Clinical Pulmonary Medicine最新文献_第4页

Bronchoscopic Myths and Legends: Utility of Bronchoscopy in ILD: A Review Article 支气管镜的神话和传说:支气管镜在ILD中的应用:一篇综述文章

Clinical Pulmonary Medicine Pub Date : 2020-05-01 DOI: 10.1097/CPM.0000000000000361

A. Kunadu, M. Bowling, V. Ramsammy

{"title":"Bronchoscopic Myths and Legends: Utility of Bronchoscopy in ILD: A Review Article","authors":"A. Kunadu, M. Bowling, V. Ramsammy","doi":"10.1097/CPM.0000000000000361","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000361","url":null,"abstract":"Interstitial lung diseases (ILDs) also known as diffuse parenchymal lung diseases can be a diagnostic dilemma, as treatment and prognosis depend largely on an accurate diagnosis. A multidisciplinary approach has become standard of care and has been shown to be the key to making the correct diagnosis with the least invasive approach. This usually comprises pulmonologists, rheumatologists, radiologists, and pathologists, and is essential to reach the correct and final diagnosis. Histologic diagnosis was considered in the past to be the end and be all for the definite diagnosis of ILDs. However, this is not the case anymore. It is now possible to make a definite diagnosis of certain ILDs such as idiopathic pulmonary fibrosis based off clinical presentation, serologies, and high-resolution computed tomography of the chest if it has typical features without the need for bronchoalveolar lavage or histology. Not all suspected ILDs need to be biopsied! An accurate diagnosis is essential due to differences in etiology, clinicopathologic features, therapeutic options, and prognosis. This article reviews where the literature stands now on the utility of bronchoscopy in diagnosing ILDs.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"73 - 78"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47262713","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}

引用次数: 0

Should We Be Using High-flow Nasal Oxygen in Addition to Noninvasive Ventilation for Patients at High Risk for Extubation Failure? 对于拔管失败风险较高的患者，除了无创通气外，我们还应该使用高流量鼻氧吗？

Clinical Pulmonary Medicine Pub Date : 2020-05-01 DOI: 10.1097/CPM.0000000000000359

T. Izakovich, L. Sanso, D. Zappetti

引用次数: 0

Monitoring Asthma in Pregnancy: Diagnosis and Treatment 妊娠期哮喘监测的诊断与治疗

Clinical Pulmonary Medicine Pub Date : 2020-05-01 DOI: 10.1097/CPM.0000000000000358

Pranav Nair, K. Prabhavalkar

引用次数: 0

Meta-analysis: COVID-19 Disease Severity Correlates With Smoking Status Meta-analysis：新冠肺炎疾病严重程度与吸烟状况相关

Clinical Pulmonary Medicine Pub Date : 2020-04-24 DOI: 10.1097/CPM.0000000000000364

Edouard Lansiaux, Pierre-Philippe Pébaÿ, Jean-Laurent Picard, Joachim Son-Forget

{"title":"Meta-analysis: COVID-19 Disease Severity Correlates With Smoking Status","authors":"Edouard Lansiaux, Pierre-Philippe Pébaÿ, Jean-Laurent Picard, Joachim Son-Forget","doi":"10.1097/CPM.0000000000000364","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000364","url":null,"abstract":"The novel Coronavirus Disease 2019 (COVID-19) disease is a contagious acute respiratory infectious disease whose causative agent has been demonstrated to be a new virus of the coronavirus family, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Multiple studies have already reported that risk factors for severe disease include older age and the presence of at least one of several underlying health conditions. However, a recent physiopathologic report and the French COVID-19 scientific council have postulated a protective effect of tobacco smoking. Thanks to a meta-analysis, we have been able to demonstrate the statistical significance in this regard of 12 series from China, France, and the United States, reporting 3 different smoking statuses (current smoker, former smoker with a smoking history) and disease severity [with odds ratio of 1.78 (1.08-3.10), 4.60 (3.13-7.17), 2.74 (0.63-5.89), respectively]. Subsequently, and using a Bayesian approach, we have established that past and present smoking is associated with more severe COVID-19 outcomes. Finally, we refute claims linking general population smoking status [N=O(108) or O(109)] to much smaller disease course series [N=O(104)]. The latter point, in particular, is presented to stimulate academic discussion, and must be further investigated by well-designed studies.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"104 - 99"},"PeriodicalIF":0.0,"publicationDate":"2020-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44248376","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}

