BackgroundThoracentesis using suction is perceived to have increased risk of complications including pneumothorax and re-expansion pulmonary edema (REPE). Current guidelines recommend limiting drainage to 1.5 L to avoid REPE. Our purpose was to examine the incidence of complications with symptom limited drainage of pleural fluid using suction and identify risk factors for REPE.MethodsA retrospective cohort study of all adult patients who underwent symptom limited thoracentesis using suction at our institution between 1/1/2004 and 8/31/2018 was performed, and a total of 10 344 thoracenteses were included.ResultsPleural fluid ≥1.5 L was removed in 19% of the procedures. Thoracentesis was stopped due to chest discomfort (39%), complete drainage of fluid (37%), and persistent cough (13%). Pneumothorax based on chest radiograph was detected in 3.98%, but only 0.28% required intervention. The incidence of REPE was 0.08%. The incidence of REPE increased with Eastern Cooperative Oncology Group performance status (ECOG) ≥3 compounded with ≥1.5 L (0.04 to 0.54%, 95% CI 0.13–2.06). Thoracentesis in those with ipsilateral mediastinal shift did not increase complications, but less fluid was removed (p<0.01).ConclusionsSymptom limited thoracentesis using suction is safe even with large volumes. Pneumothorax requiring intervention and REPE are both rare. There were no increased procedural complications in those with ipsilateral mediastinal shift. REPE increased with poor performance status and drainage ≥1.5 L. Symptom limited drainage using suction without pleural manometry is safe.
Cerebral aspergillosis has the tendency to occur in immunocompromised patients. Less commonly, immunocompetent individuals can be affected, with neuroimaging findings being difficult to interpret. The diagnosis necessitates imaging of the brain as well as the sinuses with biopsy and pathological confirmation. A surgical excision with aggressive antifungal agents are required for a proper management. This case report describes an immunocompetent patient with cerebral aspergillosis that presented radiologically as a suspicious mass to be diagnosed pathologically and excised surgically.
Background: The use of Non-Invasive Ventilation (NIV) in acute asthma exacerbation remains controversial. Comparative data on patient characteristics that benefit from NIV in asthma exacerbation to those patients that fail NIV remains limited. Our study compares some of these patient characteristics and examines if NIV is safe and effective in carefully selected patients. Methods: Following institutional review board approval, we extracted from the electronic medical record and conducted a retrospective chart-based review of those patients who received NIV in the emergency room for a diagnosis of asthma exacerbation from January 2017 to December 2018.
Results and Conclusion:The rate of failure of NIV overall was low, at 9.17%, with younger patients more likely to fail NIV (P = 0.03) and need invasive mechanical ventilation. Surprisingly, baseline asthma severity did not impact NIV failure rate, and neither did body mass index, smoking history, and a host of clinical characteristics. Understandably, the length of stay was significantly longer in the group of patients that failed NIV. There were no adverse events, such as an increased rate of barotrauma events in either group. In conclusion, this study contributes to the growing body of evidence that NIV is a safe and effective adjunct to routine care in the management of patients with asthma exacerbation.
Bronchoscopic laser interstitial thermal therapy can achieve relatively large areas of ablation of normal lung parenchyma with a low rate of periprocedural complications.
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