Management of Septated Malignant Pleural Effusions
AbstractPurpose of ReviewWe review recent studies of patients with septated malignant pleural effusions, to understand what the clinical implications for patients are and what evidence-based methods should be used to manage these effusions.Recent FindingsFibrinolytics improve effusion size assessed radiologically in patients with a chest drain inserted for septated malignant pleural effusions but this does not translate into an improvement in breathlessness relief or pleurodesis success. Fibrinolytics have also been used in patients with septated effusions associated with indwelling pleural catheters, but dyspnoea relief h...
Source: Current Respiratory Care Reports - February 1, 2018 Category: Respiratory Medicine Source Type: research
Malignant Pleural Effusion from Lung Cancers with Driver Mutations
AbstractPurpose of ReviewThe presence of driver mutations in lung cancer determines the natural course, options of specific targeted therapies and therefore prognosis and survival. The current review summarizes the knowledge about malignant pleural effusion (MPE) in lung cancer with driver mutations and the limited literature on this topic.Recent FindingsThe availability of targeted therapy highly effective in tumor control and reducing pleural effusion implies that a definitive pleural fluid control measure may not be beneficial at the early stage of the treatment. However, resistance to targeted therapies invariably deve...
Source: Current Respiratory Care Reports - January 13, 2018 Category: Respiratory Medicine Source Type: research
Endobronchial Therapy for Persistent Air Leak
AbstractPurpose of ReviewPersistent air leak (PAL) after intercostal drain insertion delays lung reexpantion, increases complications, and results in longer hospital stays and higher treatment costs. A proportion of patients will have comorbid disease or severe underlying lung disease, precluding surgery. We aimed to review the current available endobronchial treatments for PAL and the evidence for their use.Recent FindingsThe Watanabe spigot had success rates of 57% in early reports. There are numerous case reports and series evaluating endobronchial and intrabronchial valves in the management of PAL. Success rates range ...
Source: Current Respiratory Care Reports - January 13, 2018 Category: Respiratory Medicine Source Type: research
Bronchial Thermoplasty in Severe Asthma
AbstractPurpose of ReviewBronchial thermoplasty (BT) is an endoscopic treatment for severe and uncontrolled asthma. This review provides an overview of the indications, selection criteria, treatment application, and scientific evidence regarding its mechanism of action and safety and efficacy of BT in current clinical practice.Recent FindingsIt seems that reduction in airway smooth muscle is one of the principal mechanisms of action, since it correlates with clinical benefits. Regarding safety and efficacy, recent case reports and small prospective studies appear to show benefit in more severe asthma patients.SummaryFurthe...
Source: Current Respiratory Care Reports - December 1, 2017 Category: Respiratory Medicine Source Type: research
Safety of Flexible Bronchoscopy
AbstractPurpose of ReviewFlexible bronchoscopy (FB) is a procedure widely utilized in the diagnosis and management of different lung pathologies.Recent FindingsThe safety of FB in different high-risk patient populations such as severe asthma, pulmonary hypertension, COPD, immunosuppresion, obesity, elderly, increased intracranial pressure, extracorporeal membrane oxygenation support for cardiogenic shock/respiratory failure, and non-invasive positive-pressure ventilation has been advocated in numerous retrospective and prospective studies.SummaryFB is a valuable diagnostic and therapeutic tool with low incidence of adverse...
Source: Current Respiratory Care Reports - December 1, 2017 Category: Respiratory Medicine Source Type: research
Conscious Sedation During Bronchoscopy: How Far We ’ve Come
AbstractPurpose of ReviewFlexible bronchoscopy (FB) is a cornerstone of modern pulmonary medicine. However, considerable heterogeneity persists with respect to education, training, and the performance of sedation during FB.Recent FindingsSedation administered by a non-anesthesiologist during FB has been demonstrated to be safe and effective, although comorbidities and respiratory disease severity must be taken into account regarding choice of sedation and monitoring. There is undoubtedly room for improvement concerning basic education and training in this field. In addition, current study heterogeneity complicates comparis...
Source: Current Respiratory Care Reports - December 1, 2017 Category: Respiratory Medicine Source Type: research
Safety of Flexible Bronchoscopy
AbstractPurpose of ReviewFlexible bronchoscopy (FB) is a procedure widely utilized in the diagnosis and management of different lung pathologies.Recent FindingsThe safety of FB in different high-risk patient populations such as severe asthma, pulmonary hypertension, COPD, immunosuppresion, obesity, elderly, increased intracranial pressure, extracorporeal membrane oxygenation support for cardiogenic shock/respiratory failure, and non-invasive positive-pressure ventilation has been advocated in numerous retrospective and prospective studies.SummaryFB is a valuable diagnostic and therapeutic tool with low incidence of adverse...
