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Wahidi, Momen Mohammed

Overview:

Emphysema, Lung Nodules, Lung Cancer, Bronchoscopy, Pleural Diseases

Positions:

Associate Professor of Medicine

Medicine, Pulmonary, Allergy, and Critical Care Medicine
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 1992

M.D. — Damascus University, Faculty of Medicine (Syria)

News:

Grants:

Percepta R-1 Registry

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
AwardedBy
Veracyte, Inc.
Role
Principal Investigator
Start Date
June 15, 2016
End Date
June 14, 2021

CS-IP-VH-14-009

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
AwardedBy
CareFusion Corporation
Role
Principal Investigator
Start Date
October 01, 2016
End Date
September 30, 2018

NAVIGATE

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
AwardedBy
Covidien Ltd.
Role
Principal Investigator
Start Date
June 01, 2015
End Date
June 01, 2018

Remimazolam (CNS7056) Patients Undergoing Bronchoscopy

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
AwardedBy
Premier Research
Role
Principal Investigator
Start Date
May 01, 2015
End Date
May 01, 2017

BROADWAY: Broncho-Adventitial Delivery of Paclitaxel To Extend Airway Patency in Malignant Airway Obstruction Patients

Administered By
Medicine, Pulmonary, Allergy, and Critical Care Medicine
AwardedBy
Mercator MedSystems, Inc.
Role
Principal Investigator
Start Date
May 12, 2015
End Date
August 31, 2016
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Publications:

Interventional Pulmonology Fellowship Accreditation Standards: Executive Summary of the Multi-society Interventional Pulmonology Fellowship Accreditation Committee.

Interventional Pulmonology (IP) is a rapidly evolving subspecialty of pulmonary medicine. In the last ten years formal IP fellowships have increased substantially in number from just five to now over thirty. The vast majority of IP fellowship trainees are selected through the National Residency Matching Program, and validated in-service and certification exams for IP exist. Practice standards and training guidelines for IP fellowship programs have been published, however considerable variability in the environment, curriculum, and experience offered by the various fellowship programs still exists and there is currently no formal accreditation process in place to standardize IP fellowship training. Recognizing the need for more uniform training across the various fellowship programs, a multi-society accreditation committee was formed with the intent to establish common accreditation standards for all IP fellowship programs in the United States. This article provides a summary of those standards and can serve as an accreditation template for training programs and their offices of graduate medical education as they move through the accreditation process.

Authors
Mullon, JJ; Burkart, KM; Silvestri, G; Hogarth, DK; Almeida, F; Berkowitz, D; Eapen, G; Feller-Kopman, D; Fessler, HE; Folch, E; Gillespie, C; Haas, A; Islam, S; Lamb, C; Levine, SM; Majid, A; Maldonado, F; Musani, A; Piquette, C; Ray, C; Reddy, C; Rickman, O; Simoff, M; Wahidi, MM; Lee, H
MLA Citation
Mullon, JJ, Burkart, KM, Silvestri, G, Hogarth, DK, Almeida, F, Berkowitz, D, Eapen, G, Feller-Kopman, D, Fessler, HE, Folch, E, Gillespie, C, Haas, A, Islam, S, Lamb, C, Levine, SM, Majid, A, Maldonado, F, Musani, A, Piquette, C, Ray, C, Reddy, C, Rickman, O, Simoff, M, Wahidi, MM, and Lee, H. "Interventional Pulmonology Fellowship Accreditation Standards: Executive Summary of the Multi-society Interventional Pulmonology Fellowship Accreditation Committee." Chest (January 26, 2017).
PMID
28132754
Source
epmc
Published In
Chest
Publish Date
2017
DOI
10.1016/j.chest.2017.01.024

The Changing Role for Tracheostomy in Patients Requiring Mechanical Ventilation.

Tracheostomy is performed in patients who require prolonged mechanical ventilation or have upper airway instability. Percutaneous tracheostomy with Ciaglia technique is commonly used and rivals the surgical approach. Percutaneous technique is associated with decreased risk of stomal inflammation, infection, and bleeding along with reduction in health resource utilization when performed at bedside. Bronchoscopy and ultrasound guidance improve the safety of percutaneous tracheostomy. Early tracheostomy decreases the need for sedation and intensive care unit stay but may be unnecessary in some patients who can be extubated later successfully. A multidisciplinary approach to tracheostomy care leads to improved outcomes.

Authors
Mahmood, K; Wahidi, MM
MLA Citation
Mahmood, K, and Wahidi, MM. "The Changing Role for Tracheostomy in Patients Requiring Mechanical Ventilation." Clinics in chest medicine 37.4 (December 2016): 741-751.
PMID
27842753
Source
epmc
Published In
Clinics in Chest Medicine
Volume
37
Issue
4
Publish Date
2016
Start Page
741
End Page
751
DOI
10.1016/j.ccm.2016.07.013

Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions-The ASAP Trial.

Patients with malignant pleural effusions have significant dyspnea and shortened life expectancy. Indwelling pleural catheters (IPC) allow patients to drain pleural fluid at home and can lead to auto-pleurodesis. The optimal drainage frequency to achieve auto-pleurodesis and freedom from catheter has not been determined.To determine whether an aggressive daily drainage strategy is superior to the current standard every other day drainage of pleural fluid in achieving auto-pleurodesis.Patients were randomized to either an aggressive drainage (daily drainage, N=73) or standard drainage (every other day drainage, N=76) of pleural fluid via a tunneled pleural catheter. Measurements and Main results The primary outcome was the incidence of auto-pleurodesis following the placement of the IPC. The rate of auto-pleurodesis, defined as complete or partial response based on symptomatic and radiographic changes, was greater in the aggressive drainage arm than the standard drainage arm (47% vs. 24%, respectively; P = 0.003). Median time-to-auto-pleurodesis was shorter in the aggressive arm (54 days; 95% confidence interval (CI) 34 to 83) as compared to the standard arm (90 days; 95% CI 70 to non-estimable). Rate of adverse events, quality of life and patient satisfaction were not significantly different between the two arms.Among patients with malignant pleural effusion, daily drainage of pleural fluid via an indwelling pleural catheter led to a higher rate of auto-pleurodesis and faster time to liberty from catheter. Clinical trial registration available at www.clinicaltrials.gov, ID NCT00978939.

Authors
Wahidi, MM; Reddy, C; Yarmus, L; Feller-Kopman, D; Musani, A; Shepherd, RW; Lee, H; Bechara, R; Lamb, C; Shofer, S; Mahmood, K; Michaud, G; Puchalski, J; Rafeq, S; Cattaneo, SM; Mullon, J; Leh, S; Mayse, M; Thomas, SM; Peterson, B; Light, RW
MLA Citation
Wahidi, MM, Reddy, C, Yarmus, L, Feller-Kopman, D, Musani, A, Shepherd, RW, Lee, H, Bechara, R, Lamb, C, Shofer, S, Mahmood, K, Michaud, G, Puchalski, J, Rafeq, S, Cattaneo, SM, Mullon, J, Leh, S, Mayse, M, Thomas, SM, Peterson, B, and Light, RW. "Randomized Trial of Pleural Fluid Drainage Frequency in Patients with Malignant Pleural Effusions-The ASAP Trial." American journal of respiratory and critical care medicine (November 29, 2016).
PMID
27898215
Source
epmc
Published In
American journal of respiratory and critical care medicine
Publish Date
2016

Response.

Authors
Wahidi, MM; Patel, S
MLA Citation
Wahidi, MM, and Patel, S. "Response." Chest 150.1 (July 2016): 255-256.
PMID
27396787
Source
epmc
Published In
Chest
Volume
150
Issue
1
Publish Date
2016
Start Page
255
End Page
256
DOI
10.1016/j.chest.2016.05.018

Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema: The RENEW Randomized Clinical Trial.

Preliminary clinical trials have demonstrated that endobronchial coils compress emphysematous lung tissue and may improve lung function, exercise tolerance, and symptoms in patients with emphysema and severe lung hyperinflation.To determine the effectiveness and safety of endobronchial coil treatment.Randomized clinical trial conducted among 315 patients with emphysema and severe air trapping recruited from 21 North American and 5 European sites from December 2012 through November 2015.Participants were randomly assigned to continue usual care alone (guideline based, including pulmonary rehabilitation and bronchodilators; n = 157) vs usual care plus bilateral coil treatment (n = 158) involving 2 sequential procedures 4 months apart in which 10 to 14 coils were bronchoscopically placed in a single lobe of each lung.The primary effectiveness outcome was difference in absolute change in 6-minute-walk distance between baseline and 12 months (minimal clinically important difference [MCID], 25 m). Secondary end points included the difference between groups in 6-minute walk distance responder rate, absolute change in quality of life using the St George's Respiratory Questionnaire (MCID, 4) and change in forced expiratory volume in the first second (FEV1; MCID, 10%). The primary safety analysis compared the proportion of participants experiencing at least 1 of 7 prespecified major complications.Among 315 participants (mean age, 64 years; 52% women), 90% completed the 12-month follow-up. Median change in 6-minute walk distance at 12 months was 10.3 m with coil treatment vs -7.6 m with usual care, with a between-group difference of 14.6 m (Hodges-Lehmann 97.5% CI, 0.4 m to ∞; 1-sided P = .02). Improvement of at least 25 m occurred in 40.0% of patients in the coil group vs 26.9% with usual care (odds ratio, 1.8 [97.5% CI, 1.1 to ∞]; unadjusted between-group difference, 11.8% [97.5% CI, 1.0% to ∞]; 1-sided P = .01). The between-group difference in median change in FEV1 was 7.0% (97.5% CI, 3.4% to ∞; 1-sided P < .001), and the between-group St George's Respiratory Questionnaire score improved -8.9 points (97.5% CI, -∞ to -6.3 points; 1-sided P < .001), each favoring the coil group. Major complications (including pneumonia requiring hospitalization and other potentially life-threatening or fatal events) occurred in 34.8% of coil participants vs 19.1% of usual care (P = .002). Other serious adverse events including pneumonia (20% coil vs 4.5% usual care) and pneumothorax (9.7% vs 0.6%, respectively) occurred more frequently in the coil group.Among patients with emphysema and severe hyperinflation treated for 12 months, the use of endobronchial coils compared with usual care resulted in an improvement in median exercise tolerance that was modest and of uncertain clinical importance, with a higher likelihood of major complications. Further follow-up is needed to assess long-term effects on health outcomes.clinicaltrials.gov Identifier: NCT01608490.

Authors
Sciurba, FC; Criner, GJ; Strange, C; Shah, PL; Michaud, G; Connolly, TA; Deslée, G; Tillis, WP; Delage, A; Marquette, C-H; Krishna, G; Kalhan, R; Ferguson, JS; Jantz, M; Maldonado, F; McKenna, R; Majid, A; Rai, N; Gay, S; Dransfield, MT; Angel, L; Maxfield, R; Herth, FJF; Wahidi, MM; Mehta, A; Slebos, D-J
MLA Citation
Sciurba, FC, Criner, GJ, Strange, C, Shah, PL, Michaud, G, Connolly, TA, Deslée, G, Tillis, WP, Delage, A, Marquette, C-H, Krishna, G, Kalhan, R, Ferguson, JS, Jantz, M, Maldonado, F, McKenna, R, Majid, A, Rai, N, Gay, S, Dransfield, MT, Angel, L, Maxfield, R, Herth, FJF, Wahidi, MM, Mehta, A, and Slebos, D-J. "Effect of Endobronchial Coils vs Usual Care on Exercise Tolerance in Patients With Severe Emphysema: The RENEW Randomized Clinical Trial." JAMA 315.20 (May 15, 2016): 2178-2189.
PMID
27179849
Source
epmc
Published In
JAMA : the journal of the American Medical Association
Volume
315
Issue
20
Publish Date
2016
Start Page
2178
End Page
2189
DOI
10.1001/jama.2016.6261

Endogenous pneumoconiosis: Analytical scanning electron microscopic analysis of a case.

Pneumoconiosis is often considered a disease of the lung initiated by exposure to dust or other airborne particles, resulting in injury to the lungs. The term "endogenous pneumoconiosis" has been used in the literature to describe the deposition of compounds on the elastic fibers of the lung, usually in the setting of cardiac failure. In the case we present here, the patient aspirated a foreign body resulting in damage to the lung tissue and subsequent deposition of endogenous compounds on the elastic fibers of the pulmonary parenchyma and vasculature. We determined the composition of this mineral and mapped the distribution of elements using a combination of backscattered electron microscopy and energy dispersive spectrometry.

Authors
Galeotti, J; Sporn, TA; Ingram, P; Wahidi, MM; Roggli, VL
MLA Citation
Galeotti, J, Sporn, TA, Ingram, P, Wahidi, MM, and Roggli, VL. "Endogenous pneumoconiosis: Analytical scanning electron microscopic analysis of a case." Ultrastructural pathology 40.3 (May 2016): 159-162.
PMID
27281119
Source
epmc
Published In
Ultrastructural Pathology (Informa)
Volume
40
Issue
3
Publish Date
2016
Start Page
159
End Page
162
DOI
10.3109/01913123.2016.1170084

Design of a prospective, multicenter, global, cohort study of electromagnetic navigation bronchoscopy.

Electromagnetic navigation bronchoscopy (ENB) procedures allow physicians to access peripheral lung lesions beyond the reach of conventional bronchoscopy. However, published research is primarily limited to small, single-center studies using previous-generation ENB software. The impact of user experience, patient factors, and lesion/procedural characteristics remains largely unexplored in a large, multicenter study.NAVIGATE (Clinical Evaluation of superDimension™ Navigation System for Electromagnetic Navigation Bronchoscopy) is a prospective, multicenter, global, cohort study. The study aims to enroll up to 2,500 consecutive subjects presenting for evaluation of lung lesions utilizing the ENB procedure at up to 75 clinical sites in the United States, Europe, and Asia. Subjects will be assessed at baseline, at the time of procedure, and at 1, 12, and 24 months post-procedure. The pre-test probability of malignancy will be determined for peripheral lung nodules. Endpoints include procedure-related adverse events, including pneumothorax, bronchopulmonary hemorrhage, and respiratory failure, as well as quality of life, and subject satisfaction. Diagnostic yield and accuracy, repeat biopsy rate, tissue adequacy for genetic testing, and stage at diagnosis will be reported for biopsy procedures. Complementary technologies, such as fluoroscopy and endobronchial ultrasound, will be explored. Success rates of fiducial marker placement, dye marking, and lymph node biopsies will be captured when applicable. Subgroup analyses based on geography, demographics, investigator experience, and lesion and procedure characteristics are planned.Study enrollment began in April 2015. As of February 19, 2016, 500 subjects had been enrolled at 23 clinical sites with enrollment ongoing. NAVIGATE will be the largest prospective, multicenter clinical study on ENB procedures to date and will provide real-world experience data on the utility of the ENB procedure in a broad range of clinical scenarios.ClinicalTrials.gov NCT02410837 . Registered 31 March 2015.

Authors
Folch, EE; Bowling, MR; Gildea, TR; Hood, KL; Murgu, SD; Toloza, EM; Wahidi, MM; Williams, T; Khandhar, SJ
MLA Citation
Folch, EE, Bowling, MR, Gildea, TR, Hood, KL, Murgu, SD, Toloza, EM, Wahidi, MM, Williams, T, and Khandhar, SJ. "Design of a prospective, multicenter, global, cohort study of electromagnetic navigation bronchoscopy." BMC pulmonary medicine 16.1 (April 26, 2016): 60-. (Review)
PMID
27113209
Source
epmc
Published In
BMC Pulmonary Medicine
Volume
16
Issue
1
Publish Date
2016
Start Page
60
DOI
10.1186/s12890-016-0228-y

Development of a Tool to Assess Basic Competency in the Performance of Rigid Bronchoscopy.

Rigid bronchoscopy is increasingly used by pulmonologists for the management of central airway disorders. However, an assessment tool to evaluate the competency of operators in the performance of this technique has not been developed. We created the Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) to serve as an objective, competency-oriented assessment tool of basic rigid bronchoscopic skills, including rigid bronchoscopic intubation and central airway navigation.To assess whether RIGID-TASC scores accurately distinguish the basic rigid bronchoscopy skills of novice, intermediate, and expert operators, and to determine whether RIGID-TASC has adequate interrater reliability when used by different independent testers.At two academic medical centers in the United States, 30 physician volunteers were selected in three categories: 10 novices at rigid bronchoscopy (performed at least 50 flexible, but no rigid, bronchoscopies), 10 operators with intermediate experience (performed 5-20 rigid bronchoscopies), and 10 experts (performed ≥100 rigid bronchoscopies). Participants included pulmonary and critical care fellows, interventional pulmonology fellows, and faculty interventional pulmonologists. Each subject then performed rigid bronchoscopic intubation and navigation on a manikin, while being scored independently by two testers, using RIGID-TASC.Mean scores for three categories (novice, intermediate, and expert) were 58.10 (±4.6 [SE]), 78.15 (±3.8), and 94.40 (±1.1), respectively. There was significant difference between novice and intermediate (20.05, 95% confidence interval [CI] = 7.77-32.33, P = 0.001), and intermediate and expert (16.25, 95% CI = 3.97-28.53, P = 0.008) operators. The interrater reliability (intraclass correlation coefficient) between the two testers was high (r = 0.95, 95% CI = 0.90-0.98).RIGID-TASC showed evidence of construct validity and interrater reliability in this setting and group of subjects. It can be used to reliably and objectively score and classify operators from novice to expert in basic rigid bronchoscopic intubation and navigation.

Authors
Mahmood, K; Wahidi, MM; Osann, KE; Coles, K; Shofer, SL; Volker, EE; Davoudi, M
MLA Citation
Mahmood, K, Wahidi, MM, Osann, KE, Coles, K, Shofer, SL, Volker, EE, and Davoudi, M. "Development of a Tool to Assess Basic Competency in the Performance of Rigid Bronchoscopy." Annals of the American Thoracic Society 13.4 (April 2016): 502-511.
PMID
26989810
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
13
Issue
4
Publish Date
2016
Start Page
502
End Page
511
DOI
10.1513/annalsats.201509-593oc

Interventional Pulmonology: Marching Forward Together.

Authors
Wahidi, MM
MLA Citation
Wahidi, MM. "Interventional Pulmonology: Marching Forward Together." Journal of bronchology & interventional pulmonology 23.2 (April 2016): 87-88.
PMID
27058708
Source
epmc
Published In
Journal of Bronchology and Interventional Pulmonology
Volume
23
Issue
2
Publish Date
2016
Start Page
87
End Page
88
DOI
10.1097/lbr.0000000000000274

Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report.

