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Extubation failure due to airway problems is rare in critically ill patients. Intensive care mortality and morbidity among patients having extubation failure due to airway problems are less than among those requiring re-intubation due to respiratory failure. This is due to the fact that the latter group of patients is mostly comprised of postoperative patients. Postoperative extubation failure may arise because of many possible mechanical problems due to the patient, surgery or anesthesia. Problems which cause the obstruction of upper airways may not give symptoms until tracheal extubation is performed. Obesity, obstructive sleep apnea syndrome, major head and neck surgery, upper airway surgery and cervical column operations are hazardous conditions affecting extubation success. Upper airway obstructing conditions like edema, soft tissue collapse and laryngospasm are frequently observed in this group of patients and because of these conditions, it may become hard to ensure airway integrity after extubation. For this reason, it is necessary to identify the postoperative patients who are expected to have difficult extubation processes and to transfer them to intensive care unit for a careful and planned extubation process. In this review, an efficient strategy for a successful extubation will be explained for patients having high risks for extubation failure and difficult airway problems.

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Objective: The rapid shallow breathing index (RSBI) is relatively the best predictive parameter for initial assessment of readiness for the discontinuation of mechanical ventilation (MV) support. In this study, we aimed to determine the best pressure combinations that can predict successful RSBI closest to the values calculated in spontaneous ventilation (SV).
Methods: Twenty-five mechanically ventilated patients were enrolled in the study. RSBI and other weaning parameters were calculated in different combinations (pressure support ventilation (PSV) 5 cm H2O / positive-end expiratory pressure (PEEP) 5 cm H2O; PSV 0 cm H2O/PEEP 5 cm H2O; PSV 5 cm H2O/PEEP 0 cm H2O; PSV 0 cm H2O/PEEP 0 cm H2O) before T-tube trial in all patients.
Results: The mean age of the patients was 73±10 years. RSBI did not differ significantly between SV and other combinations. The best correlation with SV was found with 5 cm H2O PSV-0 cm H2O PEEP (p=0.0001, r=0.719) and the worst with 0 cm H2O PSV-5 cm H2O PEEP. RSBI showed no predictive value for weaning success. Respiration rate (f) was higher in failure than in the success group in PSV 0 cm H2O/PEEP 5 cm H2O and PSV 5 cm H2O/PEEP 0 cm H2O (p=0.030, p=0.030, respectively). f≤27 was considered as a predictive factor for spontaneous breathing trial (SBT) success (PSV 0 cm H2O/PEEP 5 cm H2O; sensitivity 93%, specificity 63%, PSV 15 cm H2O-PEEP 5 cm H2O; sensitivity 81%, specificity 75%).
Conclusion: There was a good correlation between RSBI measured by T-tube and different pressure combinations.

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Objective: Fine-needle aspiration (FNA) cytology performed by either transthoracic or transbronchial procedures is an important approach to obtain tumor tissue for histological diagnosis. We investigated the accuracy of FNA in differentiating NSCLCs of adenocarcinoma from squamous cell carcinoma histological types to correlate cytological findings with histological features and immunohistochemistry confirmation in some cases.
Methods: From 2010 to 2015, a total of 635 transbronchial needle aspirations or transthoracic needle aspirations were performed. 332 cases were diagnosed as NSCLC, with or without an indication of a specific subtype, while 303 cases were not diagnosed as NSCLC. Out of 332 cases diagnosed as NSCLC, 252 had a histological follow-up. Subsequently, histological samples included 161 surgical resections and 91 biopsies. In cases with histopathological diagnosis accompanied by FNA cytology, an immunohistochemical study was carried out and the diagnostic results of the two methods were compared to each other.
Results: The specific subtype of NSCLC was provided in 217 cases (86%) based on cytomorphology which included 115 adenocarcinomas (46%) and 102 squamous cell carcinomas (40%). The diagnosis NSCLC-NOS by FNA was set in 35 cases. At histology, 251 cases (99.6%) were sub-classified: 122 adenocarcinomas (48%), 104 squamous cell carcinomas (41%), 11 large cell carcinomas (4%), and 14 adenosquamous carcinomas (6%). Agreement between cytological and histological typing was found in 181 of 197 cases (92%) (K=0.837; p<0.001).
Conclusion: Our study proved that most NSCLC can be sub-classified as adenocarcinoma or squamous cell carcinoma by FNA through cytomorphology and the application of immunocytochemistry.

