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  1. Article ; Online: Simulation in flexible bronchoscopy and endobronchial ultrasound: a review.

    Stather, David Ryan / Lamb, Carla R / Tremblay, Alain

    Journal of bronchology & interventional pulmonology

    2011  Volume 18, Issue 3, Page(s) 247–256

    Abstract: Flexible bronchoscopy is a widely used medical procedure performed by a variety of specialists. Learning flexible bronchoscopy in a clinical setting is associated with increased learner anxiety, introduces significant variability into the learning ... ...

    Abstract Flexible bronchoscopy is a widely used medical procedure performed by a variety of specialists. Learning flexible bronchoscopy in a clinical setting is associated with increased learner anxiety, introduces significant variability into the learning experience, and increases complications placing the burden of learning on the patients. Bronchoscopy simulation involves the use of inanimate models, wet lab models, or computerized virtual reality simulators to teach and evaluate bronchoscopy skills, with the advantage of standardization of the teaching and assessment techniques without risk to the patient. The aim of this study is to provide a review of the major evidence supporting the use of bronchoscopy simulation to date and to identify limitations in the literature to stimulate further research incorporating these exciting teaching modalities.
    Language English
    Publishing date 2011-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2478320-1
    ISSN 1948-8270 ; 1944-6586
    ISSN (online) 1948-8270
    ISSN 1944-6586
    DOI 10.1097/LBR.0b013e3182296588
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  2. Article: How should we manage empyema complicating tunneled pleural catheter placement?

    Tremblay, Alain / Stather, David R / Maceachern, Paul

    Journal of bronchology & interventional pulmonology

    2010  Volume 17, Issue 2, Page(s) 106–108

    Language English
    Publishing date 2010-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2478320-1
    ISSN 1948-8270 ; 1944-6586
    ISSN (online) 1948-8270
    ISSN 1944-6586
    DOI 10.1097/LBR.0b013e3181dab03d
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  3. Article ; Online: Effect of repeated administration of low-dose silver nitrate for pleurodesis in a rabbit model.

    Tremblay, Alain / Stather, David R / Kelly, Margaret M

    Respirology (Carlton, Vic.)

    2011  Volume 16, Issue 7, Page(s) 1070–1075

    Abstract: Background and objective: Both the efficacy and toxicity of sclerosing agents are likely to be dose-dependent. Clinical pleurodesis strategies typically involve single bolus dose administration of drugs. This study was designed to test whether repeated ... ...

    Abstract Background and objective: Both the efficacy and toxicity of sclerosing agents are likely to be dose-dependent. Clinical pleurodesis strategies typically involve single bolus dose administration of drugs. This study was designed to test whether repeated administration of low doses of silver nitrate (SN) could lead to effective pleurodesis.
    Methods: Intrapleural administration, to rabbits, of decreasing doses of SN or normal saline was undertaken daily over 1, 5 or 14days. Assessment of the degree of pleurodesis was by visual inspection (score 1-8) and histological examination and scoring of inflammation and fibrosis (score 0-4). The untreated contralateral side was used as a control. A visual pleurodesis score of ≥5 was considered to be positive.
    Results: The lowest concentrations of SN leading to a visual pleurodesis score ≥5 were 0.425%, 0.085% and 0.05% for 1, 5 and 14day administration protocols respectively (P<0.05 vs control side). Visual pleurodesis scores decreased as the dose of SN decreased within each administration regimen groups (P<0.05 for single and 14day groups, P=0.058 in 5day group). A significant correlation was noted between visual pleurodesis scores and histology fibrosis scores.
    Conclusions: Effective pleurodesis can be achieved in an animal model with repeated daily administration of SN at doses significantly lower than the lowest effective single day dose. This finding could lead to better tolerated pleurodesis regimens.
    MeSH term(s) Animals ; Dose-Response Relationship, Drug ; Models, Animal ; Pleural Effusion/therapy ; Pleurodesis/methods ; Rabbits ; Sclerosing Solutions/administration & dosage ; Sclerosing Solutions/pharmacology ; Silver Nitrate/administration & dosage ; Silver Nitrate/pharmacology
    Chemical Substances Sclerosing Solutions ; Silver Nitrate (95IT3W8JZE)
    Language English
    Publishing date 2011-10
    Publishing country Australia
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1435849-9
    ISSN 1440-1843 ; 1323-7799
    ISSN (online) 1440-1843
    ISSN 1323-7799
    DOI 10.1111/j.1440-1843.2011.02007.x
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  4. Article ; Online: Clinical review: Mechanical ventilation in severe asthma.

