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Journal of Thoracic Disease Sep 2022Bronchial artery revascularization (BAR) during lung transplantation has been hypothesized to improve early tracheal healing and delay the onset of bronchiolitis...
BACKGROUND
Bronchial artery revascularization (BAR) during lung transplantation has been hypothesized to improve early tracheal healing and delay the onset of bronchiolitis obliterans syndrome (BOS). We aimed to assess the outcomes of BAR after lung transplantation.
METHODS
Electronic search in Ovid Medline, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, and Cochrane Controlled Trials Register (CCTR) databases was performed to identify all relevant studies published about lung transplantation with BAR. Studies discussing lung transplantation utilizing BAR were included while those without outcome data such as BOS and survival were excluded. Cohort-level data were extracted and pooled for analysis. A binary outcome meta-analysis of proportions with logit transformation was conducted. Newcastle-Ottawa scale was used for risk of bias assessment.
RESULTS
Seven studies were selected for the analysis comprising 143 patients. Mean patient age was 47 (95% CI: 40-55) years. Sixty-one percent (48-72%) were male. Seventy-three percent (65-79%) of patients underwent double lung transplant while 27% (21-25%) underwent single lung transplant. In patients with postoperative angiography, successful BAR was demonstrated in 93% (82-97%) of all assessed conduits. The 30-day/in-hospital mortality was 6% (3-11%). Seventy-nine percent (63-89%) of patients were free from rejection at three months. Eighty-three percent (29-98%) of patients were free from signs of airway ischemia at three and six months. Pooled survival at one year and five years was 87% (78-92%) and 71% (46-87%), respectively, with a mean follow-up time of 21 (3-38) months. Pooled freedom from bronchiolitis obliterans was 86% (77-91%) at two years.
CONCLUSIONS
While this systematic review and meta-analysis is limited by the available surgeons, institutions, and papers discussing a highly specialized technique, it does show that BAR is a viable technique to minimize BOS and early anastomotic intervention following lung transplantation.
PubMed: 36245610
DOI: 10.21037/jtd-22-213 -
Journal of Interventional Medicine Nov 2021To assess the safety and efficacy of bronchial artery embolization (BAE) for hemoptysis.
OBJECTIVE
To assess the safety and efficacy of bronchial artery embolization (BAE) for hemoptysis.
METHODS AND MATERIALS
Databases with articles published in English, including Pubmed, Embase, Web of science and Chochrane library, were comprehensively searched to get accurate, up-to-date and sufficient literature about BAE for hemoptysis until March 2020. The technical success rates, immediate control rates, recurrence rates, mortality rates, and total complication rates (minor and major complication rates) extracted from the articles were pooled to estimate and assess the efficacy and safety of BAE using random-effect and fixed-effect models.
RESULTS
21 articles published between 2008 and 2019, which include a total of 2511 patients, were studied to evaluate the safety and efficacy of BAE. The technical success and immediate control rates are 99.9% (95%CI: 99%-100%) and 99.5% (95%CI: 97.8%-99.2%), respectively. This study showed hemoptysis recurrence in 23.7% (95%CI: 18.5%-28.9%) with a mortality rate of 2% (95%CI: 0-3%). Additionally, the assessment of complications revealed a total complication rate of 13.4% (95% CI: 7.6-19.2%), in which 0.2% (95% CI: 0.2-0.4%) were major complications and 10% (95% CI: 4.7-9.6%) were minor complications.
CONCLUSION
BAE is an effective, safe, and feasible procedure with a low complication rate for hemoptysis patients. However, recurrence of hemoptysis is still at high risk after BAE due to different underlying diseases.
PubMed: 35586385
DOI: 10.1016/j.jimed.2021.08.003 -
Children (Basel, Switzerland) Oct 2022The SARS-CoV-19 (COVID-19) pandemic has become a global problem but has affected the paediatric population less so than in adults. The clinical picture in paediatrics... (Review)
Review
INTRODUCTION
The SARS-CoV-19 (COVID-19) pandemic has become a global problem but has affected the paediatric population less so than in adults. The clinical picture in paediatrics can be different to adults but nonetheless both groups have been subject to frequent imaging. The overall aim of this study was to comprehensively summarise the findings of the available literature describing the chest radiograph (CXR) findings of paediatric patients with confirmed COVID-19. The COVID-19 landscape is rapidly changing, new information is being constantly brought to light, it is therefore important to appraise clinicians and the wider scientific community on the radiographic features of COVID-19 in children.
METHODS
Four databases, which included, PubMed; Medline; CINAHL; ScienceDirect were searched from the 30 November 2020 to the 5 March 2021. The review was conducted using the "Preferred Reporting Items for Systematic Reviews and Meta-Analysis, PRISMA" guidelines. Studies were included for (1) publications with full text available, (2) patients with confirmed COVID-19 diagnoses, (3) CXR imaging features of COVID-19 were reported, (4) the age of patients was 0-18 years, (5) studies were limited to human subjects and (6) a language restriction of English was placed on the search. Quality assessment of included articles used the National of Health Quality Assessment Tool for Case Series Studies.
