Diagnosis and management of patients with stage III non‑small cell lung cancer: A joint statement by the Lebanese Society of Medical Oncology and the Lebanese Pulmonary Society (Review).

Proper management of stage III non-small cell lung cancer (NSCLC) might result in a cure or patient long-term survival. Management should therefore be preceded by adequate and accurate diagnosis and staging, which will inform therapeutic decisions. A panel of oncologists, surgeons and pulmonologists in Lebanon convened to establish a set of recommendations to guide and unify clinical practice, in alignment with international standards of care.

Carbonic anhydrase inhibitors in patients with respiratory failure and metabolic alkalosis: a systematic review and meta-analysis of randomized controlled trials.

Background: Metabolic alkalosis is common in patients with respiratory failure and may delay weaning in mechanically ventilated patients. Carbonic anhydrase inhibitors block renal bicarbonate reabsorption, and thus reverse metabolic alkalosis. The objective of this systematic review is to assess the benefits and harms of carbonic anhydrase inhibitor therapy in patients with respiratory failure and metabolic alkalosis.

Cost-utility of non-invasive mechanical ventilation: Analysis and implications in acute respiratory failure. A brief narrative review.

The growing interest in the quality of patient care at the levels of the health care managers, insurance companies, and health professionals is evident. Further, the growing population requires good quality health services. In this review, we analyzed the cost-effectiveness of noninvasive ventilation (NIV) in an acute setting for the treatment of respiratory failure.

[Nondepolarizing muscle relaxant improves direct laryngoscopy view with no effect on face mask ventilation].

Background: Difficult or impossible face mask ventilation complicated with difficult tracheal intubation during anesthesia induction occurs in 0.4% of adult anesthesia cases, possibly leading to life-threatening complications. Because of such catastrophes, muscle relaxants have been recommended to be administered after confirming adequate face mask ventilation without a solid scientific validation of this principal.

Prediction of inspired oxygen fraction for targeted arterial oxygen tension following open heart surgery in non-smoking and smoking patients.

Simple and accurate expressions describing the PO-FO relationship in mechanically ventilated patients are lacking. The current study aims to validate a novel mathematical expression for accurate prediction of the fraction of inspired oxygen that will result in a targeted arterial oxygen tension in non-smoking and smoking patients receiving mechanical ventilation following open heart surgeries. One hundred PO-FO data pairs were obtained from 25 non-smoking patients mechanically ventilated following open heart surgeries.

Linezolid Toxicity and Mitochondrial Susceptibility: A Novel Neurological Complication in a Lebanese Patient.

The recent rise in the use of linezolid to treat a variety of resistant pathogens has uncovered many side effects. Some patients develop lactic acidosis, myelosuppression, optic or peripheral neuropathies, and myopathies. We evaluated an elderly patient who presented to the Emergency Room with linezolid toxicity and a novel neurologic complication characterized by bilateral globi pallidi necrosis.

Effect of heliox- and air-driven nebulized bronchodilator therapy on lung function in patients with asthma.

Background: This study compares the effect of heliox-driven to that of air-driven bronchodilator therapy on the pulmonary function test (PFT) in patients with different levels of asthma severity.

Methods: One-hundred thirty-two participants were included in the study. Participants underwent spirometry twice with bronchodilator testing on two consecutive days.

Ventilator auto-cycling from cardiogenic oscillations: case report and review of literature.

Background: Brain death is the total loss of all brain and brain stem functions, and its diagnosis is often confirmed by an apnoea test, which relies on disconnecting the patient from the ventilator. Auto-triggering or auto-cycling is defined as a ventilator being triggered in the absence of patient effort, intrinsic respiratory drive or inspiratory muscle activity. Ventilator auto-triggering could delay the diagnosis of brain death leading to unnecessary admission for the patient and false hopes of recovery for the family.

COPD updates: what's new in pathophysiology and management?

The historic perspective that used to define chronic obstructive pulmonary disease has changed. As reviewed in this article, it is based on a better understanding of the underlying inflammatory airflow obstruction and a multidimensional classification, which mostly targets a subgroup called 'frequent exacerbators'. Clinical and radioimaging predictors are the stamina for an aggressive therapeutic approach.

Use of noninvasive positive pressure ventilation in emergency departments of public and private hospitals in Lebanon.

Noninvasive positive pressure ventilation is increasingly being used in emergency departments across Europe and North America. To our knowledge, no similar data are available from other countries. The aim of this study is to describe the current use of noninvasive positive pressure ventilation in the emergency departments of Lebanese hospitals.

Weaning from mechanical ventilation.

