Bronchoscopy
Best of ATS Video Lecture Series: Bronchoscopy. Part of a larger collection of videos curated by ATS. These videos introduces strategies for preparation, examination, and bronchoalveolar lavage.
Weiss SM, Hert RC, Gianola FJ et al. Complications of fiberoptic bronchoscopy in thrombocytopenic patients. Chest 1993;104:1025-8. Established safety of transnasal bronchs for bronchoalveolar lavage in thrombocytopenic patients.
Herth FJF, Becker HD, Ernst A. Aspirin does not increase bleeding complications after transbronchial biopsy. Chest 2002;122:1461-4 Prospective study compared 285 patients taking ASA within 24 hrs of TBB to 932 non-ASA users and found no difference in the risk of minor, moderate, or major bleeding.
***See also Lung Cancer Staging
Thoracentesis
Swiderek J, Morcos S, Donthireddy V, et al. Prospective study to determine the volume of pleural fluid required to diagnose malignancy. Chest 2010; 137:68-73. Prospective single center study of 103 patients with known or suspected malignant effusion. Three aliquots (10 mL, 60 mL, and >150 mL) were collected from each procedure and examined by direct smear/cytospin and by cell block analysis. Aliquots of 60 mL or >150 mL had significantly higher sensitivity and negative predictive value than aliquots of 10 mL, suggesting larger volumes are of diagnostic benefit. This is in contrast to earlier retrospective and smaller prospective studies suggesting diagnosis was independent of volume (See Chest 2002;122:1913-7, Chest 2009; 135:999-1001)
Lentz RJ, Lerner AD, Pannu JK, et al. Routine monitoring with pleural manometry during therapeutic large-volume thoracentesis to prevent pleural-pressure-related complications: a multicentre, single-blind randomized controlled trial. Lancet Respir Med. 2019;7(5):447-455. In this prospective randomized trial, 128 patients with large pleural effusions were assigned to thoracentesis guided by symptoms only versus symptoms plus manometry. The two groups did not differ in primary outcome of chest discomfort.
Endotracheal intubation
Walz JM, Zayaruzny M, Heard SO. Airway management in critical illness. Chest 2007; 131:608-20. Concise review of the nuts and bolts of endotracheal intubation in critically-ill patients.
Percutaneous tracheostomies
The following two resources provide a quick review of patient selection and basic tracheostomy care for the practicing intensivist/pulmonologist:
Lagambina S, Nuccio P, Weinhouse GL. Tracheostomy care: a clinician’s guide. Hosp Pract (Minneap) 2011;39:161-7.
Rashid AO, Islam S. Percutaneous tracheostomy: a comprehensive review. J Thorac Dis 2017;9(Suppl 10):S1128-S1138.
General Procedural Considerations
Wolfe K, Kress J. Risk of procedural hemorrhage. Chest 2016;150:237-46. Review article addressing the risk factors for hemorrhage associated with procedures commonly performed in the ICU, including central line placement, thoracentesis, paracentesis, lumbar puncture, and others.
Procedure Videos: The New England Journal of Medicine has developed and published a series of Videos in Clinical Medicine, intended to facilitate teaching and learning of common procedural techniques. Videos and accompanying text provide an excellent review of indications, pertinent techniques, and potential complications. Links to those procedures most applicable to critical care medicine are provided below. Access requires subscription.
- Arterial line insertion
- Arterial line insertion: ultrasound guided
- Bag-mask ventilation
- Central venous catheter insertion: internal jugular
- Central venous catheter insertion: femoral
- Central venous catheter insertion: subclavian
- Central venous catheter insertion: ultrasound guided subclavian
- Chest tube insertion
- Chest tube insertion: ultrasound guided
- Cricothyroidotomy
- Intubation: fiberoptic
- Intubation: standard orotracheal
- Lumbar puncture
- Paracentesis
- Thoracentesis