    Stather, David R / Stewart, Thomas E

    Critical care (London, England)

    2005  Volume 9, Issue 6, Page(s) 581–587

    Abstract: Respiratory failure from severe asthma is a potentially reversible, life-threatening condition. Poor outcome in this setting is frequently a result of the development of gas-trapping. This condition can arise in any mechanically ventilated patient, but ... ...

    Abstract Respiratory failure from severe asthma is a potentially reversible, life-threatening condition. Poor outcome in this setting is frequently a result of the development of gas-trapping. This condition can arise in any mechanically ventilated patient, but those with severe airflow limitation have a predisposition. It is important that clinicians managing these types of patients understand that the use of mechanical ventilation can lead to or worsen gas-trapping. In this review we discuss the development of this complication during mechanical ventilation, techniques to measure it and strategies to limit its severity. We hope that by understanding such concepts clinicians will be able to reduce further the poor outcomes occasionally related to severe asthma.
    MeSH term(s) Asthma/physiopathology ; Asthma/therapy ; Clinical Protocols ; Combined Modality Therapy/methods ; Critical Care/methods ; Humans ; Lung Volume Measurements/methods ; Patient Selection ; Positive-Pressure Respiration/methods ; Pulmonary Gas Exchange ; Respiration, Artificial/methods ; Respiration, Artificial/standards
    Language English
    Publishing date 2005-09-08
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/cc3733
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  5. Article ; Online: Safety of endobronchial ultrasound-guided transbronchial needle aspiration for patients taking clopidogrel: a report of 12 consecutive cases.

    Stather, David R / MacEachern, Paul / Chee, Alex / Tremblay, Alain

    Respiration; international review of thoracic diseases

    2012  Volume 83, Issue 4, Page(s) 330–334

    Abstract: ... by an interventional pulmonologist (D.R.S.) at the University of Calgary from July 1st, 2007 to April 1st, 2011 was ...

    Abstract Background: Clopidogrel is an oral agent commonly used for primary or secondary prevention of cardiovascular disease. It is associated with an increased risk of bleeding during some medical and surgical procedures. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a new bronchoscopic technique used to accurately biopsy intrathoracic structures during flexible bronchoscopy. It is currently unknown whether clopidogrel increases bleeding complications during EBUS-TBNA procedures.
    Objectives: To evaluate the safety of clopidogrel use in EBUS-TBNA by identifying consecutive cases of EBUS-TBNA procedures performed on patients taking clopidogrel.
    Methods: A retrospective review of a prospectively collected quality improvement database from 1,100 consecutive pulmonary procedures performed by an interventional pulmonologist (D.R.S.) at the University of Calgary from July 1st, 2007 to April 1st, 2011 was performed.
    Results: Twelve cases of EBUS-TBNA procedures performed on patients taking clopidogrel were identified. Mean age was 74 years (range 61-85). Seven patients (66.7%) were taking aspirin in addition to clopidogrel. There was no significant bleeding seen in any cases at the time of bronchoscopy and no additional complications were identified during follow-up (at least 4 weeks; median follow-up 3 months).
    Conclusions: This series of 12 cases suggests that EBUS-TBNA can be performed safely by experienced operators in patients taking clopidogrel. Nevertheless, until larger prospective studies confirm this hypothesis, proceeding to EBUS-TBNA without first withdrawing clopidogrel should only be performed in situations where the risk of short-term thrombosis is believed to outweigh the (theoretical) risk of bleeding.
    MeSH term(s) Aged ; Aged, 80 and over ; Biopsy, Fine-Needle ; Bronchoscopy/adverse effects ; Bronchoscopy/methods ; Endosonography/adverse effects ; Endosonography/methods ; Female ; Follow-Up Studies ; Hemorrhage/chemically induced ; Hemorrhage/prevention & control ; Humans ; Lung Neoplasms/diagnostic imaging ; Lung Neoplasms/pathology ; Male ; Middle Aged ; Platelet Aggregation Inhibitors/adverse effects ; Platelet Aggregation Inhibitors/therapeutic use ; Retrospective Studies ; Risk Assessment ; Safety Management ; Sampling Studies ; Ticlopidine/adverse effects ; Ticlopidine/analogs & derivatives ; Ticlopidine/therapeutic use
    Chemical Substances Platelet Aggregation Inhibitors ; clopidogrel (A74586SNO7) ; Ticlopidine (OM90ZUW7M1)
    Language English
    Publishing date 2012
    Publishing country Switzerland
    Document type Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 206674-9
    ISSN 1423-0356 ; 0025-7931
    ISSN (online) 1423-0356
    ISSN 0025-7931
    DOI 10.1159/000335254
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  6. Article ; Online: Severe airway injury due to alendronate aspiration.

