Pneumothorax Rate Research Articles

COVID-19-Related life-threatening complications: pneumothorax, pneumo mediastinum and subcutaneous emphysema

Complications of COVID-19-related pneumothorax, subcutaneous emphysema, and pneumomediastinum are frequently observed in moderate and severe pneumonia cases. The aim of this study is to determine the incidence and potential risk factors of life-threatening complications such as pneumothorax, pneumo-mediastinum, and subcutaneous emphysema that develop in patients received in the tertiary ICUs of our hospital, which serves as a pandemic hospital and to analyze their relationship with mortality. Patients' demographic characteristics, comorbid diseases, length of hospital stay, day and duration of thoracic tube placement, discharge status, and hospitalization laboratory findings were recorded, and the relationship of these parameters with mortality due to pneumothorax, subcutaneous emphysema, and pneumomediastinum were investigated. Of these patients, 33 had pneumothorax, 12 had pneumomediastinum, and 28 had subcutaneous emphysema. Male and female patients were equally represented, and mortality rates were similar. While the rate of pneumothorax in the study patients was 2.21 %, the rate of all life-threatening sequelae such as pneumothorax, pneumomediastinum, and subcutaneous emphysema was 4.7 %, with a high mortality rate (90 %) in 70 patients with these complications. Patients diagnosed with COVID-19 pneumonia should be constantly monitored for life-threatening complications such as pneumothorax, pneumomediastinum, and subcutaneous emphysema during their long-term follow-up.

How Does The Use Of Anticoagulants Influence The Outcome Of Elderly Thoraci̇c Trauma Patients?

Objective: As a result of the demographic transition, an increasing number of elderly patients require therapeutic anticoagulation for a variety of comorbidities. These individuals need multidisciplinary care because they frequently use many drugs, have concomitant conditions, and have functional status that is already compromised Material and Method: A total of 103 trauma patients over the age of 65 who were admitted to the emergency department due to thoracic trauma were evaluated according to Gender, trauma etiology and characteristics, comorbidities, antithrombolytic therapy use, rib and sternum fracture, hemothorax, pneumothorax, and contusion due to thoracic trauma. Results: There were 72 male patients and 31 female patients with The average age of 73.8 +/- 8.61 years (min: 65, max: 96). The rates of hemothorax, pneumothorax, hemopneumothorax, contusion, atelectasis, and pneumonia were not significantly different between patients using and not using antithrombolytics (respectively, p = 0.666, p = 0.320, p = 0.212, p = 0.369, p = 0.633, p = 0.652). Comorbid conditions or using antithrombolytics had no impact on how long patients stayed in the hospital (p = 0.503, p = 0.814). The only predictor that significantly increased the length of stay was determined to be the tube thoracostomy (p = 0.001). Conclusion: Antithrombolytic usage had no impact on hemothorax, pneumothorax, or contusion development. However, further research and implementation initiatives are required in order to completely integrate geriatric principles into the care of older persons who have experienced trauma.

Preoperative computed tomography-guided localization for pulmonary nodules: comparison between hook-wire and anchored needle localization.

Both hook-wire (HW) and anchored needle (AN) techniques can be used for preoperative computed tomography (CT)-guided localization for pulmonary nodules (PNs). But the outcomes associated with these two materials remain unclear. To assess the relative safety and efficacy of preoperative CT-guided HW and AN localization for PNs. This was a retrospective analysis of data collected from two institutions. Consecutive patients with PNs between January 2020 and December 2021 who underwent preoperative CT-guided HW or AN localization followed by video-assisted thoracoscopic surgery (VATS) procedures were included in these analyses, which compared the safety and clinical efficiency of these two localization strategies. In total, 98 patients (105 PNs) and 93 patients (107 PNs) underwent CT-guided HW and AN localization procedures, respectively. The HW and AN groups exhibited similar rates of successful PN localization (95.2% vs. 99.1%, p = 0.117), but the dislodgement rate in the HW group was significantly higher than that for the AN group (4.8% vs. 0.0%, p = 0.029). The mean pain score of patients in the HW group was significantly higher than that for the AN group (p = 0.001). HW and AN localization strategies were associated with comparable pneumothorax (21.4% vs. 16.1%, p = 0.349) and pulmonary hemorrhage (29.6% vs. 23.7%, p = 0.354) rates. All patients other than 1 individual in the HW group successfully underwent VATS-guided limited resection. These data suggest that AN represents a safe, well-tolerated, feasible preoperative localization strategy for PNs that may offer value as a replacement for HW localization.

