- Laryngeal mask airway versus endotracheal tube for percutaneous dilatational tracheostomy in critically ill adults. [Review]
- CDCochrane Database Syst Rev 2018 Nov 15; 11:CD009901
- CONCLUSIONS: Evidence on the safety of LMA for PDT is too limited to allow conclusions to be drawn on either its efficacy or safety compared with ETT. Although the LMA procedure may shorten the period during which the airway is insecure, it may also lead to higher conversion rates. Also, late complications have not been investigated sufficiently. These results are primarily based on single-centre trials with small sample sizes, and therefore the level of evidence remains low. Studies with low risk of bias focusing on late complications and relevant patient-related outcomes are necessary for definitive conclusions on safety issues related to this procedure. The dependency of the successful placement of a LMA on the type of LMA used should also be further assessed.There are two studies awaiting classification that may alter the conclusions once assessed.
- Early extubation followed by immediate noninvasive ventilation vs. standard extubation in hypoxemic patients: a randomized clinical trial. [Journal Article]
- ICIntensive Care Med 2018 Dec 10
- CONCLUSIONS: In highly selected hypoxemic patients, early extubation followed by immediate NIV application reduced the days spent on invasive ventilation without affecting ICU LOS.
- En Route Resuscitation - Utilization of CCATT to Transport and Stabilize Critically Injured and Unstable Casualties. [Journal Article]
- MMMil Med 2018 Dec 07
- CONCLUSIONS: This brief report demonstrates the need of CCATT in the transport of unstable patients from forward deployed locations. The Air Force has adapted and is continuing to adapt CCATT training, equipment, onboard diagnostics and therapies, and team members' clinical skills to meet en route care combat casualty needs.
- Triple lead cephalic versus subclavian vein approach in cardiac resynchronization therapy device implantation. [Journal Article]
- SRSci Rep 2018 Dec 07; 8(1):17709
- Cardiac resynchronization therapy (CRT) device implantation is associated with severe complications including pneumo- and hemothorax. Data on a sole cephalic vein approach (sCV), potentially preventi...
Cardiac resynchronization therapy (CRT) device implantation is associated with severe complications including pneumo- and hemothorax. Data on a sole cephalic vein approach (sCV), potentially preventing these complications, are limited. The aim of our study was to compare a sole cSV with a subclavian vein approach (SV) in CRT implantations with respect to feasibility and safety. We performed a prospective cohort study enrolling twenty-four consecutive de-novo CRT implantations (group A) using a sCV at two centers. Fifty-four age-matched CRT patients implanted via the SV served (group B) as reference. Procedural success rate and complications were recorded during a follow-up of 4 weeks. All CRTs could be implanted in group A, with 91.7% using cephalic access alone. In group B, CRT implantation was successfully performed in 96.3%. Procedure and fluoroscopy duration were similar for both groups (sCV vs. SV: 119 ± 45 vs. 106 ± 31 minutes, 17 ± 9 vs 14 ± 9 minutes). Radiation dosage was higher in sCV group vs. SV (2984 ± 2370 vs. 1580 ± 1316 cGy*cm2; p = 0.001). There was no case of a pneumothorax in group of sCV, while two cases were observed using SV. Overall complication rate was similar (sCV: 13.0% vs. SV: 12.5%). de-novo CRT implantation using a triple cephalic vein approach is feasible. Procedure duration and complication rates were similar, while radiation dosage was higher in the sCV compared to the SV approach. Despite its feasibility in the clinical routine, controlled prospective studies with longer follow-up are required to elucidate a potential benefit with respect to lead longevity.
- Percutaneous sentinel node removal using a vacuum-assisted needle biopsy in women with breast cancer: a feasibility and acceptability study. [Journal Article]
- CRClin Radiol 2018 Dec 06
- CONCLUSIONS: VAB removal of sentinel nodes using dual scanning is feasible. Although preliminary sensitivity and specificity levels are encouraging, complications may discourage widespread implementation.
- CT-guided Transthoracic Core-Needle Biopsies of Mediastinal and Lung Lesions in 235 Consecutive Patients: Factors Affecting the Risks of Complications and Occurrence of a Final Diagnosis of Malignancy. [Journal Article]
- ABArch Bronconeumol 2018 Dec 04
- CONCLUSIONS: CT-guided PCNB of mediastinal and lung lesions is a safe procedure with high diagnostic accuracy for malignancy.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Bronchopleural fistula (BPF) is a sinus tract between the main stem, lobar, or segmental bronchus and the pleural space. It can be a potentially catastrophic complication following pneumonectomy or o...
Bronchopleural fistula (BPF) is a sinus tract between the main stem, lobar, or segmental bronchus and the pleural space. It can be a potentially catastrophic complication following pneumonectomy or other pulmonary resection. Morbidity ranges between 25% and 71%, and diagnosis and management is often a challenge for physicians. Other common causes of BPF include pulmonary infection causing necrosis, persistent spontaneous pneumothorax, chemotherapy or radiotherapy from malignancy, and tuberculosis. Treatment for BPF ranges from medical management to bronchoscopic procedures for critically ill patients and surgical intervention for those deemed at highest risk. There is a lack of consensus regarding optimal management due to varying therapeutic success. Varoli et al. described the time of onset following surgical intervention to classify fistulas as early (1 to 7 days), intermediate (8 to 30 days), or late (more than 30 days). Although fistulas almost always occur within 3 months after surgery,  BPF following pleuropulmonary infection can occur at any point.
- Local Recurrence After Microwave Ablation of Lung Malignancies: A Systematic Review. [Review]
- ATAnn Thorac Surg 2018 Nov 30
- CONCLUSIONS: Microwave ablation of primary and secondary lung malignancies is a reasonable therapeutic approach for select patients. Estimates of local failure after treatment are highly variable, with newer reports as well as smaller tumors having more favorable treatment efficacy rates.
- Uniportal vs. triportal video-assisted thoracic surgery in the treatment of primary pneumothorax-a propensity matched bicentric study. [Journal Article]
- JTJ Thorac Dis 2018; 10(Suppl 31):S3712-S3719
- CONCLUSIONS: U-VATS is feasible and safe and may be a less invasive alternative to triportal VATS for the treatment of PSP because of its effectiveness in reducing postoperative pain, paresthesia, hospital stay and in improving cosmetic results.
New Search Next
- An unusual complication of pigtail catheter insertion. [Journal Article]
- JTJ Thorac Dis 2018; 10(10):5964-5967
- Thoracostomy tubes are indicated for management of air or fluid in the pleural cavity. Pigtail catheters have emerged as an effective and less morbid alternative to traditional large bore chest tubes...
Thoracostomy tubes are indicated for management of air or fluid in the pleural cavity. Pigtail catheters have emerged as an effective and less morbid alternative to traditional large bore chest tubes for evacuation of pleural air or fluid. However, they do not come without complications which commonly include pneumothorax and hemothorax. Rare complications in the literature such as left ventricular penetration, subclavian artery laceration and cerebral air embolism have been reported. We report a case of a 72-year-old male who presented with dyspnea and was found to have a right-sided pleural effusion requiring thoracentesis and subsequent pigtail catheter placement because of re-accumulation of the fluid. After accidental dislodgement of the catheter, it was replaced and the following day a chest X-ray (CXR) demonstrated diffuse subcutaneous emphysema. Computed tomography (CT) scan of the chest demonstrated the pigtail catheter tracking through the right middle and lower lobes reaching the posterior pleural space. We discuss the implications of this occurrence and recommended management based on our experience.