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RATIONALE: Tunneled, indwelling pleural catheters (IPC) have been demonstrated to be an effective method of managing malignant pleural effusions. However, they allow pleurodesis and can therefore be removed in only a subset of patients. A novel, silver-nitrate coated IPC was developed with the intention of creating a rapid, effective chemical pleurodesis to allow more frequent and earlier catheter removal. This study represent the pivotal clinical trial evaluating that catheter vs the standard IPC.OBJECTIVES: To compare the efficacy of a novel silver nitrate-eluting indwelling pleural catheter (SNCIPC) with that of a standard, uncoated catheter.METHODS: The SWIFT trial was a multicentre, parallel-group, randomised, controlled, patient-blind trial. Central randomisation occurred following a computer-generated schedule, stratified by site. Recruitment was from 17 secondary or tertiary-care hospitals in the USA and 3 in the UK and included adult patients with malignant pleural effusion needing drainage, without evidence of lung entrapment or significant loculation. The intervention group underwent insertion of a SNCIPC with maximal fluid drainage, followed by a tapering drainage schedule. The control group received a standard, uncoated catheter. Follow up was until 90 days. The primary outcome measure was pleurodesis efficacy, measured by fluid drainage, at 30 days.RESULTS: 119 patients were randomised. 5 withdrew before receiving treatment, leaving 114 (77 SNCIPC, 37 standard IPC) for intention-to-treat analysis. Mean age was 66 years (SD 11). More patients in the SNCIPC group were in-patients (39% vs 14%, p=0.009). For the primary outcome, pleurodesis rates were 12/37 (32%) in the control group and 17/77 (22%) in the SNCIPC group (rate difference -0.10, 95% CI -0.30-0.09). Median time to pleurodesis was 11 days (IQR 9-23) in the control group and 4 days (IQR 2-15) in the SNCIPC group. No significant difference in treatment-related adverse event rates was noted between groups.CONCLUSIONS: The SNCIPC did not improve pleurodesis efficacy compared to a standard indwelling pleural catheter. This study does not support the wider use of the SNCIPC device. Clinical trial registered with ClinicalTrials.gov (NCT02649894).

The Percepta Genomic Sequencing Classifier (GSC) was developed to up-classify as well as down-classify the risk of malignancy for lung lesions when bronchoscopy is non-diagnostic. We evaluated the performance of Percepta GSC in risk re-classification of indeterminate lung lesions. This multicenter study included individuals who currently or formerly smoked undergoing bronchoscopy for suspected lung cancer from the AEGIS I/ II cohorts and the Percepta Registry. The classifier was measured in normal-appearing bronchial epithelium from bronchial brushings. The sensitivity, specificity, and predictive values were calculated using predefined thresholds. The ability of the classifier to decrease unnecessary invasive procedures was estimated. A set of 412 patients were included in the validation (prevalence of malignancy was 39.6%). Overall, 29% of intermediate-risk lung lesions were down-classified to low-risk with a 91.0% negative predictive value (NPV) and 12.2% of intermediate-risk lesions were up-classified to high-risk with a 65.4% positive predictive value (PPV). In addition, 54.5% of low-risk lesions were down-classified to very low risk with >99% NPV and 27.3% of high-risk lesions were up-classified to very high risk with a 91.5% PPV. If the classifier results were used in nodule management, 50% of patients with benign lesions and 29% of patients with malignant lesions undergoing additional invasive procedures could have avoided these procedures. The Percepta GSC is highly accurate as both a rule-out and rule-in test. This high accuracy of risk re-classification may lead to improved management of lung lesions.

