Pub Date : 2020-05-01DOI: 10.1097/CPM.0000000000000361
A. Kunadu, M. Bowling, V. Ramsammy
Interstitial lung diseases (ILDs) also known as diffuse parenchymal lung diseases can be a diagnostic dilemma, as treatment and prognosis depend largely on an accurate diagnosis. A multidisciplinary approach has become standard of care and has been shown to be the key to making the correct diagnosis with the least invasive approach. This usually comprises pulmonologists, rheumatologists, radiologists, and pathologists, and is essential to reach the correct and final diagnosis. Histologic diagnosis was considered in the past to be the end and be all for the definite diagnosis of ILDs. However, this is not the case anymore. It is now possible to make a definite diagnosis of certain ILDs such as idiopathic pulmonary fibrosis based off clinical presentation, serologies, and high-resolution computed tomography of the chest if it has typical features without the need for bronchoalveolar lavage or histology. Not all suspected ILDs need to be biopsied! An accurate diagnosis is essential due to differences in etiology, clinicopathologic features, therapeutic options, and prognosis. This article reviews where the literature stands now on the utility of bronchoscopy in diagnosing ILDs.
{"title":"Bronchoscopic Myths and Legends: Utility of Bronchoscopy in ILD: A Review Article","authors":"A. Kunadu, M. Bowling, V. Ramsammy","doi":"10.1097/CPM.0000000000000361","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000361","url":null,"abstract":"Interstitial lung diseases (ILDs) also known as diffuse parenchymal lung diseases can be a diagnostic dilemma, as treatment and prognosis depend largely on an accurate diagnosis. A multidisciplinary approach has become standard of care and has been shown to be the key to making the correct diagnosis with the least invasive approach. This usually comprises pulmonologists, rheumatologists, radiologists, and pathologists, and is essential to reach the correct and final diagnosis. Histologic diagnosis was considered in the past to be the end and be all for the definite diagnosis of ILDs. However, this is not the case anymore. It is now possible to make a definite diagnosis of certain ILDs such as idiopathic pulmonary fibrosis based off clinical presentation, serologies, and high-resolution computed tomography of the chest if it has typical features without the need for bronchoalveolar lavage or histology. Not all suspected ILDs need to be biopsied! An accurate diagnosis is essential due to differences in etiology, clinicopathologic features, therapeutic options, and prognosis. This article reviews where the literature stands now on the utility of bronchoscopy in diagnosing ILDs.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"73 - 78"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47262713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.1097/CPM.0000000000000359
T. Izakovich, L. Sanso, D. Zappetti
Synopsis: A comparison of postextubation therapy with highflow nasal oxygen (HFNO) with noninvasive ventilation with HFNO in mechanically ventilated patients at high risk for extubation failure showed an absolute risk reduction of 6.4% in reintubation rates for patients who received both noninvasive ventilation and HFNO. Source: Thille AW, Muller G, Gacouin A, et al. Effect of postextubation high-flow nasal oxygen with noninvasive ventilation versus high-flow nasal oxygen alone on reintubation among patients at high risk of extubation failure: a randomized clinical trial. JAMA. 2019;322: 1465–1475.
{"title":"Should We Be Using High-flow Nasal Oxygen in Addition to Noninvasive Ventilation for Patients at High Risk for Extubation Failure?","authors":"T. Izakovich, L. Sanso, D. Zappetti","doi":"10.1097/CPM.0000000000000359","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000359","url":null,"abstract":"Synopsis: A comparison of postextubation therapy with highflow nasal oxygen (HFNO) with noninvasive ventilation with HFNO in mechanically ventilated patients at high risk for extubation failure showed an absolute risk reduction of 6.4% in reintubation rates for patients who received both noninvasive ventilation and HFNO. Source: Thille AW, Muller G, Gacouin A, et al. Effect of postextubation high-flow nasal oxygen with noninvasive ventilation versus high-flow nasal oxygen alone on reintubation among patients at high risk of extubation failure: a randomized clinical trial. JAMA. 2019;322: 1465–1475.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000359","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47154348","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-01DOI: 10.1097/CPM.0000000000000358
Pranav Nair, K. Prabhavalkar
Asthma is one of the most common problems that complicate pregnancy. Several maternal and fetal complications make it difficult for the physician to treat asthmatic pregnant women. Asthma not only affects the maternal quality of life but also increases the risk of adverse perinatal outcomes. Managing asthma along with proper diagnosis should be given special emphasis during pregnancy. Pregnant asthmatic patients are at an increased risk of preterm birth, congenital malformations, respiratory disorders, and other complications. Thus, optimum management of asthma along with appropriate pharmacological therapies during pregnancy helps in improving asthmatic exacerbations. This review provides insights with regard to the diagnosis, management, and safety of commonly used medications of asthma during pregnancy.