Endobronchial ultrasound (EBUS) was introduced in the last decade, enabling real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures and parabronchial lung masses. The many publications produced about EBUS-TBNA have led to a better understanding of the performance characteristics of this procedure. The goal of this document was to examine the current literature on the technical aspects of EBUS-TBNA as they relate to patient, technology, and proceduralist factors to provide evidence-based and expert guidance to clinicians.Rigorous methodology has been applied to provide a trustworthy evidence-based guideline and expert panel report. A group of approved panelists developed key clinical questions by using the PICO (population, intervention, comparator, and outcome) format that addressed specific topics on the technical aspects of EBUS-TBNA. MEDLINE (via PubMed) and the Cochrane Library were systematically searched for relevant literature, which was supplemented by manual searches. References were screened for inclusion, and well-recognized document evaluation tools were used to assess the quality of included studies, to extract meaningful data, and to grade the level of evidence to support each recommendation or suggestion.Our systematic review and critical analysis of the literature on 15 PICO questions related to the technical aspects of EBUS-TBNA resulted in 12 statements: 7 evidence-based graded recommendations and 5 ungraded consensus-based statements. Three questions did not have sufficient evidence to generate a statement.Evidence on the technical aspects of EBUS-TBNA varies in strength but is satisfactory in certain areas to guide clinicians on the best conditions to perform EBUS-guided tissue sampling. Additional research is needed to enhance our knowledge regarding the optimal performance of this effective procedure.

Authors
Wahidi, MM; Herth, F; Yasufuku, K; Shepherd, RW; Yarmus, L; Chawla, M; Lamb, C; Casey, KR; Patel, S; Silvestri, GA; Feller-Kopman, DJ
MLA Citation
Wahidi, MM, Herth, F, Yasufuku, K, Shepherd, RW, Yarmus, L, Chawla, M, Lamb, C, Casey, KR, Patel, S, Silvestri, GA, and Feller-Kopman, DJ. "Technical Aspects of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: CHEST Guideline and Expert Panel Report." Chest 149.3 (March 2016): 816-835.
PMID
26402427
Source
epmc
Published In
Chest
Volume
149
Issue
3
Publish Date
2016
Start Page
816
End Page
835
DOI
10.1378/chest.15-1216

Role Of Mitomycin C Application In Lung Transplantation Related Airway Stenosis

Authors
Mahmood, K; Elmasri, M; Wahidi, MM; Snyder, L; Shofer, SL
MLA Citation
Mahmood, K, Elmasri, M, Wahidi, MM, Snyder, L, and Shofer, SL. "Role Of Mitomycin C Application In Lung Transplantation Related Airway Stenosis." 2016.
Source
wos-lite
Published In
American journal of respiratory and critical care medicine
Volume
193
Publish Date
2016

A randomised trial of lung sealant versus medical therapy for advanced emphysema.

Uncontrolled pilot studies demonstrated promising results of endoscopic lung volume reduction using emphysematous lung sealant (ELS) in patients with advanced, upper lobe predominant emphysema. We aimed to evaluate the safety and efficacy of ELS in a randomised controlled setting.Patients were randomised to ELS plus medical treatment or medical treatment alone. Despite early termination for business reasons and inability to assess the primary 12-month end-point, 95 out of 300 patients were successfully randomised, providing sufficient data for 3- and 6-month analysis.57 patients (34 treatment and 23 control) had efficacy results at 3 months; 34 (21 treatment and 13 control) at 6 months. In the treatment group, 3-month lung function, dyspnoea, and quality of life improved significantly from baseline when compared to control. Improvements persisted at 6 months with >50% of treated patients experiencing clinically important improvements, including some whose lung function improved by >100%. 44% of treated patients experienced adverse events requiring hospitalisation (2.5-fold more than control, p=0.01), with two deaths in the treated cohort. Treatment responders tended to be those experiencing respiratory adverse events.Despite early termination, results show that minimally invasive ELS may be efficacious, yet significant risks (probably inflammatory) limit its current utility.

Authors
Come, CE; Kramer, MR; Dransfield, MT; Abu-Hijleh, M; Berkowitz, D; Bezzi, M; Bhatt, SP; Boyd, MB; Cases, E; Chen, AC; Cooper, CB; Flandes, J; Gildea, T; Gotfried, M; Hogarth, DK; Kolandaivelu, K; Leeds, W; Liesching, T; Marchetti, N; Marquette, C; Mularski, RA; Pinto-Plata, VM; Pritchett, MA; Rafeq, S; Rubio, ER; Slebos, D-J; Stratakos, G; Sy, A; Tsai, LW; Wahidi, M; Walsh, J; Wells, JM; Whitten, PE; Yusen, R; Zulueta, JJ; Criner, GJ; Washko, GR
MLA Citation
Come, CE, Kramer, MR, Dransfield, MT, Abu-Hijleh, M, Berkowitz, D, Bezzi, M, Bhatt, SP, Boyd, MB, Cases, E, Chen, AC, Cooper, CB, Flandes, J, Gildea, T, Gotfried, M, Hogarth, DK, Kolandaivelu, K, Leeds, W, Liesching, T, Marchetti, N, Marquette, C, Mularski, RA, Pinto-Plata, VM, Pritchett, MA, Rafeq, S, Rubio, ER, Slebos, D-J, Stratakos, G, Sy, A, Tsai, LW, Wahidi, M, Walsh, J, Wells, JM, Whitten, PE, Yusen, R, Zulueta, JJ, Criner, GJ, and Washko, GR. "A randomised trial of lung sealant versus medical therapy for advanced emphysema." The European respiratory journal 46.3 (September 2015): 651-662.
PMID
25837041
Source
epmc
Published In
The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
Volume
46
Issue
3
Publish Date
2015
Start Page
651
End Page
662
DOI
10.1183/09031936.00205614

The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies: A Multicenter Study.

Malignant pleural effusion is a common complication of advanced malignancies. Indwelling tunneled pleural catheter (IPC) placement provides effective palliation but can be associated with complications, including infection. In particular, hematologic malignancy and the associated immunosuppressive treatment regimens may increase infectious complications. This study aimed to review outcomes in patients with hematologic malignancy undergoing IPC placement.A retrospective multicenter study of IPCs placed in patients with hematologic malignancy from January 2009 to December 2013 was performed. Inclusion criteria were recurrent, symptomatic pleural effusion and an underlying diagnosis of hematologic malignancy. Records were reviewed for patient demographics, operative reports, and pathology, cytology, and microbiology reports.Ninety-one patients (mean ± SD age, 65.4 ± 15.4 years) were identified from eight institutions. The mean × SD in situ dwell time of all catheters was 89.9 ± 127.1 days (total, 8,160 catheter-days). Seven infectious complications were identified, all of the pleural space. All patients were admitted to the hospital for treatment, with four requiring additional pleural procedures. Two patients died of septic shock related to pleural infection.We present, to our knowledge, the largest study examining clinical outcomes related to IPC placement in patients with hematologic malignancy. An overall 7.7% infection risk and 2.2% mortality were identified, similar to previously reported studies, despite the significant immunosuppression and pancytopenia often present in this population. IPC placement appears to remain a reasonable clinical option for patients with recurrent pleural effusions related to hematologic malignancy.

Authors
Gilbert, CR; Lee, HJ; Skalski, JH; Maldonado, F; Wahidi, M; Choi, PJ; Bessich, J; Sterman, D; Argento, AC; Shojaee, S; Gorden, JA; Wilshire, CL; Feller-Kopman, D; Ortiz, R; Nonyane, BAS; Yarmus, L
MLA Citation
Gilbert, CR, Lee, HJ, Skalski, JH, Maldonado, F, Wahidi, M, Choi, PJ, Bessich, J, Sterman, D, Argento, AC, Shojaee, S, Gorden, JA, Wilshire, CL, Feller-Kopman, D, Ortiz, R, Nonyane, BAS, and Yarmus, L. "The Use of Indwelling Tunneled Pleural Catheters for Recurrent Pleural Effusions in Patients With Hematologic Malignancies: A Multicenter Study." Chest 148.3 (September 2015): 752-758.
PMID
25789576
Source
epmc
Published In
Chest
Volume
148
Issue
3
Publish Date
2015
Start Page
752
End Page
758
DOI
10.1378/chest.14-3119

Adult Bronchoscopy Training: Current State and Suggestions for the Future: CHEST Expert Panel Report.

The determination of competency of trainees in programs performing bronchoscopy is quite variable. Some programs provide didactic lectures with hands-on supervision, other programs incorporate advanced simulation centers, whereas others have a checklist approach. Although no single method has been proven best, the variability alone suggests that outcomes are variable. Program directors and certifying bodies need guidance to create standards for training programs. Little well-developed literature on the topic exists.To provide credible and trustworthy guidance, rigorous methodology has been applied to create this bronchoscopy consensus training statement. All panelists were vetted and approved by the CHEST Guidelines Oversight Committee. Each topic group drafted questions in a PICO (population, intervention, comparator, outcome) format. MEDLINE data through PubMed and the Cochrane Library were systematically searched. Manual searches also supplemented the searches. All gathered references were screened for consideration based on inclusion criteria, and all statements were designated as an Ungraded Consensus-Based Statement.We suggest that professional societies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. Bronchoscopy training programs should incorporate multiple tools, including simulation. We suggest that ongoing quality and process improvement systems be introduced and that certifying agencies move from a volume-based certification system to skill acquisition and knowledge-based competency assessment for trainees. We also suggest that assessment of skill maintenance and improvement in practice be evaluated regularly with ongoing quality and process improvement systems after initial skill acquisition.The current methods used for bronchoscopy competency in training programs are variable. We suggest that professional societies and certifying agencies move from a volume- based certification system to a standardized skill acquisition and knowledge-based competency assessment for pulmonary and thoracic surgery trainees.

Authors
Ernst, A; Wahidi, MM; Read, CA; Buckley, JD; Addrizzo-Harris, DJ; Shah, PL; Herth, FJF; de Hoyos Parra, A; Ornelas, J; Yarmus, L; Silvestri, GA
MLA Citation
Ernst, A, Wahidi, MM, Read, CA, Buckley, JD, Addrizzo-Harris, DJ, Shah, PL, Herth, FJF, de Hoyos Parra, A, Ornelas, J, Yarmus, L, and Silvestri, GA. "Adult Bronchoscopy Training: Current State and Suggestions for the Future: CHEST Expert Panel Report." Chest 148.2 (August 2015): 321-332.
PMID
25674901
Source
epmc
Published In
Chest
Volume
148
Issue
2
Publish Date
2015
Start Page
321
End Page
332
DOI
10.1378/chest.14-0678

Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction: Results of the AQuIRE Registry.

There are significant variations in how therapeutic bronchoscopy for malignant airway obstruction is performed. Relatively few studies have compared how these approaches affect the incidence of complications.We used the American College of Chest Physicians (CHEST) Quality Improvement Registry, Evaluation, and Education (AQuIRE) program registry to conduct a multicenter study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was the incidence of complications. Secondary outcomes were incidence of bleeding, hypoxemia, respiratory failure, adverse events, escalation in level of care, and 30-day mortality.Fifteen centers performed 1,115 procedures on 947 patients. There were significant differences among centers in the type of anesthesia (moderate vs deep or general anesthesia, P < .001), use of rigid bronchoscopy (P < .001), type of ventilation (jet vs volume cycled, P < .001), and frequency of stent use (P < .001). The overall complication rate was 3.9%, but significant variation was found among centers (range, 0.9%-11.7%; P = .002). Risk factors for complications were urgent and emergent procedures, American Society of Anesthesiologists (ASA) score > 3, redo therapeutic bronchoscopy, and moderate sedation. The 30-day mortality was 14.8%; mortality varied among centers (range, 7.7%-20.2%, P = .02). Risk factors for 30-day mortality included Zubrod score > 1, ASA score > 3, intrinsic or mixed obstruction, and stent placement.Use of moderate sedation and stents varies significantly among centers. These factors are associated with increased complications and 30-day mortality, respectively.

Authors
Ost, DE; Ernst, A; Grosu, HB; Lei, X; Diaz-Mendoza, J; Slade, M; Gildea, TR; Machuzak, M; Jimenez, CA; Toth, J; Kovitz, KL; Ray, C; Greenhill, S; Casal, RF; Almeida, FA; Wahidi, M; Eapen, GA; Yarmus, LB; Morice, RC; Benzaquen, S; Tremblay, A; Simoff, M
MLA Citation
Ost, DE, Ernst, A, Grosu, HB, Lei, X, Diaz-Mendoza, J, Slade, M, Gildea, TR, Machuzak, M, Jimenez, CA, Toth, J, Kovitz, KL, Ray, C, Greenhill, S, Casal, RF, Almeida, FA, Wahidi, M, Eapen, GA, Yarmus, LB, Morice, RC, Benzaquen, S, Tremblay, A, and Simoff, M. "Complications Following Therapeutic Bronchoscopy for Malignant Central Airway Obstruction: Results of the AQuIRE Registry." Chest 148.2 (August 2015): 450-471.
PMID
25741903
Source
epmc
Published In
Chest
Volume
148
Issue
2
Publish Date
2015
Start Page
450
End Page
471
DOI
10.1378/chest.14-1530

Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life.

There is significant variation between physicians in terms of how they perform therapeutic bronchoscopy, but there are few data on whether these differences impact effectiveness.This was a multicenter registry study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was technical success, defined as reopening the airway lumen to > 50% of normal. Secondary outcomes were dyspnea as measured by the Borg score and health-related quality of life (HRQOL) as measured by the SF-6D.Fifteen centers performed 1,115 procedures on 947 patients. Technical success was achieved in 93% of procedures. Center success rates ranged from 90% to 98% (P = .02). Endobronchial obstruction and stent placement were associated with success, whereas American Society of Anesthesiology (ASA) score > 3, renal failure, primary lung cancer, left mainstem disease, and tracheoesophageal fistula were associated with failure. Clinically significant improvements in dyspnea occurred in 90 of 187 patients measured (48%). Greater baseline dyspnea was associated with greater improvements in dyspnea, whereas smoking, having multiple cancers, and lobar obstruction were associated with smaller improvements. Clinically significant improvements in HRQOL occurred in 76 of 183 patients measured (42%). Greater baseline dyspnea was associated with greater improvements in HRQOL, and lobar obstruction was associated with smaller improvements.Technical success rates were high overall, with the highest success rates associated with stent placement and endobronchial obstruction. Therapeutic bronchoscopy should not be withheld from patients based solely on an assessment of risk, since patients with the most dyspnea and lowest functional status benefitted the most.

Authors
Ost, DE; Ernst, A; Grosu, HB; Lei, X; Diaz-Mendoza, J; Slade, M; Gildea, TR; Machuzak, MS; Jimenez, CA; Toth, J; Kovitz, KL; Ray, C; Greenhill, S; Casal, RF; Almeida, FA; Wahidi, MM; Eapen, GA; Feller-Kopman, D; Morice, RC; Benzaquen, S; Tremblay, A; Simoff, M
MLA Citation
Ost, DE, Ernst, A, Grosu, HB, Lei, X, Diaz-Mendoza, J, Slade, M, Gildea, TR, Machuzak, MS, Jimenez, CA, Toth, J, Kovitz, KL, Ray, C, Greenhill, S, Casal, RF, Almeida, FA, Wahidi, MM, Eapen, GA, Feller-Kopman, D, Morice, RC, Benzaquen, S, Tremblay, A, and Simoff, M. "Therapeutic bronchoscopy for malignant central airway obstruction: success rates and impact on dyspnea and quality of life." Chest 147.5 (May 2015): 1282-1298.
PMID
25358019
Source
epmc
Published In
Chest
Volume
147
Issue
5
Publish Date
2015
Start Page
1282
End Page
1298
DOI
10.1378/chest.14-1526

Simulation for Skills-based Education in Pulmonary and Critical Care Medicine.

The clinical practice of pulmonary and critical care medicine requires procedural competence in many technical domains, including vascular access, airway management, basic and advanced bronchoscopy, pleural procedures, and critical care ultrasonography. Simulation provides opportunities for standardized training and assessment in procedures without placing patients at undue risk. A growing body of literature supports the use and effectiveness of low-fidelity and high-fidelity simulators for procedural training and assessment. In this manuscript by the Skills-based Working Group of the American Thoracic Society Education Committee, we describe the background, available technology, and current evidence related to simulation-based skills training within pulmonary and critical care medicine. We outline working group recommendations for key procedural domains.

Authors
McSparron, JI; Michaud, GC; Gordan, PL; Channick, CL; Wahidi, MM; Yarmus, LB; Feller-Kopman, DJ; Makani, SS; Koenig, SJ; Mayo, PH; Kovitz, KL; Thomson, CC
MLA Citation
McSparron, JI, Michaud, GC, Gordan, PL, Channick, CL, Wahidi, MM, Yarmus, LB, Feller-Kopman, DJ, Makani, SS, Koenig, SJ, Mayo, PH, Kovitz, KL, and Thomson, CC. "Simulation for Skills-based Education in Pulmonary and Critical Care Medicine." Annals of the American Thoracic Society 12.4 (April 2015): 579-586.
PMID
25700209
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
12
Issue
4
Publish Date
2015
Start Page
579
End Page
586
DOI
10.1513/annalsats.201410-461ar

Bringing comfort to endobronchial ultrasound bronchoscopy.

Authors
Wahidi, MM; Sterman, DH
MLA Citation
Wahidi, MM, and Sterman, DH. "Bringing comfort to endobronchial ultrasound bronchoscopy." American journal of respiratory and critical care medicine 191.7 (April 2015): 727-728.
PMID
25830517
Source
epmc
Published In
American journal of respiratory and critical care medicine
Volume
191
Issue
7
Publish Date
2015
Start Page
727
End Page
728
DOI
10.1164/rccm.201502-0291ed

Bronchomediastinal fistula caused by endobronchial aspergilloma.

Endobronchial aspergilloma is a rare condition affecting immunocompromised patients. We present three cases resulting in airway fistulae.A 68-year-old male with orthotopic heart transplantation presented with fatigue, cough, and dyspnea. A computerized tomography (CT) scan of the chest and bronchoscopy revealed an endobronchial right mainstem mass and airway fistula to the mediastinum. The mass was debrided and biopsy showed Aspergillus fumigatus. He was treated with antifungals and recovered. A 52-year-old male with acquired immunodeficiency syndrome presented with cough, dyspnea, and hypoxemia. Chest CT showed a bronchus intermedius mass and fistula to the mediastinum. Bronchoscopy revealed a necrotic endobronchial mass and pseudomembranes and confirmed the presence of a fistula. The mass was resected bronchoscopically and Aspergillus fumigatus was isolated. He was treated with antifungals and the fistula healed. A 63-year-old male with chronic lymphoid leukemia was admitted for dyspnea, cough, weakness, and dysphagia. Chest CT and bronchoscopy showed a mass causing obstruction of the subglottic trachea and a fistula to the mediastinum. Biopsy showed Aspergillus fumigatus and he was treated with antifungals. The sinus healed but the patient died of leukemia.Risk factors for airway aspergilloma include immune deficiency, mucosal damage, and ischemia. We report airway fistula formation as a complication of this infection, which has not been previously emphasized.Endobronchial aspergillomas may form fistulae to the mediastinum. Aggressive treatment with antifungals and bronchoscopic interventions are required.

Authors
Argento, AC; Wolfe, CR; Wahidi, MM; Shofer, SL; Mahmood, K
MLA Citation
Argento, AC, Wolfe, CR, Wahidi, MM, Shofer, SL, and Mahmood, K. "Bronchomediastinal fistula caused by endobronchial aspergilloma." Annals of the American Thoracic Society 12.1 (January 2015): 91-95.
PMID
25513736
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
12
Issue
1
Publish Date
2015
Start Page
91
End Page
95
DOI
10.1513/annalsats.201406-247bc

Therapeutic bronchoscopy improves spirometry, quality of life, and survival in central airway obstruction.