Annual screening with low dose chest tomography has been adopted for those at high risk to aid in the early detection of lung cancer. In addition to screening, it is recommended that such persons receive evidence-based smoking-cessation. However, both lung cancer screening and evidence-based smoking-cessation strategies are underutilized in the US. We review the impact of a dedicated Tobacco Treatment Clinic (TTC), delivering evidence-based smoking cessation strategies, on lung cancer screening enrollment. Patients of the TTC, aged 50 years or older, having a minimum 20-pack-year smoking history were included. All patients had records reviewed to see if they had received lung cancer screening; if their lung cancer screening was achieved through the TTC, this was documented as “initial screening” versus “continued screening or surveillance”. Sociodemographic variables were collected as well. As for results, between January 2019 to February 2020, 92 patients enrolled in the TTC and fulfilled criteria for lung cancer screening. The mean age was 65.7 ± 8.3 years old, with 58 (63.0%) of the patients being female. Seventy-five (81.5%) patients were African American. Of the 92, 68 (73.9%) patients had lung cancer screening, with 51 patients receiving their first lung cancer screening scan through the TTC. In conclusion, through enrollment in a dedicated TTC, a significant proportion of patients were able to access lung cancer screening for the first time. Further, many of these patients were of minority status. Having a dedicated TTC may improve current health equity gaps in lung cancer screenings in certain US populations.

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: To evaluate the practice of creation of tracheostomies during the initial phases of the COVID-19 pandemic, with a focus on clinical outcomes and sedation parameters METHODS: We enrolled 45 consecutive COVID-19 positive adult patients whom a consult for tracheostomy was placed at Johns Hopkins Hospital between 4/16/2020 and 5/22/2020 A total of 38 tracheostomies were performed at the time of censoring Five of the patients were extubated before performance of tracheostomy and two were awaiting creation of tracheostomy Data was collected via manual extraction on clinical outcomes, sedative medication use for the 48 hours pre- and 48 hours post-tracheostomy RESULTS: Baseline characteristics of the 45 patients include a median age of 62, BMI of 30, with an even split of Male:Female (23:22) The median days of intubation before tracheostomy was 20 (range: 5-36), median days from consult for tracheostomy to performance of tracheostomy was 3 A multidisciplinary team across specialties performed the tracheostomy consults with Interventional Pulmonary performing 18, Otolaryngology 13, General Surgery 9, Thoracic Surgery 5 29 of the tracheostomies were performed percutaneously A bronchoalveolar lavage, tracheal aspirate, or sputum sample was obtained on the day of performance of the tracheostomy and 35 of the 38 were negative for COVID-19 The samples were sent a median of 23 5 days after the initial positive test Mortality on date of censoring was 7 (15 6%) including 5 (13 2%) of the patients with tracheostomy 10 (22 2%) had been discharged including 9 (23 7%) of the patients with tracheostomy Sedation and analgesia (total dose in 48 hours pre- (PR) and 48 hours post post-tracheostomy (PO)) expressed as median dosage for patients receiving that medication:- Dexmedetomidine (mcg/kg/hr): PR (18 patients): 28 7;PO (17 patients): 27 4- Midazolam (mg): PR (7 patients): 82 6;PO (8 patients): 55 5- Fentanyl (mcg): PR (21 patients): 450 0;PO (19 patients): 618 75- Propofol (mcg/kg/min): PR (8 patients): 1245 2;PO (5 Patients): 84 4 CONCLUSIONS: In the early-phase of the COVID-19 pandemic 38 patients with COVID-19 induced respiratory failure underwent successful tracheostomy The median length of intubation prior to tracheostomy was 20 days, longer than our historical average, likely related to initial concerns over performing this high-risk aerosolizing procedure The total dosage of each sedative medication decreased from the 48 hours pre- and post-tracheostomy, potentially related to endotracheal tube removal CLINICAL IMPLICATIONS: We were able to show that performance of tracheostomy during COVID-19 is safe and can be approached from multiple specialties Early tracheostomy should be considered in appropriate patients to reduce cumulative sedative medication dose, length of intubation, length of ICU stay, and cost of admission DISCLOSURES: No relevant relationships by Esther Ben Or, source=Web Response No relevant relationships by Nasir Bhatti, source=Web Response Consultant relationship with Veracyte, Inc Please note: $1001 - $5000 Added 04/01/2020 by David Feller-Kopman, source=Web Response, value=Consulting fee No relevant relationships by Elliott Haut, source=Web Response Receive Research Support relationship with Medtronic Please note: >$100000 Added 05/31/2020 by Alexander Hillel, source=Web Response, value=Grant/Research No relevant relationships by Chris Kapp, source=Web Response research, consultant relationship with Veran Please note: 2016-ongoing by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Research, Consultant relationship with Veracyte Please note: 2017- Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response President relationship with Association of Interventional Pulmonary Program Directors Please note: 2017-2019 by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Consu tant relationship with Veran Medical Please note: 2016-Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Consultant relationship with Veracyte Please note: 2018-Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Research relationship with Veracyte Please note: 2017-Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Research, Consultant relationship with Coridea Please note: 2017-Present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Education relationship with Intuitive Please note: 3 days by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Consultant relationship with Veracyte Please note: 2018 to present by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Advisory Board relationship with Veracyte Please note: May 2019 (1 day) by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Focus Group relationship with Cook Medical Please note: May 2019 (1 day) by Hans Lee, source=Web Response Removed 06/11/2020 by Hans Lee, source=Web Response Consultant relationship with Merit Medical Please note: 2019 Added 06/11/2020 by Hans Lee, source=Web Response, value=Honoraria Consultant relationship with Cook Medical Please note: 2019 Added 06/11/2020 by Hans Lee, source=Web Response, value=Honoraria Speaker/Speaker's Bureau relationship with Veracyte Please note: Consulting fee Added 06/11/2020 by Hans Lee, source=Web Response, value=Honoraria No relevant relationships by Laeben Lester, source=Web Response No relevant relationships by Jacqueline Stokes, source=Web Response no disclosure submitted for Jeffrey Thiboutot;No relevant relationships by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships by Lonny Yarmus, source=Web Response Removed 04/27/2020 by Lonny Yarmus, source=Web Response No relevant relationships by Lonny Yarmus, source=Web Response Removed 04/27/2020 by Lonny Yarmus, source=Web Response No relevant relationships by Lonny Yarmus, source=Web Response Removed 04/27/2020 by Lonny Yarmus, source=Web Response No relevant relationships Added 04/27/2020 by Lonny Yarmus, source=Web Response, value=Grant/Research Support Removed 05/31/2020 by Lonny Yarmus, source=Web Response No relevant relationships by Lonny Yarmus, source=Web Response Removed 04/27/2020 by Lonny Yarmus, source=Web Response

Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.

BackgroundPneumonitis from immune checkpoint inhibitors (ICI) is a potentially fatal immune-related adverse event (irAE) from antiprogrammed death 1/programmed death ligand 1 immunotherapy. Most cases of ICI pneumonitis improve or resolve with 4–6 weeks of corticosteroid therapy. Herein, we report the incidence, clinicopathological features and management of patients with non-small cell lung cancer (NSCLC) and melanoma who developed chronic ICI pneumonitis that warrants ≥12 weeks of immunosuppression.MethodsPatients with ICI pneumonitis were identified from institutional databases of ICI-treated patients with advanced melanoma and NSCLC between January 2011 and July 2018. ICI pneumonitis was defined as clinical/radiographic evidence of lung inflammation without alternative diagnoses, adjudicated by a multidisciplinary team. Chronic ICI pneumonitis was defined as pneumonitis that persists or worsens with steroid tapering, and necessitates ≥12 weeks of immunosuppression, after ICI discontinuation. Serial chest CT was used to assess radiological features, and tumor response by Response EvaluationCriteria for Solid Tumors V.1.1. Bronchoalveolar lavage fluid (BALF) samples were assessed by cell differential. Lung biopsy samples were evaluated by H&E staining and multiplex immunofluorescence (mIF), where available.ResultsAmong 299 patients, 44 developed ICI pneumonitis (NSCLC: 5/205; melanoma: 1/94), and of these, 6 experienced chronic ICI pneumonitis. The overall incidence of chronic ICI pneumonitis was thus 2%. Of those who developed chronic ICI pneumonitis: the majority had NSCLC (5/6), all sustained disease control from ICIs, and none had other concurrent irAEs. Timing of chronic ICI pneumonitis development was variable (range: 0–50 months), and occurred at a median of 12 months post ICI start. Recrudescence of ICI pneumonitis occurred at a median of 6 weeks after initial steroid start (range: 3–12 weeks), with all patients requiring steroid reintroduction when tapered to ≤10 mg prednisone/equivalent. The median total duration of steroids was 37 weeks (range: 16–43+weeks). Re-emergence of radiographic ICI pneumonitis occurred in the same locations on chest CT, in most cases (5/6). All patients who developed chronic ICI pneumonitis had BALF lymphocytosis on cell differential and organising pneumonia on lung biopsy at initial ICI pneumonitis presentation, with persistent BALF lymphocytosis and brisk CD8+ infiltration on mIF at pneumonitis re-emergence during steroid taper.ConclusionsA subset of patients who develop pneumonitis from ICIs will develop chronic ICI pneumonitis, that warrants long-term immunosuppression of ≥12 weeks, and has distinct clinicopathological features.

