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Low-dose computed tomography screening for lung cancer has led to the increased detection of peripheral pulmonary nodules (PPN). Bronchoscopic modalities of PPN biopsy (ultrathin bronchoscope, radial endobronchial ultrasound, electromagnetic navigational bronchoscopy) have not consistently shown diagnostic yields as high as ultrasound- or computed tomography-guided transthoracic needle aspiration or surgical lung biopsy. Robotic-assisted bronchoscopy gained US Food and Drug Administration approval in 2018 and 2019, and preliminary data have shown an improvement in the ability to navigate to PPN, obtain a diagnosis and evaluate tissue for molecular markers, all while maintaining a safety profile similar to that of traditional bronchoscopic methods. In this article, we aim to briefly summarize the data available on this novel technology and its potential for future applications.

Background Up to 80% of mechanically-ventilated patients experience delirium in the ICU. Delirium is associated with increased mortality and longer duration of mechanical ventilation. While bundled protocols have been instituted to prevent and manage delirium, change in rates of delirium have not been recently described. Objective Determine yearly rates of ICU-acquired delirium over time and identify factors associated with the observed trend. Methods Secondary analysis of a large screening cohort from the Pharmacological Management of Delirium (PMD) trial was performed. Data was obtained from electronic medical records and in-person assessments. English-speaking adult patients admitted to ICU for at least 24 hours between July 2010 and December 2014 were included. Patients with alcohol intoxication, persistent coma, axis-I psychiatric condition, incarcerated, pregnant/nursing, hearing impairment or legal blindness were excluded. Level of sedation and delirium were assessed twice daily using the Richmond Agitation-Sedation Scale (RASS) and Confusion Assessment Method for the ICU (CAM-ICU), respectively. ICU-acquired delirium was defined as a positive CAM-ICU screen after an initial negative assessment. Mixed-effects logistic regression models were used to test for differences in patient characteristics. Results A total of 2,117 patients were included in the analysis. ICU-acquired delirium rates decreased from 8.4% (2010) to 4.4% (2014, p=0.014).

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