Clinics in chest medicine
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Although bronchoscopy technology continues to evolve at a fairly rapid pace, basic procedures, such as bronchoalveolar lavage, transbronchial lung biopsy, and transbronchial needle aspiration, continue to play a paramount role in the diagnosis of bronchopulmonary diseases. Pulmonologists should be trained in these basic bronchoscopic procedures.
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Clinics in chest medicine · Sep 2013
ReviewBedside ultrasound for the interventional pulmonologist.
This article summarizes the current literature regarding thoracic ultrasonography and specifically guides the interventional pulmonologist in use of thoracic ultrasound for practical applications.
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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.