1
|
Di Felice C, Sharma P, Matta M, Sethi S, Machuzak M, Young BP, Avasarala SK, Argento AC, Batra H, Akulian JA. The Need for Ergonomics Training in Interventional Pulmonary Fellowship. ATS Sch 2024; 5:45-52. [PMID: 38638917 PMCID: PMC11025561 DOI: 10.34197/ats-scholar.2023-0098br] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/24/2023] [Indexed: 04/20/2024] Open
Affiliation(s)
- Christopher Di Felice
- Department of Pulmonary and Critical Care
Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center,
Cleveland, Ohio
| | - Pallavi Sharma
- Department of Pulmonary and Critical Care
Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Maroun Matta
- Department of Pulmonary and Critical Care
Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sonali Sethi
- Department of Pulmonary, Allergy, and
Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation,
Cleveland, Ohio
| | - Michael Machuzak
- Department of Pulmonary, Allergy, and
Critical Care Medicine, Respiratory Institute, Cleveland Clinic Foundation,
Cleveland, Ohio
| | - Benjamin P. Young
- Department of Pulmonary and Critical Care
Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Sameer K. Avasarala
- Department of Pulmonary and Critical Care
Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - A. Christine Argento
- Section of Interventional Pulmonology,
Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University
School of Medicine, Baltimore, Maryland
| | - Hitesh Batra
- Division of Pulmonary, Allergy, and
Critical Care Medicine, University of Alabama at Birmingham, Birmingham,
Alabama; and
| | - Jason A. Akulian
- Section of Interventional Pulmonology and
Pulmonary Oncology, Division of Pulmonary and Critical Care Medicine, University
of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
2
|
Ntiamoah P, Machuzak M, Gildea TR, Mehta AC. Ergonomics of bronchoscopy: good advice or a pain in the neck? Eur Respir Rev 2023; 32:230139. [PMID: 37852660 PMCID: PMC10582918 DOI: 10.1183/16000617.0139-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/28/2023] [Indexed: 10/20/2023] Open
Abstract
Interventional pulmonologists require a unique set of skills including precise motor abilities and physical endurance, but surprisingly the application of ergonomic principles in the field of bronchoscopy remains limited. This is particularly intriguing when considering the significant impact that poor ergonomics can have on diagnostic aptitude, income potential and overall health. It is therefore imperative to provide comprehensive education to physicians regarding the significance of ergonomics in their work, especially considering the introduction of advanced diagnostic and therapeutic procedures. By implementing simple yet effective measures (e.g. maintaining neutral positions of the wrist, neck and shoulder; adjusting the height of tables and monitors; incorporating scheduled breaks; and engaging in regular exercises), the risk of injuries can be substantially reduced. Moreover, objective tools are readily available to assess ergonomic postures and estimate the likelihood of work-related musculoskeletal injuries. This review aims to evaluate the current literature on the impact of procedure-related musculoskeletal pain on practising pulmonologists and identify modifiable factors for future research.
Collapse
Affiliation(s)
- Prince Ntiamoah
- Department of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL, USA
| | - Michael Machuzak
- Respiratory Institute, Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas R Gildea
- Respiratory Institute, Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Respiratory Institute, Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
3
|
Chen AC, Machuzak M, Cheng G, Wahidi MM. Bronchoscopic Evaluation of a Steerable Needle for Simulated Tumor Targets in the Lung Periphery: A Feasibility Study (Bullseye). Respiration 2023:1-7. [PMID: 36996776 PMCID: PMC10129018 DOI: 10.1159/000529245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/09/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Peripheral bronchoscopy is often performed to biopsy peripheral pulmonary lesions. Despite technological advancements to improve reach and access to the lung periphery, the diagnostic yield of peripheral bronchoscopy has been inconsistent, and challenging, particularly for lesions that are adjacent to peripheral bronchi. Current biopsy instruments are reliant on the catheter or scope to align properly with targeted lesions. OBJECTIVES This study evaluates the feasibility of using a steerable biopsy needle to gain access to peripheral tumor targets in a cadaveric model. METHODS Simulated tumor targets 10-30 mm in axial diameter were placed into human cadavers. Bronchoscopy was performed using a 4.2 mm OD flexible bronchoscope, CT-anatomic correlation, and multi-planar fluoroscopy for lesion localization. Once at the targeted location, a steerable needle was deployed and the needle position was determined to be in the central zone, peripheral zone, or outside of the lesion by cone beam CT imaging. If the needle position was within the lesion, a fiducial marker was deployed to mark the needle position, and the needle was articulated and/or rotated in an attempt to place another fiducial marker into a different location within the same lesion. If the needle was outside of the lesion, the bronchoscopist was provided with two additional attempts to gain access to the lesion. RESULTS Fifteen tumor targets were placed with a mean lesion size of 20.4 mm. The majority of lesions were located in the upper lobes. One fiducial marker was placed in 93.3% of lesions and a second fiducial marker was successfully placed in 80% of lesions. A fiducial marker was placed within the central zone in 60% of lesions. CONCLUSION The steerable needle was successfully placed within 93% of targeted lesions 10-30 mm in diameter in a cadaveric model, with the ability steer the instrument into another portion of the lesion in 80% of cases. The ability to steer and control needle positioning toward and within peripheral lesions may complement existing catheter and scope technology during peripheral diagnostic procedures.
Collapse
Affiliation(s)
- Alexander C Chen
- Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - George Cheng
- University of California, San Diego, California, USA
| | | |
Collapse
|
4
|
Di Felice C, Alraiyes AH, Gillespie C, Machuzak M, Gildea TR, Sethi S, Cicenia J, Mehta AC, Almeida FA. Short-term Endoscopic Outcomes of Balloon and Rigid Bronchoplasty in the Management of Benign Subglottic and Tracheal Stenosis. J Bronchology Interv Pulmonol 2023; 30:54-59. [PMID: 35696593 DOI: 10.1097/lbr.0000000000000852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/01/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Endoscopic therapies are firmly established in the management algorithm of benign subglottic and tracheal stenosis (SGTS). The optimal dilation strategy, however, has yet to be elucidated. The objective of this study was to compare the efficacy and safety of balloon versus rigid bronchoplasty in the treatment of benign SGTS. METHODS De novo cases of benign SGTS at our institution over a 9-year period were retrospectively identified. Patients were divided into 2 groups based on the initial dilation strategy of balloon or rigid bronchoplasty. Demographics, clinical findings, concurrent interventions, lesion characteristics, and complications were analyzed. Two reviewers independently assigned an index and follow-up endoscopic stenosis grade for each case. The mean stenosis grade at follow-up in both groups was then calculated and compared. RESULTS Sixty-three patients with benign SGTS were included. Most stenoses in the rigid (80%) and balloon (63%) bronchoplasty groups were complex ( P =0.174). In addition, 94% (59/63) of index stenoses were classified as Cotton Myer Grade 3. At follow-up, no significant difference was found in the mean stenosis grade between dilation strategies (1.97 vs. 2.2, P =0.287). Furthermore, no procedural-related complications were observed in either group. CONCLUSION Balloon and rigid bronchoplasty are safe and effective endoscopic tools in the early management of benign SGTS. A multimodality approach centered around mucosal sparing techniques remains vitally important to the overall and likely long-term success of treating this challenging disease entity.
