Safety and yield of transbronchial biopsy in mechanically ventilated patients.

Abstract:

OBJECTIVE:To evaluate the safety and diagnostic yield of transbronchial biopsy performed in mechanically ventilated patients. DESIGN:Retrospective, cohort analysis. SETTING:A university-affiliated teaching hospital. PATIENTS:Seventy-one consecutive, mechanically ventilated patients requiring lung tissue examination. INTERVENTIONS:Transbronchial lung biopsy. MEASUREMENTS AND MAIN RESULTS:We evaluated complications associated with transbronchial biopsy, diagnostic yield of the procedure, and changes in patient management based on the results of the transbronchial lung biopsies. Eighty-three transbronchial lung biopsy procedures were performed in this patient cohort. Complications associated with these procedures included the following: ten (14.3%) pneumothoraces in patients without preexisting chest tubes; five (6.0%) episodes of bronchial hemorrhage of > 30 mL; transient oxygen desaturation to < 90% in seven (8.4%) patients; hypotension with a mean arterial pressure of < 60 mm Hg in six (7.2%) patients; and three (3.6%) episodes of tachycardia, with a heart rate of > 140 beats/min. No patient deaths, episodes of pneumonia, or sepsis could be attributed to the transbronchial lung biopsy procedures. Specific histologic diagnoses were made with 29 (34.9%) of the transbronchial biopsies, and patient management was changed as a direct result of the lung tissue examination in 34 (41.0%) instances. Pathologic correlation between the transbronchial biopsy specimens and lung tissue obtained by open-lung biopsy or post mortem examination occurred in 11 (84.6%) of 13 paired samples. CONCLUSION:Transbronchial lung biopsy can be performed with an acceptable risk and reasonable diagnostic yield in certain types of mechanically ventilated patients, often obviating the need to perform open-lung biopsy.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

O'Brien JD,Ettinger NA,Shevlin D,Kollef MH

doi

10.1097/00003246-199703000-00012

subject

Has Abstract

pub_date

1997-03-01 00:00:00

pages

440-6

issue

3

eissn

0090-3493

issn

1530-0293

journal_volume

25

pub_type

杂志文章
  • Associations between intramucosal acidosis in the gut and organ failure.

    abstract:OBJECTIVE:To alert health professionals to the need for early detection and prevention of shock in critically ill patients. By describing the associations between intramucosal acidosis in the gut and multiple system organ failure, the author demonstrates how noninvasive measurement of gut intramucosal pH can be used to...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/00003246-199302001-00017

    authors: Fiddian-Green RG

    更新日期:1993-02-01 00:00:00

  • Cardiorespiratory monitoring during open heart surgery.

    abstract::Thirty-three patients underwent extensive cardiorespiratory monitoring during cardiac surgery. Recordings of measurements, with derived variables, were made preoperatively, postoperatively, and after extubation approximately 3 h after operation. The data provide a reference that allows decisions on whether the conditi...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:

    authors: Prakash O,Meij S,v d Borden B,Saxena PR

    更新日期:1981-07-01 00:00:00

  • Optimal sedation of mechanically ventilated pediatric critical care patients.

    abstract:OBJECTIVE:To derive a target range of optimal sedation for the COMFORT Scale and to prospectively test that target range against intensivist assessment of adequacy of sedation. DESIGN:Serial prospective agreement cohort studies. SETTING:Twelve-bed pediatric intensive care unit in an urban academic teaching hospital. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199401000-00029

    authors: Marx CM,Smith PG,Lowrie LH,Hamlett KW,Ambuel B,Yamashita TS,Blumer JL

    更新日期:1994-01-01 00:00:00

  • Ineffective triggering predicts increased duration of mechanical ventilation.

    abstract:OBJECTIVES:To determine whether high rates of ineffective triggering within the first 24 hrs of mechanical ventilation (MV) are associated with longer MV duration and shorter ventilator-free survival (VFS). DESIGN:Prospective cohort study. SETTING:Medical intensive care unit (ICU) at an academic medical center. PATI...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/ccm.0b013e3181a98a05

    authors: de Wit M,Miller KB,Green DA,Ostman HE,Gennings C,Epstein SK

    更新日期:2009-10-01 00:00:00

  • Neutrophil depletion in rats reduces burn-injury induced intestinal bacterial translocation.

    abstract:OBJECTIVE:To determine whether neutrophil depletion could eradicate intestinal bacterial translocation in bum-injured rats. DESIGN:Prospective, randomized, controlled study. SETTING:University research laboratory. SUBJECTS:Adult male Sprague-Dawley rats. INTERVENTIONS:The rats were intravenously administered a rabb...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200005000-00048

    authors: Fazal N,Shamim M,Khan SS,Gamelli RL,Sayeed MM

    更新日期:2000-05-01 00:00:00

  • Feasibility and cardiac safety of inhaled xenon in combination with therapeutic hypothermia following out-of-hospital cardiac arrest.

