Interventional pulmonology (Middletown, Del.)最新文献

{"title":"Pneumology in COVID-19 times: facing misleading diagnosis","authors":"J. Poyo Molina, Koral Fernández De Roitegui Pérez, Clara Ortega Michel, Irantzu Elorza Sagasta, Miguel Ángel Sánchez De Toro, P. Bordallo Vázquez, Blanca Virgala Ocio, Leire Álvarez Peña, David Bravo Blanco, F. J. Ribas Solís, Laura Tomás López","doi":"10.1183/13993003.congress-2021.pa839","DOIUrl":"https://doi.org/10.1183/13993003.congress-2021.pa839","url":null,"abstract":"","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77910370","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":"Bronchoscopy in COVID19 ARDS patients on mechanical ventilation: a prospective study","authors":"Ravindra Mehta, S. Bansal, Ashwin Kumar, A. Thorbole, Chakravarthi L, H. Kalpakam","doi":"10.1101/2021.02.02.21250362","DOIUrl":"https://doi.org/10.1101/2021.02.02.21250362","url":null,"abstract":"Background: Bronchoscopy has been done sparingly in COVID19 patients due to the risk of aerosol generation, with few reports describing its clinical utility. We describe a large case series of bronchoscopy in mechanically ventilated (MV) COVID-19 patients outlining the procedural, clinical, utilitarian and safety aspects. Methods: Bedside bronchoscopy was performed in suspected or confirmed COVID-19 cases on MV; only positive cases were included in the study. Demographic, clinical, bronchoscopic and laboratory findings were noted and analysed. Results: 98 procedures were performed on 61 patients, mean age of 62.1 years, 51 (83.6%) males. 42 patients (69%) had at least 1 co-morbidity. Major indications for bronchoscopy were new radiographic infiltrates with clinical deterioration, increased endotracheal tube (ETT) secretions and haemorrhagic secretions/hemoptysis. Common findings were copious secretions in 87 (88.8%), purulent in 61%, mucoid in 18%, haemorrhagic in 7% and frothy in 14% cases. Morphologically, hyperaemic airways were seen in 85 (86.7%) cases, ranging from mild (61%) to moderate-severe (39%). On the management front, antibiotics were changed in 31 (31.6%) cases based on bronchoscopic findings. Other significant changes included reduction or stopping of steroids and anticoagulation, fluid, and diuretic adjustment and ETT repositioning. The incidence of bacterial superinfection was also high (54% culture positivity for various bacteria), a significant number (94%) with multi-drug resistant organisms. Fungi were seen in 7 cases (7.1%). Pneumocystis jiroveci was not seen and cytology did not show any viral inclusions. Therapeutic mucus plug removal was done in 30 cases (30.6%), and hemoptysis control in 4% cases. The procedures were safe with no complications, and none of the HCW developed any COVID19 infection. Conclusion: Bronchoscopy in critically ill MV COVID-19 patients contributes on both diagnostic and therapeutic fronts and can significantly influence management decisions. With adequate precautions and standard protocols, it is safe for both HCW and patients.","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74944276","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":"Potential enhanced association between obstructive lung disease and history of depression in patients with diabetes.","authors":"Maria E Ramos-Nino,&nbsp;Charles D MacLean,&nbsp;Benjamin Littenberg","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Depression is one of the most common comorbidities of chronic diseases including diabetes and obstructive lung diseases (emphysema, chronic bronchitis, and asthma). Obstructive lung diseases and depression have few symptoms in common. However, they are both common in adults and associated with chronic inflammation. It is not clear if their coappearance in diabetic patients is coincidental or associated beyond that expected by chance.</p><p><strong>Methods: </strong>A total of 1,003 adults with diabetes in community practice settings were interviewed at home at the time of their enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any obstructive lung disease. Laboratory data were obtained directly from the clinical laboratory, and current medications were obtained by direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between the prevalence of obstructive lung disease and depression.</p><p><strong>Results: </strong>In a multivariate logistic regression model, obstructive lung disease was significantly associated with depression even after correcting for gender, obesity (≥30 kg/m²), high comorbidities (>2), low annual income (<$30,000/ year), cigarette smoking, alcohol problems, and education level (odds ratio=1.83; 95% confidence interval 1.27, 2.62; <i>P</i> <0.01).</p><p><strong>Conclusion: </strong>These data suggest a potential enhanced association between obstructive lung disease and depression in patients with diabetes. Future studies are needed to identify if inflammation is implicated in this association as a common denominator.