbidity, and quality of life. The results showed a promising therapeutic use for aspirin, but further randomized controlled trials are necessary for a more definitive answer.
Source: Fawzy A, Putcha N, Aaron CP, et al. Aspirin use and respiratory morbidity in COPD: a propensity score-matched analysis...
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Pity The Fool Who Extubates Too Soon: Does T-Piece Weaning Have Better Outcomes Compared With Standard Pressure Support Weaning?
Synopsis: A spontaneous breathing trial consisting of 30 minutes of pressure support ventilation, compared with 2 hours of T-piece ventilation, led to significantly higher rates of successful extubation.
Source: Subirá C, Hernández G, Vázquez A, et al. Effect of pressure support versus T-piece ventilation strategies during spontaneous breathing trials on successful extubation among patients receiving mechanical ventilation: a randomized clinical trial. JAMA. 2019;321:2175–2182. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Is This the End of Albuterol?
Synopsis: In patients with mild asthma, a strategy of budesonide-formoterol as needed was superior to albuterol as needed to prevent asthma exacerbations.
Source: Beasley R, Holiday M, Reddel HK, et al. Controlled trial of budesonide-formoterol as needed for mild asthma. N Engl J Med. 2019;380:2020–2030. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Are We Using the Correct Inhaled Medication to Treat Mild Asthma With Low Sputum Eosinophilia?
Synopsis: This crossover trial evaluated the efficacy of inhaled corticosteroids and long-acting muscarinic antagonists compared with placebo in asthmatic patients in relation to sputum eosinophil counts. No statistical significance was found between the Mometasone versus placebo or the Tiotropium versus placebo groups, and the responses to the active drugs were not greater than the responses to the placebo medications in those with a low sputum eosinophil count.
Source: Lazarus SC, Krishnan JA, King TS, et al. Mometasone or Tiotropium in mild asthma with a low sputum eosinophil level. NEJM. 2019;380:2009–2019. (Source:...
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
