Respiratory care
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We report a case of broncholithiasis secondary to pulmonary actinomycosis. Broncholithiasis has occasionally been reported in association with actinomycosis, but it is unclear if actinomycosis leads to lymph node calcification with subsequent erosion into the airway, producing a broncholith, or if an existing generic broncholith is secondarily colonized with Actinomyces. ⋯ The nodules included sulfur granules containing Gram-positive branching filamentous organisms consistent with Actinomyces. The finding of Actinomyces throughout the broncholith is strong evidence that the etiology of the broncholithiasis was a primary pulmonary Actinomyces infection.
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We evaluated the diagnostic performance and safety of combined blind nasotracheal suctioning and non-bronchoscopic mini-bronchoalveolar lavage (mini-BAL) to obtain respiratory secretion specimens from spontaneously breathing, non-intubated patients with infectious pneumonia in intensive care. ⋯ Blind nasotracheal suctioning confirmed via colorimetric capnography allows microbiological diagnosis, and can be enhanced by non-bronchoscopic mini-BAL. Colorimetric capnography helps confirm bronchial tube position. Non-bronchoscopic mini-BAL is a novel and feasible way to collect bronchial secretions without fibroscopy. (ClinicalTrials.gov NCT00763620.).