Hemorrhage Risk of Patients Receiving Bronchoscope Examination or Treatment

Bo, Liyan; Li, Yanyan; Jin, Fang; Li, Congcong

doi:10.21203/rs.3.rs-119025/v1

Cited by 5 publications

(7 citation statements)

References 12 publications

(13 reference statements)

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“…Accurate diagnosis of pneumonia in critically ill patients is challenging, in part due to frequent respiratory culture contamination, leading to unnecessary antibiotic use. We show herein that lower respiratory tract culture with NBBL: 1) is less frequently contaminated than EA, 2) may decrease unnecessary antibiotic use, 3) has minimal complications comparable to what the literature reports for fiberoptic bronchoscopy, and 4) samples the alveolar space effectively (20,21). The literature on the utility of lower respiratory culture has been mixed with other groups confirming our findings (22).…”

Section: Discussionsupporting

confidence: 85%

Nonbronchoscopic Bronchoalveolar Lavage Improves Respiratory Culture Accuracy in Critically Ill Patients

Jeng,

Orsini,

Yerke

et al. 2023

Critical Care Explorations

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OBJECTIVES: Diagnosis of pneumonia is challenging in critically ill, intubated patients due to limited diagnostic modalities. Endotracheal aspirate (EA) cultures are standard of care in many ICUs; however, frequent EA contamination leads to unnecessary antibiotic use. Nonbronchoscopic bronchoalveolar lavage (NBBL) obtains sterile, alveolar cultures, avoiding contamination. However, paired NBBL and EA sampling in the setting of a lack of gold standard for airway culture is a novel approach to improve culture accuracy and limit antibiotic use in the critically ill patients. DESIGN: We designed a pilot study to test respiratory culture accuracy between EA and NBBL. Adult, intubated patients with suspected pneumonia received concurrent EA and NBBL cultures by registered respiratory therapists. Respiratory culture microbiology, cell counts, and antibiotic prescribing practices were examined. SETTING: We performed a prospective pilot study at the Cleveland Clinic Main Campus Medical ICU in Cleveland, Ohio for 22 months from May 2021 through March 2023. PATIENTS OR SUBJECTS: Three hundred forty mechanically ventilated patients with suspected pneumonia were screened. Two hundred fifty-seven patients were excluded for severe hypoxia (Fio 2 ≥ 80% or positive end-expiratory pressure ≥ 12 cm H2O), coagulopathy, platelets less than 50,000, hemodynamic instability as determined by the treating team, and COVID-19 infection to prevent aerosolization of the virus. INTERVENTIONS: All 83 eligible patients were enrolled and underwent concurrent EA and NBBL. MEASUREMENTS AND MAIN RESULTS: More EA cultures (42.17%) were positive than concurrent NBBL cultures (26.51%, p = 0.049), indicating EA contamination. The odds of EA contamination increased by eight-fold 24 hours after intubation. EA was also more likely to be contaminated with oral flora when compared with NBBL cultures. There was a trend toward decreased antibiotic use in patients with positive EA cultures if paired with a negative NBBL culture. Alveolar immune cell populations were recovered from NBBL samples, indicating successful alveolar sampling. There were no major complications from NBBL. CONCLUSIONS: NBBL is more accurate than EA for respiratory cultures in critically ill, intubated patients. NBBL provides a safe and effective technique to sample the alveolar space for both clinical and research purposes.

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Section: Discussionsupporting

confidence: 85%

Nonbronchoscopic Bronchoalveolar Lavage Improves Respiratory Culture Accuracy in Critically Ill Patients

Jeng,

Orsini,

Yerke

et al. 2023

Critical Care Explorations

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“…Although proven to be very effective in treatment of MCAO, TB is not without complications. Reported complications and adverse events are bleeding, pneumothorax, worsening hypoxia, remaining on the ventilator, airway injury, and stent related complications ( 18 , 22 , 43 ). The overall complication rate of TB for MCAO is reported to be 3.9%.…”

Section: Complicationsmentioning

confidence: 99%

Review of the clinical outcomes of therapeutic bronchoscopy for central airway obstruction

