Search Results (1,111)

Background and Clinical Significance: Endobronchial leiomyoma is a rare benign tumor of the respiratory tract, accounting for less than 2% of all benign pulmonary neoplasms. Most cases have been treated surgically or with endoscopic modalities such as laser or rigid bronchoscopy-assisted cryotherapy. Flexible bronchoscopic cryoextraction has been rarely reported, typically with 2.2-mm probes. Small-caliber cryoprobes (1.1- and 1.7-mm) have been validated for diagnostic transbronchial cryobiopsy but not for therapeutic removal of leiomyoma. We report a case of complete removal of endobronchial leiomyoma using a 1.7-mm cryoprobe via flexible bronchoscopy, demonstrating full airway and physiologic recovery. Case Presentation: A 25-year-old never-smoking man was referred after an abnormal health-screening chest radiograph demonstrated right middle and lower lobe atelectasis. Chest CT revealed a mass obstructing the proximal bronchus intermedius. Spirometry showed reduced FEV₁ and FVC with preserved FEV₁/FVC ratio, consistent with central airway obstruction. Therapeutic flexible bronchoscopy (Olympus BF-1TQ290) was performed under endotracheal intubation. Initial forceps biopsies were followed by transbronchial cryobiopsy with a 1.7-mm cryoprobe, applied for five freeze–adhesion cycles. The mass detached en bloc and was retrieved without complications, resulting in complete airway recanalization and visualization of the right middle and lower lobe bronchi. Histopathology showed interlacing fascicles of bland spindle cells with cigar-shaped nuclei, positive for SMA and desmin and negative for S-100 and CD34, confirming leiomyoma. The patient was discharged the next day. At one-year follow-up, bronchoscopy and CT demonstrated no recurrence, and spirometry normalized. Conclusions: Reports combining flexible bronchoscopy with a 1.7-mm small-caliber cryoprobe for en bloc removal of endobronchial leiomyoma are rare. This technique may represent a minimally invasive option for selected cases, provided careful hemostatic planning and appropriate case selection. Full article

A 3-year-old West Highland White Terrier presented to our hospital with dyspnea following aspiration of barium contrast medium during diagnostic imaging for a suspected esophageal foreign body (day 0). Barium contrast radiography had revealed a foreign body in the lower esophagus. During anesthesia, the patient regurgitated and developed respiratory failure and cyanosis. Despite immediate intubation, suction, and ventilatory management, respiratory parameters remained poor. Respiratory support with extracorporeal membrane oxygenation (ECMO) enabled control of blood gas parameters, and tracheobronchial lavage with temporary complete airway occlusion was performed. ECMO was withdrawn once the respiratory status normalized (total support time: 3 h). Considering the possibility of hypoxia-induced brain damage, the patient was extubated on day 1. The dog was alert, changed positions, and drank water independently 5 h after extubation. However, neurological symptoms were observed 1 h later. Cranial magnetic resonance imaging was performed on day 6 owing to persistent neurological symptoms. Although no ECMO-related complications, such as cerebral infarction, hemorrhage, or herniation, were observed, the white matter exhibited hyposignal, indicating hypoxic encephalopathy. The patient died on day 8, without improvement in neurological symptoms. ECMO is an effective treatment option for dogs with respiratory failure, and its prompt introduction may improve survival. Full article

