RESUMEN
STUDY OBJECTIVES: To determine the optimal method of delivering supplemental oxygen during flexible bronchoscopy (FB). DESIGN: Prospective study. SETTING: University medical center. PATIENTS: Ninety-seven consecutive patients undergoing outpatient nasal FB during a 7-month period. INTERVENTION: During FB, delivery of oxygen was alternated weekly and administered by nasal cannula either nasally (52 patients) or orally (45 patients). Prior to the procedure, patients completed a questionnaire regarding oral or nasal breathing preferences, history of sinus disease, allergy history, and perceived degree of nasal congestion. RESULTS: Comparison of oxygen delivery groups demonstrated no significant difference in oxygen requirements (4.1 L/min nasal vs 3.8 L/min oral, p = 0.63), overall saturation nadir (90.9% nasal vs 91.4% oral, p = 0.85), or average saturation (95.8% nasal vs 95.7% oral, p = 0.57). No correlation between subjective symptoms or sinus or allergy history was found for oxygen requirements, average saturation, or saturation nadir. CONCLUSIONS: These data suggest that during nasal FB, no discernible difference exists between administration of oxygen using cannulas placed either nasally or orally.
Asunto(s)
Broncoscopía , Intubación/métodos , Terapia por Inhalación de Oxígeno/métodos , Humanos , Boca , Cavidad Nasal , Oxígeno/sangre , Estudios ProspectivosRESUMEN
STUDY OBJECTIVE: Positron emission tomography (PET) can contribute to diagnosing and staging lung cancer, but it has not been determined whether this information influences patient care. DESIGN: We reviewed the effects of thoracic PET scan results during an 11-month period. For each patient, physicians ordering these scans reported how PET specifically altered management, and graded the ease of interpretation and overall usefulness of PET on a 5-point scale. In addition, to appraise general attitudes about PET, we surveyed 488 national American Thoracic Society (ATS) members and 44 physicians at our comprehensive cancer center. RESULTS: One hundred twenty-six questionnaires regarding patients were mailed to 37 ordering physicians, and 98 responses (78%) were returned, primarily by cardiothoracic surgeons (35%) and pulmonologists (47%). Respondents reported that PET provided new information in 83 patients (85%) and altered patient management in 64 cases (65%). Major effects on management included decisions regarding biopsy (n = 16), surgery (n = 16), and palliative treatment (n = 16). Chest clinicians found PET to be more helpful (4.4 vs 3.9, p = 0.007) and easier to interpret (4.2 vs 3.7, p = 0.025) than other specialists. Among 139 ATS members (28%) responding to the general survey, 51 members (39%) had access to PET. PET was more frequently available to university-based (49%) than community-based (27%) physicians (p = 0.016). The majority of physicians without current access to PET (69%) indicated that they would like to have it available. ATS members with access to PET reported that PET results generally affect decisions regarding biopsy or surgery most often, but found the procedure less helpful than physicians at our center (2.77 vs 3. 56, p = 0.003) and ordered it less often for lung cancer staging (60% vs 96%, p = 0.002). CONCLUSION: PET scanning is useful in the management of patients with suspected thoracic malignancies, but impressions about its roles vary, with PET regarded more highly where, as at our center, it is used more often. Whether PET alters patient outcomes requires investigation.
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Actitud del Personal de Salud , Neoplasias Pulmonares/diagnóstico por imagen , Tomografía Computarizada de Emisión , Recolección de Datos , Humanos , Neoplasias Pulmonares/terapia , Medicina , Pautas de la Práctica en Medicina , Neumología , Especialización , Cirugía Torácica , Tomografía Computarizada de Emisión/estadística & datos numéricosRESUMEN
OBJECTIVE: To review pathology reports to determine whether a temporal change in diagnostic procedures that included bronchoscopic needle aspiration (BNA) in evaluation of small cell lung cancer (SCLC) had occurred. METHODS: A retrospective review of the computerized pathology database of the Wake Forest University Baptist Medical Center from 1990 to 1998 was performed. All pathology reports of patients newly diagnosed with SCLC were reviewed and abstracted. RESULTS: The number of patients newly diagnosed with SCLC during the 9-year study period totaled 277. Of these, 173 underwent bronchoscopy. From January 1990 to December 1991, 32% (8/25) of bronchoscopies done in patients with SCLC included BNA compared with 81% (120/148) (P < .001) from January 1992 to December 1998. In addition to the increased use of BNA in patients with SCLC undergoing bronchoscopy, the overall diagnostic yield for BNA in SCLC significantly increased over the 9-year study period from 50% (4/8) in 1990 and 1991 to 88% (106/120) thereafter (P = .001). Overall sensitivity of BNA during bronchoscopy was 86% for SCLC with only a small increase in sensitivity with use of all procedures (including BNA) to 91%. The use of forceps biopsy and bronchial brushings decreased over this period. CONCLUSION: With progressive experience with BNA, the frequency of its performance and its diagnostic yield in patients with SCLC increased markedly. The SCLC yield may be a worthwhile marker of BNA program development.