    abstract:OBJECTIVES:Preclinical studies reveal the neuroprotective properties of xenon, especially when combined with hypothermia. The purpose of this study was to investigate the feasibility and cardiac safety of inhaled xenon treatment combined with therapeutic hypothermia in out-of-hospital cardiac arrest patients. DESIGN:A...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验

    doi:10.1097/CCM.0b013e31828a4337

    authors: Arola OJ,Laitio RM,Roine RO,Grönlund J,Saraste A,Pietilä M,Airaksinen J,Perttilä J,Scheinin H,Olkkola KT,Maze M,Laitio TT

    更新日期:2013-09-01 00:00:00

  • Pulmonary capillary pressure during acute lung injury in dogs.

    abstract:OBJECTIVES:To measure pulmonary capillary pressure and pulmonary artery occlusion pressures both during control conditions and during acute lung injury and to evaluate the effects of inotropic therapy and volume loading on these measurements after lung injury. DESIGN:Prospective, randomized, controlled laboratory tria...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200202000-00023

    authors: Pellett AA,Lord KC,Champagne MS,deBoisblanc BP,Johnson RW,Levitzky MG

    更新日期:2002-02-01 00:00:00

  • Immunodepression following neurosurgical procedures.

    abstract:OBJECTIVE:To determine the influence of a selective, sterile central nervous system surgery on immune reactivity, particularly whether a decrease of monocytic human leukocyte antigen-DR expression, indicating immunodepression, occurs after neurosurgery and if this measurement is useful for identification of patients wi...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199512000-00006

    authors: Asadullah K,Woiciechowsky C,Döcke WD,Liebenthal C,Wauer H,Kox W,Volk HD,Vogel S,Von Baehr R

    更新日期:1995-12-01 00:00:00

  • Burden of early-onset candidemia: analysis of culture-positive bloodstream infections from a large U.S. database.

    abstract:OBJECTIVES:: To characterize the epidemiology and burden of early-onset, nonnosocomial candidemia. DESIGN:: Retrospective review of Cardinal Health Outcomes Research Database, which comprises all acute care admissions at participating hospitals. SETTING:: A total of 176 acute care hospitals. PATIENTS:: All patients ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3181a0f95d

    authors: Shorr AF,Gupta V,Sun X,Johannes RS,Spalding J,Tabak YP

    更新日期:2009-09-01 00:00:00

  • Sucralfate does not reduce the risk of acid aspiration pneumonitis.

    abstract:OBJECTIVE:To study the pulmonary effects of aspirating a mixture of sucralfate in water and sucralfate in hydrochloric acid in an animal model of aspiration pneumonia. DESIGN:Prospective, randomized, controlled study with repeated measures. SETTING:University research laboratory. SUBJECTS:Thirty-two in situ, isolate...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199309000-00020

    authors: Toung TJ,Rosenfeld BA,Yoshiki A,Grayson RF,Traystman RJ

    更新日期:1993-09-01 00:00:00

  • Cerebral effects of resuscitation with hypertonic saline and a new low-sodium hypertonic fluid in hemorrhagic shock and head injury.

    abstract:OBJECTIVES:A 2400-mOsm/L hypertonic solution (isosal) with a lower sodium content, compared with conventional 7.5% hypertonic saline, was formulated using a mixture of sodium chloride, glucose, and mixed amino acids. This solution was developed to minimize hypernatremia during resuscitation. We assessed the effects of ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199607000-00027

    authors: Sheikh AA,Matsuoka T,Wisner DH

    更新日期:1996-07-01 00:00:00

  • Pulmonary hypertension in acute respiratory failure.

    abstract::In order to examine the prognostic value of pulmonary arterial hypertension (PAH) in patients with moderate and severe acute respiratory failure (ARF), 225 patients with ARF who had been treated with mechanical ventilation and admitted to our ICU during a 3-yr period (January, 1983 to January, 1986) were prospectively...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198906000-00007

    authors: Villar J,Blazquez MA,Lubillo S,Quintana J,Manzano JL

    更新日期:1989-06-01 00:00:00

  • Serum lipids and disease severity in children with severe meningococcal sepsis.

    abstract:OBJECTIVE:To evaluate the role of cholesterol and lipoproteins in children with severe meningococcal sepsis. DESIGN:Retrospective observational study. SETTING:A university-affiliated pediatric intensive care unit. PATIENTS:Fifty-seven patients admitted to the pediatric intensive care unit with meningococcal sepsis o...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000171272.50888.ad

    authors: Vermont CL,den Brinker M,Kâkeci N,de Kleijn ED,de Rijke YB,Joosten KF,de Groot R,Hazelzet JA

