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Abstract Rationale Transbronchial lung cryobiopsy is increasingly being used for the assessment of diffuse parenchymal lung diseases. Several studies have shown larger biopsy samples and higher yields compared with conventional transbronchial biopsies. However, the higher risk of bleeding and other complications has raised concerns for widespread use of this modality. Objectives To study the diagnostic accuracy and safety profile of transbronchial lung cryobiopsy and compare with video-assisted thoracoscopic surgery (VATS) by reviewing available evidence from the literature. Methods Medline and PubMed were searched from inception until December 2016. Data on diagnostic performance were abstracted by constructing two-by-two contingency tables for each study. Data on a priori selected safety outcomes were collected. Risk of bias was assessed with the Quality Assessment of Diagnostic Accuracy Studies tool. Random effects meta-analyses were performed to obtain summary estimates of the diagnostic accuracy. Results The pooled diagnostic yield, pooled sensitivity, and pooled specificity of transbronchial lung cryobiopsy were 83.7% (76.9–88.8%), 87% (85–89%), and 57% (40–73%), respectively. The pooled diagnostic yield, pooled sensitivity, and pooled specificity of VATS were 92.7% (87.6–95.8%), 91.0% (89–92%), and 58% (31–81%), respectively. The incidence of grade 2 (moderate to severe) endobronchial bleeding after transbronchial lung cryobiopsy and of post-procedural pneumothorax was 4.9% (2.2–10.7%) and 9.5% (5.9–14.9%), respectively. Conclusions Although the diagnostic test accuracy measures of transbronchial lung cryobiopsy lag behind those of VATS, with an acceptable safety profile and potential cost savings, the former could be considered as an alternative in the evaluation of patients with diffuse parenchymal lung diseases.

The field of sleep medicine has gone through tremendous evolution since the discovery of REM sleep in 1953 and remarkable research in recent years has led to multiple advances in sleep medicine. Approvals for new medicines for treating sleep disorders along with new evidence-based interventions for insomnia and sleep apnea, have transformed sleep medicine into a medical specialty in its own right. The Latest Trends in Sleep Medicine reviews the most important improvements in sleep medicine, with contributions from over fifteen international and respected experts in the discipline. Ten chapters cover topics of interest to healthcare professionals who are focused on somnology such as the management of sleep disorders, restless leg syndrome, sleep apnea medication and surgery, REM sleep behavior disorder and cognitive behavioral therapy for insomnia. In addition to these topics in medicine, the contributors present broader picture of sleep medicine by reviewing secondary topics such as sleep and aging, and driving safety. The Latest Trends in Sleep Medicine will be useful to healthcare professionals seeking to improve their understanding about contemporary sleep medicine. It also serves as a timely update for respiratory and sleep medicine clinicians, whose efforts are still needed in treating and improving the quality and length of life in patients with complex sleep disorders.

Tumors of the mediastinum represent a wide diversity of disease states. The location and composition of a mass is critical to narrowing the differential diagnosis. The most common causes of an anterior mediastinal mass include the following: thymoma; teratoma; thyroid disease; and lymphoma. Masses of the middle mediastinum are typically congenital cysts, including foregut and pericardial cysts, while those that arise in the posterior mediastinum are often neurogenic tumors. The clinical sequelae of mediastinal masses can range from being asymptomatic to producing symptoms of cough, chest pain, and dyspnea. This article will review the anatomy of the mediastinum as well as the different clinical, radiographic, and prognostic features, and therapeutic options of the most commonly encountered masses.

Keywords: Bronchoscopy, Interventional pulmonology, Climate change, Carbon footprint

