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  • 1
    Online Resource
    Online Resource
    Management of Significant Airway Bleeding during Robotic Assisted Bronchoscopy: A Tailored Approach
    S. Karger AG ; 2021
    In:  Respiration Vol. 100, No. 6 ( 2021), p. 547-550
    Details
    In: Respiration, S. Karger AG, Vol. 100, No. 6 ( 2021), p. 547-550
    Abstract: Robotic assisted bronchoscopy represents a major turning point in bronchoscopic history. The management strategies to address significant airway bleeding in this “robotic era” are not well documented, and further guidance is required. We present a case report that exemplifies our approach and management strategy using a combined and simultaneous flexible/robotic bronchoscopy if this complication is encountered.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000514830
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1464419-8
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  • 2
    Online Resource
    Online Resource
    Stent Evaluation for Expiratory Central Airway Collapse : Does the Type of Stent Really Matter?
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Journal of Bronchology & Interventional Pulmonology Vol. 30, No. 1 ( 2022-03-23), p. 37-46
    Details
    In: Journal of Bronchology & Interventional Pulmonology, Ovid Technologies (Wolters Kluwer Health), Vol. 30, No. 1 ( 2022-03-23), p. 37-46
    Abstract: Careful selection of patients with expiratory central airway collapse (ECAC) that may benefit from tracheobronchoplasty (TBP) can be aided by a short-term airway stent evaluation. This can be performed with either silicone Y-stents (SYSs) or uncovered self-expanding metallic airway-stents (USEMAS). No direct comparison has been made between these 2 stent types. Methods: This was a small retrospective review of consecutive patients that underwent a stent evaluation. A propensity score was used to match patients in the USEMAS and SYS groups. Outcomes included complications, changes in the health-related quality-of-life (HR-QoL), and changes in exercise capacity. Baseline measurements were compared with those obtained during stent evaluation and after TBP. Results: Forty-two patients with severe ECAC underwent USEMAS placement, while 18 patients had an SYS placed. Propensity score matching resulted in 13 matched SYS and USEMAS pairs. The SYS group had an increased rate of mucus plugging (38.5% vs. 0%, P 〈 0.047). Although not statically significant, a clinical improvement was observed in HR-QoL and exercise capacity in the USEMAS group during stent placement. In patients who underwent TBP, both USEMAS and SYS groups had a statistically significant change in the Modified Medical Research Council Dyspnea Scale during stent evaluation and after TBP. Conclusion: In patients with severe ECAC, short-term evaluation with airway stents appears to be safe and improves respiratory symptoms, HR-QoL, and exercise capacity. The use of USEMAS led to a lower complication rate, a greater improvement in HR-QoL and exercise capacity, and appeared to better predict how the patients would respond to TBP.
    Type of Medium: Online Resource
    ISSN: 1948-8270
    URL: Article
    DOI: 10.1097/LBR.0000000000000842
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
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  • 3
    Online Resource
    Online Resource
    Efficacy of the Spiration Valve System in Patients with Severe Heterogeneous Emphysema: A Systematic Review and Meta-Analysis
    S. Karger AG ; 2020
    In:  Respiration Vol. 99, No. 1 ( 2020), p. 62-72
    Details
    In: Respiration, S. Karger AG, Vol. 99, No. 1 ( 2020), p. 62-72
    Abstract: Background: Spiration Valve System (SVS) is an alternative for patients with severe heterogeneous emphysema; however, data about efficacy from randomized controlled trials (RCT) are unclear. Objectives: To explore both efficacy and safety of SVS in patients with severe emphysema and hyperinflation. Methods: We included PubMed, EMBASE, Coch­rane database. All searches were performed until August 2019. Only RCTs were included for analysis. Risk of bias was assessed using Cochrane risk of bias tool. A meta-analysis evaluated change in forced expiratory volume in 1 s (FEV1), 6-min walking test (6MWT), residual volume, modified medical research council (mMRC) and Saint George respiratory questionnaire (SGRQ), all-cause mortality, risk of pneumothorax, and risk of acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Quality of the evidence was rated using GRADE approach. Results: Four RCTs including 629 subjects were included. SVS showed an overall change of 0.03 L (–0.07 to 0.13, I2 = 90%) in the in FEV1 (L) and a 2.03% (–2.50 to 6.57, I2 = 96%) in the predicted FEV1 (%) compared to baseline; however, studies without collateral ventilation (CV) showed an improvement of 0.12 L (95% CI 0.09–0.015, I2 = 0%), This subgroup also reported better results in SGRQ –12.27 points (95% CI –15.84 to –8.70, I2 = 0%) and mMRC –0.54 (95% CI –0.74 to –0.33, I2 = 0%). We found no benefit in 6MWT mean difference = 4.56 m (95% CI –21.88 to 31.00, I2 = 73%). Relative risk of mortality was 2.54 (95% CI 0.81–7.96, I2 = 0%), for pneumothorax 3.3 (95% CI 0.61–18.12, I2 = 0%) and AECOPD 1.68 (95% CI 1.04–2.70, I2 = 0%). Conclusion: In patients with severe heterogeneous emphysema and hyperinflation without CV, SVS is an alternative that showed an improvement in pulmonary function, quality of life, and dyspnea score with an acceptable risk profile.