    更新日期:2005-07-01 00:00:00

  • High-frequency jet ventilation for differential lung ventilation.

    abstract::High-frequency jet ventilation using a jet injector located at the right mainstem bronchus was superimposed on standard mechanical ventilation to ventilate the injured lung of a patient with unilateral massive atelectasis secondary to pulmonary hemorrhage. This technique of differential ventilation markedly improved a...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198409000-00039

    authors: Nishimura M,Takezawa J,Nishijima MK,Taenaka N,Shimada Y,Yoshiya I,Fujimoto Y

    更新日期:1984-09-01 00:00:00

  • Evaluation of Institutional Review Board review and informed consent in publications of human research in critical care medicine.

    abstract:OBJECTIVE:To examine the frequency of obtaining Institutional Review Board (IRB) approval and informed consent in critical care research. DATA SOURCES AND DATA EXTRACTION:One-year retrospective review of original critical care research in humans published in seven journals, including American Journal of Respiratory an...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199809000-00035

    authors: Matot I,Pizov R,Sprung CL

    更新日期:1998-09-01 00:00:00

  • Use of bispectral electroencephalogram monitoring to assess neurologic status in unsedated, critically ill patients.

    abstract:OBJECTIVE:To test whether spectral indices derived from the electroencephalogram (EEG), and especially the bispectral index (BIS), can be used as measures of neurologic status in unsedated, critically ill patients. DESIGN:Prospective, observational study. SETTING:Medical intensive care unit (ICU) of a university-affi...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200110000-00024

    authors: Gilbert TT,Wagner MR,Halukurike V,Paz HL,Garland A

    更新日期:2001-10-01 00:00:00

  • Patients' recollection of intensive care unit experience.

    abstract::This study evaluates the recall of 100 patients after ICU admission. There was a wide spectrum of race, religion, occupation, and educational levels. The more common diagnoses included asthma, pneumonia, trauma, and adult respiratory distress syndrome. The average Acute Physiology and Chronic Health Evaluation (APACHE...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199009000-00012

    authors: Turner JS,Briggs SJ,Springhorn HE,Potgieter PD

    更新日期:1990-09-01 00:00:00

  • Severe acute respiratory syndrome and critical care medicine: the Toronto experience.

    abstract:BACKGROUND:The 2003 global outbreak of severe acute respiratory syndrome (SARS) provided numerous challenges to the delivery of critical care. The Toronto critical care community has learned important lessons from SARS, which will help in preparation for future disease outbreaks. OBJECTIVES:The objectives of this stud...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/01.ccm.0000150954.88817.6

    authors: Booth CM,Stewart TE

    更新日期:2005-01-01 00:00:00

  • Radial Artery Applanation Tonometry for Continuous Noninvasive Cardiac Output Measurement: A Comparison With Intermittent Pulmonary Artery Thermodilution in Patients After Cardiothoracic Surgery.

    abstract:OBJECTIVES:Radial artery applanation tonometry allows completely noninvasive continuous cardiac output estimation. The aim of the present study was to compare cardiac output measurements obtained with applanation tonometry (AT-CO) using the T-Line system (Tensys Medical, San Diego, CA) with cardiac output measured by i...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000000979

    authors: Wagner JY,Sarwari H,Schön G,Kubik M,Kluge S,Reichenspurner H,Reuter DA,Saugel B

    更新日期:2015-07-01 00:00:00

  • Prognostication during physician-family discussions about limiting life support in intensive care units.

    abstract:OBJECTIVE:Prognostic information is important to the family members of incapacitated, critically ill patients, yet little is known about what prognostic information physicians provide. Our objectives were to determine the types of prognostic information provided to families of critically ill patients when making major ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/01.CCM.0000254723.28270.14

    authors: White DB,Engelberg RA,Wenrich MD,Lo B,Curtis JR

    更新日期:2007-02-01 00:00:00

  • Critical care for clonidine poisoning in toddlers.

    abstract::Clonidine may be a source of serious toxicity when ingested by toddlers. We describe 11 cases of clonidine ingestion by toddlers (mean dose 0.15 mg/kg; range 0.01 to 0.57). The source of the clonidine was a grand-parent in six of 11 cases. Symptoms included altered level of consciousness (n = 11), miosis (n = 5), brad...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199010000-00014

    authors: Fiser DH,Moss MM,Walker W

    更新日期:1990-10-01 00:00:00

  • Improving code team performance and survival outcomes: implementation of pediatric resuscitation team training.

