Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Dec 2014
ReviewInterventional pulmonology for asthma and emphysema: bronchial thermoplasty and bronchoscopic lung volume reduction.
Emphysema and asthma are responsible for economic and social burden. Altering the natural course of these diseases is a field of intense research. The National Emphysema Treatment Trial showed that lung volume reduction surgery (LVRS) could significantly reduce both morbidity and mortality in properly selected patients. ⋯ In patients suffering from asthma who cannot achieve control with standard medical care, BT has been shown to be safe and improves symptoms, with long lasting benefit. BT does not seem to affect traditional markers of asthma severity such as forced expiratory volume in 1 second and questions remain regarding proper patient selection for this therapy and its true physiologic effects. This article is a review of bronchoscopic modalities for emphysema and asthma.
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Semin Respir Crit Care Med · Dec 2014
ReviewInterventional pulmonology in the intensive care unit: percutaneous tracheostomy and gastrostomy.
Bedside percutaneous tracheostomy and gastrostomy tube placement are cost-effective and safe techniques employed in the management of critically ill patients requiring prolonged mechanical ventilation. Both procedures have been well characterized and studied in the surgical and gastroenterology literature. ⋯ We will discuss the techniques available and the relevant background data regarding choice of method and its integration into clinical practice. In addition, we discuss the creation of a multidisciplinary tracheostomy care team, its effect on patient care, hospital finances, and the interventional pulmonologists role.
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Ultrasonography of the thorax has become a more recognized tool in pulmonary medicine, thanks to continuing clinical research that has proven its many valuable roles in the day-to-day management of pulmonary and pleural diseases. Ultrasound examination is a cost-effective imaging modality that permits the pulmonologist to obtain information about the pathologies in the thorax without the risk of exposure to ionizing radiation, providing the examiner with real-time and immediate results. Its ease of use and training along with its portability to the patient's bedside and accurate examination of the pleural space has allowed for safer pleural procedures such as thoracentesis, chest tube placement, tunneled pleural catheter placement, and medical thoracoscopy. In this review, we summarize the technique of chest ultrasonography, compare ultrasound to other frequently used thoracic imaging modalities, and focus on its use in obtaining pleural access while performing invasive pleural procedures.
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The field of interventional pulmonology (IP) is a rapidly growing subspecialty of pulmonary and critical care medicine (PCCM), primarily focused on the evaluation and management of patients with lung nodules, masses, mediastinal and hilar adenopathy, central airway obstruction, and pleural disease. Traditionally passed on in the apprenticeship model, dedicated fellowships began in the early 2000s and there are currently approximately 24 IP fellowships throughout the United States. In addition to the evaluation and management of patients with the above diseases, the additional year provides training in advanced diagnostic and minimally invasive therapeutic procedures that are not specifically taught during a standard PCCM fellowship. This article will review the evolution of the field of IP as well as the pathways to learn advanced procedural techniques.