Collapse
Affiliation(s)
- Christopher Di Felice
- Division of Pulmonary, Critical Care, and Sleep Medicine, Case Western Reserve University
- Louis Stokes Cleveland Veterans Affairs Medical Center
| | - Abdul H Alraiyes
- Department of Medicine, Rosalind Franklin University, North Chicago, IL
| | - Colin Gillespie
- Department of Pulmonary, Allergy, and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Michael Machuzak
- Department of Pulmonary, Allergy, and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Thomas R Gildea
- Department of Pulmonary, Allergy, and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Sonali Sethi
- Department of Pulmonary, Allergy, and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Joseph Cicenia
- Department of Pulmonary, Allergy, and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Department of Pulmonary, Allergy, and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | - Francisco A Almeida
- Department of Pulmonary, Allergy, and Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH
| |
Collapse
|
5
|
Martinez-Zayas G, Almeida FA, Yarmus L, Steinfort D, Lazarus DR, Simoff MJ, Saettele T, Murgu S, Dammad T, Duong DK, Mudambi L, Filner JJ, Molina S, Aravena C, Thiboutot J, Bonney A, Rueda AM, Debiane LG, Hogarth DK, Bedi H, Deffebach M, Sagar AES, Cicenia J, Yu DH, Cohen A, Frye L, Grosu HB, Gildea T, Feller-Kopman D, Casal RF, Machuzak M, Arain MH, Sethi S, Eapen GA, Lam L, Jimenez CA, Ribeiro M, Noor LZ, Mehta A, Song J, Choi H, Ma J, Li L, Ost DE. Predicting Lymph Node Metastasis in Non-small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models. Chest 2021; 160:1108-1120. [PMID: 33932466 DOI: 10.1016/j.chest.2021.04.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in patients with non-small cell lung cancer (NSCLC) as determined by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to prospectively externally validate both models at multiple centers. RESEARCH QUESTION Are the HAL and HOMER models valid across multiple centers? STUDY DESIGN AND METHODS This multicenter prospective observational cohort study enrolled consecutive patients with PET-CT clinical-radiographic stages T1-3, N0-3, M0 NSCLC undergoing EBUS-TBNA staging. HOMER was used to predict the probability of N0 vs N1 vs N2 or N3 (N2|3) disease, and HAL was used to predict the probability of N2|3 (vs N0 or N1) disease. Model discrimination was assessed using the area under the receiver operating characteristics curve (ROC-AUC), and calibration was assessed using the Brier score, calibration plots, and the Hosmer-Lemeshow test. RESULTS Thirteen centers enrolled 1,799 patients. HAL and HOMER demonstrated good discrimination: HAL ROC-AUC = 0.873 (95%CI, 0.856-0.891) and HOMER ROC-AUC = 0.837 (95%CI, 0.814-0.859) for predicting N1 disease or higher (N1|2|3) and 0.876 (95%CI, 0.855-0.897) for predicting N2|3 disease. Brier scores were 0.117 and 0.349, respectively. Calibration plots demonstrated good calibration for both models. For HAL, the difference between forecast and observed probability of N2|3 disease was +0.012; for HOMER, the difference for N1|2|3 was -0.018 and for N2|3 was +0.002. The Hosmer-Lemeshow test was significant for both models (P = .034 and .002), indicating a small but statistically significant calibration error. INTERPRETATION HAL and HOMER demonstrated good discrimination and calibration in multiple centers. Although calibration error was present, the magnitude of the error is small, such that the models are informative.
Collapse
Affiliation(s)
- Gabriela Martinez-Zayas
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Lonny Yarmus
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Daniel Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Donald R Lazarus
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Michael J Simoff
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Timothy Saettele
- Department of Pulmonary Disease and Critical Care Medicine, Saint Luke's Hospital of Kansas City, Kansas City, MO
| | - Septimiu Murgu
- Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Tarek Dammad
- Department of Pulmonary Medicine, University of New Mexico, Albuquerque, NM; Department of Pulmonary and Critical Care Medicine, CHRISTUS St. Vincent Medical Center, Santa Fe, NM
| | - D Kevin Duong
- Department of Pulmonary, Allergy and Critical Care Medicine, Stanford University Medical Center and School of Medicine, Stanford, CA
| | - Lakshmi Mudambi
- Division of Pulmonary and Critical Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR
| | - Joshua J Filner
- Department of Pulmonary Medicine, Northwest Permanente and The Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Sofia Molina
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carlos Aravena
- Department of Respiratory Diseases, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Jeffrey Thiboutot
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Asha Bonney
- Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Australia
| | - Adriana M Rueda
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Labib G Debiane
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Harmeet Bedi
- Department of Pulmonary, Allergy and Critical Care Medicine, Stanford University Medical Center and School of Medicine, Stanford, CA
| | - Mark Deffebach
- Division of Pulmonary and Critical Care, VA Portland Health Care System, Oregon Health and Science University, Portland, OR
| | - Ala-Eddin S Sagar
- Department of Pulmonary Medicine, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Joseph Cicenia
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Diana H Yu
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Avi Cohen
- Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Laura Frye
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Horiana B Grosu
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Thomas Gildea
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - David Feller-Kopman
- Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD
| | - Roberto F Casal
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Machuzak
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Muhammad H Arain
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sonali Sethi
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - George A Eapen
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Louis Lam
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Carlos A Jimenez
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Manuel Ribeiro
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Laila Z Noor
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Atul Mehta
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Humberto Choi
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Junsheng Ma
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Liang Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David E Ost
- Department of Pulmonary Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| |
Collapse
|
6
|
Alshabani K, Gildea TR, Machuzak M, Cicenia J, Hatipoğlu U. Bronchoscopic lung volume reduction with valves: What should the internist know? Cleve Clin J Med 2020; 87:278-287. [PMID: 32357983 DOI: 10.3949/ccjm.87a.19083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Traditional therapies for emphysema such as bronchodilators and anti-inflammatory drugs have limited value due to permanent structural changes in the emphysematous lung that result in hyperinflation. Surgical lung volume reduction partially corrects hyperinflation by removing emphysematous lung and is an option in selected patients, but it carries a risk of morbidity and death. Valve therapy is a less-invasive option that involves bronchoscopic implantation of 1-way valves in emphysematous lung segments to allow air flow and mucus clearance in the direction of central airways. The authors review the rationale, evidence, and applications of valve therapy.
