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Truong B, Zapala M, Kammen B, Luu K. Automated Detection of Pediatric Foreign Body Aspiration from Chest X-rays Using Machine Learning. Laryngoscope 2024; 134:3807-3814. [PMID: 38366768 DOI: 10.1002/lary.31338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/19/2024] [Accepted: 01/26/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE/HYPOTHESIS Standard chest radiographs are a poor diagnostic tool for pediatric foreign body aspiration. Machine learning may improve upon the diagnostic capabilities of chest radiographs. The objective is to develop a machine learning algorithm that improves the diagnostic capabilities of chest radiographs in pediatric foreign body aspiration. METHOD This retrospective, diagnostic study included a retrospective chart review of patients with a potential diagnosis of FBA from 2010 to 2020. Frontal view chest radiographs were extracted, processed, and uploaded to Google AutoML Vision. The developed algorithm was then evaluated against a pediatric radiologist. RESULTS The study selected 566 patients who were presented with a suspected diagnosis of foreign body aspiration. One thousand six hundred and eighty eight chest radiograph images were collected. The sensitivity and specificity of the radiologist interpretation were 50.6% (43.1-58.0) and 88.7% (85.3-91.5), respectively. The sensitivity and specificity of the algorithm were 66.7% (43.0-85.4) and 95.3% (90.6-98.1), respectively. The precision and recall of the algorithm were both 91.8% with an AuPRC of 98.3%. CONCLUSION Chest radiograph analysis augmented with machine learning can diagnose foreign body aspiration in pediatric patients at a level similar to a read performed by a pediatric radiologist despite only using single-view, fixed images. Overall, this study highlights the potential and capabilities of machine learning in diagnosing conditions with a wide range of clinical presentations. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3807-3814, 2024.
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Affiliation(s)
- Brandon Truong
- School of Medicine, University of California, San Francisco, California, U.S.A
| | - Matthew Zapala
- Division of Pediatric Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, U.S.A
| | - Bamidele Kammen
- Division of Pediatric Radiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, U.S.A
| | - Kimberly Luu
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, California, U.S.A
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Reihani AR, Zohouri M, Thomas J. Breaking New Ground in Interventional Pulmonology: Integrating Cone Beam CT and Robotic-Assisted Bronchoscopy for High-Risk Pneumothorax in Peripherally Located Solitary Pulmonary Nodules. Cureus 2024; 16:e62532. [PMID: 38887749 PMCID: PMC11182144 DOI: 10.7759/cureus.62532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2024] [Indexed: 06/20/2024] Open
Abstract
Lung cancer, a leading cause of global cancer-related deaths, necessitates the development of innovative diagnostic techniques. Traditional bronchoscopy, while useful, has limitations in diagnosing peripheral pulmonary lesions (PPLs) and carries a higher risk of complications such as pneumothorax. However, the field of interventional pulmonology has seen significant advancements, including the introduction of robotic-assisted bronchoscopy (RAB), cone-beam computed tomography (CBCT), radial endobronchial ultrasound (R-EBUS), and rapid on-site evaluation (ROSE). These advancements have greatly improved the precision of diagnosing high-risk PPLs. This report presents the case of a 60-year-old female smoker with chronic obstructive pulmonary disease and extensive centrilobular emphysema, who had a peripherally located high-risk pulmonary nodule. She was successfully diagnosed with metastatic adenocarcinoma using an integrated approach, despite the challenging location of the lesion and high risk of pneumothorax. The integration of RAB with CBCT and augmented fluoroscopy offers a groundbreaking approach for diagnosing and managing difficult-to-reach, high-risk pulmonary nodules, marking a significant stride in the field of interventional pulmonology.
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Affiliation(s)
- Amir R Reihani
- Pulmonary and Critical Care Medicine, Eisenhower Medical Center, Rancho Mirage, USA
- Critical Care Medicine, Stony Brook University, Stony Brook, USA
| | - Mahshid Zohouri
- Internal Medicine, Eisenhower Medical Center, Rancho Mirage, USA
| | - Justin Thomas
- Interventional Pulmonary and Critical Care Medicine, Eisenhower Medical Center/University of California Riverside, Rancho Mirage, USA
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3
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Ahn C, Park Y, Oh Y. Early bronchoscopy in severe pneumonia patients in intensive care unit: insights from the Medical Information Mart for Intensive Care-IV database analysis. Acute Crit Care 2024; 39:179-185. [PMID: 38476070 PMCID: PMC11002625 DOI: 10.4266/acc.2023.01165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Pneumonia frequently leads to intensive care unit (ICU) admission and is associated with a high mortality risk. This study aimed to assess the impact of early bronchoscopy administered within 3 days of ICU admission on mortality in patients with pneumonia using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. METHODS A single-center retrospective analysis was conducted using the MIMIC-IV data from 2008 to 2019. Adult ICU-admitted patients diagnosed with pneumonia were included in this study. The patients were stratified into two cohorts based on whether they underwent early bronchoscopy. The primary outcome was the 28-day mortality rate. Propensity score matching was used to balance confounding variables. RESULTS In total, 8,916 patients with pneumonia were included in the analysis. Among them, 783 patients underwent early bronchoscopy within 3 days of ICU admission, whereas 8,133 patients did not undergo early bronchoscopy. The primary outcome of the 28-day mortality between two groups had no significant difference even after propensity matched cohorts (22.7% vs. 24.0%, P=0.589). Patients undergoing early bronchoscopy had prolonged ICU (P<0.001) and hospital stays (P<0.001) and were less likely to be discharged to home (P<0.001). CONCLUSIONS Early bronchoscopy in severe pneumonia patients in the ICU did not reduce mortality but was associated with longer hospital stays, suggesting it was used in more severe cases. Therefore, when considering bronchoscopy for these patients, it's important to tailor the decision to each individual case, thoughtfully balancing the possible advantages with the related risks.
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Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoonseok Oh
- Data engineer, SciAL Tech Inc., Seoul, Korea
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Yao A, Liu Z, He W, Rao H, Wang C, Xie S. Brochoscopic Airway Clearance Therapy vs. Conventional Sputum Aspiration: The Future of Flexible Brochoscopes in Intensive Care Units? Diagnostics (Basel) 2023; 13:3276. [PMID: 37892097 PMCID: PMC10606468 DOI: 10.3390/diagnostics13203276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: The aim of our study is to investigate the effectiveness of bronchoscopic airway clearance therapy (B-ACT) on severe pneumonia (SP) patients with invasive mechanical ventilation (IMV) in the intensive care unit (ICU). (2) Methods: Our study retrospectively enrolled 49 patients with sputum aspiration and 99 patients with B-ACT, and the latter were divided into the ≤once every 3 days group (n = 50) and >once every 3 days group (n = 49). (3) Results: We found most laboratory blood results were significantly improved in the B-ACT group as compared with those in sputum aspiration group (p < 0.05). Patients in the B-ACT group and those in ≤once every 3 days group also had significantly better survival to hospital discharge than those in their counterpart groups (Logrank p < 0.001). In patients with cardiopulmonary diseases or positive cultures for bacteria, the B-ACT group and those in the ≤once every 3 days group had significantly better survival outcomes to discharge than those in their counterpart groups (Logrank p < 0.001). B-ACT and the average frequency of ≤once every 3 days had significantly better impact on survival outcomes than their counterpart groups (HR: 0.444, 95% CI: 0.238-0.829, p = 0.011; HR: 0.285, 95% CI: 0163-0.498, p < 0.001). (4) Conclusions: In the future, flexible bronchoscopes may paly an important role in ACT for SP patients with IMV.
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Affiliation(s)
- Anjie Yao
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China;
| | - Zixuan Liu
- School of Medicine, Tongji University, Shanghai 200092, China; (Z.L.); (W.H.); (H.R.)
| | - Wenni He
- School of Medicine, Tongji University, Shanghai 200092, China; (Z.L.); (W.H.); (H.R.)
| | - Hanyu Rao
- School of Medicine, Tongji University, Shanghai 200092, China; (Z.L.); (W.H.); (H.R.)
