Pulse oximetry is an important diagnostic tool in monitoring and treating both in-patients and ambulatory patients. Modern pulse oximeters exploit different body sites (eg fingertip, forehead or earlobe). All those are bulky and uncomfortable, resulting in low patient compliance. Therefore, we evaluated the accuracy and precision of a wrist-sensor pulse oximeter (Oxitone-1000, Oxitone Medical) vs. the traditional fingertip device. Fifteen healthy volunteers and 23 patients were recruited. The patient group included chronic obstructive pulmonary disease (COPD) (N = 8), asthma (N = 6), sarcoidosis (N = 5) and others. Basic demographic data, skin tone type, smoking status and medical history were recorded. Blood oxygen level (SpO2) and pulse-rate values were determined by a non-invasive pulse oximeter (Reference, a conventional FDA-cleared fingertip pulse oximeter) and by Oxitone-1000. All tests were performed in singleton and in a blinded fashion. The measurements were done in sitting and standing positions, as well as after a 6-min walk test. The mean age was 60.4 ± 9.83 years, 55% were male. No significant differences were observed between the wrist-sensor and the traditional fingertip pulse oximeters in all tested parameters. Mean SpO2 was 96.45% vs. 97.18% and the mean pulse was 74.64 vs. 74.6 bpm (Oxitone-1000 vs. Reference, respectively, p < 0.0001). Precision rate was 2.28472% and the accuracy was met (Arms -Root mean-square-error < 3%). The Oxitone-1000 is both accurate and precise for SpO2 and pulse measurements during daily activities of pulmonary patients, and is not inferior to standard devices for spot checking or short period examinations. Its wrist-sensor design is comfortable and provides the advantage of extended use.

PURPOSE: Haemoptysis can be life-threatening and often requires immediate intervention. Fiberoptic bronchoscopy or computed tomography angiogram is the main diagnostic modalities prior to further intervention. For non-massive haemoptysis, the role of inhaled tranexamic acid remains controversial. METHODS: We describe the use of inhaled tranexamic acid of 250 mg concentration diluted with 5 mls of 0.9% normal saline and administered through a nebulizer using a flow rate of 5 L of oxygen per minute over 15 minutes duration in a patient with moderate haemoptysis. RESULTS: A 30-year-old man with a history of treated pulmonary tuberculosis presented with acute haemoptysis with compromised hemodynamics. He was hypotensive; BP: 60/52 mmHg, heart rate of 122 bpm, temperature of 38 °C and oxygen saturation of 90% under ambient air. Chest radiography revealed the presence of right upper zone consolidation with bronchiectasis changes at the right middle zone. An urgent bronchoscopy demonstrated blood clots at right upper lobe with no evidence of active bleeding. Anti-tuberculous was commenced with the suspicion of reactivation of pulmonary tuberculosis. Subsequently computed tomography angiography thorax failed to locate any source of bleeding. The patient declined surgical intervention and did not respond to further intravenous tranexamic acid. However, resolution of haemoptysis was achieved after 48 hours of nebulized tranexamic acid. CONCLUSIONS: Our findings are consistent with several previous studies that inhaled tranexamic acid may help achieve early resolution of haemoptysis. CLINICAL IMPLICATIONS: Inhalations of tranexamic acid can be considered as an alternative treatment for non-massive haemoptysis.

Background Silicosis is an occupational lung disease resulting from inhalation of respirable crystalline silica. Recently, an international silicosis epidemic has been noted among artificial stone workers. Objective Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is currently used for patients with unexplained lymphadenopathy. Since silicosis may present with prominent lymphadenopathy, the diagnostic yield of EBUS-TBNA in diagnosing silicosis was evaluated. Methods Twenty-eight patients with suspected silicosis referred for outpatient evaluation in three large tertiary hospitals were evaluated. Patients with mediastinal lymphadenopathy underwent EBUS-TBNA, while others underwent TBB and/or video-assisted thoracoscopic surgery (VATS). Results Eleven patients with mediastinal lymphadenopathy (39%) were evaluated using EBUS-TBNA. The diagnosis was accurate in all cases, demonstrating silica particles under polarized light, with no complications. Among the remaining patients, TBB was only 76% diagnostic, therefore requiring VATS. Conclusions EBUS-TBNA is a useful and sufficient tool to diagnose silicosis in patients with mediastinal lymphadenopathy along compatible exposure histories.

