Chest
-
The use of mechanical circulatory support (MCS) devices has increased sixfold since 2006. Although there is an established legal and ethical consensus that patients have the right to withdraw and withhold life-sustaining interventions when burdens exceed benefits, this consensus arose prior to the widespread use of MCS technology and is not uniformly accepted in these cases. ⋯ Our center recently encountered the challenge of an awake and functionally improving patient with a total artificial heart (TAH) who requested its deactivation. We present a narrative description of this case with discussion of the following questions: (1) Is it ethically permissible to deactivate this particular device, the TAH? (2) Are there any particular factors in this case that are ethical contraindications to proceeding with deactivation? (3) What are the specific processes necessary to ensure a compassionate and respectful deactivation? (4) What proactive practices could have been implemented to lessen the intensity of this case's challenges? We close with a list of recommendations for managing similar cases.
-
Respiratory Infections PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Azithromycin (AZ) is a macrolide that has shown increased survival in patients with community-acquired pneumonia and bacteremic pneumococcal pneumonia. Immunomodulatory properties are claimed to be associated with the beneficial effects of macrolides. However, limited data are available about the clinical efficacy in patients with severe sepsis. Our aim was to assess the efficacy of AZ in addition to standard of care (SOC) therapy compared to SOC antimicrobial therapy in a pilot randomized controlled trial (RCT) in critically ill patients with severe sepsis. ⋯ Marcos Restrepo: Grant monies (from sources other than industry): NIH/NHLBI K23HL096054 The following authors have nothing to disclose: Paola Faverio, Alejandro Arango, Oriol Sibila, Eric Mortensen, Grant Waterer, Richard Wunderink, Antonio AnzuetoNo Product/Research Disclosure Information.
-
Linear endobronchial ultrasound (EBUS) allows real-time guidance of transbronchial needle aspiration of thoracic structures and has become an increasingly important diagnostic tool for chest physicians. Little has been published about the learning experience of operators with this technology. The purpose of this study was to define the learning experience of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) among pulmonary trainees. ⋯ Pulmonary trainees needed an average of 13 procedures to achieve first independent successful performance of EBUS-TBNA following a training protocol that included a didactic curriculum and simulation-based practice. Our findings could guide pulmonary fellowship directors in planning EBUS training and establishing a reasonable juncture to assess EBUS skills with validated assessment tools.
-
Lung Cancer ISESSION TYPE: Slide PresentationsPRESENTED ON: Saturday, March 22, 2014 at 02:15 PM - 03:45 PMPURPOSE: To report local control and overall survival following CyberKnife treatment for central NSCLC conventional radiation failures. ⋯ Sean Collins: Consultant fee, speaker bureau, advisory committee, etc.: Consultant Accuray Inc. Brian Collins: Consultant fee, speaker bureau, advisory committee, etc.: Speaker Bureau Accuray Inc. The following authors have nothing to disclose: Ryan Malik, Shaan Kataria, Catherine Jamis, Leonard Chen, Simeng Suy, Cristina Reichner, Eric AndersonNo Product/Research Disclosure Information.
-
COPD QVA149 PostersSESSION TYPE: Poster PresentationsPRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PMPURPOSE: Current COPD treatment guidelines recommend long-acting β2-agonist/inhaled corticosteroids (LABA/ICS) for severe COPD patients with a history of exacerbations. The 26-week ILLUMINATE study in moderate-to-severe COPD patients showed superiority of QVA149 versus the LABA/ICS salmeterol/fluticasone combination (SFC) in lung function. A novel study design to evaluate the effect of QVA149 versus SFC on COPD exacerbations in more severe patients with a history of exacerbations is presented. ⋯ Jadwiga Wedzicha: Consultant fee, speaker bureau, advisory committee, etc.: JW has received speaking fee and/or for advisory boards from GlaxoSmithKline, AstraZeneca, Novartis, Bayer, Boehringer Ingelheim, Nycomed. Chiesi and Respifor as well as travel reimbursements from Boehringer Ingelheim. JW has received research grants from GlaxoSmithKline, AstraZeneca, Chiesi and Novartis. Nicola Gallagher: Employee: Novartis employee Donald Banerji: Employee: Novartis employee The following authors have nothing to disclose: Jørgen VestboClinical trial results of QVA149, combination of two approved products indacaterol and glycopyrronium, will be presented, QVA is in the late stage phase 3 trials prior to approval.