J.S. Sager

Outcomes Using Extracorporeal Life Support for Adult Respiratory Failure due to Status Asthmaticus

Our objective was to describe the outcomes for extracorporeal life support (ECLS) use in adult respiratory failure because of status asthmaticus and to determine whether ECLS use in status asthmaticus is associated with greater survival than other indications for ECLS. This retrospective cohort study used the multicenter, International ECLS Organization Registry. The study population included 1,257 adults with respiratory failure requiring ECLS. Status asthmaticus was the primary indication for ECLS in 24 patients. A total of 83.3% of asthmatics survived to hospital discharge compared with 50.8% of nonasthmatics (n = 1,233) [odds ratio (OR) favoring survival for asthmatics = 4.86, 95% confidence interval (CI) 1.65–14.31, p = 0.004]. The survival advantage for asthmatics remained significant after adjustment for potential confounders. Complications were noted in 19 of 24 asthmatics (79.2%). In conclusion, we found that status asthmaticus, as an indication for ECLS in adult respiratory failure, seemed to be associated with greater survival than other indications for ECLS. However, complications are common and whether ECLS confers a survival advantage compared with other salvage treatment options remains unknown. More detailed information and complete reporting of ECLS use for status asthmaticus are needed to determine whether and when the potentially life-saving intervention of ECLS should be initiated in the asthmatic failing conventional therapy.

Transbronchial Needle Injection: A Systematic Review of a New Diagnostic and Therapeutic Paradigm

Background and Objective: Transbronchial needle catheters are commonly used during flexible and rigid bronchoscopy for needle aspiration. The use of these catheters can be expanded by employing the technique of transbronchial needle injection. Methods and Results: By injecting lesions in the airways, peribronchial structures, mediastinum, or lung parenchyma, transbronchial needle injection has been applied to the treatment of lung cancer, inflammatory disorders of the airways, recurrent respiratory papillomatosis, as well as bronchopleural fistulas. Diagnostic applications have included the localization of peripheral lung nodules as well as sentinel lymph nodes. Conclusions: Our review defines this bronchoscopic technique and summarizes its various reported applications.

Association of Clinical Risk Factors with Functional Status Following Lung Transplantation

A fundamental goal of lung transplantation is the regaining of functional capacity, yet little is known about what factors are associated with the achievement of this goal. The aim of this study is to test the association of clinical risk factors with functional status 1 year following lung transplantation. We conducted a cohort study of 321 lung transplants and assessed functionality by the distance achieved during a standard 6‐min walk test (6MWT). Preoperative recipient risk factors were evaluated for association with functional status and adjusted for confounding using multivariable linear regression models. In these multivariable analyses, recipient female gender (p < 0.001), recipient pretransplant body mass index (BMI) of greater than 27 kg/m2 (p = 0.017) and shorter pretransplant 6MWT distances (p = 0.006) were independently associated with shorter distances achieved during 6MWT after lung transplant, while cystic fibrosis (CF) (p = 0.003), and bilateral lung transplant (p = 0.014) were independently associated with longer distances achieved. Approximately 51% of the variance in 6MWT distance was explained by these risk factors in the linear regression models (R2= 0.51). These findings may have implications in patient counseling, selection, procedure choice, and may lead to interventions aimed at improving the functional outcomes of lung transplantation.

Nontraumatic Tracheal Injuries in Adults: A Case Report and Review of the Literature

Tracheal injuries not caused by trauma are uncommon, and are usually related to endobronchial procedures, including intubation, and thoracic surgery. The clinical consequences of tracheal injuries can be minimal or life threatening, depending on the extent of injury and time to recognition. Management of nontraumatic tracheal injuries is uncertain, and it ranges from watchful waiting, to endobronchial intervention, to surgical management. A representative case is presented in which a tracheal laceration failed surgical repair, precipitated a pneumothorax, and required endobronchial administration of fibrin glue and 2-octylcyanoacrylate with successful resolution of a tracheopleural fistula. Historically, operative management has been a mainstay of tracheal laceration repair, but recent evidence using endobronchial techniques and cautious monitoring has yielded promising results. Specific approaches to management of tracheal injuries are described, including open surgical technique, bridging with endotracheal tube, endobronchial placement of stents and fibrin glue, and endobronchial surgical repair, as well as potential limitations and complications of these approaches.

Lung transplantation for chronic obstructive pulmonary disease

Given its high prevalence and propensity to cause disabling disease, it is not surprising that COPD represents the most common indication worldwide for lung transplantation, accounting for nearly half of all lung transplant procedures. Despite over 4 decades of experience with this procedure in the COPD population, a number of important clinical issues remain unresolved. This article provides an overview of lung transplantation, with special emphasis on issues unique to the COPD population.