RESULTS
Eight studies met our criteria for inclusion in the review. All eight studies documented the number of CXRs obtained, along with the number of abnormal CXRs. Seven out of the eight studies noted greater than 50% of the CXRs taken were abnormal. Opacification was the number one feature that was recorded in all eight studies, followed by pleural effusion which was seen in six studies. Consolidation and peri-bronchial thickening features were both evident in four studies. Opacification was sub-divided into common types of opacities i.e., consolidation, ground glass opacities, interstitial, alveolar and hazy. Consolidation was reported in half of the studies followed by ground glass opacities and interstitial opacities which was seen in three out of the eight studies.
CONCLUSION
This systematic review provides insight into the common COVID-19 features that are seen on CXRs in paediatric patients. Opacification was the most common feature reported, with consolidation, ground glass and interstitial opacities the top three opacifications seen. Peri-bronchial thickening is reported. in the paediatric population but this differs from the adult population and was not reported as a common radiographic finding typically seen in adults.
ADVANCES IN KNOWLEDGE
This systematic review highlights the CXR appearances of paediatric patients with confirmed SARS-CoV-19, to gain insight into the disease pathophysiology and provide a comprehensive summary of the features for clinicians aiding optimal management.
PubMed: 36360348
DOI: 10.3390/children9111620 -
Presse Medicale (Paris, France : 1983) 2017Heroin use can be responsible for many respiratory complications including asthma. (Review)
Review
INTRODUCTION
Heroin use can be responsible for many respiratory complications including asthma.
OBJECTIVES
Systematic literature review of data on asthma in heroin users.
DOCUMENTARY SOURCES
Medline, on the period 1980-2017 with the following keywords: keywords: "asthma" or "bronchospasm" and "heroin" or "opiate" or "opiates", limits "title/abstract"; the selected languages were English or French. Among 97 articles, 67 abstracts have given use to a dual reading to select 23 studies.
RESULTS
The seven case reports included 21 patients (mean age: 28 years [19-46 years]; sex-ratio: 2.5 [males: 71.5%]). Heroin was inhaled (71.4%), sniffed (19%) or injected by intravenous route (9.5%). Associated addictive substances were tobacco (81%), cannabis (38%), alcohol (4.7%) and cocaine (4.7%). Outcome was fatal in 3 subjects (14.3%). Other studies included one cross-sectional study, 3 case-control studies and 12 longitudinal studies (11 retrospective studies and one prospective study). The proportion of heroin users was higher in asthmatic subjects and the prevalence of asthma and bronchial hyperreactivity was higher in heroin users. Heroin use can be responsible for asthma onset, with a temporal relationship between the onset of heroin use and asthma onset in 28 to 31% of subjects. A positive association between inhaled heroin use and acute asthma exacerbation was observed. Asthma treatment observance was lower in heroin users. In case of asthma exacerbation, heroin users were more likely to seek care in the emergency department, to be admitted in intensive care units and to require intubation and invasive ventilation. Asthma deaths related to heroin use mainly occurred following an intravenous injection (especially in the case of overdose), but also following heroin use by nasal (sniff) or pulmonary route.
CONCLUSION
Heroin use may be responsible for asthma onset, acute asthma exacerbations (which may require intubation and invasive ventilation) or deaths related to asthma. Heroin use must be sought in case of asthma exacerbation in young persons and practitioners must help heroin users to stop their consumption.
Topics: Administration, Intranasal; Asthma; Bronchial Hyperreactivity; Heroin Dependence; Humans
PubMed: 28734637
DOI: 10.1016/j.lpm.2017.06.002 -
Occupational and Environmental Medicine Nov 2020There is consistent evidence of increased respiratory symptoms in occupational cleaners; however, uncertainty remains on type of respiratory health effects, underlying... (Review)
Review
There is consistent evidence of increased respiratory symptoms in occupational cleaners; however, uncertainty remains on type of respiratory health effects, underlying causal agents, mechanisms and respiratory phenotypes. We aimed to conduct a systematic review and if possible, a meta-analysis of the available literature to characterise and quantify the cleaning-related respiratory health effects. We searched MEDLINE and EMBASE databases and included studies that evaluated the association of any respiratory health outcome with exposure to cleaning occupation or products in occupational cleaners. A modified GRADE was used to appraise the quality of included studies. We retrieved 1124 articles, and after applying our inclusion criteria, 39 were selected for the systematic review. We performed a meta-analysis of the 21 studies evaluating asthma which showed a 50% increased pooled relative risk in cleaners (meta-relative risk (RR)=1.50; 95% CI 1.44 to 1.56). Population-based cross-sectional studies showed more stable associations with asthma risk. No evidence of atopic asthma as dominant phenotype emerged. Also, we estimated a 43% increased risk (meta-RR=1.43; 95% CI 1.31 to 1.56) of chronic obstructive pulmonary disease. Evidence for associations with bronchial-hyper-responsiveness, lung function decline, rhinitis, upper and lower respiratory tract symptoms was weaker. In our systematic review and meta-analysis, we found that working as a cleaner is associated with an increased risk of reversible and even irreversible obstructive airway diseases. All studies lacked quantitative exposure assessment to cleaning products; this would help elucidate underlying causal agents and mechanisms. Exposure control and respiratory surveillance among cleaners is warranted to prevent the associated respiratory health burden. Trial registration number: CRD4201705915.
