The IMPACT of Endobronchial Valve Therapy for Patients With Severe Homogenous Emphysema
Synopsis: Bronchoscopic placement of a 1-way endobronchial valve in patients with homogenous emphysema without collateral ventilation resulted in improvements in lung function, exercise capacity, and quality of life.
Source: Valipour A, Slebos, D, Herth F, et al. Endobronchial valve therapy in patients with homogeneous emphysema: results from the IMPACT study. Am J Respir Crit Care Med. 2016; 194(9):1073–1082. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Pulmonary Varix: An Uncommon Pulmonary Vascular Anomaly
Pulmonary varices are rare lesions reflecting localized dilation of one or more pulmonary veins. These anomalies are rare, with (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2017 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Interventional Bronchoscopy for COPD
Novel bronchoscopic therapies for patients with chronic obstructive pulmonary disease are under development to target hyperinflation and airways disease. Of the lung volume reduction treatments, endobronchial valves have been the most successful when implanted in patients with severe heterogenous and homogenous emphysema without collateral ventilation. Endobronchial coils have proved beneficial in patients with heterogenous and homogenous emphysema including those with collateral ventilation: randomized controlled trials have shown modest benefit. Sealants and vapor therapy offer the possibility of a segmental approach tar...
Source: Clinical Pulmonary Medicine - March 1, 2017 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Diagnostic Utility of Transbronchial Cryobiopsy in Interstitial Lung Disease
Interstitial lung disease is a heterogenous group of disorders characterized by varying patterns of inflammation and fibrosis. Its diagnosis requires a multidisciplinary approach including clinical and imaging correlation, but atypical presentations and imaging warrant tissue biopsy. Transbronchial forceps biopsy has a low yield and is not recommended for diagnosis. Although considered as the gold standard, surgical lung biopsy is associated with significant morbidity and mortality. Transbronchial cryobiopsy is a relatively newer technique, but only limited data are available to establish its utility in diagnosing intersti...
Source: Clinical Pulmonary Medicine - March 1, 2017 Category: Respiratory Medicine Tags: Interstitial, Inflammatory, Occupational Lung Disease/Interventional Pulmonary Medicine Source Type: research
Tranexamic Acid for Hemoptysis: A Review
Tranexamic acid (TXA) is an antifibrinolytic agent used to promote hemostasis. TXA is widely used to arrest bleeding in trauma, perioperatively after cardiac surgery, for menorrhagia, and in hemophilia. Less attention has been given to using TXA to lessen hemoptysis, which is the subject of this systematic review. Three small, underpowered randomized controlled trials have examined the efficacy of TXA in hemoptysis. Two of these assessed intravenous TXA, one of which showed significant reduction in the severity and duration of hemoptysis. The third trial examined oral TXA for controlling hemoptysis and failed to show a sig...
Source: Clinical Pulmonary Medicine - March 1, 2017 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Chylothorax: A Review of Management Options
Chylothorax is a rare condition caused by obstruction or injury to the thoracic duct leading to accumulation of chyle in the pleural cavity. A definitive guideline for management is lacking and most cases are managed with a staged care plan that moves from the least invasive options to more invasive interventions. First-line therapy consists of treatment of underlying conditions, pleural drainage to control symptoms, and dietary modifications. Surgical measures including pleurodesis and thoracic duct ligation are pursued if conservative measures are ineffective. In recent times, percutaneous image-guided interventions such...
Source: Clinical Pulmonary Medicine - March 1, 2017 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Updates in Advanced Diagnostic Bronchoscopy: Electromagnetic Navigational Bronchoscopy Chasing the Solitary Pulmonary Nodule
Evaluation of the solitary pulmonary nodule has been limited with standard bronchoscopic approaches. The addition of advanced imaging, endobronchial ultrasound and virtual bronchoscopy has improved the bronchoscopic assessment of these lesions. Electromagnetic navigational bronchoscopy is one of the newer devices that creates a 3-dimensional reconstruction of the patient’s anatomy based on a computed tomography scan of the chest, which with electromagnetic technology can combine the virtual image with the patient’s actual anatomy at the time of the procedure and thus guide tissue collection from the pulmonary nodule. T...
