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BMC Pulmonary Medicine Apr 2022Bronchoscopy is critical in the treatment of patients with coronavirus disease (COVID-19), and its use is associated with the challenges of stringent sterilization and...
BACKGROUND
Bronchoscopy is critical in the treatment of patients with coronavirus disease (COVID-19), and its use is associated with the challenges of stringent sterilization and virus transmission risk. We developed a disposable and portable bronchoscope (YunSendo-R) and compared its safety and function with those of current reusable and single-use bronchoscopes using an animal model.
METHODS
We compared the YunSendo-R system with a commercially available reusable bronchoscope (Olympus, BF-H290) and single-use bronchoscope (Ambu, Ambu® aScope3™). Eight physicians used the three types of bronchoscopes to operate on Guangxi Bama mini pigs. Each operator performed bronchoscopy and completed a 10-point Likert scale questionnaire for evaluating visual ability and manoeuvrability. Operation time and scores were collected.
RESULTS
Operation time had no significant differences among the three bronchoscopes. In visual ability, the YunSendo-R bronchoscope showed superior performance to the Ambu bronchoscope in image clarity, colour contrast, and illumination (P < 0.05) and no significant difference in performance compared with the Olympus bronchoscope (P > 0.05). The YunSendo-R bronchoscope had similar manoeuvrability to the Olympus bronchoscope and better scope tip flexibility than the Ambu bronchoscope (P > 0.05). No relevant complications were reported.
CONCLUSION
We have developed a new bronchoscopy system with the advantages of disposability and portability, which was effective and safe in an animal model. It has better visual ability than the Ambu bronchoscope and similar visual ability and manoeuvrability to the Olympus bronchoscope. The YunSendo-R bronchoscope is a promising device for clinical practice, especially in reusable-endoscope-transmitted infectious diseases such as COVID-19.
Topics: Animals; Bronchoscopes; Bronchoscopy; COVID-19; China; Humans; Swine; Swine, Miniature
PubMed: 35395795
DOI: 10.1186/s12890-022-01933-z -
Revista Espanola de Quimioterapia :... Apr 2022Patients with a compromised immune system suffer a wide variety of insults. Pulmonary complications remain a major cause of both morbidity and mortality in... (Review)
Review
Patients with a compromised immune system suffer a wide variety of insults. Pulmonary complications remain a major cause of both morbidity and mortality in immunocompromised patients. When such individuals present with radiographic infiltrates, the clinician faces a diagnostic challenge. The differential diagnosis in this setting is broad and includes both infectious and non-infectious conditions. Evaluation of the immunocompromised host with diffuse pulmonary infiltrates can be difficult, frustrating, and time-consuming. This common and serious problem results in significant morbidity and mortality, approaching 90%. Infections are the most common causes of both acute and chronic lung diseases leading to respiratory failure. Non-invasive diagnostic methods for evaluation are often of little value, and an invasive procedure (such as bronchoalveolar lavage, transbronchial biopsy or even open lung biopsy) is therefore performed to obtain a microbiologic and histologic diagnosis. Bronchoscopy allows certain identification of some aetiologies, and often allows the exclusion of infectious agents. Early use of computed tomography scanning is able to demonstrate lesions missed by conventional chest X-ray. However, even when a specific diagnosis is made, it might not impact patient's overall survival and outcomes.
Topics: Bronchoalveolar Lavage; Bronchoscopy; Humans; Immunocompromised Host; Lung Diseases; Pneumonia
PubMed: 35488835
DOI: 10.37201/req/s01.20.2022 -
Scientific Reports Nov 2023Although remimazolam is an ultra-short-acting benzodiazepine with a shorter elimination half-life and faster recovery time than midazolam, studies evaluating its safety... (Randomized Controlled Trial)
Randomized Controlled Trial
Although remimazolam is an ultra-short-acting benzodiazepine with a shorter elimination half-life and faster recovery time than midazolam, studies evaluating its safety and efficacy during bronchoscopy are limited. This study aimed to compare the safety and efficacy of remimazolam with those of midazolam for bronchoscopy. This prospective randomized parallel-group study was conducted at a single institution. The primary outcome was the time from the end of the procedure to full alertness. Other procedural time parameters, satisfaction profiles, and adverse effects were thoroughly evaluated. The time taken to reach peak sedation and the time from the end of the procedure to full alertness was significantly shorter in the remimazolam group than in the midazolam group (median [interquartile range], 2 min [1-4] vs. 3 min [2-5], P = 0.006; and median, 2 min [1-5] vs. 5 min [1-12], P = 0.035, respectively). In patients with non-biopsy procedures (n = 79), participant satisfaction was significantly higher in the remimazolam group than in the midazolam group (median rated scale, 10 vs. 7, P = 0.042). Physician satisfaction and willingness to repeat the procedure were similar between groups. Although the incidence of adverse effects was similar between the groups and there was no significant difference, the midazolam group had a higher antidote administration rate than the remimazolam group (15.7% vs. 4.1%, P = 0.092). Remimazolam is effective and safe for achieving adequate sedation, with a shorter onset time and faster neuropsychiatric recovery than midazolam. It may be a new option for sedation during bronchoscopy.Trial registration: The trial registration number is NCT05994547, and the date of first registration is 16/08/2023.
