Journal of Bronchology & Interventional Pulmonology最新文献

{"title":"Tracheobronchial Amyloid Subglottic Stenosis Treatment Using Low-temperature Radio frequency Therapy.","authors":"Noah Kosnik, Marlee Colligan, Michael Neuenschwander","doi":"10.1097/LBR.0000000000000893","DOIUrl":"10.1097/LBR.0000000000000893","url":null,"abstract":"iodine.7,8 In the modern era, intrapleural antiseptics are not used due to an expanded armamentarium of antibiotics and improved surgical techniques. A small, randomized control trial did demonstrate improved pleural evacuation with normal saline irrigation when used in addition to standard management.9 In this challenging case, it is possible that the inability to fully evacuate his pleural space despite standard medical management contributed to increasing antibiotic resistance. We felt it was imperative to achieve source control to manage his sepsis. As he was not a candidate for surgical evacuation, we opted to use Dakin’s Solution when multiple courses of tPA/ DNase failed. It is unclear whether the empyema would have resolved with escalation of antibiotics alone. His empyema, however, recurred despite 2 rounds of appropriate antibiotics, thoracostomy tube drainage, and intrapleural fibrinolytics.He achieved resolution of his empyema after irrigation with Dakin’s Solution which suggests it may have played a role in his improvement. Notably, he tolerated the procedure well without any serious complications. Intrapleural antiseptics may be considered in patients with medically refractory empyema who are not surgical candidates.","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"298-301"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9743377","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":"Intrapleural Dakin's Solution for Refractory Empyema in a Critically Ill Patient.","authors":"Soibhan R Kelley, Abraham Scott McCall, Edward T Qian, Eugene Wesley Ely","doi":"10.1097/LBR.0000000000000886","DOIUrl":"10.1097/LBR.0000000000000886","url":null,"abstract":"Middle mediastinal lesions: imaging findings and pathologic correlation. Eur J Radiol. 2000;35:30–38. 5. Crapo JD, Glassroth J, Karlinsky J, et al. Baum’s Textbook of Pulmonary Diseases. Philadelphia, PA: Lippincott Williams & Wilkins; 2004:883–912. 6. Vilmann P, Clementsen PF, Colella S, et al. Combined endobronchial and oesophageal endosonography for the diagnosis and staging of lung cancer. European Society of Gastrointestinal Endoscopy (ESGE) guideline, in cooperation with the European Respiratory Society (ERS) and the European Society of Thoracic Surgeons (ESTS). Eur Respir J. 2015;46:40–60. 7. De Waele M, Carp L, Lauwers P, et al. Paravertebral schwannoma with high uptake of fluorodeoxyglucose on positron emission tomography. Acta Chir Belg. 2005; 105:537–538. 8. Navani N, Nankivell M, Lawrence DR, et al. Lung cancer diagnosis and staging with endobronchial ultrasound-guided transbronchial needle aspiration compared with conventional approaches: an openlabel, pragmatic, randomized controlled trial. Lancet Respir Med. 2015;3:282–289.","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"296-298"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9749564","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":"A Novel Simulator for Teaching Endobronchial Ultrasound-guided Needle Biopsy.","authors":"Yousef Ahmad,&nbsp;Luke Domaleski,&nbsp;Michael Hellmann,&nbsp;Patrick Kosciuk,&nbsp;Christopher Radchenko,&nbsp;Arjan Flora,&nbsp;Roman Jandarov","doi":"10.1097/LBR.0000000000000873","DOIUrl":"10.1097/LBR.0000000000000873","url":null,"abstract":"<p><strong>Background: </strong>Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has become standard for the diagnosis of lung cancer, and there is an increasing need for procedural competence in trainees. We evaluate a low-cost, gelatin-based EBUS-TBNA training simulator to assess pulmonary fellows' baseline skills and facilitate procedural development.</p><p><strong>Methods: </strong>A low-cost ($30) gelatin-based, high-fidelity simulator was created to represent the airways, major vessels, and lymph node stations essential to identify for EBUS-TBNA. Trainees had a baseline skills assessment using the simulator and were then provided a 1-hour didactic session on EBUS-TBNA and additional practice time with the simulator. Trainees then underwent a postsimulation skills assessment using a modified endobronchial ultrasound (EBUS)-Skills and Tasks Assessment Tool (STAT) performance assessment tool. Simulator fidelity and trainee procedural confidence was assessed using a 10-point scale.