Pub Date : 2019-11-01DOI: 10.1097/CPM.0000000000000335
B. Park, P. Hountras
Drug rash with eosinophilia and systemic symptoms (DRESS) is a well-recognized phenomenon that is considered to be a hyperinflammatory reaction in response to the administration of a drug. It is typical to have systemic signs of inflammation, and the most commonly reported pulmonary manifestations include pneumonitis, interstitial lung disease, and acute respiratory distress syndrome. Here, we present a 62-year-old woman with a history of chronic hypersensitivity pneumonitis who presented in respiratory distress with a new progressive rash. Bronchoscopy demonstrated diffuse alveolar hemorrhage (DAH), and a clinical diagnosis of DRESS was made. The patient was diagnosed with respiratory failure from DAH in the setting of acute exacerbation of chronic hypersensitivity pneumonitis and DRESS. We review the available literature on the pathophysiology, diagnosis, and clinical presentation of DRESS and DAH. To our knowledge, there is no reported case associating DRESS with DAH.
{"title":"Diffuse Alveolar Hemorrhage in the Setting of an Acute Exacerbation of Chronic Hypersensitivity Pneumonitis Due to Drug Rash With Eosinophilia and Systemic Symptoms: A Case Report","authors":"B. Park, P. Hountras","doi":"10.1097/CPM.0000000000000335","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000335","url":null,"abstract":"Drug rash with eosinophilia and systemic symptoms (DRESS) is a well-recognized phenomenon that is considered to be a hyperinflammatory reaction in response to the administration of a drug. It is typical to have systemic signs of inflammation, and the most commonly reported pulmonary manifestations include pneumonitis, interstitial lung disease, and acute respiratory distress syndrome. Here, we present a 62-year-old woman with a history of chronic hypersensitivity pneumonitis who presented in respiratory distress with a new progressive rash. Bronchoscopy demonstrated diffuse alveolar hemorrhage (DAH), and a clinical diagnosis of DRESS was made. The patient was diagnosed with respiratory failure from DAH in the setting of acute exacerbation of chronic hypersensitivity pneumonitis and DRESS. We review the available literature on the pathophysiology, diagnosis, and clinical presentation of DRESS and DAH. To our knowledge, there is no reported case associating DRESS with DAH.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"181 - 183"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000335","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42123823","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 : 2019-11-01DOI: 10.1097/CPM.0000000000000337
S. Pagliuca, D. Zappetti
Synopsis: Several randomized controlled trials (RCTs) and meta-analyses have shown improved outcomes when using corticosteroids in community-acquired pneumonia (CAP), including shorter length of stay, reduced treatment failure, and even lower mortality rates in severe disease. In this reviewed study, a bundled intervention including corticosteroids did not improve outcomes and suggested that corticosteroids may even cause harm. Source: Lloyd M, Karahalios A, Janus E, et al. Effectiveness of a bundled intervention including corticosteroids on outcomes of hospitalized patients with community-acquired pneumonia. JAMA Intern Med. 2019;179:1052–1060.
