Harmeet Bedi

All Publications

• VENTILATOR WAVEFORM ANALYSIS: THE SQUARE ROOT SIGN IN A PATIENT WITH A TRACHEAL-PLEURAL FISTULA Rozenbaum, D., Wingo, M., Patel, P., Nassar, A., Bedi, H., Lui, N. LIPPINCOTT WILLIAMS & WILKINS. 2024

  View details for Web of Science ID 001131541101594

• Immediate and Follow-up Imaging Findings after Cone-Beam CT-guided Transbronchial Lung Cryobiopsy. Radiology. Cardiothoracic imaging Pogatchnik, B. P., Swenson, K. E., Duong, D. K., Shaller, B., Bedi, H., Guo, H. H. 2023; 5 (2): e220149

  Abstract

  To evaluate findings after transbronchial lung cryobiopsy (TBLC) using intraprocedural cone-beam CT (CBCT) and follow-up chest CT examinations.A single-center, prospective cohort study was performed with 14 participants (mean age, 65 years ± 13 [SD]; eight male participants) undergoing CBCT-guided TBLC between August 2020 and February 2021 who underwent follow-up chest CT imaging. Intraprocedural CBCT and follow-up chest CT images were interpreted for changes compared with baseline CT images. Statistical analyses were performed using independent samples t test and analysis of variance.A total of 62 biopsies were performed, with 48 in the field of view of CBCT immediately after biopsy. All 48 biopsy sites had evidence of postprocedural hemorrhage, and 17 (35%) had pneumatoceles at the biopsy site. Follow-up CT images showed resolution of these findings. Solid nodules developed at 18 of the 62 (29%) biopsy sites.Postbiopsy hemorrhage and pneumatoceles on intraprocedural CBCT images (which were clinically occult and resolved spontaneously) and new solid nodules on follow-up chest CT images were commonly observed after TBLC. These findings may help alleviate unnecessary follow-up imaging and tissue sampling.Keywords: Biopsy/Needle Aspiration, CT, Lungs, Lung Biopsy, Interventional Bronchoscopy© RSNA, 2023.

  View details for DOI 10.1148/ryct.220149

  View details for PubMedID 37124647

  View details for PubMedCentralID PMC10141444

• Diagnostic value of bronchoscopy in Sars-Cov-2 infection: A systematic review JOURNAL OF THE PAKISTAN MEDICAL ASSOCIATION Raza, H., Raja, M., Bain, P., Bedi, H., Salam, R., Jamil, B., Shafiq, M. 2023; 73 (1): 98-105

  Abstract

  To investigate the diagnostic performance of bronchoscopy in patients with coronavirus disease 2019 infection.The systematic review was conducted in April 2021 and comprised search of published articles and preprint servers for original articles assessing diagnostic performance of bronchoscopy in patients with suspected coronavirus disease 2019 infection. The primary outcome of interest was diagnostic sensitivity of bronchoalveolar lavage in the patients. The quality of each study was assessed using the Quality Assessment, Data Abstraction and Synthesis-2 tool.Of the 29 full-text articles assessed for eligibility, 4(13.8%) were included collectively comprising 209 patients who had undergone bronchoalveolar lavage. Mean sensitivity of bronchoalveolar lavage was 83.5% ± 10.63 (range: 68.2-940%). Overall, the 4 studies had an unclear or low risk of bias.Limited data suggested that bronchoscopy with bronchoalveolar lavage did not have reliably higher diagnostic sensitivity than that reported for either nasopharyngeal or oropharyngeal swabs.

  View details for DOI 10.47391/JPMA.5668

  View details for Web of Science ID 000919721100022

  View details for PubMedID 36842016

• Foreign Bodies in the Airway: Endoscopic Methods Interventions in Pulmonary Medicine Simoff, M., Bedi, H., Eperjesiova, B. edited by Diaz-Jimenez, J., Rodriquez, A.. 2023; 3rd
• Endobronchial Ultrasound-guided Transbronchial Needle Aspiration of Primary Cardiac Synovial Sarcoma of the Left Ventricle. American journal of respiratory and critical care medicine Irfan, H., Filsuf, D., Mooney, K. L., Bedi, H., Shaller, B. D. 2022

