Chest
-
Review Meta Analysis
Video Laryngoscopy for Endotracheal Intubation of Critically Ill Adults: A Systemic Review and Meta-analysis.
Endotracheal intubation (EI) in ICU patients is associated with an increased risk of life-threatening adverse events due to unstable conditions, rapid deterioration, limited preparation time, and variability in the expertise of operators. The goal of this study was to compare the effect of video laryngoscopy (VL) and direct laryngoscopy (DL) in ICU patients requiring EI. ⋯ The VL technique did not increase the first-attempt success rate during EI in ICU patients compared with DL. These findings do not support routine use of VL in ICU patients.
-
Meta Analysis
Reduced COPD exacerbation risk correlates with improved FEV1: A meta-regression analysis.
The mechanism by which various classes of medication reduce COPD exacerbation risk remains unknown. We hypothesized a correlation between reduced exacerbation risk and improvement in airway patency as measured according to FEV1. ⋯ A significant correlation between increased FEV1 and lower COPD exacerbation risk suggests that airway patency is an important mechanism responsible for this effect.
-
Airway complications following lung transplantation result in considerable morbidity and are associated with a mortality of 2% to 4%. The incidence of lethal and nonlethal airway complications has decreased since the early experiences with double- and single-lung transplantation. ⋯ The broadening array of bronchoscopic therapies has enhanced treatment options for lung transplant recipients with airway complications. This article reviews the risk factors, clinical manifestations, and treatments of airway complications following lung transplantation and provides our expert opinion when evidence is lacking.
-
Femoral venous access for catheter introduction represents the cornerstone of electrophysiology (EP) procedures. Limited data are available regarding postprocedure VTE. The aim of this systematic review is to determine the incidence of DVT and pulmonary embolism (PE) associated with femoral vein catheterization during EP procedures. ⋯ A lower incidence of symptomatic DVT and PE was observed after AF ablations as opposed to non-AF ablations, likely due to the use of routine periprocedural anticoagulation. Asymptomatic DVTs appear to be common, although their significance is unclear. Future studies are required to weigh the risk of hematoma against the risk of VTE associated with the use of prophylactic anticoagulation after non-AF ablation procedures.
-
The use of extracorporeal membrane oxygenation (ECMO) for respiratory failure in adults is growing rapidly, driven in large part by advances in technology, which have made ECMO devices easier to implement and safer and more efficient. Accompanying this increase in use is a nearly exponential increase in ECMO-related literature. ⋯ The overall lack of high-quality data, including prospective randomized trials, makes it difficult to justify the rate at which ECMO use is increasing and calls attention to the need for more rigorously designed studies. Nonetheless, given its ability to support patients with severe gas exchange impairment and the potential for it to minimize the deleterious effects of invasive mechanical ventilation, there appears to be a legitimate role for ECMO in severe respiratory failure in adults.