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Casso G, Schoettker P, Savoldelli GL, Azzola A, Cassina T. Development and Initial Evaluation of a Novel, Ultraportable, Virtual Reality Bronchoscopy Simulator: The Computer Airway Simulation System. Anesth Analg 2020; 129:1258-1264. [PMID: 29481426 DOI: 10.1213/ane.0000000000003316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Virtual reality (VR) simulation is an effective and safe method of teaching bronchoscopic skills. Few VR bronchoscopy simulators exist; all are expensive. The present study aimed to describe the design, development, and evaluation of a new, affordable, VR bronchoscopy simulator. METHODS Anesthesiologists and engineers collaborated to design and develop the Computer Airway Simulation System (CASS), an iPad-based, high-fidelity, VR bronchoscopy simulator. We describe hardware and software development, as well as the technical and teaching features of the CASS. Twenty-two senior anesthesiologists evaluated various aspects of the simulator (using a 5-point Likert scale) to assess its face validity. RESULTS Anesthesiologists performed a simulated bronchoscopy (mouth to carina) with a median (range) procedural time of 66 seconds (30-96). The simulator's ease of use was rated 4.3 ± 0.8 and the bronchoscope proxy's handling 4.0 ± 0.7. Criticisms included that excessive system reactivity created handling difficulties. Anatomical accuracy, 3-dimensional bronchial segmentation, and mucosal texture were judged to be very realistic. The simulator's usefulness for teaching and its educational value were highly rated (4.9 ± 0.3 and 4.8 ± 0.4, respectively). CONCLUSIONS We describe the design, development, and initial evaluation of the CASS-a new, ultraportable, affordable, VR bronchoscopy simulator. The simulator's face validity was supported by excellent assessments from senior anesthesiologists with regard to anatomical realism, quality of graphics, and handling performance, even though some future refinements are required. All the practitioners agreed on the significant educational potential of the CASS.
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Affiliation(s)
- Gabriele Casso
- From the Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
| | - Patrick Schoettker
- Department of Anesthesiology, University Hospital Centre and University of Lausanne, Lausanne, Switzerland
| | - Georges L Savoldelli
- Department of Anesthesiology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Andrea Azzola
- Division of Pulmonology, Ente Ospedaliero Cantonale, Ospedale Civico, Lugano, Switzerland
| | - Tiziano Cassina
- From the Department of Cardiac Anesthesia and Intensive Care, Cardiocentro Ticino, Lugano, Switzerland
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2
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Panchabhai TS, Biswas Roy S, Madan N, Abdelrazek H, Patel VJ, Walia R, Bremner RM. Electromagnetic navigational bronchoscopy for diagnosing peripheral lung lesions in lung transplant recipients: a single-center experience. J Thorac Dis 2018; 10:5108-5114. [PMID: 30233886 DOI: 10.21037/jtd.2018.07.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tanmay S Panchabhai
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Sreeja Biswas Roy
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Nikhil Madan
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Hesham Abdelrazek
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Vipul J Patel
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Ross M Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
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Kruklitis R, French K, Cangelosi MJ, Kovitz KL. Investing in New Technology in Pulmonary Medicine: Navigating the Tortuous Path to Success. Chest 2017. [PMID: 28642108 DOI: 10.1016/j.chest.2017.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The introduction of new technologies offers the promise to advance medicine. This occurs alongside improved efforts to control costs of health care by hospital administrators, the Centers for Medicare & Medicaid Services' (CMS) pivot to value programs, and commercial payers' efforts to reduce reimbursement. These trends present a challenge for the pulmonologist, among others, who must navigate increasingly complex and highly scrutinized evaluation processes used to secure new technology (NT). Health-care providers are turning toward value assessments while simultaneously tasked with the mission of offering state of the art technologies and services. Pulmonologists desiring NT are thus faced with increased scrutiny in their evaluation of costs and clinical data to support investments. Consideration of this scrutiny and further evidence to temper the evaluation will improve the likelihood of adoption and patient access to clinically impactful technology. The identification of this evidence may provide a comprehensive view of the clinical and economic benefits of such technologies to both administrators and pulmonary clinicians. It is imperative that all parties involved in the decision process work collaboratively to deploy value added and clinically impactful technologies. Although a physician group might invest in such NT, the capital required often leads such decisions to a larger organization such as a hospital, health-care system, or privately owned entity. This article aims to provide a framework for pulmonary clinicians to better understand the processes that purchasers use to evaluate NT, the pressures that influence their consideration, and what resources may be leveraged toward success.