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China;
| | - Shuanshuan Xie
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China;
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Sánchez-Castellano MÁ, Marcelo C, Marco J, Figueira-Iglesias JC, García-Rodríguez J. A Tale of Two Hospitals: Comparing CAPA Infections in Two ICUs During the Spanish Fourth Pandemic Wave. Mycopathologia 2023; 188:335-344. [PMID: 37256502 PMCID: PMC10230482 DOI: 10.1007/s11046-023-00750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE COVID-19 associated pulmonary aspergillosis (CAPA) is a new clinical entity linked to SARS-CoV-2 infection that is causing a rise on the risk of complications and mortality, particularly in critical patients. METHODS We compared diagnostic and clinical features in two cohorts of patients with severe COVID-19 admitted in the intensive care units (ICU) of two different hospitals in Madrid, Spain, between February and June 2021. Clinical and microbiological relevant aspects for CAPA diagnosis were collected for further classification. CAPA was classified as colonization, possible, probable, proven, and tracheobronchial aspergillosis according to the ECMM/ISHAM consensus, with some modifications to consider tracheobronchial aspirate as sample comparable to non-bronchoscopic lavages (NBL). RESULTS 56 patients admitted in HULP (Hospital Universitario La Paz) ICU and 61 patients admitted in HEEIZ (Hospital de Emergencias Isabel Zendal) ICU had clinical suspicion of invasive fungal disease in the context of COVID-19 infection. Cultures were positive for Aspergillus spp. in 32 patients. According to 2020 European Confederation of Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus, 11 patients were diagnosed with possible CAPA and 10 patients with probable CAPA. Global incidence for CAPA was 6.3%. Global median days between ICU admission and diagnosis was 14 day. Aspergillus fumigatus complex was the main isolated species. Antifungal therapy was used in 75% of patients with CAPA suspicion, with inter-hospital differences in the administered antifungals. Global overall mortality rate for CAPA patients was 66.6% (14/21). All-cause mortality in non-CAPA cohorts were of 26.3% in HULP group (34/129) and 56.8% (104/183) in HEEIZ group. CONCLUSIONS There were no significant differences in incidence between the two hospitals, and differences in antifungal therapy did not correlate with differences in mortality, reflecting that both first-line azoles and Amphotericin B could be effective in treating CAPA infections, according to the current guideline indications.
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Affiliation(s)
| | - Cristina Marcelo
- Infectious Diseases Unit, Internal Medicine Department, Hospital Universitario La Paz, Madrid, Spain
| | - Javier Marco
- Hospital de Emergencias Enfermera Isabel Zendal, Madrid, Spain
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Skóra M, Gajda M, Namysł M, Wordliczek J, Zorska J, Piekiełko P, Żółtowska B, Krzyściak P, Heczko PB, Wójkowska-Mach J. COVID-19-Associated Pulmonary Aspergillosis in Intensive Care Unit Patients from Poland. J Fungi (Basel) 2023; 9:666. [PMID: 37367602 DOI: 10.3390/jof9060666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 06/28/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has been shown to be a favoring factor for aspergillosis, especially in a severe course requiring admission to the intensive care unit (ICU). The aim of the study was to assess the morbidity of CAPA among ICU patients in Poland and to analyze applied diagnostic and therapeutic procedures. Medical documentation of patients hospitalized at the temporary COVID-19 dedicated ICU of the University Hospital in Krakow, Poland, from May 2021 to January 2022 was analyzed. In the analyzed period, 17 cases of CAPA were reported with an incidence density rate of 9 per 10 000 patient days and an incidence rate of 1%. Aspergillus fumigatus and Aspergillus niger were isolated from lower respiratory samples. Antifungal therapy was administered to 9 patients (52.9%). Seven patients (77.8%) received voriconazole. The CAPA fatality case rate was 76.5%. The results of the study indicate the need to increase the awareness of medical staff about the possibility of fungal co-infections in ICU patients with COVID-19 and to use the available diagnostic and therapeutic tools more effectively.
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Affiliation(s)
- Magdalena Skóra
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Street, 31-121 Krakow, Poland
| | - Mateusz Gajda
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Street, 31-121 Krakow, Poland
| | - Magdalena Namysł
- Department of Microbiology, University Hospital in Krakow, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland
| | - Jerzy Wordliczek
- Interdisciplinary Intensive Care Clinic, Jagiellonian University Medical College, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland
| | - Joanna Zorska
- Center for Innovative Medical Education, Jagiellonian University Medical College, Medyczna 7 Street, 30-688 Krakow, Poland
- Intensive Care Unit, University Hospital in Krakow, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland
| | - Piotr Piekiełko
- Department of Internal Diseases and Circulatory Failure, Center of Pulmonology and Thoracic Surgery in Bystra, Juliana Fałata 2 Street, 43-360 Bystra, Poland
- Department of Pulmonology and Respiratory Failure, Center of Pulmonology and Thoracic Surgery in Bystra, Juliana Fałata 2 Street, 43-360 Bystra, Poland
| | - Barbara Żółtowska
- Center for Innovative Therapy, Clinical Research Coordination Center, University Hospital in Krakow, Macieja Jakubowskiego 2 Street, 30-688 Krakow, Poland
| | - Paweł Krzyściak
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Street, 31-121 Krakow, Poland
| | - Piotr B Heczko
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Street, 31-121 Krakow, Poland
| | - Jadwiga Wójkowska-Mach
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18 Street, 31-121 Krakow, Poland
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Falck-Jones S, Österberg B, Smed-Sörensen A. Respiratory and systemic monocytes, dendritic cells, and myeloid-derived suppressor cells in COVID-19: Implications for disease severity. J Intern Med 2023; 293:130-143. [PMID: 35996885 PMCID: PMC9538918 DOI: 10.1111/joim.13559] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Since the beginning of the SARS-CoV-2 pandemic in 2020, researchers worldwide have made efforts to understand the mechanisms behind the varying range of COVID-19 disease severity. Since the respiratory tract is the site of infection, and immune cells differ depending on their anatomical location, studying blood is not sufficient to understand the full immunopathogenesis in patients with COVID-19. It is becoming increasingly clear that monocytes, dendritic cells (DCs), and monocytic myeloid-derived suppressor cells (M-MDSCs) are involved in the immunopathology of COVID-19 and may play important roles in determining disease severity. Patients with mild COVID-19 display an early antiviral (interferon) response in the nasopharynx, expansion of activated intermediate monocytes, and low levels of M-MDSCs in blood. In contrast, patients with severe COVID-19 seem to lack an early efficient induction of interferons, and skew towards a more suppressive response in blood. This is characterized by downregulation of activation markers and decreased functional capacity of blood monocytes and DCs, reduced circulating DCs, and increased levels of HLA-DRlo CD14+ M-MDSCs. These suppressive characteristics could potentially contribute to delayed T-cell responses in severe COVID-19 cases. In contrast, airways of patients with severe COVID-19 display hyperinflammation with elevated levels of inflammatory monocytes and monocyte-derived macrophages, and reduced levels of tissue-resident alveolar macrophages. These monocyte-derived cells contribute to excess inflammation by producing cytokines and chemokines. Here, we review the current knowledge on the role of monocytes, DCs, and M-MDSCs in COVID-19 and how alterations and the anatomical distribution of these cell populations may relate to disease severity.
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Affiliation(s)
- Sara Falck-Jones
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Österberg
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Smed-Sörensen
- Division of Immunology and Allergy, Department of Medicine Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Bauer PR, Midthun DE. Bronchoscopy in the Critically Ill: Yes, No, Maybe? Chest 2023; 163:10-11. [PMID: 36628662 DOI: 10.1016/j.chest.2022.08.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Philippe R Bauer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN.