Introduction: Lung cancer is still the leading cause of cancer among cancer patients. Although there are novel therapies as second line treatment for NSCLC, there is an issue for elderly patients. Patients and Methods: We collected retrospectively data from 60 patients >75 years of age. Thirty of these patients received nab-paclitaxel and first line treatment and were compared to thirty patients that received only best supportive care. Results: The median life of patients at the date of disease progression, although increased by the administration of the drug (92 days versus 70) was not confirmed statistically significantly (Mann-Whitney test: W = 280, p = 0.138). The administration of drug seems to keep stable the biological condition of patients (McNemar's test: χ2 = 0.033, p = 0.99). Patients with chemotherapy the death rate was increased by 50% as compared to those with best supportive care (12 vs 8), the median life until the unfortunate event surpassed statistically significantly the latter (150 days of life as compared to 108, Mann-Whitney test: W = 57.5, p = 0.045). Discussion: Nab-paclitaxel as a monotherapy could be considered as a first line treatment option for patients > 75 years of age without any previous cardiological medical history when compared to best supportive care.

The functioning of the pleura and the endocrine system are not entirely independent of each other. Some hormones can reach a greater concentration in the pleural exudate than in the blood. However, the clinical significance of this finding remains unknown. In some circumstances, hormonal changes are responsible for pathological manifestations in the pleura. Hypothyroidism is one of the most common diseases that can cause a pleural effusion, likely resulting from alterations in capillary permeability. The presence of ectopic endometrial tissue within the lung parenchyma, pleura, pericardium or diaphragm is known as thoracic endometriosis and is one of the causes of catamenial pneumothorax and /or catamenial hemothorax, which can affect women of childbearing age and arises within 72 h from the onset of menstruation. Treatment and prevention of recurrent catamenial pneumothorax / hemothorax usually requires an approach that combines surgery and hormone therapy. Malignant pleural effusion from breast cancer may contain estrogen receptor-positive cells. In such a case, endocrine treatment may be effective in reducing the amount of pleural fluid and the associated symptoms. Thyroid cancer and lymphangioleiomyomatosis (LAM) are further hormone-sensitive malignancies in which pleura is frequently involved. The solitary fibrous tumor of pleura (SFPT) is an example of a pleural disease that can cause hormonal balance disorders. It can lead to a rise in the releasing factor for growth hormone (GHRH), human beta chorionic gonadotropin (Beta-hCG), and insulin-like growth factor 2 (IGF2). The consequence of such hormonal imbalance include hypertrophic pulmonary osteoarthropathy, gynecomastia, and refractory hypoglycemia, respectively.

BACKGROUND: Empyema affects up to 65,000 patients annually in the United States. Recent consensus guidelines demonstrate ambiguity about optimal treatment. We examined current treatment practices and outcomes for inpatient treatment of empyema using a comprehensive, longitudinal dataset that encompasses an entire state cohort of hospitalized patients. METHODS: We queried the Healthcare Cost and Utilization Project (HCUP) New York State Inpatient Database (2009–2014) for patients with primary empyema and subsequent readmissions. Patients were categorized into three groups by definitive treatment during their initial hospitalization: chest tube drainage, VATS decortication/drainage, or open decortication/drainage. Treatment outcomes including success rates, readmission, reintervention, and mortality were compared between groups. RESULTS: The cohort included 4,095 patients undergoing intervention for primary empyema discharged during this period with chest tube, VATS, or open drainage and decortication. The majority of patients received definitive operative management (chest tube: 38.2%, VATS: 32.1%, open: 29.8%, p