    Maceachern, Paul R / Brazil, Aiden / Tremblay, Alain / Stather, David R / Chee, Alex C / Chou, Julie

    Canadian respiratory journal

    2013  Volume 20, Issue 6, Page(s) 410–412

    Abstract: Sequelae of foreign body aspiration can range from clinically silent and asymptomatic to immediate asphyxiation and death. Only two previous cases of bisphosphonate tablet aspiration have been reported. Ulcerative esophagitis, a known adverse effect of ... ...

    Abstract Sequelae of foreign body aspiration can range from clinically silent and asymptomatic to immediate asphyxiation and death. Only two previous cases of bisphosphonate tablet aspiration have been reported. Ulcerative esophagitis, a known adverse effect of oral bisphosphonate formulations, occurs primarily with prolonged exposure of esophageal mucosa to the medication. Little is known about the effects of bisphosphonates on the airway mucosa. The authors present a case involving an 84-year-old woman who required multiple bronchoscopic debridements, intubation for airway protection and intensive care unit admission following airway injury believed to be due to delayed recognition of aspiration of an alendronate tablet.
    MeSH term(s) Acute Lung Injury/diagnosis ; Acute Lung Injury/etiology ; Aged, 80 and over ; Alendronate/adverse effects ; Bone Density Conservation Agents/adverse effects ; Bronchi ; Female ; Foreign Bodies/diagnosis ; Foreign Bodies/etiology ; Humans ; Respiratory Aspiration/complications
    Chemical Substances Bone Density Conservation Agents ; Alendronate (X1J18R4W8P)
    Language English
    Publishing date 2013-10-17
    Publishing country Egypt
    Document type Case Reports ; Journal Article
    ZDB-ID 1213103-9
    ISSN 1916-7245 ; 1198-2241
    ISSN (online) 1916-7245
    ISSN 1198-2241
    DOI 10.1155/2013/753906
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  7. Article ; Online: Trainee impact on procedural complications: an analysis of 967 consecutive flexible bronchoscopy procedures in an interventional pulmonology practice.

    Stather, David R / MacEachern, Paul / Chee, Alex / Dumoulin, Elaine / Tremblay, Alain

    Respiration; international review of thoracic diseases

    2013  Volume 85, Issue 5, Page(s) 422–428

    Abstract: ... medical procedures performed by an interventional pulmonologist (D.R.S.) at the University of Calgary ...

