Scholarly Journals--Published

  • Chrissian A A, & Bedi H. (2015). Bronchoscopist-directed Continuous Propofol Infusion for Targeting Moderate Sedation During Endobronchial Ultrasound Bronchoscopy: A Practical and Effective Protocol. J Bronchology Interv Pulmonol, 22(3), 226-36. BACKGROUND: Propofol use for sedation during routine flexible bronchoscopy is expanding. However, there are concerns over propofol's reliability in targeting moderate sedation during more complex and lengthy procedures, such as endobronchial ultrasound (EBUS) bronchoscopy. Its delivery by continuous infusion, which provides a steady sedation effect, may be a practical model for achieving reliable outcomes in this setting. METHODS: We tested a continuous propofol infusion protocol targeting moderate sedation for EBUS bronchoscopy. A fixed loading rate of 125 mcg/kg/min and initial maintenance rate of 75 mcg/kg/min were used. Sedation assessments were performed every 2.5 minutes. The infusion was adjusted by a nurse under the direction of the bronchoscopist to maintain moderate sedation, normal vital signs, and patient comfort. Prospectively collected data from the first 31 patients using the protocol were analyzed. RESULTS: A mix of EBUS types was performed in a fellowship training environment. Median procedure duration was 51 minutes (interquartile range, 41 to 75 min). Ninety-four percent of total bronchoscopy time was spent in moderate sedation, whereas only 1.9% was occupied by agitation-related delays. Average propofol dose per case was 0.07 mg/kg/min (+/-0.020), and infusion adjustments were required once every 8 minutes. Sampling goals were met in all patients, and diagnostic and nodal staging accuracies were 90% and 91%, respectively. All tumor specimens sent for genetics were sufficient for analysis. There were no major procedure-related complications. CONCLUSION: Bronchoscopist-directed continuous propofol infusion is effective and practical for reliably and safely targeting moderate sedation during EBUS bronchoscopy, without sacrificing the breadth and accuracy of the procedure. (07/2015) (link)
  • Giri P C, Bellinghausen Stewart A, Dinh V A, Chrissian A A, & Nguyen H B. (2015). Developing a percutaneous dilatational tracheostomy service by medical intensivists: experience at one academic institution. J Crit Care, 30(2), 321-6. PURPOSE: Percutaneous dilatational tracheostomy (PDT) is increasingly becoming the preferred method, compared with open surgical tracheostomy, for patients requiring chronic ventilatory assistance. Little is known regarding the process involved to incorporate PDT as a standard service in the medical intensive care unit. In this report, we describe our experience developing a "PDT service" led by medical intensivists. MATERIALS AND METHODS: With support from our leadership and surgical colleagues, we developed a credentialing and training process for medical intensivists, formulated a bedside team to perform PDT, refined our technique, and maintained a patient data registry for quality improvement. RESULTS: To date, our service includes 4 medical intensivists with PDT privileges. Over a 4-year period, we performed 171 PDTs for patients in the medical intensive care unit after 12.1 +/- 8.2 days of mechanical ventilation. Our procedure-related complication rates are similar to other reports. No patient required emergent open surgical tracheostomy, and there were no deaths related to PDT. We required minimal to no backup support from our surgical colleagues in performing PDT. CONCLUSIONS: We successfully developed a medical intensivist-driven PDT service, sharing our unique successes and challenges, to facilitate the care of our patients requiring prolonged ventilator support. (04/2015) (link)
  • Dinh V A, Farshidpanah S, Lu S, Stokes P, Chrissian A, . . . Nguyen H B. (2014). Real-time sonographically guided percutaneous dilatational tracheostomy using a long-axis approach compared to the landmark technique. J Ultrasound Med, 33(8), 1407-15. OBJECTIVES: Sonographic evaluation of neck anatomy before performing percutaneous dilatational tracheostomy (PDT) has been shown to predict PDT success. In this study, we compared the real-time, long-axis, in-plane approach to the traditional bronchoscopically guided landmark technique. METHODS: Data were analyzed from a prospectively maintained PDT database at a university tertiary care medical intensive care unit. A convenience sample of adult patients requiring PDT for prolonged mechanical ventilation dependence was enrolled. Critical care fellows, under direct supervision of an attending intensivist, performed all PDTs. Tracheostomy performance from the sonographically guided and landmark techniques was compared. RESULTS: Twenty-three patients were enrolled: 11 in the sonography group and 12 in the landmark group. Initial midline introducer needle puncture was achieved in 72.7% in the sonography group compared to 8.3% in the landmark group (P< .001). The mean number of introducer needle punctures +/- SD was significantly lower in the sonography group compared to the landmark group (1.4 +/- 0.7 versus 2.6 +/- 0.9; P < .001). The total tracheostomy time was 11.4 +/- 4.2 minutes in the sonography group versus 15.3 +/- 6.8 minutes in the landmark group (P = .12). Sonography accurately predicted tracheal ring space insertion in 90.9% of patients. Procedural complications did not differ significantly between the groups. CONCLUSIONS: Percutaneous dilatational tracheostomy under real-time sonographic guidance using a long-axis approach may increase the rate of midline punctures and decrease the number of needle punctures when compared to the landmark technique. Sonographic guidance can also help guide accurate and efficient placement of a tracheostomy tube into the desired tracheal ring space. (08/2014) (link)


  • Shah H, & Chrissian A. (2013). EGFR MUTATION ANALYSIS IN PRIMARY LUNG ADENOCARCINOMA DIAGNOSED BY RADIAL EBUS-GUIDED BRONCHOSCOPY. Journal of Investigative Medicine, 61(1), 133-133. (01/2013)
  • Farshidpanah S, Chrissian A, & Cheek G. (2012). TRIMMING THE FAT WAS A BREATH OF FRESH AIR: A CASE REPORT OF A RARE ENDOBRONCHIAL LESION. Journal of Investigative Medicine, 60(1), 217-217. (01/2012)
  • Farshidpanah S, Chrissian A, & Cheek G. (2012). TRIMMING THE FAT WAS A BREATH OF FRESH AIR: A CASE REPORT OF A RARE ENDOBRONCHIAL LESION. Journal of Investigative Medicine, 60(1), 217-217. (01/2012)