Ho¹,

Shah²,

Sagar³

2023

Mediastinum

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Central airway obstruction (CAO) is a debilitating condition with a significant impact on patient’s quality of life and risk of hospitalization from respiratory failure. The causes of CAO can be both benign and malignant. Benign CAO may be idiopathic or secondary to other disease processes (infection, intubation, tracheostomy, etc.). Malignant central airway obstruction (MCAO) may occur in patients with primary lung malignancy as well as metastasis from other malignancies including renal cell, colon, and breast. In a cohort review, MCAO was found in up to 13% of patients with newly diagnosed lung cancer. The obstruction may occur either due to endoluminal disease, extrinsic compression, or a combination of both. Several bronchoscopic tools are available to manage such obstruction. Practice patterns and tools used to relieve CAO vary between institutions and may depend on physician preference, patient characteristics, emergency nature of the procedure, and nature of the obstruction. To quantify the effect and added value of such interventions, it is crucial to understand the clinical impact these interventions have on patients. The clinical impact of therapeutic bronchoscopy (TB) must then be weighed against the potential complications to justify its value. Early studies of TB for CAO included patients with both malignant and benign etiologies. The study population’s heterogeneity makes it difficult to determine how TB affects clinical outcomes, as clinical outcomes are disease specific. The impact of TB for a MCAO may be different when compared to a benign CAO. Similarly, the clinical outcome of treating an idiopathic benign CAO may be different than that of a post tracheostomy airway obstruction. In this article, we will focus on the clinical outcomes of TB in MCAO. TB has been shown to have a clear impact on weaning from mechanical ventilation, dyspnea, health-related quality of life, survival and quality adjusted survival. The potential impact of TB on these outcomes should be weighed against the potential risk of complications. Understanding the factors associated with improved clinical outcomes will help physicians decide when and if TB is helpful. Future studies should focus on creating a decision analysis tool to further define decision thresholds.

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“…Retention and accumulation of Dox in non-target tissues are attributed to major side effects of Dox formulations, particularly cardiotoxicity [35]. After i.v.…”

Section: In Vivo Pharmacokinetic and Antitumor E Cacy Analyses 281 Ph...mentioning

confidence: 99%

B7H3 Targeting Gold Nanocage pH-Sensitive Conjugates for Precise and Synergistic Chemo-Photothermal Therapy against NSCLC

Chen

Zheng

Fang

et al. 2023

Preprint

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Background: The strategy of combining a drug delivery with an immune checkpoint target has been widely investigated in cancer therapy, but the remarkable benefit to patients from this strategy is still limited. B7 homolog 3 protein (B7-H3), also known as CD276 (B7-H3/CD276), is a promising anti-cancer therapeutic target that is broadly overexpressed on the surface of malignant cells and tumor vasculature, that is, associated with poor prognosis. Herein, we report B7H3 targeting doxorubicin (Dox)-conjugated gold nanocages (B7H3/Dox@GNCs) with pH-responsive drug release as a selective, precise, and synergistic chemotherapy-photothermal therapy agent against non-small-cell lung cancer (NSCLC). Results: In vitro, B7H3/Dox@GNCs showed tumor acidic microenvironment responsive Dox release, enhanced intracellular uptake, promoted cell cycle arrest, and increased apoptosis in B7H3 overexpressing NSCLC cells. B7H3/Dox@GNCs also exhibited tumor tissue targeting and acidic environment responsive sustained drug release in xenograft tumor models, wherein they synchronously destroyed B7H3 positive tumor cells, tumor-associated vasculature, and stroma fibroblasts. Conclusion: This study presents a dual-compartment targeted B7H3 multifunctional gold conjugate system that can precisely control Dox exposure in a spatio-temporal manner without evident toxicity and suggests a general strategy for synergistic therapy against NSCLC.

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Hemorrhage Risk of Patients Receiving Bronchoscope Examination or Treatment

Cited by 5 publications

References 12 publications

Nonbronchoscopic Bronchoalveolar Lavage Improves Respiratory Culture Accuracy in Critically Ill Patients

Nonbronchoscopic Bronchoalveolar Lavage Improves Respiratory Culture Accuracy in Critically Ill Patients

Review of the clinical outcomes of therapeutic bronchoscopy for central airway obstruction

B7H3 Targeting Gold Nanocage pH-Sensitive Conjugates for Precise and Synergistic Chemo-Photothermal Therapy against NSCLC

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