Collapse
Affiliation(s)
| | - Thomas R Gildea
- Section of Bronchoscopy, Department of Pulmonary Medicine, Respiratory Institute, and Transplantation Center, Cleveland Clinic
| | - Michael Machuzak
- Section of Bronchoscopy, Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic
| | - Joseph Cicenia
- Section of Bronchoscopy, Department of Pulmonary Medicine, Respiratory Institute, Cleveland Clinic
| | - Umur Hatipoğlu
- Director, COPD Center, Respiratory Institute, Cleveland Clinic
| |
Collapse
|
7
|
Leon CA, Inaty H, Urbas A, Grafmeyer K, Machuzak M, Sethi S, Gildea T. EARLY OUTCOMES WITH 3D PRINTING AND AIRWAY STENTS. Chest 2019. [DOI: 10.1016/j.chest.2019.08.264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
8
|
Criner GJ, Sue R, Wright S, Dransfield M, Rivas-Perez H, Wiese T, Sciurba FC, Shah PL, Wahidi MM, de Oliveira HG, Morrissey B, Cardoso PFG, Hays S, Majid A, Pastis N, Kopas L, Vollenweider M, McFadden PM, Machuzak M, Hsia DW, Sung A, Jarad N, Kornaszewska M, Hazelrigg S, Krishna G, Armstrong B, Shargill NS, Slebos DJ. A Multicenter Randomized Controlled Trial of Zephyr Endobronchial Valve Treatment in Heterogeneous Emphysema (LIBERATE). Am J Respir Crit Care Med 2019; 198:1151-1164. [PMID: 29787288 DOI: 10.1164/rccm.201803-0590oc] [Citation(s) in RCA: 209] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE This is the first multicenter randomized controlled trial to evaluate the effectiveness and safety of Zephyr Endobronchial Valve (EBV) in patients with little to no collateral ventilation out to 12 months. OBJECTIVES To evaluate the effectiveness and safety of Zephyr EBV in heterogeneous emphysema with little to no collateral ventilation in the treated lobe. METHODS Subjects were enrolled with a 2:1 randomization (EBV/standard of care [SoC]) at 24 sites. Primary outcome at 12 months was the ΔEBV-SoC of subjects with a post-bronchodilator FEV1 improvement from baseline of greater than or equal to 15%. Secondary endpoints included absolute changes in post-bronchodilator FEV1, 6-minute-walk distance, and St. George's Respiratory Questionnaire scores. MEASUREMENTS AND MAIN RESULTS A total of 190 subjects (128 EBV and 62 SoC) were randomized. At 12 months, 47.7% EBV and 16.8% SoC subjects had a ΔFEV1 greater than or equal to 15% (P < 0.001). ΔEBV-SoC at 12 months was statistically and clinically significant: for FEV1, 0.106 L (P < 0.001); 6-minute-walk distance, +39.31 m (P = 0.002); and St. George's Respiratory Questionnaire, -7.05 points (P = 0.004). Significant ΔEBV-SoC were also observed in hyperinflation (residual volume, -522 ml; P < 0.001), modified Medical Research Council Dyspnea Scale (-0.8 points; P < 0.001), and the BODE (body mass index, airflow obstruction, dyspnea, and exercise capacity) index (-1.2 points). Pneumothorax was the most common serious adverse event in the treatment period (procedure to 45 d), in 34/128 (26.6%) of EBV subjects. Four deaths occurred in the EBV group during this phase, and one each in the EBV and SoC groups between 46 days and 12 months. CONCLUSIONS Zephyr EBV provides clinically meaningful benefits in lung function, exercise tolerance, dyspnea, and quality of life out to at least 12 months, with an acceptable safety profile in patients with little or no collateral ventilation in the target lobe. Clinical trial registered with www.clinicaltrials.gov (NCT 01796392).
Collapse
Affiliation(s)
- Gerard J Criner
- 1 Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Richard Sue
- 2 St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Shawn Wright
- 2 St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Mark Dransfield
- 3 University of Alabama at Birmingham UAB Lung Health Center, Birmingham, Alabama
| | - Hiram Rivas-Perez
- 4 Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Tanya Wiese
- 4 Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Frank C Sciurba
- 5 Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pallav L Shah
- 6 Royal Brompton Hospital and Imperial College, London, United Kingdom
| | - Momen M Wahidi
- 7 Duke University Medical Center, Duke University, Durham, North Carolina
| | | | - Brian Morrissey
- 9 Division of Pulmonary, Critical Care and Sleep Medicine, University of California, Davis, Sacramento, California
| | - Paulo F G Cardoso
- 10 Instituto do Coracao, Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Steven Hays
- 11 University of California, San Francisco, San Francisco, California
| | - Adnan Majid
- 12 Interventional Pulmonology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nicholas Pastis
- 13 Medical University of South Carolina, Charleston, South Carolina
| | - Lisa Kopas
- 14 Pulmonary Critical Care and Sleep Medicine Consultants, Houston Methodist, Houston, Texas
| | - Mark Vollenweider
- 15 Orlando Health Pulmonary and Sleep Medicine Group, Orlando Regional Medical Center, Orlando, Florida
| | - P Michael McFadden
- 16 Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Michael Machuzak
- 17 Center for Major Airway Diseases, Cleveland Clinic, Cleveland Clinic Foundation, Respiratory Institute, Cleveland, Ohio
| | - David W Hsia
- 18 Los Angeles Biomedical Research Institute at Harbor-University of California Los Angeles, Torrance, California
| | - Arthur Sung
- 19 Stanford Hospital and Clinics, Stanford, California
| | - Nabil Jarad
- 20 University Hospital Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Malgorzata Kornaszewska
- 21 Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, United Kingdom
| | - Stephen Hazelrigg
- 22 Division of Cardiothoracic Surgery, Department of Surgery, Southern Illinois University School of Medicine, Springfield, Illinois
| | - Ganesh Krishna
- 23 Palo Alto Medical Foundation, El Camino Hospital, Mountain View, California
| | | | | | - Dirk-Jan Slebos
- 26 Department of Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | | |
Collapse
|
9
|
Crespo MM, McCarthy DP, Hopkins PM, Clark SC, Budev M, Bermudez CA, Benden C, Eghtesady P, Lease ED, Leard L, D'Cunha J, Wigfield CH, Cypel M, Diamond JM, Yun JJ, Yarmus L, Machuzak M, Klepetko W, Verleden G, Hoetzenecker K, Dellgren G, Mulligan M. ISHLT Consensus Statement on adult and pediatric airway complications after lung transplantation: Definitions, grading system, and therapeutics. J Heart Lung Transplant 2018; 37:548-563. [PMID: 29550149 DOI: 10.1016/j.healun.2018.01.1309] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 01/31/2018] [Indexed: 11/18/2022] Open
Abstract
Airway complications remain a major cause of morbidity and mortality after cardiothoracic transplantation. The reported incidence of airway ischemic complications varies widely, contributed to by the lack of a universally accepted grading system and standardized definitions. Furthermore, the majority of the existing classification systems fail to integrate the wide range of possible bronchial complications that may develop after lung transplant. Hence, a Working Group was created by the International Society for Heart and Lung Transplantation with the aim of elaborating a universal definition of adult and pediatric airway complications and grading system. One such area of focus is to understand the problem in the context of a more standardized consensus of classifying airway ischemia. This consensus definition will have major clinical, therapeutics, and research implications.
