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Journal of Thoracic Disease Aug 2021The clinical manifestations of foreign body (FB) aspiration can range from an asymptomatic presentation to a life-threatening emergency. Patients may present with acute... (Review)
Review
The clinical manifestations of foreign body (FB) aspiration can range from an asymptomatic presentation to a life-threatening emergency. Patients may present with acute onset cough, chest pain, breathlessness or sub-acutely with unexplained hemoptysis, non-resolving pneumonia and at times, as an incidental finding on imaging. Patients with iatrogenic FB such as an aspirated broken tooth during difficult intubation or a broken instrument are more common scenarios in the intensive care unit (ICU). Patients with post-obstructive pneumonia with or without sepsis, or variable degree of hemoptysis often require ICU level of care and bronchoscopic interventions. Rigid bronchoscopy has traditionally been the modality of choice; however, with the innovation in instrumentation and wider availability of flexible bronchoscopes, most of the FB removal is now successfully performed using flexible bronchoscopy. Proceduralists choose instruments in accordance with their training and expertise. We describe the use of most common instruments including forceps, balloon catheters, and baskets. Role of cryoprobe and LASER in FB removal is reviewed as well. In general, larger working channel bronchoscopes are preferred; however, smaller working channel bronchoscopes may be used in situations when the patients are intubated with a smaller diameter endotracheal or tracheostomy tubes. Large size FB are removed with the grasping tool, bronchoscope, and endotracheal or tracheostomy tube, requiring preparation to safely re-establish the airway. After FB removal, bronchoscopy is re-performed to identify any residual FB, assess any injury to the airway, suction post-obstructive secretions or pus, control any active bleeding and remove granulation tissue that may be obstructing the airway. Additional interventions like balloon dilatation may be required to dislodge an impacted FB or to maintain patency of bronchial lumen. If bronchoscopic methods fail, surgery may be required for retrieval of FB in symptomatic patients or to resect suppurative or necrotizing lung process. Multidisciplinary approach involving intensivists, surgeons, and anesthesiologists is the key to optimal patient outcomes.
PubMed: 34527356
DOI: 10.21037/jtd.2020.03.94 -
Panminerva Medica Sep 2019Endobronchial ultrasound (EBUS) has revolutionized the field of bronchoscopy because it allows to observe peribronchial structures and distal peripheral lung lesions.... (Review)
Review
Endobronchial ultrasound (EBUS) has revolutionized the field of bronchoscopy because it allows to observe peribronchial structures and distal peripheral lung lesions. The use of EBUS was first described by Hurte and Hanrath in 1992. EBUS technology exists in two forms: radial and convex transducer probes. The radial EBUS probe has a 20-MHZ (12-30 MHz available) rotating transducer that can be inserted together with or without a guide sheath through the working channel (2.0-2.8 mm) of a standard flexible bronchoscope. The transducer rotates and produces a 360-degree circular image around the central position of the probe. There are two types of radial EBUS probes: "peripheral" probes, used to identify parenchymal lung lesions, and "central" probes, with balloon sheaths, used for the assessment of airway walls and peribronchial lymph nodes.
Topics: Artifacts; Bronchoscopes; Bronchoscopy; Clinical Competence; Endosonography; Equipment Design; Humans; Lung Diseases; Lung Neoplasms; Lymph Nodes; Mediastinal Neoplasms; Mediastinum; Pulmonary Medicine; Sensitivity and Specificity; Ultrasonography, Doppler; Virtual Reality
PubMed: 30421897
DOI: 10.23736/S0031-0808.18.03570-X -
Panminerva Medica Sep 2019We describe the current knowledge and skills for the main techniques of operative bronchoscopy and their applications in the treatment of malignant and benign central... (Review)
Review
We describe the current knowledge and skills for the main techniques of operative bronchoscopy and their applications in the treatment of malignant and benign central airway disorders. Rigid bronchoscopy has a history of over 100 years. The use of rigid bronchoscopy was abandoned upon the introduction of the fiberoptic bronchoscope but has made a reappearance with the development of interventional pulmonology in the late nineteenth and early twentieth century. The advantages of rigid bronchoscopy include allowing simultaneous procedures, such as ablation, debulking and suctioning, without limiting ventilation but at the moment there are no standard approaches to perform the procedure. Rigid bronchoscopy also plays a vital role in stent placement, repositioning, maintenance and removal. An interventional pulmonology practice should only be developed when there is a locoregional unmet medical need and when a dedicated interventional pulmonology unit can be guaranteed. These departments should be available 7 days a week and should provide a fast and appropriate response to referrals in emergency cases. There is a clear need to define a competency-based training program for rigid bronchoscopy, including stent placement. An optimal, multimodality training program for bronchoscopy should include didactic lectures, web-based learning, case-based reviews and hands-on training.
