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- Risk Factors for Acquiring Potentially Drug-Resistant Pathogens in Immunocompetent Patients with Pneumonia Developed Out of Hospital. [JOURNAL ARTICLE]
- Respiration 2014 Jul 2.
Background: The concept of healthcare-associated pneumonia (HCAP) exists to identify patients infected with highly resistant pathogens who are exposed to the healthcare environment. However, many studies have included immunosuppressed patients who were excluded from the original concept. Objectives: The risk factors of potentially drug-resistant (PDR) pathogens in patients with pneumonia developed outside the hospital were reevaluated after excluding the patients who had immunosuppression. Methods: This was a retrospective study of prospectively collected data from all consecutive patients with pneumonia who were admitted to hospital via the emergency department between January 2008 and December 2011. Results: Pathogens were isolated in a total of 315 patients with pneumonia from our cohort; 33% with PDR pathogens did not meet the criteria for HCAP, but 44% without PDR pathogens did meet the criteria. Variables independently associated with PDR included nursing home residency, hospitalization in the preceding 90 days, antibiotics in the 30 days prior to pneumonia, poor function status and chronic lung disease. The new predictive scoring system based on the logistic regression model had a higher predictive power for the risk of PDR pathogens than the presence of the risk factors or the HCAP criteria. Conclusions: Functional status, pulmonary comorbidity and previous exposure to the healthcare environment were significantly associated with acquiring PDR pathogens in immunocompetent patients with pneumonia that developed out of hospital. However, a risk stratification model was more accurate than the presence of the risk factors or the HCAP criteria for assessing the probability of PDR pathogens. © 2014 S. Karger AG, Basel.
- Bronchoscopic Lung Volume Reduction Is Springing with Potential for Patients with Homogenous Emphysema. [JOURNAL ARTICLE]
- Respiration 2014 Jul 2.:89-91.
- Endobronchial Ultrasonography with a Guide Sheath for Pure or Mixed Ground-Glass Opacity Lesions. [JOURNAL ARTICLE]
- Respiration 2014 Jul 2.:137-143.
Background: Ground-glass opacity (GGO) lesions are difficult to diagnose by transbronchial biopsy (TBB). Objectives: We attempted to diagnose solitary peripheral GGO predominant-type lesions by TBB using endobronchial ultrasonography with a guide sheath (EBUS-GS) under X-ray fluoroscopic guidance, and to evaluate several factors associated with diagnostic yield. Methods: The medical records of 67 patients with GGO predominant-type lesions who underwent TBB using EBUS-GS under X-ray fluoroscopic guidance were retrospectively reviewed. Results: Of the 67 lesions, 38 (57%) were successfully diagnosed by EBUS-GS (5/11 pure GGO lesions and 33/56 mixed GGO lesions). The diagnosable lesions were significantly larger than the nondiagnosable lesions (24 vs. 17 mm, respectively; p < 0.01). Regarding the diagnostic yield by signs on computed tomography, the lesions with a bronchus leading directly to a lesion had a significantly higher diagnostic yield than the others (p < 0.05). When GGO lesions were confirmed under X-ray fluoroscopic guidance, the diagnostic yield was 79% (vs. 40% in lesions not visible on X-ray fluoroscopy; p < 0.05). Conclusions: EBUS-GS is a useful and valuable diagnostic modality, even for GGO predominant-type lesions located at the lung periphery. © 2014 S. Karger AG, Basel.
- Can Lung Ultrasound Replace Chest Radiography for the Diagnosis of Pneumonia in Hospitalized Children? [JOURNAL ARTICLE]
- Respiration 2014 Jul 2.:112-115.
Background: Lung ultrasound is a non-radiating accurate alternative tool to chest X-ray (CXR) in the diagnosis of community-acquired pneumonia (CAP) in adults. Objectives: The aim of our study was to define the accuracy of ultrasound in the diagnosis of CAP in children. Methods: 107 consecutive children with suspected CAP underwent clinical examination, blood sample analysis, CXR and lung ultrasound on admission to the Pediatric Department of the San Paolo Hospital. The diagnosis of pneumonia was made by an independent committee of physicians on the basis of the overall clinical and CXR data. Results: The diagnosis of CAP was confirmed by the committee in 81 patients (76%). Ultrasound and CXR were performed in all patients. Ultrasound had a sensitivity of 94% and specificity of 96%, while CXR showed a sensitivity of 82% and a specificity of 94%. In patients with CAP, ultrasound revealed subpleural consolidations with air bronchogram in 70 cases and focal B-lines in 6. A parapneumonic pleural effusion was detected in 17 patients by ultrasound, while only 11 of them could be detected by CXR. Conclusions: In our series, lung ultrasound was highly accurate for the diagnosis of CAP in hospitalized children. These results provide the rationale for a multicenter study in children. © 2014 S. Karger AG, Basel.
- Respiratory Impedance and Response to Salbutamol in Healthy Individuals and Patients with COPD. [JOURNAL ARTICLE]
- Respiration 2014 Jul 2.:101-111.