1253: EFFECT OF PERIPHERALLY INFUSED NOREPINEPHRINE ON REDUCING CENTRAL VENOUS CATHETER UTILIZATION

Introduction: Vasoactive agents like norepinephrine have been historically administered via central venous catheters (CVCs) due to the perceived risk of local tissue injury with peripheral infusion. While infusion-related complications may be reduced with CVC administration, the higher rates of bacteremia, pneumothorax, and air embolism must be weighed, along with delays in administration and achievement of hemodynamic stability. This study is designed to add to the available safety data of peripheral norepinephrine administration while also investigating the direct cost savings associated with CVC avoidance. Methods: This is a retrospective analysis of adult patients who received norepinephrine between January 1 and September 1, 2021. A hospital guideline allows peripheral infusion of norepinephrine via dedicated, 16 – 20 gauge, mid-to-upper arm IV catheters for up to 24 hours. The primary outcome was the need for central venous access in patients initially started on peripherally infused norepinephrine. Safety outcomes included local tissue injury attributed to norepinephrine infusion. Results: Ninety-eight of 124 total patients initially received peripheral norepinephrine infusions, most of which required vasopressors for distributive or mixed shock. Thirty-six patients (37%) avoided the need for central line placement. The median duration of vasopressors was 6 hours [IQR 3.3 – 11.3] at a median maximum rate of 0.08 mcg/kg/min [IQR 0.05 – 0.15]. In the remaining 62 patients who progressed from peripheral to central line placement, the median duration was 15.5 hours [IQR 6 – 38.5] at a median maximum rate of 0.15 mcg/kg/min [IQR 0.06 – 0.25]. Eighty of the 98 patients (82%) who started peripherally infused norepinephrine required therapy for ≤12 hours. No extravasation or local complications were observed regardless of site of infusion. Avoiding progression to a CVC in 37 of every 100 peripheral lines resulted in an estimated direct supply cost savings of $8,900. Conclusions: Initial administration of norepinephrine via a dedicated peripheral IV site was safe and led to a reduction in the need for subsequent CVC access. To minimize cost while achieving timely resuscitation goals and maintaining patient safety, initial peripheral administration should be considered for all patients.

1074 AXILLARY VEIN PUNCTURE VERSUS CEPHALIC VEIN CUTDOWN FOR CARDIAC IMPLANTABLE ELECTRONIC DEVICE IMPLANTATION: A METANALYSIS

Abstract Introduction Transvenous lead implantation for pacemaker implantation is commonly performed by the cephalic vein cutdown (CVC), subclavian (SVP), or axillary vein puncture (AVP)(1). However, the CVC or AVP should be considered as first choice, according to the last guidelines, due to high rate of lead complications and pneumothorax of SVP. Objective To compare efficacy and safety of AVP compared with CVC for CIED implantation by a meta-analysis. Methods We systematically searched Medline, Embase and Cochrane electronic databases up to September 5th, 2022, for studies that evaluated the efficacy and safety of AVP and CVC reporting at least one clinical outcome of interest. The primary outcome was acute procedural success. The secondary outcomes were pneumothorax, lead failure, pocket hematoma/bleeding, device infection, total procedure time, venous access time and fluoroscopy time. The effect size was estimated using a random-effect model as Risk Ratio (RR) and relative 95% Confidence Interval (CI). Results A total of 8 studies were included enrolling 1926 patients with 3532 leads and average age of 72.3±14.8 years. AVP compared to CVC showed a significant increase in the procedural success (95.7% vs 76.1%; RR: 1.24; 95% CI: 1.09-1.40; p=0.001), (Figure 1). Total procedural time (Mean Difference [MD]: -8.25 min; 95%CI: -10.23- -6.27; p<0.0001) and Venous access time (MD: -6.24 min; 95%CI: -7.01- -5.47; p<0.0001) were significantly shorter with AVP compared with CVC. No differences were found between AVP and CVC for pneumothorax (RR: 0.72; 95% CI: 0.13 - 4.0; p=0.71), lead failure (RR: 0.58; 95% CI: 0.23-1.48; p=0.26), pocket hematoma/bleeding (RR: 0.58; 95% CI: 0.15- 2.23; p=0.43), device infection (RR: 0.95; 95% CI: 0.14- 6.60; p=0.96) and fluoroscopy time (MD: -0.24 min; 95%CI: -0.75- 0.28; p=0.36). Conclusion Our meta-analysis proved that AVP improves procedural success and reduces total procedural time and venous access time compared to CVC. Figure 1 – Forest plots comparing Acute Procedural Success between Axillary Vein Puncture Versus Cephalic Vein Cutdown.