Collapse
Affiliation(s)
- Maria M Crespo
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Daniel P McCarthy
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine, Madison, Wisconsin
| | | | | | - Marie Budev
- Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Christian A Bermudez
- Division of Cardiothoracic Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christian Benden
- Department of Pulmonary Medicine, University Hospital of Zurich, Zurich, Switzerland
| | - Pirooz Eghtesady
- Division of Pediatric Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri
| | - Erika D Lease
- Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington
| | - Lorriana Leard
- Division of Pulmonary and Critical Care Medicine, University of California, San Francisco Medical Center, San Francisco, California
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | - Marcelo Cypel
- Division of Thoracic Surgery, Toronto General Hospital UHN, Toronto, Ontario, Canada
| | - Joshua M Diamond
- Division of Pulmonary, Allergy and Critical Care Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - James J Yun
- Division of Cardiothoracic Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Lonny Yarmus
- Division of Pulmonary and Critical Care, The John Hopkins University Hospital, Baltimore, Maryland
| | | | - Walter Klepetko
- Department of Thoracic Surgery, Vienna Medical University, Vienna, Austria
| | - Geert Verleden
- Department of Respiratory Diseases, University Hospital of Gasthuisberg, Leuven, Belgium
| | | | - Göran Dellgren
- Cardiothoracic Department, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Michael Mulligan
- Division of Cardiothoracic Surgery, University of Washington, Seattle, Washington
| |
Collapse
|
10
|
|
11
|
O'Connell OJ, Almeida FA, Simoff MJ, Yarmus L, Lazarus R, Young B, Chen Y, Semaan R, Saettele TM, Cicenia J, Bedi H, Kliment C, Li L, Sethi S, Diaz-Mendoza J, Feller-Kopman D, Song J, Gildea T, Lee H, Grosu HB, Machuzak M, Rodriguez-Vial M, Eapen GA, Jimenez CA, Casal RF, Ost DE. A Prediction Model to Help with the Assessment of Adenopathy in Lung Cancer: HAL. Am J Respir Crit Care Med 2017; 195:1651-1660. [PMID: 28002683 DOI: 10.1164/rccm.201607-1397oc] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
RATIONALE Estimating the probability of finding N2 or N3 (prN2/3) malignant nodal disease on endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in patients with non-small cell lung cancer (NSCLC) can facilitate the selection of subsequent management strategies. OBJECTIVES To develop a clinical prediction model for estimating the prN2/3. METHODS We used the AQuIRE (American College of Chest Physicians Quality Improvement Registry, Evaluation, and Education) registry to identify patients with NSCLC with clinical radiographic stage T1-3, N0-3, M0 disease that had EBUS-TBNA for staging. The dependent variable was the presence of N2 or N3 disease (vs. N0 or N1) as assessed by EBUS-TBNA. Univariate followed by multivariable logistic regression analysis was used to develop a parsimonious clinical prediction model to estimate prN2/3. External validation was performed using data from three other hospitals. MEASUREMENTS AND MAIN RESULTS The model derivation cohort (n = 633) had a 25% prevalence of malignant N2 or N3 disease. Younger age, central location, adenocarcinoma histology, and higher positron emission tomography-computed tomography N stage were associated with a higher prN2/3. Area under the receiver operating characteristic curve was 0.85 (95% confidence interval, 0.82-0.89), model fit was acceptable (Hosmer-Lemeshow, P = 0.62; Brier score, 0.125). We externally validated the model in 722 patients. Area under the receiver operating characteristic curve was 0.88 (95% confidence interval, 0.85-0.90). Calibration using the general calibration model method resulted in acceptable goodness of fit (Hosmer-Lemeshow test, P = 0.54; Brier score, 0.132). CONCLUSIONS Our prediction rule can be used to estimate prN2/3 in patients with NSCLC. The model has the potential to facilitate clinical decision making in the staging of NSCLC.
Collapse
Affiliation(s)
| | | | - Michael J Simoff
- 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and
| | - Lonny Yarmus
- 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Benjamin Young
- 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Yu Chen
- 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and
| | - Roy Semaan
- 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and
| | | | - Joseph Cicenia
- 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Harmeet Bedi
- 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and
| | - Corrine Kliment
- 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Liang Li
- 5 Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Sonali Sethi
- 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Javier Diaz-Mendoza
- 3 Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, Michigan; and
| | - David Feller-Kopman
- 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Juhee Song
- 5 Department of Biostatistics, MD Anderson Cancer Center, Houston, Texas
| | - Thomas Gildea
- 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Hans Lee
- 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland
| | | | - Michael Machuzak
- 2 Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | | |
Collapse
|
12
|
Lam L, Gildea T, Machuzak M, Meli Y. Electromagnetic Navigation Bronchoscopy Paired With Cone-Beam CT Confirmation for Biopsy of Difficult Peripheral Lung Lesions: A Prospective Pilot Trial. Chest 2016. [DOI: 10.1016/j.chest.2016.08.1111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
13
|
Inaty H, Jawad A, Lane C, Tsuang W, Turowski J, Akindipe O, Mehta A, Budev M, Machuzak M. The Optimal Number of Transbronchial Biopsies Needed to Evaluate Rejection in the Lung Allograft. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
14
|
Ost DE, Ernst A, Grosu HB, Lei X, Diaz-Mendoza J, Slade M, Gildea TR, Machuzak M, Jimenez CA, Toth J, Kovitz KL, Ray C, Greenhill S, Casal RF, Almeida FA, Wahidi M, Eapen GA, Yarmus LB, Morice RC, Benzaquen S, Tremblay A, Simoff M. Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction: Results of the AQuIRE Registry. Chest 2015; 148:450-471. [PMID: 25741903 DOI: 10.1378/chest.14-1530] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There are significant variations in how therapeutic bronchoscopy for malignant airway obstruction is performed. Relatively few studies have compared how these approaches affect the incidence of complications. METHODS We used the American College of Chest Physicians (CHEST) Quality Improvement Registry, Evaluation, and Education (AQuIRE) program registry to conduct a multicenter study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was the incidence of complications. Secondary outcomes were incidence of bleeding, hypoxemia, respiratory failure, adverse events, escalation in level of care, and 30-day mortality. RESULTS Fifteen centers performed 1,115 procedures on 947 patients. There were significant differences among centers in the type of anesthesia (moderate vs deep or general anesthesia, P < .001), use of rigid bronchoscopy (P < .001), type of ventilation (jet vs volume cycled, P < .001), and frequency of stent use (P < .001). The overall complication rate was 3.9%, but significant variation was found among centers (range, 0.9%-11.7%; P = .002). Risk factors for complications were urgent and emergent procedures, American Society of Anesthesiologists (ASA) score > 3, redo therapeutic bronchoscopy, and moderate sedation. The 30-day mortality was 14.8%; mortality varied among centers (range, 7.7%-20.2%, P = .02). Risk factors for 30-day mortality included Zubrod score > 1, ASA score > 3, intrinsic or mixed obstruction, and stent placement. CONCLUSIONS Use of moderate sedation and stents varies significantly among centers. These factors are associated with increased complications and 30-day mortality, respectively.
