Chest
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Ventilator-associated pneumonia (VAP) is the most frequent health care-associated infection in severely ill patients, and aspiration of contaminated oropharyngeal content around the cuff of the tracheal tube is the main route of contamination. ⋯ ClinicalTrials.gov; No.: NCT02534974; URL: www.clinicaltrials.gov.
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Practice Guideline
Diagnosis and Evaluation of Hypersensitivity Pneumonitis: CHEST Guideline and Expert Panel Report.
The purpose of this analysis is to provide evidence-based and consensus-derived guidance for clinicians to improve individual diagnostic decision-making for hypersensitivity pneumonitis (HP) and decrease diagnostic practice variability. ⋯ Diagnosis of HP should employ a patient-centered approach and include a multidisciplinary assessment that incorporates the environmental and occupational exposure history and CT pattern to establish diagnostic confidence prior to considering BAL and/or lung biopsy. Criteria are presented to facilitate diagnosis of HP. Additional research is needed on the performance characteristics and generalizability of exposure assessment tools and traditional and new diagnostic tests in modifying clinical decision-making for HP, particularly among those with a provisional diagnosis.
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Programmed death-ligand 1 (PD-L1) testing is feasible in most specimens acquired using endobronchial ultrasound-guided needle aspiration (EBUS-TBNA). ⋯ These findings suggest that PD-L1 results in EBUS-TBNA samples can guide ICI therapy, with treatment outcomes being comparable to those of patients in whom PD-L1 expression was assessed in histological specimens.
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The value of the single-breath diffusing capacity of the lungs for carbon monoxide (Dlco) relates to outcomes for patients with COPD. However, little is known about the natural course of Dlco over time, intersubject variability, and factors that may influence Dlco progression. ⋯ Patients with COPD have an accelerated decline in Dlco compared with smokers without the disease. However, the decline is slow, and a testing interval of 3 to 4 years may be clinically informative. The lower and more rapid decline in Dlco values in women, compared with men, suggests a differential impact of sex in gas exchange function.
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Indwelling tunneled pleural catheters (IPCs) are used regularly for recurrent pleural effusion management. Catheter obstruction is not uncommon, often requiring intrapleural medications instillation (ie, alteplase) to restore flow. The safety profile of intrapleural medications has been reported previously; however, most studies exclude anticoagulated patients. ⋯ We report a relatively low incidence of complications and, in particular, bleeding complications in patients receiving intrapleural alteplase for nondraining IPCs. Bleeding episodes occurred in five of 94 patients (5.3%) with no apparent increased risk of bleeding complication, regardless of whether receiving anticoagulation. Additional study is warranted to identify risk factors for complications, in particular bleeding complications, in this patient population.