Bronchoscopically Placed Dye Marking for Minimally Invasive Thoracic Surgery: A Surgeon’s Perspective
Small and nonsolid peripheral lung lesions pose a difficult diagnostic problem for surgeons and pulmonologists. Utilizing electromagnetic navigation bronchoscopy with dye marking of these lesions may improve the ability of the surgeon to resect via minimally invasive means. The authors present the rationale behind the use of dye marking via navigation bronchoscopy as well as their preferred method and case examples to demonstrate the technique. In addition, a systematic literature search was performed in PubMed using the terms “navigation bronchoscopy,” “dye marking,” and “lung nodules,” and a literature review...
Source: Clinical Pulmonary Medicine - November 1, 2017 Category: Respiratory Medicine Tags: Topics/Interventional Pulmonary Medicine Source Type: research
Sjögren’s Syndrome-Associated Lung Disease
Primary Sjögren syndrome (pSS) is an autoimmune disease that is characterized by oral and ocular sicca but is also recognized to have frequent pulmonary involvement. pSS can impact the respiratory tract, with manifestations extending from the large airways to interstitial lung disease. The pathogenesis of pSS-related lung involvement is thought to involve an interplay of the innate and adaptive immune system. Therapy for treatment of pulmonary manifestations of pSS ranges from supportive measures to systemic immunosuppression. The purpose of this review is to provide an overview of the epidemiology, pathogenesis, and trea...
Source: Clinical Pulmonary Medicine - November 1, 2017 Category: Respiratory Medicine Tags: Interstitial, Inflammatory and Occupational Lung Disease Source Type: research
Factors Determining the Quality of Life of Patients With COPD: A Review
Predictors of health-related quality of life (HRQL) were controversial in the literature. To this end, we conducted a review to describe predictors of HRQL in patients with chronic obstructive pulmonary disease. The search comprised all the articles published until the end of 2016, which are consistent with our inclusion criteria. These factors could be structured into 5 groups: demographic factors, comorbidity, factors related to the disease, psychological factors, and other factors. The most common predictors of HRQL of chronic obstructive pulmonary disease patients were age, severity stage of the disease, dyspnea grade,...
Source: Clinical Pulmonary Medicine - November 1, 2017 Category: Respiratory Medicine Tags: Clinical Practice Management/Topics Source Type: research
One-Third of Patients With “Asthma” in the Community May Not Currently Have Asthma
Synopsis: One-third of patients with physician-diagnosed asthma did not have active asthma when evaluated with serial assessment of symptoms, spirometry, and bronchial provocation tests upon discontinuation of asthma medications, which can be attributed to diagnostic inaccuracy or spontaneous remission.
Source: Aaron S, Vandemheen K, FitzGerald J, et al. Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA. 2017;317(3):269–279. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
The Physiological Effect of High-flow Nasal Cannula
Synopsis: High-flow nasal cannula is superior to standard facemask oxygen for patients with acute hypoxic respiratory failure. A study by Tommaso Mauri and colleagues examines the physiological changes associated with high-flow nasal cannula, which may explain the unique benefits of this therapy.
Source: Mauri T, Turrini C, Eronia N, et al. Physiologic effects of high-flow nasal cannula in acute hypoxemic respiratory failure. Am J Respir Crit Care Med. 2017;195(9):1207–1215. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Anesthetic Safety During Adult Bronchoscopic Evaluation of Mediastinal Masses
We present a literature review of anesthesia safety during adult bronchoscopy. A thorough evaluation and preparation for such complications should be a focus for the astute bronchoscopist. The planned approach should be individualized to the anatomy of the patient and the location of the mass. Most importantly, a management strategy should be in place for anesthetic-induced airway and hemodynamic catastrophes. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2017 Category: Respiratory Medicine Tags: Clinical Myths and Evidence Based Medicine Source Type: research
Adult-Onset Pulmonary Hypertension Due to Undiagnosed Scimitar Syndrome
Congenital abnormalities may occasionally escape detection during childhood and present in adulthood. In addition, given the advances in pediatric cardiovascular surgical techniques, catheter-based interventions, and advances in medical management, pediatric patients with congenital cardiovascular abnormalities are increasing living well into adulthood and therefore may be increasingly encountered in medical practice. Among congenital cardiovascular abnormalities that may present in adulthood, partial anomalous pulmonary venous return (PAPVR) is not uncommon. Typically incidental in nature, PAPVR may occasionally result in...
