A Case of Vanishing Lung Cysts
Pulmonary cysts are frequently encountered at thoracic computed tomography, often incidentally detected. For patients older than 40 years of age, a few pulmonary cysts found at thoracic computed tomography can be a normal finding. The etiologies of pulmonary cysts are numerous, and cysts should be distinguished from other focal lucent lung lesions, such as the numerous causes of cavitary lung disease, bronchiectasis, honeycombing, and emphysema. When pulmonary cysts are encountered in older children or adult patients, a number of specific disorders, collectively referred to as diffuse cystic lung diseases, merit considerat...
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Acute Respiratory Failure Due to Acute Exacerbation of Chronic Obstructive Pulmonary Disease: The Spectrum of Ventilator Strategies
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death in the United States. Acute exacerbation of COPD is associated with a faster decline in lung function, lower quality of life, and increased mortality. Management of acute exacerbation of COPD in the intensive care unit includes pharmacotherapy and mechanical ventilatory support. Noninvasive mechanical ventilation has led to significant improvement in outcomes of COPD and reduced morbidity and mortality compared with invasive mechanical ventilation. An emerging modality, extracorporeal carbon dioxide removal is now being studied to reduce the n...
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Providing an Antibiotic Allergy Service
Approximately 10% of patients report an allergy to ≥1 antibiotics, most commonly penicillins. Having a label of penicillin allergy has important health consequences for the individual, as well as health and economic impact at the population level. Despite this, only a minority of patients have the opportunity to have suspected antibiotic allergies confirmed. Busy clinicians seldom have time to explore the history of suspected antibiotic allergies in detail; an important role of the antibiotic allergy service is to do just this, including gathering contemporaneous notes, charts, and correspondence where necessary. The lik...
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Time-limited Trials in the Intensive Care Unit to Promote Goal-Concordant Patient Care
Consider the hypothetical case of a 75-year-old patient admitted to the intensive care unit (ICU) for acute hypoxemic respiratory failure due to pneumonia and systolic heart failure. Although she suffers from a potentially treatable infection, her advanced age and chronic illness increase her risk of experiencing a poor outcome. Her family feels conflicted about whether the use of mechanical ventilation would be acceptable given what they understand about her values and preferences. In the ICU setting, clinicians, patients, and surrogate decision-makers frequently face challenges of prognostic uncertainty and uncertainty w...
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Prevalence and Impact on Mechanical Ventilation Weaning of Pleural Effusion in ICU Patients
Pleural effusion is frequently encountered in patients who are mechanically ventilated in the intensive care unit and may be logically suspected in case of difficult weaning from mechanical ventilation. Through several mechanisms, pleural effusion may impair gas exchange, respiratory mechanics, and ventilation/perfusion matching. However, data exploring the respective contribution of pleural effusion on weaning failure are scarce. This review discusses the most recent findings pertaining to the potential role of pleural effusion in weaning outcome. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Revisiting Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome
Synopsis: Despite at least 1 large trial showing benefit, the use of neuromuscular blockade during treatment of acute respiratory distress syndrome has never become routine. This trial evaluates 90-day mortality after randomization to either early neuromuscular blockade or usual low target sedation.
Source: National Heart, Lung, and Blood Institute Prevention and Early Treatment of Acute Lung Injury (PETAL) Clinical Trials Network, Moss M, Huang DT, Brower RG, et al. Early Neuromuscular Blockade in the Acute Respiratory Distress Syndrome. N Engl J Med. 2019;380:1997–2008. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Living in a Poor, Rural Community Is an Independent Risk Factor for Developing Chronic Obstructive Pulmonary Disease
Synopsis: In this nationally representative sample of Americans, the following characteristics were significant risk factors associated with a higher prevalence of COPD: living in a rural area with a high level of poverty in the community. Among nonsmokers, living in a community that uses coal for heating was an additional risk factor.
Source: Raju S, Keet CA, Paulin LM, et al. Rural residence and poverty are independent risk factors for chronic obstructive pulmonary disease in the United States. Am J Respir Crit Care Med. 2019;199(8):961–969. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Omadacycline is a Potential New Drug For Treatment in Moderate to Severe Community-acquired Pneumonia
Synopsis: Omadacycline is a new antibiotic, derived from the tetracycline class, which might fill the need for a novel antibiotic that is effective against the common bacterial organisms causing community-acquired pneumonia. This trial showed it to be noninferior to moxifloxacin.