    Abstract Background: Increased complications have been demonstrated in patients undergoing some medical procedures performed by trainees. Flexible bronchoscopy is generally considered a safe procedure; however, complications can include pneumothorax, bleeding and even death.
    Objectives: This study aimed to determine the impact of trainees during interventional pulmonology procedures on procedure time, sedation use and complications.
    Methods: A retrospective review of a quality improvement database from all consecutive medical procedures performed by an interventional pulmonologist (D.R.S.) at the University of Calgary, from July 1, 2007, to April 1, 2011.
    Results: Of 1,100 consecutive procedures during the study period, 967 were flexible bronchoscopies. A trainee participated in 82.2% of the procedures. Complications occurred in 38 patients (3.9%). No death occurred. Significant differences were seen when a trainee participated in the procedure versus when no trainee participated for procedure length [50.81 vs. 32.49 min, difference 18.32 min (95% CI 16.04-20.60), p = 0.001], dose of midazolam used [6.34 vs. 5.73 mg, difference 0.61 mg (95% CI 0.15-1.08), p = 0.01], dose of propofol used [153.08 vs. 111.60 mg, difference 41.48 mg (95% CI 21.81-61.15), p = 0.001], as well as the number of complications [4.5 vs. 1.2%, difference 3.3%, p = 0.048].
    Conclusions: In an academic interventional pulmonology practice utilizing the apprenticeship model for procedural education, trainee participation in procedures can increase procedure time and the amount of sedation required, and result in increased complications. Medical procedural training methods that do not involve practicing on patients warrant further investigation in order to reduce the burden of procedural learning for patients.
    MeSH term(s) Aged ; Bronchoscopy/adverse effects ; Bronchoscopy/education ; Bronchoscopy/methods ; Canada ; Clinical Competence ; Conscious Sedation/methods ; Educational Status ; Female ; Humans ; Intraoperative Complications/classification ; Intraoperative Complications/epidemiology ; Intraoperative Complications/prevention & control ; Male ; Middle Aged ; Models, Educational ; Operative Time ; Pulmonary Medicine/education ; Quality Improvement ; Respiratory Tract Diseases/diagnosis ; Respiratory Tract Diseases/therapy ; Retrospective Studies ; Teaching/methods ; Teaching/standards
    Language English
    Publishing date 2013
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 206674-9
    ISSN 1423-0356 ; 0025-7931
    ISSN (online) 1423-0356
    ISSN 0025-7931
    DOI 10.1159/000346650
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  8. Article: Repair costs for endobronchial ultrasound bronchoscopes.

    Hergott, Christopher A / Maceachern, Paul / Stather, David R / Tremblay, Alain

    Journal of bronchology & interventional pulmonology

    2010  Volume 17, Issue 3, Page(s) 223–227

    Abstract: Background: The development of endobronchial ultrasound (EBUS) has revolutionized the diagnostic approach to lung cancer and mediastinal lymphadenopathy. The capital costs associated with implementing EBUS are easily obtained from manufacturers, but the ...

    Abstract Background: The development of endobronchial ultrasound (EBUS) has revolutionized the diagnostic approach to lung cancer and mediastinal lymphadenopathy. The capital costs associated with implementing EBUS are easily obtained from manufacturers, but the ongoing maintenance and repair costs are unknown.
    Objective: The purpose of this study was to delineate the maintenance and repair costs associated with EBUS.
    Methods: For the period between October 2005 and June 30, 2009, the number of procedures and the maintenance and repair costs for both EBUS and flexible bronchoscopes were recorded. Two BF-160UCF-OL8 (Olympus, Canada) linear convex EBUS bronchoscopes were used for EBUS procedures during the course of the study. Total costs were calculated on a yearly basis and on a per procedure basis for EBUS and standard bronchoscopes and are presented in Canadian and US dollars ($1 CAN=$0.88 USD).
    Results: During the period of October 2005 and June 2009, a total of 949 linear convex EBUS procedures and 2767 flexible bronchoscopies were carried out. During this period, 13 separate repair issues were encountered with the EBUS bronchoscopes and control unit. The total cost for maintenance and repair of the EBUS and flexible bronchoscopes was $110,151.46 ($96,933.28 USD) and $67,301.49 ($59,225.31 USD), respectively. The average cost per procedure for EBUS and flexible bronchoscopy was $116.00 ($102.08 USD) and $24.32 ($21.42 USD), respectively.
    Conclusions: The cost of EBUS repairs per procedure is significant and illustrates the importance of understanding the ongoing maintenance issues inherent in these delicate pieces of medical equipment.
    Language English
    Publishing date 2010-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2478320-1
    ISSN 1948-8270 ; 1944-6586
    ISSN (online) 1948-8270
    ISSN 1944-6586
    DOI 10.1097/LBR.0b013e3181e77280
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  9. Article ; Online: Endobronchial schwannoma.

    Dumoulin, Elaine / Gui, Xianyong / Stather, David R / MacEachern, Paul / Tremblay, Alain

    Journal of bronchology & interventional pulmonology

    2012  Volume 19, Issue 1, Page(s) 75–77

    Abstract: Schwannomas are benign nerve-sheath tumors that arise from Schwann cells. They can present as endobronchial lesions with symptoms of obstruction and hemoptysis. We describe the first case of multiple endobronchial schwannomas at 3 different sites in a ... ...

