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Boily-Daoust C, Plante A, Adam C, Fortin M. Performance and safety of diagnostic procedures in superior vena cava syndrome. ERJ Open Res 2021; 7:00392-2020. [PMID: 33532462 PMCID: PMC7836491 DOI: 10.1183/23120541.00392-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Superior vena cava syndrome (SVCS) is an uncommon condition resulting from extrinsic compression or intraluminal blockade of the superior vena cava. The increased upper body venous pressure results in distended subcutaneous vessels and oedema of the head, neck and arms. SVCS can be a medical emergency if associated with laryngeal or cerebral oedema. The most common SVCS aetiologies are intrathoracic malignancies, accounting for 60 to 86% of cases [1–3]. Standard bronchoscopy and EBUS-TBNA have good diagnostic yield and are relatively safe procedures in the setting of SVCS. However, complications may arise from the underlying malignancy and its proximity to central vital structures.https://bit.ly/37HXFUY
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Affiliation(s)
- Catherine Boily-Daoust
- Dept of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Alexandre Plante
- Dept of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Cedrick Adam
- Dept of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Marc Fortin
- Dept of Pulmonary Medicine, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
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Royds J, Buckley MA, Campbell MD, Donnelly GM, James MFM, Mhuircheartaigh RN, McCaul CL. Achieving proficiency in rigid bronchoscopy-a study in manikins. Ir J Med Sci 2018; 188:979-986. [PMID: 30552645 DOI: 10.1007/s11845-018-1944-5] [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: 07/04/2018] [Accepted: 11/30/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Rigid bronchoscopy may be used to relieve acute airway obstruction following induction of anaesthesia and is a recommended option for management of the difficult airway. The ability of anaesthetists to perform rigid bronchoscopy has not been reported. We sought to explore the acquisition of procedural skill in rigid bronchoscopy by anaesthesiologists in a manikin. METHODS In a prospective interventional study, participants were asked to perform 40 rigid bronchoscopies in a TruCorp AirSim Advance airway manikin, configured to a randomised sequence of easy or difficult laryngoscopic grades to which the participants were blinded. The primary outcome was stabilisation (the attempt after which no further reduction in procedural time occurred). Dental injury and oesophageal intubation were also recorded. Forty anaesthesiologists and 40 unskilled controls (without laryngoscopic skills) participated. RESULTS In the easy model, stabilisation occurred at attempt 8 in the anaesthesiology group and 10 in the unskilled controls. In the difficult model, stabilisation occurred at attempt 10 in both groups. Dental injury was less common in the anaesthesiology group. The proportion of participants achieving procedural competency did not differ between groups in either the easy (35/40 vs. 30/40) or difficult model (32/40 vs. 25/40). CONCLUSIONS This study shows that the technical skill of rigid bronchoscopy can be acquired within 10 repetitions in a manikin model. As procedural competence and complication frequency vary with the laryngoscopic grade of the model, both easy and difficult configurations should be used for training. Advanced laryngoscopic skills are not required prior to training in this technique.
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Affiliation(s)
- Jonathan Royds
- Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland
| | - Muiris A Buckley
- Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland
| | - Mark D Campbell
- Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland
| | - Grace M Donnelly
- Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland
| | | | - Roisin Ní Mhuircheartaigh
- Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland.,Mater Misericordiae University Hospital, Dublin, Ireland
| | - Conan L McCaul
- Department of Anaesthesia, The Rotunda Hospital, Parnell Square, Dublin, Ireland. .,Mater Misericordiae University Hospital, Dublin, Ireland. .,University College Dublin, Dublin, Ireland.
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Morin S, Grateau A, Reuter D, de Kerviler E, de Margerie-Mellon C, de Bazelaire C, Zafrani L, Schlemmer B, Azoulay E, Canet E. Management of superior vena cava syndrome in critically ill cancer patients. Support Care Cancer 2017; 26:521-528. [PMID: 28836006 DOI: 10.1007/s00520-017-3860-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 08/16/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE The purpose of this study is to describe the management and outcome of critically ill cancer patients with Superior Vena Cava Syndrome (SVCS). METHODS All cancer patients admitted to the medical intensive care unit (ICU) of the Saint-Louis University Hospital for a SVCS between January 2004 and December 2016 were included. RESULTS Of the 50 patients included in the study, obstruction of the superior vena cava was partial in two-thirds of the cases and complete in one-third. Pleural effusion was reported in two-thirds of the patients, pulmonary atelectasis in 16 (32%), and pulmonary embolism in five (10%). Computed tomography of the chest showed upper airway compression in 18 (36%) cases, while echocardiography revealed 22 (44%) pericardial effusions. The causes of SVCS were diagnosed one (0-3) day after ICU admission, using interventional radiology procedures in 70% of the cases. Thirty (60%) patients had hematological malignancies, and 20 (40%) had solid tumors. Fifteen (30%) patients required invasive mechanical ventilation, seven (14%) received vasopressors, and renal replacement therapy was implemented in three (6%). ICU, in-hospital, and 6-month mortality rates were 20, 26, and 48%, respectively. The cause of SVCS was the only factor independently associated with day 180 mortality by multivariate analysis. Patients with hematological malignancies had a lower mortality than those with solid tumors (27 versus 80%) (odds ratio 0.12, 95% confidence interval (0.02-0.60), p < 0.01). CONCLUSION Airway obstruction and pleural and pericardial effusions contributed to the unstable condition of cancer patients with SVCS. The vital prognosis of SVCS was mainly related to the underlying diagnosis.
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Affiliation(s)
- Sarah Morin
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Adeline Grateau
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Danielle Reuter
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France
| | - Eric de Kerviler
- Department of Radiology, Saint-Louis University Hospital, AP-HP, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | | | - Cédric de Bazelaire
- Department of Radiology, Saint-Louis University Hospital, AP-HP, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Lara Zafrani
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Benoit Schlemmer
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Elie Azoulay
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.,Paris Diderot University-Sorbonne Paris Cité, Paris, France
| | - Emmanuel Canet
- Medical Intensive Care Unit, Saint-Louis University Hospital, AP-HP, 1 avenue Claude Vellefaux, 75010, Paris, France.
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