Source: Stets R, Popescu M, Gonong JR, et al. Omadacycline for community-acquired bacterial pneumonia. N Engl J Med. 2019;380:517–527. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
A Rare Cause of Spontaneous Pneumothorax
Pulmonary nodules detected at thoracic imaging studies are a frequent occurrence. The management of such nodules largely revolves around comparison with prior imaging studies to document stability, and, in the absence of such priors, serial imaging assessment, as determined by the patient’s age, smoking status, and nodule characteristics, including size, border characteristics, and nodule attenuation. Often such incidentally detected nodules, particularly when small, are ultimately shown to be benign through lack of growth at serial imaging assessment, and therefore a conservative approach to these nodules is generally f...
Source: Clinical Pulmonary Medicine - July 1, 2019 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Myths and Legends: Do Bronchial Valves Have a Role in the Management of Emphysema?
This article also reviews the potential benefits of EBVs and the associated complications. Although bronchial valves have yielded promising results and are a potentially safer alternative to lung volume reduction surgery, further guidelines are needed to improve patient selection and procedure performance.
Myth: In severe emphysema, surgical resection is the only option for lung volume reduction. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2019 Category: Respiratory Medicine Tags: Clinical Myths and Evidence-Based Medicine Source Type: research
Biomarkers in Pulmonary Infections
Pneumonia, either community acquired or hospital acquired, is the most frequent severe infection. Despite all new tools and developments, pneumonia is difficult to diagnose clinically, resulting from the lack of a “gold standard” method of diagnosis. This uncertainty is at least in part responsible for the overuse and misuse of antibiotics in the community and in the hospital, and this practice is probably a main drive for antibiotic resistance. Biomarkers may improve the clinical evaluation of a patient with a clinical suspicion of pneumonia. Among all the potential biomarkers, C-reactive protein and procalcitonin are...
Source: Clinical Pulmonary Medicine - July 1, 2019 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Fatal Sepsis and Septic Shock Secondary to Aeromonas hydrophila Pneumonia: Report of a Case and Review of the Literature
We report a case of a 40-year-old immunocompetent woman who presented with pneumonia and septic shock secondary to A. hydrophila infection. Her clinical course was complicated by acute respiratory distress syndrome, metabolic acidosis, and multiorgan failure resulting in mortality. The isolate was susceptible to third-generation and fourth-generation cephalosporins, piperacillin-tazobactam, fluoroquinolones, and trimotheprim/sulfamethoxazole. Review of the literature for previous reports of infection with Aeromonas species infection in previously healthy individuals suggests that pneumonia and bacteremia due to A. hydrophi...
Source: Clinical Pulmonary Medicine - July 1, 2019 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Etiologies and Outcomes of Acute Respiratory Distress Syndrome With No Identified Common Risk Factor
Almost 10% of patients with acute respiratory distress syndrome (ARDS) have no identified ARDS risk factor at ARDS diagnosis. A prompt identification of the cause of ARDS is required to initiate a targeted treatment. The purpose of this review is to delineate the main rare causes of ARDS and to provide clinicians with a pragmatic diagnostic workup. Recent epidemiological data have proposed the identification of a subgroup of ARDS patients lacking exposure to common risk factors. These can be categorized as having immune-mediated, drug-induced, malignant, and idiopathic diseases. A standardized diagnostic workup including c...
Source: Clinical Pulmonary Medicine - July 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Relapsing Plastic Bronchitis: A Brief Review of Currently Available Management Strategies
We describe one such case, wherein all the traditionally described medical therapies did not provide sustained amelioration of symptoms and required transfer for thoracic duct ligation. The patient’s clinical and radiographic features, management strategies, and clinical course are reviewed, alongside a brief review of the currently available management strategies for the clinical practitioner in dealing with plastic bronchitis. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2019 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Can Quadrupling Inhaled Glucocorticoid Dose During Early Asthma Exacerbation Reduce the Need For Systemic Steroids or Hospital Admission?
Synopsis: In this unblinded, multicenter, randomized control trial, patients with mild asthma who quadrupled the dose of their inhaled glucocorticoids upon initial signs of asthma control deterioration experienced fewer severe asthma exacerbations than patients who did not quadruple their inhaled glucocorticoid dose.
Source: McKeever T, Mortimer K, Wilson A, et al. Quadrupling inhaled glucocorticoid dose to abort asthma exacerbations. N Engl J Med. 2018;378:902–910. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