{"title":"Monitoring Asthma in Pregnancy: Diagnosis and Treatment","authors":"Pranav Nair, K. Prabhavalkar","doi":"10.1097/CPM.0000000000000358","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000358","url":null,"abstract":"Asthma is one of the most common problems that complicate pregnancy. Several maternal and fetal complications make it difficult for the physician to treat asthmatic pregnant women. Asthma not only affects the maternal quality of life but also increases the risk of adverse perinatal outcomes. Managing asthma along with proper diagnosis should be given special emphasis during pregnancy. Pregnant asthmatic patients are at an increased risk of preterm birth, congenital malformations, respiratory disorders, and other complications. Thus, optimum management of asthma along with appropriate pharmacological therapies during pregnancy helps in improving asthmatic exacerbations. This review provides insights with regard to the diagnosis, management, and safety of commonly used medications of asthma during pregnancy.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"67 - 72"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48722605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-24DOI: 10.1097/CPM.0000000000000364
Edouard Lansiaux, Pierre-Philippe Pébaÿ, Jean-Laurent Picard, Joachim Son-Forget
The novel Coronavirus Disease 2019 (COVID-19) disease is a contagious acute respiratory infectious disease whose causative agent has been demonstrated to be a new virus of the coronavirus family, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Multiple studies have already reported that risk factors for severe disease include older age and the presence of at least one of several underlying health conditions. However, a recent physiopathologic report and the French COVID-19 scientific council have postulated a protective effect of tobacco smoking. Thanks to a meta-analysis, we have been able to demonstrate the statistical significance in this regard of 12 series from China, France, and the United States, reporting 3 different smoking statuses (current smoker, former smoker with a smoking history) and disease severity [with odds ratio of 1.78 (1.08-3.10), 4.60 (3.13-7.17), 2.74 (0.63-5.89), respectively]. Subsequently, and using a Bayesian approach, we have established that past and present smoking is associated with more severe COVID-19 outcomes. Finally, we refute claims linking general population smoking status [N=O(108) or O(109)] to much smaller disease course series [N=O(104)]. The latter point, in particular, is presented to stimulate academic discussion, and must be further investigated by well-designed studies.
{"title":"Meta-analysis: COVID-19 Disease Severity Correlates With Smoking Status","authors":"Edouard Lansiaux, Pierre-Philippe Pébaÿ, Jean-Laurent Picard, Joachim Son-Forget","doi":"10.1097/CPM.0000000000000364","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000364","url":null,"abstract":"The novel Coronavirus Disease 2019 (COVID-19) disease is a contagious acute respiratory infectious disease whose causative agent has been demonstrated to be a new virus of the coronavirus family, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Multiple studies have already reported that risk factors for severe disease include older age and the presence of at least one of several underlying health conditions. However, a recent physiopathologic report and the French COVID-19 scientific council have postulated a protective effect of tobacco smoking. Thanks to a meta-analysis, we have been able to demonstrate the statistical significance in this regard of 12 series from China, France, and the United States, reporting 3 different smoking statuses (current smoker, former smoker with a smoking history) and disease severity [with odds ratio of 1.78 (1.08-3.10), 4.60 (3.13-7.17), 2.74 (0.63-5.89), respectively]. Subsequently, and using a Bayesian approach, we have established that past and present smoking is associated with more severe COVID-19 outcomes. Finally, we refute claims linking general population smoking status [N=O(108) or O(109)] to much smaller disease course series [N=O(104)]. The latter point, in particular, is presented to stimulate academic discussion, and must be further investigated by well-designed studies.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"104 - 99"},"PeriodicalIF":0.0,"publicationDate":"2020-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000364","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44248376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/CPM.0000000000000355
Sally J. Rockwell, Joe Miller, B. Brown, Amy L. Kiskaddon, Frances Gilliland, G. Freire, Daniel A. Mauriello
Pulmonary hypertension (PH) causes significant morbidity and mortality in children, and, while the treatment strategies for PH in adults are well studied and developed, few data exist for pediatric patients. In adult patients, successful transitions from intravenous (IV) epoprostenol to subcutaneous (SC) treprostinil are reported, but this information is limited for pediatric patients. Furthermore, while there are reports of SC to IV treprostinil in adults, there are no reports of the transition from IV to SC treprostinil. This case report recounts a successful transition from IV treprostinil to SC treprostinil in a pediatric patient with WHO Class 3, PH, secondary to interstitial lung disease.