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000504183
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
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  • 4
    Online Resource
    Online Resource
    Performing Bronchoscopy in Times of the COVID-19 Pandemic: Practice Statement from an International Expert Panel
    S. Karger AG ; 2020
    In:  Respiration Vol. 99, No. 5 ( 2020), p. 417-422
    Details
    In: Respiration, S. Karger AG, Vol. 99, No. 5 ( 2020), p. 417-422
    Abstract: These recommendations for physicians who perform bronchoscopy will help to protect those patients (un)-affected by the current COVID-19 pandemic, minimize the risk of transmission, and maintain clinical care for all patients.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000507898
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
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  • 5
    Online Resource
    Online Resource
    Safety and Efficacy of the Tracheobronchial Bonastent: A Single-Center Case Series
    S. Karger AG ; 2020
    In:  Respiration Vol. 99, No. 4 ( 2020), p. 353-359
    Details
    In: Respiration, S. Karger AG, Vol. 99, No. 4 ( 2020), p. 353-359
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Tracheobronchial stents are widely used devices in interventional pulmonology; however, the current literature on the effectiveness and complication rates of the different types of stents is limited. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 We report the largest case series of airway Bonastent placement and describe the efficacy and early ( & #x3c;30 days) and late (≥30 days) complication rates. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We performed a retrospective review of our prospectively collected database of patients who underwent therapeutic bronchoscopy with stent placement. All adult patients who had a tracheal/bronchial Bona­stent placed between July 1, 2017, and July 30, 2019, for any indication at our institution were included. The efficacy as well as intraoperative and short- and long-term complications of Bonastent placement were evaluated. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Sixty Bonastents were placed in 50 patients. The etiology was malignant in 90% of the cases, while 2 patients had a tracheoesophageal fistula. All procedures were performed via rigid bronchoscopy. The most common location for stent placement was the bronchus intermedius, followed by the trachea, in 32 and 30% of the cases, respectively. Seventy percent of the patients (35/50) had improvement of respiratory symptoms within 30 days. Twenty-eight stents (48%) were removed at a mean of 74 days. Seventeen patients (34%) died within 30 days of stent placement. The overall complication rate was 54% (27/50 patients) at a mean follow-up of 111 days. The stent-related complication rate was 23.3% (14/60 cases) within & #x3c;30 days and 53% (18/34 cases) at ≥30 days. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The tracheobronchial Bonastent is effective for the treatment of patients with central airway obstruction and tracheoesophageal fistulae with an acceptable safety profile.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000506815
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
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  • 6
    Online Resource
    Online Resource
    Endoscopic Lung Volume Reduction in Relation to Body Mass Index in Patients with Severe Heterogeneous Emphysema
    S. Karger AG ; 2020
    In:  Respiration Vol. 99, No. 6 ( 2020), p. 477-483
    Details
    In: Respiration, S. Karger AG, Vol. 99, No. 6 ( 2020), p. 477-483