摘要:几项随机对照试验(RCTs)和荟萃分析显示，在社区获得性肺炎(CAP)中使用皮质类固醇可改善预后，包括缩短住院时间，减少治疗失败，甚至降低重症患者的死亡率。在本综述的研究中，包括皮质类固醇在内的捆绑干预并没有改善结果，甚至表明皮质类固醇可能会造成伤害。资料来源:Lloyd M, Karahalios A, Janus E等。包括皮质类固醇在内的捆绑干预对社区获得性肺炎住院患者结局的有效性美国医学杂志，2019;179:1052-1060。
{"title":"Corticosteroids in Community-acquired Pneumonia: To Give or Not To Give?","authors":"S. Pagliuca, D. Zappetti","doi":"10.1097/CPM.0000000000000337","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000337","url":null,"abstract":"Synopsis: Several randomized controlled trials (RCTs) and meta-analyses have shown improved outcomes when using corticosteroids in community-acquired pneumonia (CAP), including shorter length of stay, reduced treatment failure, and even lower mortality rates in severe disease. In this reviewed study, a bundled intervention including corticosteroids did not improve outcomes and suggested that corticosteroids may even cause harm. Source: Lloyd M, Karahalios A, Janus E, et al. Effectiveness of a bundled intervention including corticosteroids on outcomes of hospitalized patients with community-acquired pneumonia. JAMA Intern Med. 2019;179:1052–1060.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"197 - 197"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000337","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41593770","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 : 2019-11-01DOI: 10.1097/CPM.0000000000000333
S. Hale, P. Speigel, S. See, Baljash Cheema
Background: Tuberculosis (TB), an ancient infectious disease caused by the bacteria Mycobacterium tuberculosis, still remains a leading cause of morbidity and mortality in our modern world, causing ∼1.3 million deaths worldwide in 2017 alone. Because it disproportionately impacts the developing world, the unique manifestations of TB may be less encountered and therefore less known to many physicians in developed countries.
{"title":"Poncet Disease: A Case-based Review of an Uncommon Extrapulmonary Manifestation of Tuberculosis","authors":"S. Hale, P. Speigel, S. See, Baljash Cheema","doi":"10.1097/CPM.0000000000000333","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000333","url":null,"abstract":"Background: Tuberculosis (TB), an ancient infectious disease caused by the bacteria Mycobacterium tuberculosis, still remains a leading cause of morbidity and mortality in our modern world, causing ∼1.3 million deaths worldwide in 2017 alone. Because it disproportionately impacts the developing world, the unique manifestations of TB may be less encountered and therefore less known to many physicians in developed countries.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000333","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48711338","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 : 2019-11-01DOI: 10.1097/CPM.0000000000000332
R. Ronaghi, W. Kareem, Ramyar Mahdavi, B. Yaghmour
Background: Lung cancer is the leading cause of cancer-related death in the United States and has a high propensity to metastasize to the brain. According to multiple studies, primary lung malignancy is the leading cause of brain metastasis. In many cases, patients with suspected lung cancer will present with brain metastasis and require bronchoscopy for diagnostic and therapeutic purposes, specifically, endobronchial ultrasound transbronchial needle aspiration, which can both diagnose and stage lung cancer. There is a concern that general anesthesia and bronchoscopic procedures can increase intracranial pressures and lead to neurological complications. Methods: We conducted a retrospective study evaluating the safety of performing bronchoscopy under general anesthesia in patients with known space-occupying brain lesions at Keck Hospital of the University of Southern California between 2015 and 2018. Results: Overall, 10% of patients who underwent bronchoscopy had brain lesions at the time of the procedure, similar to previous studies, which showed rates of 10% to 20%. Overall complication rate with general anesthesia and bronchoscopy was 21% in our patients with brain lesions; however, only 3.5% of patients experienced serious adverse events, including respiratory failure or neurological deterioration requiring intensive care unit admission and intervention. There was no difference in complications among those with brain metastasis and those without who underwent bronchoscopy. Conclusion: These results confirm that the rate of serious complications in patients with space-occupying brain lesions who undergo bronchoscopy with general anesthesia is similar to that in patients without brain lesions, indicating that bronchoscopy can be performed safely in this patient population.