Background: Recent studies suggested that the bronchodilator response depends on airway obstruction. The forced oscillation technique (FOT) may help improve our understanding of the changes in respiratory mechanics that occur after the application of a bronchodilator. Objectives: We aimed to (1) assess the response to salbutamol and to compare the impedance changes in healthy individuals and COPD patients, (2) investigate the effects of airway obstruction on this response and (3) evaluate the utility of the FOT as a complementary measurement to assess the response to the bronchodilator. Methods: Twenty-five healthy individuals and 82 patients with COPD were assessed with the FOT followed by spirometry before and after the use of salbutamol. Results: The changes exhibited by the COPD subgroups were greater than in the healthy individuals (p < 0.05). Increased obstruction resulted in decreased reductions in mean resistance and increased improvements in mean reactance (p < 0.001). In addition, the bronchodilation reduced the ventilation heterogeneity and the impedance modulus in all COPD stages (p < 0.05). The correlation coefficients for the spirometric and FOT changes were low (0.21-0.38). Conclusions: In the initial phases of COPD (stage I), the effects of bronchodilation are greater than in healthy volunteers. The bronchodilator use improved the oscillatory mechanics in all of the studied groups of COPD patients. These improvements are reduced in more advanced phases of airway obstruction (II, III and IV). The FOT provides information that complements the data supplied by spirometry, contributing to an improvement in the evaluation of the bronchodilator response in COPD. © 2014 S. Karger AG, Basel.
- Propofol versus Midazolam in Medical Thoracoscopy: A Randomized, Noninferiority Trial. [JOURNAL ARTICLE]
- Respiration 2014 Jun 21.
Background: Hypoxemia is a surrogate marker for periprocedural endoscopic complications. There are no data comparing the safety of propofol sedation with another sedative regimen in medical thoracoscopy. Objective: To evaluate whether sedation with propofol is as safe and effective as sedation with midazolam. Methods: Ninety consecutive patients undergoing medical thoracoscopy were randomly allocated to receive either intravenous propofol or midazolam. Predefined periprocedural complications included hypoxemia, hypotension, bleeding, need for airway insertion, mechanical ventilation, intensive care unit transfer and death. The primary endpoint was the mean lowest oxygen saturation during the procedure. Results: Randomized groups had similar demographics (64 ± 16 years, 57% male, 91% American Society of Anesthesiologists class III-IV) and a balanced distribution of procedures. The mean lowest oxygen saturation during the procedure was significantly lower in the propofol group as compared to the midazolam group (93 ± 6 vs. 96 ± 3%, p = 0.007). Patients randomized to propofol showed more episodes of hypoxemia (27 vs. 4%, p = 0.007) and hypotension (82 vs. 40%, p < 0.0001). No procedure had to be aborted. None of the patients required an artificial airway, mechanical ventilation or intensive care unit care, and none died. Conclusions: As assessed by the surrogate marker hypoxemia, propofol should not be considered the first choice for sedation in medical thoracoscopy. © 2014 S. Karger AG, Basel.
- Authors' Reply. [LETTER]
- Respiration 2014 Jun 13.
- Prognostic Factors in Patients with Malignant Pleural Effusion. [LETTER]
- Respiration 2014 Jun 14.
- Chronic Pulmonary Aspergillosis: An Update on Diagnosis and Treatment. [JOURNAL ARTICLE]
- Respiration 2014 Jun 17.
Chronic pulmonary aspergillosis (CPA) affects individuals with non-systemic or mildly systemic immunodepression or altered pulmonary integrity due to underlying disease. It has been reported with a variety of clinical and radiological patterns. The condition should be distinguished from simple aspergilloma and allergic bronchopulmonary aspergillosis as well as invasive aspergillosis in severely immunocompromised patients. CPA generally requires long-term antifungal treatment and surgery may be considered. Life-threatening haemoptysis may be prevented by bronchial arteriography with embolisation. However, currently there are no documented treatment recommendations for CPA. This review provides an up-to-date practical overview of this condition, including a comprehensive update on diagnosis and management. © 2014 S. Karger AG, Basel.
- Bronchoalveolar Lavage Cellular Patterns in Monoclonal Antibody-Induced Lung Disease. [JOURNAL ARTICLE]
- Respiration 2014 Jun 13.
Background: The increase in the use of monoclonal antibodies (mAB) as a targeted therapy for a variety of diseases has been accompanied by an increase in reports of interstitial lung abnormalities in treated patients. Objective: Bronchoalveolar lavage (BAL) is routinely performed in these patients to rule out infection, so we sought to determine the BAL cellular pattern in individuals with mAB-induced lung disease (mAB-ILD). Methods: We utilized a case-control study design. Among patients treated with mAB, cases were defined as those with otherwise-unexplained interstitial lung abnormalities, which resolved after cessation of treatment, while controls were defined as those with interstitial abnormalities clearly explained by other etiologies. Results: From 2000 to 2012, we identified 9 cases and 7 controls. The mean age of the cases was 62.6 ± 26 years and 6 were female. The most common radiographic finding was diffuse ground-glass opacities. The most common BAL cellular pattern was mixed inflammation with moderate lymphocytic and mild neutrophilic alveolitis. The cases had a higher mean lymphocyte count than the controls (40.1 ± 32.6 vs. 13.1 ± 25.5, p = 0.008). The rest of the BAL cellular analyses were similar between the 2 groups. The median CD4:CD8 ratio in 7 patients with >15% lymphocytes was 0.9 (0.6-3). There was no significant difference in the CD4:CD8 ratio between the 2 groups. Conclusions: Mixed inflammation with moderate lymphocytic and mild neutrophilic alveolitis is the most common BAL cellular pattern in patients with mAB-ILD. Such findings may be useful for the early identification of mAB-ILD. © 2014 S. Karger AG, Basel.