</p>","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"1 1","pages":"1-4"},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8783552/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39853738","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":"Unexpected Diagnosis of Pulmonary Tuberculosis During Bronchoscopy Using Radial Probe Endobronchial Ultrasound","authors":"H. Chung, Soohyun Bae, Insu Kim, H. Ahn, J. Eom","doi":"10.21203/rs.3.rs-76693/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-76693/v1","url":null,"abstract":"\u0000 Background: Bronchoscopy using radial probe endobronchial ultrasound (EBUS) is performed when a peripheral lung lesion (PLL) is suspected to be malignant. However, pulmonary tuberculosis is unexpectedly diagnosed in some patients, and healthcare workers could therefore be exposed to tuberculosis if sufficient precautions are not taken. In this study, we examined the incidence of and factors associated with unexpected diagnosis of pulmonary tuberculosis during bronchoscopy using radial probe EBUS.Methods: This retrospective study included 970 patients who received bronchoscopy using radial probe EBUS between December 2015 and November 2018. Clinical, histological, radiological, and microbiological data were reviewed.Results: Pulmonary tuberculosis was unexpectedly diagnosed in 31 patients (3.2%) during bronchoscopy using radial probe EBUS. Patients with a lower age were significantly more likely to be diagnosed with tuberculosis than elderly patients (odds ratio [OR], 0.951; 95% confidence interval [CI], 0.924–0.978; P = 0.001). Among the various CT findings, a low HUs difference between pre- and post-enhanced CT (OR, 0.976; 95% CI, 0.955–0.996; P = 0.022), the presence of concentric cavitation (OR, 5.211; 95% CI, 1.447–18.759; P = 0.012), and the presence of satellite centrilobular nodules (OR, 22.925; 95% CI, 10.556–49.785; P < 0.001) were independently associated with unexpected diagnosis of tuberculosis.Conclusions: The risk of healthcare workers being exposed to Mycobacterium tuberculosis during bronchoscopy using radial probe EBUS has been underestimated. Our results suggest that healthcare workers in the bronchoscopy suite should consider high-grade respiratory protection when examining patients with risk factors for an unexpected diagnosis of pulmonary tuberculosis.","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91117788","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":"Endoscopic treatment of tracheo-oesophageal fistulae: an innovative procedure","authors":"G. Galluccio, G. Lucantoni, Sofia Romani, R. D. Iacono, S. Batzella","doi":"10.1183/13993003.congress-2020.1192","DOIUrl":"https://doi.org/10.1183/13993003.congress-2020.1192","url":null,"abstract":"Surgical repair of tracheo-esophageal fistula is a complex procedure that can be challenging in compromised patients.Surgical repair remains the gold standard,however,in compromised patients,may be difficult or dangerous.We present our experience with a totally endoscopic approach based on the suture of a fistula with resorbable stitches.The procedure was performed in a young patient with a congenital tracheo-esophageal fistula located in the middle third of the trachea 2cm long.The patient had rigid bronchoscopy.A rigid telescope (Storz)connected to a camera and a rigid aspirator were inserted through the tube.The fistula was exposed and sutured by means of resorbable stitches (Vycryl© 3.0),using a long needle holder.The knots were tied outside of the tracheoscope and were pushed down with a knot pusher.The surgical thread was cut with a contact Yag laser fiber (Figure 1).The procedure lasted 40 min, and the patient was discharged after 24 h.He was able to eat normally the same day.After 3 months, the patient was in excellent condition, free of cough and of pulmonary symptoms.A monthly endoscopic examination and CT scan confirmed the stability of the suture,and no recurrence of the fistula was observed.Our experience demonstrates that an endoscopic suture of the fistula is feasible and may be effective for palliation.Long-term follow-up will indicate whether this procedure may also be considered a definitive intervention.","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"14 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91440950","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":"Bronchoalveolar lavage: are we following ATS guidance?","authors":"Ivor Allon, S. Joseph, R. Mogal, R. Vancheeswaran","doi":"10.1183/13993003.congress-2020.2837","DOIUrl":"https://doi.org/10.1183/13993003.congress-2020.2837","url":null,"abstract":"Introduction: Bronchoalveolar lavage (BAL) is performed for diagnostic and management purposes in interstitial lung disease. ATS produced the only official guidance on using BAL as such, which was incorporated at our trust in 2019. Aims: We aimed to identify if guidelines were being met focussing on CT indication and sampling of the distal airways. This was to include the volume instilled and pooled as well as cytology confirming bronchial epithelial cell count Methods: We retrospectively analysed each BAL performed from 14/01/19-2/10/19 where samples were sent to cytology (n=92). Using procedure records, the documented instilled and pooled volumes were analysed, while cytology results were also evaluated. 