Azithromycin in bronchiolitis obliterans: is the evidence strong enough?
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Azithromycin↗
Biomedical subjects
Luis F Angel
Publications and source records attributed to Luis F Angel.
The patient who has undergone lung transplantation: Implications for respiratory care.
Lung transplantation is now performed in patients with end-stage pulmonary parenchymal or vascular lung disease. The process of evaluating a patient for transplantation, managing the patient during the peri-operative period, and caring for the patient following transplantation is complex. Lung-transplant recipients are prone to unique complications of lung transplantation, as well as general complications of an immunosuppressed host. This article reviews the indications for, expected outcomes of, and management of complications that can develop following lung transplantation. Respiratory therapists play an instrumental role in assisting in the management of this group of patients in the pretransplant and post-transplant periods, and in their long-term management.
Airway Obstruction↗
Steroid infusion for severe pneumonia: not so fast...
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Community-Acquired Infections↗
Comparison of surgical and percutaneous dilational tracheostomy.
When significant clinical end points are considered, PDT is a cost-effective and safe alternative to ST in critically ill patients in the ICU when performed by skilled and experienced practitioners [1, 40]. There are insufficient data to establish clear superiority of either technique. Important advantages of PDT may include eliminating the need for operating room facilities and personnel by the performance of the procedure at the bedside and significantly decreasing the time interval between the decision to perform tracheostomy and the actual procedure [1, 2, 20].
Dilatation↗
Primary graft failure: who is at risk?
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Humans↗
Repeat bedside percutaneous dilational tracheostomy is a safe procedure.
OBJECTIVE: Previous tracheostomy has been considered a relative contraindication for percutaneous dilational tracheostomy. The objective of this study was to assess the safety of percutaneous dilational tracheostomy in critically ill patients with a history of previous tracheostomy. DESIGN: Retrospective, single-center case series of all consecutive patients requiring repeat tracheostomy for continued mechanical ventilatory support. SETTING: Intensive care unit of a tertiary-care referral center. SUBJECTS: Fourteen patients (eight female, six male) with a median age of 70 yrs (range, 33-94). All patients had previously undergone tracheostomy. INTERVENTION: Bedside percutaneous dilational tracheostomy. MEASUREMENT AND MAIN RESULTS: Subjects' previous tracheostomies dated back between 10 days and 8 yrs. Present intubation time before percutaneous dilational tracheostomy varied between 4 and 30 days. Bedside percutaneous dilational tracheostomy was performed successfully in all 14 patients by trained pulmonologists and surgeons. Eleven patients received an 8-mm and three received a 7-mm tracheostomy tube. There were no significant periprocedural complications, and no patient required surgical revision. The only postprocedural complication was accidental decannulation in one patient, which was managed with repeat percutaneous dilational tracheostomy. CONCLUSIONS: Trained physicians can safely perform bedside percutaneous dilational tracheostomy after previous tracheostomy. Percutaneous dilational tracheostomy offers an alternative to surgical tracheostomy in this particular patient population and should not be considered contraindicated.
Adult↗