The Feasibility of Using the "Artery Sign" for Pre-Procedural Planning in Navigational Bronchoscopy for Parenchymal Pulmonary Lesion Sampling.

Electromagnetic navigation bronchoscopy (ENB) and robotic-assisted bronchoscopy (RAB) systems are used for pulmonary lesion sampling, and utilize a pre-procedural CT scan where an airway, or "bronchus sign", is used to map a pathway to the target lesion. However, up to 40% of pre-procedural CT's lack a "bronchus sign" partially due to surrounding emphysema or limitation in CT resolution. Recognizing that the branches of the pulmonary artery, lymphatics, and airways are often present together as the bronchovascular bundle, we postulate that a branch of the pulmonary artery ("artery sign") could be used for pathway mapping during navigation bronchoscopy when a "bronchus sign" is absent. Herein we describe the navigation success and safety of using the "artery sign" to create a pathway for pulmonary lesion sampling. We reviewed data on consecutive cases in which the "artery sign" was used for pre-procedural planning for conventional ENB (superDimension™, Medtronic) and RAB (Monarch™, Johnson & Johnson). Patients who underwent these procedures from July 2020 until July 2021 at the University of Minnesota Medical Center and from June 2018 until December 2019 at the University of Chicago Medical Center were included in this analysis (IRB #19-0011 for the University of Chicago and IRB #00013135 for the University of Minnesota). The primary outcome was navigation success, defined as successfully maneuvering the bronchoscope to the target lesion based on feedback from the navigation system. Secondary outcomes included navigation success based on radial EBUS imaging, pneumothorax, and bleeding rates. A total of 30 patients were enrolled in this analysis. The median diameter of the lesions was 17 mm. The median distance of the lesion from the pleura was 5 mm. Eleven lesions were solid, 15 were pure ground glass, and 4 were mixed. All cases were planned successfully using the "artery sign" on either the superDimension™ ENB (n = 15) or the Monarch™ RAB (n = 15). Navigation to the target was successful for 29 lesions (96.7%) based on feedback from the navigation system (virtual target). Radial EBUS image was acquired in 27 cases (90%) [eccentric view in 13 (43.33%) and concentric view in 14 patients (46.66%)], while in 3 cases (10%) no r-EBUS view was obtained. Pneumothorax occurred in one case (3%). Significant airway bleeding was reported in one case (3%). We describe the concept of using the "artery sign" as an alternative for planning EMN and RAB procedures when "bronchus sign" is absent. The navigation success based on virtual target or r-EBUS imaging is high and safety of sampling of such lesions compares favorably with prior reports. Prospective studies are needed to assess the impact of the "artery sign" on diagnostic yield.

Accuracy of Preliminary Pathology for Robotic Bronchoscopic Biopsy

BackgroundDiagnosis and treatment of peripheral pulmonary lesions (PPLs) currently require at least 2 procedures. An all-in-1 approach would require diagnosing malignancy with preliminary cytology results. This study investigated the concordance between preliminary cytology and final pathology results in biopsies of PPLs obtained by shape-sensing robotic-assisted bronchoscopy (ssRAB). MethodsThis study was a retrospective, consecutive, single-arm, single-center study of 110 ssRABs for PPLs. Concordance was defined as agreement between preliminary cytology and final pathology results. Accuracy, sensitivity, specificity, positive and negative predictive values, and safety outcomes were examined. ResultsThe concordance was 89% for needle biopsies, 85% for forceps biopsies, and 92% overall, with substantial agreement. There was no significant association of concordance with patients’ demographics or lesion characteristics. Preliminary cytology resulted in a malignant diagnosis in 70%, a nonmalignant diagnosis in 4%, and a nondiagnostic result in 26%, with accuracy of 86% and sensitivity of 84%. The total complication rate was 3.6%, with a pneumothorax rate of 1.8%. ConclusionsThis study compared the concordance of preliminary pathology results with final pathology results for ssRAB biopsies in PPLs. The results showed that preliminary samples have a high concordance with final pathology results and may enable management of PPLs with a single anesthetic procedure including biopsy, staging, and treatment.