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Affiliation(s)
- Robert Kruklitis
- Department of Medicine, Lehigh Valley Health Network, Allentown, PA
| | | | | | - Kevin L Kovitz
- Department of Medicine, the University of Illinois at Chicago College of Medicine, Chicago, IL.
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Botana-Rial M, Fernández-Villar A. The importance of units specialising in pleural disease for postgraduate training. Rev Clin Esp 2016; 216:481-482. [PMID: 27908379 DOI: 10.1016/j.rce.2016.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/17/2016] [Indexed: 11/19/2022]
Affiliation(s)
- M Botana-Rial
- Servicio de Neumología, Hospital Álvaro Cunqueiro, EOXI de Vigo, Grupo de Investigación en enfermedades respiratorias NeumoVigo I+i. Instituto de Investigación Sanitaria Galicia Sur (IISGS).
| | - A Fernández-Villar
- Servicio de Neumología, Hospital Álvaro Cunqueiro, EOXI de Vigo, Grupo de Investigación en enfermedades respiratorias NeumoVigo I+i. Instituto de Investigación Sanitaria Galicia Sur (IISGS)
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Ferguson JS, Sonetti DA. Surprised but Not Shaken: AQuIRE Sheds New Light on Innovations in Bronchoscopy. Am J Respir Crit Care Med 2016; 193:9-10. [PMID: 26720786 DOI: 10.1164/rccm.201509-1907ed] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- J Scott Ferguson
- 1 Division of Allergy, Pulmonary, and Critical Care Medicine University of Wisconsin-Madison Madison, Wisconsin
| | - David A Sonetti
- 1 Division of Allergy, Pulmonary, and Critical Care Medicine University of Wisconsin-Madison Madison, Wisconsin
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Hou G, Miao Y, Hu XJ, Wang W, Wang QY, Wu GP, Wang EH, Kang J. The optimal sequence for bronchial brushing and forceps biopsy in lung cancer diagnosis: a random control study. J Thorac Dis 2016; 8:520-6. [PMID: 27076949 DOI: 10.21037/jtd.2016.02.12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Optimizing basic techniques in diagnostic bronchoscopy is important for improving medical services in developing countries. In this study, the optimal sequence of bronchial brushing relative to bronchial biopsy for lung cancer diagnosis was evaluated. METHODS A total of 420 patients with visible endobronchial tumors were prospectively and randomly enrolled in two groups: a pre-biopsy brushing group, receiving two brushings before biopsy; two brushings which performed afterwards; were set as self-control and compared with the pre-biopsy brushings as the intra-group comparison; and a post-biopsy brushing group, only receiving two brushings after biopsy, which were compared with the pre-biopsy brushings as the inter-group comparison. Diagnostic yield of brushing was compared before and after biopsy, and as well as for different tumor pathologies and bronchoscopic morphologies. The occurrence of treated bleeding which defined as bleeding needed further intervention with argon plasma coagulation and/or anti-coagulation drugs in two groups was also compared. RESULTS Only patients with a definitive cytological or histological diagnosis of lung cancer based on bronchoscopy or other confirmatory techniques were included. Patients were excluded if they had submucosal lesions, extrinsic compressions, pulmonary metastasis of extrapulmonary malignancies or uncommon non-small cell lung carcinoma (NSCLC). A total of 362 patients who met the inclusion criteria were analyzed. Diagnostic yield for pre-biopsy brushing (49.2%, 88/179) was significantly higher than for post-biopsy brushing within the same pre-biopsy brushing group (31.8%, 57/179) (P=0.007) as the intra-group comparison, and significantly higher than for post-biopsy brushing in the post group (30.6%, 56/183) (P<0.001) as the inter-group comparison. No difference in occurrence of treated bleeding for pre- vs. post-biopsy bronchial brushing was found. CONCLUSIONS Supplementing bronchoscopic forceps biopsy with brushing improves diagnostic yield in lung cancer. In cases of endobronchial exophytic tumors, pre-biopsy brushing appears to be superior to post-biopsy brushing.
