Acute Respiratory Distress Syndrome as a Precursor to Post–Intensive Care Syndrome
More than 6 million patients are cared for in an intensive care unit annually in the United States, and millions more internationally. Acute respiratory failure (ARF) is a common indication for intensive care unit admission, one that afflicts more than half of critically ill patients. Acute respiratory distress syndrome (ARDS) is a severe, life-threatening form of ARF. With advances in care over the last 50 years, the majority of ARF and ARDS patients survive. The survivorship literature is largely one that describes functional impairments and reduced quality of life after critical illness. In this review article, we put f...
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Pulmonary Vasculitides: A Review
Vasculitides are uncommon diseases that target multiple sites of the respiratory tract. Their manifestations vary widely, ranging from the banal (cough, rash) to life threatening (renal failure, diffuse alveolar hemorrhage). Small-vessel, antineutrophil cytoplasmic antibody–associated vasculitides are the principal forms affecting the lungs. Less often, larger vessel and immune-complex vasculitides afflict the respiratory tract, although the management of these conditions often mirrors that of the antineutrophil cytoplasmic antibody–associated vasculitides with immunosuppression and supplemental modalities such as plas...
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
Rituximab in Connective Tissue Disease–associated Interstitial Lung Disease: A Community-based Experience and Review of Literature
Interstitial lung disease (ILD) is an important manifestation of the connective tissue disorders (CTD), which can lead to significant morbidity and mortality. Conventional therapy involves immunosuppression. Rituximab (RTX), a chimeric monoclonal antibody leading to B-cell depletion, appears to have some benefit in different forms of CTD-ILD. Our community-based, university-affiliated ILD clinic receives referrals from various medical practitioners in the community, including non-university based rheumatologists. The approach to the assessment and management of these patients is multidisciplinary and involves discussions w...
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
Does Therapy With Adjuvant Corticosteroids Change Outcomes in Pneumocystis Pneumonia in Patients Without HIV?
Synopsis: Corticosteroids in Pneumocystis pneumonia without associated human immunodeficiency virus have long been controversial. However, recent literature is demonstrating that they may have no benefit, but rather cause an increase in morbidity.
Source: Wieruszewski PM, Barreto JN, Frazee E, et al. Early corticosteroids for Pneumocystis pneumonia in adults without human immunodeficiency virus are not associated with better outcome. Chest 2018;154(3):636–644. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Does Dose Matter in Intravenous Thrombolysis for Acute Pulmonary Embolism?
Synopsis: In a retrospective analysis of intensive care unit patients using voluntarily reported national data, half-dose intravenous tissue plasminogen activator (tPA) for acute pulmonary embolism increased the need for escalation of care when compared with full-dose intravenous tPA. There was a lower risk of bleeding for half-dose tPA.
Source: Kiser TH, Burnham EL, Clark B, et al. Half-dose versus full-dose alteplase for treatment of pulmonary embolism. Crit Care Med. 2018;46(10). (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Pulmonary Fat Embolism Syndrome After Liposuction Surgery
We present the case of a 52-year-old woman who developed FES as a complication of liposuction of the axilla, pectoris, and back. This case presents the typical radiologic findings in a patient with liposuction-induced FES. With the growing number of liposuction procedures, it is important for physicians to become aware of the fact that liposuction is not a risk-free procedure. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Primary Tracheal Lymphoma as a Rare Cause of Focal Tracheal Stenosis in an HIV-negative Patient
A human immunodeficiency virus negative, 71-year-old man who presented with a stridorous cough was found to have a focal tracheal stenosis associated with regional lymphadenopathy on chest computed tomography. On direct inspection, tracheal lesions were noted and biopsied with a 2.4 mm cryoprobe, establishing the diagnosis of primary tracheal lymphoma. The patient subsequently received chemotherapy, with clinical and imaging improvement of the tracheal stenosis. This case highlights a very rare cause for tracheal lesions and the use of cryoprobe over forceps biopsy as a tool to facilitate optimal tissue acquisition and d...
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Myth: For Bronchoscopy Training in the 21st Century, there is a Standard Curriculum or Metrics for EBUS-TBNA Bronchoscopy Education With Good Supporting Evidence
Lung cancer-related deaths in the United States in 2015 totaled 153,718, which is equivalent to a major catastrophe such as a Boeing 777 aircraft crashing and killing 550 passengers every 1.5 days per year. Lung cancer is the third most common cancer after breast cancer (for women) and prostate cancer (for men). In 2015, there were 218,527 new cases of lung cancer diagnosed in the United States. The large incidence and mortality of this malignancy makes it essential for efficient, accurate, and timely diagnosis via minimally invasive methods for lung cancer as well as staging. It is, therefore, of utmost importance to adeq...
