The Role of Interventional Pulmonology in Critical Care Patients



The Role of Interventional Pulmonology in Critical Care Patients

Authors:

Maher Tabba, MD, FCCP

Assistant Professor

Tufts Medical Center

800 Washington St. #369Boston, MA 02111

Phone: 617-636-6366

Correspondence email: mtabba@tuftsmedicalcenter.org

Heidi O'Connor, MD, FCCP

New England Sinai Hospital

150 York Street

Stoughton, MA 02072

Phone: 617-636-6366

Email: hoconnor@nesinai.org

Armin Ernst, MD, FCCP

Associate Professor

Beth Israel Deaconess Medical Center

Harvard Medical School

330 Brookline Ave

Boston, MA 02215

Phone: 617-667-7000

Email: aernst@bidmc.harvard.edu

Abstract

Interventional pulmonology is considered a newly formulated subspecialty field focuses on providing diagnostic and therapeutic techniques for a group of patients with complex airway diseases and pleural disorders. It is has been a major cornerstone in the multidisciplinary approach of critically ill patients in managing their complex center airway diseases, pleural effusion and provide them with artificial airway and tube feeding. The increase utilization of this service in the critical care setting required adequate understanding and proper communication between the intensiviest and the interventional pulmonologist to optimize the benefit and to achieve better outcome.

Key words:

Interventional pulmonology, Tracheostomy, Pleural disease, Foreign body aspiration, Massive Hemoptysis

Table of Contents

ABSTRACT4

Key words:4

INTRODUCTION7

PERCUTANEOUS DILATION TRACHEOSTOMY (PDT)10

Definition10

History10

Benefits10

Timing11

Complications12

CREATION AND CARE OF LONG-TERM ARTIFICIAL AIRWAYS13

NOSOCOMIAL PNEUMONIA14

PERCUTANEOUS DILATION TRACHEOSTOMY (PDT) VS SURGICAL TRACHEOSTOMY (ST)14

Techniques15

Preparations15

Location15

Skin incision16

Types of PDT Four types of PDT techniques have been described and performed:16

BRONCHOSCOPIC GUIDANCE17

Special considerations17

MAJOR AIRWAY OBSTRUCTION18

Lung Cancer Introduction20

Mechanisms20

Treatment21

General management21

Outcome22

TRACHEOMALACIA22

FOREIGN BODY ASPIRATION:22

Introduction22

Techniques23

MASSIVE HEMOPTYSIS23

Definition23

Diagnosis and Management24

Management24

PEG tube placement25

Pleural Effusion26

CONCLUSIONS26

REFERENCES27

The Role of Interventional Pulmonology in Critical Care Patients

Introduction

Interventional pulmonology (IP) is emerging as an important subspecialty of pulmonary medicine. It is becoming a vital part of the multidisplinary approach of pulmonary and critical care patients. Multiple diagnostic and therapeutic modalities can be provided by the Interventional pulmonologists to manage central airway and pleural diseases. Emerging technologies provided the area with increasing applications.

Interventional pulmonology (IP) is a new field in pulmonary medicine with emphasis on providing comprehensive care to patients with structural airway disorders and pleural diseases. The scope of practice is rapidly growing and extending into new disease states and patient populations such as endoscopic lung volume reduction in patients with chronic obstructive pulmonary disease (COPD) and early detection of lung cancer. The incorporation of laser technology into the tracheobronchial tree and the advent of airway stents in the early 1990s sparked an interest among pulmonologists to gain more experience in the diagnosis and management of airway disorders and caused a resurgence of rigid bronchoscopy. IP encompasses 3 major areas including diagnostic and therapeutic bronchoscopy, airway interventions, and treatment of pleural diseases. Although individual pulmonologists may be able to perform any combination of these procedures, ideally, the designation “interventional pulmonologist” is reserved for a pulmonologist who obtains training and gains experience that spans the entire spectrum of aforementioned skills. The value of dedicated IP training versus gaining experience during general pulmonary fellowships has been recently debated. The American College of Chest Physicians (ACCP) published guidelines for interventional pulmonary procedures addressing their technique, necessary equipment and personnel, and training requirements. 

The IP training can be acquired through experience with the procedures over the time or by dedicated training program, where the trainee gets exposed to the wide spectrum of the IP procedures.

Recent data from the American Association of Medical Colleges2 once again notes the high cost of medical education and the subsequent $100,000 to ...