Collapse
Affiliation(s)
- David E Ost
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | | | - Horiana B Grosu
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xiudong Lei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Javier Diaz-Mendoza
- The Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | - Mark Slade
- Department of Thoracic Oncology, Papworth Hospital, Cambridge, England
| | - Thomas R Gildea
- Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic Foundation, Cleveland, OH
| | - Michael Machuzak
- Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH
| | - Carlos A Jimenez
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | - Kevin L Kovitz
- University of Illinois Hospital & Health Sciences Center, Chicago, IL
| | - Cynthia Ray
- Department of Internal Medicine, Henry Ford Hospital, Detroit, MI
| | - Sara Greenhill
- Chicago Chest Center Interventional Pulmonology, Elk Grove Village, IL
| | - Roberto F Casal
- Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX
| | - Francisco A Almeida
- Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic Foundation, Cleveland, OH
| | - Momen Wahidi
- Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Raleigh, NC
| | - George A Eapen
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Lonny B Yarmus
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Rodolfo C Morice
- Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Sadia Benzaquen
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH
| | - Alain Tremblay
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael Simoff
- The Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI
| | | |
Collapse
|
15
|
Abstract
Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.
Collapse
Affiliation(s)
- Michael Machuzak
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jose F Santacruz
- Pulmonary, Critical Care and Sleep Medicine Consultants, Houston Methodist, Houston, TX 77030, USA
| | - Thomas Gildea
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| |
Collapse
|
16
|
Alraiyes AH, Shaheen K, Reynolds J, Machuzak M. Recurrent Bronchogenic Cyst After Surgical Resection. Ochsner J 2015; 15:176-179. [PMID: 26130981 PMCID: PMC4482560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Bronchogenic cysts are rare congenital anomalies that are often solitary and rarely multiple. Most bronchogenic cysts are asymptomatic, and symptoms when present are usually the result of compression by the cyst on the surrounding structures. CASE REPORT We report a case of recurrent bronchogenic cyst following a partial resection treated with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). CONCLUSION EBUS-TBNA can provide instant decompression of the cyst and relieves the pressure on the surrounding structures.
Collapse
Affiliation(s)
- Abdul Hamid Alraiyes
- Interventional Pulmonology, Department of Medicine, Roswell Park Cancer Institute and University at Buffalo, State University of New York, Buffalo, NY
| | - Khaldoon Shaheen
- Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | - Jordan Reynolds
- Pathology and Laboratory Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Michael Machuzak
- Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH
| |
Collapse
|
17
|
Affiliation(s)
- Zahra Aryan
- Cleveland Clinic, Respiratory Institute, Cleveland, OH, USA.,Student's Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Atul C Mehta
- Cleveland Clinic, Respiratory Institute, Cleveland, OH, USA
| |
Collapse
|
18
|
Cicenia J, Panchabhai T, Vijhani P, Almeida F, Gildea T, Machuzak M, Mazzone P, Sethi S, Mehta A. Transvascular EBUS-TBNA: Another Tool in the Diagnostic Assessment of Hilar Lymph Nodes and Lung Lesions. Chest 2014. [DOI: 10.1378/chest.1993516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
19
|
Joshi D, Almeida F, Cicenia J, Machuzak M, Mehta A, Sethi S, Gildea T. Time Utilization of Ultrasound Guided Thoracentesis at a Tertiary Care Center. Chest 2014. [DOI: 10.1378/chest.1993832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
20
|
Alraiyes AH, Khemasuwan D, M. Meli Y, Cicenia J, Gildea T, Jaber W, Machuzak M, Mehta A, Sethi S, Wang J, Almeida F. Management of Benign Tracheal Stenosis: Gentle vs Rigid Dilation. Chest 2014. [DOI: 10.1378/chest.1994306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
21
|
Sethi S, Wang J, Machuzak M, Almeida F, Cicenia J, Mehta A, Gildea T. Clinical Success Stenting Lobar and Segmental Bronchi for “Lobar Salvage” in Bronchial Stenosis. Chest 2014. [DOI: 10.1378/chest.1992298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
22
|
Salam S, Reynolds J, Gildea T, Cicenia J, Sethi S, Machuzak M, Khemasuwan D, Alraiyes AH, Mehta A, Almeida F. Role of EBUS-TBNA in Quasi-Central Pulmonary Lesions: Moving Forward. Chest 2014. [DOI: 10.1378/chest.1994551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
23
|
Zaki K, Aryan Z, Mehta A, Machuzak M. Glomus Tumor of the Trachea. Chest 2014. [DOI: 10.1378/chest.1990628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
24
|
Rokadia H, Cicenia J, Almeida F, Gildea T, Machuzak M, Sethi S, Mehta A. The Utility of Rapid On-Site Evaluation (ROSE) in the Detection of Granulomas in Mediastinal Lymph Nodes. Chest 2014. [DOI: 10.1378/chest.1994936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
25
|
Rokadia H, Machuzak M, Budev M, Mehta A, Yarmus L, Gildea T. Endobronchial Therapeutics in Lung Transplant Recipients: A Multi-Center Experience. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
26
|
Sethi S, Machuzak M, Almeida F, Gildea T, Mazzone P, Mehta A, Patel J, Cicenia J. The Utility of EBUS-TBNA in Diagnosing Hodgkin's Lymphoma. Chest 2013. [DOI: 10.1378/chest.1703888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
27
|
Cicenia J, Minca E, Almeida F, Gildea T, Machuzak M, Sethi S, Brainard J, Tubbs R. Novel Methodology for Detection of EGFR Gene Mutation and ALK Gene Rearrangement From FNA-Based Sampling in Non-small Cell Lung Cancer: Potential Implications on EBUS-TBNA. Chest 2013. [DOI: 10.1378/chest.1705316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
28
|
