-
Expert Review of Respiratory Medicine Jun 2018Rigid bronchoscopy is an invaluable tool for the management of airway disorders and an essential skill for an interventional pulmonologist. Since its introduction in the... (Review)
Review
Rigid bronchoscopy is an invaluable tool for the management of airway disorders and an essential skill for an interventional pulmonologist. Since its introduction in the late 19th century, it has remained an important technique for the management of central airway obstruction, foreign body aspiration and massive hemoptysis. Areas covered: This article will review the history, indications, contraindication, technique and complications of rigid bronchoscopy. We will also briefly discuss the methods of anesthesia and ventilation and finally our perspective on the future of rigid bronchoscopy. Expert commentary: Although the rise of flexible bronchoscopy in the 1960s led to a decline in the use of rigid bronchoscopy, the last two decades have witnessed resurgence in its popularity. We anticipate that it will remain an important tool used by interventional pulmonologists for decades to come. We suggest that interventional pulmonologists must have training and develop expertise in this technique.
Topics: Airway Obstruction; Anesthesia, General; Arrhythmias, Cardiac; Bronchoscopes; Bronchoscopy; Contraindications, Procedure; Dilatation; Equipment Design; Foreign Bodies; Hemoptysis; Humans; Hypoxia; Intubation; Lung Neoplasms; Mouth; Myocardial Ischemia; Spinal Cord Injuries; Stents; Tooth Injuries; Trachea; Vocal Cords
PubMed: 29727208
DOI: 10.1080/17476348.2018.1473037 -
Internal Medicine Journal Feb 2017Transoesophageal endobronchial ultrasound (EBUS) video-bronchoscope insertion provides pulmonologists access to conduct endoscopic fine-needle aspiration (EUS-B-FNA) of... (Observational Study)
Observational Study
BACKGROUND
Transoesophageal endobronchial ultrasound (EBUS) video-bronchoscope insertion provides pulmonologists access to conduct endoscopic fine-needle aspiration (EUS-B-FNA) of mediastinal lymph node (LN) lesions and also assist in lung cancer staging by sampling left adrenal gland (LAG) lesions. Limited literature has described additional diagnostic value whilst maintaining patient safety. To elicit whether combining endoscopic transoesophageal fine-needle aspiration using convex probe bronchoscope (EUS-B-FNA) and EBUS bronchoscopy enhances the diagnostic yield of mediastinal nodal staging in lung cancer, whilst maintaining safety.
METHODS
All eligible patients with paraoesophageal lesions on thoracic computed tomography (CT) underwent pulmonologist-performed EUS-B-FNA at two tertiary centres and were included in this prospective observational cohort study.
RESULTS
EUS-B-FNA sampling was performed at 69 mediastinal LN lesion sites, including 17 sites inaccessible to bronchoscopic sampling. Four LAG lesions were sampled via EUS-B-FNA. There were no complications. EBUS-TBNA was augmented by EUS-B-FNA because of accessibility of sampling lesions otherwise unamenable bronchoscopically, thereby increasing diagnostic utility. Diagnostic sensitivity of EUS-B-FNA for malignancy in mediastinal LN lesions was 88% (51 of 58). For mediastinal LN lesions not amenable to EBUS-TBNA, the sensitivity for diagnosis of malignancy via EUS-B-FNA was 88% (15 of 17). Diagnostic sensitivity of EUS-B-FNA for malignancy in LAG lesions was 50% (2 of 4).
CONCLUSION
EUS-B-FNA is a precise and safe approach in the evaluation and staging of lung cancer when performed by a pulmonologist. It complements and increases the diagnostic utility of EBUS-TBNA by further coverage of mediastinal LN stations and access to LAG lesions.
