Interstitial Lung Disease, Body Mass Index, Energy Expenditure and Malnutrition —a Review
AbstractPurpose of ReviewInterstitial lung disease (ILD) comprises a spectrum of chronic disorders that cause various degrees of inflammation or fibrosis in the pulmonary interstitium. Although limited, data exists on nutritional concerns in ILD. However, previous research has not fully explored the broad range of potential nutritional concerns in ILD and impacts on outcomes. The purpose of this review was to identify and describe the overall nutritional status and relating concerns within the ILD population.Recent FindingsAppropriate weight management in this population may positively impact both pre- and post-transplant ...
Source: Current Respiratory Care Reports - February 28, 2017 Category: Respiratory Medicine Source Type: research
Optimizing Enteral Nutrition in Medical Intensive Care Patients
AbstractPurpose of ReviewCritically ill patients have increased metabolic requirements as well as increased protein catabolism. Nutrition support and in particular enteral nutrition have been recently a topic of increased research and commentary in the critical care literature.Recent FindingsAlthough there remains a paucity of large randomized multi-center trials to answer definitively the questions of best timing, delivery, how to monitor for tolerance, and enteral formula selection, there is good overall data to support the use of enteral nutrition in critically ill patients.SummaryIn applying the existing evidence, clin...
Source: Current Respiratory Care Reports - February 26, 2017 Category: Respiratory Medicine Source Type: research
Cytological diagnosis of malignant pleural mesothelioma
AbstractPurpose of reviewAdvances in the pathology and genetics of malignant pleural mesothelioma (MPM) have impacted upon cytology diagnosis. Cytological diagnosis can, in many cases, negate the need for more invasive diagnostic procedures in patients with epithelioid and mixed-type MPM with implications for patient morbidity and health care expenditure.Recent findingsThe diagnostic accuracy of effusion cytology is enhanced by a standardised approach to sample preparation, allowing optimal microscopy, immunohistochemistry (IHC), fluorescent in situ hybridisation (FISH) and other molecular analyses. Loss of BRCA1-associate...
Source: Current Respiratory Care Reports - February 9, 2017 Category: Respiratory Medicine Source Type: research
The obesity paradox: validity and clinical implications
AbstractPurpose of reviewObesity has been associated with increased incidence of diabetes, atherosclerotic disease, numerous cancers, and other comorbidities. Given the increased comorbidities and challenges associated with bedside care of the critically ill obese patient, the expectation would be worse overall clinical outcomes. However, it has been noted that there are improved outcomes in critically ill patients who are overweight or mildly obese compared to their underweight and morbidly obese counterparts. This has been termed the obesity paradox. The purpose of this article is to discuss the validity of the obesity p...
Source: Current Respiratory Care Reports - February 6, 2017 Category: Respiratory Medicine Source Type: research
Blood Patch for Pneumothorax: a Literature Review
This article reviewed the existing literature for the use of autologous blood patch in patients with a pneumothorax.Recent findingsIntra-pleural instillation of autologous blood for pneumothorax has been advocated in numerous case reports, case series, retrospective and prospective studies, often with very promising results. However, high-quality randomised evidence remains lacking. There is no standard approach to the application and delivery method of autologous blood patch, and its underlying mechanism is debated.SummaryAutologous blood patch for persistent air leak in pneumothorax is efficacious, readily available, che...
Source: Current Respiratory Care Reports - February 1, 2017 Category: Respiratory Medicine Source Type: research
Identifying nutritional risk in critical illness
AbstractPurpose of reviewWhile several tools are available to quantify nutritional risk in clinical practice, most of these consider all critically ill patients to be at equally high risk despite clear evidence that ICU patients express a range of responses to nutritional therapy.Recent findingsRecent studies indicate that patients at high nutritional risk benefit the most from aggressive nutritional intervention compared to those with lower risk. This association is most pronounced in patients with a body mass index (BMI) below 25 or greater than 35, with less benefit observed in patients with a BMI between 25 and 35. Add...
Source: Current Respiratory Care Reports - January 31, 2017 Category: Respiratory Medicine Source Type: research
Idiopathic Pleuroparenchymal Fibroelastosis
AbstractPurpose of the reviewIdiopathic pleuroparenchymal fibroelastosis (IPPFE) is a rare fibrosing lung disease, affecting the visceral pleura and the subpleural parenchyma with an upper lobe predilection, included as a distinct clinicopathologic entity in the latest international multidisciplinary classification of the idiopathic interstitial pneumonias (IIP). We aim to summarize the current evidence on IPPFE, in terms of clinical features and potential treatments.Recent findingsOverall, there is increasing awareness of PPFE in association with a separate ILD pattern. Although an agreed consensus on diagnosis has yet to...
