Annals of the American Thoracic Society
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The American Thoracic Society (ATS) previously published standards for Flexible Airway Endoscopy (FAE) in children in the American Review of Respiratory Diseases in 1992 [1]. Since that time there have been significant advances in the field with expansion in the use of FAE for diagnostic and therapeutic purposes. ⋯ The technical standards describe the equipment, personnel, competencies, and procedures necessary for pediatric FAE. This summary is prepared for practicing clinicians.
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Prognostic models can inform management decisions for patients requiring prolonged mechanical ventilation. The ProVent score was developed to predict one-year mortality in these patients. External evaluation of such models is needed before they are adopted for routine use. ⋯ The modified ProVent model was accurate in our cohort. This supports its geographic and temporal generalizability. It can also accurately identify patients at risk of one-year mortality at day 14 of mechanical ventilation, but additional confirmation is required. Further studies should explore the implications of adopting the model into routine use. 347 words .
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Multicenter Study Comparative Study
Symptom Burden of Chronic Lung Disease Compared with Lung Cancer at Time of Referral for Palliative Care Consultation.
A growing evidence base supports provision of palliative care services alongside life-prolonging care. Whereas palliative care processes have been implemented widely in the care of patients with lung cancer, the same is not true for patients with chronic, progressive lung disease. ⋯ Patients with chronic lung disease have symptom burdens similar to those of patients with lung cancer at the time of first palliative care encounter. Given the population burden of chronic lung disease and limitations in the palliative care workforce, attention should be focused on ensuring that pulmonologists are prepared to assess and manage the common palliative care needs of patients with chronic lung disease.
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Tunneled pleural catheters have been established to be safe and effective in the management of recurrent symptomatic pleural effusions. Obstruction of the tunneled pleural catheter is rare; however, when obstructed the catheter fails to achieve its primary goal of symptom palliation. The management of pleural catheter obstruction has not been studied. ⋯ Fibrinolytic instillation through a tunneled pleural catheter is safe and effective in restoring function of an obstructed catheter, as evidenced by the lack of complications and success in achieving catheter patency. The procedure can also be performed safely in an outpatient setting. Patients who experience catheter obstruction may be prone to reobstruction; however, fibrinolysis was safe and effective in reestablishing patency of the reobstructed catheter.