  View details for DOI 10.1164/rccm.202207-1362IM

  View details for PubMedID 36480961

• Genomic Profiling of Bronchoalveolar Lavage Fluid in Lung Cancer. Cancer research Nair, V. S., Hui, A. B., Chabon, J. J., Shahrokh Esfahani, M., Stehr, H., Nabet, B. Y., Zhou, L., Chaudhuri, A. A., Benson, J. A., Ayers, K., Bedi, H., Ramsey, M. C., Van Wert, R., Antic, S., Lui, N. S., Backhus, L. M., Berry, M. F., Sung, A. W., Massion, P. P., Shrager, J. B., Alizadeh, A. A., Diehn, M. 2022

  Abstract

  Genomic profiling of Bronchoalveolar Lavage (BAL) samples may be useful for tumor profiling and diagnosis in the clinic. Here, we compared tumor-derived mutations detected in BAL samples from subjects with non-small cell lung cancer (NSCLC) to those detected in matched plasma samples. CAncer Personalized Profiling by deep Sequencing (CAPP-Seq) was used to genotype DNA purified from BAL, plasma and tumor samples from patients with NSCLC. The characteristics of cell-free DNA (cfDNA) isolated from BAL fluid were first characterized to optimize the technical approach. Somatic mutations identified in tumor were then compared to those identified in BAL and plasma, and the potential of BAL cfDNA analysis to distinguish lung cancer patients from risk-matched controls was explored. In total, 200 biofluid and tumor samples from 38 cases and 21 controls undergoing BAL for lung cancer evaluation were profiled. More tumor variants were identified in BAL cfDNA than plasma cfDNA in all stages (p<0.001) and in stage I-II disease only. Four of 21 controls harbored low levels of cancer-associated driver mutations in BAL cfDNA (mean VAF=0.5%), suggesting the presence of somatic mutations in non-malignant airway cells. Finally, using a Random Forest model with leave-one-out cross validation, an exploratory BAL genomic classifier identified lung cancer with 69% sensitivity and 100% specificity in this cohort and detected more cancers than BAL cytology. Detecting tumor-derived mutations by targeted sequencing of BAL cfDNA is technically feasible and appears to be more sensitive than plasma profiling. Further studies are required to define optimal diagnostic applications and clinical utility.

  View details for DOI 10.1158/0008-5472.CAN-22-0554

  View details for PubMedID 35748739

• The Value of Endobronchial Ultrasound Guided-Fine Needle Aspiration in Research Biobanking Miyakawa-Liu, M., Lundi, L., Padda, S., Leuenberger, D., Sung, A., Ramsey, M., Nair, V., Bedi, H., Ozawa, M. SPRINGERNATURE. 2022: 286-287

  View details for Web of Science ID 000770361800267

• Systemic arterial gas embolism (SAGE) as a complication of bronchoscopic lung biopsy: a case report and systematic literature review JOURNAL OF THORACIC DISEASE Swenson, K. E., Shaller, B. D., Duong, K., Bedi, H. 2021

  View details for DOI 10.21037/jtd-21-717

  View details for Web of Science ID 000720527100001

• Predicting Lymph Node Metastasis in Non-Small Cell Lung Cancer: Prospective External and Temporal Validation of the HAL and HOMER Models. Chest Martinez-Zayas, G., Almeida, F. A., Yarmus, L., Steinfort, D., Lazarus, D. R., Simoff, M. J., Saettele, T., Murgu, S., Dammad, T., Duong, D. K., Mudambi, L., Filner, J. J., Molina, S., Aravena, C., Thiboutot, J., Bonney, A., Rueda, A. M., Debiane, L. G., Hogarth, D. K., Bedi, H., Deffebach, M., Sagar, A. S., Cicenia, J., Yu, D. H., Cohen, A., Frye, L., Grosu, H. B., Gildea, T., Feller-Kopman, D., Casal, R. F., Machuzak, M., Arain, M. H., Sethi, S., Eapen, G. A., Lam, L., Jimenez, C. A., Ribeiro, M., Noor, L. Z., Mehta, A., Song, J., Choi, H., Ma, J., Li, L., Ost, D. E. 2021

