Single-use flexible bronchoscopes compared with reusable bronchoscopes: Positive organizational impact but a costly solution.

Rationale, Aims, And Objectives: There is at present no standard methodology to analyse the organizational impacts (OIs) of medical devices (MDs), and the field is still in its infancy. The aim of the present study was to assess, at a hospital level, the organizational and economic impacts of the introduction of a new MD, specifically the single-use flexible bronchoscope (FB).

Methods: Both the organizational and economic impacts of the single-use FB were evaluated in comparison with the reusable FB currently used as standard practice in our institution.

[Obesity and lung cancer: incidence and repercussions on epidemiology, pathology and treatments].

Introduction: Obesity and lung cancer are major public health problems. The purpose of this work is to review the data concerning this association.

Method: We report clinical and epidemiological data on obesity and discuss the impact on the incidence of lung cancer, as well as the safety and efficiency of anti-tumor treatments.

Severe excessive dynamic airway collapse in a patient with primary Sjögren's syndrome.

Airway and cystic lung diseases can be observed in patients with Sjögren's syndrome. We report a case of such a patient suffering from respiratory failure due to recurrent episodes of right pneumothorax, requiring invasive mechanical ventilation. Despite thoracic drainage and adequate pneumothorax management, the patient could not be weaned from the ventilator.

A new endoscopic standardized grading system for macroscopic central airway complications following lung transplantation: the MDS classification.

Objectives: After lung transplant, between 9 and 13% of bronchial anastomoses develop complications severe enough to warrant therapeutic intervention. These complications include stenosis, dehiscence, granulation tissue, bronchomalacia and fistula. Most of these have already been included in a classification or another, but none of these have been universally accepted.

Outcome of patients with interstitial lung disease admitted to the intensive care unit.

Introduction: The outcome of acute respiratory failure (ARF) affecting patients with various interstitial lung diseases (ILD) is poorly defined particularly in those with drug-induced ILD (DI-ILD). We investigated this issue focusing on fibrosing idiopathic interstitial pneumonitis (FIIP) and DI-ILD.

Methods: We carried out a retrospective study of patients with ILD admitted in a single center ICU.

Should all cases of lung cancer be presented at Tumor Board Conferences?

Tumor Board Conferences (TBCs) have been associated with higher adherence of staging and treatment to guidelines. The influence of TBCs on the rate of curative treatments has been established. Patients with lung nodules and tumors of unknown histology should not be presented before surgery, but every patient with malignant histology should be declared to the TBC coordinator and registered at the time of histologic confirmation.

Pulmonary arterial hypertension in women.

Introduction: Pulmonary arterial hypertension (PAH) is a rare condition characterized by sustained elevation in pulmonary arterial resistance leading to right heart failure.

Background: PAH afflicts predominantly women. Echocardiography is the initial investigation of choice for non-invasive detection of PAH but right-heart catheterization is necessary to confirm the diagnosis.

[Massive pulmonary embolism].

Massive pulmonary embolism is defined by systemic hypotension or cardiogenic shock. Clinically stable patients with right ventricular dysfunction on echocardiography, elevated brain natriuretic peptide or troponin are usually considered as having sub-massive pulmonary embolism, but this definition is not universally accepted. The time-lag to confirm massive pulmonary embolism should be kept as short as possible and every effort should be done to rely on bedside tests and to avoid patient transfer to the radiology department.

[Pulmonary arterial hypertension in women].

Introduction: Pulmonary arterial hypertension (PAH) is a rare condition characterized by sustained elevation in pulmonary arterial resistance leading to right heart failure.

Background: PAH afflicts predominantly women. Echocardiography is the initial investigation of choice for non-invasive detection of PAH but right-heart catheterization is necessary to confirm the diagnosis.

Molecular diagnosis of Kingella kingae pericarditis by amplification and sequencing of the 16S rRNA gene.