Topics: Bronchoscopes; Bronchoscopy; Clinical Competence; Constriction, Pathologic; Fiber Optic Technology; Humans; Lung; Lung Diseases; Pulmonary Medicine; Stents; Trachea
PubMed: 31364332
DOI: 10.23736/S0031-0808.19.03602-4 -
Respiratory Medicine Oct 2009The efficacy and technical aspects of endobronchial ultrasound (EBUS) are reviewed because this technology promises to revolutionise bronchoscopy. EBUS extends the... (Review)
Review
The efficacy and technical aspects of endobronchial ultrasound (EBUS) are reviewed because this technology promises to revolutionise bronchoscopy. EBUS extends the endoscopist's view beyond the mucosal surface of the large airways to peri-bronchial structures and peripheral lung lesions. Guided biopsies and real-time transbronchial needle aspirations (TBNA) have been shown to increase the diagnostic yield over conventional bronchoscopic techniques. The technology is available in two forms: radial EBUS probes and linear EBUS-TBNA bronchoscopes. Radial EBUS utilizes higher frequencies and the transducer is inserted via a standard flexible bronchoscope. The higher ultrasound frequencies improve image resolution to <1mm. Radial EBUS is used to assess airway walls, guide TBNA (diagnostic yield: 72-86%) and diagnose peripheral lung lesions (diagnostic yield: 61-80%). Linear EBUS-TBNA transducers are built into dedicated bronchoscopes to produce sector view images and permit real-time TBNA. The pooled sensitivity of real-time EBUS-TBNA in lung cancer is 90% but the false negative rate is 20%. Therefore, EBUS-TBNA is a viable alternative to cervical mediastinoscopy in the diagnosis and staging of mediastinal lymphadenopathy. However, negative results need either further confirmatory testing or adequate clinical follow-up. Complications are rare with either EBUS modality and are usually related to the underlying biopsy procedure rather than the use of ultrasound. Procedure duration is short enough to be incorporated into an outpatient setting and can performed under moderate sedation. Clear training standards are emerging to facilitate credentialing as EBUS is rapidly evolving to become a part of standard diagnostic bronchoscopy.
Topics: Bronchoscopes; Bronchoscopy; Clinical Competence; Humans; Lung Diseases; Lymph Nodes; Lymphatic Diseases; Ultrasonography, Interventional
PubMed: 19447014
DOI: 10.1016/j.rmed.2009.04.010 -
Panminerva Medica Sep 2019Bronchial thermoplasty (BT) is an innovative non-pharmacological endoscopic treatment for patients with severe persistent asthma based on controlled heat release with a... (Review)
Review
Bronchial thermoplasty (BT) is an innovative non-pharmacological endoscopic treatment for patients with severe persistent asthma based on controlled heat release with a device called Alair™ Catheter (Boston Scientific, Natick, MA, USA). The Alair™ system is the first device that works by delivering radiofrequency or thermal energy to selectively reduce the amount of airway smooth muscle (ASM) in bronchi. Literature showed significant improvement in clinical outcomes such as symptom control, severe exacerbation rate, hospitalization, quality of life, and number of working or school days lost for asthma. Besides smooth muscle effects changes in inflammatory pattern after BT have been documented. Bronchial thermoplasty requires an experienced physician who had a proficiency training in bronchoscopy and had rigor, dexterity and a thorough knowledge of the airway anatomy. Furthermore, right selection of severe asthma patient is crucial in order to have best response after BT. This article reviews BT device description and how to perform the procedure. Criteria for right selection and management of patient before and after BT will be discussed.
Topics: Asthma; Bronchi; Bronchial Thermoplasty; Bronchoscopes; Bronchoscopy; Clinical Competence; Humans; Pulmonary Medicine; Radio Waves
PubMed: 30486619
DOI: 10.23736/S0031-0808.18.03582-6 -
Thorax Dec 2023Traditional electromagnetic navigation bronchoscopy (ENB) is a real-time image-guided system and used with thick bronchoscopes for the diagnosis of peripheral pulmonary...
