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Respirology Case Reports Dec 2023Plastic bronchitis is characterized by sputum obstructing the bronchus and causing atelectasis. Bronchoscopic removal of the clogged bronchial cast is typically...
Plastic bronchitis is characterized by sputum obstructing the bronchus and causing atelectasis. Bronchoscopic removal of the clogged bronchial cast is typically performed, but small-diameter bronchoscopes with narrow suction ports cannot achieve adequate suction. Suction using a bronchoscope as a guide sheath may be effective for treating plastic bronchitis in children.
PubMed: 38028566
DOI: 10.1002/rcr2.1248 -
British Journal of Anaesthesia Dec 2009Selective collapse of a lung and one-lung ventilation (OLV) is now performed for most thoracic surgical procedures. Modern double-lumen endobronchial tubes and bronchial... (Review)
Review
Selective collapse of a lung and one-lung ventilation (OLV) is now performed for most thoracic surgical procedures. Modern double-lumen endobronchial tubes and bronchial blockers have made lung separation safe and relatively easy to achieve. However, OLV in the patient with a 'difficult airway' can present a challenge to the anaesthesiologist. This review considers the different techniques used to achieve lung separation and their application to the patient with a difficult airway.
Topics: Bronchoscopes; Fiber Optic Technology; Humans; Intubation, Intratracheal; Laryngoscopy; Respiration, Artificial; Thoracic Surgical Procedures
PubMed: 20007992
DOI: 10.1093/bja/aep262 -
Infection Control and Hospital... Aug 2021
Topics: Adenoviridae; Bronchoscopes; Bronchoscopy; Disease Outbreaks; Humans
PubMed: 33827727
DOI: 10.1017/ice.2021.129 -
Proceedings of the American Thoracic... May 2008Lung volume reduction surgery (LVRS) produces physiological, symptomatic, and survival benefits in selected patients with advanced emphysema. Because it is associated... (Review)
Review
Lung volume reduction surgery (LVRS) produces physiological, symptomatic, and survival benefits in selected patients with advanced emphysema. Because it is associated with significant morbidity, mortality, and cost, nonsurgical alternatives for achieving volume reduction have been developed. Three bronchoscopic lung volume reduction (BLVR) approaches have shown promise and reached later-stage clinical trials. These include the following: (1) placement of endobronchial one-way valves designed to promote atelectasis by blocking inspiratory flow; (2) formation of airway bypass tracts using a radiofrequency catheter designed to facilitate emptying of damaged lung regions with long expiratory times; and (3) instillation of biological adhesives designed to collapse and remodel hyperinflated lung. The limited clinical data currently available suggest that all three techniques are reasonably safe. However, efficacy signals have been substantially smaller and less durable than those observed after LVRS. Studies to optimize patient selection, refine treatment strategies, characterize procedural safety, elucidate mechanisms of action, and characterize short- and longer-term effectiveness of these approaches are ongoing. Results will be available over the next few years and will determine whether BLVR represents a safe and effective alternative to LVRS.
Topics: Bronchoscopes; Bronchoscopy; Clinical Trials as Topic; Equipment Design; Humans; Patient Selection; Pneumonectomy; Pulmonary Emphysema; Respiratory Function Tests; Risk Factors
PubMed: 18453355
DOI: 10.1513/pats.200707-085ET -
Tidsskrift For Den Norske Laegeforening... May 2003Bronchoscopic examination is an established method, most often performed by lung doctors, yet still mandatory in the training of specialists in otolaryngology. Little...
BACKGROUND
Bronchoscopic examination is an established method, most often performed by lung doctors, yet still mandatory in the training of specialists in otolaryngology. Little has so far been published on the safety and diagnostic and therapeutic value of this procedure in our country.
MATERIAL AND METHODS
Specialists or residents in otolaryngology performed 140 flexible bronchoscopies in 132 consecutive patients during 1993-2000. Local anaesthesia was used in 132 and general anaesthesia in 8. There were 59 outpatient and 81 inpatient procedures. The medical records were examined retrospectively.
RESULTS
The indication for bronchoscopy was suspected cancer in 98 cases. At the time of the examination 78 patients had intrathoracic malignant disease. Diagnostic sensitivity in bronchogenic cancer (n = 65) was 71%. Diagnostic sensitivity when tumour was endoscopically visible (n = 41) and non-visible (n = 37) was 85 % and 49% respectively. No cancer was found in patients with haemoptysis as the only symptom (n = 11). No serious complications occurred.
INTERPRETATION
Bronchoscopy, including examination for malignant disease was performed safely and with good results. The number of bronchoscopic examinations on non-cancer or classical otolaryngologic patients would probably be too low to maintain the skills and secure good education in our department.
