Publications by authors named "Peter Doelken"

Pressure-dependent pneumothorax is a common clinical event, often occurring after pleural drainage in patients with visceral pleural restriction, partial lung resection, or lobar atelectasis from bronchoscopic lung volume reduction or an endobronchial obstruction. This type of pneumothorax and air leak is clinically inconsequential. Failure to appreciate the benign nature of such air leaks may result in unnecessary pleural procedures or prolonged hospital stay.

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Prolonged air leak (PAL) after partial lung resection can occur owing to surgical complications or in the presence of residual thoracic space. The former type results in drainage-independent PAL (DIPAL), whereas the latter type results in drainage-dependent PAL (DDPAL). DDPAL is described after thoracentesis in patients with nonexpandable lung, where the thoracostomy tube can be discontinued safely despite an ongoing air leak.

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Background: Both elevated pleural elastance (E-P) and radiographic evidence of incomplete lung expansion following thoracentesis have been used to exclude patients with a malignant pleural effusion (MPE) from undergoing pleurodesis. This article reports on a cohort of patients with MPE in whom complete drainage was attempted with pleural manometry to determine the frequency of E-P and its relation with postthoracentesis radiographic findings.

Methods: Seventy consecutive patients with MPE who underwent therapeutic pleural drainage with pleural manometry were identified.

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Article Synopsis
  • Flexible bronchoscopy (FB) in mechanically ventilated patients can lead to increased airway resistance, and the study aimed to assess changes in end-expiratory lung volume (EELV) while limiting tidal volume (VT).
  • Out of 16 intubated subjects studied, FB insertion decreased EELV in 64% of cases, and suctioning further decreased EELV in 76% of cases, with no significant changes in respiratory mechanics noted.
  • The conclusions suggest that there was no significant increase in EELV during FB, and suctioning should be minimized in at-risk patients to avoid adverse effects on lung recruitment.
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Background: Prolonged pulmonary air leaks (PALs) are associated with increased morbidity and extended hospital stay. We sought to investigate the role of bronchoscopic placement of 1-way valves in treating this condition.

Methods: We queried a prospectively maintained database of patients with PAL lasting more than 7 days at a tertiary medical center.

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The management of patients with cirrhosis along with acute kidney injury is complex and depends in large part on accurate assessment of intravascular volume status. Assessment of intravascular volume status by point-of-care echocardiography often relies solely on inferior vena cava size and variability evaluation; however, this parameter should be interpretated with an understanding of right ventricular function integrated with stroke volume and flow. Attempts to optimize intra-abdominal hemodynamics favorably are clearly problematic when physical examination findings or rudimentary assessments of central venous pressure or change in central venous pressure are used.

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Objectives: Timing to video-assisted thoracoscopic surgery (VATS) in hemothorax is based on preventing acute and long-term complications of retained blood products in the pleural space, including pleural space infection. We propose that the persistence of blood in the pleural space induces a proinflammatory state, independent of active infection.

Methods: We identified six patients with a hemothorax by clinical history, radiographic imaging, and pleural fluid analysis from a database of 1133 patients undergoing thoracentesis from 2002 to 2010 at the Medical University of South Carolina.

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Purpose: Propofol is known to provide excellent intubation conditions without the use of neuromuscular blocking agents. However, propofol has adverse effects that may limit its use in the critically ill patients, particularly in the hemodynamically unstable patient. We report on the safety and efficacy of propofol for use as an agent for urgent endotracheal intubation (UEI) in the critically ill patients.

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Background: Application of Light's criteria results in misclassification of some transudative effusions as exudative, particularly because of congestive heart failure (CHF). We sought to determine if the serum to pleural fluid albumin (SF-A) and serum to pleural fluid protein (SF-P) gradients increased the predictive accuracy to correctly identify exudative effusions.

Methods: We retrospectively analyzed 1,153 consecutive patients who underwent a diagnostic thoracentesis at the Medical University South Carolina.

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Background: In individual patients, especially those who are hospitalized, several conditions often coexist that may be responsible for the development of a pleural effusion and may affect the pleural fluid analysis (PFA). The objective of this study was to investigate the effects of end-stage renal disease and pneumonia on PFA in patients with hydrostatic pleural effusion.

Methods: In a retrospective analysis of 1,064 consecutive patients who underwent thoracentesis at a university hospital, cell counts and pleural fluid protein, lactate dehydrogenase, pH, and glucose levels were examined in those (n = 300) with clinical evidence of hydrostatic pleural effusion.

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Introduction: The past decade has witnessed the increased use of patient simulation in medical training as a method to teach complex bedside skills. Although effective bag-mask ventilation (BMV) is a critical part of airway management, the quality of training in this skill has been questioned.

Methods: First-year internal medicine house staff (novices) were used to evaluate a computerized patient simulator as a tool to teach difficult BMV.