{"title":"The Safety and Efficacy of General Anesthesia Bronchoscopy in Patients With Metastatic Brain Lesions","authors":"R. Ronaghi, W. Kareem, Ramyar Mahdavi, B. Yaghmour","doi":"10.1097/CPM.0000000000000332","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000332","url":null,"abstract":"Background: Lung cancer is the leading cause of cancer-related death in the United States and has a high propensity to metastasize to the brain. According to multiple studies, primary lung malignancy is the leading cause of brain metastasis. In many cases, patients with suspected lung cancer will present with brain metastasis and require bronchoscopy for diagnostic and therapeutic purposes, specifically, endobronchial ultrasound transbronchial needle aspiration, which can both diagnose and stage lung cancer. There is a concern that general anesthesia and bronchoscopic procedures can increase intracranial pressures and lead to neurological complications. Methods: We conducted a retrospective study evaluating the safety of performing bronchoscopy under general anesthesia in patients with known space-occupying brain lesions at Keck Hospital of the University of Southern California between 2015 and 2018. Results: Overall, 10% of patients who underwent bronchoscopy had brain lesions at the time of the procedure, similar to previous studies, which showed rates of 10% to 20%. Overall complication rate with general anesthesia and bronchoscopy was 21% in our patients with brain lesions; however, only 3.5% of patients experienced serious adverse events, including respiratory failure or neurological deterioration requiring intensive care unit admission and intervention. There was no difference in complications among those with brain metastasis and those without who underwent bronchoscopy. Conclusion: These results confirm that the rate of serious complications in patients with space-occupying brain lesions who undergo bronchoscopy with general anesthesia is similar to that in patients without brain lesions, indicating that bronchoscopy can be performed safely in this patient population.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"178 - 180"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000332","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43399446","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 : 2019-11-01DOI: 10.1097/CPM.0000000000000338
S. Kariyawasam, D. Zappetti
{"title":"Can C-reactive Protein Testing Help Guide Antibiotic Therapy for Outpatients With COPD Exacerbations?","authors":"S. Kariyawasam, D. Zappetti","doi":"10.1097/CPM.0000000000000338","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000338","url":null,"abstract":"","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000338","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48540813","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 : 2019-11-01DOI: 10.1097/CPM.0000000000000330
R. Cartin-Ceba, L. Vaszar, E. Jensen, P. Panse, C. Jokerst, K. Cummings, M. Gotway
Diagnostic imaging plays a prominent role in the evaluation of numerous medical conditions, ranging from suspected infections to assessment of the acutely injured patient to staging malignancies and numerous other conditions, both common and rare. Imaging can be a very powerful tool in the diagnosis of medical disorders and plays a major role in the assessment of therapeutic response as well. It is common in practice for imaging studies to provide findings that may corroborate the clinical or laboratory impression of a disorder, allowing a presumptive diagnosis and institution of therapy, often circumventing the morbidity and even mortality that could be associated with an invasive tissue confirmation of a suspected diagnosis. Furthermore, imaging may occasionally detect entirely unsuspected disorders in minimally symptomatic, or even entirely asymptomatic, patients, the latter typically in the context of screening for malignancies. However, on occasion, imaging may fail to disclose a condition that “should be there” on the basis of findings at clinical and/or laboratory examination; this situation is particularly true when imaging fails to reveal abnormalities in the context of a suspected paraneoplastic syndrome. In this circumstance, there may be few, if any, alternatives to approach diagnosing such patients, and the appropriate treatment of these patients becomes exceedingly difficult. Such a situation can even lead to unnecessary, perhaps even inappropriate, interventions. In this circumstance, careful reconsideration of the imaging findings is paramount for correct patient management.