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Objective: Medical thoracoscopy is a minimally invasive procedure that is performed by experienced pulmonologists under local anesthesia and conscious intravenous sedation. It allows direct observation and evaluation of the pleural space. Our aim is to evaluate the diagnostic efficacy and safety of this procedure while presenting our results of medical thoracoscopy performed by rigid thoracoscopy in our clinic.
Methods: Thirty-seven patients who had gone thorough medical thoracoscopy between March 2011 and August 2014 were evaluated retrospectively.
Results: Of these 37 patients, 26 were male and the average age was 50.94±15.38 years. Fourteen patients had right-sided pleural effusion, whereas 23 had left-sided pleural effusion. Closed pleural biopsy was performed previously in 16 patients with no diagnostic results. In 36 patients (97.3%), a specific diagnosis was achieved. One patient, diagnosed as lymphocytic pleuritis by medical thoracoscopy, underwent decortication and the pathology was consistent with biphasic malignant pleural mesothelioma. Another patient, diagnosed as chronic nonspecific pleuritis with medical thoracoscopy, underwent decortication and the diagnosis was fibrinous pleuritis characterized by extensive fibrosis. Three patients had expansion defects during the post-operative period. Hemothorax occurred in one patient that died of respiratory failure on day 34 of hospitalization. The median length of stay in the hospital after the procedure was 5 days (1–34).
Conclusion: Medical thoracoscopy is a secure procedure with high diagnostic value in the management of exudative pleural effusion.

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Objective: Sarcoidosis is a multisystemic disease, exact cause of disease is unknown but it is assumed that genetic predisposition and ethnic factors play a role in etiology. Studies related with familial sarcoidosis is limited and only case reports about familial sarcoidosis is available from our country. We aimed to evaluate the prevelance of familial sarcoidosis and clinical findings of cases with familial sarcoidosis.
Methods: We retrospectively documented file records of 678 patients diagnosed with sarcoidosis and followed up in outpatient clinic of sarcoidosis from January 1996 to February 2016. 28 familial sarcoidosis cases in 14 families were enrolled into the study. Their demographic findings, family relationship, symptoms, laboratory and pulmonary function test results, radiological apperances, diagnostic methods, treatments were recorded.
Results: Twenty-eight sarcoidosis patients out of 678 reported as familial cases, giving a prevelance of familial sarcoidosis as 4%. There were 8 sarcoidosis sib, 4 sarcoidosis mother-child, 1 sarcoidosis father-child and 1 sarcoidosis cousin relationship. Female/male ratio was 1.8, mean age of the study population was 43, most freguent symptoms were cough and dyspnea, stage 2 was mostly seen according to chest X-ray, most common CT appearance was mediastinal lymphadenopathy and mediastinoscopy was the most freguent diagnostic method.
Conclusion: This study is important to lead interrogation of family in patients with suspected sarcoidosis and future studies investigating familial aggregation in sarcoidosis.

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Objective: The most important factor for accurate treatment of patients with small cell lung carcinoma (SCLC) is accuracy of the initial staging. The aim of this study was to determine how often patients, staged as local or local-advanced disease by standard staging procedures (SSPs), would be staged to have a metastatic disease based on the findings of the positron emission tomography–computed tomography (PET-CT) scan.
Methods: Patients with SCLC who were staged as I, II, or III disease by SSPs (according to the American Joint Committee on Cancer Staging, 7th edition) formed the study population. SSPs included computed tomography of chest, abdomen, brain (or magnetic resonance imaging of brain), and bone scintigraphy. These patients were re-staged with 18F-FDG PET-CT scan.
Results: Between 2013 and 2015, 27 patients were prospectively studied. Of these patients, 92.5% were male and the median age was 61. Among 27 patients, distant metastasis was detected by PET-CT in 7 (25.9%) patients. Two of 7 patients were determined as stage IIIA by SSPs and 5 of 17 patients that were determined as stage IIIB by SSPs were upstaged to metastatic disease by PET-CT. All of the 7 patients had bone metastasis by PET-CT. But bone metastasis could not be detected with bone scintigraphy.
Conclusion: PET-CT detected distant metastasis in one quarter of SCLC stage III patients by SSPs. Patients who staged local-advanced SCLC with CT of the chest have to be assessed by PET-CT for extracranial distant metastasis.