Central airway obstruction (CAO) occurs in patients with primary or metastatic lung malignancy and nonmalignant pulmonary disorders and results in significant adverse effects on respiratory function and quality of life.The objective of this study was to assess the effect of therapeutic bronchoscopic interventions on spirometry, dyspnea, quality of life, and survival in patients with CAO.We prospectively studied patients who underwent therapeutic rigid bronchoscopy for CAO. Spirometry, San Diego Shortness of Breath questionnaire (SOBQ), and SF-36 questionnaire responses were obtained before the procedure and at follow-up 6-8 weeks after the procedure.Fifty-three patients (24 malignant and 29 nonmalignant CAO), who underwent successful rigid bronchoscopic intervention, were enrolled. Airway stent placement and various debulking techniques including mechanical debridement and heat therapy were used. After bronchoscopy, there was a significant increase in forced vital capacity (2.2 ± 0.91 l before, 2.7 ± 0.80 l after, p = 0.009) and forced expiratory volume at 1 s (1.4 ± 0.60 l before, 1.8 ± 0.67 l after, p = 0.002). The SOBQ score improved from 55.8 ± 30.1 before the procedure to 37.9 ± 27.25 after the procedure (p = 0.002). In the SF-36, there was an improvement in almost all domains, with statistically significant improvement seen in several domains. Benefits were seen independent of the etiology of CAO, site of intervention or stent placement. The patients with malignant CAO, in whom airway patency could not be achieved, had a poor survival.Alleviation of CAO with therapeutic rigid bronchoscopy results in improvement in spirometry, shortness of breath, quality of life, and survival.

Authors
Mahmood, K; Wahidi, MM; Thomas, S; Argento, AC; Ninan, NA; Smathers, EC; Shofer, SL
MLA Citation
Mahmood, K, Wahidi, MM, Thomas, S, Argento, AC, Ninan, NA, Smathers, EC, and Shofer, SL. "Therapeutic bronchoscopy improves spirometry, quality of life, and survival in central airway obstruction." Respiration; international review of thoracic diseases 89.5 (January 2015): 404-413.
PMID
25925488
Source
epmc
Published In
Respiration; international review of thoracic diseases
Volume
89
Issue
5
Publish Date
2015
Start Page
404
End Page
413
DOI
10.1159/000381103

High Dose Brachytherapy For Bronchial Stenosis In Lung Transplant Recipients

Authors
Ali, HA; Snyder, LD; Mahmood, K; Wahidi, MM; Argento, AC; Larrier, NA; Shofer, SL
MLA Citation
Ali, HA, Snyder, LD, Mahmood, K, Wahidi, MM, Argento, AC, Larrier, NA, and Shofer, SL. "High Dose Brachytherapy For Bronchial Stenosis In Lung Transplant Recipients." 2015.
Source
wos-lite
Published In
American journal of respiratory and critical care medicine
Volume
191
Publish Date
2015

Ablative therapies for central airway obstruction.

Central airway obstruction (CAO) is seen in malignant and nonmalignant airway disorders and can lead to significant morbidity and mortality. Endobronchial ablative therapies are used in conjunction with mechanical debridement to achieve hemostasis and restore airway patency. These therapies can be classified into modalities with immediate or delayed effect. Therapies with immediate effect include heat therapies (such as electrocautery, argon plasma coagulation, and laser) and cryorecanalization using a cryoprobe for tissue extraction. These modalities can be used in severe CAO for immediate relief of obstruction. Therapies with delayed effect include cryotherapy, brachytherapy, and photodynamic therapy. These modalities should not be used for acutely symptomatic CAO, and typically require follow-up bronchoscopy for removal of debris from the airway. Multimodality approach typically leads to better outcomes.

Authors
Mahmood, K; Wahidi, MM
MLA Citation
Mahmood, K, and Wahidi, MM. "Ablative therapies for central airway obstruction." Seminars in respiratory and critical care medicine 35.6 (December 2, 2014): 681-692.
PMID
25463159
Source
epmc
Published In
Seminars in Respiratory and Critical Care Medicine
Volume
35
Issue
6
Publish Date
2014
Start Page
681
End Page
692
DOI
10.1055/s-0034-1395501

ATS Core Curriculum 2014: part I. Adult pulmonary medicine.

Authors
Nyendak, MR; Lewinsohn, DM; Shah, RD; Wunderink, RG; Koch, CD; Morris, A; McDade, KE; Michaud, GC; Mahajan, AK; Channick, CL; Argento, AC; Wahidi, MM; Beckett, WS; George, G; Thomson, CC
MLA Citation
Nyendak, MR, Lewinsohn, DM, Shah, RD, Wunderink, RG, Koch, CD, Morris, A, McDade, KE, Michaud, GC, Mahajan, AK, Channick, CL, Argento, AC, Wahidi, MM, Beckett, WS, George, G, and Thomson, CC. "ATS Core Curriculum 2014: part I. Adult pulmonary medicine." Annals of the American Thoracic Society 11.7 (September 2014): 1136-1144.
PMID
25237992
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
11
Issue
7
Publish Date
2014
Start Page
1136
End Page
1144
DOI
10.1513/annalsats.201406-262cme

Tumor acquisition for biomarker research in lung cancer.

The biopsy collection data from two lung cancer trials that required fresh tumor samples be obtained for microarray analysis were reviewed. In the trial for advanced disease, microarray data were obtained on 50 patient samples, giving an overall success rate of 60.2%. The majority of the specimens were obtained through CT-guided lung biopsies (N = 30). In the trial for early-stage patients, 28 tissue specimens were collected from excess tumor after surgical resection with a success rate of 85.7%. This tissue procurement program documents the feasibility in obtaining fresh tumor specimens prospectively that could be used for molecular testing.

Authors
Stevenson, M; Christensen, J; Shoemaker, D; Foster, T; Barry, WT; Tong, BC; Wahidi, M; Shofer, S; Datto, M; Ginsburg, G; Crawford, J; D'Amico, T; Ready, N
MLA Citation
Stevenson, M, Christensen, J, Shoemaker, D, Foster, T, Barry, WT, Tong, BC, Wahidi, M, Shofer, S, Datto, M, Ginsburg, G, Crawford, J, D'Amico, T, and Ready, N. "Tumor acquisition for biomarker research in lung cancer." Cancer investigation 32.6 (July 2014): 291-298.
PMID
24810245
Source
epmc
Published In
Cancer Investigation (Informa)
Volume
32
Issue
6
Publish Date
2014
Start Page
291
End Page
298
DOI
10.3109/07357907.2014.911880

Ventilation and anesthetic approaches for rigid bronchoscopy.

Due to growing interest in management of central airway obstruction, rigid bronchoscopy is undergoing a resurgence in popularity among pulmonologists. Performing rigid bronchoscopy requires use of deep sedation or general anesthesia to achieve adequate patient comfort, whereas maintaining oxygenation and ventilation via an uncuffed and often open rigid bronchoscope requires use of ventilation strategies that may be unfamiliar to most pulmonologists. Available approaches include apneic oxygenation, spontaneous assisted ventilation, controlled ventilation, manual jet, and high-frequency jet ventilation. Anesthetic technique is partially dictated by the selected ventilation strategy but most often relies on a total intravenous anesthetic approach using ultra-short-acting sedatives and hypnotics for a rapid offset of action in this patient population with underlying respiratory compromise. Gas anesthetic may be used with the rigid bronchoscope, minimizing leaks with fenestrated caps placed over the ports, although persistent circuit leaks can make this approach challenging. Jet ventilation, the most commonly used ventilatory approach, may be delivered manually using a Sanders valve or via an automated ventilator at supraphysiologic respiratory rates, allowing for an open rigid bronchoscope to facilitate ease of moving tools in and out of the airway. Despite a patient population that often suffers from significant respiratory compromise, major complications with rigid bronchoscopy are uncommon and are similar among modern ventilation approaches. Choice of ventilation technique should be determined by local expertise and equipment availability. Appropriate patient selection and recognition of limitations associated with a given ventilation strategy are critical to avoid procedural-related complications.

Authors
Pathak, V; Welsby, I; Mahmood, K; Wahidi, M; MacIntyre, N; Shofer, S
MLA Citation
Pathak, V, Welsby, I, Mahmood, K, Wahidi, M, MacIntyre, N, and Shofer, S. "Ventilation and anesthetic approaches for rigid bronchoscopy." Annals of the American Thoracic Society 11.4 (May 2014): 628-634.
PMID
24635585
Source
epmc
Published In
Annals of the American Thoracic Society
Volume
11
Issue
4
Publish Date
2014
Start Page
628
End Page
634
DOI
10.1513/annalsats.201309-302fr

Rebuttal from drs Wahidi and Ernst.

Authors
Wahidi, MM; Ernst, A
MLA Citation
Wahidi, MM, and Ernst, A. "Rebuttal from drs Wahidi and Ernst." Chest 145.3 (March 2014): 451-452.
PMID
24590019
Source
epmc
Published In
Chest
Volume
145
Issue
3
Publish Date
2014
Start Page
451
End Page
452
DOI
10.1378/chest.13-2723

Point: should ultrasonographic endoscopy be the preferred modality for staging of lung cancer? Yes.

Authors
Wahidi, MM; Ernst, A
MLA Citation
Wahidi, MM, and Ernst, A. "Point: should ultrasonographic endoscopy be the preferred modality for staging of lung cancer? Yes." Chest 145.3 (March 2014): 447-449.
PMID
24590017
Source
epmc
Published In
Chest
Volume
145
Issue
3
Publish Date
2014
Start Page
447
End Page
449
DOI
10.1378/chest.13-2722

Point: Should UItrasonographic Endoscopy Be the Preferred Modality for Staging of Lung Cancer? Yes.

Authors
Wahidi, MM; Ernst, A
MLA Citation
Wahidi, MM, and Ernst, A. "Point: Should UItrasonographic Endoscopy Be the Preferred Modality for Staging of Lung Cancer? Yes." Chest 145.3 (March 2014): 447-449.
PMID
27845631
Source
epmc
Published In
Chest
Volume
145
Issue
3
Publish Date
2014
Start Page
447
End Page
449
DOI
10.1378/chest.13-2722

Learning experience of linear endobronchial ultrasound among pulmonary trainees.

BACKGROUND: Linear endobronchial ultrasound (EBUS) allows real-time guidance of transbronchial needle aspiration of thoracic structures and has become an increasingly important diagnostic tool for chest physicians. Little has been published about the learning experience of operators with this technology. The purpose of this study was to define the learning experience of EBUS-guided transbronchial needle aspiration (EBUS-TBNA) among pulmonary trainees. METHODS: This was a multicenter cohort study of fellows in pulmonary medicine over the first 2 years of their training. Prior to performing EBUS-TBNA, all participants had to complete 30 conventional bronchoscopies, an EBUS-specific didactic curriculum, and a simulation session with a plastic airway model. Each consecutive EBUS procedure was scored with a checklist that evaluated the ability to pass a bronchoscope through vocal cords, identify the appropriate node for sampling, acquire adequate ultrasound images, guide the bronchoscopy team through the technical steps of EBUS-TBNA, and obtain adequate tissue samples. RESULTS: Thirteen pulmonary trainees from three training programs were enrolled in the study and were observed over a 2-year period. The majority of trainees were able to perform all essential steps of EBUS-TBNA and obtain adequate tissue after performing an average of 13 (95% CI, 7-16) procedures. CONCLUSIONS: Pulmonary trainees needed an average of 13 procedures to achieve first independent successful performance of EBUS-TBNA following a training protocol that included a didactic curriculum and simulation-based practice. Our findings could guide pulmonary fellowship directors in planning EBUS training and establishing a reasonable juncture to assess EBUS skills with validated assessment tools.

Authors
Wahidi, MM; Hulett, C; Pastis, N; Shepherd, RW; Shofer, SL; Mahmood, K; Lee, H; Malhotra, R; Moser, B; Silvestri, GA
MLA Citation
Wahidi, MM, Hulett, C, Pastis, N, Shepherd, RW, Shofer, SL, Mahmood, K, Lee, H, Malhotra, R, Moser, B, and Silvestri, GA. "Learning experience of linear endobronchial ultrasound among pulmonary trainees." Chest 145.3 (March 2014): 574-578.
PMID
24114380
Source
epmc
Published In
Chest
Volume
145
Issue
3
Publish Date
2014
Start Page
574
End Page
578
DOI
10.1378/chest.13-0701

Feasibility of using an epigenetic marker of risk for lung cancer, methylation of p16, to promote smoking cessation among US veterans.

Providing smokers feedback using epigenetic markers of lung cancer risk has yet to be tested as a strategy to motivate smoking cessation. Epigenetic modification of Rb-p16 (p16) due to tobacco exposure is associated with increased risk of developing lung cancer. This study examined the acceptance of testing for methylated p16 and the understanding of test results in smokers at risk for development of lung cancer.Thirty-five current smokers with airways obstruction viewed an educational presentation regarding p16 function followed by testing for the presence of methylated p16 in sputum. Participants were offered smoking cessation assistance and asked to complete surveys at the time of enrolment regarding their understanding of the educational material, perception of risk associated with smoking and desire to quit. Participants were notified of their test result and follow-up surveys were administered 2 and 10 weeks after notification of their test result.Twenty per cent of participants had methylated p16. Participants showed high degree of understanding of educational materials regarding the function and risk associated with p16 methylation. Sixty-seven per cent and 57% of participants with low-risk and high-risk test results, respectively, reported that the information was more likely to motivate them to quit smoking. Smoking cessation rates were similar between methylated and non-methylated participants.Testing for an epigenetic marker of lung cancer risk is accepted and understood by active smokers. A low-risk test result does not decrease motivation to stop smoking.NCT01038492.

Authors
Shofer, S; Beyea, M; Li, S; Bastian, LA; Wahidi, MM; Kelley, M; Lipkus, IM
MLA Citation
Shofer, S, Beyea, M, Li, S, Bastian, LA, Wahidi, MM, Kelley, M, and Lipkus, IM. "Feasibility of using an epigenetic marker of risk for lung cancer, methylation of p16, to promote smoking cessation among US veterans." BMJ open respiratory research 1.1 (January 2014): e000032-.
PMID
25478181
Source
epmc
Published In
BMJ Open Respiratory Research
Volume
1
Issue
1
Publish Date
2014
Start Page
e000032
DOI
10.1136/bmjresp-2014-000032

The use of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in a pediatric population: A multicenter study

Introduction The presence of intrathoracic lymphadenopathy and mediastinal masses in the pediatric population often presents a diagnostic challenge. With limited minimally invasive methodologies to obtain a diagnosis, invasive sampling via mediastinoscopy or thoracotomy is often pursued. Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, outpatient procedure that has demonstrated significant success in the adult population in the evaluation of such abnormalities. Within the pediatric literature there is limited data regarding the use of EBUS-TBNA. We report the first multicenter review of a pediatric population undergoing EBUS-TBNA procedures identifying the feasibility, safety, utility, and outcomes of this procedure. Methods All patients of 18 years of age or younger undergoing EBUS-TBNA at six major academic medical centers from the years 2007 through 2013 were reviewed. Data regarding procedural performance, outcomes, and complications were recorded. Results A total of 21 patients meeting the inclusion criteria were identified in six centers. The mean age of the cohort was 13.7 (±4.1) years. EBUS-TBNA provided adequate sampling in 20/21 (95%) of the cases with diagnostic material obtained in 10 (48%) cases. Eight patients (38%) underwent additional surgical procedures to confirm or obtain diagnostic tissue. Within our cohort, 13 patients (62%) were able to avoid invasive surgical biopsy procedures. No procedural or anesthesia related complications were identified. Conclusion We report the first multicenter study to date confirming the feasibility and utility of EBUS-TBNA in the pediatric population. Due to the low overall procedural risk of EBUS-TBNA, it should be considered as a potential first line diagnostic option for children presenting with mediastinal or hilar abnormalities but further prospective studies are needed. © 2013 Wiley Periodicals, Inc.

Authors
Gilbert, CR; Chen, A; Akulian, JA; Lee, HJ; Wahidi, M; Argento, AC; Tanner, NT; Pastis, NJ; Harris, K; Sterman, D; Toth, JW; Chenna, PR; Feller-Kopman, D; Yarmus, L
MLA Citation
Gilbert, CR, Chen, A, Akulian, JA, Lee, HJ, Wahidi, M, Argento, AC, Tanner, NT, Pastis, NJ, Harris, K, Sterman, D, Toth, JW, Chenna, PR, Feller-Kopman, D, and Yarmus, L. "The use of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in a pediatric population: A multicenter study." Pediatric Pulmonology 49.8 (2014): 807-815.
Source
scival
Published In
Pediatric Pulmonology
Volume
49
Issue
8
Publish Date
2014
Start Page
807
End Page
815
DOI
10.1002/ppul.22887

ATS core curriculum 2014: Part I. Adult pulmonary medicine: Diagnosis and treatment of Mycobacterium tuberculosis

Authors
Nyendak, MR; Lewinsohn, DM; Shah, RD; Wunderink, RG; Koch, CD; Morris, A; McDade, KE; Michaud, GC; Mahajan, AK; Channick, CL; Argento, AC; Wahidi, MM; Beckett, WS; George, G; Thomson, CC
MLA Citation
Nyendak, MR, Lewinsohn, DM, Shah, RD, Wunderink, RG, Koch, CD, Morris, A, McDade, KE, Michaud, GC, Mahajan, AK, Channick, CL, Argento, AC, Wahidi, MM, Beckett, WS, George, G, and Thomson, CC. "ATS core curriculum 2014: Part I. Adult pulmonary medicine: Diagnosis and treatment of Mycobacterium tuberculosis." Annals of the American Thoracic Society 11.7 (2014): 1137-1143.
Source
scival
Published In
Annals of the American Thoracic Society
Volume
11
Issue
7
Publish Date
2014
Start Page
1137
End Page
1143
DOI
10.1513/AnnalsATS.201406-262CME

Partial anomalous pulmonary venous return to azygos vein with absent segmental bronchus.

Authors
Kavakli, K; Gaudet, M; Balderson, SS; Wahidi, M; D'Amico, TA
MLA Citation
Kavakli, K, Gaudet, M, Balderson, SS, Wahidi, M, and D'Amico, TA. "Partial anomalous pulmonary venous return to azygos vein with absent segmental bronchus." Ann Thorac Surg 96.4 (October 2013): 1486-.
PMID
24088473
Source
pubmed
Published In
Annals of Thoracic Surgery
Volume
96
Issue
4
Publish Date
2013
Start Page
1486
DOI
10.1016/j.athoracsur.2013.03.041

Rebuttal from Drs Wahidi and Yasufuku.

Authors
Wahidi, MM; Yasufuku, K
MLA Citation
Wahidi, MM, and Yasufuku, K. "Rebuttal from Drs Wahidi and Yasufuku." Chest 144.3 (September 2013): 737-738.
PMID
24008950
Source
pubmed
Published In
Chest
Volume
144
Issue
3
Publish Date
2013
Start Page
737
End Page
738
DOI
10.1378/chest.13-0703

Point: Should endobronchial ultrasound guide every transbronchial needle aspiration of lymph nodes? Yes.