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
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Wayne MT, Valley TS, Arenberg DA, De Cardenas J, Prescott HC. Temporal Trends and Variation in Bronchoscopy Use for Acute Respiratory Failure in the United States. Chest 2023; 163:128-138. [PMID: 36007595 PMCID: PMC9859725 DOI: 10.1016/j.chest.2022.08.2210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND National data on bronchoscopy for the evaluation of acute respiratory failure are lacking, and the limited available data suggest wide variation in use. RESEARCH QUESTION How commonly is bronchoscopy performed among hospitalizations with acute respiratory failure? How has use changed over time and across hospitals? STUDY DESIGN AND METHODS This was an observational cohort study of adult hospitalizations (2012-2018) treated with invasive mechanical ventilation (IMV) using the National Inpatient Sample, which represents 97% of all hospitalizations in the United States. We measured the proportion of hospitalizations treated with IMV who underwent bronchoscopy and assessed trends in bronchoscopy use over time. Multilevel linear regression models were used to quantify hospital-level variation, adjusting for differences in patient and hospital characteristics. RESULTS We identified 6,101,070 IMV-treated hospitalizations (2012-2018), of whom 609,405 underwent bronchoscopy; among hospitalizations receiving bronchoscopy, mean age was 61 years, 41.8% were women, and in-hospital mortality was 30.8%. The percentage of IMV-treated hospitalizations receiving bronchoscopy increased from 9.5% (95% CI, 9.1%-9.9%) in 2012 to 10.8% (95% CI, 10.4%-11.2%) in 2018 (P < .001 for difference). In 2018, bronchoscopy use varied from 0% to 57.1% among 1,787 hospitals, and in multilevel models adjusted for patient and hospital characteristics, 16.0% of the variation was explained at the hospital level. The median OR was 2.13 (95% CI, 2.05-2.21), indicating 113% increased odds of receiving bronchoscopy if moving from a lower-use to a higher-use hospital. INTERPRETATION Bronchoscopy use among hospitalizations treated with IMV has increased over time. The large variation in use of bronchoscopy across hospitals suggests potentially unwarranted practice variation and need for further studies to clarify which patients benefit from bronchoscopy.
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Affiliation(s)
- Max T Wayne
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI.
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Douglas A Arenberg
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI
| | - Jose De Cardenas
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
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Abstract
Veno-venous extracorporeal membrane oxygenation (ECMO) support surged during the COVID-19 pandemic. Our program changed the model of care pursuing to protect the multidisciplinary team from the risk of infection and to serve as many patients as possible. Patient-healthcare interactions were restricted, and the ECMO bed capacity was increased by reducing the ECMO specialist-patient ratio to 1:4 with non-ECMO trained nurses support. The outcomes worsened and we paused while we evaluated and modified our model of care. The ECMO bed capacity was reduced to allow a nurse ECMO-specialist nurse ratio 2:1 with an ECMO trained nurse assistant's support. Intensivists, general practitioners, nurse assistants, and physical and respiratory therapists were trained on ECMO. Tracheostomy, bronchoscopy, and microbiological molecular diagnosis were done earlier, and family visits and rehabilitation were allowed in the first 48 hours of ECMO cannulation. There were 35 patients in the preintervention cohort and 66 in the postintervention cohort. Ninety days mortality was significantly lower after the intervention (62.9% vs. 31.8%, p = 0.003). Factors associated with increased risk of death were the need for cannulation or conversion to veno arterial or veno arterio venous ECMO, hemorrhagic stroke, and renal replacement therapy during ECMO. The interventions associated with a decrease in the risk of death were the following: early fiberoptic bronchoscopy and microbiological molecular diagnostic tests. Increasing the ECMO multidisciplinary team in relation to the number of patients and the earlier performance of diagnostic and therapeutic interventions, such as tracheostomy, fiberoptic bronchoscopy, molecular microbiological diagnosis of pneumonia, rehabilitation, and family support significantly decreased mortality of patients on ECMO due to COVID-19.
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A Prospective Study of Plasma and Bronchoalveolar Lavage Fluid CMV DNA Load Quantification for the Diagnosis and Outcome of CMV Pneumonitis in Immunocompromised Hosts. J Clin Virol 2022; 155:105243. [PMID: 35908479 DOI: 10.1016/j.jcv.2022.105243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 07/05/2022] [Accepted: 07/14/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Molecular testing has been utilized for cytomegalovirus (CMV) pneumonitis (CMVP) diagnosis, although its validity and optimal cut-off values remain limited. METHODS A prospective study of CMVP diagnosis among immunocompromised patients was conducted by measuring quantitative CMV DNA polymerase chain reaction in plasma and bronchoalveolar lavage fluid (BALF). RESULTS Forty-five adult immunocompromised patients were investigated. Thirty-two patients (71%) received immunosuppressive therapy. Eleven patients (24%) were confirmed to have CMVP. Of those, three and eight patients were classified as proven and probable CMVP, respectively. Median (IQR) plasma CMV DNA loads in CMVP and non-CMVP were 41,939 (4,424-122,608) and 0 (0-44) IU/mL, respectively (p<0.001). Median (IQR) BALF CMV DNA loads in CMVP and non-CMVP were 379,652 (163,800-1,254,000) and 0 (0-1,348) IU/mL, respectively (p<0.001). A significant correlation was observed between plasma and BALF CMV DNA loads (r=0.887, p<0.001). Plasma CMV DNA load of 831 IU/mL was established as a cut-off value for diagnosing CMVP (AUC 0.9987, sensitivity 100%, specificity 94.1%, positive predictive value 84.5%, negative predictive value 100%). CONCLUSIONS A strongly positive correlation was observed between CMV DNA loads measured in plasma and BALF. CMV DNA load quantification could potentially assist in diagnosing CMVP in immunocompromised patients, although bronchoscopy remains encouraged for a definitive diagnosis.
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Serra Mitjà P, Centeno C, Garcia-Olivé I, Antuori A, Casadellà M, Tazi R, Armestar F, Fernández E, Andreo F, Rosell A. Bronchoscopy in Critically Ill COVID-19 Patients: Findings, Microbiological Profile, and Coinfection. J Bronchology Interv Pulmonol 2022; 29:186-190. [PMID: 35730778 DOI: 10.1097/lbr.0000000000000807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bronchoscopy is a widely use technique in critically ill patients. Nosocomial coinfections are a cause of morbidity and mortality in intensive care units. OBJECTIVES Our aim was to describe bronchoscopy findings and analyze microbiological profile and probably coinfection through bronchial aspirate (BA) samples in patients with coronavirus disease 2019 pneumonia requiring intensive care unit admission. METHODS Retrospective observational study analyzing the BA samples collected from intubated patients with coronavirus disease 2019 in a referral Hospital (Spain). RESULTS One hundred fifty-five consecutive BA samples were collected from 75 patients. Ninety (58%) were positive cultures for different microorganisms, 11 (7.1%) were polymicrobial, and 37 (23.7%) contained resistant microorganisms. There was a statistically significant association between increased days of orotracheal intubation and positive BA (18.9 vs. 10.9 d, P<0.01), polymicrobial infection (22.11 vs. 13.54, P<0.01) and isolation of resistant microorganisms (18.88 vs. 10.94, P<0.01). In 88% of the cases a new antibiotic or change in antibiotic treatment was made. CONCLUSION Bronchoscopy in critically ill patient was safe and could be useful to manage these patients and conduct the microbiological study, that seems to be higher and different than in nonepidemic periods. The longer the intubation period, the greater the probability of coinfection, isolation of resistant microorganisms and polymicrobial infection.