引用次数: 1

Transition From Intravenous to Subcutaneous Treprostinil in a Pediatric Patient With Pulmonary Hypertension 儿童肺动脉高压患者从静脉注射到皮下注射曲前列素的转变

Clinical Pulmonary Medicine Pub Date : 2020-03-01 DOI: 10.1097/CPM.0000000000000355

Sally J. Rockwell, Joe Miller, B. Brown, Amy L. Kiskaddon, Frances Gilliland, G. Freire, Daniel A. Mauriello

引用次数: 0

Bedside Rules for Managing Acid-Base Derangement in Respiratory Failure: Applications to COVID-19 处理呼吸衰竭患者酸碱紊乱的床边规则:在COVID-19中的应用

Clinical Pulmonary Medicine Pub Date : 2020-03-01 DOI: 10.1097/CPM.0000000000000354

M. Marano, Luigi Senigalliesi

{"title":"Bedside Rules for Managing Acid-Base Derangement in Respiratory Failure: Applications to COVID-19","authors":"M. Marano, Luigi Senigalliesi","doi":"10.1097/CPM.0000000000000354","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000354","url":null,"abstract":"Respiratory failure is typically associated with changes in pCO2leading to respiratory alkalosis (type 1 failure) and respiratory acidosis (type 2). As a compensatory response, plasma HCO3concentration decreases if pCO2decreases and increases conversely. These secondary responses prevent large pH fluctuations. However, metabolic acid-base disorders may still occur as a consequence of dysfunction of other organs and/or medical treatments. To recognize superimposed acid-base disorders, the availability of an accurate prediction of the expected HCO3that corresponds to a given pCO2is crucial. In chronic hypocapnia, the compensatory metabolic response is regulated by the equation ΔHCO3/ΔpCO2=0.4 mEq/L per mm Hg. An easy rule to compute the expected value of HCO3may be 0.4×pCO2+9. In chronic hypercapnia, the equation is ΔHCO3/ΔpCO2=0.48 mEq/L per mm Hg, and the expected value of HCO3becomes 0.48×pCO2+4.74. While this expression is accurate, it seems to be of limited use for simple \"bedside\" predictions. In this contribution, we propose the simpler expression: the expected value of HCO3in chronic hypercapnia=½ pCO2+3.5. For values of pCO2not exceeding 70 mm Hg, with the proposed expression, the difference in HCO3prediction in respect to the previous one is <0.5 mEq/L, which is clinically negligible. The root mean square value of the error introduced by the proposed expression is as small as 0.19 mEq/L. Because of its accuracy, we believe that the proposed formula may be useful to identify mixed disorders at the bedside in a simpler way.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44232572","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}

引用次数: 0

Does Metoprolol Influence the Risk of Exacerbation in a High-risk COPD Patient Population? 美托洛尔是否影响COPD高危患者的病情加重风险？

Clinical Pulmonary Medicine Pub Date : 2020-03-01 DOI: 10.1097/CPM.0000000000000353