Accuracy of CT-Guided Core-Needle Biopsy in Diagnosis of Thoracic Lesions Suspicious for Primitive Malignancy of the Lung: A Five-Year Retrospective Analysis.

Lung cancer represents a heterogeneous group of neoplasms, with the highest frequency and mortality in both sexes combined. In a clinical scenario characterized by the widespread of multidetector-row spiral CT, core-needle biopsy under tomographic guidance is one of the main and safest methods to obtain tissue specimens, even though there are relatively high rates of pneumothorax (0-60% incidence) and pulmonary hemorrhage (4-27% occurrence rates). The aim of this retrospective study is to assess the diagnostic accuracy of CT-guided core-needle biopsy in the diagnosis of primary lung malignancies and to compare our results with evidence from the literature. Our analysis included 350 thoracic biopsies, performed from 2017 to 2022 with a 64-row CT guidance and 16/18 G needles mounted on a biopsy gun. We included in the final cohort all samples with evidence of primary lung malignancies, precursor lesions, and atypia, as well as inconclusive and negative diagnoses. There was sensitivity of 90.07% (95% CI 86.05-93.25%), accuracy of 98.87% (95% CI 98.12-99.69%), positive predictive value of 100%, and negative value of 98.74% (95% CI 98.23-99.10%). Specificity settled at 100% (93.84-100%). The AUC was 0.952 (95% CI 0.924-0.972). Only three patients experienced major complications after the procedure. Among minor complications, longer distances from the pleura, the presence of emphysema, and the lower dimensions of the lesions were correlated with the development of pneumothorax after the procedure, while longer distances from the pleura and the lower dimensions of the lesions were correlated with intra-alveolar hemorrhage. Immunohistochemistry analysis was performed in 51% of true positive cases, showing TTF-1, CK7, and p40 expression, respectively, in 26%, 24%, and 10% of analyzed samples. The CT-guided thoracic core-needle biopsy is an extremely accurate and safe diagnostic procedure for the histological diagnosis of lung cancer, a first-level interventional radiology exam for peripheral and subpleural lesions of the lung, which is also able to provide adequate samples for advanced pathologic assays (e.g., FISH, PCR) to assess molecular activity and genetic sequencing.

The Outcome- or Cost-Effectiveness Analysis of LUS-Based Care or CXR-Based Care of Neonatal Lung Diseases: The Clinical Practice Evidence from a Level Ⅲ NICU in China.

To compare the effect of managing neonatal lung disease with lung ultrasound (LUS) or chest X-ray (CXR) monitoring on health outcomes and cost-effectiveness. The data obtained from the NICU of the Beijing Chaoyang District Maternal and Child Healthcare Hospital were used as the study group, as LUS has completely replaced CXR in managing newborn lung disease in the hospital for the past 5 years. The primary outcomes of this study were the misdiagnosis rate of respiratory distress syndrome (RDS), the using status of mechanical ventilation, the incidence rate of bronchopulmonary dysplasia (BPD) and the survival rate in hospitalized infants. The secondary outcomes included the use pulmonary surfactant (PS), and the mortality rate of severe diseases (such as pneumothorax, pulmonary hemorrhage and RDS, etc.). Managing neonatal lung disease with LUS monitoring may enable the following effects: The frequency of ventilator use reducing by 40.2%; the duration of mechanical ventilation reducing by 67.5%; and the frequency of ventilator weaning failure being totally avoided. A misdiagnosis rate of 30% for RDS was also avoided. The dosage of PS was significantly reduced by 50% to 75%. No BPD occurred in the LUS-based care group for 5 years. The fatality rates of RDS, pneumothorax and pulmonary hemorrhage decreased by 100%. The poor prognosis rate of VLBW infants decreased by 85%, and the total mortality rate of hospitalized infants decreased by 90%. Therefore, the cost of LUS-based care was inevitably saved. Diagnosing and managing neonatal lung diseases with LUS monitoring have significant benefits, and this technology should be widely promoted and applied around the world.

Diagnostic value and safety of endobronchial ultrasonography with a guide sheath transbronchial biopsy for diagnosing peripheral pulmonary lesions in patients with interstitial lung disease.

