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Respiratory Care Jun 2014Fiberoptic intubation (FOI) is an effective technique for establishing airway access in patients with both anticipated and unanticipated difficult airways. First... (Review)
Review
Fiberoptic intubation (FOI) is an effective technique for establishing airway access in patients with both anticipated and unanticipated difficult airways. First described in the late 1960s, this approach can facilitate airway management in a variety of clinical scenarios given proper patient preparation and technique. This paper seeks to review the pertinent technology, clinical techniques, and indications for and complications of its use. The role of FOI in airway management algorithms is discussed. Evidence is presented comparing FOI to other techniques with regard to difficult airway management. In addition, we have reviewed the literature on training processes and skill development in FOI.
Topics: Anesthesia; Bronchoscopes; Equipment Design; Fiber Optic Technology; Humans; Intubation, Intratracheal; Laryngoscopes; Patient Positioning; Patient Safety; Patient Simulation; Risk Factors
PubMed: 24891196
DOI: 10.4187/respcare.03012 -
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 -
IEEE Transactions on Bio-medical... Mar 2019Bronchoscopy enables many minimally invasive chest procedures for diseases such as lung cancer and asthma. Guided by the bronchoscope's video stream, a physician can...
Bronchoscopy enables many minimally invasive chest procedures for diseases such as lung cancer and asthma. Guided by the bronchoscope's video stream, a physician can navigate the complex three-dimensional (3-D) airway tree to collect tissue samples or administer a disease treatment. Unfortunately, physicians currently discard procedural video because of the overwhelming amount of data generated. Hence, they must rely on memory and anecdotal snapshots to document a procedure. We propose a robust automatic method for summarizing an endobronchial video stream. Inspired by the multimedia concept of the video summary and by research in other endoscopy domains, our method consists of three main steps: 1) shot segmentation, 2) motion analysis, and 3) keyframe selection. Overall, the method derives a true hierarchical decomposition, consisting of a shot set and constituent keyframe set, for a given procedural video. No other method to our knowledge gives such a structured summary for the raw, unscripted, unedited videos arising in endoscopy. Results show that our method more efficiently covers the observed endobronchial regions than other keyframe-selection approaches and is robust to parameter variations. Over a wide range of video sequences, our method required on average only 6.5% of available video frames to achieve a video coverage = 92.7%. We also demonstrate how the derived video summary facilitates direct fusion with a patient's 3-D chest computed-tomography scan in a system under development, thereby enabling efficient video browsing and retrieval through the complex airway tree.
Topics: Algorithms; Bronchoscopy; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Lung; Lung Neoplasms; Phantoms, Imaging; Tomography, X-Ray Computed; Video Recording
PubMed: 30047870
DOI: 10.1109/TBME.2018.2859322 -
Informatics in Medicine Unlocked 2021The staging of the central-chest lymph nodes is a major step in the management of lung-cancer patients. For this purpose, the physician uses a device that integrates...
The staging of the central-chest lymph nodes is a major step in the management of lung-cancer patients. For this purpose, the physician uses a device that integrates videobronchoscopy and an endobronchial ultrasound (EBUS) probe. To biopsy a lymph node, the physician first uses videobronchoscopy to navigate through the airways and then invokes EBUS to localize and biopsy the node. Unfortunately, this process proves difficult for many physicians, with the choice of biopsy site found by trial and error. We present a complete image-guided EBUS bronchoscopy system tailored to lymph-node staging. The system accepts a patient's 3D chest CT scan, an optional PET scan, and the EBUS bronchoscope's video sources as inputs. System workflow follows two phases: (1) procedure planning and (2) image-guided EBUS bronchoscopy. Procedure planning derives airway guidance routes that facilitate optimal EBUS scanning and nodal biopsy. During the live procedure, the system's graphical display suggests a series of device maneuvers to perform and provides multimodal visual cues for locating suitable biopsy sites. To this end, the system exploits data fusion to drive a multimodal virtual bronchoscope and other visualization tools that lead the physician through the process of device navigation and localization. A retrospective lung-cancer patient study and follow-on prospective patient study, performed within the standard clinical workflow, demonstrate the system's feasibility and functionality. For the prospective study, 60/60 selected lymph nodes (100%) were correctly localized using the system, and 30/33 biopsied nodes (91%) gave adequate tissue samples. Also, the mean procedure time including all user interactions was 6 min 43 s All of these measures improve upon benchmarks reported for other state-of-the-art systems and current practice. Overall, the system enabled safe, efficient EBUS-based localization and biopsy of lymph nodes.