Stefi F. Lee, D. Zappetti

{"title":"Does Metoprolol Influence the Risk of Exacerbation in a High-risk COPD Patient Population?","authors":"Stefi F. Lee, D. Zappetti","doi":"10.1097/CPM.0000000000000353","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000353","url":null,"abstract":"related to antibiotic administration, such as Clostridium difficile colitis. The strengths of this trial include a multicenter design with appropriate blinding, the systematic implementation of VAP prevention bundles in both groups, and the use of a blinded adjudication committee for diagnosis of VAP. Furthermore, the study excluded patients with evidence of overt aspiration at the time of endotracheal intubation; inclusion of this population could have increased the benefit seen from antibiotics. Limitations of the trial include the use of an intravenous antibiotic not available in the United States; however, ampicillin-sulbactam (Unasyn) is available in our country and has comparable coverage. As regards applicability, it is plausible to extend these results to out-of-hospital arrest patients with an initial nonshockable rhythm who undergo TTM, but application to an inhospital arrest population is limited by the increased likelihood that these patients will have MDR organisms. In conclusion, a 2-day course of ampicillin-sulbactam in out-of-hospital cardiac arrest patients undergoing targeted temperature management reduces the incidence of early VAP while posing little immediate risk to the patient.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000353","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44382585","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}

引用次数: 0

Does a 2-Day Course of Antibiotics Lower the Incidence of Ventilator-associated Pneumonia in Patients Undergoing Targeted Temperature Management Following Cardiac Arrest? 2天抗生素疗程是否能降低心脏骤停后接受定向体温管理的患者呼吸机相关性肺炎的发生率?

Clinical Pulmonary Medicine Pub Date : 2020-03-01 DOI: 10.1097/CPM.0000000000000352

E. Lafond, D. Zappetti

引用次数: 0

ARDS as the Presenting Complication of Hyperviscosity Syndrome in Chronic Lymphocytic Leukemia: A Case Report 慢性淋巴细胞白血病高粘滞综合征并发ARDS 1例

Clinical Pulmonary Medicine Pub Date : 2020-03-01 DOI: 10.1097/CPM.0000000000000350

I. Karaman, S. Ozen, Başak Ballica, T. Uzar, O. Balçik, S. Ozkaya

引用次数: 1

Moderate Sedation Versus General Anesthesia for Endobronchial Ultrasound-guided Transbronchial Biopsy in an Academic Training Center 中等镇静与全麻在学术培训中心超声引导下支气管活检中的比较

Clinical Pulmonary Medicine Pub Date : 2020-03-01 DOI: 10.1097/CPM.0000000000000349

R. Ronaghi, W. Kareem, B. Yaghmour, Ramyar Mahdavi

{"title":"Moderate Sedation Versus General Anesthesia for Endobronchial Ultrasound-guided Transbronchial Biopsy in an Academic Training Center","authors":"R. Ronaghi, W. Kareem, B. Yaghmour, Ramyar Mahdavi","doi":"10.1097/CPM.0000000000000349","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000349","url":null,"abstract":"Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a widely used procedure for the diagnosis and staging of lung cancer. Several studies have shown the diagnostic utility of EBUS-TBNA effectiveness for decreasing the need for invasive mediastinal sampling. The current recommendation is that most patients with lung cancer should undergo mediastinal staging with EBUS-TBNA. EBUS-TBNA can be safely performed under general anesthesia or moderate sedation, and, according to previous studies, the choice of anesthesia on the effect of outcomes has been variable. We investigated differences between EBUS-TBNA performed with general anesthesia and moderate sedation in a training program in which trainees performed EBUS-TBNA. This retrospective study evaluated 121 patients undergoing fellow-driven EBUS-TBNA under the supervision of an interventional pulmonary trained faculty member. We found no difference between general anesthesia and moderate sedation in terms of diagnostic yield, procedural time, or complication rates. We did, however, find an overall higher number of total lymph nodes sampled in the general anesthesia group, as well as a higher number of hilar lymph nodes sampled. We conclude that EBUS-TBNA can be performed safely and with good diagnostic ability with either general anesthesia or moderate sedation in a fellowship-driven program without affecting overall outcomes. This is beneficial, as it can reduce overall cost and the ability to do the procedure without the need of an anesthesiologist.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"39 - 42"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"61657946","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}

引用次数: 2