</p><p><strong>Results: </strong>Ten fellows received training on the EBUS-TBNA simulator. First-year trainees scored the lowest on the 18-point performance scale with a mean score of 9, while third-year trainees scored highest with a mean score of 17.5. Mean 18-point performance score improvement after simulator training and didactics was 4.31 points for all trainees with the largest change in first-year trainees amounting to 8.25 points. First-year trainees experienced the greatest improvement in EBUS procedural confidence by a mean of 2.5 points on a 10-point confidence survey.</p><p><strong>Conclusion: </strong>A low-cost EBUS simulator effectively differentiated early and advanced learners based on graded procedural performance scores. Simulation-based practice significantly improved learners' procedural performance, and the degree of improvement correlated with learner inexperience. The simulation significantly increased early learner confidence in EBUS-TBNA technique.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"252-257"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9741497","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":"In the Pursuit to Develop a Meaningful Scoring System for EDAC.","authors":"Nakul Ravikumar,&nbsp;Septimiu Murgu","doi":"10.1097/LBR.0000000000000928","DOIUrl":"https://doi.org/10.1097/LBR.0000000000000928","url":null,"abstract":"","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"197-199"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9757659","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":"Five Versus 10 Pharyngeal Sprays of 10% Lignocaine for Topical Anesthesia During Flexible Bronchoscopy: A Multicenter, Randomized Controlled Trial.","authors":"Hariharan Iyer,&nbsp;Mayank Mishra,&nbsp;Girish Sindhwani,&nbsp;Saurabh Mittal,&nbsp;Pawan Tiwari,&nbsp;Vijay Hadda,&nbsp;Anant Mohan,&nbsp;Randeep Guleria,&nbsp;Karan Madan","doi":"10.1097/LBR.0000000000000869","DOIUrl":"10.1097/LBR.0000000000000869","url":null,"abstract":"<p><strong>Background: </strong>Ensuring adequate patient comfort is crucial during bronchoscopy. Although lidocaine spray is recommended for topical pharyngeal anesthesia, the optimum dose of sprays is unclear. We compared 5 versus 10 sprays of 10% lidocaine for topical anesthesia during bronchoscopy.</p><p><strong>Methods: </strong>In this investigator-initiated, prospective, multicenter, randomized clinical trial, subjects were randomized to receive 5 (group A) or 10 sprays (group B) of 10% lidocaine. The primary objective was to compare the operator-rated overall procedure satisfaction between the groups.</p><p><strong>Results: </strong>Two hundred eighty-four subjects were randomized (143 group A and 141 group B). The operator-rated overall procedure satisfaction, VAS [mean (SD)] was similar between the groups [group A, 74.1 (19.9) and group B, 74.3 (18.5), P =0.93]. The VAS scores of patient-rated cough [group A, 32.5 (22.9) and group B, 32.3 (22.2), P =0.93], and operator-rated cough [group A, 29.8 (22.3) and group B, 26.9 (21.5), P =0.26] were also similar. The time to reach vocal cords, overall procedure duration, mean doses of sedatives, the proportion of subjects willing to return for a repeat procedure (if required), and complications were not significantly different. Subjects in group A received significantly less cumulative lidocaine (mg) [group A, 293.9 (11.6) and group B, 343.5 (10.6), P <0.001].</p><p><strong>Conclusion: </strong>During bronchoscopy, topical anesthesia with 5 sprays of 10% lidocaine is preferred as it is associated with a similar operator-rated overall procedure satisfaction at a lower cumulative lidocaine dose compared with 10 sprays.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"232-237"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9796434","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":"The Prognostic Predictors of Airway Stenting in Malignant Airway Involvement From Esophageal Carcinoma.","authors":"Nophol Leelayuwatanakul,&nbsp;Vorawut Thanthitaweewat,&nbsp;Virissorn Wongsrichanalai,&nbsp;Chawalit Lertbutsayanukul,&nbsp;Anussara Prayongrat,&nbsp;Sarin Kitpanit,&nbsp;Thitiwat Sriprasart","doi":"10.1097/LBR.0000000000000879","DOIUrl":"10.1097/LBR.0000000000000879","url":null,"abstract":"<p><strong>Background: </strong>In locoregional esophageal carcinoma (EC), airway involvement is the most common route of extraesophageal metastasis. The prognosis remains poor even with a multimodality approach. Although airway stenting is well known for restoration of the airway, the survival benefit is still lacking.