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Endotracheal aspirates (ETAs) are widely used for microbiologic studies of the respiratory tract in intubated patients. However, they involve sampling through an established endotracheal tube using suction catheters, both of which can acquire biofilms that may confound results. Does standard clinical ETA in intubated patients accurately reflect the authentic lower airway bacterial microbiome? Comprehensive quantitative bacterial profiling using 16S rRNA V1-V2 gene sequencing was applied to compare bacterial populations captured by standard clinical ETA vs contemporaneous gold standard samples acquired directly from the lower airways through a freshly placed sterile tracheostomy tube. The study included 13 patients undergoing percutaneous tracheostomy following prolonged (median, 15 days) intubation. Metrics of bacterial composition, diversity, and relative quantification were applied to samples. Pre-tracheostomy ETAs closely resembled the gold standard immediate post-tracheostomy airway microbiomes in bacterial composition and community features of diversity and quantification. Endotracheal tube and suction catheter biofilms also resembled cognate ETA and fresh tracheostomy communities. Unbiased molecular profiling shows that standard clinical ETA sampling has good concordance with the authentic lower airway microbiome in intubated patients. [ABSTRACT FROM AUTHOR]

The article presents a brief review on the advances in pleural effusion management approaches in the U.S. and presents updated changes to common procedural terminology (CPT) billing codes in the wake of technological advances in pleural disease management approaches. Topics include the emerging tools in improving noninvasive pleural disease evaluation and procedures and the separate CPT codes for newer techniques such as imaging and percutaneous approaches.

The article discusses the proposed Current Procedural Terminology code which reflects work performed during stereotactic body radiation therapy (SBRT) by consulting specialists and subspecialists. It cites the increasing use of SBRT in treating patients with stage I non-small cell lung cancer (NSCLC). Particular focus is given to the clinical outcomes, toxicity profiles and treatment delivery for SBRT.

The article provides Malignant Pleural Effusions (MPE) management strategies. MPE is a complication of advanced malignancies, with lung and breast cancer accounting for most of it. There are several approaches to MPE management, with each procedure to drain the pleural space and to relieve respiratory syndromes including repeat thoracentesis, placement of an indwelling cuffed and medical pleuroscopy.