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Malignant Central Airway Obstruction: What's New?
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1748187Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and li...
Source: Seminars in Respiratory and Critical Care Medicine - June 2, 2022 Category: Respiratory Medicine Authors: Shaller, Brian D. Filsoof, Darius Pineda, Jorge M. Gildea, Thomas R. Tags: Review Article Source Type: research

Mechanical Ventilation in the Critically Ill Patient
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1749449 Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - June 1, 2022 Category: Respiratory Medicine Authors: Li Bassi, Gianluigi Laffey, John G. Tags: Review Article Source Type: research

Endoscopic Options for Moderate COPD, Chronic Bronchitis, and Uncontrolled Asthma
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1747939Until now, interventional therapies for patients with chronic obstructive pulmonary disease have been available in the form of lung volume reduction procedures as end-stage options. Currently, the range of indications is expanding to include earlier stages of the diseases. Lung denervation is available for moderate COPD, and patients with chronic bronchitis are being evaluated for endoscopic goblet cell ablation. Rheoplasty, metered spray cryo technique, and Karakoca resector balloon are used for this indication. But also, for patients with severe uncontrolled asthma, s...
Source: Seminars in Respiratory and Critical Care Medicine - June 1, 2022 Category: Respiratory Medicine Authors: Herth, Felix J.F. Kontogianni, Konstantina Brock, Judith Tags: Review Article Source Type: research

Prone Positioning and Neuromuscular Blocking Agents as Adjunctive Therapies in Mechanically Ventilated Patients with Acute Respiratory Distress Syndrome
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1744304Neuromuscular blocking agents (NMBAs) and prone position (PP) are two major adjunctive therapies that can improve outcome in moderate-to-severe acute respiratory distress syndrome. NMBA should be used once lung-protective mechanical ventilation has been set, for 48 hours or less and as a continuous intravenous infusion. PP should be used as early as possible for long sessions; in COVID-19 its use has exploded. In nonintubated patients, PP might reduce the rate of intubation but not mortality. The goal of this article is to perform a narrative review on the pathophysio...
Source: Seminars in Respiratory and Critical Care Medicine - May 29, 2022 Category: Respiratory Medicine Authors: Gu érin, Claude Cour, Martin Argaud, Laurent Tags: Review Article Source Type: research

Management of Malignant Pleural Effusion: Where Are We Now?
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1748185Pleural malignancies are among the most common causes of pleural disease and form the basis of our daily pleural practice. There has been significant research and increase in both diagnostic and therapeutic management of malignant pleural diseases in the last decade. Good-quality data have led to a paradigm shift in the management options of pleural malignancies, and indwelling pleural catheter is now recommended and widely used as first-line intervention. Several trials compared different treatment modalities for pleural malignancies and continue to emphasize the need ...
Source: Seminars in Respiratory and Critical Care Medicine - May 25, 2022 Category: Respiratory Medicine Authors: Guinde, Julien Dutau, Herv é Astoul, Philippe Tags: Review Article Source Type: research

Interventional Pulmonology and Esophagus: Combined Endobronchial Ultrasound and Endoscopic Ultrasound for Mediastinal Staging
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1748764Endoscopic ultrasound (EUS) techniques in addition to endobronchial ultrasound (EBUS) can lead to diagnosis and complete accurate staging of the mediastinum in a single session. This allows for decreased health care costs, less delay in diagnosis and treatment, reduced patient discomfort, and decreased morbidity compared with invasive surgical staging techniques. In comparison to conventional mediastinoscopy, the cost-effectiveness and reduced complication profile of the endoscopic approach has made this a superior initial step in the staging and diagnosis of lung cance...
Source: Seminars in Respiratory and Critical Care Medicine - May 16, 2022 Category: Respiratory Medicine Authors: Khalid, Sameeha Hegde, Pravachan Tags: Review Article Source Type: research

Bronchoscopic Lung Volume Reduction for Emphysema: Review and Update
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1747938In carefully selected patients with severe chronic obstructive pulmonary disease, characterized by emphysema and hyperinflation, lung volume reduction is an option to reduce lung hyperinflation, improve lung function, quality of life, and exercise capacity. Currently, there are several bronchoscopic and surgical treatment options to achieve lung volume reduction. It is important to carefully phenotype these patients, to select the optimal treatment option, with consideration of possible adverse events or contraindications, and it is highly recommended to discuss these t...
Source: Seminars in Respiratory and Critical Care Medicine - May 13, 2022 Category: Respiratory Medicine Authors: Koster, T. David Dijk, Marlies Van Slebos, Dirk-Jan Tags: Review Article Source Type: research

Therapeutic Gases and Inhaled Anesthetics as Adjunctive Therapies in Critically Ill Patients
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1747966The administration of exogenous oxygen to support adequate gas exchange is the cornerstone of respiratory care. In the past few years, other gaseous molecules have been introduced in clinical practice to treat the wide variety of physiological derangement seen in critical care patients.Inhaled nitric oxide (NO) is used for its unique selective pulmonary vasodilator effect. Recent studies showed that NO plays a pivotal role in regulating ischemia-reperfusion injury and it has antibacterial and antiviral activity.Helium, due to its low density, is used in patients with up...
Source: Seminars in Respiratory and Critical Care Medicine - May 9, 2022 Category: Respiratory Medicine Authors: Gianni, Stefano Valsecchi, Carlo Berra, Lorenzo Tags: Review Article Source Type: research