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Affiliation(s)
- Pere Serra Mitjà
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | - Carmen Centeno
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | - Ignasi Garcia-Olivé
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | | | | | - Rachid Tazi
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | - Fernando Armestar
- Servei de Medicina Intensiva
- Department of Medicine, Autonomous University of Barcelona, Barcelona
| | - Ester Fernández
- Thoracic Surgery Unit, Germans Trias i Pujol University Hospital
- Department of Medicine, Autonomous University of Barcelona, Barcelona
| | - Felipe Andreo
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- Department of Medicine, Autonomous University of Barcelona, Barcelona
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
| | - Antoni Rosell
- Pneumology Unit
- Germans Trias and Pujol Research Institute (IGTP)
- Department of Medicine, Autonomous University of Barcelona, Barcelona
- CibeRes, Cyber Respiratory Diseases, Bunyola, Spain
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Sachdev A, Gupta N, Khatri A, Jha G, Menon GR. Utility and safety of flexible fiberoptic bronchoscopy in mechanically ventilated children in pediatric intensive care unit. Pediatr Pulmonol 2022; 57:1310-1317. [PMID: 35170875 DOI: 10.1002/ppul.25863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/12/2022] [Accepted: 01/30/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES To study the utility, safety, and effects of flexible fiberoptic bronchoscopy (FFB) on oxygenation status, ventilation parameters, and hemodynamics in mechanically ventilated children. DESIGN Retrospective study. PATIENTS Children aged >1 month to 18 years suffering from critical medical and surgical diseases. RESULTS First bronchoscopy data of 131 patients were analyzed. Indication, FFB findings, the microbiological yield from bronchoalveolar lavage, and medical and surgical interventions based on FFB results were recorded. Hemodynamic and ventilation parameters before, during, and 3 h after FFB were also captured. The majority of bronchoscopies were done for diagnostic purposes with a positivity rate of 90.8%. Retained mucopurulent secretion in the airways was the commonest finding in 60 patients. A cause for weaning or extubation failure could be identified in 83.3%. Post-FFB radiological resolution of atelectasis was seen in 34/59 (57.6%; p-value: 0.001) chest radiographs. Forty-seven medical and 25 surgical interventions were done depending on FFB and BAL findings. There was a significant drop in oxygenation parameters and a rise in heart rate during FFB (p-value: <0.0001). The peak inspiratory pressure, positive end-expiratory pressure, and mean airway pressure increased significantly during bronchoscopy (p value: <.0001) while patients were on pressure-regulated volume-controlled ventilation. All these changes reversed to pre-FFB levels. There were minor procedure-related complications. CONCLUSION FFB was an important diagnostic and therapeutic tool for mechanically ventilated children and the results helped plan interventions. It was a safe procedure with transient reversible cardiopulmonary alterations.
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Affiliation(s)
- Anil Sachdev
- Department of Pediatrics, Division of Pediatric Emergency, Critical Care and Pulmonology, Sir Ganga Ram Hospital, New Delhi, India
| | - Neeraj Gupta
- Department of Pediatrics, Division of Pediatric Emergency, Critical Care and Pulmonology, Sir Ganga Ram Hospital, New Delhi, India
| | - Anuj Khatri
- Department of Pediatrics, Division of Pediatric Emergency and Critical Care, Sir Ganga Ram Hospital, New Delhi, India
| | - Ganpat Jha
- Department of Pediatrics, Division of Pediatric Emergency and Critical Care, Sir Ganga Ram Hospital, New Delhi, India
| | - Geetha R Menon
- National Institute of Medical Statistics, New Delhi, India
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14
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Wen SWC, Wen J, Hansen TF, Jakobsen A, Hilberg O. Cell Free Methylated Tumor DNA in Bronchial Lavage as an Additional Tool for Diagnosing Lung Cancer-A Systematic Review. Cancers (Basel) 2022; 14:2254. [PMID: 35565384 PMCID: PMC9099950 DOI: 10.3390/cancers14092254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
This systematic review investigated circulating methylated tumor DNA in bronchial lavage fluid for diagnosing lung cancer. PROSPERO registration CRD42022309470. PubMed, Embase, Medline, and Web of Science were searched on 9 March 2022. Studies of adults with lung cancer or undergoing diagnostic workup for suspected lung cancer were included if they used bronchial lavage fluid, analyzed methylated circulating tumor DNA, and reported the diagnostic properties. Sensitivity, specificity, and lung cancer prevalence were summarized in forest plots. Risk of bias was assessed using the QUADAS-2 tool. A total of 25 studies were included. All were case-control studies, most studies used cell pellet for analysis by quantitative PCR. Diagnostic sensitivity ranged from 0% for a single gene to 97% for a four-gene panel. Specificity ranged from 8% for a single gene to 100%. The studies employing a gene panel decreased the specificity, and no gene panel had a perfect specificity of 100%. In conclusion, methylated circulating tumor DNA can be detected in bronchial lavage, and by employing a gene panel the sensitivity can be increased to clinically relevant levels. The available evidence regarding applicability in routine clinical practice is limited. Prospective, randomized clinical trials are needed to determine the further usefulness of this biomarker.
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Affiliation(s)
- Sara Witting Christensen Wen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; (T.F.H.); (A.J.)
- Department of Regional Health Research, J.B. Winsloews Vej 19, 3rd Floor, 5000 Odense C, Denmark;
| | - Jan Wen
- General Practice, Region of Southern Denmark, Damhaven 12, 7100 Vejle, Denmark;
| | - Torben Frøstrup Hansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; (T.F.H.); (A.J.)
- Department of Regional Health Research, J.B. Winsloews Vej 19, 3rd Floor, 5000 Odense C, Denmark;
| | - Anders Jakobsen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark; (T.F.H.); (A.J.)
- Department of Regional Health Research, J.B. Winsloews Vej 19, 3rd Floor, 5000 Odense C, Denmark;
| | - Ole Hilberg
- Department of Regional Health Research, J.B. Winsloews Vej 19, 3rd Floor, 5000 Odense C, Denmark;
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15
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The incidence, clinical characteristics, and outcome of polytrauma patients with the combination of pulmonary contusion, flail chest and upper thoracic spinal injury. Injury 2022; 53:1073-1080. [PMID: 34625240 DOI: 10.1016/j.injury.2021.09.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 05/12/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Chest trauma was the third most common cause of death in polytrauma patients, accounting for 25% of all deaths from traumatic injury. Chest trauma involves in injury to the bony thorax, intrathoracic organs and thoracic medulla. This study aimed to investigate the incidence, clinical characteristics, and outcome of polytrauma patients with pulmonary contusion, flail chest and upper thoracic spinal injury. METHODS Patients who met inclusion criteria were divided into groups: Pulmonary contusion group (PC); Pulmonary contusion and flail chest group (PC + FC); Pulmonary contusion and upper thoracic spinal cord injury group (PC + UTSCI); Thoracic trauma triad group (TTT): included patients with flail chest, pulmonary contusion and the upper thoracic spinal cord injury coexisted. Outcomes were determined, including 30-day mortality and 6-month mortality. RESULTS A total 84 patients (2.0%) with TTT out of 4176 polytrauma patients presented to Tongji trauma center. There was no difference in mean ISS among PC + FC group, PC + UTSCI group and TTT group. Patients with TTT had a longer ICU stay (21.4 days vs. 7.5 and 6.2; p<0.01), relatively higher 30-day mortality (40.5% vs. 6.0% and 4.3%; p<0.01), and especially higher 6-month mortality (71.4% vs. 6.5%, 13.0%; p<0.01), compared to patients with PC + FC or with PC + UTSCI. The leading causes of death for patients with TTT were ARDS (44.1%) and pulmonary infection (26.5%) during first 30 days after admission. For those patients who died later than 30 days during the 6 months, the predominant underlying cause of death was MOF (53.8%). CONCLUSIONS Lethal triad of thoracic trauma (LTTT) were described in this study, which consisting of pulmonary contusion,flail chest and the upper thoracic spine cord injury. Like the classic "lethal triad", there was a synergy between the factors when they coexist, resulting in especially high mortality rates. Polytrauma patients with LTTT were presented relatively high 30-day mortality and 6 months mortality. We should pay much more attention to the patients with LTTT for further minimizing complications and mortality.