BACKGROUND:Tranexamic acid (TA) is an antifibrinolytic drug currently used systemically to control bleeding. To date, there have been no prospective studies of the effectiveness of inhaled TA for the treatment of hemoptysis. OBJECTIVES:The goal of this study was to prospectively assess the effectiveness of TA inhalations (ie, nebulized TA) for hemoptysis treatment. METHODS:This analysis was a double-blind, randomized controlled trial of treatment with nebulized TA (500 mg tid) vs placebo (normal saline) in patients admitted with hemoptysis of various etiologies. Patients with massive hemoptysis (expectorated blood > 200 mL/24 h) and hemodynamic or respiratory instability were excluded. Mortality and hemoptysis recurrence rate were assessed at 30 days and following 1 year. RESULTS:Forty-seven patients were randomized to receive TA inhalations (n = 25) or normal saline (n = 22). TA was associated with a significantly reduced expectorated blood volume starting from day 2 of admission. Resolution of hemoptysis within 5 days of admission was observed in more TA-treated patients than in those receiving placebo (96% vs 50%; P < .0005). Mean hospital length of stay was shorter for the TA group (5.7 ± 2.5 days vs 7.8 ± 4.6 days; P = .046), with fewer patients requiring invasive procedures such as interventional bronchoscopy or angiographic embolization to control the bleeding (0% vs 18.2%; P = .041). No side effects were noted in either group throughout the follow-up period. In addition, a reduced recurrence rate was noted at the 1-year follow-up (P = .009). CONCLUSIONS:TA inhalations can be used safely and effectively to control bleeding in patients with nonmassive hemoptysis. TRIAL REGISTRY:ClinicalTrials.gov; No.: NCT01496196; URL: www.clinicaltrials.gov.

Background Patients with lung cancer undergoing surgical and medical treatment are at increased risk for pulmonary complications. The importance of routine bronchoscopy procedure in populations with lung cancer has rarely been defined. We aimed to determine the growth of potentially pathogenic microorganisms (PPM) among patients evaluated by bronchoscopy for lung cancer. Methods This prospective study included 155 consecutive patients with lung mass or radiologic findings suspicious for malignancy. Baseline demographic, clinical and radiologic features were collected. Clinical features of infection were compared to microbiologic and histologic results. Results The bacterial spectrum of lung cancer patients was similar to those without malignancy. The most frequently isolated organisms were Pseudomonas sp. and Staphylococcus aureus. Among all patients, bronchial bacterial positive PPM growth was noted in 30% (46/155). The significant PPM growth rate was three-fold higher among those with clinical signs of infection (P<0.001). Interestingly, 30 of these 46 patients (66%) did not show signs of clinical infection. Conclusions Bronchoscopic evaluations should include bacterial cultures for direct targeted antibiotic therapy only in the symptomatic patients.

SESSION TITLE: Interventional Pulmonology Posters II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Linear endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has proven useful for evaluation meditational masses and lymph nodes (LN). The aim of this study was to evaluate the efficacy and safety of EBUS-TBNA performed among elderly patients (pts) population (>70 years old) patients METHODS: Charts were reviewed for all pts referred to our institution for EBUS procedure between January 2012 and June 2014. Collected data included age and gender of pts, indication for EBUS, final diagnosis, complication rate, time to discharge after the procedure. All pts underwent sedation with midazolam and fentanyl. RESULTS: Between 2012 and 2014 years, 127 patients underwent EBUS-TBNA procedure in our department. 24% (30 pts) of them were 71 y.o. and older. Mean age of these pts was 81.5 (range 71-92) and 60% of them (18 pts) were men. 80% (24 pts) underwent EBUS-TBNA as out-patient and were discharged at the same day of the procedure. Indication for EBUS-TBNA were investigation of mediastinal LN 53% (16 pts), suspicion for lung cancer in pts with lung mass and mediastinal lymphadenopathy 23% (7 pts), staging for previously diagnosed NSCLC 16% (5pts) and one pts underwent EBUS for biopsy of enlarged thyroid gland coming down into mediastinal space and in another case EBUS was done for pt with diagnosed stage IV NSCLC in order obtain tissue for receptors testing. Most common EBUS-TBNA obtained diagnosis was Primary Lung Cancer 43.3%, followed by hematologic malignancies (Lymphoma/CLL) 13.3%. Reactive LN was found in 33% of biopsies. In 93.3% (28 pts) diagnosis by EBUS biopsy was coincided with final diagnosis. Two pts were needed to undergo mediastinoscopy after EBUS-TBNA to complete their final diagnosis (pt with diagnosed lymphoma and pt with non diagnostic biopsy). The most common site for biopsy was subcarinal (63%) and right paratracheal (43%) lymph nodes. No serious complications had been observed during the EBUS-TBNA, 3 pts were needed sedation with Propofol. CONCLUSIONS: EBUS-TBNA procedure is as effective and safe for older pts as for all general population. CLINICAL IMPLICATIONS: EBUS-TBNA procedure should be not be precluded in the elderly due to age alone. DISCLOSURE: The following authors have nothing to disclose: Michael Kuchuk, Matthew Koslow, Alona Matveychuk, Alex Guber No Product/Research Disclosure Information