An Update on Cardiorespiratory Physiotherapy during Mechanical Ventilation
This article provides an update of cardiorespiratory physiotherapy for patients receiving mechanical ventilation in ICU. Common and some more novel assessment tools and treatment options are described, along with the mechanisms of action of the treatment options and the evidence and physiology underpinning them. The aim is not only to summarize the current state of cardiorespiratory physiotherapy but also to provide information that will also hopefully help support clinicians to deliver personalized and optimal patient care, based on the patient's unique needs and guided by accurate interpretation of assessment findings an...
Source: Seminars in Respiratory and Critical Care Medicine - April 22, 2022 Category: Respiratory Medicine Authors: Tronstad, Oystein Mart í, Joan-Daniel Ntoumenopoulos, George Gosselink, Rik Tags: Review Article Source Type: research

Modeling Mechanical Ventilation In Silico —Potential and Pitfalls
We present new results highlighting the link between model complexity and predictive capability, using data on the responses of individual patients with acute respiratory distress syndrome to changes in multiple ventilator settings. The current limitations and potential of in silico modeling are discussed from a clinical perspective, and future challenges and research directions highlighted. [...] Thieme Medical Publishers, Inc. 333 Seventh Avenue, 18th Floor, New York, NY 10001, USAArticle in Thieme eJournals: Table of contents  |  Abstract  |  Full text (Source: Seminars in Respiratory and Critical Care Medicine)
Source: Seminars in Respiratory and Critical Care Medicine - April 21, 2022 Category: Respiratory Medicine Authors: Hannon, David M. Mistry, Sonal Das, Anup Saffaran, Sina Laffey, John G. Brook, Bindi S. Hardman, Jonathan G. Bates, Declan G. Tags: Review Article Source Type: research

Physiological and Pathophysiological Consequences of Mechanical Ventilation
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1744447Mechanical ventilation is a life-support system used to ensure blood gas exchange and to assist the respiratory muscles in ventilating the lung during the acute phase of lung disease or following surgery. Positive-pressure mechanical ventilation differs considerably from normal physiologic breathing. This may lead to several negative physiological consequences, both on the lungs and on peripheral organs. First, hemodynamic changes can affect cardiovascular performance, cerebral perfusion pressure (CPP), and drainage of renal veins. Second, the negative effect of mechani...
Source: Seminars in Respiratory and Critical Care Medicine - April 19, 2022 Category: Respiratory Medicine Authors: Silva, Pedro Leme Ball, Lorenzo Rocco, Patricia R.M. Pelosi, Paolo Tags: Review Article Source Type: research

Mechanical Ventilation for COVID-19 Patients
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1744305Non-invasive ventilation (NIV) or invasive mechanical ventilation (MV) is frequently needed in patients with acute hypoxemic respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. While NIV can be delivered in hospital wards and nonintensive care environments, intubated patients require intensive care unit (ICU) admission and support. Thus, the lack of ICU beds generated by the pandemic has often forced the use of NIV in severely hypoxemic patients treated outside the ICU. In this context, awake prone positioning has been wide...
Source: Seminars in Respiratory and Critical Care Medicine - April 19, 2022 Category: Respiratory Medicine Authors: Brioni, Matteo Meli, Andrea Grasselli, Giacomo Tags: Review Article Source Type: research

Nutrition in Asthma
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1742385An emerging body of evidence suggests that diet plays an important role in both the development and management of asthma. The relationship between dietary intake and asthma risk has been explored in epidemiological studies, though intervention trials examining the effects of nutrient intake and dietary patterns on asthma management are scarce. Evidence for diets high in fruits and vegetables, antioxidants, omega-3 fatty acids and soluble fiber such as the Mediterranean diet is conflicting. However, some studies suggest that these diets may reduce the risk of asthma, par...
Source: Seminars in Respiratory and Critical Care Medicine - March 10, 2022 Category: Respiratory Medicine Authors: Williams, Evan J. Berthon, Bronwyn S. Stoodley, Isobel Williams, Lily M. Wood, Lisa G. Tags: Review Article Source Type: research

FeNO in Asthma
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1743290Asthma is a common disease affecting 350 million people worldwide, which is characterized by airways inflammation and hyperreactivity. Historically diagnosis and treatment have been mainly based on symptoms, which have the potential to result in misdiagnosis and inappropriate treatment. Nitric oxide (NO) is exhaled in human breath and is a marker of airways inflammation. Levels of NO are increased in the exhaled breath of patients with type 2 asthma and fractional exhaled nitric oxide (FeNO) provides an objective biomarker of airway inflammation. FeNO testing is an acce...
Source: Seminars in Respiratory and Critical Care Medicine - March 4, 2022 Category: Respiratory Medicine Authors: Loewenthal, Lola Menzies-Gow, Andrew Tags: Review Article Source Type: research

Imaging in Asthma Management
Semin Respir Crit Care Med DOI: 10.1055/s-0042-1743289Asthma is a heterogeneous disease characterized by chronic airway inflammation that affects more than 300 million people worldwide. Clinically, asthma has a widely variable presentation and is defined based on a history of respiratory symptoms alongside airflow limitation. Imaging is not needed to confirm a diagnosis of asthma, and thus the use of imaging in asthma has historically been limited to excluding alternative diagnoses. However, significant advances continue to be made in novel imaging methodologies, which have been increasingly used to better understand respi...
Source: Seminars in Respiratory and Critical Care Medicine - February 24, 2022 Category: Respiratory Medicine Authors: Niedbalski, Peter J. Choi, Jiwoong Hall, Chase S. Castro, Mario Tags: Review Article Source Type: research