Kingella kingae is a fastidious gram-negative bacillus that is considered an emerging pathogen in pediatric settings but remains less common in adults. Here we describe a case of pericarditis in an immunocompetent adult host. The microorganism was identified directly from the clinical sample by molecular techniques, i.

Clinical probability and alveolar dead space measurement for suspected pulmonary embolism in patients with an abnormal D-dimer test result.

Background: Most patients with suspected pulmonary embolism (PE) have a positive D-dimer test and undergo diagnostic imaging. Additional non-invasive bedside tests are required to reduce the need for further diagnostic tests.

Objectives: We aimed to determine whether a combination of clinical probability assessment and alveolar dead space fraction measurement can confirm or exclude PE in patients with an abnormal D-dimer test.

[Treatment of venous thromboembolic disease].

Adequate initial anticoagulant treatment is required to prevent thrombus growth and recurrence. Intravenous unfractionated heparin is being replaced by low-molecular-weight heparin as the anticoagulant of choice for initial treatment of venous thromboembolism. Vitamin K antagonists remain the only oral anticoagulant available (target international normalized ratio: 2.

Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial.

Context: The optimal duration of antimicrobial treatment for ventilator-associated pneumonia (VAP) is unknown. Shortening the length of treatment may help to contain the emergence of multiresistant bacteria in the intensive care unit (ICU).

Objective: To determine whether 8 days is as effective as 15 days of antibiotic treatment of patients with microbiologically proven VAP.

[Bilateral pleurisy and cardiac tamponade. A rare etiology: pancreatico-pleural fistula].

Pancreatico-pleural fistula is a rare complication of chronic pancreatitis. It commonly presents with small, but recurrent, pleural effusions. Pericarditis rarely occurs in this context.

Characterization of an animal model of ventilator-acquired pneumonia.

To develop an experimental model of ventilator-acquired pneumonia (VAP), we investigated whether healthy piglets could develop endogenously acquired pulmonary infection as a result of prolonged mechanical ventilation (MV). Thirty-three piglets underwent MV with anesthesia, analgesia, and paralysis produced by continuous infusion of midazolam, fentanyl, and pancuronium bromide. Ten animals received antibioprophylaxis with ceftriaxone (ATB group) and 23 received no antibiotics (control group).

Influence of pulmonary bacteriology and histology on the yield of diagnostic procedures in ventilator-acquired pneumonia.

We investigated the influence of pulmonary bacteriology and histology on the yield of diagnostic procedures in a clinically relevant model of ventilator-acquired pneumonia (VAP). Twenty-seven piglets entered a 4-d protocol of ventilatory support under general anesthesia. Endotracheal aspirates (EA), protected specimen brush (PSB), and bronchoalveolar lavage (BAL) were obtained on Day 4.

[Fibroscopic bronchoscopy in intensive care].

The field of application for fibreoptic bronchoscopy (FB) in the intensive care unit has been extended since the generalised introduction of fibroscopes of 4.9 mm in diameter (previously called paediatric fibroscopes). Paediatric and neonatal intensive care units have benefited from the availability in the market of these small endoscopes for 3.

Relationship between microbiologic and histologic features in bacterial pneumonia.

To investigate the relationship between the lung damage resulting from pneumonia and the local bacterial burden, we conducted a study comparing histologic and bacteriologic findings in pigs infected with bacterial pneumonia while free of antibiotic therapy and previous or concomitant lung disease. Seventy-eight lung specimens were obtained from 17 animals. The main findings are the following: (1) histologic lesions of pneumonia as well as parenchymal bacterial burden were unevenly distributed within the lungs and even within the lung segments; (2) specimens showing histologic evidence of pneumonia had significantly higher bacterial counts than specimens with bronchial infection and specimens with neither bronchial nor lung infection; (3) there was no significant difference in bacterial counts between lesions defined as pneumonia, confluent pneumonia and abscessed pneumonia; (4) we could not define a clearcut threshold for quantitative cultures to discriminate the presence or absence of pneumonia.