PubMed: 34532565
DOI: 10.1016/j.imu.2021.100665 -
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 -
Advances in Therapy Nov 2020The coronavirus disease (COVID-19) pandemic has highlighted the importance of reducing occupational exposure to severe acute respiratory syndrome coronavirus 2... (Review)
Review
The coronavirus disease (COVID-19) pandemic has highlighted the importance of reducing occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The reprocessing procedure for reusable flexible bronchoscopes (RFBs) involves multiple episodes of handling of equipment that has been used during an aerosol-generating procedure and thus is a potential source of transmission. Single-use flexible bronchoscopes (SUFBs) eliminate this source. Additionally, RFBs pose a risk of nosocomial infection transmission between patients with the identification of human proteins, deoxyribonucleic acid (DNA) and pathogenic organisms on fully reprocessed bronchoscopes despite full adherence to the guidelines. Bronchoscopy units have been hugely impacted by the pandemic with restructuring of pre- and post-operative areas, altered patient protocols and the reassessment of air exchange and cleaning procedures. SUFBs can be incorporated into these protocols as a means of improving occupational safety. Most studies on the efficacy of SUFBs have occurred in an anaesthetic setting so it remains to be seen whether they will perform to an acceptable standard in complex respiratory procedures such as transbronchial biopsies and cryotherapy. Here, we outline their potential uses in a respiratory setting, both during and after the current pandemic.
Topics: Betacoronavirus; Bronchoscopes; Bronchoscopy; COVID-19; Coronavirus Infections; Disposable Equipment; Equipment Contamination; Humans; Microbiological Techniques; Pandemics; Pneumonia, Viral; SARS-CoV-2
PubMed: 32944885
DOI: 10.1007/s12325-020-01495-8 -
Journal of Thoracic Disease Dec 2020Flexible bronchoscopes are being continuously improved, and an ultrathin bronchoscope with a working channel that allows the use of a radial-type endobronchial... (Review)
Review
Flexible bronchoscopes are being continuously improved, and an ultrathin bronchoscope with a working channel that allows the use of a radial-type endobronchial ultrasound (EBUS) probe is now available. The ultrathin bronchoscope has good maneuverability for passing through the small bronchi and good accessibility to peripheral lung lesions. This utility is particularly enhanced when it is used with other imaging devices, such as EBUS and navigation devices. Multimodality bronchoscopy using an ultrathin bronchoscope leads to enhanced diagnostic yield.
PubMed: 33447460
DOI: 10.21037/jtd-2020-abpd-001 -
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 -
Pneumologie (Stuttgart, Germany) Dec 2016
Topics: Bronchoscopes; Cross Infection; Disease Outbreaks; Equipment Contamination; Germany; Humans; Incidence; Lubricants; Pseudomonas Infections; Pseudomonas aeruginosa
PubMed: 27931073
DOI: 10.1055/s-0036-1596079 -
Italian Journal of Pediatrics Sep 2022Along with the wide spread application and technical development of the flexible and rigid bronchoscopy, the airway foreign body removing method cme to the specific...
BACKGROUND
Along with the wide spread application and technical development of the flexible and rigid bronchoscopy, the airway foreign body removing method cme to the specific technique for different foreign bodies from the single foreign body forceps.
METHODS
Selected 633 children who were diagnosed as airway foreign bodies by the Department of Respiratory Intervention, Children's Hospital affiliated to Shandong University from January 1st, 2018 to December 31st, 2021, and the airway foreign bodies were diagnosed using bronchoscopy. After comprehensive assessment of the foreign body nature in the airway, the foreign bodies were removed by freezing, laser, electrocoagulation, balloon and other techniques, the success rate of the foreign body removed from the airway was observed, the percentage of the foreign body removed using different techniques, the operation time, and the incidence of post-adverse reactions during operation.
RESULTS
The success rate using flexible bronchoscope alone to remove foreign bodies in the airway was 99.2%. After flexible bronchoscopy, 19 cases of foreign bodies were removed by vacuum suction alone, 513 cases were removed by foreign body forceps alone, 62 cases were combined with cryotherapy, 2 cases were electrocoagulation, 6 cases were mesh baskets, 3 cases were balloons, 5 cases were laser, and various 18 cases of foreign bodies were invloved by technical combination. 5 cases of flexible bronchoscope combined with rigid bronchoscope combined to remove foreign bodies. The operation time was from 5 min to 1 h, with an average of 20 min. There were 17 cases of hypoxemia (2.7%) during operation, 36 cases (5.7%) of bleeding caused by airway mucosa injury after treatment, and 70 cases (11.2%) of laryngeal edema. The total incidence of adverse reactions was 19.6%, there were no deaths due to foreign bodies and treatment.
CONCLUSIONS
According to different properties of airway foreign bodies, it is safe and effective to select appropriate techniques to remove foreign bodies using the flexible bronchoscope, which can increase the removal rate of airway foreign bodies and reduce the occurrence of serious complications.
Topics: Bronchi; Bronchoscopes; Bronchoscopy; Child; Foreign Bodies; Humans; Retrospective Studies; Trachea
PubMed: 36056440
DOI: 10.1186/s13052-022-01347-x