Pulmonary & Respiratory Medicine

The editorial mission of Pulmonary & Respiratory Medicine is to report scientific research findings that advance understanding of all aspects of pulmonology and respiratory. Research covering a wide range of topics and emerging challenges in pulmonology and respiratory medicine is published. Pulmonary intervention and outcome research furthermore as qualitative and mixed methods analysis are within the editorial focus of Pulmonary Research. Basic, translational, and clinical research is published. Research about Pulmonary and Respiratory, Respiratory therapy is also published as is research describing new or advanced Research methods, Analytic strategies, and Analysis protocols. Our mission at Pulmonary & Respiratory Medicine is to report scientific research findings that advance understanding of all aspects of pulmonology and respiratory. We intend to do this in the way we understand best-through editorial assessment, peer review, academic editing, and highly efficient production processes. We hope that all researchers strive to make their research findings known through careful, unbiased publication such as we aim to provide at Pulmonary & Respiratory Medicine. We welcome your comments and importantly, your continued contributions to achieve the mission we have set for ourselves.

Introduction: Pulmonary nodules suspicious for malignancy may require surgical biopsy. Options include wedge resection using video-assisted thoracoscopic surgery (VATS) or open thoracotomy. Nodules may be identified by visual inspection or digital palpation. Recent localization technical advancements have included preoperative hook wire placement, percutaneous dye injection and electromagnetic navigational bronchoscopy. Intraoperative conversion of VATS to open thoracotomy may stem from unsuccessful nodule localization. We hereby describe a novel approach to preoperative marking of the visceral pleura in order to assist with intraprocedural nodule localization. We present a series of patients who underwent visceral pleural marking by robotic bronchoscopy.

Materials and Methods: This study was performed at a single institution by two interventional pulmonologists and one cardiothoracic surgeon. Seventeen patients who required wedge resection of pulmonary nodules and underwent preoperative visceral pleural marking were studied. An electromagnetic navigational robotic bronchoscopy platform was utilized for dye marking, with fluoroscopy to facilitate needle placement. The primary objective was to advance the bronchoscope within close proximity of the suspicious nodule and mark the visceral pleura. A Wang needle was used to inject indocyanine green and methylene blue dyes. The robotic scope was then retracted to allow for surgical intervention. Wedge resection via robot-assisted VATS was subsequently performed.

Results: Seventeen patients underwent wedge resection for known or suspected malignancy: 13/17 were positive for malignancy, most commonly from extra thoracic metastasis; 6/17 proceeded to completion lobectomy following confirmation of non-small cell lung carcinoma (NSCLC) from intraoperative frozen section examination. There were no reported complications, including pneumothorax, bleeding or dye-related side effects.

Conclusion: Robotic bronchoscopy can be a safe and effective technique for visceral pleural marking prior to VATS resection of pulmonary nodules. Theoretically, this approach may reduce the conversion of VATS to open thoracotomy in selected cases. Further studies are needed to determine statistical differences in outcomes among different techniques for nodule localization, e.g. percutaneous vs robotic bronchoscopy. Limitations of the study include sample size, operator dependence and limited length of follow up.

Background: Ototoxicity remains one of the major adverse events during multidrug-resistant tuberculosis (MDR-TB) treatment. It is related to the use of aminoglycosides.
Bedaquiline offers an opportunity to promote a shorter regimen without aminoglycosides.

Methods: This is a retrospective study. We reviewed all the MDR-TB patients with hearing losses for which a 9 month regimen has been applied in 2018 in Kinshasa, DR
Congo. Kamamycin and Moxifloxacin had been replaced by Bedaquiline and levofloxacin. Treatment was given ambulatory under dot’s unless the emergencies. Monthly
follow-up included clinical and bacteriological features, renal and liver functions, QT Interval.

Results: From 184 patients selected for 9 months shorter regimen according to WHO guidelines, 39 had hearing loss (21.2%) and were selected for the study. Mean-age
was 35.7 years (Range 18-65), 21 male (54%), 8 (21%) HIV positive, 25 (64%) were under weighted; 26 patients (66.7%) had 50% or less, the 2 lungs fields affected on
chest X-ray, and 20 patients (51.2%) with one or more cavities. Sputum smear conversion was respectively 82% and 97.2% at 2 and 4 months. Culture conversion was
86% and 97.2% for the same time. Cultures and Sputum smear remained negative until 9th month for 97.2% patients. Adverse events have been reported by 23 patients
(58.9%), but they were severe and very severe only in 2 cases (5.1%). No QT interval over 500 millisecond (ms) noted. Treatment outcomes were: 32 patients cured
(82.05%), 3 with treatment completed (7.7%), 3 (7.7%) Died, 1 (2.5%) failure. The follow-up of 6 months after treatment completion did not reveal relapse case.

Conclusion: The 9 months shorter regimen with bedaquiline showed a good safety and efficacy with a treatment success of 89.75%. This study shows also that the use
of bedaquiline is possible even in low-income environment.