{"title":"When the Lesion Should Be There, But Isn’t …","authors":"R. Cartin-Ceba, L. Vaszar, E. Jensen, P. Panse, C. Jokerst, K. Cummings, M. Gotway","doi":"10.1097/CPM.0000000000000330","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000330","url":null,"abstract":"Diagnostic imaging plays a prominent role in the evaluation of numerous medical conditions, ranging from suspected infections to assessment of the acutely injured patient to staging malignancies and numerous other conditions, both common and rare. Imaging can be a very powerful tool in the diagnosis of medical disorders and plays a major role in the assessment of therapeutic response as well. It is common in practice for imaging studies to provide findings that may corroborate the clinical or laboratory impression of a disorder, allowing a presumptive diagnosis and institution of therapy, often circumventing the morbidity and even mortality that could be associated with an invasive tissue confirmation of a suspected diagnosis. Furthermore, imaging may occasionally detect entirely unsuspected disorders in minimally symptomatic, or even entirely asymptomatic, patients, the latter typically in the context of screening for malignancies. However, on occasion, imaging may fail to disclose a condition that “should be there” on the basis of findings at clinical and/or laboratory examination; this situation is particularly true when imaging fails to reveal abnormalities in the context of a suspected paraneoplastic syndrome. In this circumstance, there may be few, if any, alternatives to approach diagnosing such patients, and the appropriate treatment of these patients becomes exceedingly difficult. Such a situation can even lead to unnecessary, perhaps even inappropriate, interventions. In this circumstance, careful reconsideration of the imaging findings is paramount for correct patient management.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"191 - 196"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000330","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44101132","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 : 2019-11-01DOI: 10.1097/CPM.0000000000000340
M. Younis, Anees Sohail, A. Choudhry, A. J. Choudhry, R. Abd-rabu, A. Al-Shyoukh, Jason M. Wallen
Despite bronchoscopy’s minimally invasive approach, it is not without errors and complications. When such errors do occur, patients may seek legal redress. The aim of the study was to describe the setting, contributing characteristics, and outcomes of litigation targeting bronchoscopic procedures. Westlaw (Thompson Reuters), an online legal research data set, was queried for all medical malpractice cases reported in the United States from 1983 to 2018 wherein bronchoscopy was performed. A total of 87 cases were included. Pulmonology was the most common specialty named in the cases (n=42, 48%). The most common alleged reason for litigation was procedural complication (n=25, 29%), followed by failure to diagnose (n=24, 28%) and failure to treat (n=16, 18%). A total of 49 cases (56%) were decided in favor of the defendant physician, and a settlement was reached before the trial verdict in 20 cases (23%). A verdict delivered in favor of the plaintiff occurred in 18 cases (21%). The median (interquartile range) plaintiff award and settlement payouts were $1,729,560 ($497,088 to $3,895,337) and $648,000 ($184,961 to $2,874,875), respectively. Failure to obtain complete informed consent was the only case characteristic that was significantly associated with an increased risk of payout (odds ratio: 6.67, 95% confidence interval: 1.1-84, P=0.04). Despite bronchoscopy’s utility in identifying numerous pulmonary pathologies, bronchoscopy-related complications were found to be the leading cause of litigation. Identifying and addressing errors with care and proper consent may reduce the number of malpractice claims related to bronchoscopy. Level of Evidence: Level III.
{"title":"Medical Malpractice and Bronchoscopy: Why Do Physicians Face Litigation?","authors":"M. Younis, Anees Sohail, A. Choudhry, A. J. Choudhry, R. Abd-rabu, A. Al-Shyoukh, Jason M. Wallen","doi":"10.1097/CPM.0000000000000340","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000340","url":null,"abstract":"Despite bronchoscopy’s minimally invasive approach, it is not without errors and complications. When such errors do occur, patients may seek legal redress. The aim of the study was to describe the setting, contributing characteristics, and outcomes of litigation targeting bronchoscopic procedures. Westlaw (Thompson Reuters), an online legal research data set, was queried for all medical malpractice cases reported in the United States from 1983 to 2018 wherein bronchoscopy was performed. A total of 87 cases were included. Pulmonology was the most common specialty named in the cases (n=42, 48%). The most common alleged reason for litigation was procedural complication (n=25, 29%), followed by failure to diagnose (n=24, 28%) and failure to treat (n=16, 18%). A total of 49 cases (56%) were decided in favor of the defendant physician, and a settlement was reached before the trial verdict in 20 cases (23%). A verdict delivered in favor of the plaintiff occurred in 18 cases (21%). The median (interquartile range) plaintiff award and settlement payouts were $1,729,560 ($497,088 to $3,895,337) and $648,000 ($184,961 to $2,874,875), respectively. Failure to obtain complete informed consent was the only case characteristic that was significantly associated with an increased risk of payout (odds ratio: 6.67, 95% confidence interval: 1.1-84, P=0.04). Despite bronchoscopy’s utility in identifying numerous pulmonary pathologies, bronchoscopy-related complications were found to be the leading cause of litigation. Identifying and addressing errors with care and proper consent may reduce the number of malpractice claims related to bronchoscopy. Level of Evidence: Level III.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"184 - 190"},"PeriodicalIF":0.0,"publicationDate":"2019-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000340","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42402149","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 : 2019-09-01DOI: 10.1097/cpm.0000000000000323