Source: Clinical Pulmonary Medicine - September 1, 2017 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Palliative Management and End-of-Life Care in Nonmalignant Advanced Lung Disease
This article aims to discuss the major components and barriers involved in the palliative management and EOL care in ALD. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - September 1, 2017 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine/Clinical Practice Management Source Type: research
Rescue Therapies for Severe Acute Respiratory Distress Syndrome
Refractory hypoxemia is the hallmark of severe acute respiratory distress syndrome. Mechanical ventilation utilizing low-tidal volumes remains the standard of care for these patients; however, correction of the hypoxemia does not always correlate with improved mortality. Nevertheless, clinical management aims at achieving adequate oxygenation while minimizing ventilator-induced lung injury. Continued assessment of the patient’s hemodynamics is required, as acute respiratory distress syndrome is often associated with hemodynamic instability, which may be a significant factor in the high mortality rate reported in this con...
Source: Clinical Pulmonary Medicine - September 1, 2017 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Interstitial Pneumonia With Autoimmune Features: Overview of Proposed Criteria and Recent Cohort Characterization
The accurate diagnosis of interstitial lung disease is essential for optimal prognostication and management. Although connective tissue disease is among the most common causes of interstitial lung disease, some patients have features suggestive of autoimmunity without meeting criteria for a specific connective tissue disease. To help define and study this disease entity more uniformly, a 2015 research statement proposed consensus-based criteria and coined the term “interstitial pneumonia with autoimmune features” (IPAF). In this review, we summarize and compare previously proposed criteria to characterize these patient...
Source: Clinical Pulmonary Medicine - September 1, 2017 Category: Respiratory Medicine Tags: Interstitial, Inflammatory and Occupational Lung Disease Source Type: research
Aerosolized Antibiotics
Aerosolized antibiotics potentially enable delivery of drugs directly at the site of lung infection with limited systemic side effects. Progress in understanding determinants of pharmacokinetics and drug deposition in the lung enable delivery of high antibiotic concentrations in the lung. The present review summarizes experimental and clinical pharmacokinetic and scintigraphic deposition studies evaluating aerosolized antibiotics. Practical implementation of different aerosolization devices is reviewed for delivery to patients breathing spontaneously or undergoing mechanical ventilation. Current clinical indications among ...
Source: Clinical Pulmonary Medicine - September 1, 2017 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Does a Sedation Strategy Including Dexmedetomidine Decrease Mortality and the Need for Mechanical Ventilation in Sepsis?
Synopsis: Septic patients requiring mechanical ventilation did not have decreased mortality or fewer ventilator days if given light sedation that included dexmedetomidine.
Source: Kawazoe Y, Miyamoto K, Morimoto T, et al. Effect of dexmedetomidine on mortality and ventilator-free days in patients requiring mechanical ventilation with sepsis (DESIRE). JAMA. 2017;317(13): 1321–1328. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - June 30, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Pulmonary Rehabilitation Maintenance Program May Prevent Accelerated FEV1 Decline in Patients With COPD
The objective of this study was to investigate the impact of prolonged EMT (>2 y) on patient-centered and functional outcomes.
Methods: A total of 36 subjects (EMT, n=12 and control, n=24) were screened; 6 cases and 17 controls completed the study. All subjects underwent a 6-week PR program. Subjects in the EMT group (but not the control group) underwent additional EMT for at least 2 years. Spirometry and 6-minute walk test were assessed at baseline (post-PR) and post-EMT. All subjects also completed questionnaires (Short Form 36 and health care utilization), underwent exhaled nitric oxide (fraction of exhaled nitric oxid...
Source: Clinical Pulmonary Medicine - June 30, 2017 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Clinical Myths and Legends: Balloon Bronchoplasty for Benign Diseases of the Airway: Erratum
No abstract available (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - June 30, 2017 Category: Respiratory Medicine Tags: Erratum Source Type: research
Conservative Oxygen Therapy Might be Beneficial to Patients in the Intensive Care Unit
Synopsis: In patients admitted to the intensive care unit for 72 hours or longer, conservative oxygen therapy resulted in lower mortality. However, further studies must be conducted to replicate the findings in another study, as this trial was terminated early.
Source: Girardis M, Busani S, Damiani E, et al. Effect of conservative vs. conventional oxygen therapy on mortality among patients in an intensive care unit: the oxygen-ICU randomized clinical trial. JAMA 2016; 316:1583–1589. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - June 30, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