Source: Current Respiratory Care Reports - January 26, 2017 Category: Respiratory Medicine Source Type: research
Thoracic Ultrasound: What Non-radiologists Need to Know
AbstractPurpose of reviewThe aim of this review is to provide the theoretical and practical knowledge essential for non-radiologists to develop the skills necessary to apply thoracic ultrasound as an extension of clinical assessment and intervention.Recent findingsIssues relating to training and competence are discussed and a library of thoracic ultrasound videos is provided to illustrate artefacts, pleural, parenchymal and pneumothorax pathology as well as important pitfalls to consider. Novel and future diagnostic applications of thoracic ultrasound in the setting of acute cardiorespiratory pathology including consolidat...
Source: Current Respiratory Care Reports - January 26, 2017 Category: Respiratory Medicine Source Type: research
Chest Drain Size: the Debate Continues
This article reviews the evidence for the treatment efficacy and potential adverse effects of different chest tube sizes.Recent findingsIn a large randomised study, the small difference in pain scores between large and small drains was not clinically significant. However, small-bore chest tubes commonly suffer from blockage or inadvertent removal, and may not be as effective in providing successful pleurodesis for malignant pleural effusions.SummaryAlthough they may be effective in managing pleural infection, and less painful than large drains, small bore drains may be less effective for pleurodesis. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - January 25, 2017 Category: Respiratory Medicine Source Type: research
Persistent, Immunosuppression, Inflammation, Catabolism Syndrome and Diaphragmatic Dysfunction
AbstractPurpose of reviewThe purpose of this review is to explore the relationship between ICU-acquired weakness, diaphragm dysfunction, and persistent immunosuppression, inflammation, catabolism syndrome (PICS), as well as if there are any therapies that can help rehabilitate these patients.Recent findingsLiterature pertaining to PICS is scant, as it is a relatively new description of encompassing chronic multiorgan dysfunction and chronic critical illness. PICS patients invariably have persistent diaphragm dysfunction and ICU-acquired weakness. To better understand how severe each state is and how they are related, the l...
Source: Current Respiratory Care Reports - January 23, 2017 Category: Respiratory Medicine Source Type: research
Empyema in Children: Update of Aetiology, Diagnosis and Management Approaches
AbstractPurpose of ReviewThe global epidemiology and aetiology of empyema in children is changing due to the impact of pneumococcal conjugate vaccine (PCV). The aim of this paper was to review current data on the epidemiology, aetiology and management of childhood empyema.Recent FindingsFollowing the introduction of 7-valent PCV (PCV7),Streptococcus pneumoniae continued to be a major cause of empyema with an increasing incidence in some geographic regions. However, with subsequent introduction of 13-valent PCV (PCV 13), a significant reduction in the incidence of childhood empyema and complicated pneumonia has been reporte...
Source: Current Respiratory Care Reports - January 18, 2017 Category: Respiratory Medicine Source Type: research
Primary ciliary dyskinesia
AbstractPrimary ciliary dyskinesia (PCD) is a rare, autosomal recessive disorder of motile cilia that leads to chronic respiratory disease. Current estimate for the prevalence is ∼1 in 15,000–20,000 individuals in the USA; this number is likely to change with increased awareness and improved diagnostic methods. There has been a striking increase in interest in the disease in recent years, leading to an increased understanding of the phenotype. The use of genetic testing has greatly aided the diagnosis of PCD and further helped the understanding of the pathogenesis of the disease. In parallel, the establishment of longi...
Source: Current Respiratory Care Reports - October 24, 2016 Category: Respiratory Medicine Source Type: research
Immunodeficiency and Bronchiectasis
AbstractVarious defects in host immunity predispose a patient to the development of bronchiectasis. The human immunodeficiency virus and hypogammaglobulinemia are two classic examples of host defects resulting in bronchiectasis. Recommendations for work up and therapy in these diseases are discussed. Hyper-immunoglobulin E syndrome has a significant association with bronchiectasis and pulmonary pathology. Antigen processing deficiency and dysregulated adaptive immunity toPseudomonas bacteria are both specific immune deficits that can result in hyperactivity of innate immunity. These interactions are best described as “im...
Source: Current Respiratory Care Reports - October 14, 2016 Category: Respiratory Medicine Source Type: research
Endobronchial ultrasonography (EBUS) using a radial ultrasound miniature probe for peripheral pulmonary lesions: tips and techniques
ConclusionThere are several techniques of EBUS using a guide sheath (EBUS-GS) for getting adequate specimens of PPLs. (Source: Current Respiratory Care Reports)
Source: Current Respiratory Care Reports - October 12, 2016 Category: Respiratory Medicine Source Type: research
Bronchiectasis and connective tissue diseases
AbstractConnective tissue diseases (CTD) encompass a range of heritable and autoimmune conditions that are well known for their systemic effects. While these conditions have been observed to impact the lung in myriad fashion, bronchiectasis remains an often overlooked pulmonary complication, despite the fact that the prevalence of bronchiectasis can be as high as 60 % in patients with rheumatoid arthritis. In this review, we cover the epidemiology and clinical findings of bronchiectasis in autoimmune CTDs such as rheumatoid arthritis and Sjögren’s syndrome and heritable CTDs such as Marfan syndrome and Ehlers-Danlos s...
Source: Current Respiratory Care Reports - October 9, 2016 Category: Respiratory Medicine Source Type: research