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Objective: The physician is responsible for inserting one or more chest tubes into the pleural space or the mediastinal space and connecting them to an appropriate drainage system. When the general principles about care of patients with chest drains were implemented correctly and effectively by nurses, nurse will contribute to accelerate the healing process of patients. In this context, the aim of this study was to determine the nurses’ level of knowledge regarding the care of patients with chest drains.
Methods: The study was conducted with 153 nurses who worked in a chest diseases and thoracic surgery hospital in July 2014. Questionnaire form of 35 questions prepared by investigators was used to collect data. For the analysis of results, frequency tests, independent sample t-test and oneway ANOVA test were used.
Results: 69.3% of nurses stated that they had obtained information from colleguages. 35.3% considered their knowledge about chest drain management to be inadequate. 55.6% scored 13 points and above from knowledge questionnaire about chest drain management. There were statistically significant difference between knowledge level and educational background, clinic work type, working unit, years of professional experience and institutional experience, frequency of contact patients with chest drain and perception of knowledge level (p<0.05).
Conclusion: Results of this study indicate that lack of evidence-based nursing care and insufficient training has resulted in uncertainty and knowledge deficit in important aspects of chest drain care. It can be concluded that nurses receive training needs and training protocols are about chest drain management.

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Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a relatively safe and minimally invasive procedure frequently used to investigate mediastinal lymphadenopathy of unknown etiology. Due to its safety in comparison to mediastinoscopy, which is the diagnostic gold standard, EBUS-TBNA can be used as the first-line diagnostic modality for approaching mediastinal lymphadenopathy in suspected sarcoidosis. In this study, we evaluated the diagnostic yield and safety of EBUS-TBNA for sarcoidosis at our institution.
Methods: A retrospective review was performed for all patients who presented with mediastinal lymphadenopathy and underwent EBUS-TBNA for presumed sarcoidosis for a three-year period and subsequently diagnosed with sarcoidosis. Twenty-five patients were included, and parameters such as nodal station sampled, radiographic stage, adverse events, alternative diagnosis method, and symptoms were recorded.
Results: Thirteen of 25 patients had non-caseating granulomas on EBUS-TBNA with a diagnostic yield of 52%. Of 12 patients not diagnosed via EBUS-TBNA, a diagnosis was made in four patients (33%) via transbronchial lung biopsy, in three (25%) via mediastinoscopy, in one (8%) via video-assisted thoracoscopic surgery, in three (25%) with an elevated bronchoalveolar lavage (BAL) CD4/CD8 ratio and response to therapy, and in one (8%) via muscle biopsy. The average BAL CD4/CD8 ratio was 5.4 for all patients with sarcoidosis. All patients tolerated the procedure without major complications.
Conclusion: EBUS-TBNA is a useful and minimally invasive tool for the diagnosis of sarcoidosis. It should be used as the first-line diagnostic study in suspected sarcoidosis if mediastinal lymphadenopathy is present.

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Objective: To assess atherosclerotic comorbidity in chronic obstructive pulmonary disease (COPD) patients and its relationship to COPD severity, hypoxemia, and hypercapnia.
Methods: A hospital-based observational case-control study was conducted on 86 male COPD patients, and 86 age-matched healthy subjects (non-COPD group). Carotid intima-media thickness (CIMT) was assessed by Doppler ultrasound; in addition, spirometry and arterial blood gas tests were done.
Results: CIMT was significantly increased in the COPD group compared to the non-COPD group (0.84±0.15 vs. 0.63±0.076, p<0.001). When the CIMT value of ≥0.8 mm was defined as a cutoff value for a thickened CIMT complex, 64% of COPD patients versus 8.1% of non-COPD subjects had a thickened CIMT. COPD patients with a thickened CIMT were older and had a higher PaCO2, lower FEV1%, FVC, and FEF25–75% compared to COPD patients with a normal CIMT. Thickened CIMT in COPD patients was significantly associated with hypoxemia (p=0.008, OR=8.2), hypercapnia (p=0.04, OR=6.2), and airflow limitation (p=0.11, OR=2.1). There was no significant difference in CIMT in relation to COPD severity (p=0.83).
Conclusion: Atherosclerosis is prevalent in COPD patients, even in the early stages of the disease. Hypoxemia, hypercapnia, and airflow limitation are risk factors of atherosclerosis in COPD patients.

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