PubMed: 33234692
DOI: 10.1136/oemed-2020-106776 -
Pediatric Allergy and Immunology :... Aug 2021It is unclear in which periods of life lung function deficits develop, and whether these are affected by risk factors such as asthma, bronchial hyper-responsiveness... (Review)
Review
BACKGROUND
It is unclear in which periods of life lung function deficits develop, and whether these are affected by risk factors such as asthma, bronchial hyper-responsiveness (BHR) and allergic comorbidity. The goal of this systematic review was to identify temporal associations of asthma, BHR and allergic comorbidity with large and small lung function development from birth until peak function in early adulthood.
METHODS
We searched MEDLINE, EMBASE, Web of Science and CINAHL for papers published before 01.01.2020 on risk factors and lung function measurements of large and small airways. Studies were required to report lung function at any time point or interval from birth until peak lung function (age 21-26) and include at least one candidate risk factor.
RESULTS
Of the 45 papers identified, 44 investigated cohorts and one was a clinical trial with follow-up. Asthma, wheezing, BHR and allergic sensitization early in life and to multiple allergens were associated with a lower lung function growth of large and small airways during early childhood compared with the control populations. Lung function development after childhood in subjects with asthma or persistent wheeze, although continuing to grow at a lower level, largely tracked parallel to non-affected individuals until peak function was attained.
CLINICAL IMPLICATIONS AND FUTURE RESEARCH
Deficits in lung function growth develop in early childhood, and children with asthma, BHR and early-life IgE (poly)sensitization are at risk. This period is possibly a critical window of opportunity to identify at-risk subjects and provide treatment aimed at preventing long-term sequelae of lung function.
Topics: Adult; Asthma; Bronchial Hyperreactivity; Child; Child, Preschool; Humans; Hypersensitivity; Lung; Respiratory Sounds; Young Adult
PubMed: 33835532
DOI: 10.1111/pai.13516 -
Journal of Critical Care Oct 2023Nebulized colistin (NC) is a potential therapy for ventilator-associated pneumonia (VAP); however, the clinical efficacy and safety of NC remain unclear. This study... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
Nebulized colistin (NC) is a potential therapy for ventilator-associated pneumonia (VAP); however, the clinical efficacy and safety of NC remain unclear. This study investigated whether NC is an effective therapy for patients with VAP.
MATERIALS AND METHODS
We performed a search in Web of Science, PubMed, Embase, and the Cochrane Library to retrieve randomized controlled trials (RCTs) and observational studies published at any time until February 6, 2023. The primary outcome was clinical response. Secondary outcomes included microbiological eradication, overall mortality, length of mechanical ventilation (MV), length of intensive care unit stay (ICU-LOS), nephrotoxicity, neurotoxicity, and bronchospasm.
RESULTS
Seven observational studies and three RCTs were included. Despite exhibiting a higher microbiological eradication rate (OR,2.21; 95%CI, 1.25-3.92) and the same nephrotoxicity risk (OR,0.86; 95%CI, 0.60-1.23), NC was not significantly different in clinical response (OR,1.39; 95%CI, 0.87-2.20), overall mortality (OR,0.74; 95%CI, 0.50-1.12), MV length (mean difference (MD),-2.5; 95%CI, -5.20-0.19), and the ICU-LOS (MD,-1.91; 95%CI, -6.66-2.84) than by the intravenous antibiotic. Besides, the risk of bronchospasm raised significantly (OR, 5.19; 95%CI, 1.05-25.52) among NC.
CONCLUSION
NC was associated with better microbiological outcomes but did not result in any remarkable changes in the prognosis of patients with VAP.