Source: Clinical Pulmonary Medicine - March 1, 2017 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Diagnostic Utility of Bronchoalveolar Lavage in Patients Suspected to Have Pulmonary Tuberculosis: A Literature Review
Patients who are suspected to have pulmonary tuberculosis but are unable to produce sputum spontaneously or have smear-negative sputum present a diagnostic challenge. Clinicians vary in their practice in proceeding with sputum induction or flexible bronchoscopy in this clinical scenario. This manuscript reviews and compares the evidence behind the diagnostic utilities of both of these modalities. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - March 1, 2017 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Inhaled Mannitol in the Diagnosis and the Management of Asthma: Erratum
No abstract available (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Erratum Source Type: research
Continuous Positive Airway Pressure Does Not Prevent Cardiovascular Events in Patients With Moderate-to-Severe Sleep Apnea and Cardiovascular Disease
Synopsis: In patients with moderate-to-severe sleep apnea and coronary or cerebral vascular disease, treatment with continuous positive airway pressure, when compared with usual care, did not significantly reduce cardiovascular events. Continuous positive airway pressure significantly reduced daytime sleepiness and days of missed work due to poor health, and improved mood and health-related quality-of-life scores.
Source: McEvoy R, Antic N, Heely E, et al. CPAP for prevention of cardiovascular events in obstructive sleep apnea. N Engl J Med. 2016;375:919–931. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Fluticasone Furoate-Vilanterol Decreases COPD Exacerbations in a Pragmatic Trial
This study demonstrates that fluticasone furoate-vilanterol reduces Chronic Obstructive Pulmonary Disease exacerbations compared with usual care when studied in a real-world primary care setting.
Source: Vestbo J, Leather D, Bakerly ND, New J et al. Effectiveness of fluticasone furoate-vilanterol for COPD in clinical practice. N Engl J Med. 2016. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Chest Tubes: Indications, Sizing, Placement, and Management
Despite a significant array of published literature on chest tubes, there are few definitive data, making evidence-based recommendations challenging. In 2010, the British Thoracic Society came up with a definitive set of guidelines on many topics involving chest tubes, but a follow-up on the guidelines showed a (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Clinical Myths & Evidence-Based Medicine Source Type: research
A Rare Cause of Right Ventricular Failure
Metastatic disease may affect the thorax in a number of different ways, most commonly in the form of lung nodules, lymph node enlargement, pleural effusion, and osseous lesions. Much less commonly, extrathoracic malignancies may embolize to the lungs. Large vessel tumor emboli may be detected in thoracic imaging studies as pulmonary arterial filling defects or as “beaded”-appearing pulmonary vessels. Occasionally, tumor embolization may affect only the small pulmonary arteries and may induce fibrocellular intimal hyperplasia and produce thrombotic vascular occlusion, resulting in increased pulmonary vascular resistance...
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
ICU Admissions From the Emergency Department on Holidays and Weekends
Emergency hospital admissions for respiratory diseases are sharply reduced by 18% on Christmas Day compared with the admissions on previous days, according to a single report based on data from the Office of National Statistics in England. Respiratory admissions and respiratory deaths increase above the trend on the next and subsequent days. We hypothesized that intensive care unit (ICU) admissions from the emergency department (ED) decrease during holidays and increase immediately after. We retrospectively reviewed the electronic medical records of ICU admissions from the ED during, before, and after major holidays at the...
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Effects of Pulmonary Hypertension on Kidney Function
There is a scarcity of data defining hemodynamic correlates of renal function in pulmonary hypertension (PH). The aim of this study was to assess the correlation between standard and novel hemodynamic indices, including the pulmonary artery pulsatility index (PAPi) and the right atrial to pulmonary capillary wedge pressure (RA:PCWP) ratio, and renal function in PH. We conducted a retrospective study of adult patients with PH diagnosed by right-heart catheterization (RHC) between January 2007 and October 2012 at Einstein Medical Center, Philadelphia. Patients with end-stage renal disease were excluded. Pulmonary artery puls...
Source: Clinical Pulmonary Medicine - January 1, 2017 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
