Update on the Utility and Safety of Flexible Bronchoscopy in the Intensive Care Unit
Flexible bronchoscopy is a procedure that is utilized in many settings including the intensive care unit. In this patient population, it can be challenging given that most may have a significant illness or require certain therapies such as mechanical ventilation with high airway pressure or require anticoagulation that increases the risk of a complication with the procedure. This review focuses on the utility and safety of bronchoscopy as a diagnostic and therapeutic tool in critically ill patients. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Critical Care/Topics Source Type: research
Occupational Hypersensitivity Pneumonitis: What Is the Evidence, When to Think of It, and What to Do
Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is a relatively rare condition with a variable natural history (acute, subacute, or chronic) and fairly nonspecific features. Patients present with pulmonary symptoms with or without constitutional disturbance. HP can be caused by >300 different agents, which broadly comprise microbial agents (bacteria, fungus), animal antigens, and chemicals, and exposure to these agents may occur in occupational settings—the focus of this article—or elsewhere. HP, particularly due to occupational exposures, is underdiagnosed due to a lack of awareness of the conditi...
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Interstitial, Inflammatory, and Occupational Lung Disease Source Type: research
Macrolides for Reducing Acute Exacerbations of Chronic Obstructive Pulmonary Disease: New Evidence
In the natural course of chronic obstructive pulmonary disease (COPD), exacerbations are important events influencing the outcome. Pharmacological and nonpharmacological interventions are available to reduce the exacerbation frequency. Despite these strategies to reduce exacerbations of COPD, there is still a subgroup of COPD patients who are experiencing exacerbations of COPD. Macrolide antibiotics may be an alternative therapy in this distinct subgroup of patients. This review describes the current understanding of the value of maintenance therapy with macrolides to reduce COPD exacerbations, according to recent studies....
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Cytomegalovirus Reactivation in Intensive Care Unit Patients: Should It Be Treated?
In the past 2 decades, numerous studies have reported viral “nosocomial” infections in nonimmunocompromised intensive care unit (ICU) patients. These infections are mainly reactivation of viruses from the herpes group, and especially the cytomegalovirus (CMV). Although these viral reactivations had often been discussed with the assumption that they were only the marker of the severity of patients’ illness rather than a real disease, several studies and meta-analyses then suggested that they may represent an independent risk factor for the mortality and the major morbidity in ICU patients. Hence, this situation may cr...
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Antimicrobial Stewardship (AMS) in the Community
The importance of improving outpatient antibiotic use is acknowledged, but no comprehensive recommendations to curb the use in this setting have been made because of the lack of sufficient data to guide such efforts. A targeted application of antimicrobial stewardship (AMS) principles to the ambulatory setting has the potential to affect the most common indications for systemic antibiotic use in that the majority (80%) of antibiotic use occurs in the community, with acute respiratory-tract infections being the most common indication. However, the reasons driving the excessive prescription of antibiotics in the community ar...
Source: Clinical Pulmonary Medicine - December 22, 2015 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Budesonide/Formoterol Therapy Increases FEV1 in Stem Cell Transplant–associated Bronchiolitis Obliterans Syndrome
Synopsis: In patients with mild to severe bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation, the administration of inhaled budesonide\formoterol led to a significant improvement in FEV1.
Source: Bergeron A, Chevret S, Chagnon K, Godet C, Bergot E, Peffault de Latour R, Dominique S, de Revel T, Juvin K, Maillard N, et al. Budesonide/formoterol for bronchiolitis obliterans after hematopoietic stem cell transplantation. Am J Respir Crit Care Med. 2015;191(11):1242–1249. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
The Addition of Prednisone to Antibiotics for the Treatment of Community-acquired Pneumonia May Shorten the Time to Clinical Stability
Synopsis: In patients admitted to the hospital for community-acquired pneumonia, the use of prednisone for 7 days led to a shorter time to clinical stability, defined by vital sign stability for 24 hours, and an overall reduction in the length of hospital stay, with a higher incidence of hyperglycemia needing insulin, but without a difference in pneumonia-related complications at 30 days after randomization when compared with placebo.