Cicenia J, Almeida F, Machuzak M, Mazzone P, Mehta A, Sethi S, Patel J, Gildea T. The Utility of Rapid On-Site Evaluation (ROSE) in the Detection of Granulomas in Mediastinal Lymph Nodes. Chest 2013. [DOI: 10.1378/chest.1705246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
29
|
Narula T, Sethi S, Raja S, Cicenia J, Gildea T, Machuzak M, Almeida F. Bronchoscopic Therapy for Atrial Fibrillation - Case of a Large Bronchogenic Cyst. Chest 2013. [DOI: 10.1378/chest.1704426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
30
|
Sethi S, Machuzak M, Almeida F, Cicenia J, Gildea T. The Utility of Backward Grabbing “Inverted V” Rigid Forceps. Chest 2013. [DOI: 10.1378/chest.1703834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
31
|
Sethi S, Gildea T, Almeida F, Machuzak M. Dumon Silicone Y-Stenting in Malignant and Nonmalignant Central Airway Obstruction. Chest 2013. [DOI: 10.1378/chest.1703801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
32
|
Ha D, Choi H, Almeida F, Arrossi V, Brainard J, Cicenia J, Farver C, Gildea T, Machuzak M, Mazzone P. Histologic and Molecular Characterization of Lung Cancer With Tissue Obtained by Electromagnetic Navigation Bronchoscopy. Chest 2012. [DOI: 10.1378/chest.1388872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
33
|
Choi H, Brainard J, Ha D, Jaber W, Abdul-Karim F, Booth C, Chute D, Cicenia J, Gildea T, Goyal A, Kotnis G, Machuzak M, Mazzone P, Patel J, Reynolds J, Almeida F. Histologic Characterization of Lung Cancer and Other Solid Tumors With Tissue Obtained by Bronchoscopy Guided by Endobronchial Ultrasound Transbronchial Needle Aspiration. Chest 2012. [DOI: 10.1378/chest.1390104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
34
|
Cumbo-Nacheli G, Budev M, Machuzak M, Gildea T. Usefulness of Advanced Diagnostic Bronchoscopic Techniques Among Lung Transplant Recipients With Pulmonary Nodules. Chest 2012. [DOI: 10.1378/chest.1390124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
35
|
Folch E, Santacruz J, Machuzak M, Gildea T, Majid A. Safety and Efficacy of EBUS-Guided TBNA Through the Pulmonary Artery: A Preliminary Report. Chest 2011. [DOI: 10.1378/chest.1119000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
36
|
Mason D, Murthy S, Yun J, Machuzak M, Shrestha R, Avery R, McCurry K, Budev M, Pettersson G. Lung Transplantation in a Recipient with Novel 2009 H1N1 Influenza: Lessons Learned. Thorac Cardiovasc Surg 2011; 59:126-7. [DOI: 10.1055/s-0030-1250240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
37
|
Doyle DJ, Abdelmalak B, Machuzak M, Gildea TR. Anesthesia and airway management for removing pulmonary self-expanding metallic stents. J Clin Anesth 2010; 21:529-32. [PMID: 20006263 DOI: 10.1016/j.jclinane.2008.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 10/13/2008] [Accepted: 11/10/2008] [Indexed: 10/20/2022]
Abstract
The use of bronchoscopically placed self-expanding metallic stents (SEMS) and silastic stents in patients suffering from tracheobronchial stenosis or similar problems has proven to be an important clinical option. When complications occur, it may be necessary to remove the device. Removal of a SEMS is usually performed during general anesthesia with muscle relaxation and positive pressure ventilation, often using total intravenous anesthesia. Airway management depends on stent type and location. Intubating patients' tracheas with a tracheal stent requires special caution, as it risks damaging tissue and dislodging the stent distally. Potential complications with removal include tracheal disruption, retained stent pieces, mucosal tears, re-obstruction requiring new stent placement, the need for postoperative ventilation, pneumothorax, damage to the pulmonary artery, and death.
Collapse
Affiliation(s)
- D John Doyle
- Cleveland Clinic Lerner College of Medicine, Department of General Anesthesiology, Case Western Reserve University, Cleveland, OH 44195, USA.
| | | | | | | |
Collapse
|
38
|
Sterman D, Mehta A, Wood D, Mathur P, McKenna, Jr. R, Ost D, Truwit J, Diaz P, Wahidi M, Cerfolio R, Maxfield R, Musani A, Gildea T, Sheski F, Machuzak M, Haas A, Gonzalez H, Springmeyer S. A multicenter pilot study of a bronchial valve for the treatment of severe emphysema. Respiration 2010; 79:222-33. [PMID: 19923790 PMCID: PMC7068788 DOI: 10.1159/000259318] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2009] [Accepted: 10/05/2009] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) affects millions of people and has limited treatment options. Surgical treatments for severe COPD with emphysema are effective for highly selected patients. A minimally invasive method for treating emphysema could decrease morbidity and increase acceptance by patients. OBJECTIVE To study the safety and effectiveness of the IBV(R) Valve for the treatment of severe emphysema. METHODS A multicenter study treated 91 patients with severe obstruction, hyperinflation and upper lobe (UL)-predominant emphysema with 609 bronchial valves placed bilaterally into ULs. RESULTS Valves were placed in desired airways with 99.7% technical success and no migration or erosion. There were no procedure-related deaths and 30-day morbidity and mortality were 5.5 and 1.1%, respectively. Pneumothorax was the most frequent serious device-related complication and primarily occurred when all segments of a lobe, especially the left UL, were occluded. Highly significant health-related quality of life (HRQL) improvement (-8.2 +/- 16.2, mean +/- SD change at 6 months) was observed. HRQL improvement was associated with a decreased volume (mean -294 +/- 427 ml, p = 0.007) in the treated lobes without visible atelectasis. FEV(1), exercise tests, and total lung volume were not changed but there was a proportional shift, a redirection of inspired volume to the untreated lobes. Combined with perfusion scan changes, this suggests that there is improved ventilation and perfusion matching in non-UL lung parenchyma. CONCLUSION Bronchial valve treatment of emphysema has multiple mechanisms of action and acceptable safety, and significantly improves quality of life for the majority of patients.