Background and objective Patients with pulmonary hypertension (PH) are considered to be at risk for complications associated with flexible bronchoscopy (FB), but data concerning the degree of PH are often lacking. We investigated whether COPD patients with PH who undergo bronchoscopy are at greater risk for complications. Methods This prospective study included 207 consecutive COPD patients undergoing FB. All underwent an echo-Doppler to evaluate pulmonary artery pressure on the day of the bronchoscopy procedure. Pulmonologists were blinded to the echocardiogram results. Results A total of 167 patients (80.7%) had normal pulmonary pressure. The remaining 40 patients (19.3%) had PH: 27 (13.0%) mild, eight (3.9%) moderate, and five (2.4%) severe. Noninvasive hemodynamic parameters between groups before and after FB were similar. Two patients with normal pulmonary pressure developed supraventricular tachycardia. None developed hemodynamically significant dysrhythmia. Bleeding episodes between groups in bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) did not differ. PH patients who underwent BAL and TBB had decreased O2 saturation during the procedure compared with the non-PH group (23.5% vs 6.9%, P=0.033). No deaths were attributable to FB. Conclusion PH is common among COPD patients undergoing FB. PH patients undergoing BAL and TBB are at higher risk of decreased O2 saturation than those without PH. Further studies should assess the risk among COPD patients with moderate-to-severe PH.

INTRODUCTION:The endobronchial ultrasound (EBUS) examination is the prime choice in patients with unexplained mediastinal lymphadenopathy. We summarize our experience at Meir Medical Center with EBUS in the elderly (over 75 years of age) patients with lung cancer including indications, benefits and risks factors.METHODS:The study included 20 patients over the age of 75, 13 men and 7 women. The average age was 81 ± 5 years. Indications included 11 patients with lung cancer and nine patients with mediastinal lymphadenopathy. Sixteen patients (80%] were diagnosed by the EBUS. Three patients needed a further diagnostic procedure. There was test accuracy in 18 of 20 patients (90%). Side effects included: One patient developed severe cough and another patient developed hypoxemia without the need for respiration, no bleeding was observed and there were no decreases in blood pressure. There was no arrhythmia or other complications. All patients were released on the examination day.CONCLUSIONS:The efficacy and safety of EBUS in the elderly are similar to the conditions for the general population. There were no significant complications observed including bleeding or arrhythmias.

Treatment with anti-TNF increases the rate of the reactivation of latent tuberculosis (TB) infection. We present five case reports of patients who were treated with anti-TNF and developed active TB infection. Physicians should be aware of this possible complication and should conduct screening with the purified protein derivative test (PPD) or the interferon gamma release assay (IGRA) before anti-TNF treatment.

BACKGROUND:This evaluation was undertaken to determine the incidence of bacteremia and infectious complications associated with argon plasma coagulation (APC) procedures.METHODS:Consecutive patients undergoing bronchoscopy with APC for treatment of endobronchial lesions were studied. Venesection was performed for blood cultures within 60 s of the APC procedure. APC catheter washings were cultured. Patients with positive blood cultures were reviewed immediately. All patients underwent clinical review 1 and 12 weeks after APC.RESULTS:Forty-two patients underwent 44 APC procedures. Their mean age was 66 ± 12 years. One case (2.3 %) had bacteremia with Acinetobacter lwolfii. APC catheter washing culture was positive in 14 (31.8 %) procedures. No patient had clinical features suggesting infection and there were no complications. Phone review after 1 week revealed no complications. After 3 months, 8 (18 %) had died, all related to advanced lung malignancy and not to the APC procedure.CONCLUSIONS:APC does not appear to increase the risk of bacteremia compared to airway insertion of the bronchoscope. Although contamination of the APC catheter with oropharyngeal commensal bacteria is common, clinically significant infection following the APC procedure is rare.

Background: Bronchial colonization with potentially pathogenic microorganisms (PPM) is associated with adverse outcomes in lung cancer patients undergoing resection. Methods: A prospective study of 155 patients with suspected malignancy evaluated by bronchoscopy . Results: Of 155 patients, 30% demonstrated bacterial growth with PPM. Clinical infection significantly predict PPM growth, 35% and 5%, respectively (p=.000). Conclusion: Bronchial colonization with PPM is common (30%) among patients with malignancy and clinical infection. Bacterial culture during bronchoscopy may assist with targeted antibiotic therapy prior to treatment.