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Affiliation(s)
- Gang Hou
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Yuan Miao
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Xue-Jun Hu
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Wei Wang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Qiu-Yue Wang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Guang-Ping Wu
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - En-Hua Wang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
| | - Jian Kang
- 1 Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang 110001, China ; 2 Department of Pathology, The First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China
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Raval AA, Amir L. Community hospital experience using electromagnetic navigation bronchoscopy system integrating tidal volume computed tomography mapping. Lung Cancer Manag 2016; 5:9-19. [PMID: 30643545 PMCID: PMC6310327 DOI: 10.2217/lmt-2015-0007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 03/22/2016] [Indexed: 11/23/2022] Open
Abstract
Results of the first 50 consecutive patients referred for bronchoscopy or surgery by the tumor review board to confirm suspect lung lesions identified by computed tomography. Electromagnetic navigation was used to biopsy peripheral pulmonary nodules, (19.3 ± 10.7 mm). An electromagnetic tracking system was used to detect miniature position sensors integrated directly into tip-tracked instruments advanced through a 2 mm working channel in a bronchoscope. Learning curve, diagnostic yield, safety and use of the 4D positional information on the patient's tidal volume expiration computed tomography map demonstrate a potential to improve the diagnostic yield of transbronchial biopsies of peripheral pulmonary nodules less than 30 mm reporting a diagnostic yield of 83.3% (40/48). Early experience was safe and effective, with a limited learning curve.
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Affiliation(s)
- Abhijit A Raval
- AnMed Health - Pulmonology, 2000 East Greenville Street, Suite 1100, Anderson, SC 29621, USA.,AnMed Health - Pulmonology, 2000 East Greenville Street, Suite 1100, Anderson, SC 29621, USA
| | - Leah Amir
- Institute for Quality Resource Management - Health Economics, 1 City Place Drive, Suite 285, St Louis, MO 63141, USA.,Institute for Quality Resource Management - Health Economics, 1 City Place Drive, Suite 285, St Louis, MO 63141, USA
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8
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Choi JH, Sim JH, Choi DK, Choi IC. Application of Ventilating-Bronchoscopy-Adaptor by Fusing a Laparoscopic Trocar during Bronchial Thermoplasty under General Anesthesia. Yonsei Med J 2016; 57:534-5. [PMID: 26847313 PMCID: PMC4740553 DOI: 10.3349/ymj.2016.57.2.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/10/2015] [Accepted: 08/06/2015] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jeong Hyun Choi
- Department of Anesthesiology and Pain Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ji Hoon Sim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Kee Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - In Cheol Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
The clinical practice of pulmonary and critical care medicine requires procedural competence in many technical domains, including vascular access, airway management, basic and advanced bronchoscopy, pleural procedures, and critical care ultrasonography. Simulation provides opportunities for standardized training and assessment in procedures without placing patients at undue risk. A growing body of literature supports the use and effectiveness of low-fidelity and high-fidelity simulators for procedural training and assessment. In this manuscript by the Skills-based Working Group of the American Thoracic Society Education Committee, we describe the background, available technology, and current evidence related to simulation-based skills training within pulmonary and critical care medicine. We outline working group recommendations for key procedural domains.
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Whitney DH, Elashoff MR, Porta-Smith K, Gower AC, Vachani A, Ferguson JS, Silvestri GA, Brody JS, Lenburg ME, Spira A. Derivation of a bronchial genomic classifier for lung cancer in a prospective study of patients undergoing diagnostic bronchoscopy. BMC Med Genomics 2015; 8:18. [PMID: 25944280 PMCID: PMC4434538 DOI: 10.1186/s12920-015-0091-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 04/23/2015] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The gene expression profile of cytologically-normal bronchial airway epithelial cells has previously been shown to be altered in patients with lung cancer. Although bronchoscopy is often used for the diagnosis of lung cancer, its sensitivity is imperfect, especially for small and peripheral suspicious lesions. In this study, we derived a gene expression classifier from airway epithelial cells that detects the presence of cancer in current and former smokers undergoing bronchoscopy for suspect lung cancer and evaluated its sensitivity to detect lung cancer among patients from an independent cohort. METHODS We collected bronchial epithelial cells (BECs) from the mainstem bronchus of 299 current or former smokers (223 cancer-positive and 76 cancer-free subjects) undergoing bronchoscopy for suspected lung cancer in a prospective, multi-center study. RNA from these samples was run on gene expression microarrays for training a gene-expression classifier. A logistic regression model was built to predict cancer status, and the finalized classifier was validated in an independent cohort from a previous study. RESULTS We found 232 genes whose expression levels in the bronchial airway are associated with lung cancer. We then built a classifier based on the combination of 17 cancer genes, gene expression predictors of smoking status, smoking history, and gender, plus patient age. This classifier had a ROC curve AUC of 0.78 (95% CI, 0.70-0.86) in patients whose bronchoscopy did not lead to a diagnosis of lung cancer (n = 134). In the validation cohort, the classifier had a similar AUC of 0.81 (95% CI, 0.73-0.88) in this same subgroup (n = 118). The classifier performed similarly across a range of mass sizes, cancer histologies and stages. The negative predictive value was 94% (95% CI, 83-99%) in subjects with a non-diagnostic bronchoscopy. CONCLUSION We developed a gene expression classifier measured in bronchial airway epithelial cells that is able to detect lung cancer in current and former smokers who have undergone bronchoscopy for suspicion of lung cancer. Due to the high NPV of the classifier, it could potentially inform clinical decisions regarding the need for further invasive testing in patients whose bronchoscopy is non diagnostic.