Collapse
Affiliation(s)
- D.H. Sterman
- University of Pennsylvania Medical Center, Philadelphia, Pa
| | | | - D.E. Wood
- University of Washington, Seattle, Wash
| | - P.N. Mathur
- Indiana University Hospital, Indianapolis, Ind
| | | | - D.E. Ost
- North Shore University Hospital, Manhasset, N.Y
| | - J.D. Truwit
- University of Virginia Health System, Charlottesville, Va
| | - P. Diaz
- Ohio State University, Columbus, Ohio
| | | | - R. Cerfolio
- University of Alabama at Birmingham, Birmingham, Ala
| | - R. Maxfield
- Columbia University Medical Center, New York, N.Y
| | - A.I. Musani
- University of Pennsylvania Medical Center, Philadelphia, Pa
| | | | - F. Sheski
- University of Washington, Seattle, Wash
| | - M. Machuzak
- University of Pennsylvania Medical Center, Philadelphia, Pa,Cleveland Clinic, Cleveland, Ohio
| | - A.R. Haas
- University of Pennsylvania Medical Center, Philadelphia, Pa
| | | | | | | |
Collapse
|
39
|
Mazzone PJ, Videtic G, Murthy S, Mason D, Rice T, Pennell N, Rich T, Machuzak M, Mekhail T. The serial effects of multimodality therapy for stage III non-small cell carcinoma on lung function. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.7551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
7551 Purpose: To describe the effects of multimodality treatment on lung function in patients with stage III non-small cell carcinoma of the lung (NSCLC) Methods: Pulmonary function tests (PFTs) were reviewed for 32 patients with stage III NSCLC who were enrolled in a multimodality protocol that included neoadjuvant (NAd) combined chemoradiotherapy (taxol 50 mg/m2, carboplatin AUC 2 weekly X 3, radiation (XRT) 1.8 Gy BID to 30 Gy + erlotinib 150 mg/d for 28 days, followed by resection (R) and adjuvant (Ad) chemoradiotherapy (same as induction) followed by erlotinib 150mg/d maintenance (M) for 2 years. Changes in PFTs were analyzed at multiple time points (baseline to after NAd, after NAd to after R, after R to after Ad) and for the overall effect of treatment (baseline to the end of treatment). Results: The table below shows changes in percent predicted pulmonary function test values at each step in the treatment course. + signifies an increase and - a decrease. P indicates pneumonectomy and L lobectomy. Numbers in parentheses are the number of patients with complete testing at that time point. Conclusions: Neoadjuvant combined chemoradiotherapy has a small effect on lung function testing. The combined effect of multimodality therapy for stage III lung cancer that includes surgical resection leads to larger declines in lung function than have been reported historically for resection alone. [Table: see text] [Table: see text]
Collapse
Affiliation(s)
| | | | | | | | - T. Rice
- Cleveland Clinic, Cleveland, OH
| | | | - T. Rich
- Cleveland Clinic, Cleveland, OH
| | | | | |
Collapse
|
40
|
Abstract
Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition that has frequent morbidity and mortality, with associated costs of US $ 2.5 billion annually and nearly 14,000 deaths each year. In the most advanced stages it causes debilitating breathlessness which is not improved despite maximal medical therapy including smoking cessation, bronchodilators, steroids and supplemental oxygen. Limitations of medical therapy led to the development of several surgical techniques to improve quality of life. However, surgical techniques still carry substantial morbidity even if the mortality is low at centers with larger experience; hence investigators are vigorously pursuing research into innovative, alternative methods for achieving lung volume reduction (LVR), in recent years. Endoscopic techniques for LVR are proposed, based on two main approaches, either closing of anatomical airway passages into destroyed lobe/segment of the lung to affect a collapse and reduction in volume or opening extra-anatomical airway passages, aimed at improving expiratory collateral flow from hyper-inflated areas bypassing the flow limited segments of the emphysematous airways. This article reviews the available endoscopic devises and the evidence supporting their use in the treatment of COPD.
Collapse
Affiliation(s)
- Hina Sahi
- Department of Pulmonary, Allergy and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | |
Collapse
|
41
|
Tendulkar RD, Fleming PA, Reddy CA, Gildea TR, Machuzak M, Mehta AC. High-Dose-Rate Endobronchial Brachytherapy for Recurrent Airway Obstruction From Hyperplastic Granulation Tissue. Int J Radiat Oncol Biol Phys 2008; 70:701-6. [PMID: 17904764 DOI: 10.1016/j.ijrobp.2007.07.2324] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/03/2007] [Accepted: 07/04/2007] [Indexed: 11/15/2022]
Abstract
PURPOSE Benign endobronchial granulation tissue causes airway obstruction in up to 20% of patients after lung transplantation or stent placement. High-dose-rate endobronchial brachytherapy (HDR-EB) has been successful in some cases refractory to standard bronchoscopic interventions. METHODS AND MATERIALS Between September 2004 and May 2005, 8 patients with refractory benign airway obstruction were treated with HDR-EB, using one to two fractions of Ir-192 prescribed to 7.1 Gy at a radius of 1 cm. Charts were retrospectively reviewed to evaluate subjective clinical response, forced expiratory volume in 1 second (FEV(1)), and frequency of therapeutic bronchoscopies over 6-month periods before and after HDR-EB. RESULTS The median follow-up was 14.6 months, and median survival was 10.5 months. The mean number of bronchoscopic interventions improved from 3.1 procedures in the 6-month pretreatment period to 1.8 after HDR-EB. Mean FEV(1) improved from 36% predicted to 46% predicted. Six patients had a good-to-excellent subjective early response, but only one maintained this response beyond 6 months, and this was the only patient treated with HDR-EB within 24 h from the most recent bronchoscopic intervention. Five patients have expired from causes related to their chronic pulmonary disease, including one from hemoptysis resulting from a bronchoarterial fistula. CONCLUSION High-dose-rate-EB may be an effective treatment for select patients with refractory hyperplastic granulation tissue causing recurrent airway stenosis. Performing HDR-EB within 24-48 h after excision of obstructive granulation tissue could further improve outcomes. Careful patient selection is important to maximize therapeutic benefit and minimize toxicity. The optimal patient population, dose, and timing of HDR-EB should be investigated prospectively.
Collapse
Affiliation(s)
- Rahul D Tendulkar
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH 44195, USA.
| | | | | | | | | | | |
Collapse
|
42
|
Sterman DH, Recio A, Carroll RG, Gillespie CT, Haas A, Vachani A, Kapoor V, Sun J, Hodinka R, Brown JL, Corbley MJ, Parr M, Ho M, Pastan I, Machuzak M, Benedict W, Zhang XQ, Lord EM, Litzky LA, Heitjan DF, June CH, Kaiser LR, Vonderheide RH, Albelda SM, Kanther M. A phase I clinical trial of single-dose intrapleural IFN-beta gene transfer for malignant pleural mesothelioma and metastatic pleural effusions: high rate of antitumor immune responses. Clin Cancer Res 2007; 13:4456-66. [PMID: 17671130 DOI: 10.1158/1078-0432.ccr-07-0403] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This phase 1 dose escalation study evaluated the safety and feasibility of single-dose intrapleural IFN-beta gene transfer using an adenoviral vector (Ad.IFN-beta) in patients with malignant pleural mesothelioma (MPM) and metastatic pleural effusions (MPE). EXPERIMENTAL DESIGN Ad.IFN-beta was administered through an indwelling pleural catheter in doses ranging from 9 x 10(11) to 3 x 10(12) viral particles (vp) in two cohorts of patients with MPM (7 patients) and MPE (3 patients). Subjects were evaluated for (a) toxicity, (b) gene transfer, (c) humoral, cellular, and cytokine-mediated immune responses, and (d) tumor responses via 18-fluorodeoxyglucose-positron emission tomography scans and chest computed tomography scans. RESULTS Intrapleural Ad.IFN-beta was generally well tolerated with transient lymphopenia as the most common side effect. The maximally tolerated dose achieved was 9 x 10(11) vp secondary to idiosyncratic dose-limiting toxicities (hypoxia and liver function abnormalities) in two patients treated at 3 x 10(12) vp. The presence of the vector did not elicit a marked cellular infiltrate in the pleural space. Intrapleural levels of cytokines were highly variable at baseline and after response to gene transfer. Gene transfer was documented in 7 of the 10 patients by demonstration of IFN-beta message or protein. Antitumor immune responses were elicited in 7 of the 10 patients and included the detection of cytotoxic T cells (1 patient), activation of circulating natural killer cells (2 patients), and humoral responses to known (Simian virus 40 large T antigen and mesothelin) and unknown tumor antigens (7 patients). Four of 10 patients showed meaningful clinical responses defined as disease stability and/or regression on 18-fluorodeoxyglucose-positron emission tomography and computed tomography scans at day 60 after vector infusion. CONCLUSIONS Intrapleural instillation of Ad.IFN-beta is a potentially useful approach for the generation of antitumor immune responses in MPM and MPE patients and should be investigated further for overall clinical efficacy.