Authors
Wahidi, MM; Yasufuku, K
MLA Citation
Wahidi, MM, and Yasufuku, K. "Point: Should endobronchial ultrasound guide every transbronchial needle aspiration of lymph nodes? Yes." Chest 144.3 (September 2013): 732-734.
PMID
24008948
Source
pubmed
Published In
Chest
Volume
144
Issue
3
Publish Date
2013
Start Page
732
End Page
734
DOI
10.1378/chest.13-0702

Endobronchial fiducial to guide stereotactic body radiotherapy.

Optimal treatment for unresectable central airway tumors is not well established. Stereotactic body radiation therapy has shown efficacy for both peripheral and central lung lesions. However, the treatment of central tumors has been limited because of associated radiation toxicity. We report the use of an endobronchial fiducial to localize hypofractionated stereotactic body radiation therapy treatment of a limited central airways disease in a patient with recurrent metastatic squamous cell lung cancer. The fiducial was instrumental in designing the treatment field and minimizing related treatment toxicity. Future studies may take advantage of this technique in patients with unresectable central airways non-small cell lung cancers.

Authors
Shofer, SL; Dunphy, F; Mahmood, K; Wahidi, MM; Yoo, D
MLA Citation
Shofer, SL, Dunphy, F, Mahmood, K, Wahidi, MM, and Yoo, D. "Endobronchial fiducial to guide stereotactic body radiotherapy." J Bronchology Interv Pulmonol 20.3 (July 2013): 274-275.
PMID
23857206
Source
pubmed
Published In
Journal of Bronchology and Interventional Pulmonology
Volume
20
Issue
3
Publish Date
2013
Start Page
274
End Page
275
DOI
10.1097/LBR.0b013e31829dd690

Symptom management in patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

BACKGROUND: Many patients with lung cancer will develop symptoms related to their disease process or the treatment they are receiving. These symptoms can be as debilitating as the disease progression itself. To many physicians these problems can be the most difficult to manage. METHODS: A detailed review of the literature using strict methodologic review of article quality was used in the development of this article. MEDLINE literature reviews, in addition to Cochrane reviews and other databases, were used for this review. The resulting article lists were then reviewed by experts in each area for quality and finally interpreted for content. RESULTS: We have developed recommendations for the management of many of the symptom complexes that patients with lung cancer may experience: pain, dyspnea, airway obstruction, cough, bone metastasis, brain metastasis, spinal cord metastasis, superior vena cava syndrome, hemoptysis, tracheoesophageal fistula, pleural effusions, venous thromboembolic disease, depression, fatigue, anorexia, and insomnia. Some areas, such as dyspnea, are covered in considerable detail in previously created high-quality evidence-based guidelines and are identified as excellent sources of reference. The goal of this guideline is to provide the reader recommendations based on evidence supported by scientific study. CONCLUSIONS: Improved understanding and recognition of cancer-related symptoms can improve management strategies, patient compliance, and quality of life for all patients with lung cancer.

Authors
Simoff, MJ; Lally, B; Slade, MG; Goldberg, WG; Lee, P; Michaud, GC; Wahidi, MM; Chawla, M
MLA Citation
Simoff, MJ, Lally, B, Slade, MG, Goldberg, WG, Lee, P, Michaud, GC, Wahidi, MM, and Chawla, M. "Symptom management in patients with lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines." Chest 143.5 Suppl (May 2013): e455S-e497S.
PMID
23649452
Source
pubmed
Published In
Chest
Volume
143
Issue
5 Suppl
Publish Date
2013
Start Page
e455S
End Page
e497S
DOI
10.1378/chest.12-2366

Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines.

BACKGROUND: Lung cancer is usually suspected in individuals who have an abnormal chest radiograph or have symptoms caused by either local or systemic effects of the tumor. The method of diagnosis of lung cancer depends on the type of lung cancer (small cell lung cancer or non-small cell lung cancer [NSCLC]), the size and location of the primary tumor, the presence of metastasis, and the overall clinical status of the patient. The objective of this study was to determine the test performance characteristics of various modalities for the diagnosis of suspected lung cancer. METHODS: To update previous recommendations on techniques available for the initial diagnosis of lung cancer, a systematic search of the MEDLINE, Healthstar, and Cochrane Library databases covering material to July 2011 and print bibliographies was performed to identify studies comparing the results of sputum cytology, conventional bronchoscopy, flexible bronchoscopy (FB), electromagnetic navigation (EMN) bronchoscopy, radial endobronchial ultrasound (R-EBUS)-guided lung biopsy, transthoracic needle aspiration (TTNA) or biopsy, pleural fluid cytology, and pleural biopsy with histologic reference standard diagnoses among at least 50 patients with suspected lung cancer. Recommendations were developed by the writing committee, graded by a standardized method (see the article "Methodology for Development of Guidelines for Lung Cancer" in this guideline), and reviewed by all members of the Lung Cancer Guideline Panel prior to approval by the Thoracic Oncology NetWork, the Guidelines Oversight Committee, and the Board of Regents of the American College of Chest Physicians. RESULTS: Sputum cytology is an acceptable method of establishing the diagnosis of lung cancer, with a pooled sensitivity rate of 66% and a specificity rate of 99%. However, the sensitivity of sputum cytology varies according to the location of the lung cancer. For central, endobronchial lesions, the overall sensitivity of FB for diagnosing lung cancer is 88%. The diagnostic yield of bronchoscopy decreases for peripheral lesions. Peripheral lesions < 2 or > 2 cm in diameter showed a sensitivity of 34% and 63%, respectively. R-EBUS and EMN are emerging technologies for the diagnosis of peripheral lung cancer, with diagnostic yields of 73% and 71%, respectively. The pooled sensitivity of TTNA for the diagnosis of lung cancer was 90%. A trend toward lower sensitivity was noted for lesions < 2 cm in diameter. TTNA is associated with a higher rate of pneumothorax compared with bronchoscopic procedures. In a patient with a malignant pleural effusion, pleural fluid cytology is reported to have a mean sensitivity of about 72%. A definitive diagnosis of metastatic disease to the pleural space can be estalished with a pleural biopsy. The diagnostic yield for closed pleural biopsy ranges from 38% to 47% and from 75% to 88% for image-guided closed biopsy. Thoracoscopic biopsy of the pleura carries the highest diagnostic yield, 95% to 97%. The accuracy in differentiating between small cell and non-small cell cytology for the various diagnostic modalities was 98%, with individual studies ranging from 94% to 100%. The average false-positive and false-negative rates were 9% and 2%, respectively. Although the distinction between small cell and NSCLC by cytology appears to be accurate, NSCLCs are clinically, pathologically, and molecularly heterogeneous tumors. In the past decade, clinical trials have shown us that NSCLCs respond to different therapeutic agents based on histologic phenotypes and molecular characteristics. The physician performing diagnostic procedures on a patient suspected of having lung cancer must ensure that adequate tissue is acquired to perform accurate histologic and molecular characterization of NSCLCs. CONCLUSIONS: The sensitivity of bronchoscopy is high for endobronchial disease and poor for peripheral lesions < 2 cm in diameter. The sensitivity of TTNA is excellent for malignant disease, but TTNA has a higher rate of pneumothorax than do bronchoscopic modalities. R-EBUS and EMN bronchoscopy show potential for increasing the diagnostic yield of FB for peripheral lung cancers. Thoracoscopic biopsy of the pleura has the highest diagnostic yield for diagnosis of metastatic pleural effusion in a patient with lung cancer. Adequate tissue acquisition for histologic and molecular characterization of NSCLCs is paramount.

Authors
Rivera, MP; Mehta, AC; Wahidi, MM
MLA Citation
Rivera, MP, Mehta, AC, and Wahidi, MM. "Establishing the diagnosis of lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines." Chest 143.5 Suppl (May 2013): e142S-e165S.
PMID
23649436
Source
pubmed
Published In
Chest
Volume
143
Issue
5 Suppl
Publish Date
2013
Start Page
e142S
End Page
e165S
DOI
10.1378/chest.12-2353

Straightening out chest tubes: what size, what type, and when.

Although chest tube placement is one of the most common procedures in managing patients with pleural disease, it is not clear what size and type of chest tube is indicated for various conditions. Chest tubes can be divided into small- (≤14 French [Fr]) and large-bore (>14 Fr) and can be placed by blunt dissection, guidewire (Seldinger), or trocar guidance. Recently a trend has been seen toward using smaller chest tubes for most indications, given their relative ease and patient comfort. This article summarizes the rationale for using different chest tubes depending on the clinical scenario.

Authors
Mahmood, K; Wahidi, MM
MLA Citation
Mahmood, K, and Wahidi, MM. "Straightening out chest tubes: what size, what type, and when." Clin Chest Med 34.1 (March 2013): 63-71. (Review)
PMID
23411057
Source
pubmed
Published In
Clinics in Chest Medicine
Volume
34
Issue
1
Publish Date
2013
Start Page
63
End Page
71
DOI
10.1016/j.ccm.2012.11.007

Significance of and risk factors for the development of central airway stenosis after lung transplantation.

Central airways stenosis (CAS) after lung transplant is a poorly understood complication. Objectives of this study were to determine if CAS was associated with chronic rejection or worse survival after transplant as well as to identify factors associated with CAS in a large cohort of lung transplant recipients. Lung transplant recipients transplanted at a single center were retrospectively reviewed for the development of CAS requiring airway dilation. A total of 467 subjects met inclusion criteria with 60 (13%) of these developing CAS requiring intervention. Of these 60 recipients, 22 (37%) had resolution of CAS with bronchoplasty alone, while 32 (53%) ultimately required stent placement. CAS that required intervention was not a risk factor for the development of bronchiolitis obliterans syndrome or worse overall survival. Significant risk factors for the subsequent development of CAS in a time-dependant multivariable model were pulmonary fungal infections and the need for postoperative tracheostomy. While CAS was not associated with BOS or worse survival, it remains an important complication after lung transplant with potentially preventable risk factors.

Authors
Shofer, SL; Wahidi, MM; Davis, WA; Palmer, SM; Hartwig, MG; Lu, Y; Snyder, LD
MLA Citation
Shofer, SL, Wahidi, MM, Davis, WA, Palmer, SM, Hartwig, MG, Lu, Y, and Snyder, LD. "Significance of and risk factors for the development of central airway stenosis after lung transplantation." Am J Transplant 13.2 (February 2013): 383-389.
PMID
23279590
Source
pubmed
Published In
American Journal of Transplantation
Volume
13
Issue
2
Publish Date
2013
Start Page
383
End Page
389
DOI
10.1111/ajt.12017

Alendronate tracheobronchitis.

Authors
Mahmood, K; Koubar, S; Shofer, SL; Ninan, NA; Wahidi, MM
MLA Citation
Mahmood, K, Koubar, S, Shofer, SL, Ninan, NA, and Wahidi, MM. "Alendronate tracheobronchitis." Ann Am Thorac Soc 10.1 (February 2013): 64-66.
PMID
23509337
Source
pubmed
Published In
Annals of the American Thoracic Society
Volume
10
Issue
1
Publish Date
2013
Start Page
64
End Page
66
DOI
10.1513/AnnalsATS.201212-124OT

Simulation for endoscopy training

© Springer Science+Business Media New York 2013.Bronchoscopy is a common procedure, with an estimated 500,000 bronchoscopies performed annually in the United States. It is mainly performed by pulmonologists, but surgeons, anesthesiologists, and intensivists also perform this procedure for a variety of diagnostic and therapeutic purposes. Acquisition and maintenance of bronchoscopy skills for both novice and advanced learners is an issue of high priority to ensure optimal delivery o health care and reduce errors and complications. Simulation presents a new option in the armamentarium of skill teaching and is positioned to play an essential role in the education of current and future physicians. In this chapter, I will review the current state of bronchoscopy training and the evolving role and data on simulation in bronchoscopy.

Authors
Wahidi, MM
MLA Citation
Wahidi, MM. "Simulation for endoscopy training." Principles and Practice of Interventional Pulmonology. January 1, 2013. 111-116.
Source
scopus
Publish Date
2013
Start Page
111
End Page
116
DOI
10.1007/978-1-4614-4292-9_11

The use of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in a pediatric population: A multicenter study

Introduction: The presence of intrathoracic lymphadenopathy and mediastinal masses in the pediatric population often presents a diagnostic challenge. With limited minimally invasive methodologies to obtain a diagnosis, invasive sampling via mediastinoscopy or thoracotomy is often pursued. Endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, outpatient procedure that has demonstrated significant success in the adult population in the evaluation of such abnormalities. Within the pediatric literature there is limited data regarding the use of EBUS-TBNA. We report the first multicenter review of a pediatric population undergoing EBUS-TBNA procedures identifying the feasibility, safety, utility, and outcomes of this procedure. Methods: All patients of 18 years of age or younger undergoing EBUS-TBNA at six major academic medical centers from the years 2007 through 2013 were reviewed. Data regarding procedural performance, outcomes, and complications were recorded. Results: A total of 21 patients meeting the inclusion criteria were identified in six centers. The mean age of the cohort was 13.7 (±4.1) years. EBUS-TBNA provided adequate sampling in 20/21 (95%) of the cases with diagnostic material obtained in 10 (48%) cases. Eight patients (38%) underwent additional surgical procedures to confirm or obtain diagnostic tissue. Within our cohort, 13 patients (62%) were able to avoid invasive surgical biopsy procedures. No procedural or anesthesia related complications were identified. Conclusion: We report the first multicenter study to date confirming the feasibility and utility of EBUS-TBNA in the pediatric population. Due to the low overall procedural risk of EBUS-TBNA, it should be considered as a potential first line diagnostic option for children presenting with mediastinal or hilar abnormalities but further prospective studies are needed. © 2013 Wiley Periodicals, Inc.

Authors
Gilbert, CR; Chen, A; Akulian, JA; Lee, HJ; Wahidi, M; Argento, AC; Tanner, NT; Pastis, NJ; Harris, K; Sterman, D; al, E
MLA Citation
Gilbert, CR, Chen, A, Akulian, JA, Lee, HJ, Wahidi, M, Argento, AC, Tanner, NT, Pastis, NJ, Harris, K, Sterman, D, and al, E. "The use of convex probe endobronchial ultrasound-guided transbronchial needle aspiration in a pediatric population: A multicenter study." Pediatric Pulmonology (2013).
PMID
24039186
Source
scival
Published In
Pediatric Pulmonology
Publish Date
2013
DOI
10.1002/ppul.22887

Significance of and risk factors for the development of central airway stenosis after lung transplantation

Central airways stenosis (CAS) after lung transplant is a poorly understood complication. Objectives of this study were to determine if CAS was associated with chronic rejection or worse survival after transplant as well as to identify factors associated with CAS in a large cohort of lung transplant recipients. Lung transplant recipients transplanted at a single center were retrospectively reviewed for the development of CAS requiring airway dilation. A total of 467 subjects met inclusion criteria with 60 (13%) of these developing CAS requiring intervention. Of these 60 recipients, 22 (37%) had resolution of CAS with bronchoplasty alone, while 32 (53%) ultimately required stent placement. CAS that required intervention was not a risk factor for the development of bronchiolitis obliterans syndrome or worse overall survival. Significant risk factors for the subsequent development of CAS in a time-dependant multivariable model were pulmonary fungal infections and the need for postoperative tracheostomy. While CAS was not associated with BOS or worse survival, it remains an important complication after lung transplant with potentially preventable risk factors. The authors examine a large single-center cohort of lung transplantation patients for risk factors for the development of central airway stenosis and find strong associations with fungal infections, postoperative tracheostomy, and prolonged hospitalization after transplant, but not with bronchiolitis obliterans syndrome or acute rejection. © Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

Authors
Shofer, SL; Wahidi, MM; Davis, WA; Palmer, SM; Hartwig, MG; Lu, Y; Snyder, LD
MLA Citation
Shofer, SL, Wahidi, MM, Davis, WA, Palmer, SM, Hartwig, MG, Lu, Y, and Snyder, LD. "Significance of and risk factors for the development of central airway stenosis after lung transplantation." American Journal of Transplantation 13.2 (2013): 383-389.
Source
scival
Published In
American Journal of Transplantation
Volume
13
Issue
2
Publish Date
2013
Start Page
383
End Page
389
DOI
10.1111/ajt.12017

Familial idiopathic interstitial pneumonia: histopathology and survival in 30 patients.

CONTEXT: Familial idiopathic interstitial pneumonia (F-IIP) describes the unexplained occurrence of diffuse parenchymal lung disease in related individuals. Prevailing wisdom suggests that the histopathology of F-IIP is indistinguishable from that of idiopathic pulmonary fibrosis, namely, usual interstitial pneumonia (UIP). OBJECTIVE: To define the histopathology of F-IIP in lung tissue samples. DESIGN: Tissue sections from 30 patients with F-IIP, enrolled in a national research program, were evaluated by 3 pulmonary pathologists using 15 predefined histopathologic features. Each feature was recorded independently before a final diagnosis was chosen from a limited list dichotomized between UIP or "not UIP." These 2 groups were then compared to survival. RESULTS: The consensus diagnosis for the F-IIP cohort was an unclassifiable parenchymal fibrosis (60%), with a high incidence of histopathologic honeycombing, fibroblast foci, and smooth muscle in fibrosis. Usual interstitial pneumonia, strictly defined, was identified in less than half of the F-IIP cases (range, 23%-50%). Interobserver agreement was fair (κ  =  0.37) for 2 observers for the overall diagnosis of UIP. Findings unexpected in UIP were prevalent. The survival for the entire F-IIP cohort was poor, with an estimated mortality of 93% and a median age at death of 60.9 years. Subjects with UIP had a shorter survival and younger age at death. CONCLUSIONS: Pulmonary fibrosis was the dominant histopathology identified in our patients, but diagnostic features of UIP were seen in less than 50% of the samples. Overall survival was poor, with mortality accelerated apparently by the presence of a UIP pattern of disease.

Authors
Leslie, KO; Cool, CD; Sporn, TA; Curran-Everett, D; Steele, MP; Brown, KK; Wahidi, MM; Schwartz, DA
MLA Citation
Leslie, KO, Cool, CD, Sporn, TA, Curran-Everett, D, Steele, MP, Brown, KK, Wahidi, MM, and Schwartz, DA. "Familial idiopathic interstitial pneumonia: histopathology and survival in 30 patients." Arch Pathol Lab Med 136.11 (November 2012): 1366-1376.
PMID
23106582
Source
pubmed
Published In
Archives of Pathology and Laboratory Medicine
Volume
136
Issue
11
Publish Date
2012
Start Page
1366
End Page
1376
DOI
10.5858/arpa.2011-0627-OAI

Endobronchial injection of botulinum toxin for the reduction of bronchial hyperreactivity induced by methacholine inhalation in dogs.