(1) Background: Ground Emergency Medical Services in Hungary are provided by the National Ambulance Service. Paramedics, physicians, and specialists in this service are competent in performing endotracheal intubation (ETI) on patients. The aim of this study is to evaluate the impact of the standardized Rapid Sequence Intubation (RSI) procedure on safety and effectiveness. (2) Methods: A retrospective observational study was conducted concerning the RSI procedure. Patient documentation from a 2-year implementation period was analyzed using a dedicated Case Report Form (CRF), where both RSI and non-RSI methods were used. Our primary endpoint was Definitive Airway Sans Hypoxia and Hypotension on First Attempt (DASH-1A). Our secondary endpoints included success on the first attempt; overall success; and hypoxia, hypotension, and cardiac arrest complications. (3) Results: In total, 6399 intubation cases were studied; non-RSI was used in 3236, and RSI was applied in 3163 cases. DASH-1A was attained in a significantly higher number of cases with RSI than non-RSI (55.0 vs. 68.5%, p < 0.0001). The DASH-1A results of the RSI group were significantly better in the paramedic (54.0 vs. 68.5%, p < 0.0001) and the physician (55.0 vs. 66.7%, p = 0.0017) subgroups. In the specialist subgroup, the difference was not statistically significant (64.5 vs. 69.7%, p = 0.1514). (4) Conclusions: Standardized RSI significantly increased effectiveness and safety in the paramedic and physician subgroups. Full article

Background: Long COVID—defined as the persistence of symptoms or the development of new symptoms beyond four weeks after acute SARS-CoV-2 infection—affects an estimated 10–30% of individuals recovering from COVID-19, posing a significant public health burden. Emerging evidence suggests that type I interferons (IFNs) (a critical group of cytokines in the antiviral defense) and hematologic alterations, such as lymphopenia and elevated inflammatory markers, are linked to both the severity of acute COVID-19 and the likelihood of developing long-term symptoms. The aim of this study is to explore the association between type I IFN signatures and long COVID. A second aim is to examine the relationship between laboratory findings during acute infection and long COVID. Methods: The study included 61 patients investigated for the presence of long COVID symptoms 16.5 ±1.5 months after acute infection. Patients were divided into two groups of higher symptom burden of long COVID and those with milder symptoms based on demographic, laboratory, and clinical data as well as type I IFN-inducible gene expression (MX-1, IFIT-1, and IFI-44) measured in peripheral blood by real-time PCR. Data collected during acute infection were recorded. Peripheral blood samples were collected during the acute phase of infection, within the first 48 h of hospital admission. IFN-inducible gene expression was measured prospectively at that time, and RNA was extracted immediately for subsequent analysis. Results: History of intubation emerged as a significant associated factor of severe long COVID, with 75% of intubated patients reporting >8 persistent symptoms approximately 16 months post-infection. Higher white blood cell (WBC) and neutrophil counts but lower eosinophil and monocyte counts in acute infection were found to be associated with a high burden of long COVID symptoms. Interestingly, absolute monocyte count was found to independently correlate with higher long COVID symptom burden. Lactate dehydrogenase (LDH) and serum glutamic-oxaloacetic transaminase (SGOT) also differed significantly between groups, with higher levels correlating with a high burden of long COVID symptoms. Notably, MX-1 transcript levels in peripheral blood at the time of acute infection were reduced in patients with a high burden of long COVID symptoms, suggesting that dysregulated immune responses during the acute phase may contribute to persistent symptoms. Conclusions: These findings suggest the potential association of hematological and immune markers with long COVID severity, as well as the importance of monitoring these parameters to identify at-risk patients for early interventions. Full article

Background: Tracheal stenosis in children is a rare but potentially life-threatening condition. We report a case of multilevel tracheal stenosis in a child who sustained blunt chest trauma in a car accident. Case Presentation: The patient is an 11-year-old previously healthy boy who presented to the pediatric emergency room unconscious after being rolled over while seated unstrained inside a vehicle. A chest CT scan showed bilateral pulmonary contusions. He required intubation and mechanical ventilation initially but was noted to have biphasic stridor after extubation. He presented to the pediatric pulmonary clinic 2 weeks after discharge from the hospital with persistent stridor and shortness of breath on exertion. Spirometry revealed flattening of the inspiratory and expiratory limbs of the flow-volume loop, suggestive of fixed large airway obstruction. Direct laryngoscopy and bronchoscopy were performed and revealed multilevel tracheal stenosis. He was successfully treated with repeated bronchoscopic balloon dilatation with sustained improvement in symptoms and spirometry findings 8 months post final procedure. Conclusion: Tracheal stenosis should be suspected in children who sustain blunt chest trauma. Early recognition and treatment with bronchoscopic balloon dilatation can prevent long-term complications. Full article