</p><p><strong>Methods: </strong>A total of 37 of patients with airway involvement from EC who underwent airway stenting at a single institution from 2015 to 2020 were retrospectively reviewed. Survival curves after stent placement among different groups were analyzed using Kaplan-Meier method.</p><p><strong>Results: </strong>Of 37 patients, 34 were male, and the mean age was 58.9 years (42 to 80). EC was commonly located at midesophagus (51.4%). The site of airway involvement was left main bronchus (48.6%), trachea (32.4%), multiple sites (16.2%), and right main bronchus (2.7%). The nature of airway involvement was tumor invasion (91.9%), compression (62.2%), and fistula (37.8%). Twenty-three patients (62.2%) had airway involvement at the time of esophageal cancer diagnosis. Only 4 patients underwent esophageal stenting. The median survival time after stent placement was 97 days (5 to 539). Chemotherapy and/or radiotherapy were given before stent placement in 18 patients (48.6%). Treatment-naive before airway stenting and diagnosis of airway involvement at the same time of EC diagnosis were independent predictors for the increased survival after stent placement ( P <0.05). Poststent treatment was associated with improved survival ( P =0.002).</p><p><strong>Conclusion: </strong>In patients with malignant airway involvement from EC who underwent airway stenting, the prognostic predictors for improved survival were treatment-naive status, receiving treatment after airway stenting, and early-onset of airway involvement.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"277-284"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/7c/3b/lbr-30-277.PMC10312900.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9796888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mediastinal Infection After Endobronchial Ultrasound-guided Transbronchial Needle Aspiration: An Uncommon Complication.","authors":"Paige K Marty,&nbsp;Zachary A Yetmar,&nbsp;Zhenmei Zhang,&nbsp;Zelalem Temesgen,&nbsp;Darlene R Nelson","doi":"10.1097/LBR.0000000000000909","DOIUrl":"10.1097/LBR.0000000000000909","url":null,"abstract":"E ndobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a modern bronchoscopic technique used in evaluating mediastinal adenopathy, masses, and pulmonary nodules, as well as lung cancer staging. It has the advantage of higher diagnostic yield than traditional TBNA, while being less invasive than mediastinoscopy or open biopsy.1 However, EBUSTBNA is associated with potential complications, including hemorrhage, pneumothorax, airway compromise, and anesthesia-related complications.1 The frequency of these complications, particularly mediastinal infection, is likely comparable to those occurring from conventional TBNA,2,3 which has existed for decades before the addition of EBUS. However, definitive data regarding this are lacking. Several types of infections can complicate EBUS-TBNA. These include mediastinitis, pericarditis, lymphadenitis, and empyema.1 Although these types of infections have been described, data are largely limited to case reports. As such, the incidence of such infections is difficult to estimate. Furthermore, these infections are often complicated, and little is known regarding their management or outcomes. We analyzed our institution’s cohort of patients who have undergone EBUS-TBNA. The aims of this study were to determine the incidence of subsequent mediastinal infection and describe their microbiology, treatment approach, and outcomes.","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"307-310"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10129612","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":"A Complete Ultrathin Bronchoscopy Blackout.","authors":"Chan Sin Chai,&nbsp;Swee Kim Chan,&nbsp;Sze Shyang Kho,&nbsp;Aiful Ahmad,&nbsp;Siew Teck Tie","doi":"10.1097/LBR.0000000000000922","DOIUrl":"10.1097/LBR.0000000000000922","url":null,"abstract":"Ultrathin bronchoscopy (UTB) is increasingly being used in solitary pulmonary nodule (SPN) diagnostics. The increasing capabilities of the bronchoscope in reaching peripheral regions of the lungs have allowed us to examine and understand the bronchoscopic appearance of previously