Indications and Contraindications for Tube Thoracostomy

Indications for chest drain insertion

  • Pneumothorax
    • in any ventilated patient
    • tension pneumothorax after initial needle relief
    • persistent or recurrent pneumothorax after simple aspiration
    • large secondary spontaneous pneumothorax in patients over 50 years Continue reading

CURB-65 and CRB-65 Severity Scores for Community-Acquired Pneumonia (CAP)

CURB and CRB-65 scores can be used in the hospital and out-patients setting to assess pneumonia severity and the risk of death.

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Diagnostic Criteria for the Hepatopulmonary Syndrome (HPS)

The hepatopulmonary syndrome is characterized as the triad of liver disease, pulmonary gas exchange abnormalities leading to arterial deoxygenation and evidence of intrapulmonary vascular dilatations.

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ATS/ERS Criteria for Diagnosis of Idiopathic Pulmonary Fibrosis (IPF) in Absence of Surgical Lung Biopsy

Major Criteria

  1. Exclusion of other known causes of ILD such as certain drug toxicities, environmental exposures, and connective tissue diseases

  2. Abnormal pulmonary function studies that include evidence of restriction (reduced VC, often with an increased FEV1/FVC ratio) and impaired gas exchange [increased P(A–a)O2, decreased PaO2 with rest or exercise or decreased DLCO]

  3. Bibasilar reticular abnormalities with minimal ground glass opacities on HRCT scans

  4. Transbronchial lung biopsy or BAL showing no features to support an alternative diagnosis

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Light Criteria for Exudative Pleural Effusion

Transudative and exudative pleural effusions are distinguished by measuring the lactate dehydrogenase (LDH) and protein levels in the pleural fluid. Exudative pleural effusions meet at least one of the following criteria, whereas transudative pleural effusions meet none:
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Diagnostic Criteria for Adult Respiratory Distress Syndrome (ARDS)

Acute Respiratory Distress Syndrome (ARDS) is a syndrome of inflammation and increased permeability associated with a constellation of clinical, radiologic, and physiologic abnormalities unexplained by elevations in left atrial or pulmonary capillary pressure.

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GOLD Staging System for Chronic Obstructive Lung Disease (COPD) Severity

The European Respiratory Society (ERS) diagnostic criteria for COPD include the following symptoms: coughing, sputum production and/or dyspnoea, as well as a history of exposure to risk factors for COPD. The diagnosis is confirmed by a post-bronchodilator FEV1/FVC < 0.7 in spirometry, as sign of the airflow limitation that is not fully reversible.

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Indications for Lung Biopsy

Patients with lesions on the chest radiograph should be discussed in a multidisciplinary meeting with a respiratory physician and radiologist at a minimum.

Percutaneous transthoracic lung biopsy (PTLB) should be considered in the following:

  • New or enlarging solitary nodule or mass on the chest radiograph which is not amenable to diagnosis by bronchoscopy or CT shows it is unlikely to be accessible by bronchoscopy.
  • Multiple nodules in a patient not known to have malignancy or who has had a prolonged remission or more than one primary malignancy.
  • Persistent focal infiltrates, either single or multiple, for which no diagnosis has been made by sputum or blood culture, serology, or bronchoscopy.
  • Hilar mass following negative bronchoscopy. Continue reading

GINA Classification of Asthma Severity

The Global Initiative for Asthma (GINA) works with health care professionals and public health officials around the world to reduce asthma prevalence, morbidity, and mortality. The gold standard in classifying severity of asthma is the GINA classification.

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