Radial endobronchial ultrasonography transbronchial biopsy with and without a guide sheath is a useful method for diagnosing peripheral pulmonary lesions (PPLs). However, the diagnostic yield and complications of radial endobronchial ultrasonography transbronchial biopsy for PPLs remains elusive in patients with interstitial lung disease (ILD). We retrospectively analysed 431 patients (69 with and 362 without ILD) who underwent radial endobronchial ultrasonography with a guide sheath transbronchial biopsy (EBUS-GS TBB) for PPLs from April 1, 2011, to March 31, 2020. We investigated the diagnostic yield and complications of the procedure for PPLs and compared them between patients with and without ILD. We also evaluated the factors contributing to successful diagnosis. The diagnostic yield of radial endobronchial ultrasonography in patients with ILD was significantly lower than in those without ILD (62.3% vs. 75.4%, P=0.024). Multivariate analysis showed that the presence of ILD as background lung [odds ratio (OR) =0.517], probe position within the lesion (OR =4.654), and the presence of solid lesion (OR =1.946) significantly affected the diagnostic yield of PPLs. There was a significant difference in the rate of pneumothorax between the patients with ILD and those without ILD (4.3% vs. 0.6%, P=0.031). The presence of ILD as the background lung significantly affected the diagnostic yield of PPLs with radial EBUS-GS TBB. Regarding the complications, pneumothorax occurred more frequently in patients with ILD than in those without ILD.

Preoperative localization of lung nodules: a comparative analysis of hookwire and radio-guided procedures.

Histological diagnosis of pulmonary nodules requires surgical resection on many occasions. There are multiple localization strategies each with their own benefits and complications. The objective of this study is to compare preoperative lung nodule localization with hookwire and radiotracer injection (radioguided occult lesion localization, ROLL). To compare results, complications, and volume of the sample resected with both techniques. Patients undergoing resection of pulmonary nodules with video-assisted thoracoscopy and pre-surgical localization with hookwire or ROLL were studied. Eighty-eight pulmonary nodules were resected in 76 patients: 52 with a hook wire and 36 with a radiotracer. The localization rate, the shortest distance between the nodule and the pleura, the intrapulmonary distance of the locator, the complications, the volume of the resection piece, and the histological result were all assessed. In addition, the factors that influence the volume of the surgical piece were analyzed. All the nodules were resected with both techniques. The intrapulmonary path of the locator is longer for the ROLL group (23.91 vs. 16.28 mm; P=0.04), with no differences in the distance from the nodule to the pleura. The rate of pneumothorax was significantly higher after the placement of a hook wire (69.2% vs. 24.2%; P<0.0001), while there were no differences in the presence of hemorrhage. The volume of the pieces resected using ROLL was more minor than with hookwire, although not statistically significant (20.19 vs. 34.26 cc; P=0.07). Preoperative localization with the ROLL technique is safer than the placement of hookwire. In addition, the ROLL technique shows a tendency to obtain a smaller volume of resected tissue since the marking is not affected by the intrapulmonary route used during marker placement. ROLL technique allows to locate lung nodules with fewer complications than hookwire and probably gets smaller resection samples.

Spontaneous pneumothorax in COVID-19: a single center experience.

The effect of pulmonary complications of COVID-19, such as pneumothorax, pneumomediastinum, and subcutaneous emphysema, is still unclear. This study aimed at investigating the relationship between COVID-19 and spontaneous pneumothorax. This study was conducted as a single-center retrospective study. Groups were assigned as study and control groups. The study group (n=120) included patients who were followed up in ICU and developed pneumothorax during their follow-up. The control group (n=120) included patients who did not develop a pneumothorax in ICU and who had been randomly selected using hospital records. Demographic findings, laboratory parameters, radiological findings, clinical management, patients' follow-up patterns, and survival status of the patients were recorded. There was a significant relationship between gender, outcome, last hospitalization, general condition, first follow-up, intubation, uptake tomography, uptake rate, CO-RADS, and involvement variables between groups (p<0.05). In the survival analysis performed in the control and study groups, a significant difference was obtained between the averages of the two groups (LogRank=3.944, p<0.05). Intubation and mortality rates of the patients who developed pneumothorax during the patient follow-ups were significantly higher than the control group. We found that patients diagnosed with COVID-19 who developed pneumothorax during intensive care follow-up had a higher hospital stay and intubation rate. The pneumothorax rate was also higher in follow-up methods such as noninvasive/HFO providing PEEP to the patients. The data in our study may help reducing mortality by shedding light on the early prevention and recognition of pneumothorax in critically ill patients diagnosed with COVID-19.