inaccessible SPNs. Melanoma is a tumor produced by the malignant transformation of melanocytes, usually in the skin, and is the most aggressive form of skin cancer with a low survival rate in patients with metastatic disease. The most common site of metastases is the lungs, affecting up to 30% of patients.1","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"285-288"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9754319","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":"Excessive Dynamic Airway Collapse Severity Scoring System: A Call Out for an Overall Severity Determination.","authors":"David Abia-Trujillo,&nbsp;Alejandra Yu Lee-Mateus,&nbsp;Daniel Hernandez-Rojas,&nbsp;Sai Priyanka Pulipaka,&nbsp;Juan C Garcia-Saucedo,&nbsp;Omran Saifi,&nbsp;Adnan Majid,&nbsp;Sebastian Fernandez-Bussy","doi":"10.1097/LBR.0000000000000918","DOIUrl":"10.1097/LBR.0000000000000918","url":null,"abstract":"<p><strong>Background: </strong>Severe excessive dynamic airway collapse (EDAC) is defined as airway narrowing due to posterior wall protrusion into the airway lumen, >90%. We aimed to establish an overall severity score to assess severe EDAC and the need for subsequent intervention.</p><p><strong>Methods: </strong>A retrospective study of patients who underwent dynamic bronchoscopy for evaluation of expiratory central airway collapse between January 2019 and July 2021. A numerical value was given to each tracheobronchial segmental collapse: 0 points (<70%), 1 point (70% to 79%), 2 points (80% to 89%), and 3 points (>90%) to be added for an overall EDAC severity score per patient. We compared the score among patients who underwent stent trials (severe EDAC) and those who did not. Based on the receiver operating characteristics curve, a cutoff total score to predict severe EDAC was calculated.</p><p><strong>Results: </strong>One hundred fifty-eight patients were included. Patients were divided into severe (n = 60) and nonsevere (n = 98) EDAC. A cutoff of 9 as the total score had a sensitivity of 94% and a specificity of 74% to predict severe EDAC, based on an area under the curve 0.888 (95% CI: 0.84, 0.93; P < 0.001).</p><p><strong>Conclusion: </strong>Our EDAC Severity Scoring System was able to discern between severe and nonsevere EDAC by an overall score cutoff of 9, with high sensitivity and specificity for predicting severe disease and the need for further intervention, in our institution.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"200-206"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10112351","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":"Reporting Standards for Diagnostic Testing: Guidance for Authors From Editors of Respiratory, Sleep, and Critical Care Journals.","authors":"David E Ost,&nbsp;David J Feller-Kopman,&nbsp;Anne Gonzalez,&nbsp;Horiana B Grosu,&nbsp;Felix Herth,&nbsp;Peter Mazzone,&nbsp;John E S Park,&nbsp;José M Porcel,&nbsp;Samira Shojaee,&nbsp;Ioana Tsiligianni,&nbsp;Anil Vachani,&nbsp;Jonathan Bernstein,&nbsp;Richard Branson,&nbsp;Patrick A Flume,&nbsp;Cezmi A Akdis,&nbsp;Martin Kolb,&nbsp;Esther Barreiro Portela,&nbsp;Alan Smyth","doi":"10.1097/LBR.0000000000000920","DOIUrl":"10.1097/LBR.0000000000000920","url":null,"abstract":"<p><p>Diagnostic testing is fundamental to medicine. However, studies of diagnostic testing in respiratory medicine vary significantly in terms of their methodology, definitions, and reporting of results. This has led to often conflicting or ambiguous results. To address this issue, a group of 20 respiratory journal editors worked to develop reporting standards for studies of diagnostic testing based on a rigorous methodology to guide authors, peer reviewers, and researchers when conducting studies of diagnostic testing in respiratory medicine. Four key areas are covered, including defining the reference standard of truth, measures of dichotomous test performance when used for dichotomous outcomes, measures of multichotomous test performance for dichotomous outcomes, and what constitutes a useful definition of diagnostic yield. The importance of using contingency tables for reporting results is addressed with examples from the literature. A practical checklist is provided as well for reporting studies of diagnostic testing.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"30 3","pages":"207-222"},"PeriodicalIF":3.3,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9741257","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}