Funding/Support: Dr Restrepo is partially funded by the National Heart, Lung, and Blood Institute [K23HL096054].
Financial/nonfinancial disclosures: The authors have reported to CHEST the following conflicts of interest: Dr Restrepo is a former participant in advisory boards for Theravance Inc; Forest Laboratories, Inc; Johnson & Johnson Services, Inc; Trius Therapeutics; and Novartis AG and has been a consultant for Theravance Inc; Trius Therapeutics; and Pfizer, Inc. Drs Fernandez and Levine have reported that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.
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#1Juan F. Fernandez(University of Texas Health Science Center at San Antonio)H-Index: 9
#2Stephanie M Levine(University of Texas Health Science Center at San Antonio)H-Index: 29
Last. Marcos I. Restrepo(University of Texas Health Science Center at San Antonio)H-Index: 60
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Ventilator-associated pneumonia (VAP) is associated with high morbidity, mortality, and costs. Interventions to prevent VAP are a high priority in the care of critically ill patients requiring mechanical ventilation (MV). Multiple interventions are recommended by evidence-based practice guidelines to prevent VAP, but there is a growing interest in those related to the endotracheal tube (ETT) as the main target linked to VAP. Microaspiration and biofilm formation are the two most important mechan...
: Bedside thoracic ultrasound is gaining popularity among non-radiologists, because of its advantages in the diagnosis and management of pleural disease. However, it has significant potential pitfalls and formal training is essential to avoid harm. This review gives an overview of the utility of ultrasound and discusses training.
In hospital practice, pleural aspiration (thoracocentesis) and chest drain insertion may be required in many different clinical settings for a variety of indications. Doctors in most specialities will be exposed to patients requiring pleural drainage and need to be aware of safe techniques. There have been many reports of the dangers of large-bore chest drains and it had been anticipated that, with the previous guidelines, better training and the advent of small-bore Seldinger technique chest dr...
Purpose of reviewComplications from pleural drainage procedures are common, but their incidence is often underrecognized. Significant morbidity and mortality can arise, particularly as a result of poor procedural technique, lack of training and inadequate supervision. This review discusses safety co
Background Thoracic ultrasound-guided pleural procedures are associated with fewer adverse events than ‘blind’ procedures for patients with pleural effusion. Ultrasound is increasingly practised by respiratory physicians but there has been no prospective assessment of its safety and diagnostic accuracy when delivered by respiratory physicians. Methods The activity level, safety and diagnostic accuracy of thoracic ultrasound delivered by respiratory physicians were prospectively assessed. Diagnos...
Background Little is known about the factors related to the development of pneumothorax following thoracentesis. We aimed to determine the mean pneumothorax rate following thoracentesis and to identify risk factors for pneumothorax through a systematic review and meta-analysis. Methods We reviewed MEDLINE-indexed studies from January 1, 1966, through April 1, 2009, and included studies of any design with at least 10 patients that reported the pneumothorax rate following thoracentesis. Two invest...
Pleural procedures are commonly performed by physicians from a range of specialities. These procedures vary in complexity, from relatively straightforward pleural aspiration to more challenging procedures such as pleuroscopy. After appropriate training, even complex pleural procedures have a low risk of complications. Nevertheless, an appreciation of procedural risks is essential for physician training and forms the crux of a valid patient consent process. This review presents a systematic evalu...
Last. Philippe Vignon(French Institute of Health and Medical Research)H-Index: 45
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Objective To define competence in critical care ultrasonography (CCUS). Design The statement is sponsored by the Critical Care NetWork of the American College of Chest Physicians (ACCP) in partnership with La Societe de Reanimation de Langue Francaise (SRLF). The ACCP and the SRLF selected a panel of experts to review the field of CCUS and to develop a consensus statement on competence in CCUS. Results CCUS may be divided into general CCUS (thoracic, abdominal, and vascular), and echocardiograph...
Objective Patients receiving mechanical ventilation through an endotracheal tube are at increased risk for pneumonia. Because microaspiration of contaminated supraglottic secretions past the endotracheal tube cuff is considered to be central in the pathogenesis of ventilator-associated and postoperative pneumonia, better sealing of the upper trachea by the endotracheal tube cuff could possibly reduce this risk. We therefore postulated that use of a polyurethane cuffed tube would prevent early po...
Rationale: Subglottic secretion drainage (SSD) appears to be effective in preventing ventilator-associated pneumonia (VAP), primarily by reducing early-onset pneumonia; but it may not prevent late-onset pneumonia. We tested the hypothesis using an endotracheal tube incorporating an ultrathin polyurethane cuff (which reduces channel formation and fluid leakage from the subglottic area), in addition to an SSD lumen, which would reduce the incidence of late-onset VAP.Objectives: To compare the inci...
#1Hein Lamprecht(UCT: University of Cape Town)H-Index: 6
#2Gustav Lemke(UCT: University of Cape Town)H-Index: 1
Last. Lee A. Wallis(UCT: University of Cape Town)H-Index: 32
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Clinical ultrasound is commonly used in medical practices worldwide due to the multiple benefits the modality offers clinicians. Rigorous credentialing standards are necessary to safeguard patients against operator errors. The purpose of the study was to establish and analyse the barriers that specifically lead to poor credentialing success within a resource-limited clinical ultrasound training programme. An electronic cross-sectional survey was e-mailed to all trainees who attended the introduc...
Pleural disease is common with a rising case frequency. Many of these patients will be symptomatic and require diagnostic and/or therapeutic procedures. Patients with pleural disease present to a number of different medical specialties, and an equally broad range of clinicians are therefore required to have practical knowledge of these procedures. There is often underestimation of the morbidity and mortality associated with pleural interventions, even those regarded as being relatively straightf...
Objectives With the advent of compact ultrasound (US) devices, it is easier for physicians to enhance their physical examinations through the use of US. However, although this new tool is widely available, few internal medicine physicians have US training. This study sought to understand physicians’ baseline knowledge and skill, provide education in US principles, and demonstrate that proper use of compact US devices is a skill that can be quickly learned. Methods Training was performed at the M...