BACKGROUND
Traditional electromagnetic navigation bronchoscopy (ENB) is a real-time image-guided system and used with thick bronchoscopes for the diagnosis of peripheral pulmonary nodules (PPNs). A novel ENB that could be used with thin bronchoscopes was developed. This study aimed to evaluate the diagnostic yield and the experience of using this ENB system in a real clinical scenario.
METHODS
This multicentre study enrolled consecutive patients with PPNs adopting ENB from March 2019 to August 2021. ENB was performed with different bronchoscopes, ancillary techniques and sampling instruments according to the characteristics of the nodule and the judgement of the operator. The primary endpoint was the diagnostic yield. The secondary endpoints included the diagnostic yield of subgroups, procedural details and complication rate.
RESULTS
In total, 479 patients with 479 nodules were enrolled in this study. The median lesion size was 20.9 (IQR, 15.9-25.9) mm. The overall diagnostic yield was 74.9% (359/479). A thin bronchoscope was used in 96.2% (461/479) nodules. ENB in combination with radial endobronchial ultrasound (rEBUS), a guide sheath (GS) and a thin bronchoscope was the most widely used guided method, producing a diagnostic yield of 74.1% (254/343). The median total procedural time was 1325.0 (IQR, 1014.0-1676.0) s. No severe complications occurred.
CONCLUSION
This novel ENB system can be used in combination with different bronchoscopes, ancillary techniques and sampling instruments with a high diagnostic yield and safety profile for the diagnosis of PPNs, of which the combination of thin bronchoscope, rEBUS and GS was the most common method in clinical practice.
TRIAL REGISTRATION NUMBER
NCT03716284.
Topics: Humans; Bronchoscopy; Solitary Pulmonary Nodule; Prospective Studies; Electromagnetic Phenomena; Lung Neoplasms
PubMed: 37734951
DOI: 10.1136/thorax-2022-219664 -
Polish Journal of Microbiology Sep 2021Bronchoscopes have been linked to outbreaks of nosocomial infections. The phenotypic and genomic profiles of bronchoscope-associated isolates are largely unknown. In...
Bronchoscopes have been linked to outbreaks of nosocomial infections. The phenotypic and genomic profiles of bronchoscope-associated isolates are largely unknown. In this work, a total of 358 isolates and 13 isolates were recovered from samples after clinical procedures and samples after decontamination procedures, respectively, over the five months. Antimicrobial susceptibility testing found seven isolates exhibiting a low-level resistance to antimicrobial agents. Among seven isolates, we found five sequence types (STs) clustered into three main clades. Collectively, this study described for the first time the phenotypic and genomic characteristics of bronchoscope-associated .
Topics: Anti-Bacterial Agents; Bronchoscopes; Drug Resistance, Bacterial; Enterobacter aerogenes; Genome, Bacterial; Genomics
PubMed: 34584536
DOI: 10.33073/pjm-2021-038 -
Minerva Surgery Feb 2023The aim of this study was to investigate the diagnostic value and safety of ultrathin bronchoscope and endobronchial ultrasonography with a guide sheath (EBUS-GS)...
Diagnostic value and safety of ultrathin bronchoscope and endobronchial ultrasonography with a guide sheath combined with rapid on-site evaluation system for peripheral pulmonary infectious diseases.
BACKGROUND
The aim of this study was to investigate the diagnostic value and safety of ultrathin bronchoscope and endobronchial ultrasonography with a guide sheath (EBUS-GS) combined with rapid on-site evaluation (ROSE) system for peripheral pulmonary infectious diseases.
METHODS
The clinical data of 196 patients visiting our hospital, who had peripheral pulmonary lesions (PPLs) indicated by spiral computed tomography (CT) of the chest and were finally diagnosed as infectious PPLs, were retrospectively collected. Then the patients were divided into ultrathin bronchoscope + ROSE group, EBUS-GS + ROSE group and ultrathin bronchoscope + EBUS-GS + ROSE group based on different diagnostic techniques. Moreover, the general conditions, diagnostic results and specific operation parameters of the patients were recorded, and the diagnostic rate, sensitivity and complications were compared.