Todd D VanKerkhoff, Elizabeth M Viglianti, Michael E Detsky, Jacqueline M Kruser
Consider the hypothetical case of a 75-year-old patient admitted to the intensive care unit (ICU) for acute hypoxic respiratory failure due to pneumonia and systolic heart failure. Although she suffers from a potentially treatable infection, her advanced age and chronic illness increase her risk of experiencing a poor outcome. Her family feels conflicted about whether the use of mechanical ventilation would be acceptable given what they understand about her values and preferences. In the ICU setting, clinicians, patients, and surrogate decision-makers frequently face challenges of prognostic uncertainty as well as uncertainty regarding patients' goals and values. Time-limited trials (TLTs) of life-sustaining treatments in the ICU have been proposed as one strategy to help facilitate goal-concordant care in the midst of a complex and high-stakes decision-making environment. TLTs represent an agreement between clinicians and patients or surrogate decision-makers to employ a therapy for an agreed-upon time period, with a plan for subsequent reassessment of the patient's progress according to previously-established criteria for improvement or decline. Herein, we review the concept of TLTs in intensive care, and explore their potential benefits, barriers, and challenges. Research demonstrates that, in practice, TLTs are conducted infrequently and often incompletely, and are challenged by system-level factors that diminish their effectiveness. The promise of TLTs in intensive care warrants continued research efforts, including implementation studies to improve adoption and fidelity, observational research to determine optimal timeframes for TLTs, and interventional trials to determine if TLTs ultimately improve the delivery of goal-concordant care in the ICU.
{"title":"Time-Limited Trials in the Intensive Care Unit to Promote Goal-Concordant Patient Care.","authors":"Todd D VanKerkhoff, Elizabeth M Viglianti, Michael E Detsky, Jacqueline M Kruser","doi":"10.1097/cpm.0000000000000323","DOIUrl":"https://doi.org/10.1097/cpm.0000000000000323","url":null,"abstract":"<p><p>Consider the hypothetical case of a 75-year-old patient admitted to the intensive care unit (ICU) for acute hypoxic respiratory failure due to pneumonia and systolic heart failure. Although she suffers from a potentially treatable infection, her advanced age and chronic illness increase her risk of experiencing a poor outcome. Her family feels conflicted about whether the use of mechanical ventilation would be acceptable given what they understand about her values and preferences. In the ICU setting, clinicians, patients, and surrogate decision-makers frequently face challenges of prognostic uncertainty as well as uncertainty regarding patients' goals and values. Time-limited trials (TLTs) of life-sustaining treatments in the ICU have been proposed as one strategy to help facilitate goal-concordant care in the midst of a complex and high-stakes decision-making environment. TLTs represent an agreement between clinicians and patients or surrogate decision-makers to employ a therapy for an agreed-upon time period, with a plan for subsequent reassessment of the patient's progress according to previously-established criteria for improvement or decline. Herein, we review the concept of TLTs in intensive care, and explore their potential benefits, barriers, and challenges. Research demonstrates that, in practice, TLTs are conducted infrequently and often incompletely, and are challenged by system-level factors that diminish their effectiveness. The promise of TLTs in intensive care warrants continued research efforts, including implementation studies to improve adoption and fidelity, observational research to determine optimal timeframes for TLTs, and interventional trials to determine if TLTs ultimately improve the delivery of goal-concordant care in the ICU.</p>","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 5","pages":"141-145"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/cpm.0000000000000323","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37974297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-01DOI: 10.1097/CPM.0000000000000324
M. Dres, K. Razazi
Pleural effusion is frequently encountered in patients who are mechanically ventilated in the intensive care unit and may be logically suspected in case of difficult weaning from mechanical ventilation. Through several mechanisms, pleural effusion may impair gas exchange, respiratory mechanics, and ventilation/perfusion matching. However, data exploring the respective contribution of pleural effusion on weaning failure are scarce. This review discusses the most recent findings pertaining to the potential role of pleural effusion in weaning outcome.