Background: Little information exists concerning infectious complications associated with bronchoscopy with argon plasma coagulation (APC) (Bolliger CT et al. Eur Respir J. 2002;19:356-73, Yigla M. et al. Eur Respir J. 1999;14:789–791.). This evaluation was undertaken to determine the incidence of bacteremia and infectious complications associated with APC procedures. Methods : Consecutive patients undergoing bronchoscopy with APC for treatment of endobronchial lesions were studied prospectively. Venous blood was drawn immediately after APC procedure for aerobic and anaerobic cultures. Saline washings of APC catheter were cultured. Patients with positive blood cultures underwent clinical review upon results arrival and all patients reviewed at 1 week and 3 months after APC procedure. Results : 42 patients underwent 44 APC procedures. Mean age was 66±12 years; 30 (71%) were male. 36 (86%) patients were with malignant disease and 6 (14%) with non-malignant disease. One case (2.3%) had clinically not significant bacteremia with Acinetobacter Iwolfii . APC catheter washing culture was positive in 14 (31.8%) procedures. Neither patient with the positive washing cultures had clinical infection. Phone review 1 week after the procedures revealed no complications. After 3 months eight patients (18%) died. All deaths related to the advanced lung malignancy. Conclusions : The incidence of bacteremia following APC is comparable to that of routine flexible bronchoscopy. APC does not appear to increase the risk of bacteremia compared to airway insertion of the bronchoscope. Contamination of the APC catheter with oropharyngeal commensal bacteria is common; clinically significant infection following APC procedure is rare.

SETTING: Tertiary care medical centre in Israel.BACKGROUND: Pulmonary hypertension (PH) is a predictor of poor outcome in patients with sarcoidosis. Early diagnosis may improve outcome.OBJECTIVE: To determine factors that might contribute to the early diagnosis of PH in sarcoidosis patients with near normal lung function tests.DESIGN: Retrospective patient review.METHODS: Data from 127 patients with sarcoidosis and near normal lung function tests (forced vital capacity > 70%, forced expiratory volume in 1 second > 70% and diffusion capacity of carbon monoxide [D-LCO] > 60%), who underwent high resolution computed tomography (HRCT) scan, the 6-minute walk distance (6MWD) test and echocardiogram were analysed. Demographic, clinical and HRCT findings were compared between patients with and those without PH.RESULTS: Thirty-six patients (28.3%) had PH. Patients with PH tended to have lower D-LCO (68% +/- 8 vs. 75% +/- 17, P = 0.038), 6MWD (308 m +/- 106 vs. 486 m +/- 99, P = 0.009) and exercise saturation (91 +/- 4 vs. 95 +/- 3, P = 0.0001) compared to those without PH. HRCT patterns in PH showed higher frequencies of interstitial thickening (P = 0.004), ground glass appearance (P = 0.01) and fibrosis (P = 0.032). In logistic regression, only 6MWD was predictive of PH (P = 0.005, 95%CI 0.970-0.995).CONCLUSION: Physiological and radiographic characteristics appeared to differentiate patients with PH from those without. Physicians should be aware of PH in patients with sarcoidosis, even in those with near normal lung function.

SETTING Tertiary care university-affiliated medical centre. OBJECTIVE To determine the value of routine culture of bronchoscopy samples for mycobacteria even when tuberculosis (TB) is not strongly suspected in low TB prevalence areas. DESIGN A prospective study of 362 consecutive patients who underwent a bronchoscopy procedure. All demographic, clinical and computed tomography findings, and bacterial and mycobacterial culture results were collected. RESULTS A total of 217 men and 145 women, with a mean age of 63 ± 15 years, were included in the study. All underwent bronchoscopy with routine culture for TB. Ten cultures (2.8%) grew mycobacteria: 2 (0.55%) Mycobacterium tuberculosis and 8 (2.2%) non-tuberculous mycobacteria (NTM). The NTM included M. avium complex (MAC) in six patients and M. simiae in two patients. Two patients had two different mycobacteria species: 1 patient with M. simiae and MAC and the other with TB and MAC. All eight patients were negative for microscopy. CONCLUSION Based on our results, we suggest that routine culture of bronchial specimens for TB is not indicated in patients with a low clinical suspicion of active TB in countries with a low TB burden.

