CRC INTRVNT PULM MED PDF

PREFACE

There have been many advances in the world of pulmonary medicine in the last 25 years. These include areas of imaging, new drug development, and improvements in ventilator management and ICU care. Among these exciting advances are the development and maturation of the field of interventional pulmonology. We have had the privilege to be involved in this field since its inception, and we have worked together on a number of projects involving interventional pulmonology. We have enlisted many leading experts in the field-some recognized leaders, some new to the interventional pulmonology world-in order to present in this book the state of the art. Although interventional pulmonology is focused on a number of procedures performed by pulmonologists and critical care physicians, we have deliberately tried not to present a "how to" book but to emphasize the science behind the clinical application of these procedures.

Interventional pulmonary medicine involves the clinical application of a number of relatively invasive, high-risk procedures in patients who present with highly symptomatic, often potentially fatal, airway and pleural conditions. Interventional pulmonary medicine can be broken down into several categories: therapeutic bronchoscopy, advanced diagnostic bronchoscopy, pleuroscopy, percutaneous tracheotomy and whole-lung lavage.

The book is organized around these major categories, with initial chapters dealing with the history of rigid bronchoscopy and interventional flexible bronchoscopy and a closing segment addressing clinical outcomes and training.

Although many physicians have contributed to advances in interventional pulmonary medicine, two stand out. Dr. Shigeto Ikeda from Tokyo, Japan, introduced flexible fiberoptic bronchoscopy-an instrument that has helped define the field of modern pulmonary medicine. Dr. Ikeda has provided modern interventional pulmonologists with their major tool both for advanced diagnostic techniques (such as autofluorescence, TBNA, and endobronchial ultrasound) and for potentially all therapeutic bronchoscopy applications, except for the placement of silicone stents and some cases of critical central airway obstruction. Dr. Ikeda's favorite motto was "never give up." This seems to be a motto shared by many interventional pulmonologists as they deal with advanced disease and critically ill patients. His other favorite motto was "there's more hope with the bronchoscope."

Dr. Jean Francois Dumon of Marseille, France, helped define the field of interventional pulmonology by emphasizing the therapeutic applications of bronchoscopy and introducing Nd:YAG laser bronchoscopy and silicone stents to physicians throughout the world. His creativity and technical expertise in the field of bronchology have inspired many current interventional pulmonologists. The death of Dr. Ikeda in 2002 and Dr. Dumon's recent retirement mark the end of the original era of interventional pulmonology. We have dedicated this book to these superb physicians, who have been mentors to generations of thoracic physicians. We hope that our book will chronicle their and others' contributions during the early decades of interventional pulmonology and will be a resource for the next generation.

We wish to acknowledge and thank all our contributors. Many are friends, colleagues, and collaborators. All of them are highly productive, clinically active individuals and we appreciate the time and effort that they set aside in order to contribute. We thank Sandra Beberman and Moraima Suarez from Marcel Dekker, Inc., for their gentle prodding and encouragement to take on and complete this task and to Dr. Claude Lenfant for inviting us to contribute to the Lung Biology in Health and Disease series. We also thank our families and local colleagues for their continued support whenever we take on new projects.