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Affiliation(s)
- Duncan H Whitney
- Allegro Diagnostics, Corp, Maynard, MA, USA. .,Present affiliation: Veracyte, Inc, South San Francisco, CA, USA.
| | | | - Kate Porta-Smith
- Allegro Diagnostics, Corp, Maynard, MA, USA. .,Present affiliation: Veracyte, Inc, South San Francisco, CA, USA.
| | - Adam C Gower
- Boston University School of Medicine, Boston, MA, USA.
| | - Anil Vachani
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - J Scott Ferguson
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
| | | | | | | | - Avrum Spira
- Boston University School of Medicine, Boston, MA, USA.
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Tofts RPH, Lee PM, Sung AW. Interventional pulmonology approaches in the diagnosis and treatment of early stage non small cell lung cancer. Transl Lung Cancer Res 2015; 2:316-31. [PMID: 25806251 DOI: 10.3978/j.issn.2218-6751.2013.10.11] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 09/24/2013] [Indexed: 12/19/2022]
Abstract
Lung cancer management is complex and requires a multi-disciplinary approach to provide comprehensive care. Interventional pulmonology (IP) is an evolving field that utilizes minimally invasive modalities for the initial diagnosis and staging of suspected lung cancers. Endobronchial ultrasound guided sampling of mediastinal lymph nodes for staging and detection of driver mutations is instrumental for prognosis and treatment of early and later stage lung cancers. Advances in navigational bronchoscopy allow for histological sampling of suspicious peripheral lesions with minimal complication rates, as well as assisting with fiducial marker placements for stereotactic radiation therapy. Furthermore, IP can also offer palliation for inoperable cancers and those with late stage diseases. As the trend towards early lung cancer detection with low dose computed tomography is developing, it is paramount for the pulmonary physician with expertise in lung nodule management, minimally invasive sampling and staging to integrate into the paradigm of multi-specialty care.
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Affiliation(s)
- Ryu Peter Hambrook Tofts
- Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York, NY 10003, USA
| | - Peter Mj Lee
- Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York, NY 10003, USA
| | - Arthur Wai Sung
- Division of Pulmonary and Critical Care Medicine, Beth Israel Medical Center, New York, NY 10003, USA
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12
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Gilbert CR, Feller-Kopman D, Akulian J, Hayes M, Yarmus L. Interventional pulmonology procedures in the pediatric population. Pediatr Pulmonol 2014; 49:597-604. [PMID: 23836724 DOI: 10.1002/ppul.22855] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 05/10/2013] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Advanced training in interventional pulmonology (IP) includes a multidisciplinary approach to a wide variety of pathologic conditions affecting different age groups. The role of the interventional pulmonologist in the pediatric patient population has not been described. We report our experience of the care of pediatric patients by IP at an academic institution. METHODS A retrospective review of inpatient and outpatient IP procedures from 2008 to 2011 was performed. All patients' less than 21 years of age at the time of their procedure were identified. Data regarding age, procedure performed, pre-operative diagnosis, results, and complications were collected. RESULTS Thirty-five patients younger than the age of 21, with 14 of these patients being under the age of 18, were identified. Fifty-six procedures were performed on the entire cohort, 30 as inpatient procedures and 26 as outpatient procedures. There were no deaths or major complications related to any procedure. DISCUSSION We identified a cohort of pediatric patients that were able to successfully undergo diagnostic and therapeutic procedures under the direction of an experienced IP team. Cases included the evaluation and management of both malignant and benign complex airway and pleural diseases. There was no major morbidity or mortality related to our procedures, demonstrating an ability to safely evaluate and manage complex airway and pleural disease in the pediatric population.
