Pulmonology Commons^™

Flawed Design And Selection Bias In Critical Care Randomized Controlled Trials (Rcts): The Patient Safety Risk Of The "Rct Mimic"., Lawrence A Lynn

Ambulatory and Primary Care Articles

Over three decades, randomized controlled trials (RCTs) for critical care syndromes such as acute respiratory distress syndrome (ARDS), sepsis, and community acquired pneumonia (CAP) have repeatedly produced non-reproducible results, at times leading to high-impact reversals of global protocols when later studies revealed harm. These trials enroll patients using expert-derived threshold sets intended to define the syndrome. This analytic review presents the first historical and formal methodological review and mathematical analysis of such RCT using causal symbolic modeling (cSM), directed acyclic graphs (DAGs), and do-calculus. The review includes landmark publications, task-force threshold sets, and case examples, including the 2025 REMAP-CAP corticosteroid …

Recurrent Endobronchial Coil Migration Associated With Needle Biopsy Following Pulmonary Artery Pseudoaneurysm Embolization., Michael H Koenig, Mina S Makary, Tejas Sinha, Jeffrey C Horowitz, Nicholas Pastis

Ambulatory and Primary Care Articles

Endobronchial coil migration is a rare complication of pulmonary artery embolization, occurring when coils erode through a vessel into an airway. We describe a patient who underwent embolization of pulmonary artery pseudoaneurysms associated with a lung mass. The unique aspect of this case is the development of recurrent endobronchial coil migration following a CT-guided core needle biopsy and a subsequent endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) of the mass. In both circumstances, the portion of the coil that migrated into the large airways was cut with endoscopic scissors and removed with a flexible bronchoscope. This case highlights that while cutting …

Balsalazide-Induced Pneumonitis Causing Dyspnea In A Patient With Inflammatory Bowel Disease., Jeffrey Sobecki, Kruti Patel, Ryan Kahl, Mark Minaudo

Ambulatory and Primary Care Articles

Inflammatory bowel disease complications can be related to inflammatory bowel disease-related pulmonary diseases or a form of hypersensitivity pneumonitis secondary to the immunosuppressive medications. We present a patient with intermittent chest pain and hypoxic respiratory failure who was found to have balsalazide-induced pneumonitis. We discuss the treatment and long-term outlook.

A Prospective, Single-Arm, Multicenter Trial Of Catheter-Directed Mechanical Thrombectomy For Intermediate-Risk Acute Pulmonary Embolism: The Flare Study., Thomas Tu, Catalin Toma, Victor F Tapson, Christopher Adams, Wissam A Jaber, Mitchell Silver, Sameer Khandhar, Rohit Amin, Mitchell Weinberg, Tod Engelhardt, Monica Hunter, David Holmes, Glenn Hoots, Hussam Hamdalla, Robert L Maholic, Scott M Lilly, Kenneth Ouriel, Kenneth Rosenfield, Flare Investigators

Ambulatory and Primary Care Articles

OBJECTIVES: The aim of this study was to evaluate the safety and effectiveness of percutaneous mechanical thrombectomy using the FlowTriever System (Inari Medical, Irvine, California) in a prospective trial of patients with acute intermediate-risk pulmonary embolism (PE).

BACKGROUND: Catheter-directed thrombolysis has been shown to improve right ventricular (RV) function in patients with PE. However, catheter-directed thrombolysis increases bleeding risk and many patients with PE have relative and absolute contraindications to thrombolysis.

METHODS: Patients with symptomatic, computed tomography-documented PE and RV/left ventricular (LV) ratios ≥0.9 were eligible for enrollment. The primary effectiveness endpoint was core laboratory-assessed change in RV/LV ratio. The …

The Denali Trial: An Interim Analysis Of A Prospective, Multicenter Study Of The Denali Retrievable Inferior Vena Cava Filter., S William Stavropoulos, Ronald F Sing, Fakhir Elmasri, Mitchell J Silver, Alex Powell, Frank C Lynch, Ahmed Kamel Abdel Aal, Alexandra J Lansky, Richard A Settlage, Bart E Muhs, Denali Trial Investigators

Heart and Vascular Articles

Purpose: To assess safety and effectiveness of a nitinol retrievable inferior vena cava (IVC) filter in patients who require caval interruption to protect against pulmonary embolism (PE).

Materials and methods: Two hundred patients with temporary indications for an IVC filter were enrolled in this prospective, multicenter clinical study. Patients undergoing filter implantation were to be followed for 2 years or for 30 days after filter retrieval. At the time of the present interim report, all 200 patients had been enrolled in the study, and 160 had undergone a retrieval attempt or been followed to 6 months with their filter in …