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Clinical Myths And Evidence-based Medicine Source Type: research
Septic Pulmonary Embolism: A Case Series, Proposed Set of Diagnostic Criteria, and Review of the Literature
We report on 4 cases of septic pulmonary embolism and provide a comprehensive review of this important entity. We also propose a modified set of diagnostic criteria in order to evaluate suspected cases clinically and confirm this diagnosis. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Acute Respiratory Distress Syndrome as a Precursor to Post–Intensive Care Syndrome
More than 6 million patients are cared for in an intensive care unit annually in the United States, and millions more internationally. Acute respiratory failure (ARF) is a common indication for intensive care unit admission, one that afflicts more than half of critically ill patients. Acute respiratory distress syndrome (ARDS) is a severe, life-threatening form of ARF. With advances in care over the last 50 years, the majority of ARF and ARDS patients survive. The survivorship literature is largely one that describes functional impairments and reduced quality of life after critical illness. In this review article, we put f...
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Pulmonary Vasculitides: A Review
Vasculitides are uncommon diseases that target multiple sites of the respiratory tract. Their manifestations vary widely, ranging from the banal (cough, rash) to life threatening (renal failure, diffuse alveolar hemorrhage). Small-vessel, antineutrophil cytoplasmic antibody–associated vasculitides are the principal forms affecting the lungs. Less often, larger vessel and immune-complex vasculitides afflict the respiratory tract, although the management of these conditions often mirrors that of the antineutrophil cytoplasmic antibody–associated vasculitides with immunosuppression and supplemental modalities such as plas...
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
Rituximab in Connective Tissue Disease–associated Interstitial Lung Disease: A Community-based Experience and Review of Literature
Interstitial lung disease (ILD) is an important manifestation of the connective tissue disorders (CTD), which can lead to significant morbidity and mortality. Conventional therapy involves immunosuppression. Rituximab (RTX), a chimeric monoclonal antibody leading to B-cell depletion, appears to have some benefit in different forms of CTD-ILD. Our community-based, university-affiliated ILD clinic receives referrals from various medical practitioners in the community, including non-university based rheumatologists. The approach to the assessment and management of these patients is multidisciplinary and involves discussions w...
Source: Clinical Pulmonary Medicine - January 1, 2019 Category: Respiratory Medicine Tags: Interstitial, Inflammatory & Occupational Lung Disease Source Type: research
Is Procalcitonin No Longer Relevant for Guiding Antibiotic Use for Lower Respiratory Tract Infections?
Synopsis: In this multicenter randomized trial, the utility of procalcitonin assay results for decreasing antibiotic use in lower respiratory tract infections was investigated. Emergency department and hospital-based clinicians were provided with procalcitonin assay results and instructions on their interpretation for a group of patients presenting with lower respiratory tract infections whose need for antibiotics was still uncertain. The provision of these results and the instruction on their utility did not result in less antibiotic use compared with usual care.
Source: Huang DT, Yealy DM, Filbin MR et al. Procalcitonin...
Source: Clinical Pulmonary Medicine - November 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
What’s the Risk? Varenicline May Increase Cardiovascular Complications in Users
Synopsis: Data are mixed and controversial with regard to the literature on varenicline causing increased cardiovascular complications. The authors of this study determined that there may be a 34% higher risk of cardiovascular complications associated with the use of varenicline, compared with no use.
Source: Gershon AS, Campitelli MA, Hawken S, et al. Cardiovascular and neuropsychiatric events after varenicline use for smoking cessation. Am J Respir Crit Care Med. 2018;197:913–922. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - November 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
A Rare Etiology for an Endobronchial Lesion
Solitary pulmonary nodules are a frequent finding at thoracic imaging studies. Most solitary pulmonary nodules are the result of malignancy—either primary lung malignancies or solitary metastases—or infections, particularly granulomatous infections. Lesions arising from a bronchus are less common causes of solitary pulmonary nodules at thoracic imaging studies; most such lesions represent malignancies arising from the airways, such as carcinoid tumors and minor salivary gland tumors. Primary endobronchial neoplasms, both benign and malignant, often have a similar appearance at imaging studies, particularly thoracic com...
Source: Clinical Pulmonary Medicine - November 1, 2018 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