Topics: Humans; Pneumonia, Ventilator-Associated; Colistin; Bronchial Spasm; Respiration, Artificial; Anti-Bacterial Agents
PubMed: 37120926
DOI: 10.1016/j.jcrc.2023.154315 -
International Journal of Infectious... Nov 2017Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. Early diagnosis and treatment are key to prevent Mycobacterium tuberculosis... (Review)
Review
Tuberculosis (TB) is one of the leading causes of morbidity and mortality worldwide. Early diagnosis and treatment are key to prevent Mycobacterium tuberculosis transmission. Bronchoscopy can play a primary role in pulmonary TB diagnosis, particularly for suspected patients with scarce sputum or sputum smear negativity, and with endobronchial disease. Bronchoscopic needle aspiration techniques are accurate and safe means adopted to investigate hilar and mediastinal lymph nodes in cases of suspected TB lymphadenopathy. Tracheobronchial stenosis represents the worst complication of endobronchial tuberculosis. Bronchoscopic procedures are less invasive therapeutic strategies than conventional surgery to be adopted in the management of TB-related stenosis. We conducted a non-systematic review aimed at describing the scientific literature on the role of bronchoscopic techniques in the diagnosis and therapy of patients with TB. We focused on three main areas of interventions: bronchoscopic diagnosis of smear negative/sputum scarce TB patients, endobronchial TB diagnosis and treatment and needle aspiration techniques for intrathoracic TB lymphadenopathy. We described experiences on bronchoalveolar lavage, bronchial washing, and biopsy techniques for the diagnosis of patients with tracheobronchial and pulmonary TB; furthermore, we described the role played by conventional and ultrasound-guided transbronchial needle aspiration in the diagnosis of suspected hilar and mediastinal TB adenopathy. Finally, we assessed the role of the bronchoscopic therapy in the treatment of endobronchial TB and its complications, focusing on dilation techniques (such as balloon dilation and airway stenting) and ablative procedures (both heat and cold therapies).
Topics: Bronchoalveolar Lavage; Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Lymph Nodes; Mycobacterium tuberculosis; Tuberculosis, Lymph Node; Tuberculosis, Pulmonary
PubMed: 28864395
DOI: 10.1016/j.ijid.2017.08.008 -
The Korean Journal of Internal Medicine Jun 2011We made a systematic review and evaluation of endoscopic cryotherapy of endobronchial tumors, investigating safety and efficacy. (Review)
Review
BACKGROUND/AIMS
We made a systematic review and evaluation of endoscopic cryotherapy of endobronchial tumors, investigating safety and efficacy.
METHODS
Qualified studies regarding endoscopic cryotherapy of lung tumors were systemically evaluated using available databases according to predefined criteria.
RESULTS
In total, 16 publications were included in the final assessment. A narrative synthesis was performed because a formal meta-analysis was not viable due to the lack of controlled studies and study heterogeneity. Overall success rates for significant recanalization of the obstruction were approximately 80%, although they varied, depending on disease status in the patient population. Complications from the procedure developed in 0-11.1% of cases, most of which were minor and controlled by conservative management. Although limited data were available on comprehensive functional assessment, some studies showed that respiratory symptoms, pulmonary function tests, and performance status were significantly improved.
CONCLUSIONS
Endoscopic cryotherapy was found to be a safe and useful procedure in the management of endobronchial tumors although its efficacy and appropriate indications have yet to be determined in well-designed controlled studies.
Topics: Bronchial Neoplasms; Bronchoscopy; Cryosurgery; Humans; Lung Neoplasms; Neoplasm Staging; Risk Assessment; Treatment Outcome
PubMed: 21716589
DOI: 10.3904/kjim.2011.26.2.137 -
Multidisciplinary Respiratory Medicine 2018Uncertainty exists regarding the physiological basis of physiotherapy strategies to facilitate mucus clearance. The aim of this review was to describe the physiological... (Review)
Review
BACKGROUND
Uncertainty exists regarding the physiological basis of physiotherapy strategies to facilitate mucus clearance. The aim of this review was to describe the physiological factors and intrinsic conditions that facilitate airway mucus transport.
METHOD
A scoping review was performed. A systematic literature search of six databases was executed. Eligibility criteria were applied by two researchers to reach the aim of the review. Papers were identified independently by two reviewers on title, abstract and full-text level. Any discrepancies were discussed with a third reviewer.
RESULTS
The search identified 35 papers published between 1975 and 2015. These differed significantly in terms of outcome measures, measurement techniques and methodologies and included animal studies, laboratory investigations, and the use of small human samples. Nine key factors influencing mucus transport were identified. These include: temperature and humidity, bronchial perfusion, ATP, forced expiratory technique and cough, generation of oscillation, ventilation patterns/airflow, epithelial differences, mucus properties and positioning.
CONCLUSION
This review provides a framework for factors/conditions influencing mucus transport. Existing physiotherapy strategies for augmentation of airway mucus clearance can now be evaluated against the framework and new modalities informed.
PubMed: 29988934
DOI: 10.1186/s40248-018-0127-6