Summary Background Indwelling pleural catheters are an established management option for malignant pleural effusion and have advantages over talc slurry pleurodesis. The optimal regimen of drainage after indwelling pleural catheter insertion is debated and ranges from aggressive (daily) drainage to drainage only when symptomatic. Methods AMPLE-2 was an open-label randomised trial involving 11 centres in Australia, New Zealand, Hong Kong, and Malaysia. Patients with symptomatic malignant pleural effusions were randomly assigned (1:1) to the aggressive (daily) or symptom-guided drainage groups for 60 days and minimised by cancer type (mesothelioma vs others), performance status (Eastern Cooperative Oncology Group [ECOG] score 0–1 vs ≥2), presence of trapped lung, and prior pleurodesis. Patients were followed up for 6 months. The primary outcome was mean daily breathlessness score, measured by use of a 100 mm visual analogue scale during the first 60 days. Secondary outcomes included rates of spontaneous pleurodesis and self-reported quality-of-life measures. Results were analysed by an intention-to-treat approach. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12615000963527. Findings Between July 20, 2015, and Jan 26, 2017, 87 patients were recruited and randomly assigned to the aggressive (n=43) or symptom-guided (n=44) drainage groups. The mean daily breathlessness scores did not differ significantly between the aggressive and symptom-guided drainage groups (geometric means 13·1 mm [95% CI 9·8–17·4] vs 17·3 mm [13·0–22·0]; ratio of geometric means 1·32 [95% CI 0·88–1·97]; p=0·18). More patients in the aggressive group developed spontaneous pleurodesis than in the symptom-guided group in the first 60 days (16 [37·2%] of 43 vs five [11·4%] of 44, p=0·0049) and at 6 months (19 [44·2%] vs seven [15·9%], p=0·004; hazard ratio 3·287 [95% CI 1·396–7·740]; p=0·0065). Patient-reported quality-of-life measures, assessed with EuroQoL-5 Dimensions-5 Levels (EQ-5D-5L), were better in the aggressive group than in the symptom-guided group (estimated means 0·713 [95% CI 0·647–0·779] vs 0·601 [0·536–0·667]). The estimated difference in means was 0·112 (95% CI 0·0198–0·204; p=0·0174). Pain scores, total days spent in hospital, and mortality did not differ significantly between groups. Serious adverse events occurred in 11 (25·6%) of 43 patients in the aggressive drainage group and in 12 (27·3%) of 44 patients in the symptom-guided drainage group, including 11 episodes of pleural infection in nine patients (five in the aggressive group and six in the symptom-guided drainage group). Interpretation We found no differences between the aggressive (daily) and the symptom-guided drainage regimens for indwelling pleural catheters in providing breathlessness control. These data indicate that daily indwelling pleural catheter drainage is more effective in promoting spontaneous pleurodesis and might improve quality of life. Funding Cancer Council of Western Australia and the Sir Charles Gairdner Research Advisory Group.

Malignant pleural effusion (MPE) is a common but serious condition that is related with poor quality of life, morbidity and mortality. Its incidence and associated healthcare costs are rising and its management remains palliative, with median survival ranging from 3 to 12 months. During the last decade there has been significant progress in unravelling the pathophysiology of MPE, as well as its diagnostics, imaging, and management. Nowadays, formerly bed-ridden patients are genotyped, phenotyped, and treated on an ambulatory basis. This article attempts to provide a comprehensive overview of current advances in MPE from bench to bedside. In addition, it highlights unanswered questions in current clinical practice and suggests future directions for basic and clinical research in the field.