BACKGROUND: Airway smooth muscle contraction causes bronchial constriction and is the main cause of bronchospasm in response to stimulants in asthma patients. In this pilot study, we tested the possibility of using a commercially available neurotoxin-botulinum toxin A (BTX-A)-to reduce bronchial hyperreactivity in dogs. METHODS: Two bronchoscopic sessions were conducted in 6 healthy mongrel dogs. In the first session, BTX-A (concentration 10 U/mL) was injected in small aliquots submucosally in 1 caudal lobe and its subsegments, leaving the other side as control. During the second bronchoscopy conducted 2 weeks later, the airway calibers of the treated and untreated sides were measured in each animal before and after instillation of methacholine in the airways to induce bronchial hyperreactivity (concentration 25 mg/mL). RESULTS: The mean pretreatment diameter was 3.356 (± 1.294) mm and 2.765 (± 0.603) mm in the treated and untreated airways, respectively. After provocation with methacholine, the diameter of the treated airways was 1.985 (± 0.888) mm versus 0.873 (± 0.833) mm in the untreated airways (P=0.000). Local injection of BTX-A in the airway resulted in reduction of bronchial hyperreactivity by 58.6% (P=0.001). There were no complications resulting from the submucosal injection of BTX-A in the airways. CONCLUSIONS: Endobronchial injection of BTX-A reduces bronchial hyperreactivity in the airways of healthy dogs.

Authors
Al-Halfawy, A; Gomaa, NE; Refaat, A; Wissa, M; Wahidi, MM
MLA Citation
Al-Halfawy, A, Gomaa, NE, Refaat, A, Wissa, M, and Wahidi, MM. "Endobronchial injection of botulinum toxin for the reduction of bronchial hyperreactivity induced by methacholine inhalation in dogs." J Bronchology Interv Pulmonol 19.4 (October 2012): 277-283.
PMID
23207526
Source
pubmed
Published In
Journal of Bronchology and Interventional Pulmonology
Volume
19
Issue
4
Publish Date
2012
Start Page
277
End Page
283
DOI
10.1097/LBR.0b013e318271179e

Association of gender with outcomes in critically ill patients.

INTRODUCTION: The influence of gender on mortality and other outcomes of critically ill patients is not clear. Different studies have been performed in various settings and patient populations often yielding conflicting results. We wanted to assess the relationship of gender and intensive care unit (ICU) outcomes in the patients included in the Acute Physiology and Chronic Health Evaluation (APACHE) IV database (Cerner Corporation, USA). METHODS: We performed a retrospective review of the data available in the APACHE IV database. A total of 261,255 consecutive patients admitted to adult ICUs in United States from 1 January 2004 to 31 December 2008 were included. Readmissions were excluded from the analysis. The primary objective of the study was to assess the relationship of gender with ICU mortality. The secondary objective was to evaluate the association of gender with active therapy, mechanical ventilation, length of stay in the ICU, readmission rate and hospital mortality. The gender-related outcomes for disease subgroups including acute coronary syndrome, coronary artery bypass graft (CABG) surgery, sepsis, trauma and chronic obstructive pulmonary disease (COPD) exacerbation were assessed as well. RESULTS: ICU mortality was 7.2% for men and 7.9% for women, odds ratio (OR) for death for women was 1.07 (95% confidence interval (CI): 1.04 to 1.1). There was a statistically significant interaction between gender and age. In patients <50 years of age, women had a reduced ICU mortality compared with men, after adjustment for acute physiology score, ethnicity, co-morbid conditions, pre-ICU length of stay, pre-ICU location and hospital teaching status (adjusted OR 0.83, 95% CI: 0.76 to 0.91). But among patients ≥ 50 years of age, there was no significant difference in ICU mortality between men and women (adjusted OR 1.02, 95% CI: 0.98 to 1.06). CONCLUSIONS: Among the critically ill patients, women less than 50 years of age had a lower ICU mortality compared to men, while 50 years of age or older women did not have a significant difference compared to men. Women had a higher mortality compared to men after CABG surgery and lower mortality with COPD exacerbation. There was no difference in mortality in acute coronary syndrome, sepsis or trauma.

Authors
Mahmood, K; Eldeirawi, K; Wahidi, MM
MLA Citation
Mahmood, K, Eldeirawi, K, and Wahidi, MM. "Association of gender with outcomes in critically ill patients. (Published online)" Crit Care 16.3 (May 22, 2012): R92-.
PMID
22617003
Source
pubmed
Published In
Critical Care (UK)
Volume
16
Issue
3
Publish Date
2012
Start Page
R92
DOI
10.1186/cc11355

Bronchial thermoplasty for severe asthma.

Bronchial thermoplasty (BT) is a novel treatment of patients with severe asthma who continue to be symptomatic despite maximal medical treatment. It aims to reduce the smooth muscle mass in the airways by delivering controlled thermal energy to the airway walls during a series of three bronchoscopies. Randomized controlled clinical trials of BT in severe asthma have not been able to show a reduction in airway hyperresponsiveness or change in FEV(1) but have suggested an improvement in quality of life, as well as a reduction in the rate of severe exacerbations, emergency department visits, and days lost from school or work. Strict inclusion and exclusion criteria of these trials resulted in the elimination of patients with severe asthma who experienced more than three exacerbations per year. Therefore, the generalizability of this treatment to the broader severe asthma population still needs to be determined. The short-term adverse events consist primarily of airway inflammation and occasionally more severe events requiring hospitalization. Long-term safety data are evolving and have shown thus far clinical and functional stability up to 5 years after BT treatment. Additional studies on BT are needed to establish accurate phenotyping of positive responders, durability of effect, and long-term safety.

Authors
Wahidi, MM; Kraft, M
MLA Citation
Wahidi, MM, and Kraft, M. "Bronchial thermoplasty for severe asthma." Am J Respir Crit Care Med 185.7 (April 1, 2012): 709-714. (Review)
PMID
22077066
Source
pubmed
Published In
American journal of respiratory and critical care medicine
Volume
185
Issue
7
Publish Date
2012
Start Page
709
End Page
714
DOI
10.1164/rccm.201105-0883CI

Flexible Bronchoscopy Training

Authors
Wahidi, MM; Sandhu Sindhwani, N; Shofer, SL; Musani, AI
MLA Citation
Wahidi, MM, Sandhu Sindhwani, N, Shofer, SL, and Musani, AI. "Flexible Bronchoscopy Training." (January 5, 2012): 63-69. (Chapter)
Source
scopus
Publish Date
2012
Start Page
63
End Page
69
DOI
10.1002/9781444346428.ch6

Latest advances in advanced diagnostic and therapeutic pulmonary procedures

Over the past 15 years, patients with a myriad of pulmonary conditions have been diagnosed and treated with new technologies developed for the pulmonary community. Advanced diagnostic and therapeutic procedures once performed in an operating theater under general anesthesia are now routinely performed in a bronchoscopy suite under moderate sedation with clinically meaningful improvements in outcome. With the miniaturization of scopes and instruments, improvements in optics, and creative engineers, a host of new devices has become available for clinical testing and use. A growing community of pulmonologists is doing comparative effectiveness trials that test new technologies against the current standard of care. While more research is needed, it seems reasonable to provide an overview of pulmonary procedures that are in various stages of development, testing, and practice at this time. Five areas are covered: navigational bronchoscopy, endobronchial ultrasound, endoscopic lung volume reduction, bronchial thermoplasty, and pleural procedure. Appropriate training for clinicians who wish to provide these services will become an area of intense scrutiny as new skills will need to be acquired to ensure patient safety and a good clinical result. © 2012 American College of Chest Physicians.

Authors
Silvestri, GA; Feller-Kopman, D; Chen, A; Wahidi, M; Yasufuku, K; Ernst, A
MLA Citation
Silvestri, GA, Feller-Kopman, D, Chen, A, Wahidi, M, Yasufuku, K, and Ernst, A. "Latest advances in advanced diagnostic and therapeutic pulmonary procedures." Chest 142.6 (2012): 1636-1644.
PMID
23208336
Source
scival
Published In
Chest
Volume
142
Issue
6
Publish Date
2012
Start Page
1636
End Page
1644
DOI
10.1378/chest.12-2326

Response

Authors
Wahidi, MM; Lee, P
MLA Citation
Wahidi, MM, and Lee, P. "Response." Chest 141.6 (2012): 1641--.
Source
scival
Published In
Chest
Volume
141
Issue
6
Publish Date
2012
Start Page
1641-
DOI
10.1378/chest.12-0754

Response

Authors
Wahidi, MM; Barbour, SY; Silvestri, GA
MLA Citation
Wahidi, MM, Barbour, SY, and Silvestri, GA. "Response." Chest 141.4 (2012): 1125-1126.
Source
scival
Published In
Chest
Volume
141
Issue
4
Publish Date
2012
Start Page
1125
End Page
1126
DOI
10.1378/chest.12-0160

Endobronchial metastatic breast cancer with pagetoid histology mimicking bronchial pagetoid squamous cell carcinoma in situ.

We report a case of a 56-year-old woman with endobronchial breast cancer metastasis of unusual histology. The patient presented with persistent cough, and a lesion was noted in the left mainstem bronchus on bronchoscopic examination. Biopsy revealed extensive squamous metaplasia of bronchial epithelium along with large, atypical cells exhibiting pagetoid intraepithelial spread within squamous mucosa. Immunohistochemical stains were compatible with a diagnosis of metastatic breast adenocarcinoma with pagetoid spread. To our knowledge, this is the first reported case of endobronchial breast cancer metastasis with this histologic presentation. In this report, we describe the clinical, radiographic, bronchoscopic, histologic, and immunohistochemical characteristics of this case. We provide a brief review of existing literature on endobronchial breast cancer metastasis. In addition, we discuss the principal differential diagnosis of bronchial pagetoid lesions. This report raises awareness of this uncommon manifestation of metastatic breast cancer.

Authors
West, D; Geradts, J; Wahidi, M; Roggli, V
MLA Citation
West, D, Geradts, J, Wahidi, M, and Roggli, V. "Endobronchial metastatic breast cancer with pagetoid histology mimicking bronchial pagetoid squamous cell carcinoma in situ." Hum Pathol 42.11 (November 2011): 1819-1822.
PMID
21663936
Source
pubmed
Published In
Human Pathology
Volume
42
Issue
11
Publish Date
2011
Start Page
1819
End Page
1822
DOI
10.1016/j.humpath.2011.02.009

American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients.

BACKGROUND: Optimal performance of bronchoscopy requires patient's comfort, physician's ease of execution, and minimal risk. There is currently a wide variation in the use of topical anesthesia, analgesia, and sedation during bronchoscopy. METHODS: A panel of experts was convened by the American College of Chest Physicians Interventional/Chest Diagnostic Network. A literature search was conducted on MEDLINE from 1969 to 2009, and consensus was reached by the panel members after a comprehensive review of the data. Randomized controlled trials and prospective studies were given highest priority in building the consensus. RESULTS: In the absence of contraindications, topical anesthesia, analgesia, and sedation are suggested in all patients undergoing bronchoscopy because of enhanced patient tolerance and satisfaction. Robust data suggest that anticholinergic agents, when administered prebronchoscopy, do not produce a clinically meaningful effect, and their use is discouraged. Lidocaine is the preferred topical anesthetic for bronchoscopy, given its short half life and wide margin of safety. The use of a combination of benzodiazepines and opiates is suggested because of their synergistic effects on patient tolerance during the procedure and the added antitussive properties of opioids. Propofol is an effective agent for sedation in bronchoscopy and can achieve similar sedation, amnesia, and patient tolerance when compared with the combined administration of benzodiazepines and opiates. CONCLUSIONS: We suggest that all physicians performing bronchoscopy consider using topical anesthesia, analgesic and sedative agents, when feasible. The existing body of literature supports the safety and effectiveness of this approach when the proper agents are used in an appropriately selected patient population.

Authors
Wahidi, MM; Jain, P; Jantz, M; Lee, P; Mackensen, GB; Barbour, SY; Lamb, C; Silvestri, GA
MLA Citation
Wahidi, MM, Jain, P, Jantz, M, Lee, P, Mackensen, GB, Barbour, SY, Lamb, C, and Silvestri, GA. "American College of Chest Physicians consensus statement on the use of topical anesthesia, analgesia, and sedation during flexible bronchoscopy in adult patients." Chest 140.5 (November 2011): 1342-1350.
PMID
22045879
Source
pubmed
Published In
Chest
Volume
140
Issue
5
Publish Date
2011
Start Page
1342
End Page
1350
DOI
10.1378/chest.10-3361

The use of electrocautery as the primary ablation modality for malignant and benign airway obstruction.

BACKGROUND: Laser has been the main ablative modality in the airways, but a growing experience with endobronchial electrocautery suggests a comparable efficacy and safety profile. OBJECTIVES: To evaluate the efficacy and safety of electrocautery as the primary heat therapy for malignant and benign airway obstruction. METHODS: A retrospective review of all patients undergoing endobronchial electrocautery, alone or in combination with other airway tools, at Duke University Medical Center between April 2004 and November 2009. Data on efficacy (luminal patency, symptomatic, radiographic, or physiologic improvement) and safety (complication rate) were collected. RESULTS: Ninety-four patients underwent 117 procedures with endobronchial electrocautery for endobronchial malignant and nonmalignant disease. Endoscopic improvement was seen in 94% of cases. Seventy-one percent of patients reported symptomatic improvement. Radiographic studies demonstrated luminal improvement in 78% of patients on chest computed tomography, improved aeration on chest computed tomography and chest x-ray in 63% and 43% of patients, respectively. The rate of major complications was 0.8%, whereas minor complications occurred in 6.8% of cases. There was no perioperative mortality. CONCLUSIONS: Endobronchial electrocautery is effective and safe when used as an ablative modality in malignant and benign airway obstruction and has a comparable profile to laser with the advantage of lower cost.

Authors
Wahidi, MM; Unroe, MA; Adlakha, N; Beyea, M; Shofer, SL
MLA Citation
Wahidi, MM, Unroe, MA, Adlakha, N, Beyea, M, and Shofer, SL. "The use of electrocautery as the primary ablation modality for malignant and benign airway obstruction." J Thorac Oncol 6.9 (September 2011): 1516-1520.
PMID
21792075
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
6
Issue
9
Publish Date
2011
Start Page
1516
End Page
1520
DOI
10.1097/JTO.0b013e3182242142

Fospropofol Disodium for Sedation in Elderly Patients Undergoing Flexible Bronchoscopy.

BACKGROUND: Fospropofol disodium is a water-soluble prodrug of propofol. A subset analysis was undertaken of elderly patients (≥65 y) undergoing flexible bronchoscopy, who were part of a larger multicenter, randomized, double-blind study. METHODS: Patients received fentanyl citrate (50 mcg) followed by fospropofol at initial (4.88mg/kg) and supplemental (1.63mg/kg) doses. The primary end point was sedation success (3 consecutive Modified Observer's Assessment of Alertness/Sedation scores of ≤4 and procedure completion without alternative sedative or assisted ventilation). Treatment success, time to fully alert, patient and physician satisfaction, and safety/tolerability were also evaluated. RESULTS: In the elderly patients subset (n=61), sedation success was 92%, the mean time to fully alert was 8.0±10.9 min, and memory retention was 72% during recovery, and these were comparable with the younger patients subgroup (age, <65 y). Sedation-related adverse events occurred in 23% of the elderly and 18% of the younger patients (age, <65 y) group. Hypoxemia occurred in 26% of the elderly and 18% of the younger patients group, but no escalation of care was required. CONCLUSIONS: Fospropofol provided safe and effective sedation, rapid time to fully alert, and high satisfaction in this elderly subset undergoing flexible bronchoscopy, which was comparable with outcomes in younger patients.

Authors
Silvestri, GA; Vincent, BD; Wahidi, MM
MLA Citation
Silvestri, GA, Vincent, BD, and Wahidi, MM. "Fospropofol Disodium for Sedation in Elderly Patients Undergoing Flexible Bronchoscopy." J Bronchology Interv Pulmonol 18.1 (January 2011): 15-22.
PMID
21701693
Source
pubmed
Published In
Journal of Bronchology and Interventional Pulmonology
Volume
18
Issue
1
Publish Date
2011
Start Page
15
End Page
22
DOI
10.1097/LBR.0b013e3182074892

Endobronchial metastatic breast cancer with pagetoid histology mimicking bronchial pagetoid squamous cell carcinoma in situ

We report a case of a 56-year-old woman with endobronchial breast cancer metastasis of unusual histology. The patient presented with persistent cough, and a lesion was noted in the left mainstem bronchus on bronchoscopic examination. Biopsy revealed extensive squamous metaplasia of bronchial epithelium along with large, atypical cells exhibiting pagetoid intraepithelial spread within squamous mucosa. Immunohistochemical stains were compatible with a diagnosis of metastatic breast adenocarcinoma with pagetoid spread. To our knowledge, this is the first reported case of endobronchial breast cancer metastasis with this histologic presentation. In this report, we describe the clinical, radiographic, bronchoscopic, histologic, and immunohistochemical characteristics of this case. We provide a brief review of existing literature on endobronchial breast cancer metastasis. In addition, we discuss the principal differential diagnosis of bronchial pagetoid lesions. This report raises awareness of this uncommon manifestation of metastatic breast cancer. © 2011 Elsevier Inc.

Authors
West, D; Geradts, J; Wahidi, M; Roggli, V
MLA Citation
West, D, Geradts, J, Wahidi, M, and Roggli, V. "Endobronchial metastatic breast cancer with pagetoid histology mimicking bronchial pagetoid squamous cell carcinoma in situ." Human Pathology 42.11 (2011): 1785-1788.
Source
scival
Published In
Human Pathology
Volume
42
Issue
11
Publish Date
2011
Start Page
1785
End Page
1788
DOI
10.1016/j.humpath.2011.03.004

Training for endobronchial ultrasound: methods for proper training in new bronchoscopic techniques.

PURPOSE OF REVIEW: The field of pulmonary medicine has experienced a rapid growth in innovative new technologies aimed at both diagnosis and treatment of airway, mediastinal and parenchymal disorders. Endobronchial ultrasound (EBUS) has emerged as an extremely useful tool in real-time guidance of transbronchial needle aspiration (TBNA) of mediastinal and hilar structures. A growing body of evidence has demonstrated the efficacy of EBUS-TBNA in the diagnosis and staging of lung cancer, as well as the diagnosis of benign causes of mediastinal and hilar lymphadenopathy. This has increased the demand for EBUS among general pulmonologists and thoracic surgeons and is presenting a challenge in establishing teaching venues and training guidelines to gain competence in EBUS. RECENT FINDINGS: The effectiveness of innovative teaching methods has been demonstrated with basic bronchoscopy skills. Several studies have successfully validated the efficacy of virtual reality simulators as a tool in the training of novice bronchoscopists, including a prospective, multicenter study that found a clear improvement in bronchoscopic skills with early use of virtual reality simulators. However, there is a paucity of literature that has specifically addressed the skills necessary for training in EBUS bronchoscopy. SUMMARY: Evidence-based protocols for teaching EBUS-guided TBNA and other advanced bronchoscopic procedures are necessary as these technologies continue to expand into general pulmonary practice. Ongoing research in bronchoscopy education promises to guide proper and effective training of clinicians to achieve learners' satisfaction and optimal patient outcomes.

Authors
Unroe, MA; Shofer, SL; Wahidi, MM
MLA Citation
Unroe, MA, Shofer, SL, and Wahidi, MM. "Training for endobronchial ultrasound: methods for proper training in new bronchoscopic techniques." Curr Opin Pulm Med 16.4 (July 2010): 295-300. (Review)
PMID
20531196
Source
pubmed
Published In
Current Opinion in Pulmonary Medicine
Volume
16
Issue
4
Publish Date
2010
Start Page
295
End Page
300
DOI
10.1097/MCP.0b013e32833a047a

A prospective multicenter study of competency metrics and educational interventions in the learning of bronchoscopy among new pulmonary fellows.

