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6. Standardized Definitions of Bleeding After Transbronchial Lung Biopsy: A Delphi Consensus Statement From the Nashville Working Group.

Author

Folch, Erik E, Mahajan, Amit K, Oberg, Catherine L, Maldonado, Fabien, Toloza, Eric, Krimsky, William S, Oh, Scott, Bowling, Mark R, Benzaquen, Sadia, Kinsey, Charles M, Mehta, Atul C, Fernandez-Bussy, Sebastian, Flandes, Javier, Lau, Kelvin, Krishna, Ganesh, Nead, Michael A, Herth, Felix, Aragaki-Nakahodo, Alejandro A, Barisione, Emanuela, Bansal, Sandeep, Zanchi, Dragos, Zgoda, Michael, Lutz, Peter O, Lentz, Robert J, Parks, Christopher, Salio, Mario, Perret, Kenneth, Keyes, Colleen, LeMense, Gregory P, Hinze, John D, Majid, Adnan, Christensen, Merete, Kazakov, Jordan, Labarca, Gonzalo, Waller, Ernest, Studnicka, Michael, Teba, Catalina V, and Khandhar, Sandeep J

Subjects
Lung, Humans, Blood Loss, Surgical, Bronchoscopy, Biopsy, Severity of Illness Index, Reproducibility of Results, Attitude of Health Personnel, Delphi Technique, Outcome Assessment, Health Care, biopsy, bleeding, bronchoscopy, interventional bronchoscopy, Clinical Research, Clinical Sciences, Respiratory System
Abstract

BackgroundTransbronchial lung biopsies are commonly performed for a variety of indications. Although generally well tolerated, complications such as bleeding do occur. Description of bleeding severity is crucial both clinically and in research trials; to date, there is no validated scale that is widely accepted for this purpose. Can a simple, reproducible tool for categorizing the severity of bleeding after transbronchial biopsy be created?MethodsUsing the modified Delphi method, an international group of bronchoscopists sought to create a new scale tailored to assess bleeding severity among patients undergoing flexible bronchoscopy with transbronchial lung biopsies. Cessation criteria were specified a priori and included reaching > 80% consensus among the experts or three rounds, whichever occurred first.ResultsThirty-six expert bronchoscopists from eight countries, both in academic and community practice settings, participated in the creation of the scale. After the live meeting, two iterations were made. The second and final scale was vetted by all 36 participants, with a weighted average of 4.47/5; 53% were satisfied, and 47% were very satisfied. The panel reached a consensus and proposes the Nashville Bleeding Scale.ConclusionsThe use of a simplified airway bleeding scale that can be applied at bedside is an important, necessary tool for categorizing the severity of bleeding. Uniformity in reporting clinically significant airway bleeding during bronchoscopic procedures will improve the quality of the information derived and could lead to standardization of management. In addition to transbronchial biopsies, this scale could also be applied to other bronchoscopic procedures, such as endobronchial biopsy or endobronchial ultrasound-guided needle aspiration.

Published
2020

11. Undiagnosed sleep disorder breathing as a risk factor for critical COVID-19 and pulmonary consequences at the midterm follow-up

Author

Labarca, Gonzalo, Henriquez-Beltran, Mario, Llerena, Faryd, Erices, Gustavo, Lastra, Jaime, Enos, Daniel, Castillo, Daniela, Fraga, Marco, Lamperti, Liliana, Ormazabal, Valeska, Riffo, Benilde, Rubilar, Daniel, Sanhueza, Rocio, Vasquez, Jaime, Villanueva, Carolina, Horta, Gloria, Sanhueza, Felipe, Melo, Pedro, Dreyse, Jorge, Jorquera, Jorge, Fernandez-Bussy, Sebastian, Gonzalez, Jessica, Barbe, Ferran, and Nova-Lamperti, Estefania

Published
2022
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21. Diagnostic Accuracy of a Computed Tomography-Guided Transthoracic Needle Biopsy for Ground-Glass Opacities and Subsolid Pulmonary Nodules

Author

Koratala, Anoop, primary, Chandra, Nikitha C, additional, Balasubramanian, Prasanth, additional, Yu Lee-Mateus, Alejandra, additional, Barrios-Ruiz, Alanna, additional, Garza-Salas, Ana, additional, Bowman, Andrew, additional, Grage, Rolf, additional, Fernandez-Bussy, Sebastian, additional, and Abia-Trujillo, David, additional

Published
2024
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27. Shape-Sensing Robotic-Assisted Bronchoscopy in the Multiple Pulmonary Nodule Diagnosis during a Single Anesthetic Event.

