Respiration; international review of thoracic diseases
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In neonatal respiratory distress syndrome (RDS) and acute RDS (ARDS) mechanical ventilation is often necessary to manage hypoxia, whilst protecting the lungs through lower volume ventilation and permissive hypercapnia. Mechanical ventilation can, however, induce or aggravate the lung injury caused by the respiratory distress. Helium, in a gas mixture with oxygen (heliox), has a low density and can reduce the flow in narrow airways and allow for lower driving pressures. ⋯ Although evidence so far is limited, there may be a rationale for heliox ventilation in ARDS as an intervention to improve ventilation and reduce the work of breathing.
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Lung ultrasound (LUS) is an accurate tool for the diagnosis and follow-up of pneumonia in adults as well as in children. LUS is at least as accurate as chest radiography in diagnosing pneumonia. The most important parenchymal criterion is the positive air bronchogram within an echopoor area. ⋯ For further differential diagnosis, an integrated consideration of history, clinical examination, LUS and echocardiography should be performed. LUS is an excellent tool for IS screening. Repeated LUS control examinations may reflect the dynamics of IS under therapy and so LUS may serve as a therapy guide. .
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Indwelling pleural catheters (IPC) are now established as one of the major tools for the management of recurrent pleural effusions. Their traditional role, which saw them only as second line treatment for malignant effusions, has now expanded. ⋯ IPCs are relatively simple to insert and maintain, and theoretically allow patients to be managed entirely as an outpatient, meaning that they are likely to be cost-effective in the longer term. They can also dramatically improve the quality of life in patients who have typically needed lengthy hospital admissions or who have terminal malignant disease.
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Review Meta Analysis
Diagnostic yield and safety of electromagnetic navigation bronchoscopy for lung nodules: a systematic review and meta-analysis.
Electromagnetic navigation bronchoscopy (ENB) is an emerging endoscopic technique for the diagnosis of peripheral lung lesions. A thorough analysis of ENB's yield and safety is required for comparison to other sampling modalities. ⋯ ENB is effective and particularly safe. Prospective studies are needed to clarify the role of several variables conditioning the yield of this technique.
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Conventional transbronchial needle aspiration (TBNA) and endobronchial ultrasound (EBUS)-TBNA are widely accepted tools for the diagnosis and staging of lung cancer and the initial procedure of choice for staging. Obtaining adequate specimens is key to provide a specific histologic and molecular diagnosis of lung cancer. ⋯ The number of needle aspirations with both conventional TBNA and EBUS-TBNA was found to impact the diagnostic yield, with at least 3 passes needed for optimal performance. Neither needle gauge nor the use of miniforceps, the use of suction or the type of sedation/anesthesia has been found to improve the diagnostic yield for lung cancer. The use of rapid on-site cytology examination does not increase the diagnostic yield. Molecular analysis (i.e. EGFR, KRAS and ALK) can be routinely performed on the majority of cytological samples obtained by EBUS-TBNA and conventional TBNA. There does not appear to be a superior method for specimen preparation (i.e. slide staining, cell blocks or core tissue). It is likely that optimal specimen preparation may vary between institutions depending on the expertise of pathology colleagues.