Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
How would you approach a pulmonary-renal PR3+ ANCA vasculitis patient who has persistent re-narrowing of mainstem bronchus after several dilatation and stenting procedures, with other anca features well-controlled on rituximab & avacopan?
Obviously, this is going to be a very challenging management issue. Bronchial or tracheobronchial stenosis evolves independently of other organ involvement and often fails to respond to immune suppressive regimens. There is one anecdotal study from France, suggesting that cyclophosphamide may offer ...
Is there a role for repeat surveillance blood cultures in patients with prosthetic valve endocarditis without associated cardiac abscess after a 6 week course of antibiotic treatment without surgical intervention?
Compared to NVE, PVE is associated with high morbidity and in-hospital mortality (10-30%). Patients with PVIE who are medically managed have either no surgical indication or have surgical contraindications. 2023 ESC guidelines supported repeating the blood cultures within the first week of finishing...
What indicators do you use to determine whether a patient is having a favorable or unfavorable response to nintedanib?
Unfortunately, there probably isn't a way to do this. It might be helpful to step back and see what nintedanib buys you: as compared to placebo, the nintedanib group suffered less FVC decline by ~110mL/year. Real-world data suggest there's probably a mortality benefit if you have your patients on it...
Do you always comment on VA and KCO when reading PFT's when gas transfer is ordered?
I do not. I look at the VA to see if it meets ATS criteria ( [1] >=90% of largest VC in the session; or >=85% and within 200cc or 5% of the largest VC; [2] breath hold of 10 +/- 2 sec; [3] >=85% of inh ventilation inhaled in <4sec)
Do you discontinue proning due to a perceived lack of response to intervention in a patient with ARDS?
Yes, I do.
Do you increase sedation or consider the use of neuromuscular blockade to prevent potential self-induced lung injury in patients with high respiratory drive?
My approach to patients with high respiratory drive is variable based on the disease process, the patient's physiology, and the stage of evolution of the disease. Optimization of ventilation parameters (inspiratory flow rate, flow pattern, cycle time, trigger settings) to promote synchrony is a firs...
Do you routinely isolate and test for TB in a patient incidentally found to have a miliary pattern of nodules on chest CT?
Yes, I routinely isolate and test for TB in patients incidentally found to have a milliary nodular pattern on the CT chest.
Do you use steroids in patients with respiratory failure who are infected with both influenza and COVID-19?
Yes, along with Remdesivir, Tamiflu, Bactrim, and supportive care. If there is active GGO on CAT scan, steroids are usually beneficial. Start high and then taper to the lowest necessary for about a 10-day course.
Do you routinely monitor imaging or pulmonary function in patients with pulmonary TB after the completion of therapy?
The simple answer will be: NO.
Do you rule out TB in patients with AIDS and lobar pneumonia?
Depends: +Ve Risk Factors: Travel/contact Hx, recent Quantiferon Conversion, changing CXR, Night sweats Unexplained low-grade temps Then, yes. Otherwise, no.