  Abstract

  BACKGROUND: Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in non-small cell lung cancer (NSCLC) patients as determined by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to prospectively externally validate both models at multiple centers.RESEARCH QUESTION: Are the HAL and HOMER models valid across multiple centers?STUDY DESIGN AND METHODS: This multicenter prospective observational cohort study enrolled consecutive patients with PET-CT clinical-radiographic stage T1-3, N0-3, M0 NSCLC undergoing EBUS-TBNA staging. HOMER was used to predict the probability of N0 vs. N1 vs. N2 or N3 (N2|3) disease and HAL was used to predict the probability of N2|3 (vs N0 or N1) disease. Model discrimination was assessed using the area under the receiver operating characteristics curve (ROC-AUC) while calibration was assessed using the Brier score, calibration plots, and the Hosmer-Lemeshow test.RESULTS: Thirteen centers enrolled 1,799 patients. HAL and HOMER demonstrated good discrimination: HAL ROC-AUC=0.873 (95%CI 0.856-0.891) and HOMER ROC-AUC=0.837 (95%CI 0.814-0.859) for predicting N1 disease or higher (N1|2|3) and 0.876 (95%CI 0.855-0.897) for predicting N2|3 disease. Brier scores were 0.117 and 0.349 respectively. Calibration plots demonstrated good calibration for both models. For HAL the difference between forecast and observed probability of N2|3 disease was +0.012; for HOMER the difference for N1|2|3 was -0.018 and for N2|3 was +0.002. The Hosmer-Lemeshow test was significant for both models (p=0.034 and 0.002) indicating a small but statistically significant calibration error.INTERPRETATION: HAL and HOMER demonstrated good discrimination and calibration in multiple centers. Although calibration error was present, the magnitude of the error is small, such that the models are informative.

  View details for DOI 10.1016/j.chest.2021.04.048

  View details for PubMedID 33932466

• Commentary: An innovative, minimally-invasive approach to post-pneumonectomy bronchopleural fistula. JTCVS techniques Elliott, I. A., Bedi, H. S., Lui, N. S. 2020; 4: 351-352

  View details for DOI 10.1016/j.xjtc.2020.08.032

  View details for PubMedID 34318072

  View details for PubMedCentralID PMC8304844

• Key Highlights from the AABIP Evidence-Informed Guidelines and Expert Panel Report for the Management of Indwelling Pleural Catheters. Chest Miller, C. R., Chrissian, A. A., Lee, Y. C., Rahman, N. M., Wahidi, M. M., Tremblay, A., Hsia, D. W., Almeida, F. A., Shojaee, S., Mudambi, L., Belanger, A. R., Bedi, H., Gesthalter, Y. B., Gaynor, M., MacKenney, K. L., Lewis, S. Z., Casal, R. F. 2020

  View details for DOI 10.1016/j.chest.2020.09.282

  View details for PubMedID 33152319

• AABIP Evidence-Informed Guidelines and Expert Panel Report for the Management of Indwelling Pleural Catheters. Journal of bronchology & interventional pulmonology Miller, C. R., Chrissian, A. A., Lee, Y. C., Rahman, N. M., Wahidi, M. M., Tremblay, A., Hsia, D. W., Almeida, F. A., Shojaee, S., Fccp, Mudambi, L., Belanger, A. R., Bedi, H., Gesthalter, Y. B., Gaynor, M., MacKenney, K. L., Lewis, S. Z., Casal, R. F. 2020

  Abstract

  BACKGROUND: While the efficacy of Indwelling pleural catheters for palliation of malignant pleural effusions is supported by relatively robust evidence, there is less clarity surrounding the post-insertion management.METHODS: The Trustworthy Consensus-Based Statement approach was utilized to develop unbiased, scientifically valid guidance for the management of patients with malignant effusions treated with indwelling pleural catheters. A comprehensive electronic database search of PubMed was performed based on a priori crafted PICO questions (Population/Intervention/Comparator/Outcomes paradigm). Manual searches of the literature were performed to identify additional relevant literature. Dual screenings at the title, abstract and full text levels were performed. Identified studies were then assessed for quality based on a combination of validated tools. Appropriateness for data pooling and formation of evidence-based recommendations was assessed using predetermined criteria. All panel members participated in development of the final recommendations utilizing the modified Delphi technique.RESULTS: A total of 7 studies were identified for formal quality assessment, all of which were deemed to have a high risk of bias. There was insufficient evidence to allow for data pooling and formation of any evidence-based recommendations. Panel consensus resulted in 11 ungraded consensus-based recommendations.CONCLUSIONS: This manuscript was developed to provide clinicians with guidance on the management of patients with indwelling pleural catheters placed for palliation of malignant pleural effusions. Through a systematic and rigorous process, management suggestions were developed based on the best available evidence with augmentation by expert opinion when necessary. Additionally, these guidelines highlight important gaps in knowledge which require further study.

