Bronchial Artery Revascularization (BAR)
Bronchial artery revascularization (BAR) is a surgical technique intended to restore bronchial arterial circulation to transplanted lungs. Cleveland Clinic’s Transplant Surgical Team currently is conducting a prospective pilot study offering BAR at the time of
transplantation with the reasoning that by restoring bronchial blood supply both short- and long-term outcomes in lung transplant patients may be improved.
IBV (Intra-Bronchial Valve)
Over the last few years, Cleveland Clinic pulmonologists have been participating in several multicenter trials to assess the efficacy and safety of bronchoscopic treatments for patients with severe emphysema. One such device, manufactured by Spiration, Inc., is an umbrella-shaped nitinol framed prothesis with a synthetic polymer cover. The flexible nitinol frame enables the valve to maintain contact with the airway wall and prevent air from passing
into the diseased portions of the lungs while allowing for
mucus and air to escape. This creates a one-way valve
effect and redirects inspired air from the diseased upper
lobes to the healthier lower lobes.
Exhale Airway Stents for Emphysema
Another trial currently enrolling at Cleveland Clinic is a randomized, double-blind study to evaluate the safety and effectiveness of the Exhale® drug-eluting stent in patients with homogeneous emphysema and severe hyperinflation. This technique involves creating artificial airways, or "airways bypasses," across the wall of poorly functioning existing airways.
New Bronchoscopy Suites
The Patricia L. and Thomas P. Brundige bronchoscopy suites opened on Aug. 13, 2010.These new suites are designed to provide the full range of services, from standard bronchoscopy through advanced diagnostic and major therapeutic thoracic endoscopy.
Systematic Mediastinal EBUS Staging
With the availability of general anesthesia, we can perform a minimally invasive assessment of the mediastinal lymph nodes and combine the diagnostic and staging procedures in a single step. In addition to obtaining diagnostic tissue, we assess and sample all visible lymph nodes ≥ 5 mm, even if they do not appear abnormal on CT or PET scans. The ability to diagnose and stage lung cancer in a single, minimally invasive procedure can help patients obtain appropriate treatment sooner and with less risk than that posed by multiple staged procedures.
Both malignant and nonmalignant central airway occlusions present many challenges, in that not all simple tubular silicone and self-expanding metallic stents are designed to fix the problems we face. One of the benefits of having a stock of silicone stents in our suites is that we can modify and shape stents during procedures to meet the unique needs of individual patients.
Cleveland Clinic was one of the first 10 medical centers in the world to contribute procedural data to an international registry sponsored by the American College of Chest Physicians. The AQuIRE bronchoscopy registry has been developed to gather a number of anonymous clinical variables related to bronchoscopy procedure types, complications and outcomes, the intent being to better understand the value of bronchoscopy.
Using Short-Cycle Business Intelligence to Drive Change
Beginning in late 2010, the Respiratory Institute began using short-cycle business intelligence (BI) to focus on procedural and protocol compliance for ventilation weaning. In collaboration with various respiratory therapy groups, including personnel from the Medical Intensive Care Unit, the Surgical Intensive Care Unit, the Respiratory Special Care Unit and the Neurological Intensive Care Unit, we use a variety of metrics to evaluate performance, such as: sedation levels at time of screening and spontaneous breathing trial (SBT), time (of day) SBT and screening take place, reasons for failed screening, SBT or extubation. Monitoring these specific metrics allows us to make changes to our procedures and/or protocols on a near-real-time basis, allowing for feedback on compliance and testing outcomes.
How Treating Bone Marrow Might Help Patients with Pulmonary Hypertension
Pulmonary arterial hypertension (PAH) is a proliferative vasculopathy of the pulmonary circulation leading to vascular remodeling and arterial obliteration, which increase pulmonary arterial pressures and lead to right heart failure and death. Currently available vasodilator therapies for PAH, although helpful in improving exercise tolerance and quality of life, are only moderately effective in improving survival.