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 In chronic obstructive pulmonary disease (COPD), body mass index (BMI) is significantly lower in the emphysema-dominant type. Endoscopic lung volume reduction (ELVR) is an innovative way of treating severe emphysema. However, the specific associations of low BMI values and outcomes of ELVR is not well-studied. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 We evaluated associations between initial BMI and changes in major outcomes after endobronchial valve (EBV) placement in patients with heterogeneous severe emphysema. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In a retrospective cohort study, patients were divided into 2 groups based on their baseline BMI (higher BMI ≥21 kg/m 〈 sup 〉 2 〈 /sup 〉 [ 〈 i 〉 n 〈 /i 〉 = 18] and lower BMI & #x3c;21 kg/m 〈 sup 〉 2 〈 /sup 〉 [ 〈 i 〉 n 〈 /i 〉 = 63]). Demographics, procedure data, pulmonary function test and 6-min-walk test (6MWT), dyspnea score (according to the modified Medical Research Council [mMRC] scale), BODE (BMI, airflow obstruction, dyspnea, exercise capacity) index, and complications were recorded. After 6 months, changes in variables (dWeight and dBMI) were recorded. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Comparing the 2 groups, we found the following: a dWeight of –2.34 kg and +3.39 kg ( 〈 i 〉 p 〈 /i 〉 value & #x3c;0.01) and a dBMI of –0.74 and +1.99 kg/m 〈 sup 〉 2 〈 /sup 〉 , in the higher BMI and lower BMI group, respectively ( 〈 i 〉 p 〈 /i 〉 value & #x3c;0.01). Changes in forced expiratory volume & #x3c;1 s (FEV 〈 sub 〉 1 〈 /sub 〉 ), 6MWT, mMRC score, and BODE index were not statistically significant. The most common complication was pneumothorax. The lower BMI group experienced more complications than the higher BMI group (40 vs. 24%). 〈 b 〉 〈 i 〉 Conclusion 〈 /i 〉 〈 /b 〉 : Baseline BMI is relevant when selecting candidates for ELVR. Our results show that the COPD patients with a lower BMI gained a significant amount of weight, thus increasing their BMI after the procedure. The rate of complications was higher in the lower BMI group. These findings should alert physicians and encourage nutritional assessment in this population.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000507591
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2020
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  • 7
    Online Resource
    Online Resource
    Clinical screening of oropharyngeal dysphagia: standard of care
    European Respiratory Society (ERS) ; 2017
    In:  European Respiratory Journal Vol. 50, No. 2 ( 2017-08), p. 1701030-
    Details
    In: European Respiratory Journal, European Respiratory Society (ERS), Vol. 50, No. 2 ( 2017-08), p. 1701030-
    Type of Medium: Online Resource
    ISSN: 0903-1936 , 1399-3003
    URL: Article
    DOI: 10.1183/13993003.01030-2017
    Language: English
    Publisher: European Respiratory Society (ERS)
    Publication Date: 2017
    detail.hit.zdb_id: 2834928-3
    detail.hit.zdb_id: 1499101-9
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  • 8
    Online Resource
    Online Resource
    Bronchoscopic Lung Volume Reduction with Endobronchial Zephyr Valves for Severe Emphysema: A Systematic Review and Meta-Analysis
    S. Karger AG ; 2019
    In:  Respiration Vol. 98, No. 3 ( 2019), p. 268-278
    Details
    In: Respiration, S. Karger AG, Vol. 98, No. 3 ( 2019), p. 268-278
    Abstract: Background: Endoscopic lung volume reduction using Zephyr® valves has been recently adopted as a treatment option for patients with severe emphysema without collateral ventilation (CV). Objectives: To assess the efficacy and safety of Zephyr valves in such a population. Methods: Studies were identified from MEDLINE and EMBASE databases. All searches were current until June 2018. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) evaluating the efficacy and safety of Zephyr. We defined as outcome: change in forced expiratory volume in 1 s (FEV1), in the 6-min walking test (6MWT), in the St George’s Respiratory Questionnaire (SGRQ), and in residual volume (RV). Safety analysis included relative risk (RR) of pneumothorax. We assessed the quality of the evidence using GRADE. Results: 7 RCTs reported on Zephyr valves and 5 RCTs included only patients without CV. Zephyr improved FEV1 with a mean difference (MD) of 17.36% (CI, 9.28–25.45, I2 = 78%). Subgroup analysis showed significant FEV1 improvement following Zephyr placement in patients with heterogeneous distribution: MD = 21.78% (CI, 8.70–34.86, I2 = 89%) and 16.27% (CI, 8.78–23.76, I2 = 0%) in patients with homogeneous emphysema. Studies with a follow-up of 3 months reported FEV1 MD = 17.19% (CI, 3.16–31.22, I2 = 89%) compared to studies with a follow-up of 6–12 months, which showed a consistent improvement of FEV1 MD = 17.90% (CI, 11.47–24.33, I2 = 0%). Zephyr also showed improvement of SGRQ, 6MWT, and RV. RR of pneumothorax was 6.32 (CI, 3.74–10.67, I2 = 0%). Conclusion: In this population, Zephyr valves provided significant and clinically meaningful short-term improvements in either homogeneous or heterogeneous emphysema without CV but with an increase in adverse events.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000499508
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
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