RESULTS
In ultrathin bronchoscope + EBUS-GS + ROSE group, the time of localizing lesions and operation time were the shortest, and the grade of bronchi reached by the bronchoscope was the highest. The differences were significant between any two groups (P<0.05). Patients with bacterial pneumonia, and patients with pulmonary tuberculosis and nontuberculous mycobacterial disease, ultrathin bronchoscope + EBUS-GS + ROSE group exhibited the highest definite diagnosis rate of bronchoscope and diagnostic sensitivity of ROSE system, with significant differences from those of the other two groups (P<0.05). The incidence rates of complications were low in all groups, and there were no significant differences between any two groups (P>0.05).
CONCLUSIONS
Ultrathin bronchoscope and EBUS-GS combined with ROSE system can prominently decrease the time of localizing lesions and operation time, remarkably improve the diagnostic accuracy and sensitivity and result in fewer complications.
Topics: Humans; Bronchoscopes; Lung Neoplasms; Mycobacterium Infections, Nontuberculous; Retrospective Studies; Rapid On-site Evaluation; Bronchoscopy; Nontuberculous Mycobacteria; Endosonography; Communicable Diseases
PubMed: 35837872
DOI: 10.23736/S2724-5691.22.09597-1 -
Panminerva Medica Sep 2019Bronchoscopic lung volume reduction (BLVR) has been proven to be effective in patients with severe emphysema. These techniques are divided into two groups: non-blocking... (Review)
Review
Bronchoscopic lung volume reduction (BLVR) has been proven to be effective in patients with severe emphysema. These techniques are divided into two groups: non-blocking devices that are independent of collateral ventilation and blocking devices that are dependent on collateral ventilation so the choice of the target lobe with inadequate scissors is crucial for the success of the treatment. Current evidences suggest that not all classes and phenotypes of emphysema will benefit from BLVR, and that each technique appears to provide a greater benefit to specific sub-groups of patients. Careful patient selection is imperative to prevent insertion in patients unlikely to gain clinical benefits as well as wasteful expenditure. The Chartis system represents the gold standard for measuring fissure integrity and is a direct measurement method. Indirect method is instead the TC study which, thanks to the development of software for quantitative analysis, allows us to obtain reliable measurements of regional density of parenchyma, airway thickness and scissor integrity. BLVR is a highly complex procedure: a first-level competence is a pre-requisite for admission to training. The practical training must be based on discussion of clinical cases and the insertion techniques of the different devices on plastic or animal models, or on cadavers. A specific course, offering final certification, has been developed on the use of Zephyr valves.
Topics: Bronchoscopes; Bronchoscopy; Calibration; Clinical Competence; Humans; Lung; Patient Selection; Phenotype; Pneumonectomy; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Pulmonary Medicine
PubMed: 30486616
DOI: 10.23736/S0031-0808.18.03571-1 -
Diagnostics (Basel, Switzerland) Jan 2022Flexible bronchoscopy plays a critical role in both diagnostic and therapeutic management of a variety of pulmonary disorders in the bronchoscopy suite and the intensive... (Review)
Review
Flexible bronchoscopy plays a critical role in both diagnostic and therapeutic management of a variety of pulmonary disorders in the bronchoscopy suite and the intensive care unit. In the set-ting of the ongoing viral pandemic, single-use flexible bronchoscopes (SUFB) have garnered attention as various professional pulmonary societies have released guidelines regarding uses for SUFB given the concern for risk of viral transmission when using reusable flexible bronchoscopes (RFB). In addition to offering sterility, SUFBs are portable, easily accessible, and may be more cost-effective than RFB when considering the potential costs of treating bronchoscopy-related infections. Furthermore, since SUFBs are one time use, they do not require reprocessing after use, and therefore may translate to reduced cleaning and storage costs. Despite these advantages, RFBs are still routinely used to perform advanced diagnostic and therapeutic bronchoscopic procedures given the need for optimal maneuverability, handling, angle of deflection, image quality, and larger channel size for passing of ancillary instruments. Here, we review the published evidence on the applications of single-use and reusable bronchoscopes in bronchoscopy suites and intensive care units. Specifically, we will discuss the advantages and disadvantages of these devices as pertinent to fundamental, advanced, and therapeutic bronchoscopic interventions.
PubMed: 35054345
DOI: 10.3390/diagnostics12010174