Background/Objectives: To investigate the long-term changes in conjunctival bacterial flora before and after dacryoendoscopic recanalization for lacrimal passage obstruction using silicone tube intubation. Methods: This prospective study included 135 eyes with lacrimal passage obstruction that underwent lacrimal passage recanalization and were followed for at least one year. The silicone tubes inserted during surgery were removed three months postoperatively in all cases. The study period was from November 2018 to January 2025. Conjunctival samples were obtained before surgery and at 12 months postoperatively. Aerobic cultures were performed to detect bacterial flora. The culture positivity rate, number of bacterial species identified, and proportion of commensal bacteria were compared before and after surgery. Results: The bacterial culture positivity rate significantly decreased from 36.3% preoperatively to 20.0% postoperatively (p = 0.003). The number of bacterial species detected decreased from 15 to 6, with Gram-negative bacilli decreasing from 6 species to 1. In contrast, the proportion of commensal bacteria such as coagulase-negative staphylococci and Corynebacterium spp. relatively increased from 49.1% to 80.7%. No drug-resistant bacteria were detected postoperatively. Conclusions: Dacryoendoscopic recanalization for lacrimal passage obstruction was shown to achieve long-term normalization of the conjunctival bacterial flora by reducing pathogenic and drug-resistant bacteria and increasing commensal bacteria. These findings suggest that the procedure prior to intraocular surgery in patients with lacrimal obstruction may reduce the risk of postoperative infection. Full article

Nasotracheal Intubation (NTI) is a common route of airway management in many situations. Over the years, numerous techniques and approaches have been described in performing NTI safely and effectively, including many innovative techniques being published in recent years. However, there hasn’t been a summary of the recent approaches to NTI, especially in an easy, clinically applicable decision making format. In fact, the last algorithmic approach to nasal intubation in the literature was published in 2008. This comprehensive review details an updated analysis of NTI techniques along with a new adapted algorithmic outline to approach NTI in a methodical and stepwise manner. There is also an extensive review of techniques to control epistaxis, which is the most commonly encountered complication during NTI. The newly adapted NTI algorithm simplifies the initial approach to three options: Routine Asleep NTI, Awake NTI, and an Initial Orotracheal Intubation (OTI) followed by Conversion to NTI. Older techniques, such as blind NTI, flexible intubation scope guided, “look before you leap” approach and cuff inflation technique, are discussed along with incorporation of newer techniques, such as videolaryngoscope guided, hybrid, alignment approach, and OTI to NTI conversion. Uniquely, this manuscript reviews all published techniques for converting OTI to NTI and categorizes them into two pathways: direct conversion (with glottic visualization) or indirect conversion (without glottic visualization). Furthermore, original animated videos have been created and attached to help elucidate these conversion techniques visually. Full article

Background: Neuraxial anesthesia, delivered as a combined spinal–epidural without intubation or neuromuscular blockade, is a promising alternative for patients undergoing minimally invasive colorectal surgery. Evidence is limited to case series, with no cohort studies available. Methods: This is a retrospective analysis of consecutive patients undergoing minimally invasive colorectal surgery for both benign and malignant disease at a single institution, between October 2022 and October 2024. Patients were divided by the type of anesthesia. Propensity score matching was performed to reduce confounding bias. Outcomes assessed included anesthesiologic preparation time, duration of surgery, intraoperative features, intensive care unit admission, length of hospital stay, and 90-day postoperative complications, including anastomotic leak and readmission rates. Results: Thirty-two patients (40.5%) received neuraxial anesthesia and forty-seven (59.5%) received general anesthesia. No conversions from neuraxial to general anesthesia occurred. After matching, anesthesia preparation time was longer in the neuraxial group (42.5 vs. 30 min, p = 0.011), while operative time was significantly shorter (181 vs. 231 min, p = 0.002). Length of stay, postoperative complications, including leak, and readmission rates were comparable between groups. Conclusions: Neuraxial anesthesia may be a valid alternative to general anesthesia for minimally invasive colorectal surgery. In this single-center experience, it required longer anesthetic preparation but was associated with shorter operative times, without affecting surgical outcomes or increasing complication rates. These results support further investigation into its application in colorectal procedures. Full article

