Long-Term Complications of Tracheal Intubation

Endotracheal intubation is an intervention frequently performed in the hospital setting in order to protect the central airway and provide mechanical support of ventilation. Many health care providers are expected to be able to intubate the patients for different indications. As the case in any medical intervention, endotracheal intubation can cause complications. These complications are categorized as early or late according to the time of onset of the presenting symptoms. This chapter will discuss the long term complications of endotracheal intubation that might be encountered by the treating physicians. The chapter will stress on the predisposing factors for these complications and the available methods to avoid and treat them

Imaging of pleural disease

The pleural space is a "potential" anatomical space which is formed of two layers: visceral and parietal. It normally contains a trace of fluid (∼10 mL in each hemithorax). Diseases of the pleura can manifest with thickening of the pleural membranes or by abnormal accumulation of air or liquid. Chest radiographs are often the first imaging tests to point to a pleural pathology. With the exception of pneumothorax, and due to the inherent limitations of chest radiographs, ultrasound and/or computed tomography are usually required to further characterise the pleural pathology and guide management. This review summarises the utility of different imaging tools in the management of pleural disease and discusses new and evolving tools in imaging of the pleura

Inhaler devices: A prospective cross-sectional study on inhaler mishandling

Background The main route for drug delivery in many respiratory illnesses is the inhalation route. Increasing number of inhaler devices have been approved by drug regulatory authorities. Failure to use the drug delivery devices properly has been shown to affect the control of diseases negatively. Research studies concerning the inhalation devices handling difficulties have been published previously; however, local data are lacking. Aim We aimed to study the technical errors among patients while handling the different available inhaler devices. We also aimed to compare between different devices regarding usage prevalence, duration of use and patient adherence. Patients and methods The study was a prospective, cross-sectional, observational study. It was conducted on patients aged greater than 12 years, who used an inhaler regularly for more than 4 weeks. Each patient demonstrated the inhalation technique using their inhaler, showing their usual inhalation technique. Technical mistakes that are likely to make therapy ineffective using devices metered-dose inhaler (MDI) and dry powder inhaler (Diskus, Turbohaler, Breezhaler, Handihaler, Ellipta) were recorded. A statistics analysis was then performed. Results A total of 221 patients were enrolled, comprising 116 (52.5%) males and 105 (47.5%) females, with a mean age of 47.6 ± 18.5 years. Bronchial asthma was the most frequent disease in 191 (84.6%) patients. The enrolled 221 patients used a total of 280 inhalation maneuvers with six different inhaler devices: 97 (34.6%) used MDI, 82 (29.3%) used Turbohaler, 58 (20.7%) used Diskus, 27 (9.7%) used Handihaler, and nine (3.2%) used Ellipta. A total of 167 (75.6%) patients used a single device, whereas the MDIs had the longest duration of use among the studied cases (mean: 56.15 months). The compliance was much higher among patients using Turbohaler and Handihaler (70 and 85%, respectively). Analysis of technical errors experienced by the studied patients shows that using Diskus or Turbohaler is accompanied by more frequent error compared with other devices (1.82 per patient and 1.73, respectively), whereas Handihaler had the least recorded error per patient (0.48). Conclusion Inhaler mishandling and compliance remain common problem in our locality. A good inhalation technique is mainly affected by the type of the device. Instructions given by health caregivers are the only modifiable factors useful for decreasing inhaler mishandling

Rasmussen's pseudoaneurysm- case report

Background: Pulmonary aneurysms and pseudoaneurysms have various etiologies; however, the term Rasmussen's pseudoaneurysm refers specifically to a focal dilatation of a branch of the pulmonary artery into adjacent tuberculous cavity. The incidence of such tuberculosis related pulmonary vascular complication is extremely rare, hence, under recognized by many physicians. Management of pulmonary pseudoaneurysms is challenging as they present by life-threatening hemoptysis. Furthermore, contrary to the most causes of massive hemoptysis their bleeding is of pulmonary rather than bronchial artery origin. Prompt diagnosis and early interventions are needed as a very high mortality rate is associated with this illness. Case description: We are reporting on a case of a young male who was presented to our hospital with recurrent episodes of massive hemoptysis and was diagnosed to have pulmonary tuberculosis. Despite being actively treated, his hemoptysis persisted. We describe in this case the role of different diagnostic modalities and the available therapeutic options. Conclusion: Rasmussen's psudoaneurysm is rare and potentially lethal pulmonary vascular complication of tuberculosis. It should be considered in the differential diagnosis of hemoptysis in patients known or suspected to have pulmonary tuberculosis. In such cases, multidetector computed tomography (MDCT) scanning is the investigation of choice to confirm the diagnosis and to localize the source of bleeding prior to the therapeutic interventions. Head to head comparison between interventional radiology procedures and surgery in treatment of pulmonary psudoaneurysms is lacking, thus, choice depend on the availability and local expertise