{"title":"Prevalence and Impact on Mechanical Ventilation Weaning of Pleural Effusion in ICU Patients","authors":"M. Dres, K. Razazi","doi":"10.1097/CPM.0000000000000324","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000324","url":null,"abstract":"Pleural effusion is frequently encountered in patients who are mechanically ventilated in the intensive care unit and may be logically suspected in case of difficult weaning from mechanical ventilation. Through several mechanisms, pleural effusion may impair gas exchange, respiratory mechanics, and ventilation/perfusion matching. However, data exploring the respective contribution of pleural effusion on weaning failure are scarce. This review discusses the most recent findings pertaining to the potential role of pleural effusion in weaning outcome.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"137 - 140"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000324","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46489487","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 : 2019-09-01DOI: 10.1097/CPM.0000000000000325
G. Scadding
Approximately 10% of patients report an allergy to ≥1 antibiotics, most commonly penicillins. Having a label of penicillin allergy has important health consequences for the individual, as well as health and economic impact at the population level. Despite this, only a minority of patients have the opportunity to have suspected antibiotic allergies confirmed. Busy clinicians seldom have time to explore the history of suspected antibiotic allergies in detail; an important role of the antibiotic allergy service is to do just this, including gathering contemporaneous notes, charts, and correspondence where necessary. The likelihood of true allergy, the mechanisms of immune hypersensitivity, the approach to testing, and the risk of reexposure to the same or related antibiotics can then be considered. Skin testing remains the mainstay of investigation, with challenge testing generally used to confirm tolerance. A basic knowledge of the frequency with which different drugs cause different hypersensitivity responses and that of the patterns of cross-reactivity between related drugs is very useful to a wide range of clinicians.
{"title":"Providing an Antibiotic Allergy Service","authors":"G. Scadding","doi":"10.1097/CPM.0000000000000325","DOIUrl":"https://doi.org/10.1097/CPM.0000000000000325","url":null,"abstract":"Approximately 10% of patients report an allergy to ≥1 antibiotics, most commonly penicillins. Having a label of penicillin allergy has important health consequences for the individual, as well as health and economic impact at the population level. Despite this, only a minority of patients have the opportunity to have suspected antibiotic allergies confirmed. Busy clinicians seldom have time to explore the history of suspected antibiotic allergies in detail; an important role of the antibiotic allergy service is to do just this, including gathering contemporaneous notes, charts, and correspondence where necessary. The likelihood of true allergy, the mechanisms of immune hypersensitivity, the approach to testing, and the risk of reexposure to the same or related antibiotics can then be considered. Skin testing remains the mainstay of investigation, with challenge testing generally used to confirm tolerance. A basic knowledge of the frequency with which different drugs cause different hypersensitivity responses and that of the patterns of cross-reactivity between related drugs is very useful to a wide range of clinicians.","PeriodicalId":10393,"journal":{"name":"Clinical Pulmonary Medicine","volume":"26 1","pages":"146 - 153"},"PeriodicalIF":0.0,"publicationDate":"2019-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1097/CPM.0000000000000325","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46699189","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}
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