Bronchoscopic management of iatrogenic tracheal laceration using polyurethane-covered nitinol tracheal stents.

Iatrogenic tracheal laceration is a known complication of emergent endotracheal intubation. Patients with tracheal laceration present a therapeutic challenge. There is no established standard treatment approach in this patient population. Interventions reported include conservative management, stent placement, or surgery. We present our experience of tracheal tears in patients with respiratory failure successfully managed with polyurethane-covered nitinol stent, including three cases of postintubation and one case of postsurgical tracheostomy tracheal injury.

Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report.

BACKGROUND: Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians. METHODS: Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion. RESULTS: Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement. CONCLUSIONS: Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure.

Quality-of-life improvement and cost-effectiveness of interventional pulmonary procedures.

Most interventional pulmonology studies focus on the technical success of procedures without measuring validated quality-of-life (QoL) outcomes. Studies are now incorporating end points that include QoL measurements and there are examples of interventional procedures that likely improve QoL. It is vital for the interventional pulmonary literature to incorporate cost-effectiveness when introducing new technology. While not uniformly analyzed in a rigorous manner in all studies, there are examples of interventional pulmonary studies that analyze cost-effectiveness through avoidance of more expensive procedures, cost savings per day free of emergency room visit, or cost savings per day not requiring intensive care unit care.

Thoracentesis and thoracic ultrasound: state of the art in 2013.

Thoracentesis is one of the most common medical procedures performed today. With the advent of thoracic ultrasound, thoracentesis has been enhanced with additional preprocedural, intraprocedural, and postprocedural information. The authors review modern-day thoracentesis and the use of ultrasonography. Nearly 200,000 thoracenteses are performed among 1.5 million patients with pleural effusion each year. A solid foundation in didactic knowledge and procedural proficiency is important to avoid unwanted complications. Ultrasound has become an indispensable tool to guide performance of thoracentesis. Ultrasonography for this purpose has several advantages. The authors provide a contemporary review on thoracentesis and the use of ultrasonography.