Topics: Adolescent; Adult; Aged; Bronchoscopes; Bronchoscopy; Clinical Competence; Female; Hemoptysis; Humans; Lung Neoplasms; Male; Middle Aged; Norway
PubMed: 12822016
DOI: No ID Found -
PloS One 2023Endotracheal intubation with a flexible bronchoscope is a well-recognized airway management technique that anesthesiologists must master. Skill acquisition and knowledge...
BACKGROUND
Endotracheal intubation with a flexible bronchoscope is a well-recognized airway management technique that anesthesiologists must master. Skill acquisition and knowledge must reach an appropriate level before trainees perform independent practice on patients. There are a paucity of evidence-based outcome measures of trainee competence in performing flexible bronchoscopy. The objectives of this study were to 1) construct a learning curve for flexible bronchoscope-guided orotracheal intubation for anesthesiology residents using the CUSUM method and 2) determine the number of procedures required to achieve proficiency.
METHODS
This study included 12 first-year anesthesiology residents with no previous experience with flexible bronchoscopic intubation. Trainees attended theoretical and simulation training and performed flexible bronchoscope-guided orotracheal intubation in adult patients with normal airways under general anesthesia. Number of intubation attempts, intubation success rate, time to intubation, and incidence of dental and mucosal injuries were recorded. The cumulative sum (CUSUM) method was used to evaluate the learning curve of flexible bronchoscope-guided orotracheal intubation.
RESULTS
Trainees performed flexible bronchoscope-guided orotracheal intubation on 364 patients. First-attempt intubation success occurred in 317 (87.1%) patients. Second-attempt intubation success occurred in 23 (6.3%) patients. Overall, the flexible bronchoscope-guided orotracheal intubation success rate was 93.4% (range, 85.3% to 100%). The mean number of orotracheal intubation procedures per trainee was 31 ± 5 (range, 23 to 40). All trainees crossed the lower decision boundary (H0) after 15.1 ± 5.6 procedures (range, 8 to 25 procedures). There was a significant decrease in median intubation time [39s (IQR: 30, 50) vs. 76s (IQR: 54, 119)] (P < 0.001) after crossing the lower decision boundary (H0) compared to before. There were no dental, mucosa, arytenoid or vocal cord trauma events associated with intubation.
CONCLUSIONS
Learning curves constructed with CUSUM analysis showed that all trainees (anesthesiologist residents) included in this study achieved competence (intubation success rates ≥ 80%) in flexible bronchoscope-guided orotracheal intubation. Trainees needed to perform 15 (range, 8 to 25) procedures to achieve proficiency. There was wide variability between trainees.
TRIAL REGISTRATION
Trial registration: Chinese Clinical Trial Register, ChiCTR 2000032166.
Topics: Adult; Humans; Learning Curve; Bronchoscopy; Bronchoscopes; Anesthesiology; Intubation, Intratracheal; Clinical Competence
PubMed: 37440528
DOI: 10.1371/journal.pone.0288617 -
Performance of a new single-use bronchoscope versus a marketed single-use comparator: a bench study.BMC Pulmonary Medicine May 2022Single-use flexible bronchoscopes eliminate cross contamination from reusable bronchoscopes and are cost-effective in a number of clinical settings. The present bench...
BACKGROUND
Single-use flexible bronchoscopes eliminate cross contamination from reusable bronchoscopes and are cost-effective in a number of clinical settings. The present bench study aimed to compare the performance of a new single-use bronchoscope (Boston Scientific EXALT Model B) to a marketed single-use comparator (Ambu aScope 4), each in slim, regular and large diameters.
METHODS
Three bronchoscopy tasks were performed: water suction and visualization, "mucus" mass (synthetic mucoid mixture) suctioned in 30 s, and "mucus" plug (thicker mucoid mixture) suction. Suction ability, task completion times, and subjective ratings of visualization and overall performance on a scale of one to 10 (best) were compared. All bronchoscopy tasks were completed by 15 physicians representing diversity in specialization including pulmonary, interventional pulmonary, critical care, anesthesia, and thoracic surgery. Each physician utilized the six bronchoscope versions with block randomization by bronchoscope and task.
RESULTS
Aspirated mean mass of "mucus" using EXALT Model B Regular was comparable to that for an aScope 4 Large (41.8 ± 8.3 g vs. 41.5 ± 5.7 g respectively, p = 0.914). In comparisons of scopes with the same outer diameter, the aspirated mean mass by weight of water and "mucus" was significantly greater for EXALT Model B than for aScope 4 (p < 0.001 for all three diameters). Mean ratings for visualization attributes were significantly better for EXALT Model B compared to aScope 4 (p-value range 0.001-0.029).
CONCLUSION
A new single-use bronchoscope provided strong suction capability and visualization compared to same-diameter marketed single-use comparators in a bench model simulation.