{"title":"Transition From Intravenous to Subcutaneous Treprostinil in a Pediatric Patient With Pulmonary Hypertension","authors":"Sally J. Rockwell, Joe Miller, B. Brown, Amy L. Kiskaddon, Frances Gilliland, G. Freire, Daniel A. Mauriello","doi":"10.1097/CPM.0000000000000355","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000355","url":null,"abstract":"Pulmonary hypertension (PH) causes significant morbidity and mortality in children, and, while the treatment strategies for PH in adults are well studied and developed, few data exist for pediatric patients. In adult patients, successful transitions from intravenous (IV) epoprostenol to subcutaneous (SC) treprostinil are reported, but this information is limited for pediatric patients. Furthermore, while there are reports of SC to IV treprostinil in adults, there are no reports of the transition from IV to SC treprostinil. This case report recounts a successful transition from IV treprostinil to SC treprostinil in a pediatric patient with WHO Class 3, PH, secondary to interstitial lung disease.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"43 - 47"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49540096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/CPM.0000000000000354
M. Marano, Luigi Senigalliesi
Respiratory failure is typically associated with changes in pCO2leading to respiratory alkalosis (type 1 failure) and respiratory acidosis (type 2). As a compensatory response, plasma HCO3concentration decreases if pCO2decreases and increases conversely. These secondary responses prevent large pH fluctuations. However, metabolic acid-base disorders may still occur as a consequence of dysfunction of other organs and/or medical treatments. To recognize superimposed acid-base disorders, the availability of an accurate prediction of the expected HCO3that corresponds to a given pCO2is crucial. In chronic hypocapnia, the compensatory metabolic response is regulated by the equation ΔHCO3/ΔpCO2=0.4 mEq/L per mm Hg. An easy rule to compute the expected value of HCO3may be 0.4×pCO2+9. In chronic hypercapnia, the equation is ΔHCO3/ΔpCO2=0.48 mEq/L per mm Hg, and the expected value of HCO3becomes 0.48×pCO2+4.74. While this expression is accurate, it seems to be of limited use for simple "bedside" predictions. In this contribution, we propose the simpler expression: the expected value of HCO3in chronic hypercapnia=½ pCO2+3.5. For values of pCO2not exceeding 70 mm Hg, with the proposed expression, the difference in HCO3prediction in respect to the previous one is <0.5 mEq/L, which is clinically negligible. The root mean square value of the error introduced by the proposed expression is as small as 0.19 mEq/L. Because of its accuracy, we believe that the proposed formula may be useful to identify mixed disorders at the bedside in a simpler way.
呼吸衰竭通常与pco2的变化相关，导致呼吸性碱中毒(1型衰竭)和呼吸性酸中毒(2型)。作为一种代偿反应，血浆hco3浓度随着pco2的降低而降低，反之则升高。这些次生反应防止了pH值的大波动。然而，代谢性酸碱紊乱仍可能由于其他器官功能障碍和/或药物治疗而发生。为了识别叠加的酸碱失调，准确预测与给定pco2对应的预期hco3是至关重要的。在慢性低碳酸血症中，代偿代谢反应由方程ΔHCO3/ΔpCO2=0.4 mEq/L / mm Hg调节。计算hco3期望值的简单规则为0.4×pCO2+9。慢性高碳酸血症方程为ΔHCO3/ΔpCO2=0.48 mEq/L / mm Hg, hco3期望值为0.48×pCO2+4.74。虽然这种表达是准确的，但对于简单的“床边”预测，它的用途似乎有限。在这篇文章中，我们提出了一个更简单的表达式:慢性高碳酸血症中hco3的期望值=½pCO2+3.5。对于不超过70 mm Hg的pco2值，采用本文提出的表达，hco3预测值与之前的预测值的差异<0.5 mEq/L，在临床上可以忽略不计。该表达式引入的误差均方根值小至0.19 mEq/L。由于其准确性，我们相信所提出的公式可能有助于以更简单的方式识别床边的混合性疾病。
{"title":"Bedside Rules for Managing Acid-Base Derangement in Respiratory Failure: Applications to COVID-19","authors":"M. Marano, Luigi Senigalliesi","doi":"10.1097/CPM.0000000000000354","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000354","url":null,"abstract":"Respiratory failure is typically associated with changes in pCO2leading to respiratory alkalosis (type 1 failure) and respiratory acidosis (type 2). As a compensatory response, plasma HCO3concentration decreases if pCO2decreases and increases conversely. These secondary responses prevent large pH fluctuations. However, metabolic acid-base disorders may still occur as a consequence of dysfunction of other organs and/or medical treatments. To recognize superimposed acid-base disorders, the availability of an accurate prediction of the expected HCO3that corresponds to a given pCO2is crucial. In chronic hypocapnia, the compensatory metabolic response is regulated by the equation ΔHCO3/ΔpCO2=0.4 mEq/L per mm Hg. An easy rule to compute the expected value of HCO3may be 0.4×pCO2+9. In chronic hypercapnia, the equation is ΔHCO3/ΔpCO2=0.48 