39 of the procedures had their imaging and serology analysed to confirm BAL indication. Results: Of the 39 reviewed, 15(38.5%) had CT +/- serology indication, with 24(61.5%) lacking indication. These typically had infective or clear IPF pictures. 20(21.7%) BALs were taken from upper lobes, of which 10(55.6%) of those with details yielded ≥30% of the instilled volume. From lower and middle lobes (35(38%) each), 16(61.5%) and 25(83.3%) yielded ≥30% respectively. All cytology samples contained ≥5ml pooled saline, with 85(92.4%) containing ≥10ml. Two samples were excluded. Of the remaining 90, 61(67.8%) had a bronchial epithelial cell count ≤5% with 29(32.2%) >5%. Conclusions: There is clear room for improvement by reducing unnecessary BALs (61.5%), although more analysis is required, and increasing the pooled volume to >30% of that instilled (only 68.4%). While appropriate sample volumes are being sent to cytology, nearly a third (32.2%) were of no diagnostic benefit. We shall introduce methods for improvement and re-audit htis data.","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91153536","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":"Flexible bronchoscopy as the first-line strategy for extraction of tracheobronchial foreign bodies>","authors":"João Nunes Caldeira Marinho Matos, Sofia Sousa, L. Fernandes, Y. Martins, F. Barata","doi":"10.1183/13993003.congress-2020.1197","DOIUrl":"https://doi.org/10.1183/13993003.congress-2020.1197","url":null,"abstract":"","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75160871","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":"An improved technique in cryobiopsy of pleura","authors":"R. Teja, S. Tousheed, P. Manjunath, H. Kumar, Sagar Chandrashekaraih, B. Mohan, Ranganath Ramanjenaya","doi":"10.1183/13993003.congress-2020.1584","DOIUrl":"https://doi.org/10.1183/13993003.congress-2020.1584","url":null,"abstract":"","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76153832","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":"Evaluation of regional pulmonary function using a bronchoscopic capnometer in patients with COPD","authors":"Shingo Matsuzawa, H. Nishine, H. Kida, T. Miyazawa, Takeo Inoue, M. Mineshita","doi":"10.17264/stmarieng.10.81","DOIUrl":"https://doi.org/10.17264/stmarieng.10.81","url":null,"abstract":"Background: Partial pressure of carbon dioxide (PCO 2 ) measured by capnometer is mainly used to evaluate the respiratory condition of the lungs under ventilator control. Recently, the use of bronchoscopy has been reported in the evaluation of lung function after lobectomy in patients with lung cancer and those with chronic obstruc‐ tive pulmonary disease (COPD), who underwent bronchoscopic lung volume reduction (BLVR). Objectives: To determine the usefulness of bronchoscopic capnometry to assess treatment sites for BLVR. Method: Twenty patients with COPD suspected of having lung cancer who underwent transbronchial biopsy were included. PCO 2 was measured at the healthy side of the segmental bronchus under room air with a capn‐ ometer. Distribution of the percentage of low attenuation area (%LAA) as measured by chest computed tomog‐ raphy (CT), was calculated and compared to end-tidal CO 2 (EtCO 2 ) distribution obtained by the capnometer. Results: All 20 patients displayed homogeneous patterns on CT, but the distribution of EtCO 2 as measured by capnometer was uneven in 3 patients. There was no significant correlation between %LAA and EtCO 2 in the 20 patients, but in 9 patients with higher %LAA values, %LAA correlation significantly with EtCO 2 (r = −0.437, p = 0.023). Conclusions: Capnography was useful in physiologically evaluating local ventilation and perfusion status of the lung. We recommend capnography as an adjunct to CT to assess functional heterogeneity in patients potentially undergoing BLVR.","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86041515","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":"EBUS TBNA in the rapid microbiological diagnosis of drug resistant tuberculous mediastinal lymphadenopathy","authors":"P. Chhajed, Preyas J Vaidya, Neha P. Mandovra, Vinod B. Chavhan, Tejashree T. Lele, Rekha Nair, J. Leuppi, Avinandan Saha","doi":"10.1183/13993003.congress-2019.pa325","DOIUrl":"https://doi.org/10.1183/13993003.congress-2019.pa325","url":null,"abstract":"","PeriodicalId":93455,"journal":{"name":"Interventional pulmonology (Middletown, Del.)","volume":"13 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75212470","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}