17 Early nasal intermittent positive pressure ventilation versus early nasal continuous positive airway pressure for preterm infants

Abstract Background Respiratory distress syndrome (RDS) is very common in preterm infants and multiple options are available to support their breathing in the early neonatal course. Non-invasive ventilation has become widely used given the opportunity to avoid intubation, mechanical ventilation and reduce the risk of ventilator-associated lung injury. Non-invasive ventilation includes nasal continuous positive airway pressure (NCPAP) and non-invasive positive pressure ventilation (NIPPV). NCPAP provides one constant pressure throughout the respiratory cycle. NIPPV additionally provides higher-pressure breaths (peak inspiratory pressure – PIP) over the constant baseline pressure. The use of these two modalities has previously been compared in a Cochrane systematic review to better comprehend the favoured option in preterm with RDS. Objectives We re-examine the risks and benefits of NIPPV versus NCPAP when implemented within the first 6 hours after birth, for preterm infants with respiratory distress in this updated Cochrane review. Design/Methods We used the criteria and standard methods of Cochrane and Cochrane Neonatal to conduct a comprehensive literature search for inclusion of all randomized, quasi-randomized trials and cross-over trials fitting our inclusion criteria. Primary endpoints are respiratory failure and the need for intubated ventilatory support during the first week of life. Secondary endpoints included chronic lung disease, length of stay (LOS), pneumothorax, and mortality. We analyzed the included trials using risk ratio (RR), risk difference and the number needed to treat for an additional beneficial outcome or an additional harmful outcome for dichotomous outcomes, and mean difference (MD) for continuous outcomes. We used the GRADE approach to assess the quality of evidence. Results In this updated systematic review, we screened 1143 studies for the title and abstract screening. 36 studies were retained for full-text review and 8 new trials were added to this update. We re-affirmed the superiority of NIPPV VS CPAP to prevent respiratory failure (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.52 to 0.75), in reducing the need for intubation (risk ratio RR 0.70, CI 0.60 to 0.82), chronic lung disease (risk ratio RR 0.68, CI 0.50 to 0.92) and LOS (Mean difference -3.05 days, CI -4.92, -1.17). We did not find any difference in the mortality rate or rate of pneumothorax. For most outcomes, the certainty of evidence was graded as moderate or low. Conclusion NIPPV is superior to NCPAP as a primary respiratory support modality for preterm infants with RDS, in preventing respiratory failure and the need for intubation in the first week of life.

Safety and Feasibility of a Sheath Cryoprobe for Bronchoscopic Transbronchial Biopsy: The FROSTBITE Trial

Background: Bronchoscopic lung biopsy is typically performed using transbronchial forceps. However, this method is limited by small sample size and presence of crush artifact. Cryobiopsy offers the potential to overcome these limitations with larger artifact-free samples but has not been widely adopted due to concerns over increased rates of bleeding and pneumothorax. A new, smaller 1.1-mm cryoprobe has been developed that operates in a similar fashion to forceps, though the safety profile of this cryoprobe has not yet been prospectively studied. Objective: The aim of this study was to investigate the safety of transbronchial biopsy using a novel 1.1-mm cryoprobe. Methods: This prospective, single-arm study enrolled patients referred for transbronchial biopsy. All procedures were performed using the 1.1-mm cryoprobe with oversheath. The primary outcome was the composite of significant complications related to the cryobiopsy procedure (bleeding Grade ≥3, pneumothorax Grade ≥2, and respiratory failure). Bleeding and pneumothorax were graded according to previously published scales. Results: Fifty participants from two academic medical centers underwent transbronchial cryobiopsy. Indications for biopsy included evaluation of lung transplant allograft (50%), diffuse lung disease (44%), and pulmonary parenchymal lesion (6%). There were two pneumothoraces (4%), neither of which required aspiration or chest tube placement. There were no Grade 3 or 4 bleeding events. Mild bleeding (Grade ≤2) was observed in 25 cases (50%). No complications occurred that met the a priori primary outcome of bleeding Grade ≥3, pneumothorax Grade ≥2, and respiratory failure. Conclusions: Transbronchial cryobiopsy using a 1.1-mm cryoprobe is feasible with an acceptable safety profile.