    abstract:OBJECTIVE:To determine whether implementation of Composite Resuscitation Team Training is associated with improvement in survival to discharge and code team performance after pediatric in-hospital cardiopulmonary arrest. DESIGN, SETTING, AND SUBJECTS:We conducted a prospective observational study with historical contr...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0b013e3182a6439d

    authors: Knight LJ,Gabhart JM,Earnest KS,Leong KM,Anglemyer A,Franzon D

    更新日期:2014-02-01 00:00:00

  • Nosocomial Infection.

    abstract:OBJECTIVE:The first 70 years of critical care can be considered a period of "industrial revolution-like" advancement in terms of progressing the understanding and care of critical illness. Unfortunately, like the industrial revolution's impact on the environment, advancing ICU care of increasingly elderly, immunosuppre...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000004783

    authors: Kollef MH,Torres A,Shorr AF,Martin-Loeches I,Micek ST

    更新日期:2021-02-01 00:00:00

  • High-frequency jet ventilation in weaning the ventilator-dependent patient.

    abstract::Nine ventilator-dependent patients were successfully weaned from mechanical ventilatory support by high-frequency jet ventilation. All patients had been on ventilatory support for at least 2 wk, and had not responded to attempts at weaning by intermittent mandatory ventilation. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-198409000-00021

    authors: Klain M,Kalla R,Sladen A,Guntupalli K

    更新日期:1984-09-01 00:00:00

  • Incidence, Risk Factors, and Clinical Consequence of Enteral Feeding Intolerance in the Mechanically Ventilated Critically Ill: An Analysis of a Multicenter, Multiyear Database.

    abstract:OBJECTIVES:To determine the incidence of enteral feed intolerance, identify factors associated with enteral feed intolerance, and assess the relationship between enteral feed intolerance and key nutritional and clinical outcomes in critically ill patients. DESIGN:Analysis of International Nutrition Survey database col...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/CCM.0000000000004712

    authors: Heyland DK,Ortiz A,Stoppe C,Patel JJ,Yeh DD,Dukes G,Chen YJ,Almansa C,Day AG

    更新日期:2021-01-01 00:00:00

  • Iced temperature injectate for thermodilution cardiac output determination causes minimal effects on cardiodynamics.

    abstract:OBJECTIVES:Controversy exists regarding the ideal injectate temperature for measuring cardiac output. Iced temperature injectate gives a higher signal/noise ratio and less variability in the measured cardiac output. Thus, less volume and fewer measurements are required. Advocates of room temperature injectate have sugg...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199603000-00021

    authors: Fang HK,Krahmer RL,Rypins EB,Law WR

    更新日期:1996-03-01 00:00:00

  • Time course of platelet counts in critically ill patients.

    abstract:BACKGROUND:Although thrombocytopenia in the intensive care unit (ICU) is associated with a poorer outcome, the precise relationship between the time course of platelet counts and the mortality rate has not been well defined. OBJECTIVE:To describe the time course of the platelet count in relation to the mortality rate ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究

    doi:10.1097/00003246-200204000-00005

    authors: Akca S,Haji-Michael P,de Mendonça A,Suter P,Levi M,Vincent JL

    更新日期:2002-04-01 00:00:00

  • Effects of levosimendan, a novel inotropic calcium-sensitizing drug, in experimental septic shock.

    abstract:OBJECTIVE:Levosimendan is a novel inodilator that improves cardiac contractility by sensitizing troponin C to calcium. This drug has proved to be effective in treating advanced congestive heart failure but has not been evaluated in septic settings. The purpose of the present study was to study the effects of this drug ...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-200111000-00022

    authors: Oldner A,Konrad D,Weitzberg E,Rudehill A,Rossi P,Wanecek M

    更新日期:2001-11-01 00:00:00

  • Critical care of immunocompromised patients: human immunodeficiency virus.

    abstract:OBJECTIVE:To describe critical illnesses that occur commonly in patients with human immunodeficiency virus (HIV) infection. METHODS:We reviewed and summarized the literature on critical illness in HIV infection using a computerized MEDLINE search. SUMMARY:In the last 10 yrs, our perception of HIV infection and acquir...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审

    doi:10.1097/01.CCM.0000232491.15369.AB

    authors: Rosen MJ,Narasimhan M

    更新日期:2006-09-01 00:00:00

  • Survival in patients with severe adult respiratory distress syndrome treated with high-level positive end-expiratory pressure.

    abstract:OBJECTIVE:To assess the mortality rate and complications in a population of surgical patients with severe adult respiratory distress syndrome (ARDS) treated with positive end-expiratory pressure (PEEP) of > 15 cm H2O in an attempt to reduce intrapulmonary shunt to approximately 0.20 and reduce FIO2 to < 0.50. DESIGN:R...

    journal_title:Critical care medicine

    pub_type: 杂志文章

    doi:10.1097/00003246-199509000-00008

    authors: DiRusso SM,Nelson LD,Safcsak K,Miller RS

    更新日期:1995-09-01 00:00:00