  View details for DOI 10.1097/LBR.0000000000000707

  View details for PubMedID 32804745

• COVID-19 Test Correlation Between Nasopharyngeal Swab and Bronchoalveolar Lavage in Asymptomatic Patients. Chest Chang, J. n., Swenson, K. E., Sung, A. n., Bedi, H. n. 2020

  View details for DOI 10.1016/j.chest.2020.11.006

  View details for PubMedID 33217415

• Radiology-pathology Correlation in Recovered COVID-19, Demonstrating Organizing Pneumonia. American journal of respiratory and critical care medicine Pogatchnik, B. P., Swenson, K. E., Sharifi, H. n., Bedi, H. n., Berry, G. J., Guo, H. H. 2020

  View details for DOI 10.1164/rccm.202004-1278IM

  View details for PubMedID 32609531

• Microhemorrhage-associated tissue iron enhances the risk forAspergillus fumigatusinvasion in a mouse model of airway transplantation. Science translational medicine Hsu, J. L., Manouvakhova, O. V., Clemons, K. V., Inayathullah, M. n., Tu, A. B., Sobel, R. A., Tian, A. n., Nazik, H. n., Pothineni, V. R., Pasupneti, S. n., Jiang, X. n., Dhillon, G. S., Bedi, H. n., Rajadas, J. n., Haas, H. n., Aurelian, L. n., Stevens, D. A., Nicolls, M. R. 2018; 10 (429)

  Abstract

  Invasive pulmonary disease due to the moldAspergillus fumigatuscan be life-threatening in lung transplant recipients, but the risk factors remain poorly understood. To study this process, we used a tracheal allograft mouse model that recapitulates large airway changes observed in patients undergoing lung transplantation. We report that microhemorrhage-related iron content may be a major determinant ofA. fumigatusinvasion and, consequently, its virulence. Invasive growth was increased during progressive alloimmune-mediated graft rejection associated with high concentrations of ferric iron in the graft. The role of iron inA. fumigatusinvasive growth was further confirmed by showing that this invasive phenotype was increased in tracheal transplants from donor mice lacking the hemochromatosis gene (Hfe -/- ). The invasive phenotype was also increased in mouse syngrafts treated with topical iron solution and in allograft recipients receiving deferoxamine, a chelator that increases iron bioavailability to the mold. The invasive growth of the iron-intolerantA. fumigatusdouble-knockout mutant (ΔsreA/ΔcccA) was lower than that of the wild-type mold. Alloimmune-mediated microvascular damage and iron overload did not appear to impair the host's immune response. In human lung transplant recipients, positive staining for iron in lung transplant tissue was more commonly seen in endobronchial biopsy sections from transplanted airways than in biopsies from the patients' own airways. Collectively, these data identify iron as a major determinant ofA. fumigatusinvasive growth and a potential target to treat or preventA. fumigatusinfections in lung transplant patients.

  View details for PubMedID 29467298

• Foreign Bodies in the Airway: Endoscopic Methods Interventions in Pulmonary Medicine Simoff, M., Bedi, H. edited by Diaz-Jimenez, J., Rodriquez, A. Springer. 2018; 2nd: 547–569
• Innovative use of a Montgomery cannula in the bronchoscopic management of tracheal stenosis and failed tracheostomy decannulation. Respiratory medicine case reports Huang, H. n., Chen, C. n., Bedi, H. n., Bai, C. n., Li, Q. n., Hohenforst-Schmidt, W. n., Zarogoulidis, P. n. 2017; 22: 130–32

  Abstract

  Endoprosthesis are being used in the everyday clinical practice either as a permanent solution or transient. They can be used in both benign and malignant situations.We report a case in which a temporary Montgomery cannula is used in conjunction with therapeutic bronchoscopy to manage a patient with failed tracheostomy decannulation secondary to a distal complex tracheal stenosis.This innovative use of the Montgomery cannula allowed for successful management of the patient's tracheal stenosis and subsequent tracheostomy tube decannulation.

