The insertion of a subclavian central venous catheter is generally associated with a high rate of success and a favorable risk profile. The use of ultrasound for procedural guidance has been demonstrated to further increase the rate of success and reduce the risk of specific mechanical complications, especially in patients with difficult surface anatomy. Many individual ultrasound techniques have been described in the literature; this article presents a systematic approach for incorporating these tools into bedside practice and includes a series of illustrative figures and narrated video presentations to demonstrate the techniques described.

We examined the validity and responsiveness of the Depression Anxiety and Stress Scales-21 (DASS-21) in patients with COPD following an 8-week pulmonary rehabilitation program (PRP).

The golden ratio (phi, Φ = 1.618) is a proportion that has been found in many phenomena in nature, including the cardiovascular field. We tested the hypothesis that the systolic over mean pulmonary artery pressure ratio (sPAP/mPAP) and the mean over diastolic pressure ratio (mPAP/dPAP) may match Φ in patients with pulmonary arterial hypertension (PAH) and in control patients.

Aspirin use in COPD has been associated with reduced all-cause mortality in meta-regression analysis with few equivocal studies. However, the effect of aspirin on COPD morbidity is unknown.

Despite the lack of evidence for the effectiveness of physical restraints, their use in patients is widespread. The best ethical justification for restraining patients is that it prevents them from harming themselves. We argue that even if the empirical evidence supported their effectiveness in achieving this aim, the use of restraints would nevertheless be unethical, so long as well-known exceptions to informed consent fail to apply. Specifically, we argue that ethically justifiable restraint use demands certain necessary and sufficient conditions. These conditions are that the physician obtained informed consent for their application, that their application be medically appropriate, and that restraints be the least liberty-restricting way of achieving the intended benefit. It is a further question whether their application is ever medically appropriate, given the dearth of evidence for their effectiveness.

Percutaneous dilatational tracheotomy (PDT) has become increasingly popular and has gained widespread acceptance. The modern PDT procedure has also evolved to whereby it can be safely performed by surgeons and nonsurgeons in the ICU. Moreover, bedside PDT has proven clinical outcomes and can save hospital resources. As such, PDT done in the ICU is now a widely performed procedure, often being the tracheostomy procedure of choice. Today, many pulmonologists and intensivists who can use bedside PDT do not perform this procedure; it is conceivable this practice may expand, especially among pulmonologists and intensivists. Although numerous indications exist for tracheostomy, the focus of this article is limited to bedside PDT for prolonged mechanical ventilation, which is the most common indication for this procedure. We describe the logistics and operations needed for programs to incorporate PDT into routine ICU care.

Airway stenting has been practiced for several decades. It is one of the most common procedures performed by interventional pulmonologists. Typically, these stents are implanted to maintain the tubular patency of the tracheobronchial tree. They are only considered as a temporizing measure, or when a surgical option cannot be pursued. Through the past few decades, a number of metallic airway stents have been introduced into the market. First generation stents were comparatively simplistic and crafted from stainless steel. The latest generation of metallic airway stents are hybrid in nature and constructed with complex alloys. As airway stenting become more widely practiced, concerns arose regarding their safety. However, with improved understanding of stent-airway interactions, advancements in biomedical engineering, and a larger emphasis on post procedural care, the use of metallic endobronchial stents has been resurrected. We present the history, technological advancement, and contemporary indications of metallic airway stents.

The most important determinant of long-term survival in patients with idiopathic pulmonary fibrosis is the right ventricular (RV) adaptation to the increased pulmonary vascular resistance. Our aim was to explore RV contractile reserve during stress echocardiography in early-stage IPF.

Critical care transesophageal echocardiography (ccTEE) performed by intensivists is increasingly used to investigate cardiorespiratory failure in the ICU. Validation of the accuracy of TEE in the hands of intensivists remains largely unknown. The goal of this study was to characterize the diagnostic accuracy of ccTEE.

The incidence of complications and the outcomes of temporary transvenous pacemaker (TTP) placement in the modern era are not well established.

Lobar atelectasis (or collapse) is an exceedingly common, rather predictable, and potentially pathogenic companion to many forms of acute illness, postoperative care, and chronic debility. Readily diagnosed by using routine chest imaging and bedside ultrasound, the consequences from lobar collapse may be minor or serious, depending on extent, mechanism, patient vulnerability, abruptness of onset, effectiveness of hypoxic vasoconstriction, and compensatory reserves. Measures taken to reduce secretion burden, assure adequate secretion clearance, maintain upright positioning, reverse lung compression, and sustain lung expansion accord with a logical physiologic rationale. Both classification and logical approaches to prophylaxis and treatment of lobar atelectasis derive from a sound mechanistic knowledge of its causation.