Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
When do you screen for pulmonary hypertension in ILD patients?
Pulmonary hypertension (PH) is a frequent finding in patients with advanced interstitial lung disease (ILD) and its presence is associated with worse morbidity and mortality. The prevalence of PH will depend on the severity of ILD, ranging from around 10% at diagnosis and about 60% of patients with ...
Is the adage “If GCS <8, intubate” still relevant for non-TBI patients?
It's a challenging area. NICO does lead credence to withholding intubation among patients that are comatose from acute poisoning with improvements in "composite end point of in-hospital death, length of ICU stay, and length of hospital stay."Practically speaking, I've never liked hard and fast rules...
When would you consider biopsy for an incidentally noted, PET negative, solid, solitary pulmonary nodule that is >8mm in size?
No, probably not. The whole point of a PET scan is to use it for its negative predictive value (which is very high for a nodule that is solid, and large enough). I'd like to know just how large it is because smaller nodules (e.g. just at or above the 8 mm size threshold we all perseverate on) can be...
What steroid regimen do you use in patients with both septic shock and ARDS?
Personally, I have used Hydrocortisone 50mg q6h for patients with refractory shock, regardless of the presence of absence of ARDS. I have not been an adopter of Steroids in ARDS.
What is your approach to treatment for MDA5 dermatomyositis patients with rapidly progressive ILD?
Rapidly progressive ILD is a temporal term, describing rapidly declining lung function within weeks (usually defined as 3 months). Therefore, we commonly use this term when the patient is already hospitalized with respiratory failure. The majority of the data stem from Japan and China, where they en...
Would you treat a sputum culture positive for Aspergillus niger despite an atypical CT chest and a negative serum galactomannan in an immunosuppressed patient who is too high risk for bronchoscopy?
Do you consider surgical thrombectomy in patients with a large, obstructive pulmonary venous thrombosis after lung transplant?
The occurrence of pulmonary embolism after a lung transplant is well-reported (Kahan et al., PMID 17403474). Consequences of large PE can include immediate life-threatening circulatory compromise, hypoxia and the potential for pulmonary infarction. I will weigh in on both the immediate life-threaten...
When do you begin antifibrotic therapy for a patient with newly diagnosed ILD that is not IPF?
The evidence behind starting anti-fibrotic therapy for non-IPF ILD is largely based on the results of the INBUILD trial where patients who have non-IPF ILD who demonstrate progression (based on at least a 10% decline in FVC or a 5% decline in FVC with worsening symptoms or radiologic progression) ha...
What factors do you consider while selecting high risk patients for prophylactic NIV after planned extubation?
I use prophylactic NIV in severe Cardiomyopathy/CHF, severe COPD, and Obesity hypoventilation.
When do you consider the use of corticosteroids in patients diagnosed with EVALI?
If they have ground glass opacities on CT which is considered to be secondary to EVALI.