Purpose Of Review: Liberation from mechanical ventilation is a defining moment for intubated patients, and thus a critical clinical decision. Extubating the patient too early exposes the patient to extubation failure and reintubation. Waiting too long increases the complications of prolonged intubation.

Persistent snoring under conscious sedation during colonoscopy is a predictor of obstructive sleep apnea.

Background: Obstructive sleep apnea (OSA) is characterized by cessation of breathing during sleep. Conscious sedation (CS) induces sleep and may uncover sleep-related breathing disorders.

Objective: To determine whether snoring during CS is a sensitive predictor of OSA.

Prophylactic amiodarone versus lidocaine for prevention of reperfusion ventricular fibrillation after release of aortic cross-clamp.

Background And Objective: Ventricular fibrillation is common after aortic cross-clamp release in patients undergoing open-heart surgeries. The aim of the study was to evaluate the efficacy of the prophylactic administration of 150 mg amiodarone by way of the pump 2 min before release of aortic cross-clamp in preventing ventricular fibrillation.

Methods: The present study is a prospective, randomized, controlled and blinded study performed at a teaching university hospital where 120 patients undergoing coronary bypass graft surgery were randomly assigned to three groups.

Critical care clinicians' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia.

Background: Ventilator-associated pneumonia is the most common hospital-acquired infection among patients receiving mechanical ventilation in an intensive care unit. Different initiatives for the prevention of ventilator-associated pneumonia have been developed and recommended.

Objective: To evaluate knowledge of critical care providers (physicians, nurses, and respiratory therapists in the intensive care unit) about evidence-based guidelines for preventing ventilator-associated pneumonia.

Use of recombinant activated factor VII for intractable bleeding in patients without hemophilia: A developing country tertiary care center's experience.

Although the use of recombinant activated factor VII (rFVIIa) to control intractable bleeding in nonhemophiliac patients is expanding, several issues pertinent to its potential thrombotic complications and effect on patient mortality are still of concern. We herein describe our experience at a developing country tertiary care center over a period of 4 years. A total of 49 patients were identified of whom 28.

Primary dedifferentiated chondrosarcoma of the lung.

Extraskeletal dedifferentiated chondrosarcomas (DC) are uncommon tumors that predominantly occur in the head and neck. Herein, we describe a case of pulmonary DC detected in a patient with systemic sclerosis and presenting with a symptomatic large pleural effusion and a pulmonary lobar consolidation on chest imaging. To the best of our knowledge, this is the first report of pulmonary chondrosarcoma involving the pleura and occurring in association with systemic sclerosis.

Clinical review: liberation from mechanical ventilation.

Mechanical ventilation is the defining event of intensive care unit (ICU) management. Although it is a life saving intervention in patients with acute respiratory failure and other disease entities, a major goal of critical care clinicians should be to liberate patients from mechanical ventilation as early as possible to avoid the multitude of complications and risks associated with prolonged unnecessary mechanical ventilation, including ventilator induced lung injury, ventilator associated pneumonia, increased length of ICU and hospital stay, and increased cost of care delivery. This review highlights the recent developments in assessing and testing for readiness of liberation from mechanical ventilation, the etiology of weaning failure, the value of weaning protocols, and a simple practical approach for liberation from mechanical ventilation.

Metabolic and respiratory variables during pressure support versus synchronized intermittent mandatory ventilation.

Background: Mechanically ventilated patients interact and respond differently to different modes of ventilatory support.

Objectives: To assess changes in metabolic and respiratory variables during equivalent changes with either pressure support ventilation (PSV) or volume-cycled synchronized intermittent mandatory ventilation (SIMV) in non-tracheostomized patients without known obstructive pulmonary disease receiving short-term mechanical ventilation in the intensive care unit.

Methods: Fourteen patients receiving volume-cycled SIMV at 12 breaths/min (SIMV(100%)) were included in the study.

Metastases in malignant pleural mesothelioma: a new radiological appearance.

This report describes a patient with malignant pleural mesothelioma who presented with a right-sided pleural effusion and contralateral parenchymal metastases manifesting as alveolar opacities with air bronchograms. This radiological pattern of metastases has never been described before. The patient died from respiratory failure related to extensive parenchymal metastases, an outcome seldom reported with malignant pleural mesothelioma.

Value of pretransplant pulmonary function tests in predicting pulmonary complications after autologous peripheral stem cell transplantation.

The aim of this study was to evaluate the value of pulmonary function tests performed before an autologous peripheral stem cell transplant (APSCT) in identifying patients who are at risk for developing post-transplant pulmonary complications. This retrospective study included patients who underwent autologous peripheral stem cell transplantation from January 1997 to December 2006. The total sample consisted of 43 patients with 24 patients (55.