mEq/L per mm Hg, and the expected value of HCO3becomes 0.48×pCO2+4.74. While this expression is accurate, it seems to be of limited use for simple \"bedside\" predictions. In this contribution, we propose the simpler expression: the expected value of HCO3in chronic hypercapnia=½ pCO2+3.5. For values of pCO2not exceeding 70 mm Hg, with the proposed expression, the difference in HCO3prediction in respect to the previous one is <0.5 mEq/L, which is clinically negligible. The root mean square value of the error introduced by the proposed expression is as small as 0.19 mEq/L. Because of its accuracy, we believe that the proposed formula may be useful to identify mixed disorders at the bedside in a simpler way.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44232572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/CPM.0000000000000353
Stefi F. Lee, D. Zappetti
related to antibiotic administration, such as Clostridium difficile colitis. The strengths of this trial include a multicenter design with appropriate blinding, the systematic implementation of VAP prevention bundles in both groups, and the use of a blinded adjudication committee for diagnosis of VAP. Furthermore, the study excluded patients with evidence of overt aspiration at the time of endotracheal intubation; inclusion of this population could have increased the benefit seen from antibiotics. Limitations of the trial include the use of an intravenous antibiotic not available in the United States; however, ampicillin-sulbactam (Unasyn) is available in our country and has comparable coverage. As regards applicability, it is plausible to extend these results to out-of-hospital arrest patients with an initial nonshockable rhythm who undergo TTM, but application to an inhospital arrest population is limited by the increased likelihood that these patients will have MDR organisms. In conclusion, a 2-day course of ampicillin-sulbactam in out-of-hospital cardiac arrest patients undergoing targeted temperature management reduces the incidence of early VAP while posing little immediate risk to the patient.
{"title":"Does Metoprolol Influence the Risk of Exacerbation in a High-risk COPD Patient Population?","authors":"Stefi F. Lee, D. Zappetti","doi":"10.1097/CPM.0000000000000353","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000353","url":null,"abstract":"related to antibiotic administration, such as Clostridium difficile colitis. The strengths of this trial include a multicenter design with appropriate blinding, the systematic implementation of VAP prevention bundles in both groups, and the use of a blinded adjudication committee for diagnosis of VAP. Furthermore, the study excluded patients with evidence of overt aspiration at the time of endotracheal intubation; inclusion of this population could have increased the benefit seen from antibiotics. Limitations of the trial include the use of an intravenous antibiotic not available in the United States; however, ampicillin-sulbactam (Unasyn) is available in our country and has comparable coverage. As regards applicability, it is plausible to extend these results to out-of-hospital arrest patients with an initial nonshockable rhythm who undergo TTM, but application to an inhospital arrest population is limited by the increased likelihood that these patients will have MDR organisms. In conclusion, a 2-day course of ampicillin-sulbactam in out-of-hospital cardiac arrest patients undergoing targeted temperature management reduces the incidence of early VAP while posing little immediate risk to the patient.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000353","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44382585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/CPM.0000000000000352
E. Lafond, D. Zappetti
Synopsis: This double-blind, randomized control trial evaluated the efficacy of a 2-day course of amoxicillin-clavulanate in reducing the incidence of early ventilator-associated pneumonia in patients undergoing targeted temperature management following an out-of-hospital cardiac arrest with initial shockable rhythm. There was a significant reduction in the incidence of early ventilator-associated pneumonia in the treatment group when compared with placebo, but no reduction in ventilator-free days or mortality at day 28. Source: Francois B, Cariou A, Clere-Jehl R, et al. Prevention of early ventilator-associated pneumonia after cardiac arrest. N Engl J Med. 2019;381:1831–1842.
