Respiration; international review of thoracic diseases
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Although endobronchial ultrasound (EBUS)-guided transbronchial biopsy (TBB) has been shown to increase the diagnostic yield over conventional bronchoscopic techniques, an important issue regarding the optimal number of biopsy specimens required has not been thoroughly investigated. ⋯ Probe position independently predicts the diagnostic yield of EBUS-guided TBB. In real-world practice, the optimal number of biopsy specimens should be decided on a case-by-case basis.
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The severity of hemoptysis is usually assessed on the amount of blood expectorated, although no threshold has been agreed upon. Respiratory or hemodynamic failures are additional severity criteria but occur in few cases. ⋯ Our results provide useful information about the short-term prognosis of patients with hemoptysis, which could help design therapeutic approaches and management plans according to the risk of in-hospital mortality.
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Argon plasma coagulation (APC) is a common and safe bronchoscopic technique used in the management of obstructing lesions and hemorrhage in the central airways. Complications of bronchoscopic APC are uncommon and include hemorrhage, perforation and fire in the airways. While bronchoscopic APC has been reported to cause systemic gas embolization and associated cardiovascular collapse, we report a case of cerebral gas embolization that occurred during bronchoscopic APC and highlight underappreciated potential risk factors for its occurrence.
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Patients with advanced non-small-cell lung cancer (NSCLC) and acute respiratory failure (ARF) from central airway obstruction (CAO) may be offered end-of-life care rather than intensive care treatment and palliative bronchoscopic intervention. ⋯ Intubated patients with respiratory failure caused by CAO from NSCLC can be successfully and rapidly removed from mechanical ventilation after bronchoscopic interventions aimed at restoring airway patency. Median survival greater than 10 months justifies ICU hospitalization and referral for bronchoscopic treatment.
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There have been no reports on the efficacy of noninvasive positive pressure ventilation (NPPV) in elderly patients. ⋯ An APACHE II score <29 and a GCS score ≥9 were predictors of a successful outcome of NPPV in elderly people.