BACKGROUND: Learning medical procedures relies predominantly on the apprenticeship model, and competency is established based on the number of performed procedures. Our study aimed to establish bronchoscopy competency metrics based on performance and enhanced learning with educational interventions. METHODS: We conducted a prospective study of the acquisition of bronchoscopy skills and cognitive knowledge in two successive cohorts of new pulmonary fellows between July 5, 2006, and June 30, 2008. At prespecified milestones, validated tools were used for testing: the Bronchoscopy Skills and Tasks Assessment Tool (BSTAT), an objective evaluation of bronchoscopy skills with scores ranging from 0 to 24, and written multiple-choice questions examinations. The first cohort received training in bronchoscopy as per the standards set by each institution, whereas the second cohort received educational interventions, including training in simulation bronchoscopy and an online bronchoscopy curriculum. RESULTS: There was significant variation among study participants in bronchoscopy skills at their 50th bronchoscopy, the minimum number previously set to achieve competency in bronchoscopy. An educational intervention of incorporating simulation bronchoscopy enhanced the speed of acquisition of bronchoscopy skills, as shown by the statistically significant improvement in mean BSTAT scores for seven of the eight milestone bronchoscopies (P < .05). The online curriculum did not improve the performance on the written tests; however, compliance of the learners with the curriculum was low. CONCLUSIONS: Performance-based competency metrics can be used to evaluate bronchoscopy skills. Educational interventions, such as simulation-based training, accelerated the acquisition of bronchoscopy skills among first-year pulmonary fellows as assessed by a validated objective assessment tool.

Authors
Wahidi, MM; Silvestri, GA; Coakley, RD; Ferguson, JS; Shepherd, RW; Moses, L; Conforti, J; Que, LG; Anstrom, KJ; McGuire, F; Colt, H; Downie, GH
MLA Citation
Wahidi, MM, Silvestri, GA, Coakley, RD, Ferguson, JS, Shepherd, RW, Moses, L, Conforti, J, Que, LG, Anstrom, KJ, McGuire, F, Colt, H, and Downie, GH. "A prospective multicenter study of competency metrics and educational interventions in the learning of bronchoscopy among new pulmonary fellows." Chest 137.5 (May 2010): 1040-1049.
PMID
19858234
Source
pubmed
Published In
Chest
Volume
137
Issue
5
Publish Date
2010
Start Page
1040
End Page
1049
DOI
10.1378/chest.09-1234

An approach to interventional pulmonary fellowship training.

Interventional pulmonology continues to be a specialty that is experiencing an evolution of new technologies, with an emphasis on multidisciplinary care. The diversity and application of these procedures in patients with more complex conditions is leading to the need for more specific recommendations in training within this area. As patient safety and outcomes-based measures of clinical practice and procedures are in the forefront, the need for standardization in procedural training in high-volume centers of excellence beyond pulmonary and critical care fellowships must be considered. Other procedure-based specialties have developed such training programs, with structured curricula to enhance patient safety and outcomes, develop validated metrics for competency assessment of trainees, improve trainee education, and further advance the field by fostering research.

Authors
Lamb, CR; Feller-Kopman, D; Ernst, A; Simoff, MJ; Sterman, DH; Wahidi, MM; Kovitz, KL
MLA Citation
Lamb, CR, Feller-Kopman, D, Ernst, A, Simoff, MJ, Sterman, DH, Wahidi, MM, and Kovitz, KL. "An approach to interventional pulmonary fellowship training." Chest 137.1 (January 2010): 195-199. (Review)
PMID
20051404
Source
pubmed
Published In
Chest
Volume
137
Issue
1
Publish Date
2010
Start Page
195
End Page
199
DOI
10.1378/chest.09-0494

A multicenter pilot study of a bronchial valve for the treatment of severe emphysema.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) affects millions of people and has limited treatment options. Surgical treatments for severe COPD with emphysema are effective for highly selected patients. A minimally invasive method for treating emphysema could decrease morbidity and increase acceptance by patients. OBJECTIVE: To study the safety and effectiveness of the IBV(R) Valve for the treatment of severe emphysema. METHODS: A multicenter study treated 91 patients with severe obstruction, hyperinflation and upper lobe (UL)-predominant emphysema with 609 bronchial valves placed bilaterally into ULs. RESULTS: Valves were placed in desired airways with 99.7% technical success and no migration or erosion. There were no procedure-related deaths and 30-day morbidity and mortality were 5.5 and 1.1%, respectively. Pneumothorax was the most frequent serious device-related complication and primarily occurred when all segments of a lobe, especially the left UL, were occluded. Highly significant health-related quality of life (HRQL) improvement (-8.2 +/- 16.2, mean +/- SD change at 6 months) was observed. HRQL improvement was associated with a decreased volume (mean -294 +/- 427 ml, p = 0.007) in the treated lobes without visible atelectasis. FEV(1), exercise tests, and total lung volume were not changed but there was a proportional shift, a redirection of inspired volume to the untreated lobes. Combined with perfusion scan changes, this suggests that there is improved ventilation and perfusion matching in non-UL lung parenchyma. CONCLUSION: Bronchial valve treatment of emphysema has multiple mechanisms of action and acceptable safety, and significantly improves quality of life for the majority of patients.

Authors
Sterman, DH; Mehta, AC; Wood, DE; Mathur, PN; McKenna, RJ; Ost, DE; Truwit, JD; Diaz, P; Wahidi, MM; Cerfolio, R; Maxfield, R; Musani, AI; Gildea, T; Sheski, F; Machuzak, M; Haas, AR; Gonzalez, HX; Springmeyer, SC; IBV Valve US Pilot Trial Research Team,
MLA Citation
Sterman, DH, Mehta, AC, Wood, DE, Mathur, PN, McKenna, RJ, Ost, DE, Truwit, JD, Diaz, P, Wahidi, MM, Cerfolio, R, Maxfield, R, Musani, AI, Gildea, T, Sheski, F, Machuzak, M, Haas, AR, Gonzalez, HX, Springmeyer, SC, and IBV Valve US Pilot Trial Research Team, . "A multicenter pilot study of a bronchial valve for the treatment of severe emphysema." Respiration 79.3 (2010): 222-233.
PMID
19923790
Source
pubmed
Published In
Respiration; international review of thoracic diseases
Volume
79
Issue
3
Publish Date
2010
Start Page
222
End Page
233
DOI
10.1159/000259318

Comparative effectiveness of low- and high-fidelity bronchoscopy simulation for training in conventional transbronchial needle aspiration and user preferences.

BACKGROUND: Conventional transbronchial needle aspiration (TBNA) can be learned using high-fidelity virtual-reality platforms and low-fidelity models comprised of molded silicone or excised animal airways. OBJECTIVES: The purpose of this study was to determine perceptions and preferences of learners and instructors regarding the comparative effectiveness of low-fidelity and high-fidelity bronchoscopy simulation for training in TBNA. METHODS: During the 2008 annual CHEST conference, a prospective randomized crossover design was used to train study participants in three methods of conventional TBNA using low- and high-fidelity models. Likert style questions were administered to learners and instructors in order to elicit preferences and opinions regarding educational effectiveness of the models. Results were tabulated and depicted in graphic format, with medians calculated. RESULTS: Learners felt that the models were equally enjoyable (13-13) and enthusiasm generating (low 17-high 15). There was preference for low-fidelity in terms of realism (23-17), ease of learning (20-6), and learning all three TBNA methods (31-7 for hub-against-wall, 31-6 for jabbing, 29-6 for piggyback). Low-fidelity was preferred as an ideal model overall (19-11). Instructors thought that low-fidelity was more useful in teaching TBNA (9-0 for all three methods). Instructors perceived the low-fidelity model overall as an ideal tool for learning TBNA (8-0) and a more effective teaching instrument (8-0). CONCLUSION: Based on learner and instructor perceptions, a low-fidelity model is superior to a high-fidelity platform for training in three methods of conventional TBNA.

Authors
Davoudi, M; Wahidi, MM; Zamanian Rohani, N; Colt, HG
MLA Citation
Davoudi, M, Wahidi, MM, Zamanian Rohani, N, and Colt, HG. "Comparative effectiveness of low- and high-fidelity bronchoscopy simulation for training in conventional transbronchial needle aspiration and user preferences." Respiration 80.4 (2010): 327-334.
PMID
20616534
Source
pubmed
Published In
Respiration; international review of thoracic diseases
Volume
80
Issue
4
Publish Date
2010
Start Page
327
End Page
334
DOI
10.1159/000318674

Comparison of transbronchial lung biopsy yield between standard forceps and electrocautery hot forceps in swine.

BACKGROUND: Transbronchial lung biopsy (TBLB) is a commonly performed bronchoscopic procedure. Previous studies have suggested that larger biopsy forceps may improve diagnostic yield; however, the risk of bleeding associated with larger samples may be increased. The hot forceps are large forceps that are connected to an electrocautery system to minimize bleeding at the time of biopsy. OBJECTIVES: We evaluated the hot forceps for improvement in biopsy size and the number of sampled alveoli. METHODS: TBLBs were performed in 2 swine using one type of the forceps, followed by the other forceps 24 h later. Electrocautery was applied from closure of the forceps to retrieval of the sample. A blinded pathologist measured the size of each sample in its longest dimension and calculated the total alveolar content within the largest cross-section from each biopsy. RESULTS: A total of 74 biopsies were collected using each forceps type. Alveolar tissue was present in 25/74 and 26/74 of the biopsies using the hot and conventional forceps, respectively. There was no difference in the size of biopsies collected (2.10 +/- 1.10 vs. 1.83 +/- 0.94 mm; p = 0.164) or in the amount of alveoli per sample (343.2 +/- 402.4 vs. 439.5 +/- 463.5 alveoli; p = 0.433) for hot and conventional forceps, respectively. There was no artifact related to the use of electrocautery, and bleeding was minimal using either forceps system. CONCLUSIONS: The use of the electrocautery hot forceps for TBLB did not result in improvement of the size of biopsies or the amount of collected alveolar tissue in healthy pigs.

Authors
Wahidi, MM; Shofer, SL; Sporn, TA; Ernst, A
MLA Citation
Wahidi, MM, Shofer, SL, Sporn, TA, and Ernst, A. "Comparison of transbronchial lung biopsy yield between standard forceps and electrocautery hot forceps in swine." Respiration 79.2 (2010): 137-140.
PMID
19707013
Source
pubmed
Published In
Respiration; international review of thoracic diseases
Volume
79
Issue
2
Publish Date
2010
Start Page
137
End Page
140
DOI
10.1159/000235818

Response

Authors
Kovitz, KL; Feller-Kopman, D; Lamb, C; Ernst, A; Simoff, M; Sterman, D; Wahidi, M
MLA Citation
Kovitz, KL, Feller-Kopman, D, Lamb, C, Ernst, A, Simoff, M, Sterman, D, and Wahidi, M. "Response." Chest 138.3 (2010): 761-762.
Source
scival
Published In
Chest
Volume
138
Issue
3
Publish Date
2010
Start Page
761
End Page
762
DOI
10.1378/chest.10-1230

Accuracy of Bronchoscopic Implantation of an Anchored Beacon Transponder in a Cadaveric Human Lung Tumor Model

Authors
Gorden, J; Mayse, ML; Smith, RL; Wahidi, MM
MLA Citation
Gorden, J, Mayse, ML, Smith, RL, and Wahidi, MM. "Accuracy of Bronchoscopic Implantation of an Anchored Beacon Transponder in a Cadaveric Human Lung Tumor Model." 2010.
Source
wos-lite
Published In
International Journal of Radiation Oncology, Biology, Physics
Volume
78
Issue
3
Publish Date
2010
Start Page
S523
End Page
S523

The Hi-Lo-Fidelity Comparative TBNA Training Study: Educational Effectiveness And User Preferences

Authors
Davoudi, M; Wahidi, MM; Rohani, NZ; Colt, HG
MLA Citation
Davoudi, M, Wahidi, MM, Rohani, NZ, and Colt, HG. "The Hi-Lo-Fidelity Comparative TBNA Training Study: Educational Effectiveness And User Preferences." AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE 181 (2010).
Source
wos-lite
Published In
American journal of respiratory and critical care medicine
Volume
181
Publish Date
2010

ICU procedures of the critically ill.

Intensive Care Unit (ICU) patients often require urgent, high-risk diagnostic and therapeutic procedures. However, they are particularly vulnerable to procedural complications due to the severity and instability of their illnesses. We discuss the complications associated with bronchoscopy, percutaneous dilatational tracheostomy, pleural interventions for example thoracentesis and chest tube placement, central venous catheterization and pulmonary artery catheterization. Invasive procedures are frequently performed in critically ill patients. It is important for the operator to be familiar with the specific complications of each procedure, as well as steps to take in order to enhance safety and reduce adverse events. High standards of training and credentialing are crucial to ensure that the ICU physicians are proficient in performing these procedures.

Authors
Phua, GC; Wahidi, MM
MLA Citation
Phua, GC, and Wahidi, MM. "ICU procedures of the critically ill." Respirology 14.8 (November 2009): 1092-1097. (Review)
PMID
19909459
Source
pubmed
Published In
Respirology
Volume
14
Issue
8
Publish Date
2009
Start Page
1092
End Page
1097
DOI
10.1111/j.1440-1843.2009.01643.x

Diagnosis and outcome of early pleural space infection following lung transplantation.

BACKGROUND: Despite the frequent occurrence of pleural effusions in lung transplant recipients, little is known about early posttransplant pleural space infections. We sought to determine the predictors and clinical significance of pleural infection in this population. METHODS: We analyzed 455 consecutive lung transplant recipients and identified patients who had undergone sampling of pleural fluid within 90 days posttransplant. A case-control analysis was performed to determine the characteristics that predict infection and the impact of infection on posttransplant survival. RESULTS: Pleural effusions undergoing drainage occurred in 27% of recipients (124 of 455 recipients). Ninety-six percent of effusions were exudative. Pleural space infection occurred in 27% of patients (34 of 124 patients) with effusions. The incidence of infection did not differ significantly by native lung disease or type of transplant operation. Fungal pathogens accounted for > 60% of the infections; Candida albicans was the predominant organism found. Bacterial etiologies were present in 25% of cases. Infected pleural effusions had elevated lactate dehydrogenase levels (p = 0.036) and markedly increased neutrophil levels in the pleural space (p < 0.0001) compared to noninfected effusions. A pleural neutrophil percentage of > 21% provides a sensitivity of 70% and a specificity of 79% for correctly identifying an infection. Patients with pleural space infection had a diminished 1-year survival rate compared to those without infection (67% vs 87%, respectively; p = 0.002). CONCLUSION: Pleural infection with fungal or bacterial pathogens commonly complicates lung transplantation, and an elevated neutrophil level in the pleural fluid is the most sensitive and specific indicator of infection.

Authors
Wahidi, MM; Willner, DA; Snyder, LD; Hardison, JL; Chia, JY; Palmer, SM
MLA Citation
Wahidi, MM, Willner, DA, Snyder, LD, Hardison, JL, Chia, JY, and Palmer, SM. "Diagnosis and outcome of early pleural space infection following lung transplantation." Chest 135.2 (February 2009): 484-491.
PMID
19017896
Source
pubmed
Published In
Chest
Volume
135
Issue
2
Publish Date
2009
Start Page
484
End Page
491
DOI
10.1378/chest.08-1339

Transbronchial lung biopsy

© Cambridge University Press 2009.INTRODUCTION Transbronchial lung biopsy (TBB) is a safe and effective tool useful for the diagnosis of a wide variety of diffuse and focal pulmonary diseases. TBB is regularly performed by 69% of practicing physicians documented in a survey of 1,800 North American pulmonary and critical care physicians [1]. The procedure was first introduced by Andersen in 1965 for use via a rigid bronchoscope, and became more widely performed after it was adapted for use with the flexible bronchoscope in the early 1970s. This chapter describes the primary indications and contraindications to performing TBB during bronchoscopy, our approach to TBB, and methods to manage complications that may arise during or after the procedure. INDICATIONS Biopsy forceps commonly used for TBB via the flexible bronchoscope are generally of the order of 3 mm or smaller in any given dimension. Because of this restriction in size, tissue samples obtained via the transbronchial approach are generally 2–3 mm in any dimension. Despite the small size, TBB provides information regarding pathology that is located beyond the cartilaginous airways that may include elements of the small airways of the distal bronchial tree, the alveolar space, the vasculature, and lymphatic structures immediately surrounding the alveoli [2]. Pulmonary diseases that require examination of larger pieces of lung tissue to assess heterogeneity or homogeneity of different regions of the involved lung (such as many of the idiopathic interstitial lung diseases) are generally not amenable to diagnosis by TBB, so consideration of video-assisted thoracoscopic lung biopsy should be pursued for patients in whom these diseases are a strong consideration.

Authors
Shofer, S; Wahidi, MM
MLA Citation
Shofer, S, and Wahidi, MM. "Transbronchial lung biopsy." Introduction to Bronchoscopy. January 1, 2009. 98-106.
Source
scopus
Publish Date
2009
Start Page
98
End Page
106
DOI
10.1017/CBO9780511575334.011

A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy.

BACKGROUND: Fospropofol disodium is a water-soluble prodrug of propofol with unique pharmacokinetic/pharmacodynamic properties. This randomized, double-blind, multicenter study evaluated the use of fospropofol in patients undergoing flexible bronchoscopy. METHODS: Patients >or= 18 years of age were randomized (2:3) to receive fospropofol, 2 mg/kg or 6.5 mg/kg, after pretreatment with fentanyl, 50 microg. Supplemental doses of each were given per protocol. The primary end point was sedation success, which was defined as follows: three consecutive Modified Observer's Assessment of Alertness/Sedation scores of

Authors
Silvestri, GA; Vincent, BD; Wahidi, MM; Robinette, E; Hansbrough, JR; Downie, GH
MLA Citation
Silvestri, GA, Vincent, BD, Wahidi, MM, Robinette, E, Hansbrough, JR, and Downie, GH. "A phase 3, randomized, double-blind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy." Chest 135.1 (January 2009): 41-47.
PMID
18641105
Source
pubmed
Published In
Chest
Volume
135
Issue
1
Publish Date
2009
Start Page
41
End Page
47
DOI
10.1378/chest.08-0623

Formation of a bronchoesophageal fistula following concurrent radiation and chemotherapy for lung cancer in the setting of Behçet's disease.

Authors
Meyer, J; Wahidi, M; Shofer, S; Evans, J; Crawford, J; Kelsey, CR
MLA Citation
Meyer, J, Wahidi, M, Shofer, S, Evans, J, Crawford, J, and Kelsey, CR. "Formation of a bronchoesophageal fistula following concurrent radiation and chemotherapy for lung cancer in the setting of Behçet's disease." J Thorac Oncol 3.11 (November 2008): 1361-1362. (Letter)
PMID
18978575
Source
pubmed
Published In
Journal of Thoracic Oncology
Volume
3
Issue
11
Publish Date
2008
Start Page
1361
End Page
1362
DOI
10.1097/JTO.0b013e31818b1af2

Ultrasound: the pulmonologist's new best friend.

