Clinics in chest medicine
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Tracheostomy is a commonly performed intervention with several benefits in the treatment of patients with chronic respiratory failure. Percutaneous dilational tracheostomy techniques have allowed bedside tracheostomy placement in the modern intensive care unit. Percutaneous dilational tracheostomy can be safely performed by interventional pulmonologists, medical intensive care physicians, and surgical specialists. When performed with the assistance of adjuncts, such as flexible bronchoscopy, the percutaneous dilational method has a favorable complication rate, efficiency, and cost profile compared with surgical tracheostomy.
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Endobronchial ablative therapies are used to address a variety of malignant and benign airway lesions. By utilizing endobronchial ablative techniques patients with symptomatic airway lesions may receive significant symptom improvement, improved quality of life, and improved life expectancy. ⋯ The choice to use one therapy versus another depends on technical and patient specific factors. This article reviews indications and contraindications for each therapy, discusses details related to each endobronchial ablative therapy, complications of endobronchial ablative therapies, and briefly discusses practical consideration with endobronchial ablative therapies.
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In the staging of mediastinal lymph nodes before lung cancer surgery, endobronchial ultrasound transbronchial needle aspirations (EBUS-TBNA) have proven to be highly sensitive and specific as well as safe. Although positron emission tomography/computed tomography (PET/CT) has been a major development in the preoperative workup of patients with lung cancer, EBUS-TBNA has superior test performance and PET/CT cannot be regarded as a substitute for tissue sampling with EBUS-TBNA. In general, EBUS-TBNA staging is needed for any patient with CT nodes greater than 1 cm in short axis, or PET-positive mediastinal nodes.
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The term "interventional pulmonology" (IP) supersedes the previously used term "thoracic endoscopy," a change that reflects the evolution of a specialty devoted to performing highly sophisticated and technologically advanced procedures in the lungs and chest. Continuing advances in technology promise to further expand IP's diagnostic and therapeutic frontiers. However, standardized educational programs to train and test IP physicians will be essential to maintain a high standard of practice in the field.
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Complex airway diseases represent a therapeutic challenge and require multidisciplinary input. Surgery remains the definitive modality. ⋯ However, it has limited use if lesions are located in the upper lobes or lung periphery, but significant technological advances allow for effective treatments using the flexible bronchoscope. Rigid and flexible bronchoscopes should be seen as complementary procedures and most cases require the use of both modalities.