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 - June 23, 2017 Category: Respiratory Medicine Source Type: research
Monitoring Progress and Adherence with PAP Therapy for OSA: the Roles of Telemedicine and Mobile Health Applications
AbstractPurpose of ReviewGiven the challenge of optimizing continuous positive airway pressure (CPAP) therapy adherence in patients with obstructive sleep apnea (OSA), this paper discusses implementation of telemedicine-based mechanisms and other health-related technologies in order to develop a comprehensive and cost-effective solution for OSA management.Recent FindingsTechnology is changing every aspect of health care by empowering patients while changing the approach of providers and the health system of delivering care. Key elements include the use of electronic messaging, remote monitoring, automated care mechanisms, ...
Source: Current Respiratory Care Reports - June 20, 2017 Category: Respiratory Medicine Source Type: research
The Right Ventricle in Cardiorespiratory Failure
AbstractPurpose of ReviewThorough evaluation of the hypotensive or dyspneic patient requires an understanding of the physiology and common pathologies that relate to the right ventricle (RV). This review focuses on the role of point-of-care ultrasound (PoCUS) in evaluating the RV and discusses common clinical scenarios where PoCUS provides value.Recent FindingsThere are several signs of underlying RV pathology that can be detected using PoCUS; these including alterations in RV size, wall thickness, interventricular septal deviation, and RV function. These indicators help in differentiating between acute and chronic RV dysf...
Source: Current Respiratory Care Reports - June 16, 2017 Category: Respiratory Medicine Source Type: research
Diagnosis of Deep Venous Thrombosis at the Point-of-Care
AbstractPurpose of ReviewThe diagnosis of deep vein thrombosis (DVT) using compression ultrasound, at the point-of-care, by the treating physician is gaining acceptance, as the literature supports its diagnostic accuracy to be similar to that of exams performed by radiologists. While a traditional radiology DVT study uses both color and spectral Doppler in addition to compression (duplex or triplex exam), point-of-care ultrasonography in the diagnosis of DVT relies on compression alone without loss of sensitivity or specificity. Point-of-care ultrasound for DVT (POCdvt) has numerous advantages to radiology performed ultras...
Source: Current Respiratory Care Reports - June 9, 2017 Category: Respiratory Medicine Source Type: research
Tobacco Cessation in the Military
AbstractPurpose of ReviewThe use of tobacco products in the military is higher than in the civilian population. Tobacco use is a major cause of morbidity and mortality and a major risk factor for many illnesses to include respiratory disease, cardiovascular disease, and malignancies. The use of tobacco products has also been associated with decreased physical fitness and higher attrition from military service. In veterans, there is an increased level of tobacco-related illnesses and potentially higher health care costs.Recent FindingsThe Department of Defense (DoD) continues to modify its tobacco use policies and limit tob...
Source: Current Respiratory Care Reports - May 31, 2017 Category: Respiratory Medicine Source Type: research
Non-traumatic Pulmonary Emergencies in the Deployed Setting
AbstractPurpose of ReviewPulmonary disorders accounted for up to 8% of the over 70,000 medical evacuations conducted from Iraq and Afghanistan in the past 15 years. This review of non-traumatic pulmonary emergencies provides an overview of deployed military medical treatment capabilities and highlights pulmonary emergencies requiring aeromedical evacuation from theater.Recent FindingsRecent studies have improved the epidemiologic evaluation of non-traumatic pulmonary disease, highlighted specific parenchymal diseases, and revealed infection pathologies unique to the deployed setting. Literature regarding possible chemica...
Source: Current Respiratory Care Reports - May 27, 2017 Category: Respiratory Medicine Source Type: research
Hypoventilation Syndromes
AbstractPurpose of ReviewThis chapter provides a concise yet comprehensive overview of hypoventilation syndromes for the medical provider and offers a brief overview of the latest developments in treatments of the conditions listed.Recent FindingsThere have been few advances in the field of genetics to develop medications that target the function of genes responsible for congenital diseases that cause hypoventilation. Despite these few advances, larger-scale interventional studies need to be done. Diaphragmatic pacing and positive airway pressure (PAP) modalities continue to be used for treatment of certain hypoventilation...
Source: Current Respiratory Care Reports - May 25, 2017 Category: Respiratory Medicine Source Type: research
Chemotherapy for Malignant Pleural Mesothelioma: Past, Present and Future
AbstractPurpose of ReviewThis paper aims to propose an update on therapeutic medical options for malignant pleural mesothelioma (MPM).Recent FindingsFor 13 years, the standard of care in MPM patients has been cisplatin/pemetrexed chemotherapy. Recently, the Cis/Pem/bevacizumab triplet emerged as a new option for MPM patients eligible for bevacizumab, and not as a candidate for multimodality therapy trials, as validated by the last NCCN and French gui delines. Immunotherapy is also emerging as a promising option on its own or in combination with first-line Cis/Pem, or even as a valuable alternative to chemotherapy, radica...