Authors
Wahidi, MM
MLA Citation
Wahidi, MM. "Ultrasound: the pulmonologist's new best friend." Chest 133.4 (April 2008): 836-837.
PMID
18398111
Source
pubmed
Published In
Chest
Volume
133
Issue
4
Publish Date
2008
Start Page
836
End Page
837
DOI
10.1378/chest.07-2770

Adult tracheoesophageal fistula: A multidisciplinary approach

Fistulization between the respiratory and gastrointestinal tracts is an uncommon problem that results from a spectrum of disease processes. Tracheoesophageal fistula (TEF) formation can be either acquired or congenital; the congenital variety is a rare problem of early infancy and will not be discussed in this review article. Acquired TEFs usually result from malignancy, with the primary tumor location being the esophagus, but many nonmalignant entities can also result in TEF formation. The timely diagnosis of TEF is of vital importance to avoid serious complications such as malnutrition, chronic pulmonary infection, and ultimately overwhelming sepsis and death. In this article, we review the approach to TEFs in regards to etiology, fistula anatomy, diagnosis, and management. We place particular emphasis on a multimodality approach to this complex entity while highlighting important recent medical and surgical developments. © 2008 Lippincott Williams & Wilkins, Inc.

Authors
Singh, J; Olcese, VA; D'Amico, TA; Wahidi, MM
MLA Citation
Singh, J, Olcese, VA, D'Amico, TA, and Wahidi, MM. "Adult tracheoesophageal fistula: A multidisciplinary approach." Clinical Pulmonary Medicine 15.3 (2008): 145-152.
Source
scival
Published In
Clinical Pulmonary Medicine
Volume
15
Issue
3
Publish Date
2008
Start Page
145
End Page
152
DOI
10.1097/CPM.0b013e3181728336

Broncholith removal using cryotherapy during flexible bronchoscopy: a case report.

Pulmonary broncholithiasis can cause a management dilemma depending on its location and the possible involvement of vascular structures. Many patients undergo rigid bronchoscopy or surgical interventions for the removal of broncholiths. In this case report, we describe a 38-year-old white man with a history of performing warehouse demolitions who presented with chronic cough, dyspnea on exertion, and recurrent pneumonia. Imaging studies revealed hilar and mediastinal calcifications, as well as a calcification in the right middle lobe bronchus. Flexible bronchoscopy revealed a mobile obstructing calcified mass in the right middle lobe bronchus. Attempts at removing the mass with forceps were unsuccessful. Instead, the mass was removed using cryotherapy with minimal bleeding and complete resolution of the obstruction. Pathologic examination confirmed that the mass was a broncholith, and stains revealed the presence of histoplasma fungal forms. Partially attached broncholiths can be removed safely using flexible bronchoscopy with the aid of cryotherapy.

Authors
Reddy, AJ; Govert, JA; Sporn, TA; Wahidi, MM
MLA Citation
Reddy, AJ, Govert, JA, Sporn, TA, and Wahidi, MM. "Broncholith removal using cryotherapy during flexible bronchoscopy: a case report." Chest 132.5 (November 2007): 1661-1663.
PMID
17998368
Source
pubmed
Published In
Chest
Volume
132
Issue
5
Publish Date
2007
Start Page
1661
End Page
1663
DOI
10.1378/chest.07-0739

Assessment of pulmonary fellows acquisition of bronchoscopy skills

Authors
Wahidi, MM; Silvestri, G; Conforti, J; Ferguson, S; Coakley, R; Patel, C; Moses, L; Downie, G
MLA Citation
Wahidi, MM, Silvestri, G, Conforti, J, Ferguson, S, Coakley, R, Patel, C, Moses, L, and Downie, G. "Assessment of pulmonary fellows acquisition of bronchoscopy skills." October 2007.
Source
wos-lite
Published In
Chest
Volume
132
Issue
4
Publish Date
2007
Start Page
514S
End Page
515S

Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition).

BACKGROUND: The solitary pulmonary nodule (SPN) is a frequent incidental finding that may represent primary lung cancer or other malignant or benign lesions. The optimal management of the SPN remains unclear. METHODS: We conducted a systematic literature review to address the following questions: (1) the prevalence of SPN; (2) the prevalence of malignancy in nodules with varying characteristics (size, morphology, and type of opacity); (3) the relationships between growth rates, histology, and other nodule characteristics; and (4) the performance characteristics and complication rates of tests for SPN diagnosis. We searched MEDLINE and other databases and used previous systematic reviews and recent primary studies. RESULTS: Eight large trials of lung cancer screening showed that both the prevalence of at least one nodule (8 to 51%) and the prevalence of malignancy in patients with nodules (1.1 to 12%) varied considerably across studies. The prevalence of malignancy varied by size (0 to 1% for nodules < 5 mm, 6 to 28% for nodules 5 to 10 mm, and 64 to 82% for nodules > 20 mm). Data from six studies of patients with incidental or screening-detected nodules showed that the risk for malignancy was approximately 20 to 30% in nodules with smooth edges; in nodules with irregular, lobulated, or spiculated borders, the rate of malignancy was higher but varied across studies from 33 to 100%. Nodules that were pure ground-glass opacities were more likely to be malignant (59 to 73%) than solid nodules (7 to 9%). The sensitivity of positron emission tomography imaging for identifying a malignant SPN was consistently high (80 to 100%), whereas specificity was lower and more variable across studies (40 to 100%). Dynamic CT with nodule enhancement yielded the most promising sensitivity (sensitivity, 98 to 100%; specificity, 54 to 93%) among imaging tests. In studies of CT-guided needle biopsy, nondiagnostic results were seen approximately 20% of the time, but sensitivity and specificity were excellent when biopsy yielded a specific benign or malignant result. CONCLUSIONS: The prevalence of an SPN and the prevalence of malignancy in patients with an SPN vary widely across studies. The interpretation of these variable prevalence rates should take into consideration not only the nodule characteristics but also the population at risk. Modern imaging tests and CT-guided needle biopsy are highly sensitive for identifying a malignant SPN, but the specificity of imaging tests is variable and often poor.

Authors
Wahidi, MM; Govert, JA; Goudar, RK; Gould, MK; McCrory, DC; American College of Chest Physicians,
MLA Citation
Wahidi, MM, Govert, JA, Goudar, RK, Gould, MK, McCrory, DC, and American College of Chest Physicians, . "Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer?: ACCP evidence-based clinical practice guidelines (2nd edition)." Chest 132.3 Suppl (September 2007): 94S-107S. (Review)
PMID
17873163
Source
pubmed
Published In
Chest
Volume
132
Issue
3 Suppl
Publish Date
2007
Start Page
94S
End Page
107S
DOI
10.1378/chest.07-1352

State of the art: interventional pulmonology.

Interventional pulmonology (IP) provides comprehensive care to patients with structural airway disorders and pleural diseases. A growing armamentarium of diagnostic and therapeutic tools has expanded the interventional pulmonologist's ability to care for pulmonary patients with complex abnormalities, often in concert and close collaboration with physicians in other specialties, such as thoracic surgery. Innovative technologies promise to have an impact on diseases and clinical entities not traditionally treated by invasive pulmonary interventions, such as asthma, COPD, and the solitary pulmonary nodule. Training, credentialing, reimbursement, and scientific validation remain key necessities for the continued growth of IP, and require a concerted effort by chest physicians and their professional organizations.

Authors
Wahidi, MM; Herth, FJF; Ernst, A
MLA Citation
Wahidi, MM, Herth, FJF, and Ernst, A. "State of the art: interventional pulmonology." Chest 131.1 (January 2007): 261-274. (Review)
PMID
17218585
Source
pubmed
Published In
Chest
Volume
131
Issue
1
Publish Date
2007
Start Page
261
End Page
274
DOI
10.1378/chest.06-0975

A multicenter trial with the IBV valve for treatment of severe emphysema

Authors
Sterman, DH; Mehta, AC; Wood, DE; Mathur, P; McKenna, R; Ost, D; Diaz, P; Wahidi, MM; Truit, J
MLA Citation
Sterman, DH, Mehta, AC, Wood, DE, Mathur, P, McKenna, R, Ost, D, Diaz, P, Wahidi, MM, and Truit, J. "A multicenter trial with the IBV valve for treatment of severe emphysema." October 2006.
Source
wos-lite
Published In
Chest
Volume
130
Issue
4
Publish Date
2006
Start Page
110S
End Page
110S

Pulmonary alveolar proteinosis diagnosed in pregnancy and managed with whole-lung lavage

A 29-year-old woman presented with dyspnea, fatigue, and chills during the first trimester of pregnancy. She did not respond to empiric antibiotic therapy for bronchitis and was subsequently hospitalized with worsening respiratory symptoms and hypoxemia. During this hospitalization, the patient underwent open lung biopsy and was diagnosed with pulmonary alveolar proteinosis (PAP). A therapeutic trial with granulocyte-macrophage colony-stimulating factor proved ineffective. Later in her pregnancy, therapeutic sequential whole-lung lavage was performed owing to her worsening dyspnea and hypoxemia. Cryptococcus neoformans grew in culture from her lavage fluid. Whole-lung lavage resulted in clinical improvement and she was treated with a course of amphotericin B for her cryptococcal lung infection. A healthy male infant was delivered at term without complications. Our case is another example of the feasibility and safety of whole-lung lavage in a symptomatic pregnant woman with PAP, and also demonstrates the need for a high index of suspicion for secondary infection in PAP. © 2006 Lippincott Williams & Wilkins, Inc.

Authors
Jankowich, MD; Wahidi, MM; Feller-Kopman, D; Ernst, A
MLA Citation
Jankowich, MD, Wahidi, MM, Feller-Kopman, D, and Ernst, A. "Pulmonary alveolar proteinosis diagnosed in pregnancy and managed with whole-lung lavage." Journal of Bronchology 13.4 (2006): 204-206.
Source
scival
Published In
Journal of Bronchology
Volume
13
Issue
4
Publish Date
2006
Start Page
204
End Page
206
DOI
10.1097/01.lbr.0000212545.32835.2d

Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans

Study objectives: Clopidogrel is often prescribed for primary or secondary prevention of cardiovascular disease and has been associated with unwanted bleeding events. After having shown that transbronchial biopsy can safely be performed in pigs receiving clopidogrel, we sought to determine whether routine clopidogrel use increases the risk of bleeding after transbronchial lung biopsy in humans. Design: Prospective cohort study. Patients and interventions: Data were collected on 604 patients without underlying coagulation problems who underwent transbronclual lung biopsy over 13 months. Clopidogrel was not discontinued before biopsy in patients who were using it. Transbronchial biopsies were performed, and the incidence of bleeding and other complications among patients receiving clopidogrel was compared with that of other patients. Results: The study was stopped early because the bleeding rate in the clopidogrel-only group (n = 18) was excessive (89% [16 of 18 patients] vs 3.4% [20 of 574 control subjects; p > 0.001] and also in the group receiving clopidogrel and aspirin (100% [12 of 12 patients] vs 3.4% among control subjects [p > 0.001]. Bleeding rates were significantly higher in the clopidogrel group for each degree of bleeding severity: mild (27% vs 1.5%), moderate (34% vs 1.5%), and severe (27% vs 0.3%; p > 0.001 for all comparisons). All 12 patients receiving both aspirin and clopidogrel had bleeding: moderate in 6 patients and severe in 6 patients. All bleeding was controlled by endoscopic means. There were no fatalities or need for blood transfusions in the patients enrolled in the trial. Conclusions: Clopidogrel use greatly increases the risk of bleeding after transbronchial lung biopsy in humans and therefore should be discontinued before bronchoscopy with biopsies. Aspirin exacerbates the effect of clopidogrel on bleeding.

Authors
Ernst, A; Eberhardt, R; Wahidi, M; Becker, HD; Herth, FJF
MLA Citation
Ernst, A, Eberhardt, R, Wahidi, M, Becker, HD, and Herth, FJF. "Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans." Chest 129.3 (2006): 734-737.
PMID
16537875
Source
scival
Published In
Chest
Volume
129
Issue
3
Publish Date
2006
Start Page
734
End Page
737
DOI
10.1378/chest.129.3.734

Clinical and pathologic features of familial interstitial pneumonia.

RATIONALE: Several lines of evidence suggest that genetic factors and environmental exposures play a role in the development of pulmonary fibrosis. OBJECTIVES: We evaluated families with 2 or more cases of idiopathic interstitial pneumonia among first-degree family members (familial interstitial pneumonia, or FIP), and identified 111 families with FIP having 309 affected and 360 unaffected individuals. METHODS: The presence of probable or definite FIP was based on medical record review in 28 cases (9.1%); clinical history, diffusing capacity of carbon monoxide (DL(CO)), and chest X-ray in 16 cases (5.2%); clinical history, DL(CO), and high-resolution computed tomography chest scan in 191 cases (61.8%); clinical history and surgical lung biopsy in 56 cases (18.1%); and clinical history and autopsy in 18 cases (5.8%). RESULTS: Older age (68.3 vs. 53.1; p < 0.0001), male sex (55.7 vs. 37.2%; p < 0.0001), and having ever smoked cigarettes (67.3 vs. 34.1%; p < 0.0001) were associated with the development of FIP. After controlling for age and sex, having ever smoked cigarettes remained strongly associated with the development of FIP (odds ratio(adj), 3.6; 95% confidence interval, 1.3-9.8). Evidence of aggregation of disease was highly significant (p < 0.001) among sibling pairs, and 20 pedigrees demonstrated vertical transmission, consistent with autosomal dominant inheritance. Forty-five percent of pedigrees demonstrated phenotypic heterogeneity, with some pedigrees demonstrating several subtypes of idiopathic interstitial pneumonia occurring within the same families. CONCLUSIONS: These findings suggest that FIP may be caused by an interaction between a specific environmental exposure and a gene (or genes) that predisposes to the development of several subtypes of idiopathic interstitial pneumonia.

Authors
Steele, MP; Speer, MC; Loyd, JE; Brown, KK; Herron, A; Slifer, SH; Burch, LH; Wahidi, MM; Phillips, JA; Sporn, TA; McAdams, HP; Schwarz, MI; Schwartz, DA
MLA Citation
Steele, MP, Speer, MC, Loyd, JE, Brown, KK, Herron, A, Slifer, SH, Burch, LH, Wahidi, MM, Phillips, JA, Sporn, TA, McAdams, HP, Schwarz, MI, and Schwartz, DA. "Clinical and pathologic features of familial interstitial pneumonia." Am J Respir Crit Care Med 172.9 (November 1, 2005): 1146-1152.
PMID
16109978
Source
pubmed
Published In
American journal of respiratory and critical care medicine
Volume
172
Issue
9
Publish Date
2005
Start Page
1146
End Page
1152
DOI
10.1164/rccm.200408-1104OC

Large volume thoracentesis and the risk of reexpansion pulmonary EDEMA

Authors
Berkowitz, DM; Bechara, RI; Lunn, W; Wahidi, MM; Ernst, A; Feller-Kopman, DJ
MLA Citation
Berkowitz, DM, Bechara, RI, Lunn, W, Wahidi, MM, Ernst, A, and Feller-Kopman, DJ. "Large volume thoracentesis and the risk of reexpansion pulmonary EDEMA." October 2005.
Source
wos-lite
Published In
Chest
Volume
128
Issue
4
Publish Date
2005
Start Page
156S
End Page
156S

Role of the interventional pulmonologist in the intensive care unit.

Interventional pulmonology is a new field within the pulmonary and critical care medicine specialty with a focus on invasive diagnostic and therapeutic modalities in airway and pleural disorders. The interventional pulmonologist is highly qualified to take a prominent role in the intensive care unit in a consultative fashion to provide assistance with pleural procedures, establishment and care of artificial airways, and management of patients with respiratory failure attributable to structural central airway disorders. The presence of a dedicated operator with advanced skills facilitates access to specialized procedures in an expeditious and safe manner. Clear communication between the interventional pulmonologist and intensivist is vital to ensure a collaborative effort that delivers optimal patient care.

Authors
Wahidi, MM; Ernst, A
MLA Citation
Wahidi, MM, and Ernst, A. "Role of the interventional pulmonologist in the intensive care unit." J Intensive Care Med 20.3 (May 2005): 141-146. (Review)
PMID
15888901
Source
pubmed
Published In
Journal of Intensive Care Medicine
Volume
20
Issue
3
Publish Date
2005
Start Page
141
End Page
146
DOI
10.1177/0885066605275250

Contraindications and safety of transbronchial lung biopsy via flexible bronchoscopy. A survey of pulmonologists and review of the literature.

BACKGROUND: Transbronchial lung biopsy (TBLB) via flexible bronchoscopy is a common procedure performed by pulmonologists. Limited scientific data exist concerning the risk of this procedure in patients with conditions that may adversely affect the rate of procedural complications. OBJECTIVES: To evaluate the current practice pattern and attitude of pulmonologists toward the performance of TBLB in the presence of high-risk conditions. METHODS: A survey was constructed and distributed at the American College of Chest Physicians annual meeting, held in Philadelphia, USA, in November of 2001. RESULTS: A total of 227 surveys were distributed with a return of 158 (69.6%). Anticoagulation medications are temporarily held prior to TBLB by the majority of our survey respondents (98.7% for intravenous heparin, 90.5% for warfarin, and 87.3% for low-molecular-weight heparin). Medications with effect on platelet function are held by fewer pulmonologists. There is a wide variation in the pulmonologists' perception of the risk of performing TBLB when certain medical conditions coexist: pulmonary hypertension [absolute contraindication (AC), 28.7%; relative contraindication (RC) 58.6%], superior vena cava syndrome (AC 19.6%, RC 51%), mechanical ventilation (AC 17.8%, RC 58.6%) and lung cavity/abscess (AC 7%, RC 44.9%). A significant percentage of pulmonologists (55%) do not regard an elevated serum creatinine at any level as AC to TBLB. Thirty-eight percent of the survey participants administer desmopressin prior to TBLB in uremic patients to prevent excessive bleeding. CONCLUSIONS: Prior to performing bronchoscopic TBLB, the majority of pulmonologists temporarily holds anticoagulation medications. However, there is a lack of agreement in relation to perceived contraindications and safety of TBLB.

Authors
Wahidi, MM; Rocha, AT; Hollingsworth, JW; Govert, JA; Feller-Kopman, D; Ernst, A
MLA Citation
Wahidi, MM, Rocha, AT, Hollingsworth, JW, Govert, JA, Feller-Kopman, D, and Ernst, A. "Contraindications and safety of transbronchial lung biopsy via flexible bronchoscopy. A survey of pulmonologists and review of the literature." Respiration 72.3 (May 2005): 285-295.
PMID
15942298
Source
pubmed
Published In
Respiration; international review of thoracic diseases
Volume
72
Issue
3
Publish Date
2005
Start Page
285
End Page
295
DOI
10.1159/000085370

Effect of clopidogrel with and without aspirin on bleeding following transbronchial lung biopsy.