Background: Critical care for patients with severe burn injuries is challenging, particularly in the first 24–48 h. Multiple guidelines exist but their recommendations vary in content and in the level of detail. Methods: This narrative review analyzed recent (last 10 years) adult burn guidelines in English, Dutch and German, sourced from PubMed, Medline and official burn society publications. The review focused on airway management, mechanical ventilation, fluid resuscitation, pain management and procedural sedation. Results: All guidelines emphasize early airway assessment and timely intubation in patients at risk for loss of airway patency; however, a strategy for analyzing patients at risk is lacking. Lung-protective ventilation strategy is generally recommended. Fluid resuscitation is the cornerstone during the first phase, though recommendations for thresholds, volume and adjuncts differ. (Chronic) pain management should be multimodal, combining pharmacologic and non-pharmacologic approaches, but specifics on choice of modality are limited, also, there is no uniform strategy for procedural sedation management. Conclusion: Current guidelines offer broadly consistent recommendations for initial burn care but differ in specifics, reflecting evidence gaps. Future guidelines should address advances in airway management, fluid resuscitation endpoints, volume and adjuncts, and give a more detailed (chronic) pain strategy to improve standardization and outcomes. Full article

Background: Antimicrobial resistance (AMR) is a public health challenge, exacerbated by the inappropriate use of antibiotics (ABs) and the lack of standardized surveillance in healthcare settings. Objective: The Latin American PPS aimed to provide a standardized methodology for monitoring antibiotic use, gather data on antibiotic prescription practices, and support initiatives for antimicrobial stewardship (AMS). Methodology: Using a Spanish-adapted version of the WHO PPS methodology, a point prevalence survey (PPS) was conducted between 2022 and 2023 in 67 hospitals across five Latin American countries. Results: A total of 11,094 patients were surveyed, of which 47.9% received at least one AB; surgical and intensive care units displayed the highest prevalence. Most prescribed AB were third-generation cephalosporins (3GC) (22.0%), carbapenems (12.1%), glycopeptides (9.2%), and penicillin combinations (8.6%). A substantial use of agents classified under the WHO’s “Watch” group was found, with notable variances across countries. A multilevel logistic regression model identified that patient age, ICU admission, recent hospitalization, the presence of a catheter, and intubation were significantly associated with higher odds of AB use. In contrast, patients admitted to obstetric or pediatric wards had lower odds of receiving antibiotics. The model revealed considerable heterogeneity between countries, even after adjusting clinical and demographic factors. Conclusions: This study highlights AMS opportunities through targeted interventions, such as optimizing surgical prophylaxis, reducing the use of 3GC, carbapenems, and glycopeptides, and improving adherence to CPGs. These findings provide a comprehensive framework for policymakers and healthcare facilities to develop AMS strategies tailored to the Latin American context. Full article