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a chronic disease with episodes of acute worsening of respiratory symptoms beyond daily variations and leading to therapeutic modification, called acute exacerbations (AE). Knowledge of the characteristics of COPD patients with an exacerbation could contribute to their management.

Methods: The data collected were entered and analyzed with SPSS version 20 and archived in order to safeguard confidentiality. The quantitative variables were compared with Student's Z or t law depending on their applicability. The comparison of qualitative variables was done using the chi-square or Fisher's test (as appropriate). A value of p < .05 was considered statistically significant.

Results: The hospital prevalence of COPD PT was 4.13% over 17 months (May 1, 2016 to October 31, 2017). The mean annual number of exacerbations was 1.99+/- 0.68. Men had more COPD exacerbations than women. The number of exacerbations increased with age. Patients who lived near a high-traffic street had at least 2 exacerbations per year.

Conclusion: Knowing the profile of patients who had AE will allow us to anticipate their prevention.

Background: Pre-endoscopic endotracheal intubation is frequently performed during hematemesis, with the assumption that it will prevent aspiration and other cardiopulmonary complications. However, current literature reveals limited studies showing this benefit. Furthermore, guidelines for identifying patients who would most benefit from pre-endoscopic intubation are lacking. We hypothesize that pre-endoscopic intubation as associated with increased cardiopulmonary complications. Our study aimed to compare the frequency of cardiopulmonary complications between patients presenting with hematemesis who underwent pre-endoscopic intubation versus those who did not.

Methods: A retrospective analysis of patients who underwent esophagogastroduodenoscopy (EGD) for hematemesis between May 2015 and April 2018 was conducted. Patients were subdivided into those who underwent pre-endoscopic intubation and those who did not. The primary endpoint of “cardiopulmonary complications,” was defined as the occurrence of pneumonia, pulmonary edema, pneumothorax, hypoxemia, sedation induced hypotension, shock or cardiac arrest within 72 hours after endoscopy or intubation. Number of units of red blood cells (RBC) transfused prior to endoscopy was used as a surrogate for acuity of bleed. Appropriateness of intubation was assessed by documented reason for intubation. Intubations due to witnessed hematemesis and solely from gastroenterology request were defined as inappropriate reasons for intubation.

Results: Of 300 distinct patient encounters undergoing endoscopy, 66 (22.0%) were intubated prior to the procedure. Witnessed hematemesis was the most common indication for intubation prior to endoscopy (47.0%). Patients who underwent pre-endoscopic intubation were associated with higher acuity of illness as evidenced by validated scoring systems (SAPSII/AIMS65). Median units of blood transfused in the intubated group vs. non-intubated group were 2 and 0 (p<0.001), respectively. Cardiopulmonary complications in the intubated group were more prevalent than in the non-intubated group (27.3% vs. 1.3% respectively; p=<0.001). After adjusting for differences in SAPSII, AIMS65, and pRBC, patients who were intubated had 15.36 (95% CI: 4.52-65.67) times the odds of having a complication than those who were not intubated (p<0.001). Furthermore, there were no significant differences in the proportion of complications in appropriate vs. inappropriate intubations (33.3% vs. 25.9%; p=0.72 by Fisher’s exact test).

Conclusion: Our study demonstrates that pre-endoscopic intubation in the setting of hematemesis can be associated with increased cardiopulmonary complications. When controlling for potential confounders including severity score, bleeding risk score, and acuity of bleed, this finding persisted. We also note that patients who are intubated have similar risk of complications, regardless of reason for intubation. Thus, this suggests that intubations prior to endoscopy should be performed cautiously and only in specific scenarios.

Background: The COVID-19 pandemic has made it necessary to implement new ways to increase the volume of oxygen delivered to infected patients with respiratory involvement. When treating individuals who are not candidates for intubation, we have found that modified scuba-diving masks may be used to treat those cases requiring over 15 liters of oxygen per minute, like compassionate use.

Methods: We describe the use of modified scuba-diving masks for ventilation on 13 patients at out hospital. None of them was candidate for ICU due to comorbidity and dependency.

Findings: Patients outfitted with this modified scuba-diving masks experience immediate clinical improvement, showing an increase in oxygen saturation from 80–84% to 96–98%, with isolated cases reaching 100% saturation. Preliminary results reveal hypercapnia closely resembling that seen with a normal reservoir as well as improved oxygen saturation. The clinical evolution was favorable.

Patients progressively decreased their oxygen supply needs: 8 of them have undergone this treatment for 8 days (4 patients has already been discharged; one maintains FiO2 28% with nasal cannula and 3 require intermittent treatment); 2 patients continue with the masks. 3 patients have died.

Interpretation: Through a series of adaptations, these masks may be used to increase the volume of oxygen delivered, thereby avoiding the use of a respirator or achieving more effective management of hospital resources in situations of potential disease transmission, such as the current pandemic situation in which we currently find ourselves.