Author

Fernandez-Bussy, Sebastian, Garza-Salas, Ana, Barrios-Ruiz, Alanna, Balasubramanian, Prasanth, Yu Lee-Mateus, Alejandra, Koirala, Tapendra, Hazelett, Britney N., Chadha, Ryan, Patel, Neal M., Reisenauer, Janani S., and Abia-Trujillo, David

Subjects
*SAFETY, *BIOPSY, *THREE-dimensional imaging, *COMPUTED tomography, *RETROSPECTIVE studies, *DECISION making, *DESCRIPTIVE statistics, *PNEUMOTHORAX, *LUNG tumors, *ROBOTICS, *BRONCHOSCOPY, *TUMOR classification, *DATA analysis software, *TIME, *FLUOROSCOPY
Abstract

Introduction: The widespread use of computed tomography as a screening tool for early lung cancer has increased detection of pulmonary lesions. It is common to encounter patients with more than one peripheral pulmonary nodule (PPN) of uncertain etiology. Shape-sensing robotic-assisted bronchoscopy (ssRAB) emerges as a potential alternative to biopsy multiple PPN, in addition to mediastinal staging in single anesthetic procedure. Methods: This is a single-center, retrospective review of 22 patients who underwent ssRAB for evaluation of two or more PPN, between November 2021 and April 2023 at Mayo Clinic, FL, USA. Results: A total of 46 PPNs were biopsied in 22 patients. All lesions were ≤2 cm with a median minimum and maximum cross-sectional lesion size of 1.40 cm and 1.05 cm, respectively. Diagnostic yield was 86.9% (n = 40), and target reach was 91.3% (n = 42). Most lesions were in the upper lobes, a solid pattern was found in 78.3% (n = 36), bronchus sign was present in 82.6% of cases (n = 38), 54.4% (n = 25) were malignant nodules, and 32.6% (n = 15) were benign. Fourteen patients had at least one malignant lesion out of two or more nodules sampled, and 10 patients had a malignant diagnosis for all sampled lesions. The complication rate was 9% (n = 2) with one case of bleeding and one of pneumothorax. Conclusion: This study is, to our knowledge, the first to assess the use and safety of ssRAB for diagnosis of multiple PPN in a single anesthetic event. This procedure will mainly impact management decisions and subsequently shorten the time from diagnosis to treatment. [ABSTRACT FROM AUTHOR]

Published
2024
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28. Shape-Sensing Robotic-Assisted Bronchoscopy versus Computed Tomography-Guided Transthoracic Biopsy for the Evaluation of Subsolid Pulmonary Nodules.

Author

Fernandez-Bussy, Sebastian, Yu Lee-Mateus, Alejandra, Reisenauer, Janani, Balasubramanian, Prasanth, Barrios-Ruiz, Alanna, Garza-Salas, Ana, Chandra, Nikitha C., Koratala, Anoop, Nadrous, Anthony, Edell, Eric S., Bowman, Andrew W., Grage, Rolf A., Reisenauer, Chris J., Kurup, Anil N., Patel, Neal M., Chadha, Ryan, Hazelett, Britney N., and Abia-Trujillo, David

Subjects
*BIOPSY, *COMPUTED tomography, *CHEST X rays, *RETROSPECTIVE studies, *DESCRIPTIVE statistics, *LUNG tumors, *ROBOTICS, *SOLITARY pulmonary nodule, *RESEARCH, *MEDICAL records, *ACQUISITION of data, *BRONCHOSCOPY, *COMPARATIVE studies, *SENSITIVITY & specificity (Statistics)
Abstract

