Clinical Pulmonary Medicine最新文献

{"title":"Bronchoscopy in the Immunosuppressed Patient","authors":"J. L. Forbes, W. B. Meredith, C. Bellinger","doi":"10.1097/CPM.0000000000000301","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000301","url":null,"abstract":"Bronchoscopy in the immunosuppressed patient is routinely undertaken, as mortality of immunosuppressed hosts with pulmonary infiltrates is high. Generally, complications from bronchoscopy are rare, with pneumothorax and respiratory failure being the most serious. Immunosuppressed hosts do not have a higher complication rate than the general patient. In patients with HIV, bronchoscopy should be undertaken even if sputum samples are negative when suspicion is high for Pneumocystis jirovecii or tuberculosis. Patients with a hematologic malignancy have a high incidence of pulmonary infiltrates, and delaying bronchoscopy can significantly reduce the diagnostic yield of a causative agent. Diagnostic testing should include galactomannan levels if the concern is high, even if serum testing is negative. Transbronchial biopsy does not increase the yield of an organism. In patients with stem cell and solid organ transplant, fungal and viral studies including galactomannan should be sent, and diffuse alveolar hemorrhage should be ruled out. Diagnostic bronchoscopy for pulmonary infiltrates in the immunosuppressed host is both a relatively safe and useful tool for increasing identification of an offending pathogen in the setting of a pulmonary infiltrate. Given the high morbidity and mortality associated with many of these disease processes, quick identification and pathology-directed treatment is necessary. Myth: Bronchoscopy in immunosuppressed patients for evaluation of pulmonary infiltrates is a high risk but high yield procedure.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"61–62"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000301","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47144697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: The Doctors are In, but the Jury is Still Out","authors":"D. Wacker","doi":"10.1097/CPM.0000000000000298","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000298","url":null,"abstract":"Despite attempts to optimize outcomes in acute respiratory distress syndrome (ARDS) using mechanical ventilation and medical management, the mortality associated with this syndrome remains very high. The use of extracorporeal membrane oxygenation (ECMO), particularly veno-venous ECMO (VV-ECMO), as a rescue therapy has grown significantly in recent decades. This review outlines the risks and benefits of ECMO for the treatment of ARDS, examines the body of evidence behind this practice, including 4 randomized controlled trials and 2 case-controlled studies, and discusses the remaining questions and directions for future research. Because VV-ECMO is far more frequently used in the treatment of ARDS than veno-arterial ECMO, referral to ECMO in this review will imply VV-ECMO unless specifically stated.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"39–45"},"PeriodicalIF":0.0,"publicationDate":"2019-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000298","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48543859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Vasculitides: A Review","authors":"S. Callahan, J. Sturek, Ryan P. Richard","doi":"10.1097/CPM.0000000000000290","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000290","url":null,"abstract":"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 a","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000290","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48160195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pulmonary Fat Embolism Syndrome After Liposuction Surgery","authors":"M. Saon, D. Walker, G. Nair, S. Al-katib","doi":"10.1097/CPM.0000000000000288","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000288","url":null,"abstract":"Fat embolism syndrome (FES) after liposuction is very rare. Up until now, only 18 cases, including this case, of liposuction-induced FES have been reported. FES is underdiagnosed due to the lack of sensitive and specific laboratory tests and clinical findings. 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.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"32–35"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000288","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61657816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary Tracheal Lymphoma as a Rare Cause of Focal Tracheal Stenosis in an HIV-negative Patient","authors":"Joseph C. Keenan, Ethan E. Dincer, R. Cho","doi":"10.1097/CPM.0000000000000289","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000289","url":null,"abstract":"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 diagnosis.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000289","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42761847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rituximab in Connective Tissue Disease–associated Interstitial Lung Disease: A Community-based Experience and Review of Literature","authors":"A. Gupta, Ria E Gripaldo","doi":"10.1097/CPM.0000000000000287","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000287","url":null,"abstract":"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 with our center’s radiologists, pathologists (as applicable) and the referring rheumatologists (either university-affiliated or community-based). Therapy is initiated or changed in collaboration with the involved rheumatologists. Patients are followed clinically, functionally (using pulmonary function tests and 6-minute-walk testing), and radiologically using high-resolution chest computed tomography scans (HRCT). Among the patients referred to our clinic with CTD-ILD, six of them received RTX primarily for progressive pulmonary disease. The mean age was 51 years. All the patients were women. One patient had mixed connective tissue disease (MCTD), one patient had Sjögren’s syndrome, one patient had polymyositis, one patient had rheumatoid arthritis and two patients had antisynthetase syndrome. Among the six patients, community-based rheumatologists in private practice were managing four. Two patients received RTX prior to referral to our clinic. Four of the six patients demonstrated clinical improvement and stability in their lung function while on RTX. Three of the six patients demonstrated definite radiologic improvements. One patient developed anaphylactic symptoms and one patient developed a life-threatening infection. There is a growing body of medical literature describing the use of RTX in CTD-ILD most of which are from case series and non-controlled studies. In our university-affiliated, community-based ILD clinic, patients with CTD-ILD are co-managed with the collaborating rheumatologists. Rituximab appears to have a beneficial effect in patients with progressive ILDs in various forms of CTDs. However, serious complications can occur and careful consideration should be given to patient selection and close follow up.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"1–9"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000287","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46316242","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myth: For Bronchoscopy Training in the 21st Century, there is a Standard Curriculum or Metrics for EBUS-TBNA Bronchoscopy Education With Good Supporting Evidence","authors":"B. Dunn, S. Awadallah, Jennifer L. Stahyl, M. Bowling","doi":"10.1097/CPM.0000000000000294","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000294","url":null,"abstract":"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 adequality train pulmonary physicians to perform and provide these services to our patients. A standard curriculum for endobronchial ultrasound-guided transbronchial needle aspiration bronchoscopy education does not currently exist, and training methods vary among training programs. Can high-fidelity computer-based simulation aid in training physicians for endobronchial ultrasound-guided transbronchial needle aspiration? What assessment tools can be used to assess the skill level and competence of trainees to ensure proper training for such an important procedure?","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"27–29"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000294","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42004034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute Respiratory Distress Syndrome as a Precursor to Post–Intensive Care Syndrome","authors":"J. McPeake, J. Veith, J. Maley, M. Mikkelsen","doi":"10.1097/CPM.0000000000000295","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000295","url":null,"abstract":"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 forth the concept that ARDS is a precursor to post–intensive care syndrome, defined as new or worsening impairments in cognition, mental health, and/or physical health after critical illness. This “precursor” paradigm is suggested as a means to a better end for patients with ARDS, by detailing care provisions and strategies to optimize short-term and long-term outcomes.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"18–23"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000295","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45427748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Septic Pulmonary Embolism: A Case Series, Proposed Set of Diagnostic Criteria, and Review of the Literature","authors":"T. Chengsupanimit, B. Sundaram, G. Kane","doi":"10.1097/CPM.0000000000000296","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000296","url":null,"abstract":"Septic pulmonary embolism is an unusual manifestation of bloodstream infection that presents with fever, chest pain, fatigue, and radiographic evidence of pulmonary infarction. 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.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"24–26"},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000296","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47562762","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Dose Matter in Intravenous Thrombolysis for Acute Pulmonary Embolism?","authors":"M. Sonnick, D. Zappetti","doi":"10.1097/CPM.0000000000000292","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000292","url":null,"abstract":"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 halfdose tPA. Source: Kiser TH, Burnham EL, Clark B, et al. Half-dose versus fulldose alteplase for treatment of pulmonary embolism. Crit Care Med. 2018;46(10).","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000292","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61657827","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}