Objectives: Both autofluorescence imaging bronchoscopy and narrow-band imaging have shown promise in the detection of premalignant airway lesions, each by utilizing different bandwidths of lights for better characterization of the mucosal and submucosal vascular grid. Since previously published meta-analyses have shown poor specificity of autofluorescence imaging bronchoscopy, we specifically studied the diagnostic accuracy of narrow-band imaging alone and in combination with autofluorescence imaging bronchoscopy in the detection of premalignant airway lesions. Methods: After an extensive search of eligible studies from PubMed and Medline, extracted data were pooled with weighted averages. Symmetrical summary–receiver operating characteristic curves were constructed to summarize the results quantitatively. Study heterogeneity was assessed by the I2 index. Results: Analysis of data from eight studies on narrow-band imaging showed a pooled sensitivity of 0.80 [95% confidence interval (CI): 0.77–0.83] and a pooled specificity of 0.84 (95% CI: 0.81–0.86). Summary–receiver operating characteristic curves from the data on narrow-band imaging calculated an area-under-the-curve of 0.908 (standard error 0.01). The diagnostic odds ratio of narrow-band imaging was 31.49 (95% CI: 12.17–81.45). Data from studies where narrow-band imaging and autofluorescence imaging bronchoscopy were used together showed a pooled sensitivity, specificity, area-under-the-curve and diagnostic odds ratios of 0.86 (95% CI: 0.82–0.89), 0.75 (95% CI: 0.71–0.79), 0.964 (standard error 0.05) and 27.96 (95% CI: 3.04–257.21), respectively. Conclusions: Our findings indicate that in the evaluation of premalignant airway lesions, narrow-band imaging has a higher sensitivity, specificity and diagnostic odds ratios compared with autofluorescence imaging bronchoscopy. However, combining autofluorescence imaging bronchoscopy and narrow-band imaging does not significantly improve test performance characteristics.

ObjectivePreprocedure pleural fluid localization using bedside ultrasound has been shown to reduce complications related to thoracentesis and is now considered the standard of care. However, ultrasound-guided thoracentesis (USGT) has not been broadly adopted in many low-resource settings. With increasing affordability and portability of ultrasound equipment, barriers to USGT are changing. The aim of this multisite qualitative study is to understand the current barriers to USGT in two resource-limited settings.SettingWe studied two geographically diverse settings, Harare, Zimbabwe, and Kathmandu, Nepal.Participants19 multilevel stakeholders including clinical trainees, attendings, clinical educators and hospital administrators were interviewed. There were no exclusion criteria.Primary outcomeTo understand the current determinants of USGT adoption in these settings.ResultsThree main themes emerged from these interviews: (1) stakeholders perceived multiple advantages of USGT, (2) access to equipment and training were perceived as limited and (3) while an online training approach is feasible, stakeholders expressed scepticism that this was an appropriate modality for procedural training.ConclusionOur data suggests that USGT implementation is desired by local stakeholders and that the development of an educational intervention, cocreated with local stakeholders, should be explored to ensure optimal contextual fit.

Over the last several years, the morbidity, mortality, and high costs associated with lung volume reduction (LVR) surgery has fuelled the development of different methods for bronchoscopic LVR (BLVR) in patients with emphysema. In this meta-analysis, we sought to study and compare the efficacy of most of these methods. ELIGIBLE STUDIES WERE RETRIEVED FROM PUBMED AND EMBASE FOR THE FOLLOWING BLVR METHODS: one-way valves, sealants (BioLVR), LVR coils, airway bypass stents, and bronchial thermal vapor ablation. Primary study outcomes included the mean change post-intervention in the lung function tests, the 6-minute walk distance, and the St George's Respiratory Questionnaire. Secondary outcomes included treatment-related complications. Except for the airway bypass stents, all other methods of BLVR showed efficacy in primary outcomes. However, in comparison, the BioLVR method showed the most significant findings and was the least associated with major treatment-related complications. For the BioLVR method, the mean change in forced expiratory volume (in first second) was 0.18 L (95% confidence interval [CI]: 0.09 to 0.26; P<0.001); in 6-minute walk distance was 23.98 m (95% CI: 12.08 to 35.88; P<0.01); and in St George's Respiratory Questionnaire was -8.88 points (95% CI: -12.12 to -5.64; P<0.001). The preliminary findings of our meta-analysis signify the importance of most methods of BLVR. The magnitude of the effect on selected primary outcomes shows noninferiority, if not equivalence, when compared to what is known for surgical LVR.

Airway stents are indicated to treat symptomatic narrowing or to close fistulas of the central airways. They are generally divided into two types: the silicone stents and the metallic stents. Unlike in malignancies, removability is a major objective of temporary stenting in benign conditions, which poses the challenge of a new rigid bronchoscopic procedure under general anesthesia and stent removal with all its attendant risks and costs. The concept of a biodegradable (BD) stent that could maintain the patency of an airway for a predetermined duration of time is very appealing. These BD stents would gradually degrade and eventually vanish from the airway once they are no longer needed. Such stents are currently an area of intense research. Another very promising concept of drug delivery with such stents is also a very exciting area of current research. The aim of this comprehensive review is to discuss all pertinent available literature on the use of BD materials in various clinical applications and to extensively review all animal and humans trials involving BD airway stents.

The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the \"gold standard\" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.