Respiration; international review of thoracic diseases
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Patients with advanced non-small-cell lung cancer (NSCLC) and acute respiratory failure (ARF) from central airway obstruction (CAO) may be offered end-of-life care rather than intensive care treatment and palliative bronchoscopic intervention. ⋯ Intubated patients with respiratory failure caused by CAO from NSCLC can be successfully and rapidly removed from mechanical ventilation after bronchoscopic interventions aimed at restoring airway patency. Median survival greater than 10 months justifies ICU hospitalization and referral for bronchoscopic treatment.
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Argon plasma coagulation (APC) is a common and safe bronchoscopic technique used in the management of obstructing lesions and hemorrhage in the central airways. Complications of bronchoscopic APC are uncommon and include hemorrhage, perforation and fire in the airways. While bronchoscopic APC has been reported to cause systemic gas embolization and associated cardiovascular collapse, we report a case of cerebral gas embolization that occurred during bronchoscopic APC and highlight underappreciated potential risk factors for its occurrence.
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There have been no reports on the efficacy of noninvasive positive pressure ventilation (NPPV) in elderly patients. ⋯ An APACHE II score <29 and a GCS score ≥9 were predictors of a successful outcome of NPPV in elderly people.
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The steady rise in the number of critically ill patients in the USA has led to an increase in the need for tracheostomies in patients requiring chronic ventilatory support. There is a matched need for experienced operators to safely and efficiently perform these procedures. ⋯ There were no statistical differences in PDT between the ST and IP groups when comparing complications. There was a trend towards an increased efficiency in time to PDT after consultation within the IP PDT group. Trained IP can safely and effectively perform PDT.