Topics: Australia; Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Lung Neoplasms; Lymph Nodes; Neoplasm Staging; Prospective Studies; Pulmonologists; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 27860078
DOI: 10.1111/imj.13330 -
Archivos de Bronconeumologia Apr 2008A high percentage of the individuals who consult respiratory medicine specialists are working adults, and these patients often complain that dyspnea on exertion hinders... (Review)
Review
A high percentage of the individuals who consult respiratory medicine specialists are working adults, and these patients often complain that dyspnea on exertion hinders their ability to do their job. In other cases, patients are referred for assessment by those responsible for evaluating disability. Furthermore, diagnosis of a respiratory disease should be accompanied by a therapeutic regimen which, in addition to pharmacotherapy, should include advice on lifestyle, nutrition, and physical exercise and recommendations on the kind of work the patient can undertake. Pulmonologists are therefore heavily involved in the assessment of disability in patients with respiratory diseases. The aim of this review is to offer respiratory specialists a broad view of the medical and legal procedures used to evaluate functional impairment caused by respiratory disease, and suggest how they can make recommendations to these patients concerning the appropriate working conditions for the prevention and treatment of their disease.
Topics: Decision Trees; Disability Evaluation; Disabled Persons; Humans; Physician's Role; Pulmonary Medicine; Respiration Disorders
PubMed: 18423182
DOI: No ID Found -
MMW Fortschritte Der Medizin Aug 2018
Review
Topics: Asthma; Cross-Sectional Studies; Exercise Therapy; Humans; Pulmonary Disease, Chronic Obstructive; Pulmonologists; Smoking Cessation; Surveys and Questionnaires
PubMed: 30105689
DOI: 10.1007/s15006-018-0827-z -
Journal of Bronchology & Interventional... Apr 2017Transesophageal introduction of the endobronchial ultrasound (EBUS) videobronchoscope allows pulmonologists to perform endoscopic ultrasound fine-needle aspiration... (Observational Study)
Observational Study
BACKGROUND
Transesophageal introduction of the endobronchial ultrasound (EBUS) videobronchoscope allows pulmonologists to perform endoscopic ultrasound fine-needle aspiration (EUS-B-FNA) of mediastinal lesions. Safety, diagnostic accuracy, and feasibility of EUS-B-FNA in evaluation of pulmonary parenchymal lesions are not established.
METHODS
All patients undergoing pulmonologist-performed EUS-B-FNA of parenchymal lung lesions at 2 tertiary centers were included in this prospective observational cohort study.
RESULTS
EUS-B-FNA sampling of parenchymal lesions was performed in 27 patients. Mean (±SD) lesion size was 36±16 mm. Seven lesions were ≤18 mm. Pneumothorax occurred in 1 patient (3.7%, 95% confidence interval, 0.001%-19%). Ten target lesions (36%) were in locations inaccessible to bronchoscopic sampling via the airways, and 9 lesions were inaccessible to EBUS-guided transbronchial needle aspiration and in locations associated with low diagnostic yield from radial EBUS. EUS-B-FNA was diagnostic in 26 patients (96%), and sensitivity of EUS-B-FNA was 100% (95% confidence interval, 87%-100%) for both lung cancer (n=21) and for pulmonary metastatic lesions (n=5).
CONCLUSIONS
Pulmonologist-performed EUS-B-FNA is safe and accurate in the evaluation parenchymal lung lesions. Diagnostic accuracy is high. EUS-B-FNA may achieve access to sites not amenable to other forms of bronchoscopic sampling, or increase diagnostic accuracy in patients where anatomic position predicts a low diagnostic yield.
Topics: Adenocarcinoma; Bronchoscopes; Carcinoma, Non-Small-Cell Lung; Carcinoma, Squamous Cell; Cohort Studies; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Esophagoscopy; Humans; Lung Neoplasms; Pneumothorax; Postoperative Complications; Prospective Studies; Pulmonologists; Sensitivity and Specificity; Small Cell Lung Carcinoma; Tomography, X-Ray Computed
PubMed: 28005836
DOI: 10.1097/LBR.0000000000000350 -
Current Opinion in Anaesthesiology Feb 2017As the field of interventional pulmonology continues to expand and develop at a rapid pace, anesthesiologists are increasingly called upon to provide well tolerated... (Review)
Review
PURPOSE OF REVIEW
As the field of interventional pulmonology continues to expand and develop at a rapid pace, anesthesiologists are increasingly called upon to provide well tolerated anesthetic care during these procedures. These patients may not be candidates for surgical treatment and often have multiple comorbidities. It is important for anesthesiologists to familiarize themselves with these procedures and their associated risks and complications.
