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F1000Research 2020Clinical airway management continues to advance at a fast pace. To help update busy anesthesiologists, this abbreviated review summarizes notable airway management... (Review)
Review
Clinical airway management continues to advance at a fast pace. To help update busy anesthesiologists, this abbreviated review summarizes notable airway management advances over the past few years. We briefly discuss advances in video laryngoscopy, in flexible intubation scopes, in jet ventilation, and in extracorporeal membrane oxygenation (ECMO). We also discuss noninvasive ventilation in the forms of high-flow nasal cannula apneic oxygenation and ventilation and nasal continuous positive airway pressure (CPAP) masks. Emerging concepts related to airway management, including the physiologically difficult airway and lower airway management, new clinical subspecialties and related professional organizations such as Anesthesia for Bronchoscopy, the Society for Head and Neck Anesthesia, and fellowship training programs related to advanced airway management are also reviewed. Finally, we discuss the use of checklists and guidelines to enhance patient safety and the value of large databases in airway management research.
Topics: Airway Management; Bronchoscopy; Cannula; Humans; Respiration, Artificial
PubMed: 32489647
DOI: 10.12688/f1000research.21914.1 -
American Family Physician Feb 2022Hemoptysis is the expectoration of blood from the lower respiratory tract, usually from bronchial arteries. The most common causes are acute respiratory infections,...
Hemoptysis is the expectoration of blood from the lower respiratory tract, usually from bronchial arteries. The most common causes are acute respiratory infections, cancer, bronchiectasis, and chronic obstructive pulmonary disease. No cause is identified in 20% to 50% of cases. Hemoptysis must be differentiated from pseudohemoptysis, which is blood that originates from nasopharyngeal or gastrointestinal sources. The initial evaluation includes determining the severity of bleeding and stability of the patient and may require bronchoscopy for airway protection. Mild hemoptysis comprises more than 90% of cases and has a good prognosis, whereas massive hemoptysis has a high mortality rate. A history and physical examination can assist in identifying an etiology, but diagnostic testing is often required. Chest radiography is a good initial test, but it has limited sensitivity for determining the site and etiology of the bleeding. Computed tomography and computed tomography angiography of the chest with intravenous contrast are the preferred modalities to determine the etiology of bleeding; however, bronchoscopy may also be needed. In addition to supportive medical treatment, management should include treatment of the underlying etiology because recurrence often takes place in the absence of treatment of the identified cause. Bronchial arterial embolization is used to treat massive hemoptysis, particularly when an involved artery is noted on computed tomography angiography. Surgery is reserved for patients whose medical treatment and embolization are not effective.
Topics: Angiography; Bronchial Arteries; Bronchoscopy; Embolization, Therapeutic; Hemoptysis; Humans
PubMed: 35166503
DOI: No ID Found -
Respirology (Carlton, Vic.) Oct 2022
Topics: Bronchoscopy; COVID-19; Humans; SARS-CoV-2
PubMed: 35971646
DOI: 10.1111/resp.14348 -
Respiration; International Review of... 2020With the advent of lung cancer screening, and the increasingly frequent use of computed tomography (CT) scanning for investigating non-pulmonary pathology (for example... (Review)
Review
With the advent of lung cancer screening, and the increasingly frequent use of computed tomography (CT) scanning for investigating non-pulmonary pathology (for example CT coronary angiogram), the number of pulmonary nodules requiring further investigation has risen significantly. Most of these nodules are found in the lung periphery, which presents challenges to biopsy, and many centers rely on trans-thoracic needle biopsy performed under image guidance by radiologists. However, the desire to minimize complications is driving the development of increasingly accurate navigation bronchoscopy platforms, something that will be crucial in the new era of bronchoscopic therapeutics for lung cancer. This review describes these platforms, summarizes the current evidence for their use, and takes a look at future developments.
Topics: Bronchoscopy; Humans; Image-Guided Biopsy; Lung; Lung Neoplasms; Solitary Pulmonary Nodule; Surgery, Computer-Assisted; Surgical Navigation Systems; Tomography, X-Ray Computed
PubMed: 31600761
DOI: 10.1159/000503329 -
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 -
Respirology (Carlton, Vic.) Jan 2021
Topics: Bronchoscopy; Humans; Lung; Radiography
PubMed: 33202481
DOI: 10.1111/resp.13974 -
The European Respiratory Journal Nov 2022In patients with interstitial lung diseases (ILD), histopathological input is often required to obtain a diagnosis. Surgical lung biopsy (SLB) is considered the...