Introduction Malignant pleural effusions (MPEs) can complicate most cancers, causing dyspnoea and impairing quality of life (QoL). Indwelling pleural catheters (IPCs) are a novel management approach allowing ambulatory fluid drainage and are increasingly used as an alternative to pleurodesis. IPC drainage approaches vary greatly between centres. Some advocate aggressive (usually daily) removal of fluid to provide best symptom control and chance of spontaneous pleurodesis. Daily drainages however demand considerably more resources and may increase risks of complications. Others believe that MPE care is palliative and drainage should be performed only when patients become symptomatic (often weekly to monthly). Identifying the best drainage approach will optimise patient care and healthcare resource utilisation. Methods and analysis A multicentre, open-label randomised trial. Patients with MPE will be randomised 1:1 to daily or symptom-guided drainage regimes after IPC insertion. Patient allocation to groups will be stratified for the cancer type (mesothelioma vs others), performance status (Eastern Cooperative Oncology Group status 0–1 vs ≥2), presence of trapped lung (vs not) and prior pleurodesis (vs not). The primary outcome is the mean daily dyspnoea score, measured by a 100 mm visual analogue scale (VAS) over the first 60 days. Secondary outcomes include benefits on physical activity levels, rate of spontaneous pleurodesis, complications, hospital admission days, healthcare costs and QoL measures. Enrolment of 86 participants will detect a mean difference of VAS score of 14 mm between the treatment arms (5% significance, 90% power) assuming a common between-group SD of 18.9 mm and a 10% lost to follow-up rate. Ethics and dissemination The Sir Charles Gairdner Group Human Research Ethics Committee has approved the study (number 2015-043). Results will be published in peer-reviewed journals and presented at scientific meetings. Trial registration number ACTRN12615000963527; Pre-results.

Approximately 3 billion people-half the worldwide population-are exposed to extremely high concentrations of household air pollution due to the burning of biomass fuels on inefficient cookstoves, accounting for 4 million annual deaths globally. Yet, our understanding of the pulmonary responses to household air pollution exposure and the underlying molecular and cellular events is limited. The two most prevalent biomass fuels in India are wood and cow dung, and typical 24-hour mean particulate matter (PM) concentrations in homes that use these fuels are 300 to 5,000 μg/m(3). We dissected the mechanisms of pulmonary responses in mice after acute or subchronic exposure to wood or cow dung PM collected from rural Indian homes during biomass cooking. Acute exposures resulted in robust proinflammatory cytokine production, neutrophilic inflammation, airway resistance, and hyperresponsiveness, all of which were significantly higher in mice exposed to PM from cow dung. On the contrary, subchronic exposures induced eosinophilic inflammation, PM-specific antibody responses, and alveolar destruction that was highest in wood PM-exposed mice. To understand the molecular pathways that trigger biomass PM-induced inflammation, we exposed Toll-like receptor (TLR)2-, TLR3-, TLR4-, TLR5-, and IL-1R-deficient mice to PM and found that IL-1R, TLR4, and TLR2 are the predominant receptors that elicit inflammatory responses via MyD88 in mice exposed to wood or cow dung PM. In conclusion, this study demonstrates that subchronic exposure to PM collected from households burning biomass fuel elicits a persistent pulmonary inflammation largely through activation of TLR and IL-1R pathways, which could increase the risk for chronic respiratory diseases.

A subset of patients with severe airway disease cannot be adequately supported with conventional mechanical ventilation during complex airway procedures. We report the first successful respiratory support of a patient with severe tracheobronchomalacia with veno-venous extracorporeal membrane oxygenation during rigid bronchoscopy with stent removal and stent placement.

To provide clinicians with an evidence-based overview of all topics related to ultrasound vascular access. An international evidence-based consensus provided definitions and recommendations. Medical literature on ultrasound vascular access was reviewed from January 1985 to October 2010. The GRADE and the GRADE-RAND methods were utilised to develop recommendations. The recommendations following the conference suggest the advantage of 2D vascular screening prior to cannulation and that real-time ultrasound needle guidance with an in-plane/long-axis technique optimises the probability of needle placement. Ultrasound guidance can be used not only for central venous cannulation but also in peripheral and arterial cannulation. Ultrasound can be used in order to check for immediate and life-threatening complications as well as the catheter’s tip position. Educational courses and training are required to achieve competence and minimal skills when cannulation is performed with ultrasound guidance. A recommendation to create an ultrasound curriculum on vascular access is proposed. This technique allows the reduction of infectious and mechanical complications. These definitions and recommendations based on a critical evidence review and expert consensus are proposed to assist clinicians in ultrasound-guided vascular access and as a reference for future clinical research.