BACKGROUND: Clopidogrel, a potent inhibitor of platelet aggregation, is being commonly prescribed in the elderly population due to its benefits in patients with atherosclerotic diseases. It is currently unknown whether clopidogrel increases the risk of bleeding during invasive pulmonary procedures. METHODS: Pigs of the Yorkshire species were randomized to one of the following two arms: clopidogrel (75 mg/d) alone; or clopidogrel plus aspirin (75 mg/d and 325 mg/d, respectively). The animals underwent flexible bronchoscopy with transbronchial lung biopsies under fluoroscopic guidance at baseline and after 1 week of daily oral intake of their assigned drugs. The main outcome of the study was the quantity of blood collected through the bronchoscope following transbronchial lung biopsy (TBLB). RESULTS: Sixteen animals were enrolled in the study, with 8 animals randomized to each arm. No statistically significant difference was found in the average quantity of blood resulting from transbronchial lung biopsies between procedures performed at baseline and those performed after animals received either clopidogrel (mean [+/- SD] dose, 1.41 +/- 1.14 mL) or clopidogrel plus aspirin (mean dose, 1.75 +/- 1.28 mL; p = 0.42). CONCLUSIONS: Clopidogrel, with or without aspirin, does not increase bleeding complications after TBLB in healthy pigs.

Authors
Wahidi, MM; Garland, R; Feller-Kopman, D; Herth, F; Becker, HD; Ernst, A
MLA Citation
Wahidi, MM, Garland, R, Feller-Kopman, D, Herth, F, Becker, HD, and Ernst, A. "Effect of clopidogrel with and without aspirin on bleeding following transbronchial lung biopsy." Chest 127.3 (March 2005): 961-964.
PMID
15764782
Source
pubmed
Published In
Chest
Volume
127
Issue
3
Publish Date
2005
Start Page
961
End Page
964
DOI
10.1378/chest.127.3.961

Tracheostomy in mechanically ventilated patients: unanswered questions.

Authors
Gentile, MA; Wahidi, MM
MLA Citation
Gentile, MA, and Wahidi, MM. "Tracheostomy in mechanically ventilated patients: unanswered questions." Crit Care Med 33.2 (February 2005): 444-445.
PMID
15699852
Source
pubmed
Published In
Critical Care Medicine
Volume
33
Issue
2
Publish Date
2005
Start Page
444
End Page
445

Endoscopic removal of metallic airway stents

Background: Complications of metallic airway stents include granulation tissue formation, fracture of struts, migration, and mucous plugging. When these complications result in airway injury or obstruction, it may become necessary to remove the stent. There have been few reports detailing techniques and complications associated with endoscopic removal of metallic airway stents. We report our experience with endoscopic removal of 30 such stents over a 3-year period. Methods: We conducted a retrospective review of 25 patients who underwent endoscopic stent removal from March 2001 to April 2004. The patients ranged in age from 17 to 80 years (mean, 56.3 years). There were 10 male and 15 female patients. The stents had been placed for nonmalignant disease in 20 patients (80%) and malignant disease in 5 patients (20%). All procedures were done under general anesthesia with a rigid bronchoscope. Special attention was focused on the technique of stent removal and postoperative complications. Results: Thirty metallic airway stents were successfully removed from 25 consecutive patients over a 3-year period. The basic method of removal involved the steady application of traction to the stent with alligator forceps. In all cases, an instrument such as the barrel of the rigid bronchoscope or a Jackson dilator was employed to help separate the stent from the airway wall before removal was attempted. In some instances, the airway wall was pretreated with thermal energy prior to stent removal. Complications were as follows: retained stent pieces (n = 7), mucosal tear with bleeding (n = 4), reobstruction requiring temporary silicone stent placement (n = 14), need for postoperative mechanical ventilation (n = 6), and tension pneumothorax (n = 1). Conclusions: Although metallic stents may be safely removed endoscopically, complications are common and must be anticipated. Other investigators have described airway obstruction and death as a result of attempted stent removal. Placement and removal of metallic airway stents should only be performed at centers that are prepared to deal with the potentially life-threatening complications.

Authors
Lunn, W; Feller-Kopman, D; Wahidi, M; Ashiku, S; Thurer, R; Ernst, A
MLA Citation
Lunn, W, Feller-Kopman, D, Wahidi, M, Ashiku, S, Thurer, R, and Ernst, A. "Endoscopic removal of metallic airway stents." Chest 127.6 (2005): 2106-2112.
PMID
15947327
Source
scival
Published In
Chest
Volume
127
Issue
6
Publish Date
2005
Start Page
2106
End Page
2112
DOI
10.1378/chest.127.6.2106

The role of bronchoscopy in the management of lung transplant recipients.

Bronchoscopy is an integral piece in the complex multidisciplinary approach to the care of lung transplant recipients. Although the use of surveillance bronchoscopies is controversial, bronchoscopy undoubtedly provides valuable information in patients with respiratory symptoms or functional decline. Therapeutic bronchoscopic interventions offer effective and safe therapy for complications of anastomotic sites. Further research is needed to address critical questions regarding the role of bronchoscopy in this selected patient population. The objectives of the research should be to increase the yield of bronchoscopy, improve its safety, and decrease procedure-related discomfort. Only randomized, multicenter clinical trials with full commitment from lung transplant centers can accomplish these goals.

Authors
Wahidi, MM; Ernst, A
MLA Citation
Wahidi, MM, and Ernst, A. "The role of bronchoscopy in the management of lung transplant recipients." Respir Care Clin N Am 10.4 (December 2004): 549-562. (Review)
PMID
15585182
Source
pubmed
Published In
Respiratory care clinics of North America
Volume
10
Issue
4
Publish Date
2004
Start Page
549
End Page
562
DOI
10.1016/j.rcc.2004.06.008

Percutaneous endoscopic gastrostomy tube placement can be safely performed by the interventional pulmonologist

Authors
Feller-Kopman, DJ; Lunn, WW; Wahidi, MM; Garland, R; Ernst, A; Ashiku, S
MLA Citation
Feller-Kopman, DJ, Lunn, WW, Wahidi, MM, Garland, R, Ernst, A, and Ashiku, S. "Percutaneous endoscopic gastrostomy tube placement can be safely performed by the interventional pulmonologist." October 2004.
Source
wos-lite
Published In
Chest
Volume
126
Issue
4
Publish Date
2004
Start Page
735S
End Page
735S

A Simple Teaching Intervention Significantly Decreases Radiation Exposure during Transbronchial Biopsy

The objective of this study was to assess the need for formal instruction on radiation safety and on a means to decrease radiation exposure during pulmonary procedures for healthcare workers and patients. Radiation safety is a major healthcare concern. No studies have examined the use of fluoroscopy and adherence to established safety guidelines in pulmonary medicine. We conducted our study at a tertiary university-affiliated referral center with a busy bronchoscopy unit. Patients underwent transbronchial biopsy with fluoroscopy guidance in a standard fashion. Data was collected unbeknownst to the operator and included patient demographics, fluoroscopy use in seconds, number of biopsies and attempts, established diagnosis, and complications. This was followed by a teaching intervention for all involved personnel, and the same data was obtained postintervention. Fluoroscopy use varied widely before the intervention and safety guidelines were not adhered to consistently. After intervention, the average exposure dropped from 121.5 seconds (range, 18-306 sec) to 41.7 seconds (range, 6-108 sec) (P <0.05), and accepted guidelines were uniformly followed. There was no change in complication rate or ability to establish a diagnosis. Formal training in radiation safety and in use of fluoroscopy should be mandatory. It decreases patient and staff exposure, and thus contributes to patient safety without sacrificing yield.

Authors
Ernst, A; Smith, L; Gryniuk, L; Garland, R; Angel, L; Wahidi, M; Feller-Kopman, D; Copeland, JF
MLA Citation
Ernst, A, Smith, L, Gryniuk, L, Garland, R, Angel, L, Wahidi, M, Feller-Kopman, D, and Copeland, JF. "A Simple Teaching Intervention Significantly Decreases Radiation Exposure during Transbronchial Biopsy." Journal of Bronchology 11.2 (2004): 109-111.
Source
scival
Published In
Journal of Bronchology
Volume
11
Issue
2
Publish Date
2004
Start Page
109
End Page
111
DOI
10.1097/00128594-200404000-00008

Multiple lung nodules in a woman with a history of melanoma.

A 61-year-old Caucasian female presented with a 6-week history of dry persistent cough. She had no shortness of breath, chest pain, fever, chills, or weight loss. She had been diagnosed with melanoma on the left thigh 6 months earlier. It was a spindle cell variant, Clark's grade III, with maximal thickness of 0.5 mm. At the time of diagnosis of melanoma, there was no evidence of metastasis on chest radiographs or computed tomography (CT) of the abdomen and pelvis. Treatment of her melanoma was limited to surgical excision with no subsequent radiation or chemotherapy. Other significant past medical history included hypertension, hypothyroidism, and bilateral breast augmentation. She had a 40 pack-year history of smoking.

Authors
Taylor, JL; Quiñones Maymí, DM; Sporn, TA; McAdam, HP; Wahidi, MM
MLA Citation
Taylor, JL, Quiñones Maymí, DM, Sporn, TA, McAdam, HP, and Wahidi, MM. "Multiple lung nodules in a woman with a history of melanoma." Respiration 70.5 (September 2003): 544-548.
PMID
14665785
Source
pubmed
Published In
Respiration; international review of thoracic diseases
Volume
70
Issue
5
Publish Date
2003
Start Page
544
End Page
548

The Montgomery T-tube tracheal stent.

The Montgomery T-tube is a valuable tracheal stent that provides a functional airway while supporting the tracheal mucosa. It is used in benign and malignant tracheal diseases and provides symptomatic relief to the majority of the patients. T-tubes are simple to insert and rarely cause serious complications. The use of T-tubes continues to gain popularity with the increasing incidence of benign trachea stenosis following the use of artificial airways. Physicians dealing with diseases of the airways should be familiar with the indications, contraindication, complications, and care of the Montgomery T-tubes.

Authors
Wahidi, MM; Ernst, A
MLA Citation
Wahidi, MM, and Ernst, A. "The Montgomery T-tube tracheal stent." Clin Chest Med 24.3 (September 2003): 437-443. (Review)
PMID
14535218
Source
pubmed
Published In
Clinics in Chest Medicine
Volume
24
Issue
3
Publish Date
2003
Start Page
437
End Page
443

Deciding when to use percutaneous dilatational tracheostomy

Percutaneous dilatational tracheostomy (PDT) is a safe, minimally invasive procedure that can be performed at bedside in the ICU. The indications for PDT are the same as for surgical tracheostomy and include prolonged intubation, assistance in weaning from mechanical ventilation, upper airway obstruction, and facilitation of removal of respiratory secretions. Preprocedure evaluation includes a review of pertinent history, a detailed physical examination focusing on neck anatomy and extension, and assessment of ventilatory status. Coagulation abnormalities and bleeding tendencies are identified by checking platelet count, partial thromboplastin time, prothrombin time/international normalized ratio, and renal function. Advantages of PDT include elimination of the risky transport of critically ill patients out of the ICU, short waiting time once the decision to perform a tracheostomy has been made, and significant cost reduction. Less postoperative bleeding and infection may be seen with PDT than with surgical tracheostomy.

Authors
Wahidi, MM; Feller-Kopman, D; Ernst, A
MLA Citation
Wahidi, MM, Feller-Kopman, D, and Ernst, A. "Deciding when to use percutaneous dilatational tracheostomy." Journal of Respiratory Diseases 24.5 (2003): 195-199.
Source
scival
Published In
Journal of Respiratory Diseases
Volume
24
Issue
5
Publish Date
2003
Start Page
195
End Page
199

Ultrasound guidance for medical thoracoscopy: A novel approach

Background: Commonly, a pneumothorax is induced before medical thoracoscopy to facilitate safe entry into the pleural space. Objective: Evaluate the use of transthoracic ultrasound to locate a safe entry site for trocar placement during medical thoracoscopy without induction of a preprocedure pneumothorax. Method: The study was designed as a prospective cohort study, performed in the setting of a tertiary care hospital with an active interventional pulmonology program. It included 20 consecutive patients referred for medical thoracoscopy. Results: Ultrasound identified entry sites in all 20 patients. All sites were successfully used, despite the presence of adhesions in 3 patients. There were no complications. Conclusions: Ultrasound could safely and reliably identify entry sites for trocar placement during medical thoracoscopy, even in patients with pleural adhesions. The use of ultrasound may replace the practice of pneumothorax induction before medical thoracoscopy. Copyright © 2003 S. Karger AG, Basel.

Authors
Hersh, CP; Feller-Kopman, D; Wahidi, M; Garland, R; Herth, F; Ernst, A
MLA Citation
Hersh, CP, Feller-Kopman, D, Wahidi, M, Garland, R, Herth, F, and Ernst, A. "Ultrasound guidance for medical thoracoscopy: A novel approach." Respiration 70.3 (2003): 299-301.
PMID
12915750
Source
scival
Published In
Respiration
Volume
70
Issue
3
Publish Date
2003
Start Page
299
End Page
301
DOI
10.1159/000072012

Progression of idiopathic pulmonary fibrosis in native lungs after single lung transplantation.

This retrospective, single-center study was conducted to assess the response of native idiopathic pulmonary fibrosis (IPF) lungs to a potent cyclosporine-based immunosuppressive regimen in single-lung transplantation recipients. The study included IPF patients who had undergone single-lung transplantation and had chest CT scans before and after transplantation. Five patients underwent single-lung transplantation for IPF between April 1992 and January 2001, and met entry criteria. All patients were placed on an immunosuppressive regimen consisting of prednisone, azathioprine, and cyclosporine. In two of the five patients, ground glass attenuation in the native IPF lung improved post-transplantation. However, fibrotic changes progressed in all five patients. In patients with advanced IPF, a potent cyclosporine-based immunosuppressive regimen is not likely to have an effect on the progression of the disease.

Authors
Wahidi, MM; Ravenel, J; Palmer, SM; McAdams, HP
MLA Citation
Wahidi, MM, Ravenel, J, Palmer, SM, and McAdams, HP. "Progression of idiopathic pulmonary fibrosis in native lungs after single lung transplantation." Chest 121.6 (June 2002): 2072-2076.
PMID
12065382
Source
pubmed
Published In
Chest
Volume
121
Issue
6
Publish Date
2002
Start Page
2072
End Page
2076

Familial pulmonary fibrosis in the United States.

Authors
Wahidi, MM; Speer, MC; Steele, MP; Brown, KK; Schwarz, MI; Schwartz, DA
MLA Citation
Wahidi, MM, Speer, MC, Steele, MP, Brown, KK, Schwarz, MI, and Schwartz, DA. "Familial pulmonary fibrosis in the United States." Chest 121.3 Suppl (March 2002): 30S-.
PMID
11893669
Source
pubmed
Published In
Chest
Volume
121
Issue
3 Suppl
Publish Date
2002
Start Page
30S

Upper airway obstruction in a patient with epidermolysis bullosa acquisita

Epidermolysis bullosa acquisita (EBA) is a rare, acquired autoimmune bullous disease characterized by the development of tense bullae spontaneously or due to minor trauma to the skin and mucosal surfaces. Mucosal involvement has been reported in the oral cavity, nasal cavity, eyes, pharynx, larynx, and esophagus. Laryngeal involvement in EBA has been reported infrequently in the literature. We report a case of such involvement in a patient with EBA and marked supraglottic stenosis.

Authors
Wahidi, MM; Sago, J; Govert, JA; Schreiber, EG
MLA Citation
Wahidi, MM, Sago, J, Govert, JA, and Schreiber, EG. "Upper airway obstruction in a patient with epidermolysis bullosa acquisita." Journal of Bronchology 9.4 (2002): 298-300.
Source
scival
Published In
Journal of Bronchology
Volume
9
Issue
4
Publish Date
2002
Start Page
298
End Page
300

Familial pulmonary fibrosis in the United States

Authors
Wahidi, MM; Speer, MC; Steele, MP; Brown, KK; Schwarz, MI; Schwartz, DA
MLA Citation
Wahidi, MM, Speer, MC, Steele, MP, Brown, KK, Schwarz, MI, and Schwartz, DA. "Familial pulmonary fibrosis in the United States." Chest 121.3 (2002): 30S-.
Source
scival
Published In
Chest
Volume
121
Issue
3
Publish Date
2002
Start Page
30S

Familial pulmonary fibrosis in the United States

Authors
WAHIDI, M
MLA Citation
WAHIDI, M. "Familial pulmonary fibrosis in the United States." Chest 121 (2002).
Source
cinii-english
Published In
Chest
Volume
121
Publish Date
2002
DOI
10.1378/chest.121.3_suppl.30S

Familial pulmonary fibrosis in the USA.

Authors
Wahidi, MM; Speer, MC; Steele, M; Brown, KK; Schwarz, MI; Schwartz, DA
MLA Citation
Wahidi, MM, Speer, MC, Steele, M, Brown, KK, Schwarz, MI, and Schwartz, DA. "Familial pulmonary fibrosis in the USA." AMERICAN JOURNAL OF HUMAN GENETICS 69.4 (October 2001): 285-285.
Source
wos-lite
Published In
The American Journal of Human Genetics
Volume
69
Issue
4
Publish Date
2001
Start Page
285
End Page
285

Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel.

RATIONALE: Clopidogrel is a commonly used antiplatelet medication. The risk of local hemorrhage associated with use of this drug during routine thoracentesis or small-bore chest tube placement is not well established. OBJECTIVES: We conducted a prospective cohort study to assess the risk of hemothorax in patients taking clopidogrel while undergoing either pleural procedure. METHODS: Twenty-five consecutive adult patients who were taking clopidogrel at the time they were offered thoracentesis or small-bore (14 Fr) chest tube placement consented to continue taking the drug through their procedure. A control group consisted of 50 patients undergoing these pleural procedures who were not taking clopidogrel at the time they consented to undergo either procedure. All of the pleural procedures were performed under ultrasound guidance by an interventional pulmonologist or a fellow under direct faculty supervision. Hospitalized patients were screened for hemothorax by observing for a post-procedure drop in blood hemoglobin content of 2 g/dl or reaccumulation of their pleural effusion within 24 hours of the procedure. Outpatients were called within 2 weeks after their procedure to determine whether they had any symptoms suggestive of hemothorax. MEASUREMENTS AND MAIN RESULTS: There was one case of hemothorax after thoracentesis in the clopidogrel group versus none in the control group. The one patient with hemothorax required transfusion with 2 units of packed red blood cells and small-bore chest tube placement, and clopidogrel was withheld. There were no other clinically apparent complications of either procedure. CONCLUSIONS: Considered in combination with other small previously published studies, this single-center, nonrandomized, controlled prospective cohort study suggests that the rate of clinically consequential hemorrhage after ultrasound-guided thoracentesis or chest tube placement in patients taking clopidogrel is sufficiently low to warrant a large, randomized clinical trial designed to determine the safety of performing these procedures without interrupting clopidogrel therapy.

Authors
Mahmood, K; Shofer, SL; Moser, BK; Argento, AC; Smathers, EC; Wahidi, MM
MLA Citation
Mahmood, K, Shofer, SL, Moser, BK, Argento, AC, Smathers, EC, and Wahidi, MM. "Hemorrhagic complications of thoracentesis and small-bore chest tube placement in patients taking clopidogrel." Ann Am Thorac Soc 11.1: 73-79.
PMID
24102190
Source
pubmed
Published In
Annals of the American Thoracic Society
Volume
11
Issue
1
Start Page
73
End Page
79
DOI
10.1513/AnnalsATS.201303-050OC
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