Background: Tuberculosis (TB) is a leading cause of death among people living with HIV (PLHIV). While body mass index (BMI) affects TB risk, its association with latent tuberculosis infection (LTBI) in PLHIV is unclear. High-transmission settings, such as prisons, may further increase LTBI risk, yet this relationship has not been studied across both prison and community populations of PLHIV. Methods: We conducted a dual cross-sectional study of PLHIV in Jiangsu Province, China, recruiting participants from a prison hospital in 2021 and community healthcare facilities from July to November 2023. BMI was calculated from measured height and weight. LTBI was identified by a positive ESAT6-CFP10 (EC) skin test or the QuantiFERON-TB Gold In-Tube (QFT-GIT) assay. Logistic regression and generalized additive models (GAMs) assessed the association between BMI and LTBI, adjusting for demographic, clinical, and behavioral confounders. Results: A total of 1799 PLHIV were included in the analysis, of whom 343 (19.07%) were recruited from prison settings and 1456 (80.93%) from community-based screening. The overall prevalence of LTBI was 13.79% (n = 248). Obesity (BMI ≥ 28 kg/m²) was linked to a significantly lower risk of LTBI (adjusted OR = 0.47, 95% CI: 0.23–0.95, p = 0.036), particularly when identified by EC testing (adjusted OR = 0.13, 95% CI: 0.03–0.54, p = 0.005). The BMI–LTBI association followed a nonlinear “U-shaped” pattern, with the lowest prevalence in individuals who were obese. Among those with CD4+ T cell counts < 500 cells/μL, the inverse association between obesity and LTBI was even more marked (adjusted OR = 0.20, 95% CI: 0.05–0.83, p = 0.027). Conclusion: In summary, obesity is significantly associated with a lower risk of LTBI among PLHIV, with an approximate 54% risk reduction. This inverse relationship was most pronounced when using the EC skin test. Full article

Background/Objectives: Kaposiform hemangioendothelioma (KHE) is a rare, locally aggressive vascular tumor of infancy, often complicated by Kasabach–Merritt phenomenon (KMP), a consumptive coagulopathy characterized by severe thrombocytopenia and hypofibrinogenemia. Airway involvement at birth is exceptionally rare and can be life-threatening. This study reports the clinical presentation and treatment course of a full-term male neonate with severe airway obstruction caused by KHE with KMP. Case Presentation: The patient had unremarkable prenatal imaging but presented at birth with severe respiratory distress requiring emergent intubation. Physical examination revealed firm violaceous swelling over the right cervicothoracic region. Laboratory tests showed profound thrombocytopenia (22,000/μL), hypofibrinogenemia (75 mg/dL), and coagulopathy. Imaging findings were consistent with KHE complicated by KMP. Due to bleeding risk, the biopsy was not performed. Initial treatment included platelet and plasma transfusions, intravenous immunoglobulin (IVIG), corticosteroids, and antithrombin III replacement. Vincristine was discontinued owing to gastrointestinal toxicity. Sirolimus therapy was initiated on day 14. Following sirolimus initiation, rapid platelet recovery was observed. At three months, marked tumor regression was documented. After mild recurrence, sirolimus was reintroduced, and the patient remained stable at 16-month follow-up. Conclusions: This case underscores the critical importance of prompt airway stabilization, early recognition of consumptive coagulopathy, and sirolimus-based therapy in managing neonatal KHE with airway involvement. Full article

Weaning from invasive mechanical ventilation (IMV) is a key element in the management of critically ill patients, encompassing the entire process of discontinuing IMV. Despite its importance, considerable uncertainties remain regarding the optimal strategies to achieve successful weaning. Early weaning is crucial, as IMV is associated with complications related to high mortality rates, such as prolonged weaning and intubation-associated pneumonia (IAP). This review aims to highlight the role of non-invasive respiratory supports (NIRSs), including non-invasive ventilation (NIV) and high-flow nasal cannulas (HFNCs), as a therapeutic bridge between IMV dependency and spontaneous breathing. NIV and HFNCs are recommended to prevent post-extubation respiratory failure (PERF) in high-risk and low-risk patients, respectively, and their combination appears effective in high-risk populations. On the other hand, NIV is not advised in established non-hypercapnic PERF, as it may increase mortality by delaying intubation; however, it can facilitate extubation in patients with hypercapnic respiratory failure. NIRSs may also benefit patients at high risk of post-operative pulmonary complications such as acute respiratory failure (ARF), with either NIV or HFNCs being appropriate. In light of this evidence, appropriate NIRSs selection and application may be pivotal in achieving successful weaning and better outcomes in critically ill patients. Full article