BACKGROUND
In patients with interstitial lung diseases (ILD), histopathological input is often required to obtain a diagnosis. Surgical lung biopsy (SLB) is considered the reference standard, but many patients are clinically unfit to undergo this invasive procedure, and adverse events, length of hospitalisation and costs are considerable. This European Respiratory Society (ERS) guideline provides evidence-based clinical practice recommendations for the role of transbronchial lung cryobiopsy (TBLC) in obtaining tissue-based diagnosis in patients with undiagnosed ILD.
METHODS
The ERS Task Force consisted of clinical experts in the field of ILD and/or TBLC and methodological experts. Four PICO (Patient, Intervention, Comparator, Outcomes) questions and two narrative questions were formulated. Systematic literature searches were performed in MEDLINE and Embase (up to June 2021). GRADE (Grading, Recommendation, Assessment, Development and Evaluation) methodology was applied.
RESULTS
In patients with undiagnosed ILD and an indication to obtain histopathological data: 1) TBLC is suggested as a replacement test in patients considered eligible to undergo SLB, 2) TBLC is suggested in patients not considered eligible to undergo SLB, 3) SLB is suggested as an add-on test in patients with a non-informative TBLC, 4) no recommendation is made for or against a second TBLC in patients with a non-informative TBLC and 5) TBLC operators should undergo training, but no recommendation is made for the type of training required.
CONCLUSIONS
TBLC provides important diagnostic information in patients with undiagnosed ILD. Diagnostic yield is lower compared to SLB, at reduced serious adverse events and length of hospitalisation. Certainty of the evidence is mostly "very low".
Topics: Humans; Biopsy; Bronchoscopy; Cryosurgery; Lung; Lung Diseases, Interstitial
PubMed: 35710261
DOI: 10.1183/13993003.00425-2022 -
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 -
Ugeskrift For Laeger Apr 2024Bronchoscopy has a low risk of complications when diagnosing peripheral lung lesions suspected of malignancy, however the procedures do not always determine a diagnosis.... (Review)
Review
Bronchoscopy has a low risk of complications when diagnosing peripheral lung lesions suspected of malignancy, however the procedures do not always determine a diagnosis. Several modalities have been invented to improve the diagnostic yield, including radial endobronchial ultrasound and electromagnetic navigation, which are currently used by several departments in Denmark. Augmented fluoroscopy, CT-guided bronchoscopy and robotic bronchoscopy are not yet available in Denmark, but may improve the diagnostic work-up, as argued in this review.
Topics: Humans; Lung Neoplasms; Bronchoscopy; Fluoroscopy; Endosonography; Lung
PubMed: 38606703
DOI: 10.61409/V09230596 -
Therapeutic Advances in Respiratory... 2023Bronchopleural fistula is a potentially fatal disease most often caused after pneumonectomy. Concomitant problems such as pulmonary infection and respiratory failure are... (Review)
Review
Bronchopleural fistula is a potentially fatal disease most often caused after pneumonectomy. Concomitant problems such as pulmonary infection and respiratory failure are typically the main contributors to patient mortality because of the improper contact between the bronchial and pleural cavity. Therefore, bronchopleural fistulas need immediate treatment, which requires the accurate location and timely closure of the fistula. Currently, bronchoscopic interventions, because of their flexibility and versatility, are reliable alternative therapies in patients for whom surgical intervention is unsuitable. Possible interventions include bronchoscopic placement of blocking agents, atrial septal defect (ASD)/ventricular septal defect (VSD) occluders, airway stents, endobronchial valves (EBVs) and endobronchial Watanabe spigots (EWSs). Recent developments in mesenchymal stem cells (MSCs) transplantation technology and three-dimensional (3D) printed stents have also contributed to the treatment of bronchopleural fistula, but more research is needed to investigate the long-term benefits. This review focuses on the effectiveness of various bronchoscopic measures for the treatment of bronchopleural fistula and the directions for future development.
Topics: Humans; Bronchoscopy; Postoperative Complications; Pleural Diseases; Bronchial Fistula; Pneumonia; Pneumonectomy
PubMed: 37067054
DOI: 10.1177/17534666231164541