Collapse
Affiliation(s)
- Daniel H Sterman
- Thoracic Oncology Gene Therapy Program and Abramson Family Cancer Research Institute, University of Pennsylvania Medical Center, Philadelphia, PA 19104-4283, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Shah SS, Karnak D, Shah SN, Budev M, Machuzak M, Gildea TR, Mehta AC. Broncholith caused by donor-acquired histoplasmosis in a lung transplant recipient. J Heart Lung Transplant 2007; 26:407-10. [PMID: 17403485 DOI: 10.1016/j.healun.2007.01.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2006] [Revised: 12/30/2006] [Accepted: 01/07/2007] [Indexed: 10/23/2022] Open
Abstract
A broncholith is a calcified lymph node that erodes into and partially or completely obstructs the bronchial lumen. The natural history of broncholiths is poorly understood. They are frequently encountered in residents of areas that are endemic for Histoplasma capsulatum and Mycobacterium tuberculum. We report the first case of a broncholith in which the fungus Histoplasma capsulatum was transferred from a donor to a lung transplant (LTx) recipient. Our report highlights the time course of broncholith development and its successful management. We suspect that broncholithiasis and transmission of Histoplasma capsulatum from a donor to the recipient are under-reported in the LTx literature. We hypothesize that histoplasmosis can be transmitted from the donor to the recipient and the duration in the formation of calcification of the lymph node or the broncholith can be anywhere from 2 to 10 months.
Collapse
Affiliation(s)
- Sonia S Shah
- Department of Pulmonary, Allergy and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
| | | | | | | | | | | | | |
Collapse
|
44
|
Suttithawil W, Karnak D, Machuzak M, Gildea TR, Mehta AC. An unusual cause of T tube obstruction: 'tricho-tracheobezoar'. Respiration 2007; 76:353-5. [PMID: 17299254 DOI: 10.1159/000099616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 12/06/2006] [Indexed: 11/19/2022] Open
Abstract
A T tube is an upper airway device well described in the literature which is used to maintain tracheal lumen patency. Although tube occlusion is a known complication, it can be minimized by certain precautions. Otherwise, total occlusion can result in dramatic clinical deterioration or death. Herein, we describe a new clinical entity, 'tricho-tracheobezoar', using a new term defining a hairball in the trachea, which illustrates many of the potential pitfalls in the management of T tubes.
Collapse
Affiliation(s)
- Wudthichai Suttithawil
- Department of Pulmonary and Critical Care Medicine, Bumrungrad International, Wattana, Bangkok, Thailand
| | | | | | | | | |
Collapse
|
45
|
Wood DE, McKenna RJ, Yusen RD, Sterman DH, Ost DE, Springmeyer SC, Gonzalez HX, Mulligan MS, Gildea T, Houck WV, Machuzak M, Mehta AC. A multicenter trial of an intrabronchial valve for treatment of severe emphysema. J Thorac Cardiovasc Surg 2007; 133:65-73. [PMID: 17198782 DOI: 10.1016/j.jtcvs.2006.06.051] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2005] [Revised: 05/30/2006] [Accepted: 06/07/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Minimally invasive endoscopic treatment of emphysema could provide palliation with less risk than lung volume reduction surgery and offer therapy to patients currently not considered for lung volume reduction surgery. The Intrabronchial Valve is used to block bronchial airflow in the most emphysematous areas of lung. METHODS Patients with severe chronic obstructive pulmonary disease and heterogeneous upper lobe-predominant emphysema were eligible. Patients underwent flexible bronchoscopic placement of valves into segmental or subsegmental airways in both upper lobes. Outcomes assessed over a minimum of 6 months of follow-up included the safety, feasibility, tolerance, and success of valve placement; health-related quality of life; exercise capacity; pulmonary function; and gas exchange. RESULTS Five centers treated 30 patients. Patient follow-up ranged from 1 to 12 months. A mean of 6.1 valves were placed per patient. Valves were positioned by means of flexible bronchoscopy in 99% of desired airways, and the procedure duration ranged from 15 to 125 minutes (mean, 65 minutes). Hospital discharge occurred within 2 days in 27 of 30 patients. There were no deaths or episodes of valve migration, tissue erosion, or significant bleeding. Eighty-three percent of patients had no adverse events judged probably or definitely related to the device. Patients experienced significant improvement in health-related quality of life, although the physiologic and exercise outcomes did not show statistically significant improvements. CONCLUSIONS These first multicenter results with the Intrabronchial Valve demonstrate significant improvements in health-related quality of life and acceptable safety, ease of use, and procedural complication rates. The valve might be a safer and less-invasive alternative to surgical therapy for patients with severe emphysema.
Collapse
Affiliation(s)
- Douglas E Wood
- Division of Cardiothoracic Surgery, the University of Washington, Seattle, Wash 98195-6310, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Krimsky WS, Sharief UU, Sterman DH, Machuzak M, Musani AI. Topical Mitomycin C is an Effective, Adjunct Therapy for the Treatment of Severe, Recurrent Tracheal Stenosis in Adults. ACTA ACUST UNITED AC 2006. [DOI: 10.1097/00128594-200607000-00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
47
|
Sterman DH, Recio A, Haas A, Machuzak M, Gillespie C, Sun J, Kapoor V, Litzky LA, Vonderheide R, June C, Kucharczuk JC, Kaiser LR, Albelda SM. 1106. Results of a Phase I Clinical Trial of Adenoviral-Interferon-Beta Gene Therapy for Malignant Mesothelioma and Malignant Pleural Effusions. Mol Ther 2006. [DOI: 10.1016/j.ymthe.2006.08.1211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|