Monali Patil

Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: an observational study.

The objective of this study was to evaluate the long‐term cardiovascular mortality in patients with severe obstructive sleep apnoea (OSA) treated with either continuous positive airway pressure (CPAP) or mandibular advancing device (MAD).

Original Research: Pulmonary ProceduresManagement of Benign Pleural Effusions Using Indwelling Pleural Catheters: A Systematic Review and Meta-analysis

BACKGROUND: The indwelling pleural catheter (IPC), which was initially introduced for the management of recurrent malignant effusions, could be a valuable management option for recurrent benign pleural effusion (BPE), replacing chemical pleurodesis. The purpose of this study is to analyze the efficacy and safety of IPC use in the management of refractory nonmalignant effusions. METHODS: We conducted a systematic review and meta‐analysis on the published literature. Retrospective cohort studies, case series, and reports that used IPCs for the management of pleural effusion were included in the study. RESULTS: Thirteen studies were included in the analysis, with a total of 325 patients. Congestive heart failure (49.8%) was the most common cause of BPE requiring IPC placement. The estimated average rate of spontaneous pleurodesis was 51.3% (95% CI, 37.1%‐65.6%). The estimated average rate of all complications was 17.2% (95% CI, 9.8%‐24.5%) for the entire group. The estimated average rate of major complications included the following: empyema, 2.3% (95% CI, 0.0%‐4.7%); loculation, 2.0% (95% CI, 0.0%‐4.7%); dislodgement, 1.3% (95% CI, 0.0%‐3.7%); leakage, 1.3% (95% CI, 0.0%‐3.5%); and pneumothorax, 1.2% (95% CI, 0.0%‐4.1%). The estimated average rate of minor complications included the following: skin infection, 2.7% (95% CI, 0.6%‐4.9%); blockage and drainage failure, 1.1% (95% CI, 0.0%‐3.5%); subcutaneous emphysema, 1.1% (95% CI, 0.0%‐4.0%); and other, 2.5% (95% CI, 0.0%‐5.2%). One death was directly related to IPC use. CONCLUSIONS: IPCs are an effective and viable option in the management of patients with refractory BPE. The quality of evidence to support IPC use for BPE remains low, and high‐quality studies such as randomized controlled trials are needed.

Successful bronchoscopy in a pregnant patient with plastic bronchitis

Plastic bronchitis is a rare disorder, characterized by formation of thick fibrinous bronchial casts which can obstruct the airway and present as a life threatening emergency (1). It is more common in the pediatric population after corrective or palliative surgery for congenital heart disease like fontan procedure but has rarely been reported in adults as well (1). Pregnancy is a relative contraindication for bronchoscopy. Bronchoscopy in the pregnant patient poses significant risks as manipulation of the airway can lead to impaired oxygenation and ventilation. In addition, the drugs used during this procedure to provide sedation can have a direct impact on the developing fetus (2). In spite of these risks bronchoscopy should not be withheld in an emergent situation as it can be a lifesaving measure. We report a case of successful bronchoscopy using Propofol as the sedating agent in a pregnant female with plastic bronchitis who presented with respiratory distress.

Endobronchial Ultrasound Bronchoscope Damage.

Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration is an effective, safe, and cost-effective diagnostic bronchoscopy technique for the work-up of mediastinal lymphadenopathy. Concern has been raised, however, about the high cost of convex-probe EBUS bronchoscope repairs. The damage is usually due to breakage of the insertion tube (the flexible part that is advanced into the airways), moisture invasion and damages to the working channel, image guide bundle, or umbilical cord. Understanding the root cause of EBUS scope damage is important for its prevention. We describe 2 unusual cases of EBUS scope damage. In the first case, the distal black rubber covering of the EBUS scope insertion tube was damaged due to friction with the edge of an endotracheal tube and in the second case, the EBUS scope insertion tube was angulating laterally instead of vertically during the flexion maneuver, probably due to scope manipulation while wedged tightly in a segmental bronchus.

Rare airway tumors: an update on current diagnostic and management strategies

Primary tracheobronchial neoplasms represent approximately 0.1% of all pulmonary tumors (1). They have been a topic of interest for many decades due to the challenge in their diagnosis and management. Many of tracheobronchial tumors are found incidentally. They are sometimes misdiagnosed as asthma or chronic obstructive pulmonary disease.