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Numerous intrapleural therapies have been adopted to treat a vast array of pleural diseases. The first intrapleural therapies proposed focused on the use of fibrinolytics and DNase to promote fluid drainage in empyema. Numerous case series and five randomized controlled trials have been published to determine the outcomes of fibrinolytics in empyema treatment.

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Background: There are limited published data defining complete pleural fluid analysis, echocardiographic characteristics, or the presence or absence of ascites on sonographic or CT imaging in patients with hepatic hydrothorax.

Methods: We reviewed pleural fluid analysis and radiographic, sonographic, and echocardiographic findings in 41 consecutive patients with hepatic hydrothorax referred to the Pleural Procedure Service for thoracentesis.

Results: Ascites was detected on sonographic or CT imaging in 38 of 39 patients (97%).

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Objective: To assess the results of a quality improvement (QI) project designed to improve safety of emergency endotracheal intubation (EEI).

Design: Single center prospective observational.

Setting: 16-bed intensive care unit.

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The differential diagnosis of a pleural effusion is expanded in the cancer patient. A cancer patient may have a malignant pleural effusion, a pleural effusion indirectly caused by the cancer or its treatment, or a pleural effusion unrelated to the cancer. The approach to the cancer patient with a pleural effusion must take into account the impact of the pleural effusion on quality of life, type and stage of the underlying cancer, impact of biopsy procedures on cancer staging, availability of treatment of the underlying cancer, performance status, and patient preferences.

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Unexpandable lung is the inability of the lung to expand to the chest wall allowing for normal visceral and parietal pleural apposition. It is the direct result of either pleural disease, endobronchial obstruction resulting in lobar collapse, or chronic atelectasis. Unexpandable lung occurring as a consequence of active or remote pleural disease may present as a post-thoracentesis hydropneumothorax or an effusion that cannot be completely drained because of the development of anterior chest pain.

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Objective: Efficient diagnosis and treatment of obstructive sleep apnea (OSA) can be difficult because of time delays imposed by clinic visits and serial overnight polysomnography. In some cases, it may be desirable to initiate treatment for suspected OSA prior to polysomnography. Our objective was to compare the improvement of daytime sleepiness and sleep-related quality of life of patients with high clinical likelihood of having OSA who were randomly assigned to receive empiric auto-titrating continuous positive airway pressure (CPAP) while awaiting polysomnogram versus current usual care.

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Dasatanib, which has been approved for rescue therapy for patients with imatinib-resistant chronic myelogenous leukemia and Philadelphia chromosome positive acute lymphoblastic leukemia, is a novel, orally available multitargeted kinase inhibitor of BCR-ABL and SRC family kinases (Quintas-Cardama et al, J Clin Oncol 2007;25:3908-14). It binds to both active and inactive conformations of the ABL gene and is 325 times more potent than imatinib in inhibiting the growth of BCR/ABL cells in vitro (Morelock and Sahn, Chest 1999;116:212-21; Huggins and Sahn, Clin Chest Med 2004;25:141-53). Although dasatinib is a generally well-tolerated drug in the treatment of Philadelphia chromosome positive hematopoetic malignancies, pleural effusions have been frequently noted and have been reported in up to 35% of patients (Sahn SA.

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Objective: To define competence in critical care ultrasonography (CCUS).

Design: The statement is sponsored by the Critical Care NetWork of the American College of Chest Physicians (ACCP) in partnership with La Société de Réanimation de Langue Française (SRLF). The ACCP and the SRLF selected a panel of experts to review the field of CCUS and to develop a consensus statement on competence in CCUS.

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Objectives: Chyle is a noninflammatory, lymphocyte-predominant fluid that may cause a pleural effusion as a consequence of thoracic duct leakage into the pleural space. Although chyle is reported to have protein concentrations in the transudative range, chylous effusions are typically exudative, as defined by the standard criteria. We hypothesized that chylous effusions from a thoracic duct leak alone have low lactate dehydrogenase (LDH) concentrations due to the absence of inflammation and are lymphocyte-predominant, protein-discordant exudates.

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Synopsis of recent research by authors named "Peter Doelken"

  • - Peter Doelken's recent research primarily focuses on the physiological and clinical implications of pneumothorax, particularly in the context of air leaks following lung procedures, emphasizing the benign nature of pressure-dependent pneumothorax and its management.
  • - He has contributed to expanding the understanding of prolonged air leaks after lung resections, distinguishing between drainage-dependent and drainage-independent types, and highlighting the impact of surgical complications on patient outcomes.
  • - Doelken's work also includes innovative strategies for managing complex pulmonary conditions, involving the use of endobronchial valves and evaluating pleural manometry, aiming to improve clinical decision-making and patient care in respiratory medicine.