Introduction: Lung cancer remains the leading cause of cancer death worldwide. Subsolid nodules (SSN), including ground-glass nodules (GGNs) and part-solid nodules (PSNs), are slow-growing but have a higher risk for malignancy. Therefore, timely diagnosis is imperative. Shape-sensing robotic-assisted bronchoscopy (ssRAB) has emerged as reliable diagnostic procedure, but data on SSN and how ssRAB compares to other diagnostic interventions such as CT-guided transthoracic biopsy (CTTB) are scarce. In this study, we compared diagnostic yield of ssRAB versus CTTB for evaluating SSN. Methods: A retrospective study of consecutive patients who underwent either ssRAB or CTTB for evaluating GGN and PSN with a solid component less than 6 mm from February 2020 to April 2023 at Mayo Clinic Florida and Rochester. Clinicodemographic information, nodule characteristics, diagnostic yield, and complications were compared between ssRAB and CTTB. Results: A total of 66 nodules from 65 patients were evaluated: 37 PSN and 29 GGN. Median size of PSN solid component was 5 mm (IQR: 4.5, 6). Patients were divided into two groups: 27 in the ssRAB group and 38 in the CTTB group. Diagnostic yield was 85.7% for ssRAB and 89.5% for CTTB (p = 0.646). Sensitivity for malignancy was similar between ssRAB and CTTB (86.4% vs. 88.5%; p = 0.828), with no statistical difference. Complications were more frequent in CTTB with no significant difference (8 vs. 2; p = 0.135). Conclusion: Diagnostic yield for SSN was similarly high for ssRAB and CTTB, with ssRAB presenting less complications and allowing mediastinal staging within the same procedure. [ABSTRACT FROM AUTHOR]

Published
2024
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29. Pleural Port-A-Cath for Symptomatic Refractory Hepatic Hydrothorax in Nontransplant Liver Patients.

Author

Alshabani, Khaled, Rivera, Estefania, Paton, Alichia, Lara, Juan Camilo, Fernandez-Bussy, Sebastian, and Majid, Adnan

Subjects
HYDROTHORAX, PATIENT compliance
Abstract

The article presents case studies of two patients with refractory hepatic hydrothorax, ineligible for liver transplant or TIPS. They opted for pleural Port-A-Cath (PAC) as an alternative to tunneled pleural catheters (TPCs). It covers PAC insertion details, follow-up, outcomes, and why PAC was chosen. It sheds light on PAC as a palliative option for select hepatic hydrothorax cases.

Published
2024
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30. Mobile cone‐beam computed tomography complementing shape‐sensing robotic‐assisted bronchoscopy in the small pulmonary nodule sampling: A multicentre experience

Author

Abia‐Trujillo, David, primary, Folch, Erik E., additional, Yu Lee‐Mateus, Alejandra, additional, Balasubramanian, Prasanth, additional, Kheir, Fayez, additional, Keyes, Colleen M., additional, Villalobos, Regina, additional, Chadha, Ryan M., additional, Hazelett, Britney N., additional, and Fernandez‐Bussy, Sebastian, additional

Published
2023
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31. SHAPE-SENSING ROBOTIC-ASSISTED BRONCHOSCOPY AND NOVEL 1.1 MM CRYOPROBE FOR DIAGNOSING PERIPHERAL PULMONARY NODULES

Author

YU LEE MATEUS, ALEJANDRA, primary, BARRIOS-RUIZ, ALANNA, additional, GARZA, ANA K, additional, C. CHANDRA, NIKITHA, additional, KORATALA, ANOOP, additional, ABIA-TRUJILLO, DAVID, additional, PATEL, NEAL M, additional, CHADHA, RYAN, additional, HAZELETT, BRITNEY N, additional, REISENAUER, JANANI, additional, and FERNANDEZ-BUSSY, SEBASTIAN, additional