Pneumothorax Was More Common in Covid-Positive Patients during the Delta Surge and Remains Prognostic for Very Poor Outcomes: A Retrospective Cohort Study

Introduction: SARS-COV-2 (COVID-19) has resulted in unprecedented deaths and morbidity. Studies before the delta surge reported pneumothorax (PNX) rates of 0.3% in COVID patients and up to 12.8-23.8% if intubated. The purpose of this study was to determine if PNX rates changed during the delta surge and examine the mortality, morbidity and characteristics in this population. Methods: We performed a retrospective chart review on all patients admitted through Lakeland Regional Health Center’s ED (May-December 2021) including demographics, mortality and morbidity data. Associations were examined using a combination of chi-squares and logistic regressions. Results: 17,373 people were included in these analyses. 2993 were COVID positive with 102 developing PNX (3.4%). COVID-positive patients were at 5.60 (3.4% vs 0.6%), 1.84 (12% vs 4.6%), and 4.02 (16% vs 4.1%) times the odds of having a PNX, intubation, and death compared with COVID negative (results p < .05). In COVID-positive patients, those with PNX had a mortality or 76% (compared with 12% without PNX), were more likely to be diagnosed with septic shock (75% vs 7.1%), intubated (87% vs 9.3%), and had higher readmission if they survived (50% vs 9.3%). These patients were more likely to be obese (70% vs 50%). Surprising, they were more likely to be under 65 (77% vs 59%), and there was no difference in smoking history or ethnicity. Conclusion: PNX during the delta surge have increased in COVID patients. The mortality and morbidity in the COVID population with PNX remains very high and portends a poor prognosis.

Risk factors of pain after CT-guided preoperative localization of pulmonary nodules with four-hook needle

Objective: To identify the risk factors of pain after CT-guided preoperative localization of pulmonary nodules with 4-hook needle. Methods: The clinical data of 212 patients, who underwent CT-guided preoperative localization of single pulmonary nodule with 4-hook needle in Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School from September 2021 to February 2022 were retrospectively analyzed. All patients, including 83 males and 129 females with an age of (54±12) years, were divided into mild pain group (n=163) and moderate-severe pain group (n=49) according to numeric rating scale (NRS) for assessment of pain intensity. The gender, age, body mass index, smoking history, American Society of Anesthesiologists physical status (ASA), nodule location, nodule size, nodule distance from pleura, needle tip distance from pleura, localization-related complications (pneumothorax, pulmonary hemorrhage) and NRS for assessment of pain intensity after pulmonary nodules localization were collected and compared between the two groups. Univariate analysis and multivariate binary logistic regression analysis were performed to identify the risk factors of moderate-severe pain after CT-guided preoperative localization of pulmonary nodules with 4-hook needle. Results: The success rate of preoperative localization was 100%. The rates of pneumothorax and pulmonary hemorrhage were 22.6% and 17.0%, respectively. Univariate analysis showed that there was no significant difference in gender, age, body mass index, smoking history, ASA physical status, nodule location, nodule size, nodule distance from pleura and localization-related complications (pneumothorax, pulmonary hemorrhage) between the two groups (P>0.05), while needle tip distance from pleura of moderate-severe pain group was significantly less than that of mild pain group [7(6, 11) mm vs 15(12, 19) mm, P<0.001]. Multivariate binary logistic regression analysis showed that needle tip distance from pleura was the only risk factor for moderate-severe pain (OR=0.645, 95%CI: 0.562-0.739, P<0.001). According to receiver operating characteristic (ROC) curve analysis, when the cut-off value of needle tip distance from pleura was 9.5 mm, the sensitivity was 69.4%(34/49), the specificity was 90.2%(147/163), and the area under the curve (AUC) was 0.878 (95%CI: 0.820-0.935, P<0.001). Conclusions: Needle tip distance from pleura was the independent risk factor of moderate-severe pain after CT-guided preoperative localization of pulmonary nodules with 4-hook needle. The less needle tip distance from pleura is, the higher risk of moderate-severe pain occurs.