  View details for PubMedID 28794964

  View details for PubMedCentralID PMC5547240

• A Prediction Model to Help with the Assessment of Adenopathy in Lung Cancer (HAL). American journal of respiratory and critical care medicine O'Connell, O. J., Almeida, F. A., Simoff, M. J., Yarmus, L., Lazarus, R., Young, B., Chen, Y., Semaan, R., Saettele, T. M., Cicenia, J., Bedi, H., Kliment, C., Li, L., Sethi, S., Diaz-Mendoza, J., Feller-Kopman, D., Song, J., Gildea, T., Lee, H., Grosu, H. B., Machuzak, M., Rodriguez-Vial, M., Eapen, G. A., Jimenez, C. A., Casal, R. F., Ost, D. E. 2016

  Abstract

  Estimating the probability of finding N2 or N3 (prN2/3) malignant nodal disease on EBUS-TBNA in patients with non-small cell lung cancer (NSCLC) can facilitate the selection of subsequent management strategies.The goal of this study was to develop a clinical prediction model for estimating the prN2/3.We used the AQuIRE registry to identify patients with NSCLC with clinical radiographic stage T1-3, N0-3, M0 disease that had EBUS-TBNA for staging. The dependent variable was the presence of N2 or N3 disease (vs. N0 or N1) as assessed by EBUS-TBNA. Univariate followed by multivariable logistic regression analysis was used to develop a parsimonious clinical prediction model to estimate prN2/3. External validation was performed using data from three other hospitals.The model derivation cohort (n=633) had a 25% prevalence of malignant N2 or N3 disease. Younger age, central location, adenocarcinoma histology, and higher PET-CT N stage were associated with a higher prN2/3. Area under the ROC curve was 0.85 (95% CI, 0.82-0.89), model fit was acceptable (Hosmer-Lemeshow p=0.62, Brier score 0.125). We externally validated the model in 722 patients. Area under the ROC curve was 0.88 (95% CI, 0.85-0.90). Calibration using the general calibration model method resulted in acceptable goodness of fit (Hosmer-Lemeshow test p=0.54, Brier score 0.132).Our prediction rule can be used to estimate prN2/3 in patients with NSCLC. The model has the potential to facilitate clinical decision making in the staging of NSCLC.

  View details for DOI 10.1164/rccm.201607-1397OC

  View details for PubMedID 28002683

• Bronchoscopist-directed Continuous Propofol Infusion for Targeting Moderate Sedation During Endobronchial Ultrasound Bronchoscopy: A Practical and Effective Protocol. Journal of bronchology & interventional pulmonology Chrissian, A. A., Bedi, H. 2015; 22 (3): 226-236

  Abstract

  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.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.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.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.

  View details for DOI 10.1097/LBR.0000000000000187

  View details for PubMedID 26165893

• Identification of Early Acute Lung Injury at Initial Evaluation in an Acute Care Setting Prior to the Onset of Respiratory Failure CHEST Levitt, J. E., Bedi, H., Calfee, C. S., Gould, M. K., Matthay, M. A. 2009; 135 (4): 936-943

  Abstract

  Despite being a focus of intensive investigation, acute lung injury (ALI) remains a major cause of morbidity and mortality. However, the current consensus definition impedes identification of patients with ALI before they require mechanical ventilation. To establish a definition of early ALI (EALI), we carried out a prospective cohort study to identify clinical predictors of progression to ALI.Potential cases of EALI were identified by daily screening of chest radiographs (CXRs) for all adult emergency department and new medicine service admissions at Stanford University Hospital.Of 1,935 screened patients with abnormal CXRs, we enrolled 100 patients admitted with bilateral opacities present < 7 days and not due exclusively to left atrial hypertension. A total of 33 of these 100 patients progressed to ALI requiring mechanical ventilation during their hospitalization. Progression to ALI was associated with immunosuppression, the modified Rapid Emergency Medicine Score, airspace opacities beyond the bases, systemic inflammatory response syndrome, and the initial oxygen requirement (> 2 L/min). On multivariate analysis, only an initial oxygen requirement > 2 L/min predicted progression to ALI (odds ratio, 8.1; 95% confidence interval, 2.7 to 24.5). A clinical diagnosis of EALI, defined by hospital admission with bilateral opacities on CXR not exclusively due to left atrial hypertension and an initial oxygen requirement of > 2 L/min, was 73% sensitive and 79% specific for progression to ALI.A new clinical definition of EALI may have value in identifying patients with ALI early in their disease course.

  View details for DOI 10.1378/chest.08-2346

  View details for Web of Science ID 000265113800012

  View details for PubMedID 19188549

  View details for PubMedCentralID PMC2758305