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16
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Gao J, Guo J, Chen J, Ding C, Wang J, Huang Q, Jian Y, Zhao X, Li M, Gao Y, Yang C, Wang W. d-Amino Acid-Based Metabolic Labeling Enables a Fast Antibiotic Susceptibility Test of Both Isolated Bacteria and Bronchoalveolar Lavage Fluid. Adv Healthc Mater 2022; 11:e2101736. [PMID: 34898025 DOI: 10.1002/adhm.202101736] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/18/2021] [Indexed: 11/07/2022]
Abstract
The threat of multidrug-resistant bacteria has escalated rapidly, increasing the demand for accurate antibiotic susceptibility tests (ASTs). Traditional bacterial growth yield-based ASTs often take overnight to report, delaying the timely guidance of antibiotic use. Here, a fluorescent d-amino acid (FDAA) labeling-based AST (FaAST) is reported, which can quickly provide accurate minimum inhibitory concentrations (MICs). The FDAA-labeling signals that reflect the bacterial metabolic status underlie the flow cytometry-based strategy for MIC determination. Resistant bacteria show a reluctant decline in FDAA-labeling (inhibited metabolism) after treatment with the corresponding antibiotics, whereas susceptible bacteria demonstrate quick responses to low doses of drugs. The MICs are determined based on the changing trends in labeling. After testing 23 clinical isolates and laboratory strains of the most critical drug-resistant bacteria against a panel of representative antibiotics, FaAST shows a high susceptibility category with an accuracy of 98.13%. Moreover, FaAST can also make quick and accurate diagnosis against bronchoalveolar lavage fluids collected from hospital-acquired pneumonia patients, saving 2-4 days in guiding antibiotic use for this life-threatening infection. Thus, the speed, accuracy, and broad applicability of FaAST will be valuable in informing antibiotic decisions when treating critical infections caused by drug-resistant bacteria.
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Affiliation(s)
- Juan Gao
- Institute of Molecular Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Junnan Guo
- Institute of Molecular Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Jianxiao Chen
- Department of Critical Care Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Chenling Ding
- Department of Critical Care Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Jiemin Wang
- Department of Critical Care Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Qian Huang
- Department of Laboratory Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Ying Jian
- Department of Laboratory Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Xianyuan Zhao
- Department of Critical Care Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Min Li
- Department of Laboratory Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Yuan Gao
- Department of Critical Care Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
| | - Chaoyong Yang
- Institute of Molecular Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
- The MOE Key Laboratory of Spectrochemical Analysis and Instrumentation Key Laboratory for Chemical Biology of Fujian Province State Key Laboratory of Physical Chemistry of Solid Surfaces Department of Chemical Biology College of Chemistry and Chemical Engineering Xiamen University Xiamen 361005 China
| | - Wei Wang
- Institute of Molecular Medicine Renji Hospital Shanghai Jiao Tong University School of Medicine Shanghai 200127 China
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17
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Xu XH, Fan HF, Shi TT, Yang DY, Huang L, Jiang WH, Lu G. Influence of the timing of bronchoscopic alveolar lavage on children with adenovirus pneumonia: a comparative study. BMC Pulm Med 2021; 21:363. [PMID: 34763680 PMCID: PMC8582151 DOI: 10.1186/s12890-021-01708-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 10/26/2021] [Indexed: 12/03/2022] Open
Abstract
Background Adenovirus pneumonia is prone to severe clinical and imaging manifestations in children. Bronchoscopic alveolar lavage (BAL) is an important adjunctive therapy for patients with severe imaging findings. The study aimed to evaluate the effect of the timing on the efficacy of bronchoalveolar lavage in children with adenovirus pneumonia. Methods This study included 134 patients with adenovirus pneumonia treated with BAL at Guangzhou Women and Children's Medical Center from January 2019 to January 2020.They were classified into the severe and mild groups. Based on the timing of BAL, each group was divided into the early BAL layer (received BAL within 1–9 days of the illness course) and the late BAL layer (received BAL within 10–14 days of the illness course). The clinical data of patients with different BAL timings were analyzed in two groups. Results Among the 134 patients, 70 were categorized into the mild group and 64 were categorized into the severe group. Of the 134 patients, 42 patients received BAL early (mild group: n = 21 and severe group: n = 21) and 92 patients received BAL later (mild group: n = 49 and severe group: n = 43). In the mild group, the fever and hospital duration were shorter in patients who received BAL early than in those who received BAL later (p < 0.05). However, in the severe group, there were no statistically significant differences in the fever and hospital duration between patients who received BAL early and those who received BAL later. However, the need for mechanical ventilation and the incidence of BAL complications, such as new need for oxygen, were higher in patients who received BAL early than in those who received BAL later in the severe group (p < 0.05). Conclusion For mild adenovirus pneumonia, early BAL may shorten the fever and hospital duration. However, early BAL in severe cases might not shorten the course of the disease or improve prognosis and may even increase the risks of mechanical ventilation and BAL complications.
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Affiliation(s)
- Xue-Hua Xu
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Hui-Feng Fan
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Ting-Ting Shi
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Di-Yuan Yang
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Li Huang
- Pediatric Intensive Care Unit, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wen-Hui Jiang
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China
| | - Gen Lu
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, 510120, Guangdong, China.
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18
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Menditto VG, Mei F, Fabrizzi B, Bonifazi M. Role of bronchoscopy in critically ill patients managed in intermediate care units - indications and complications: A narrative review. World J Crit Care Med 2021; 10:334-344. [PMID: 34888159 PMCID: PMC8613715 DOI: 10.5492/wjccm.v10.i6.334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/18/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
Flexible bronchoscopy (FB) has become a standard of care for the triad of inspection, sampling, and treatment in critical care patients. It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit (ICU). Less is known about its role outside the ICU, particularly in the intermediate care unit (IMCU), a specialized environment, where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided. In the IMCU, the leading indications for a diagnostic work-up are: To visualize airway system/obstructions, perform investigations to detect respiratory infections, and identify potential sources of hemoptysis. The main procedures for therapeutic purposes are secretion aspiration, mucus plug removal to solve atelectasis (total or lobar), and blood aspiration during hemoptysis. The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients. Serious adverse events related to FB are relatively uncommon, but they may be due to lack of expertise or appropriate precautions. Finally, nowadays, during dramatic recent coronavirus disease 2019 (COVID-19) pandemic, the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined. Hence, we provide a concise review on the role of FB in an IMCU setting, focusing on its indications, technical aspects and complications.
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Affiliation(s)
- Vincenzo G Menditto
- Department of Emergency Medicine, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
| | - Federico Mei
- Respiratory Diseases Unit, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
| | - Benedetta Fabrizzi
- Cystic Fibrosis Regional Reference Center, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Ancona, Ancona 60126, Italy
| | - Martina Bonifazi
- Department of Biomedical Sciences and Public Health, Marche Polytechnic University, Ancona 60126, Italy
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19
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Lau H, Khosrawipour T, Li S, Alexander M, Frelkiewicz P, Labbé MK, Stieglitz S, Lakey JRT, Kielan W, Khosrawipour V. Exploring Insulin Production Following Alveolar Islet Transplantation (AIT). Int J Mol Sci 2021; 22:ijms221910185. [PMID: 34638521 PMCID: PMC8508311 DOI: 10.3390/ijms221910185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/11/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Abstract
Recent studies have demonstrated the feasibility of islet implantation into the alveoli. However, until today, there are no data on islet behavior and morphology at their transplant site. This study is the first to investigate islet distribution as well insulin production at the implant site. Using an ex vivo postmortem swine model, porcine pancreatic islets were isolated and aerosolized into the lung using an endoscopic spray-catheter. Lung tissue was explanted and bronchial airways were surgically isolated and connected to a perfusor. Correct implantation was confirmed via histology. The purpose of using this new lung perfusion model was to measure static as well as dynamic insulin excretions following glucose stimulation. Alveolar islet implantation was confirmed after aerosolization. Over 82% of islets were correctly implanted into the intra-alveolar space. The medium contact area to the alveolar surface was estimated at 60 +/− 3% of the total islet surface. The new constructed lung perfusion model was technically feasible. Following static glucose stimulation, insulin secretion was detected, and dynamic glucose stimulation revealed a biphasic insulin secretion capacity during perfusion. Our data indicate that islets secrete insulin following implantation into the alveoli and display an adapted response to dynamic changes in glucose. These preliminary results are encouraging and mark a first step toward endoscopically assisted islet implantation in the lung.
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Affiliation(s)
- Hien Lau
- Department of Surgery, University of California, Irvine (UCI), Orange, CA 92868, USA; (M.A.); (J.R.T.L.); (V.K.)