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Affiliation(s)
- Christopher R Gilbert
- Department of Pulmonary, Allergy, and Critical Care Medicine, Penn State College of Medicine-Milton S. Hershey Medical Center, Bronchoscopy and Interventional Pulmonary, Hershey, Pennsylvania
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Luo X. A bronchoscopic navigation system using bronchoscope center calibration for accurate registration of electromagnetic tracker and CT volume without markers. Med Phys 2014; 41:061913. [DOI: 10.1118/1.4876381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Kaukel P, Herth FJF, Schuhmann M. Bronchial thermoplasty: interventional therapy in asthma. Ther Adv Respir Dis 2013; 8:22-9. [PMID: 24334336 DOI: 10.1177/1753465813509302] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Bronchial thermoplasty is a new treatment option for patients with severe bronchial asthma who remain symptomatic despite maximal medical therapy. The aim of this interventional therapy option is the reduction of smooth muscle in the central and peripheral airways in order to reduce symptomatic bronchoconstriction via the application of heat. A full treatment with bronchial thermoplasty is divided into three bronchoscopies. Randomized, controlled clinical trials have shown an increase in quality of life, a reduction in severe exacerbations, and decreases in emergency department visits as well as days lost from school or work. The trials did not show a reduction in hyperresponsiveness or improvement in forced expiratory volume in 1 s. Short-term adverse effects include an increase in exacerbation rate, an increase in respiratory infections and an increase in hospitalizations. In the 5-year follow up of the studies available there was evidence of clinical and functional stability of the treated patients. Further studies are necessary to identify an asthma phenotype that responds well to this treatment.
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Affiliation(s)
- Philine Kaukel
- Philine Kaukel, MD Department of Pulmonology, Thoraxklinik at the University of Heidelberg, Amalienstr. 5, 69126 Heidelberg, Germany
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Manaker S, Vachani A. The changing face of outpatient bronchoscopy in 2013. Chest 2013; 143:1214-1218. [PMID: 23648906 DOI: 10.1378/chest.13-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
In 2013, the outpatient hospital payment from Medicare for a transbronchial needle aspiration more than doubled. At the same time, the recently updated American College of Chest Physicians guidelines for the diagnosis and management of lung cancer now recommend needle techniques, such as transbronchial needle aspiration, over surgical staging. The convergence of these two events will accelerate the existing forces of technology and economics that have been influencing both the practices of outpatient bronchoscopy and mediastinoscopy and the management of patients with lung cancer over the past 20 years.
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Affiliation(s)
- Scott Manaker
- Department of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Anil Vachani
- Department of Medicine, University of Pennsylvania, Philadelphia, PA
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16
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Álvarez-Maldonado P, Núñez-Pérez Redondo C, Casillas-Enríquez JD, Navarro-Reynoso F, Cicero-Sabido R. Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice? ACTA ACUST UNITED AC 2013. [DOI: 10.5402/2013/217505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose. We describe characteristics, utility, and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU). Methods. Prospective and descriptive cohort of patients admitted to a respiratory ICU from March 2010 to June 2012. Results. A total of 102 FOBs were performed in 84 patients among 580 patients that were admitted to the ICU. Mean age was 48±17 years. FOB was useful in 65% of diagnostic procedures and 83% of therapeutic procedures, with an overall utility of 75%. Indications and utility according to indication were pneumonia in 31 cases, utility of 52%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 25 cases, utility of 76%; airway exploration in 16 cases, utility of 75%; hemoptysis in two cases, utility of 100%; and difficult airway intubation in two cases, utility of 100%. A decrease in oxygen saturation (SpO2) of >5% during FOB was present in 65% of cases, and other minor complications were present in 3.9% of cases. Conclusions. Reasons for performing FOB in the ICU have remained relatively stable over time with the exception of the addition of percutaneous tracheostomy guidance. Our series documents current indications and also the utility and safety of this procedure.
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Affiliation(s)
- Pablo Álvarez-Maldonado
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México O.D. “Dr. Eduardo Liceaga”, HGM, Balmis 148, 06726 México, DF, Mexico
| | - Carlos Núñez-Pérez Redondo
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México O.D. “Dr. Eduardo Liceaga”, HGM, Balmis 148, 06726 México, DF, Mexico
| | - José D. Casillas-Enríquez
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México O.D. “Dr. Eduardo Liceaga”, HGM, Balmis 148, 06726 México, DF, Mexico
| | - Francisco Navarro-Reynoso
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México O.D. “Dr. Eduardo Liceaga”, HGM, Balmis 148, 06726 México, DF, Mexico
| | - Raúl Cicero-Sabido
- Servicio de Neumología y Cirugía de Tórax, Hospital General de México O.D. “Dr. Eduardo Liceaga”, HGM, Balmis 148, 06726 México, DF, Mexico
- Facultad de Medicina, UNAM, México, DF, Mexico
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Correction. Br J Hosp Med (Lond) 2013. [DOI: 10.12968/hmed.2013.74.3.175b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Medford ARL. Pulmonary nodule biopsy: also consider bronchoscopic techniques. Br J Hosp Med (Lond) 2013; 74:175. [PMID: 23665791 DOI: 10.12968/hmed.2013.74.3.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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