Background: Emergency airway management is a crucial and complex procedure frequently performed in the emergency department (ED). Airway contamination usually caused by blood, secretions, and emesis impairs ventilation, reduces successful intubation, and increases the complication rates, leading to difficult laryngoscopy, delayed intubation, and increased mortality rates. One technique employed to decontaminate these airways when standard approaches fail is Suction-Assisted Laryngoscopy and Airway Decontamination (SALAD). Methods: A comprehensive literature search was conducted across PubMed, Cochrane, and Science direct databases following a specific search strategy. All search results were screened in a two-stage process (title–abstract and full-text screening) in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2020 guidelines. Data from finalized articles were extracted using a standardized excel file developed a priori. Lastly, quality and risk of bias were assessed using appropriate tools according to respective study designs, and data were narratively synthesized. Results: A total of 224 records were identified. Upon screening, seven studies were included consisting of five simulation-based studies and two clinical case reports. Simulation studies reported that SALAD training significantly improved first-pass intubation success (53.7–90.2%), reduced time to intubation (up to 30 s), and enhanced airway visualization. Clinical cases further reported successful first-pass intubation in patients with massive airway contamination without complications. Overall, across both study types, the SALAD technique improved airway management performance, provider confidence, and airway contamination control compared to standard suction techniques. Conclusions: This systematic review highlights the benefits of the SALAD technique by enhancing airway visualization, reinforcing it as a significant tool for contaminated airway management. Trainees who underwent SALAD training demonstrated improved first-pass intubation success, reduced intubation time, and increased operator confidence. While data from the included studies seems promising, most studies are small simulation-based studies with limited clinical outcome data. Given its clinical relevance and educational value, future studies must prioritize high-quality research in clinical environments to establish SALAD’s efficacy and to define its role in integration into prehospital protocols. Full article

Background/Objectives: C-reactive protein (CRP) is widely used as a marker of perioperative inflammation, but its predictive value for cardiac surgical outcomes remains uncertain. Obstructive sleep apnea (OSA), a prevalent and underrecognized comorbidity, may independently contribute to postoperative complications through non-inflammatory mechanisms. This study aimed to reevaluate the prognostic role of CRP and determine the clinical impact of OSA severity on postoperative recovery, focusing on new-onset atrial fibrillation (AF), prolonged intubation time, and postoperative CPAP/AIRVO use as indicators of respiratory burden. Methods: In this prospective cohort of 142 elective cardiac surgery patients, preoperative polysomnography and serial CRP measurements were obtained. Multivariable regression, mediation analysis, and propensity score matching (PSM) were performed to evaluate associations between OSA severity, CRP, and perioperative outcomes (AF, intubation time, CPAP/AIRVO use). Results: OSA severity independently predicted prolonged intubation (β = 1.74, p = 0.0019) and new-onset AF (β = 0.85, p = 0.004), even after excluding patients with preexisting arrhythmia. CRP showed poor discriminatory power as a standalone biomarker (AUC for IOT > 14 h = 0.445) and did not mediate OSA–outcome associations. However, CRP > 2.1 mg/dL doubled the odds of moderate-to-severe OSA (OR = 2.05, p = 0.041). A composite score integrating AHI, BMI, and postoperative CRP strongly correlated with postoperative respiratory support (p < 0.0001). Conclusions: OSA exerts a stronger and more consistent influence on perioperative outcomes than CRP, challenging reliance on CRP for risk stratification. Incorporating objective OSA screening and spirometry into preoperative assessment may enhance perioperative risk prediction and guide personalized management strategies. Full article