- Correspondence: (H.L.); (T.K.)
| | - Tanja Khosrawipour
- Department of Surgery (A), University-Hospital Düsseldorf, Heinrich-Heine University, Moorenstrasse 5, D-40225 Duesseldorf, Germany
- Correspondence: (H.L.); (T.K.)
| | - Shiri Li
- Department of Surgery, Weill Medical College of Cornell University, New York, NY 10065, USA;
| | - Michael Alexander
- Department of Surgery, University of California, Irvine (UCI), Orange, CA 92868, USA; (M.A.); (J.R.T.L.); (V.K.)
| | - Piotr Frelkiewicz
- Center for Experimental Diagnostics and Biomedical Innovations, Wroclaw University of Environmental and Life Sciences, 50-375 Wroclaw, Poland;
| | - Maya Karine Labbé
- School of Dentistry, Wroclaw Medical University, 50-367 Wroclaw, Poland;
| | - Sven Stieglitz
- Department Pulmonary Medicine, Petrus-Hospital Wuppertal, University of Witten-Herdecke, D-42283 Wuppertal, Germany;
| | - Jonathan Robert Todd Lakey
- Department of Surgery, University of California, Irvine (UCI), Orange, CA 92868, USA; (M.A.); (J.R.T.L.); (V.K.)
| | - Wojciech Kielan
- 2nd Department of General Surgery and Surgical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
| | - Veria Khosrawipour
- Department of Surgery, University of California, Irvine (UCI), Orange, CA 92868, USA; (M.A.); (J.R.T.L.); (V.K.)
- 2nd Department of General Surgery and Surgical Oncology, Wroclaw Medical University, 50-556 Wroclaw, Poland;
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20
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Kalchiem-Dekel O, Hossain S, Gauran C, Beattie JA, Husta BC, Lee RP, Chawla M. An evolving role for endobronchial ultrasonography in the intensive care unit. J Thorac Dis 2021; 13:5183-5194. [PMID: 34527358 PMCID: PMC8411164 DOI: 10.21037/jtd-2019-ipicu-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/21/2020] [Indexed: 11/06/2022]
Abstract
Endobronchial ultrasound (EBUS) bronchoscopy is an established minimally-invasive modality for visualization, characterization, and guidance of sampling of paratracheal and parabronchial structures and tissues. In the intensive care unit (ICU), rapidly obtaining an accurate diagnosis is paramount to the management of critically ill patients. In some instances, diagnosing and confirming terminal illness in a critically ill patient provides needed closure for patients and their loved ones. Currently available data on feasibility, safety, and yield of EBUS bronchoscopy in critically ill patients is based on single center experiences. These data suggest that in select ICU patients convex and radial probe-EBUS bronchoscopy can serve as useful tools in the evaluation of mediastinal lymphadenopathy, central airway obstruction, pulmonary embolism, and peripheral lung lesions. Barriers to the use of EBUS bronchoscopy in the ICU include: (I) requirement for dedicated equipment, prolonged procedure time, and bronchoscopy team expertise that may not be available; (II) applicability to a limited number of patients and conditions in the ICU; and (III) technical difficulty related to the relatively large outer diameter of the convex probe-EBUS bronchoscope and an increased risk for adverse cardiopulmonary consequences due to intermittent obstruction of the artificial airway. While the prospects for EBUS bronchoscopy in critically ill patients appear promising, judicious patient selection in combination with bronchoscopy team expertise are of utmost importance when considering performance of EBUS bronchoscopy in the ICU setting.
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Affiliation(s)
- Or Kalchiem-Dekel
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Saamia Hossain
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cosmin Gauran
- Department of Anesthesia and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jason A Beattie
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bryan C Husta
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Robert P Lee
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mohit Chawla
- Section of Interventional Pulmonology, Pulmonary Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Lau H, Khosrawipour T, Alexander M, Li S, Mikolajczyk A, Nicpon J, Schubert J, Bania J, Lakey JRT, Khosrawipour V. Islet Transplantation in the Lung via Endoscopic Aerosolization: Investigation of Feasibility, Islet Cluster Cell Vitality, and Structural Integrity. Cell Transplant 2021; 29:963689720949244. [PMID: 32967455 PMCID: PMC7784503 DOI: 10.1177/0963689720949244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aerosolized drug delivery has recently attracted much attention as a possible new tool for the delivery of complex nanoparticles. This study aims to investigate whether catheter-based aerosolization of islets via endobronchial systems is a feasible option in islet transplantation. Besides investigating the feasibility of islet aerosolization, we also examined cluster cell vitality and structural integrity of the islets following aerosolization. Using an ex vivo postmortem swine model, porcine pancreatic islets were isolated and aerosolized with an endoscopic spray catheter. Following aerosolization, islet cell vitality and function were assessed via Calcein AM and propidium iodide as well as insulin production after glucose exposure. In the final step, the overall feasibility of the procedure and structural integrity of cells were analyzed and evaluated with respect to clinical applicability. No significant difference was detected in the viability of control islets (90.67 ± 2.19) vs aerosolized islets (90.68 ± 1.20). Similarly, there was no significant difference in control islets (1.62 ± 0.086) vs aerosolized islets (1.42 ± 0.11) regarding insulin release after stimulation. Indocyanine green marked islets were transplanted into the lung without major difficulty. Histological analysis confirmed retained structural integrity and predominant location in the alveolar cavity. Our ex vivo data suggest that catheter-based aerosolized islet cell delivery is a promising tool for the application of cell clusters. According to our data, islet cell clusters delivery is feasible from a mechanical and physical perspective. Moreover, cell vitality and structural integrity remain largely unaffected following aerosolization. These preliminary results are encouraging and represent a first step toward endoscopically assisted islet cell implantation in the lung.
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Affiliation(s)
- Hien Lau
- Department of Surgery, 8788University of California, Irvine (UCI), Orange, CA, USA
| | - Tanja Khosrawipour
- Department of Surgery, 8788University of California, Irvine (UCI), Orange, CA, USA.,Department of Surgery (A), University-Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Alexander
- Department of Surgery, 8788University of California, Irvine (UCI), Orange, CA, USA
| | - Shiri Li
- Department of Surgery, 8788University of California, Irvine (UCI), Orange, CA, USA
| | - Agata Mikolajczyk
- Department of Biochemistry and Molecular Biology, Faculty of Veterinary Sciences, 56641Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Jakub Nicpon
- Department of Surgery, Faculty of Veterinary Sciences, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Justyna Schubert
- Department of Food Hygiene and Consumer Health Protection, 56641Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Jacek Bania
- Department of Food Hygiene and Consumer Health Protection, 56641Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | | | - Veria Khosrawipour
- Department of Surgery, 8788University of California, Irvine (UCI), Orange, CA, USA.,Department of Biochemistry and Molecular Biology, Faculty of Veterinary Sciences, 56641Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
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22
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Duesberg CB, Valtin C, Fuge J, Logemann F, Fuehner T, Welte T, Gottlieb J. A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy. Respiration 2021; 100:600-610. [PMID: 33849036 DOI: 10.1159/000515134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/05/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopy is widely used and regarded as standard of care in most intensive care units (ICUs). Data concerning recommendations for on-call bronchoscopy are lacking. OBJECTIVES Evaluation of recommendations, complications, and outcome of on-call bronchoscopies. METHOD A retrospective single-centre analysis was conducted in a large university hospital. All on-call bronchoscopies performed outside normal working hours in the year before (period 1) and after (period 2) establishing a catalogue of recommendations for indications of on-call bronchoscopy on November 1, 2016, were included. RESULTS Overall, 924 bronchoscopies in 538 patients were analysed. A relative reduction of 83.6% from 794 bronchoscopies in 432 patients (1.84 per patient) during period 1 to 130 in 107 patients (1.21 per patient) during period 2 was observed. Most bronchoscopies (812/924, 87.9%) were performed in ICUs, and 416 patients (77.3%) were intubated. Bronchoscopies for excessive secretions decreased significantly during period 2. Fifty-three of 130 bronchoscopies (40.8%) fulfilled the specified recommendations during period 2, in comparison with 16.8% in period 1 (p < 0.001). Complications were recorded in 58 of 924 procedures (6.3%) and were more frequent in period 2, especially moderate bleeding. In-hospital mortality of patients undergoing on-call bronchoscopy did not differ between periods and was 28.7 and 30.2% in periods 1 and 2, respectively. CONCLUSION The introduction of recommendations for on-call bronchoscopy led to a significant decline of on-call bronchoscopies without negatively affecting outcome. More evidence is needed in on-call bronchoscopy, especially for ICU patients with intrinsic higher complication rates.
