Interventional pulmonology during COVID-19 pandemic: current evidence and future perspectives

Piro, Roberto; Casalini, Eleonora; Livrieri, Francesco; Fontana, Matteo; Ghidoni, Giulia; Taddei, Sofia; Facciolongo, Nicola

doi:10.21037/jtd-20-2192

Cited by 7 publications

(5 citation statements)

References 87 publications

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“…Caution should be exercised in interpreting the results of this study. Fourth, the coronavirus disease 2019 (COVID-19) pandemic is known to have had a significant impact on interventional pulmonology, and the impact of this pandemic cannot be ignored 16) . Half of the study period is during the COVID-19 pandemic, which may have affected treatment choices during periods of high COVID-19 caseloads or when a state of emergency was declared.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the Efficacy and Safety of Thoracoscopy under Local Anesthesia in Patients Aged over and under 75 Years: A Single-center Experience

Fujita,

Saito,

Ito

et al. 2024

Respiratory Endoscopy

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Background: Thoracoscopy under local anesthesia is widely performed for the diagnosis of malignancies and infectious diseases. With the aging of the population, it is increasingly performed in elderly patients, but there are still few reports on its efficacy and safety. We aimed to determine whether there were any differences in the efficacy or safety of thoracoscopy under local anesthesia between elderly (75! ) and nonelderly patients (75>). Methods: Patients who underwent thoracoscopy under local anesthesia at our hospital between January 2018 and April 2023 were reviewed retrospectively. We examined the background factors of the patients, the purpose of the examination, diseases to be examined, examination time, anesthetic methods, diagnostic and treatment success rates, and adverse events. Results: A total of 62 patients were reviewed. Of this, 32 were elderly and 30 were nonelderly. There were more men with a history of smoking and significantly more elderly patients had hypertension. Forty-three patients (69.4%) were treated for diagnostic purposes, 16 (25.8%) for pyothorax, 1 (1.6%) for pneumothorax, and 1 (1.6%) for diagnosis and treatment. There were no significant differences in anesthetic drugs, examination time, pathology diagnosis rate, or success rate in treating pyothorax/pneumothorax. The diagnostic rate of malignancy was 93.8%, while that of benign disease was 41.7%. There was no significant difference in the overall success rate of pathological diagnosis and treatment between elderly and nonelderly patients (78.1% vs. 93.3%, p = 0.148). Adverse events were hypoxemia, pain, and hypertension, in that order, with pain being significantly more common in the elderly, but no other significant differences as well as serious adverse events were observed. Conclusions: The efficacy and safety of thoracoscopy under local anesthesia were similar in elderly patients as in nonelderly patients in this retrospective single-center study.

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Section: Discussionmentioning

confidence: 99%

Comparison of the Efficacy and Safety of Thoracoscopy under Local Anesthesia in Patients Aged over and under 75 Years: A Single-center Experience

Fujita,

Saito,

Ito

et al. 2024

Respiratory Endoscopy

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“…The pulmonologist may be in a unique position of risk due to the nature of the procedures performed involving the airway and hence the high aerosol-generating potential of these procedures. In addition, pulmonologists may be involved not only in the care of acutely ill patients with COVID-19, but also of those recovering from the illness who may require post-tracheostomy care or diagnostic bronchoalveolar lavage (BAL) or lung biopsy in the setting of persistent pulmonary fibrosis ( 40 ).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…All pleural procedures, including thoracentesis, chest tube insertion and pleural biopsy by thoracostomy or pleuroscopy, might be considered aerosol-generating as patients may cough, and theoretically virus-containing aerosols may be emitted from a chest drain with an air leak ( 40 ). SARS-CoV-2 viral RNA has also been detected in pleural fluid ( 40 ), making direct transmission by contact also a potential risk due to fluid splashing and contamination. A statement from the American Association for the Surgery of Trauma (AAST) Acute Care Surgery and Critical Care Committees recommends putting in-line antimicrobial filters on the suction line of a chest tube drainage system while on suction or on water seal ( 69 ).…”

Section: Introductionmentioning

confidence: 99%

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What Have We Learned About Transmission of Coronavirus Disease-2019

Kaminsky

Husnain

Khemasuwan

2023

Clinics in Chest Medicine

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“…First, it has been documented the cost‐reduction of EBUS‐TBNA performed under conscious sedation compared with GA 16 , 17 ; in the field of the pandemic we are currently living in, this is an important matter of concern. 18 Second, the anesthesiologist's availability in contrast with the increasing number of EBUS‐TBNA procedures requested is critical in some hospitals; consequently, there is a strong need for pulmonologists to perform the procedures using strategies different from GA. Currently, the optimal sedation protocol for EBUS‐TBNA is still a matter of discussion.…”

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of EBUS‐TBNA under conscious sedation with meperidine and midazolam

et al. 2022

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Background: According to the guidelines, endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) is the technique of choice for the diagnosis of mediastinal involvement in lung cancer; it is also useful for other mediastinal malignancies and benign pathology. Nevertheless, there is still discussion about whether to perform it under general anesthesia or under conscious sedation. Methods: We retrospectively analyzed the data of all patients who underwent EBUS-TBNA under conscious sedation with up to 1 mg/kg of meperidine and up to 0.15 mg/kg of midazolam in the Interventional Pulmonology Unit of the Azienda USL-IRCCS Santa Maria Nuova of Reggio Emilia during 2 consecutive years. Demographic data, indication for the procedure, duration, number of lymph node sampled, number of passes per station, diagnostic yield, drugs dosage, questionnaire score, and complications were collected. Results: A total of 302 patients underwent EBUS-TBNA, and 68% of the patients were males and the mean age was 65 AE 13 years old. The average duration of procedures was 24.4 minutes and the mean dosage of drugs was 4.32 AE 1.52 mg for midazolam and 50.86 AE 13.71 mg for meperidine. The mean number of lymph nodes sampled per patient was 1.75 AE 0.82, and each patient received an average of 4.71 AE 1.78 passes. A total of 90.7% of patients completed the procedures, 85% had adequate samples, and 94.4% of patients declared with Likert's questionnaire that they strongly agree to repeat the test if necessary. Conclusion: EBUS-TBNA performed under conscious sedation with meperidine and midazolam is feasible and well-tolerated and has a similar diagnostic yield of that reported in literature.

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Interventional pulmonology during COVID-19 pandemic: current evidence and future perspectives

Abstract: The main symptoms of SARS-CoV-2 infection are fever, asthenia, dry cough, dyspnea ageusia and anosmia (5). In some cases, severe interstitial pneumonia, acute respiratory distress syndrome (ARDS) and subsequent multiorgan

Cited by 7 publications

References 87 publications

Comparison of the Efficacy and Safety of Thoracoscopy under Local Anesthesia in Patients Aged over and under 75 Years: A Single-center Experience

Comparison of the Efficacy and Safety of Thoracoscopy under Local Anesthesia in Patients Aged over and under 75 Years: A Single-center Experience

What Have We Learned About Transmission of Coronavirus Disease-2019

Efficacy and safety of EBUS‐TBNA under conscious sedation with meperidine and midazolam

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