Source: Current Respiratory Care Reports - May 18, 2017 Category: Respiratory Medicine Source Type: research
Sleep-Related Breathing Disorders and Cancer
AbstractPurpose of ReviewObstructive sleep apnea (OSA) has been investigated the most within the spectrum of sleep-related breathing disorders in cancer. The purpose of this review is to describe the biological pathways and review the epidemiological studies regarding OSA and cancer, and to additionally explore the spectrum of sleep-related breathing disorders in cancer.Recent FindingsMurine models have elucidated intermittent hypoxia and sleep fragmentation as oncogenic, and large epidemiologic studies have identified increased cancer incidence among those with OSA and hypoxemia. Central sleep apnea (CSA) may develop in t...
Source: Current Respiratory Care Reports - May 17, 2017 Category: Respiratory Medicine Source Type: research
Impact of High Altitude on Military Operations
AbstractPurpose of ReviewHigh-altitude combat and medical evacuation pose special challenges to military operations. We aim to summarize the physiologic changes that occur at altitude, as well as review the altitude-related diseases with emphasis on the impact on the military population. Finally, the impact of high-altitude exposure during transportation of combat trauma will be reviewed.Recent FindingsThere is increasing awareness that high-altitude exposure has an impact on mission readiness and could place mission success at risk. High-altitude headache and acute mountain sickness have affected warfighters in both train...
Source: Current Respiratory Care Reports - May 15, 2017 Category: Respiratory Medicine Source Type: research
Combat Venous Thromboembolism
AbstractPurpose of ReviewService members (SMs) injured by high energy weapons are at increased risk for hemorrhagic shock and venous thromboembolism (VTE). Military physicians must decide when to initiate thromboprophylaxis or therapeutic anticoagulation in combat casualties after massive transfusion and multiple surgeries.Recent FindingsResuscitation with blood components is associated with VTE in the combat casualty, as are amputation and injury from improvised explosive devices (IEDs). There are no formalized scores available to estimate VTE and bleeding risk for the trauma patient. The optimal agent and dosing regimen ...
Source: Current Respiratory Care Reports - April 29, 2017 Category: Respiratory Medicine Source Type: research
Overlap Syndrome
AbstractPurpose of ReviewThis paper aims to critically evaluate recent literature on the epidemiology, pathophysiology, and management of overlap syndrome (OS).Recent FindingsThe prevalence of OS is much higher in patients with either chronic obstructive pulmonary disease (COPD) or obstructive sleep apnea (OSA) (8.1% –65.9%) than in the general population (1–2%). Maladaptive neural, inflammatory, cardiovascular, and autonomic responses are intensified with the coexistence of both conditions, leading to worse diurnal and nocturnal respiratory function. Careful analysis of the oximetry and capnography findings during pol...
Source: Current Respiratory Care Reports - April 12, 2017 Category: Respiratory Medicine Source Type: research
Immunonutrition in Acute Respiratory Distress Syndrome
AbstractPurpose of ReviewDietary supplementation with nutrients such as glutamine and omega-3 fatty acids to modulate/boost host immunity in critical illness is a new concept. We review current evidence (animal and human studies) on the role of immunonutrition in acute respiratory distress syndrome (ARDS).Recent FindingsDietary supplementation during stress states (ARDS) with omega-3 fatty acids has been shown to attenuate inflammation and improve lung microvascular permeability in animals. In humans, omega-3 fatty acid supplementation has shown mixed results. While studies show improvement in oxygenation and lung mechanic...
Source: Current Respiratory Care Reports - April 11, 2017 Category: Respiratory Medicine Source Type: research
Screening Programs for Obstructive Sleep Apnea
AbstractPurpose of the ReviewThe aim of this article is to describe the literature on the rationale, methods, and outcomes of screening programs for obstructive sleep apnea (OSA).Recent FindingsThe evidence does not support screening for OSA in the general population. Instead, targeted case finding is advised among the following high-risk groups: patients with obesity, congestive heart failure, atrial fibrillation, treatment refractory hypertension, type 2 diabetes, stroke, nocturnal dysrhythmias, and pulmonary hypertension. However, the method of screening remains unclear with some studies suggesting the use of questionna...
Source: Current Respiratory Care Reports - April 11, 2017 Category: Respiratory Medicine Source Type: research
Traumatic Brain Injury in Combat Trauma
AbstractPurpose of ReviewWith more than 2 million American military personnel deployed and 350,000 traumatic brain injuries since 2001, civilian and military health care providers must recognize the impact and unique considerations for managing combat-related traumatic brain injuries. Here, we will review the etiology and manifestations of combat-related traumatic brain injuries with further discussion of acute management and aeromedical evacuation in the deployed setting.Recent FindingsTraumatic brain injuries have emerged as the signature wound of the recent wars. Previously, lethal assaults on the human body are now rou...
Source: Current Respiratory Care Reports - April 11, 2017 Category: Respiratory Medicine Source Type: research