Utilization and in-hospital complications associated with implantation of dual versus single chamber implantable cardioverter defibrillator for primary prevention of sudden cardiac death

Abstract Introduction Multiple studies showed no clinical benefit in implantation of a dual compared to a single chamber implantable cardioverter defibrillator (dICD vs. sICD) for primary prevention of sudden cardiac death (SCD), in patients with no pacing indication. We aimed to investigate the extent of utilization and complications in sICD vs. dICD implantations in the US, using the National In-Patient Sample (NIS) database. Methods Using the NIS database, we identified patients who underwent an elective ICD implantation in the US between 2015 (last quarter)-2019. Patients who had concurrent conduction disorders or indication for atrial pacing were excluded. Baseline demographics, clinical characteristics, cardiomyopathy etiologies as well as outcomes including in-hospital complications, length of stay and mortality were collected. Multivariable logistic regression models were used to identify predictors of complications. Results and discussion An estimated total of 15940 patients, who underwent elective ICD implantation for primary prevention of SCD were identified, 8860 (55.6%) of them received a dICD. Forty percent of patients had ischemic cardiomyopathy. The mean age was 64 years and 66% were males. The complication rates documented in the dICD and sICD groups were 13% and 11%, respectively (p&amp;lt;0.001),driven by increased rate of pneumothorax (4.8% vs 3.2%, p&amp;lt;0.001) and lead dislodgement (3.6% vs 2.3%, p&amp;lt;0.001, Table 1). Multivariate analysis confirmed adding an atrial lead as an independent risk factor for “any complication” during ICD implantation [OR 1.13 (1.02–1.25), p=0.022] as well as for pneumo/hemothorax [OR 1.21 (1.03–1.44), p=0.025] and lead dislodgement [OR 1.41 (1.16–1.72), p&amp;lt;0.001]. Conclusion Despite significant evidence for lack of clinical benefit in adding an atrial lead to a primary prevention ICD implantation, significant proportion of the patients in the US are implanted with a dICD. We show increased risk for complications for dICD compared with sICD implantation in the US in recent years, driven by higher incidence of pneumo/hemothorax and lead dislodgement. Funding Acknowledgement Type of funding sources: None.

META ANALYSIS OF DIAGNOSTIC YIELD AND COMPLICATIONS WITH ROBOTIC-ASSISTED NAVIGATION BRONCHOSCOPY

META ANALYSIS OF DIAGNOSTIC YIELD AND COMPLICATIONS WITH ROBOTIC-ASSISTED NAVIGATION BRONCHOSCOPY

OPTIMIZING THE RESECTION PATHWAY: CAN MINIMALLY INVASIVE DIAGNOSIS AND SURGERY (MIDAS) GUIDE PATIENT SELECTION?

OPTIMIZING THE RESECTION PATHWAY: CAN MINIMALLY INVASIVE DIAGNOSIS AND SURGERY (MIDAS) GUIDE PATIENT SELECTION?

Complications After Transthoracic Needle Biopsy of Pulmonary Nodules: A Population-Level Retrospective Cohort Analysis.

To provide recent population-based estimates of transthoracic needle biopsy (TTNB) complications and risk factors associated with these complications. This retrospective cohort analysis included adults from a nationally representative longitudinal insurance claims data set who underwent TTNB in 2017 or 2018. Complications that were evaluated included pneumothorax, hemorrhage, and air embolism. Separate logistic regression models estimated the association of pneumothorax or hemorrhage with the setting of care (ie, inpatient or outpatient) and selected baseline patient demographic and clinical characteristics including age, gender, history of chronic obstructive pulmonary disease, diagnosis of pleural effusion, tobacco use, use of oral anticoagulants and antiplatelet agents, prior lung cancer screening, previous bronchoscopy within 1 year, and Elixhauser comorbidity index. Among 16,971 patients who underwent TTNB, 25.8% experienced a complication within 3 days of the procedure (pneumothorax 23.3%, hemorrhage 3.6%, and air embolism 0.02%). Among patients who experienced pneumothorax, 31.9% required chest tube drainage. Among patients undergoing an outpatient TTNB (n= 12,443), 6.9% were hospitalized within 7 days. Biopsy in an inpatient setting, chronic obstructive pulmonary disease diagnosis, and prior bronchoscopy were associated with higher rates of both pneumothorax and hemorrhage. Prior lung cancer screening was associated with an increased risk of pneumothorax, and prior use of oral anticoagulants or antiplatelets was associated with higher rates of hemorrhage. This contemporary population-based cohort study demonstrated that approximately one-quarter of patients undergoing TTNB experienced a complication. Pneumothorax was the most frequent complication, and hemorrhage and air embolism were rare. Among outpatients, complications from TTNB are an important cause of hospitalization.