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Affiliation(s)
| | - Christina Valtin
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Frank Logemann
- Department of Anaesthesiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Thomas Fuehner
- German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory and Intensive Care Medicine, Hospital Siloah, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
| | - Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,German Center for Lung Research (DZL), Hannover, Germany
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23
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Sehgal IS, Dhooria S, Agarwal R. Should Flexible Bronchoscopy be Routinely Performed in Aspiration Pneumonitis: Non Liquet. Indian J Crit Care Med 2021; 25:113-114. [PMID: 33707882 PMCID: PMC7922438 DOI: 10.5005/jp-journals-10071-23743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
How to cite this article: Sehgal IS, Dhooria S, Agarwal R. Should Flexible Bronchoscopy be Routinely Performed in Aspiration Pneumonitis: Non Liquet. Indian J Crit Care Med 2021;25(2):113-114.
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Affiliation(s)
- Inderpaul S Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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24
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Lv ZH, Yuan N. Construction of a Risk Prediction Model for Fever After Painless Bronchoscopy. Med Sci Monit 2020; 26:e924911. [PMID: 32636353 PMCID: PMC7366786 DOI: 10.12659/msm.924911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to construct a risk prediction model for fever after painless bronchoscopy. Material/Methods A total of 188 patients were included, and a self-designed data collection form was used. By collecting relevant clinical data of patients before, during, and after the painless bronchoscopy, the influencing factors were analyzed through univariate analysis, and multiple logistic regression analysis was performed to construct the prediction equation, which was tested by ROC curve analysis. Results Of the 188 patients undergoing painless bronchoscopy, 49 had postoperative fever, and the incidence rate was 26.0%. The prediction probability model was: P=ex/1+ex, where e is the natural logarithm, X=−4.337+0.020×(CRP)+1.014 (whether the examination time was greater than 30 minutes)+1.912×(whether remifentanil was used during anesthesia)+1.514×(whether nausea or vomiting occurred during surgery or during recovery). The prediction sensitivity and specificity were 78.26% 76.72%, respectively. Conclusions Use of this risk prediction model of fever after painless bronchoscopy can improve the recognition of people at high risk of postoperative fever, and it has good ability to guide clinical nursing observation and early screening of fever after painless bronchoscopy.
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Affiliation(s)
- Zhang-Hong Lv
- Department of Respiratory, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
| | - Niu Yuan
- Department of Respiratory, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China (mainland)
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25
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Reddy PD, Nguyen SA, Deschler D. Bronchoscopy, laryngoscopy, and esophagoscopy during the COVID-19 pandemic. Head Neck 2020; 42:1634-1637. [PMID: 32348600 PMCID: PMC7267422 DOI: 10.1002/hed.26221] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Abstract
Background The United States now has the highest death toll due to COVID‐19. Many otolaryngology procedures, including laryngoscopy, bronchoscopy, and esophagoscopy, place otolaryngologists at increased risk of coronavirus transmission due to close contact with respiratory droplets and aerosolization from the procedure. The aim of this study is to provide an overview of guidelines on how to perform these procedures during the coronavirus pandemic. Methods Literature review was performed. Articles citing laryngoscopy, bronchoscopy, esophagoscopy use with regard to COVID‐19 were included. Results Laryngoscopy, bronchoscopy, and esophagoscopy are all used in both emergent and elective situations. Understanding the risk stratification of cases and the varied necessity of personal protective equipment is important in protecting patients and health care workers. Conclusions Summary guidelines based on the literature available at this time are presented in order to decrease transmission of the virus and protect those involved.
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Affiliation(s)
- Priyanka D Reddy
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Daniel Deschler
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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26
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Cordovilla R, Álvarez S, Llanos L, Nuñez Ares A, Cases Viedma E, Díaz-Pérez D, Flandes J. SEPAR and AEER consensus recommendations on the Use of Bronchoscopy and Airway Sampling in Patients with Suspected or Confirmed COVID-19 Infection. Arch Bronconeumol 2020. [PMID: 32362384 PMCID: PMC7193137 DOI: 10.1016/j.arbres.2020.03.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Este documento de consenso está elaborado por el área de Técnicas y Trasplante y el área de Enfermería de la Sociedad Española de Neumología y Cirugía Torácica, así como por la Asociación Española de Endoscopia Respiratoria, con el objetivo de proporcionar conocimientos para el uso efectivo y seguro de la broncoscopia en pacientes con sospecha o con confirmación de la infección por COVID-19. Es prioritario proporcionar la mayor seguridad a nuestros pacientes, a los sanitarios que los atienden y a la comunidad en general. En este momento de pandemia, la información de la que disponemos acerca del uso de la broncoscopia en este tipo de pacientes se basa en la experiencia de otros centros y países, y las publicaciones científicas son escasas. El objetivo de este documento es recoger esas experiencias y, en base a las recomendaciones de los organismos oficiales, ofrecer un documento de ayuda para la práctica clínica diaria.
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Affiliation(s)
- Rosa Cordovilla
- Servicio de Neumología, Unidad de Broncoscopias, Complejo Asistencial Universitario de Salamanca, Salamanca, España; Área de Técnicas y Trasplante de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER).
| | - Susana Álvarez
- Servicio de Neumología, Unidad de Broncoscopias, Hospital Universitario Fundación Jiménez Díaz IIS-FJD CIBERES, Madrid, España; Área de Enfermería Respiratoria de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
| | - Liliana Llanos
- Servicio de Neumología, Unidad de Broncoscopias, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España; Área de Enfermería Respiratoria de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
| | - Ana Nuñez Ares
- Servicio de Neumología, Unidad de Broncoscopias, Complejo Hospitalario Universitario de Albacete, Albacete , España; Área de Técnicas y Trasplante de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
| | - Enrique Cases Viedma
- Servicio de Neumología, Unidad de Endoscopias, Hospital Universitario y Politécnico La Fe, Valencia, España; Área de Técnicas y Trasplante de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
| | - David Díaz-Pérez
- Servicio de Neumología, Unidad de Broncoscopias, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España; Área de Enfermería Respiratoria de SEPAR
| | - Javier Flandes
- Servicio de Neumología, Unidad de Broncoscopias, Hospital Universitario Fundación Jiménez Díaz IIS-FJD CIBERES, Madrid, España; Área de Técnicas y Trasplante de SEPAR; Asociación Española de Endoscopia Respiratoria y Neumología Intervencionista (AEER)
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27
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De Luca D, Shankar-Aguilera S, Centorrino R, Fortas F, Yousef N, Carnielli VP. Less invasive surfactant administration: a word of caution. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:331-340. [PMID: 32014122 DOI: 10.1016/s2352-4642(19)30405-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/17/2019] [Accepted: 11/05/2019] [Indexed: 12/13/2022]
Abstract
Surfactant is a cornerstone of neonatal critical care, and the presumed less (or minimally) invasive techniques for its administration have been proposed to reduce invasiveness of neonatal critical care interventions. These techniques are generally known as less invasive surfactant administration (LISA) and have quickly gained popularity in some neonatal intensive care units. Despite the increase in the use of LISA, we believe that the pathobiological background supporting its possible clinical benefits is unclear. Similarly, it is unclear whether there are any ignored drawbacks, as LISA has been tested in only a few trials and some physiopathological issues seem to have gone unnoticed. Active research is warranted to fill these knowledge gaps before LISA can be firmly recommended. In this Viewpoint, we provide an in-depth analysis of LISA techniques, based on physiological and pathobiological factors, followed by a critical appraisal of available clinical data, and highlight some possible future research directions.