RECENT FINDINGS
The scope of the interventional pulmonologist's practice is varied and includes both diagnostic and therapeutic procedures. Bronchial thermoplasty is now offered as endoscopic treatment of severe asthma. Endobronchial lung volume reduction procedures are currently undergoing clinical trials and may become more commonplace. Interventional pulmonologists are performing medical thoracoscopy for the treatment and diagnosis of pleural disorders. Interventional radiologists are performing complex pulmonary procedures, often requiring anesthesia.
SUMMARY
The review summarizes the procedures now commonly performed by interventional pulmonologists and interventional radiologists. It discusses the anesthetic considerations for and common complications of these procedures to prepare anesthesiologists to safely care for these patients. Investigational techniques are also described.
Topics: Humans; Lung Diseases; Pulmonary Medicine; Pulmonary Surgical Procedures; Radiography, Interventional; Thoracoscopy
PubMed: 27783022
DOI: 10.1097/ACO.0000000000000414 -
Archivos de Bronconeumologia Apr 2018
Topics: Advisory Committees; Carcinoma, Non-Small-Cell Lung; Clinical Decision-Making; Combined Modality Therapy; Humans; Interdisciplinary Communication; Lung Neoplasms; Palliative Care; Patient Care Team; Physician-Patient Relations; Precision Medicine; Pulmonary Medicine; Pulmonologists
PubMed: 28838745
DOI: 10.1016/j.arbres.2017.07.007 -
The Israel Medical Association Journal... Jan 2024
Topics: Humans; Child; Pulmonologists; Asthma
PubMed: 38420634
DOI: No ID Found -
The Lancet. Respiratory Medicine Apr 2021
Topics: COVID-19; Critical Care; Humans; Infectious Disease Transmission, Patient-to-Professional; Intensive Care Units; Leadership; Patient Care Team; Peer Group; Pulmonologists; Work-Life Balance; Workload
PubMed: 33581082
DOI: 10.1016/S2213-2600(21)00039-4 -
Panminerva Medica Sep 2019In clinical practice, interventional pulmonologists face several situations which can lead to dramatic consequences especially regarding ventilation and require... (Review)
Review
In clinical practice, interventional pulmonologists face several situations which can lead to dramatic consequences especially regarding ventilation and require immediate intervention. We describe the main pathological conditions where an urgent bronchoscopy is crucial because they act through mechanisms such as airway obstructions or alteration of the anatomic integrity of the tracheobronchial tree. We point out the problems resulting from inhalation of foreign bodies, one of the most dramatic respiratory emergencies typical in childhood which needs not only the appropriate endoscopic equipment suitable for the age, but also great experience in the management of the possible related complications. Massive hemoptysis is then discussed in order to help to choose the right endoscope and to clarify the steps requested to face this dramatic event. Lastly, iatrogenic tracheal injuries are described, in spite of their low occurrence. The correct endoscopic assessment of the lesions enables to select the proper multidisciplinary therapeutic approach together with surgeons and anesthetists. Due to their peculiarities, emergencies do not allow classic training so it is difficult to estimate the procedure volume necessary to achieve an adequate endoscopic experience. We think, in this field, it is advisable to refer to numbers proposed for elections endoscopic procedures. For these reasons, we consider desirable the use of simulators and clinic case discussions during interventional pulmonologist's training.
Topics: Bronchoscopes; Bronchoscopy; Clinical Competence; Emergencies; Emergency Medicine; Endoscopy; Foreign Bodies; Foreign-Body Reaction; Hemoptysis; Humans; Inhalation; Pulmonary Medicine; Treatment Outcome
PubMed: 30303356
DOI: 10.23736/S0031-0808.18.03543-7