Published
2023
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35. Evidence-based guidelines for the use of tracheostomy in critically ill patients

Author

Raimondi, Néstor, Vial, Macarena R., Calleja, José, Quintero, Agamenón, Cortés, Albán, Celis, Edgar, Pacheco, Clara, Ugarte, Sebastián, Añón, José M., Hernández, Gonzalo, Vidal, Erick, Chiappero, Guillermo, Ríos, Fernando, Castilleja, Fernando, Matos, Alfredo, Rodriguez, Enith, Antoniazzi, Paulo, Teles, José Mario, Dueñas, Carmelo, Sinclair, Jorge, Martínez, Lorenzo, von der Osten, Ingrid, Vergara, José, Jiménez, Edgar, Arroyo, Max, Rodríguez, Camilo, Torres, Javier, Fernandez-Bussy, Sebastián, and Nates, Joseph L.

Published
2017
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36. Mobile cone‐beam computed tomography complementing shape‐sensing robotic‐assisted bronchoscopy in the small pulmonary nodule sampling: A multicentre experience.

Author

Abia‐Trujillo, David, Folch, Erik E., Yu Lee‐Mateus, Alejandra, Balasubramanian, Prasanth, Kheir, Fayez, Keyes, Colleen M., Villalobos, Regina, Chadha, Ryan M., Hazelett, Britney N., and Fernandez‐Bussy, Sebastian

Subjects
CONE beam computed tomography, PULMONARY nodules, BRONCHOSCOPY
Abstract

Background and Objective: Shape‐sensing robotic‐assisted bronchoscopy (ssRAB) has expanded as an important diagnostic tool for peripheral pulmonary nodules (PPNs), with diagnostic yields ranging from 60% to 88%. However, sampling and diagnosing PPN less than 2 cm in size has historically been challenging. Mobile cone‐beam computed tomography (mCBCT) has been recently integrated into ssRAB to improve diagnostic accuracy, but its added value remains uncertain. We aim to describe the role of mCBCT and determine if it provides any diagnostic advantage. Methods: A multicentre, retrospective study on the use of ssRAB and mCBCT in two tertiary care institutions: Mayo Clinic Florida and Massachusetts General Hospital. The primary outcome was diagnostic yield and sensitivity for malignancy of ssRAB complemented with mCBCT, compared to ssRAB with the standard 2D fluoroscopy. Results: A total of 192 nodules were biopsied from 173 patients. mCBCT was used in 117 (60.9%) nodules. The overall diagnostic yield was 85.4%. Diagnostic yield between subgroups with and without mCBCT was 83.8% and 88% (p = 0.417), respectively. The mCBCT group had fewer solid nodules (65.8% vs. 81.3%, p = 0.020) and a higher number of ground‐glass nodules (10.3% vs. 1.3%, p = 0.016). Conclusion: Overall, diagnostic yield between subgroups with and without mCBCT was similar. The complementary use of mCBCT to ssRAB allows proceduralists to target more complex and subsolid PPNs with a diagnostic yield comparable to simple solid PPNs while maintaining an excellent safety profile. While the overall diagnostic yield with and without mobile cone‐beam CT for sampling small pulmonary nodules with shape‐sensing robotic bronchoscopy was similar, the use of mobile cone‐beam CT allows for safely biopsying more complex and subsolid nodules. See relatededitorial [ABSTRACT FROM AUTHOR]

Published
2024
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45. Diagnostic Yield of Shape-Sensing Robotic-Assisted Bronchoscopy for Ground-Glass Nodules and Subsolid Nodules with a Solid Component Less than 6 mm

Author

Abia-Trujillo, David, primary, Chandra, Nikitha C., additional, Koratala, Anoop, additional, Yu Lee-Mateus, Alejandra, additional, Garza-Salas, Ana, additional, Barrios-Ruiz, Alanna, additional, Patel, Neal M., additional, Chadha, Ryan M., additional, Hazelett, Britney N., additional, and Fernandez-Bussy, Sebastian, additional

Published
2023
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