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Affiliation(s)
- Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, APHP, South Paris University Hospitals, Paris, France; Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France.
| | - Shivani Shankar-Aguilera
- Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, APHP, South Paris University Hospitals, Paris, France
| | - Roberta Centorrino
- Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, APHP, South Paris University Hospitals, Paris, France; Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
| | - Feriel Fortas
- Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, APHP, South Paris University Hospitals, Paris, France; Physiopathology and Therapeutic Innovation Unit-U999, South Paris-Saclay University, Paris, France
| | - Nadya Yousef
- Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, APHP, South Paris University Hospitals, Paris, France
| | - Virgilio P Carnielli
- Division of Neonatology, G Salesi Women and Children's Hospital, Polytechnical University of Marche, Ancona, Italy
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28
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Satici C, López-Padilla D, Schreiber A, Kharat A, Swingwood E, Pisani L, Patout M, Bos LD, Scala R, Schultz MJ, Heunks L. ERS International Congress, Madrid, 2019: highlights from the Respiratory Intensive Care Assembly. ERJ Open Res 2020; 6:00331-2019. [PMID: 32166088 PMCID: PMC7061203 DOI: 10.1183/23120541.00331-2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/23/2020] [Indexed: 12/19/2022] Open
Abstract
The Respiratory Intensive Care Assembly of the European Respiratory Society is delighted to present the highlights from the 2019 International Congress in Madrid, Spain. We have selected four sessions that discussed recent advances in a wide range of topics: from acute respiratory failure to cough augmentation in neuromuscular disorders and from extra-corporeal life support to difficult ventilator weaning. The subjects are summarised by early career members in close collaboration with the Assembly leadership. We aim to give the reader an update on the most important developments discussed at the conference. Each session is further summarised into a short list of take-home messages.
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Affiliation(s)
- Celal Satici
- Respiratory Medicine, Istanbul Gaziosmanpasa Training and Research Hospital, Health Science University, Istanbul, Turkey
| | - Daniel López-Padilla
- Respiratory Dept, Gregorio Marañón University Hospital, Spanish Sleep Network, Madrid, Spain
| | - Annia Schreiber
- Interdepartmental Division of Critical Care, University of Toronto, Unity Health Toronto (St Michael's Hospital) and the Li Ka Shing Knowledge Institute, Toronto, Canada
| | - Aileen Kharat
- Pulmonology Dept, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Ema Swingwood
- University Hospitals Bristol NHS Foundation Trust, Adult Therapy Services, Bristol Royal Infirmary, Bristol, UK
| | - Luigi Pisani
- Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Lieuwe D. Bos
- Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Respiratory Medicine, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Raffaele Scala
- Pulmonology and Respiratory Intensive Care Unit, S. Donato Hospital, Arezzo, Italy
| | - Marcus J. Schultz
- Intensive Care, Amsterdam UMC, Location AMC, University of Amsterdam, Amsterdam, the Netherlands
- Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Nuffield Dept of Medicine, University of Oxford, Oxford, UK
| | - Leo Heunks
- Intensive Care, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands
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29
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Arrieta E, Sangiovanni S, Garcia-Robledo JE, Velásquez M, Sua LF, Fernández-Trujillo L. Video-Assisted Thoracoscopic Lung Biopsy in Critically Ill Patients With Hematologic Malignancy and Acute Respiratory Distress Syndrome: A Case Series Report. J Investig Med High Impact Case Rep 2020; 8:2324709620912101. [PMID: 32189523 PMCID: PMC7082865 DOI: 10.1177/2324709620912101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 02/10/2020] [Accepted: 02/13/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary complications are prevalent among patients with hematologic malignancies, who are at high risk of developing acute respiratory distress syndrome (ARDS). Although diffuse alveolar damage is considered the diagnostic hallmark of ARDS, there are plenty of other non-diffuse alveolar damage etiologies that can mimic ARDS and benefit from a specific therapy, therefore correcting the underlying cause. When the etiology remains unclarified despite noninvasive procedures, a surgical lung biopsy (either open via thoracotomy or video-assisted thoracoscopic surgery [VATS]) may be warranted. However, the role of surgical lung biopsy has not been extensively studied in patients with hematologic malignancy and ARDS and so doubt exists about the risk-benefit relationship of such procedures. In this article, we report a series of 8 critically ill patients with hematologic malignancies and ARDS, who underwent VATS lung biopsy, in a specialized institution in Cali, Colombia, from 2015 to 2019, with special emphasis on its diagnostic yield, modifications in treatment protocol, and safety. VATS lung biopsy is a minimally invasive procedure that appears to be a relatively safe with few postoperative complications and minimal perioperative mortality. It has a high diagnostic yield, resulting in a modification of treatment in a nondepreciable percentage of patients. However, this subset of patients was critically ill, with a high risk of mortality, and the lung biopsy did not appear to affect in this aspect. Future randomized controlled trials are needed to further clarify this topic.
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Affiliation(s)
- Elizabeth Arrieta
- Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | | | | | - Mauricio Velásquez
- Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Luz Fernanda Sua
- Fundación Valle del Lili, Cali, Colombia
- Universidad Icesi, Cali, Colombia
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30
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Garner JL, Garner SD, Hardie RJ, Molyneaux PL, Singh S, Kemp SV, Shah PL. Evaluation of a re-useable bronchoscopy biosimulator with ventilated lungs. ERJ Open Res 2019; 5:00035-2019. [PMID: 31011572 PMCID: PMC6469070 DOI: 10.1183/23120541.00035-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/11/2019] [Indexed: 12/04/2022] Open
Abstract
Background Restrictions on respiratory trainee time and access to procedures reduce the opportunities to acquire necessary skills in bronchoscopy. Simulation, not subject to such impediments, is a useful supplementary aid to teaching bronchoscopic techniques in a safe environment but there is a limited choice of simulators that are sufficiently realistic and not prohibitively expensive. This study evaluated a low-cost device that simulates an intubated and ventilated patient, employing re-useable, inflatable, BioFlex-preserved, porcine lungs. Methods 26 bronchoscopists, trainee and experienced, after using the bronchoscopy biosimulator, completed a questionnaire using a five-point Likert scale comparing its performance with that of the computerised CAE AccuTouch. Results Participants were largely positive about their experience (mean score of 4.76). The bronchoscopy biosimulator was found to be realistic (mean score 4.64), easy to use (mean score 4.88), and helpful in learning to perform a variety of diagnostic and therapeutic procedures (mean score 4.85). Importantly, the bronchoscopy biosimulator compared favourably to the computer simulator (mean score 4.84). Conclusions These data support the concept of the bronchoscopy biosimulator as an acceptable model with which to supplement the experience of bronchoscopic procedures. A re-useable bronchoscopy biosimulator with ventilated lungs hones skills in an environment that is realistic, is free of patient safety issues and time constraints, and provides a complementary training tool to commercially available simulation modelshttp://ow.ly/AkWM30octSd
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Affiliation(s)
- Justin L Garner
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | | | | | - Philip L Molyneaux
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Suveer Singh
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Pallav L Shah
- Royal Brompton Hospital, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
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31
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Yu Y, Liu C, Zhang Z, Shen H, Li Y, Lu L, Gao Y. Bronchoalveolar lavage fluid dilution in ICU patients: what we should know and what we should do. Crit Care 2019; 23:23. [PMID: 30678693 PMCID: PMC6344997 DOI: 10.1186/s13054-018-2300-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/21/2018] [Indexed: 02/07/2023] Open
Affiliation(s)
- Yuetian Yu
- 0000 0004 0368 8293grid.16821.3cDepartment of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shangdong Road, Shanghai, 200001 China
| | - Chunyan Liu
- grid.452544.6Department of Emergency, Minhang District Central Hospital, 170, Xinsong Road, Shanghai, 201100 China
| | - Zhongheng Zhang
- 0000 0004 1759 700Xgrid.13402.34Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3, East Qingchun Road, Hangzhou, 310020 China
| | - Hui Shen
- 0000000123704535grid.24516.34Department of Laboratory Medicine, Shanghai East Hospital, Tongji University School of Medicine, 1800, Yuntai Road, Shanghai, 200123 China
| | - Yujie Li
- 0000 0004 0368 8293grid.16821.3cDepartment of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shangdong Road, Shanghai, 200001 China
| | - Liangjing Lu
- 0000 0004 0368 8293grid.16821.3cDepartment of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 145, Middle Shangdong Road, Shanghai, 200001 China
| | - Yuan Gao
- 0000 0004 0368 8293grid.16821.3cDepartment of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, 145 Middle Shangdong Road, Shanghai, 200001 China
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