摘要:这项双盲、随机对照试验评估了阿莫西林-克拉维酸2天疗程在降低院外心脏骤停伴有初始震荡节律后接受靶向温度管理的患者早期呼吸机相关肺炎发生率方面的疗效。与安慰剂相比，治疗组早期呼吸机相关肺炎的发生率显著降低，但无呼吸机天数和第28天死亡率没有减少。资料来源:Francois B, Cariou A, Clere-Jehl R等。心脏骤停后早期呼吸机相关性肺炎的预防。中华检验医学杂志，2019;31(1):331 - 342。
{"title":"Does a 2-Day Course of Antibiotics Lower the Incidence of Ventilator-associated Pneumonia in Patients Undergoing Targeted Temperature Management Following Cardiac Arrest?","authors":"E. Lafond, D. Zappetti","doi":"10.1097/CPM.0000000000000352","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000352","url":null,"abstract":"Synopsis: This double-blind, randomized control trial evaluated the efficacy of a 2-day course of amoxicillin-clavulanate in reducing the incidence of early ventilator-associated pneumonia in patients undergoing targeted temperature management following an out-of-hospital cardiac arrest with initial shockable rhythm. There was a significant reduction in the incidence of early ventilator-associated pneumonia in the treatment group when compared with placebo, but no reduction in ventilator-free days or mortality at day 28. Source: Francois B, Cariou A, Clere-Jehl R, et al. Prevention of early ventilator-associated pneumonia after cardiac arrest. N Engl J Med. 2019;381:1831–1842.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000352","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44392121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/CPM.0000000000000350
I. Karaman, S. Ozen, Başak Ballica, T. Uzar, O. Balçik, S. Ozkaya
Hyperviscosity syndrome (HVS) is an oncological emergency resulting from elevated cellular or protein fractions of blood causing respiratory or neurological symptoms. While the prevalence is relatively low in leukemias, there are only a few reports of HVS seen in chronic lymphoblastic leukemia patients. Here, we report a case of an unusual presentation of chronic lymphoblastic leukemia in a 73-year-old male patient with extreme hyperleukocytosis and HVS presenting as acute respiratory distress syndrome. He consulted our clinic with complaints of exertional dyspnea followed by an acute respiratory distress syndrome after hospitalization. After evaluation of computed tomography, Chest x-ray, laboratory findings, and ongoing symptoms, the patient was found to present HVS. Even though it is a rare situation, this diagnosis should also be considered when evaluating appropriate patients with hematologic malignancy.
{"title":"ARDS as the Presenting Complication of Hyperviscosity Syndrome in Chronic Lymphocytic Leukemia: A Case Report","authors":"I. Karaman, S. Ozen, Başak Ballica, T. Uzar, O. Balçik, S. Ozkaya","doi":"10.1097/CPM.0000000000000350","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000350","url":null,"abstract":"Hyperviscosity syndrome (HVS) is an oncological emergency resulting from elevated cellular or protein fractions of blood causing respiratory or neurological symptoms. While the prevalence is relatively low in leukemias, there are only a few reports of HVS seen in chronic lymphoblastic leukemia patients. Here, we report a case of an unusual presentation of chronic lymphoblastic leukemia in a 73-year-old male patient with extreme hyperleukocytosis and HVS presenting as acute respiratory distress syndrome. He consulted our clinic with complaints of exertional dyspnea followed by an acute respiratory distress syndrome after hospitalization. After evaluation of computed tomography, Chest x-ray, laboratory findings, and ongoing symptoms, the patient was found to present HVS. Even though it is a rare situation, this diagnosis should also be considered when evaluating appropriate patients with hematologic malignancy.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"27 1","pages":"48 - 50"},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000350","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47300230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-03-01DOI: 10.1097/CPM.0000000000000349
R. Ronaghi, W. Kareem, B. Yaghmour, Ramyar Mahdavi
Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a widely used procedure for the diagnosis and staging of lung cancer. Several studies have shown the diagnostic utility of EBUS-TBNA effectiveness for decreasing the need for invasive mediastinal sampling. The current recommendation is that most patients with lung cancer should undergo mediastinal staging with EBUS-TBNA. EBUS-TBNA can be safely performed under general anesthesia or moderate sedation, and, according to previous studies, the choice of anesthesia on the effect of outcomes has been variable. We investigated differences between EBUS-TBNA performed with general anesthesia and moderate sedation in a training program in which trainees performed EBUS-TBNA. This retrospective study evaluated 121 patients undergoing fellow-driven EBUS-TBNA under the supervision of an interventional pulmonary trained faculty member. We found no difference between general anesthesia and moderate sedation in terms of diagnostic yield, procedural time, or complication rates. We did, however, find an overall higher number of total lymph nodes sampled in the general anesthesia group, as well as a higher number of hilar lymph nodes sampled. We conclude that EBUS-TBNA can be performed safely and with good diagnostic ability with either general anesthesia or moderate sedation in a fellowship-driven program without affecting overall outcomes. This is beneficial, as it can reduce overall cost and the ability to do the procedure without the need of an anesthesiologist.
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