Topics: Bronchoscopes; Bronchoscopy; Cost-Benefit Analysis; Humans; Suction; Water
PubMed: 35550062
DOI: 10.1186/s12890-022-01982-4 -
Intensive Care Medicine 1992The development of the flexible, fiberoptic bronchoscope has made bronchoscopic examinations possible in ICU patients undergoing mechanical ventilation. Over the years,... (Review)
Review
The development of the flexible, fiberoptic bronchoscope has made bronchoscopic examinations possible in ICU patients undergoing mechanical ventilation. Over the years, the number of such procedures has greatly increased, with both diagnostic and therapeutic objectives, such as performing difficult intubation, management of atelectasis and hemoptysis, diagnosis of nosocomial pneumonia in ventilated patients, and early detection of airway lesions in selected situations, such as high-frequency ventilation. The complication rate can be kept low if the endoscopist has a precise knowledge of the many pathophysiological and technical facets particular to bronchoscopy under these difficult conditions. This article reviews some of these aspects, in the light of our personal experience.
Topics: Bronchoalveolar Lavage Fluid; Bronchoscopes; Bronchoscopy; Cross Infection; Hemodynamics; Hemoptysis; High-Frequency Jet Ventilation; Humans; Intensive Care Units; Intubation, Intratracheal; Pneumonia; Pulmonary Atelectasis; Pulmonary Circulation; Pulmonary Gas Exchange; Respiration, Artificial; Respiratory Mechanics; Risk Factors
PubMed: 1644964
DOI: 10.1007/BF01709240 -
European Journal of Medical Research Sep 2011For transbronchial biopsy of peripheral pulmonary lesions manouevering the biopsy instrument into acutely angulated subsegmental ostia is frequently problematic. The aim...
OBJECTIVE
For transbronchial biopsy of peripheral pulmonary lesions manouevering the biopsy instrument into acutely angulated subsegmental ostia is frequently problematic. The aim of the present study was to compare the stiffness of various biopsy instruments with regard to their use in the clinical setting. -
METHODS
The maximal anterograde and retrograde bending angles, were measured for various bronchoscopes and biopsy instruments. Measurement was made with the distal tip of the biopsy instrument either flush with the distal end of the bronchoscope, or extending 1.5 cm beyond it. The following scopes and biopsy instruments were investigated: 1. the 6.2 mm outside diameter (OD) bronchoscope, with the 2.4 mm OD forceps, 0.7 mm needle, 2.3 mm catheter, and the 1.9 mm cryoprobe. 2. the 5.1 mm OD bronchoscope, with the 1.8 mm forceps, 0.7 mm needle, and the 1.8 mm catheter. 3. the 3.7 mm bronchoscope, with the 1.0 mm forceps and the 0.8 mm forceps. -
RESULTS
Maximum angulation was greater by 35.4° with the needle extended, vis-a-vis the needle "flush". Both needle and catheter were associated with a greater angulation of up to 20.5° in comparison with the forceps. With an instrument in the working channel the largest anterograde angles were measured for the 5.1 mm bronchoscope, and the largest retrograde angles for the 6.2 mm bronchoscope. -
CONCLUSION
When selecting the optimal instrument for transbronchial biopsy specimen collection, account must be taken of the fact that the degree of angulation will depend on the type and diameter of the instrument employed.
Topics: Biopsy, Needle; Bronchi; Bronchoscopes; Bronchoscopy; Humans; Lung
PubMed: 22024444
DOI: 10.1186/2047-783x-16-9-420 -
Minerva Anestesiologica Apr 2009Difficult airway management and maintenance of oxygenation remain the two most challenging tasks for anesthetists, while also being controversial items in terms of... (Comparative Study)
Comparative Study Review
Difficult airway management and maintenance of oxygenation remain the two most challenging tasks for anesthetists, while also being controversial items in terms of clinically based-evidence to support relevant guidelines in the literature. Nevertheless, different expert groups and scientific societies from several countries have published guidelines dedicated to the management of difficult airways. These documents have been demonstrated to be useful in reducing airway management related critical accidents, despite their limited use in litigations and legal issues. The aim of this review is to compare different airway management guidelines published by the United States, United Kingdom, France, Italy, Germany, and Canada while trying to elucidate the main differences, weaknesses, and strengths for identifying critical concepts in the management of difficult airways.
Topics: Airway Obstruction; Algorithms; Anesthesiology; Bronchoscopes; Canada; Documentation; Europe; Evidence-Based Medicine; Expert Testimony; Fiber Optic Technology; Humans; Laryngoscopy; Practice Guidelines as Topic; Respiration, Artificial; United States
PubMed: 18946426
DOI: No ID Found