Source: Current Respiratory Care Reports - November 3, 2017 Category: Respiratory Medicine Source Type: research
Bronchial Thermoplasty in Severe Asthma
AbstractPurpose of ReviewBronchial thermoplasty (BT) is an endoscopic treatment for severe and uncontrolled asthma. This review provides an overview of the indications, selection criteria, treatment application, and scientific evidence regarding its mechanism of action and safety and efficacy of BT in current clinical practice.Recent FindingsIt seems that reduction in airway smooth muscle is one of the principal mechanisms of action, since it correlates with clinical benefits. Regarding safety and efficacy, recent case reports and small prospective studies appear to show benefit in more severe asthma patients.SummaryFurthe...
Source: Current Respiratory Care Reports - October 25, 2017 Category: Respiratory Medicine Source Type: research
Conscious Sedation During Bronchoscopy: How Far We ’ve Come
AbstractPurpose of ReviewFlexible bronchoscopy (FB) is a cornerstone of modern pulmonary medicine. However, considerable heterogeneity persists with respect to education, training, and the performance of sedation during FB.Recent FindingsSedation administered by a non-anesthesiologist during FB has been demonstrated to be safe and effective, although comorbidities and respiratory disease severity must be taken into account regarding choice of sedation and monitoring. There is undoubtedly room for improvement concerning basic education and training in this field. In addition, current study heterogeneity complicates comparis...
Source: Current Respiratory Care Reports - October 24, 2017 Category: Respiratory Medicine Source Type: research
Point-of-Care Ultrasonography in Critical Care
This article serves as an introduction to the series and uses a case-based approach to provide a brief overview of the applications of point-of-care ultrasonography in a patient with cardiopulmonary failure. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - September 1, 2017 Category: Respiratory Medicine Source Type: research
Airway Management in Combat Trauma
AbstractPurpose of ReviewAirway compromise remains a leading cause of death in battlefield trauma. The purpose of this review is to examine the impact of airway compromise on survival in the combat trauma population and assess the challenges in providing effective airway management in the combat environment when contrasted with the civilian peacetime environment.Recent FindingsManagement approaches in the civilian trauma setting are not necessarily applicable in the combat environment due to differences in injury patterns and extent of prehospital airway operator training. Although outcomes with airway management in both c...
Source: Current Respiratory Care Reports - September 1, 2017 Category: Respiratory Medicine Source Type: research
Point-of-Care Ultrasonography in Critical Care
This article serves as an introduction to the series and uses a case-based approach to provide a brief overview of the applications of point-of-care ultrasonography in a patient with cardiopulmonary failure. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - August 7, 2017 Category: Respiratory Medicine Source Type: research
Assessment of Left Ventricular Function in the Critically Ill Patient
AbstractPurpose of ReviewA rapid qualitative assessment of left ventricular (LV) function is one of the cornerstones of point of care ultrasonography. The purpose of this review is to use a case-based approach to demonstrate how point of care echocardiography can be used to perform a qualitative assessment of LV systolic function.Recent FindingsVarious studies have demonstrated that using standard goal-directed echocardiography views, the assessment of myocardial thickening, endocardial excursion and the motion of the anterior leaflet of the mitral valve can be used to classify the LV systolic function into four broad cate...
Source: Current Respiratory Care Reports - July 28, 2017 Category: Respiratory Medicine Source Type: research
Ultrasound Guidance for Thoracic Procedures
AbstractPurpose of ReviewUltrasound is an invaluable tool and its use for thoracic procedures continues to expand. This review evaluates current use and evidence of ultrasound with thoracic procedures.Recent Findings• Ultrasound guidance assists with proper device placement and reduces the risk of complications.• A low risk of pneumothorax can be achieved, even in high-risk populations, such as those receiving positive pressure ventilation.• Contraindications for high-risk bleeding conditions, including coagulopathy and/or clopidogrel use, deserve reconsideration because emerging evidence suggests ultrasound guidance...
Source: Current Respiratory Care Reports - July 22, 2017 Category: Respiratory Medicine Source Type: research
