Procedures

Bronchoscopy

 Wang KP. Transbronchial needle aspiration and percutaneous needle aspiration for staging and diagnosis of lung cancer. Clin Chest Med 1995;16:535-52. Focuses on the nuts and bolts of the technique rather than indications, yield, and risks. Diagrams of endobronchial landmarks for different nodes may be of practical use just prior to procedure. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8521707

Weiss SM, Hert RC, Gianola FJ et al. Complications of fiberoptic bronchoscopy in thrombocytopenic patients. Chest 1993;104:1025-8. Established safety of transnasal bronchs in thrombocytopenic patients. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8404159

Herth FJF, Becker HD, Ernst A.  Aspirin does not increase bleeding complications after transbronchial biopsy. Chest 2002;122:1461-4 Prospective study compared 285 patients taking ASA within 24 hrs of TBB to 932 non-ASA users and found no difference in the risk of minor, moderate, or major bleeding. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12377879    

***See also Lung Cancer Staging

Thoracentesis

Jones PW, Moyers JP, Rogers JT et al. Ultrasound-guided thoracentesis: is it a safer method? Chest 2003; 123:418-423. Prospective descriptive study of 605 patients referred for a total of 941 ultrasound-guided thoracenteses.  2.5% sustained a pneumothorax of whom a third received a chest tube; this is a lower incidence than most reported studies without ultrasound guidance, but all procedures were performed by 7 experienced interventional radiologists.  As with previous studies, the yield of routine post-procedure films was low in asymptomatic patients; 3 of 907 had a pneumothorax managed with a chest tube.  Of note, 2 of 373 patients (0.5%) developed re-expansion pulmonary edema following removal of > 1 liter of fluid.  Investigators terminated fluid removal if the patient developed dyspnea or excessive cough.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12576360

Sallach SM, Sallach JA, Vasquez E, et al. Volume of pleural fluid required for diagnosis of pleural malignancy.  Chest 2002;122:1913-7 In this retrospective case series, the yield of thoracentesis for the diagnosis of malignancy was independent of the volume of fluid collected. These findings were borne out in a subsequent smaller prospective study (Abouzgheib W, et al. Chest 2009; 135:999-1001). http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12475826

 
Endotracheal intubation

Walz JM, Zayaruzny M, Heard SO. Airway management in critical illness.  Chest 2007; 131:608-20.  Concise review of the nuts and bolts of endotracheal intubation in critically-ill patients.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17296669&query_hl=7&itool=pubmed_docsum

 
Percutaneous tracheostomies

Delaney A, Bagshaw SM, Nalos M. Percutaneous dilatational tracheostomy versus surgical tracheostomy in critically ill patients: a systematic review and meta-analysis.  Crit Care  2006; 10:R55.  Systematic review of 17 RCTs comparing elective percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) in adult critically ill patients (17 RCTs involving 1,212 patients). The analysis concluded that PDT reduces the overall incidence of wound infection and may further reduce clinical relevant bleeding and mortality when compared with ST performed in the operating theatre. http://www.ncbi.nlm.nih.gov/pubmed/16606435?ordinalpos=8&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Griffiths J, Barber VS, Morgan L, Young JD. Systematic review and meta-analysis of studies of the timing of tracheostomy in adult patients undergoing artificial ventilation. BMJ. 2005;330:1243. Summarizes the limited literature on outcomes following early vs. late tracheostomy in medical and surgical ICU patients.  Authors did not derive firm recommendations on the optimal timing of tracheostomy.  http://www.ncbi.nlm.nih.gov/pubmed/15901643?ordinalpos=101&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSumv

Chest Tubes

Gilbert TB, McGrath BJ, Soberman M. Chest tubes: indications, placement, management, and complications. J Intensive Care Med 1993;8:73-86.  http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10148363

Catheters, Central Venous

Sherertz RJ, Ely EW, Westbrook DM, et al. Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med 2000;132:641-8. Study found a course on central venous catheter placement for residents emphasizing the use of full-size drapes reduced catheter-related infections. This article is a motivator to teach housestaff to do the job right when the unit gets busy and there is the temptation to cut corners. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10766683

Mermel LA, Farr BM, Sherertz RJ, et al. Guidelines for the management of intravascular catheter- related infections. Clin Infect Dis 2001;32:1249-72. Comprehensive, reader-friendly. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11303260

Timsit JF, Schwebel C, Bouadma L, et al. Chlorhexidine-impregnated sponges and less frequent dressing changes for prevention of catheter-related infections in critically ill adults: a randomized controlled trial. JAMA 2009; 301:12331-41. The recent loss of Medicare and Medicaid reimbursement for the cost of managing catheter-related bloodstream infections has made prevention of line infections an especially hot topic. This study is noteworthy for finding a low rate of catheter-related infections with standard therapy (1.3/1,000 catheter days) despite not using antiseptic or antibiotic-coated catheters when best practices for placement and maintenance were employed. Use of the chlorhexidine sponges was associated with a reduction in infection rate to 0.4/1,000 catheter days. Changing dressings q 7 days was equivalent to q 3 days as long as the site was unsoiled and free of leaks. http://www.ncbi.nlm.nih.gov/pubmed/19318651?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_RVAbstractPlus