    Abstract Schwannomas are benign nerve-sheath tumors that arise from Schwann cells. They can present as endobronchial lesions with symptoms of obstruction and hemoptysis. We describe the first case of multiple endobronchial schwannomas at 3 different sites in a single patient. The autofluorescence ratio was <0.5 for 2 of 3 lesions. The optimal follow-up and treatment plan for these lesions remain unknown, especially in asymptomatic patients.
    MeSH term(s) Airway Obstruction/diagnosis ; Airway Obstruction/pathology ; Biopsy ; Bronchial Neoplasms/diagnosis ; Bronchial Neoplasms/pathology ; Bronchoscopy/methods ; Humans ; Incidental Findings ; Male ; Middle Aged ; Neoplasms, Multiple Primary/diagnosis ; Neoplasms, Multiple Primary/pathology ; Neurilemmoma/diagnosis ; Neurilemmoma/pathology ; Optical Imaging ; Sensitivity and Specificity ; Smoking
    Language English
    Publishing date 2012-01
    Publishing country United States
    Document type Case Reports ; Journal Article
    ZDB-ID 2478320-1
    ISSN 1948-8270 ; 1944-6586
    ISSN (online) 1948-8270
    ISSN 1944-6586
    DOI 10.1097/LBR.0b013e318241e5aa
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  10. Article ; Online: Use of a drug eluting pleural catheter for pleurodesis.

    Tremblay, Alain / Dumitriu, Severian / Stather, David R / Maceachern, Paul / Illanes, Oscar / Kelly, Margaret M

    Experimental lung research

    2012  Volume 38, Issue 9-10, Page(s) 475–482

    Abstract: Purpose: Repeated administration of low-dose silver nitrate (SN) has been shown to be effective in creating pleurodesis. This study aimed to determine the effectiveness of a SN-eluting pleural catheter for pleurodesis.: Methods: Catheters with a ... ...

    Abstract Purpose: Repeated administration of low-dose silver nitrate (SN) has been shown to be effective in creating pleurodesis. This study aimed to determine the effectiveness of a SN-eluting pleural catheter for pleurodesis.
    Methods: Catheters with a chitosan-SN-hyaluronic acid hydrogel coating designed to release SN over 14 days, or placebo uncoated catheters, were inserted in rabbit and lamb pleurodesis models. Pleurodesis was assessed at 28 days according to a 1-8 point scoring system and pleural fibrosis and inflammation assessed histologically on a 0-4 point scale.
    Results: In the rabbit model, pleurodesis scores were significantly increased in both the 24 mg and 50 mg SN catheters versus control animals as well as compared to the contralateral untreated pleural space (median-treated side scores were 5, 8, and 1, respectively, median score for contralateral side was 1 in all groups). In the lamb model, pleurodesis scores were significantly increased in both the 750 mg and 1000 mg catheter groups versus control animals as well as compared to the contralateral untreated pleural space (median-treated side scores were 7, 7, and 1, respectively, median score for contralateral pleural space was 1 in all groups). Catheters appeared well tolerated, although higher than expected mortality was seen in the 50 mg catheter rabbit group.
    Conclusions: A catheter designed to deliver SN to the pleural space over 14 days appears to be effective in creating pleurodesis. Further investigations to determine in-vivo catheter pharmacokinetics, toxicity, dose and optimal coating methods are warranted.
    MeSH term(s) Animals ; Anti-Infective Agents, Local/administration & dosage ; Catheterization/methods ; Disease Models, Animal ; Pleural Cavity/pathology ; Pleurodesis/methods ; Rabbits ; Sheep ; Silver Nitrate/administration & dosage
    Chemical Substances Anti-Infective Agents, Local ; Silver Nitrate (95IT3W8JZE)
    Language English
    Publishing date 2012-11
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 603791-4
    ISSN 1521-0499 ; 0190-2148
    ISSN (online) 1521-0499
    ISSN 0190-2148
    DOI 10.3109/01902148.2012.731715
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