Source: Blum CA, Nigro N, Briel M, et al. Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomized, placebo-controlled trial. Lancet....
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Diagnostic Performance of a Genomic Classifier for Lung Cancer
Synopsis: The addition of a novel genomic classifier to standard bronchoscopy for the evaluation of lung canner improved diagnostic performance regardless of the size, location or stage of the lesion.
Source: Silvestri G, Vachani A, Whitney D, et al. A bronchial genomic classifier for the diagnostic evaluation of lung cancer. N Engl J Med. 2015;373:243–251. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Imaging Studies for Pulmonary Vascular Disease
This article reviews the role of imaging in a variety of pulmonary vascular diseases, highlighting advantages and disadvantages, as well as illustrating imaging findings of these diseases. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Focused Cardiac Ultrasound in the Emergency Department for Patients Admitted With Respiratory Symptoms
This article gives a practical guide and an overview of some of the current concepts of using focused cardiac US in patients admitted with respiratory symptoms. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
The Utility of Bronchoscopy for the Placement of Fiducial Markers for Stereotactic Body Radiotherapy
Stereotactic body radiotherapy is a common method to treat early-stage lung cancer in nonoperable patients. Many of these devices rely on fiducial markers to help guide the therapy and must be placed in or around the target lesion. This review will focus on the utility of bronchoscopy for placing these markers. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Colleagues in Respiratory Medicine Source Type: research
The Role of Biomarkers for Starting Antifungals in the Intensive Care Unit
Invasive candidiasis is associated with high mortality rates (35% to 60%), similar to the range reported for septic shock. The most common types include candidemia, frequently observed in immunocompromised patients, and noncandidemic systemic candidiasis, which constitutes the majority of cases in critically ill patients. However, they are difficult to prove and a definite diagnosis usually occurs late in the course of the disease, thus contributing to their bad prognosis. Early empirical treatment improves the prognosis and currently relies on the positive predictive value (PPV) of risk-assessment strategies (colonization...
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Surgical and Bronchoscopic Lung Volume Reduction Treatment for α-1 Antitrypsin Deficiency
α-1 antitrypsin deficiency (AATD) is an underrecognized cause of emphysema with associated hyperinflation and compromised quality of life. Lung volume reduction surgery for AATD has been reported in a small number of series. In general, the magnitude and duration of benefit of lung volume reduction surgery for AATD is smaller and briefer in AATD than in α-1 antitrypsin-replete chronic obstructive pulmonary disease. Nonsurgical approaches to lung volume reduction have included various endobronchial approaches, including valves, glue, and steam. Endobronchial valves have been shown to confer benefit in chronic obstructive ...
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
Pneumonia and Host Defense in the Elderly
The population worldwide continues to age, with those over the age of 80 years constituting the fastest-growing sector of the population. As one ages, infectious complications become more frequent, leading to higher rates of hospitalization. This is also true for the lung, where pneumonia is one of the most frequent causes for hospitalization in the elderly and is the number 3 cause of death in the United States. Several unique changes occur with aging, both in the structure and the function of the respiratory system itself and in the immune system, which increase the predisposition and the potential severity of pneumonia ...
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
The PES (Pseudomonas, Enterobacteriaceae ESBL, Methicillin-resistant Staphylococcus aureus) Concept in Community-acquired Pneumonia
One of the main concerns about the management of community-acquired pneumonia (CAP) is to choose an adequate empirical antibiotic treatment. Patients with CAP usually respond to the standard antibiotics suggested by CAP guidelines; however, a small percentage of patients need a different and more aggressive treatment because of the presence of resistant pathogens. The critical point is to identify this small subgroup of CAP patients and to avoid the overtreatment of the remaining CAP patients. Therefore, it is important to create a tool to stratify patients at risk for resistant pathogens. The definition of health care–a...
Source: Clinical Pulmonary Medicine - October 31, 2015 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