BACKGROUND:Recent studies have shown that oncostatin M (OSM) might have a role in T cell-mediated inflammatory processes in which mast cells are also involved. Patients with severe sarcoidosis might develop fibrotic changes in the lung. We assessed whether there was a correlation between mast cells expressing OSM in bronchoalveolar lavage (BAL) and the severity of sarcoidosis.PATIENTS AND METHODS:Twelve consecutive patients with new diagnosis of sarcoidosis were eligible for the study. All underwent complete lung function tests, angiotensin converting enzyme (ACE), and bronchoscopy that included BAL and biopsies. Cytospins of BAL were prepared. All samples were incubated with the primary antibody rabbit anti-human c-kit, CD117 and stained for total mast cell count. The mouse anti-human Oncostatin M was applied and activated mast cells were counted. Clinical sarcoidosis parameters including ACE and lung functions were correlated with mast cells in BAL, as well as with OSM positive mast cells.RESULTS:FEV1 % was correlated with the percentage of activated mast cells, as well as with the percentage of OSM positive mast cells (r=0.61, p=0.033, 95% CI: 0.06-0.87; r=0.58, p=0.04, 95% CI: 0.015-0.86, respectively). FVC and FEV1/FVC correlated with activated mast cells (r=0.58, p=0.05; r=0.63, p=0.028, respectively).CONCLUSIONS:Direct correlation was found between clinical parameters including lung function tests (FEV1 and FVC) and OSM secretion from mast cells in patients with sarcoidosis. These findings suggest that mast cells and OSM have a role in sarcoidosis. Further studies to confirm these preliminary results are suggested.

BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a progressive disease with a 3-year median survival. Lung volume and diffusion capacity at rest are usually used to monitor the clinical course. Because of high mortality, identification of patients at high risk is crucial for treatment strategies such as lung transplantation (LTX). This study was designed to determine if tumor markers could accurately characterize disease severity and survival in patients with IPF. METHODS The study population consisted of 61 patients with progressive IPF referred for LTX. Pulmonary function tests, cardiopulmonary exercise test, 6-min walk distance test, and Doppler echocardiogram were assessed at baseline and compared with tumor marker levels. Participants were prospectively followed for at least 25 months to determine the relationship between test parameters and survival. Tumor marker levels were reassessed in patients who underwent LTX. Forty-one age- and sex-matched patients (21 LTX recipients) with COPD served as control subjects. RESULTS In the IPF group, nine patients (14.7%) died during follow-up and 20 (32.8%) underwent LTX. Univariate analysis showed correlations between carbohydrate antigen (CA) 125 and FEV(1) % (P = .0001). CA 19-9 yielded the best correlations with exercise parameters and PAP. Significant correlation with survival was noted with CA 15-3 (P = .04) only. All tumor marker levels decreased significantly following LTX, except CA 125. CA 15-3 had the largest decrease (P = .001). Among the COPD group, tumor marker levels before LTX were significantly lower compared with the IPF and did not decrease following LTX. No patient in either group developed malignancy. CONCLUSIONS CA 15-3 levels may predict disease severity in IPF. Levels decreased in patients with IPF but not with COPD following LTX and were not associated with malignancy. This preliminary observation suggests that mucin has a role in the pathogenesis of IPF and possibly is a marker for disease activity.

Background: Malignant pleural effusion is associated with enhanced fibrinolysis. However, no data are available concerning the precise role of pleural D-dimer assay in pleural effusion. We therefore assessed the role of pleural D-dimer assay in predicting malignant pleural effusion.Patients and Methods: A prospective laboratory investigation was conducted in a tertiary care teaching hospital. The study included consecutive patients with pleural effusion who presented at the Pulmonary Department between November 2009 and May 2010. Blood and pleural D-dimer levels were measured by Enzyme Linked Fluorescent assay (ELFA). The results were correlated with the clinical, laboratory, and radiological findings, and with the final diagnosis of the pleural fluid.Results: A total of 103 patients with pleural effusion were included in the study. The Pleural ELFA D-dimer results were found to be positively correlated with pleural etiology of malignancy (p = 0.0001). Pleural etiology was also correlated with pleural LDH, pleural protein, pleural PH, pleural glucose, pleural and blood CRP, but not with ADA. In a binary logistic regression, only the pleural ELFA D-dimer assay was a significant predictor of the malignant pleural effusion (odds ratio 1.007; 95% confidence interval 1.002-1.012; p = 0.007). The area under the receiver operating characteristics curve for malignancy was 0.79. A D-dimer level of 146 mg/ml had a sensitivity of 82% and a specificity of 74%.Conclusions: We found high D-dimer levels among malignant pleural effusion. D-dimer might be useful as a simple, noninvasive, surrogate marker for malignant pleural effusion. (c) 2011 Published by Elsevier Ltd.