Topics: Humans; Midazolam; Hypnotics and Sedatives; Bronchoscopy; Prospective Studies; Double-Blind Method; Benzodiazepines; Drug-Related Side Effects and Adverse Reactions
PubMed: 37993525
DOI: 10.1038/s41598-023-47271-w -
Respiratory Care May 2010Diagnostic or therapeutic flexible bronchoscopy is often necessary in severely ill patients. These patients often have comorbidities that increase the risk of... (Review)
Review
Diagnostic or therapeutic flexible bronchoscopy is often necessary in severely ill patients. These patients often have comorbidities that increase the risk of bronchoscopy-related complications. Noninvasive ventilation might decrease the risk of these complications in patients with severe refractory hypoxemia, postoperative respiratory distress, or severe emphysema, and in pediatric patients. Noninvasive ventilation may prevent hypoventilation in patients with obstructive sleep apnea and obesity hypoventilation syndrome who require bronchoscopy, and may assist in the bronchoscopic evaluation of patients with expiratory central-airway collapse. We describe the indications, contraindications, and technique of flexible bronchoscopy during noninvasive ventilation.
Topics: Bronchoscopes; Bronchoscopy; Equipment Design; Humans; Positive-Pressure Respiration; Respiratory Insufficiency
PubMed: 20420731
DOI: No ID Found -
Journal of Bronchology & Interventional... Oct 2022During diagnostic bronchoscopies, conscious sedation improves patient tolerance, but it can contribute to hypercapnia and hypoxia by various mechanisms including...
BACKGROUND
During diagnostic bronchoscopies, conscious sedation improves patient tolerance, but it can contribute to hypercapnia and hypoxia by various mechanisms including depression of ventilatory drive. This prospective study was undertaken to determine the frequency of respiratory events and associated oxygen desaturations during bronchoscopy with conscious sedation.
PATIENTS AND METHODS
The Nox-T3 monitoring system was placed before starting the bronchoscopy and remained in place for 30 minutes following the procedure. The primary endpoint was the occurrence of obstructive and central apneic events during bronchoscopy under conscious sedation.
RESULTS
Obstructive events (apnea and hypopnea) occurred in 100% of patients (n=31), and central apneas occurred in 58% of patients (n=18) during the procedure with a median of 9 and 2 events per patient, respectively. During recovery, a significant proportion of patients had detectable obstructive (86%) and central (36%) events. Higher body mass index was associated with oxygen desaturation to <90% and with the need for escalation of care. Furthermore, a conscious sedation regimen that included propofol was significantly associated with central apneic events.
CONCLUSION
Respiratory events are common during and immediately postprocedure after conscious sedation for bronchoscopy. Most events are obstructive, and the use of propofol predisposes to central apneas during the procedure. Both types of events are associated with a higher body mass index. Oxygen desaturation to <90% triggers escalation of care. A further prospective study will be required to determine the clinical significance of these apneic events and whether alleviating these events will improve the safety and outcomes of bronchoscopic procedures performed under conscious sedation.
Topics: Bronchoscopy; Conscious Sedation; Humans; Incidence; Oxygen; Propofol; Prospective Studies; Sleep Apnea, Central
PubMed: 35275851
DOI: 10.1097/LBR.0000000000000837 -
Revista Portuguesa de Pneumologia 2012We reviewed the most important diagnostic procedures implemented by means of flexible bronchoscopy, including bronchoalveolar lavage, bronchial brushing and biopsy,... (Review)
Review
We reviewed the most important diagnostic procedures implemented by means of flexible bronchoscopy, including bronchoalveolar lavage, bronchial brushing and biopsy, transbronchial lung biopsy and transbronchial needle aspiration. We reviewed the tools, techniques and potential complications of this examination.
Topics: Biopsy; Biopsy, Fine-Needle; Bronchoalveolar Lavage; Bronchoscopes; Bronchoscopy; Equipment Design; Humans
PubMed: 22317896
DOI: 10.1016/j.rppneu.2012.01.003 -
Tuberkuloz Ve Toraks 2011Flexible bronchoscopy is usually performed at a tertiary care facility in a general endoscopy unit or a specially designed bronchoscopy suite. The procedure can also be... (Review)
Review
Flexible bronchoscopy is usually performed at a tertiary care facility in a general endoscopy unit or a specially designed bronchoscopy suite. The procedure can also be performed outside the designated facility if the qualified personnel and required equipment can be mobilized. In this review, we discuss the essentials of a modern bronchoscopy suite based on the available information from the literature.
Topics: Bronchoscopy; Diagnostic Services; Facility Design and Construction; Humans; Lung Diseases
PubMed: 22087526
DOI: 10.5578/tt.2420 -
Tuberkuloz Ve Toraks Mar 2022Early isolation of the fungal pathogen and early initiation of treatment affect mortality and morbidity rates. The purpose of this study was to reveal the frequency of...
INTRODUCTION
Early isolation of the fungal pathogen and early initiation of treatment affect mortality and morbidity rates. The purpose of this study was to reveal the frequency of determination of fungal pathogens in bronchoscopy unit patients.
MATERIALS AND METHODS
The study was designed retrospectively. All patients who underwent bronchoscopy for any reason were enrolled. The patients with suspected fungal infection were divided into three groups after the procedure: 1) Proven fungal infection, 2) Colonization, 3) Without infection.
RESULT
One thousand one hundred and twenty-eight patients were included in the study. Fungal infection was suspected in 188 (16.7%) patients before bronchoscopy. After the examination of the bronchoscopic materials, it was determined that 59 (5.2%) patients had proven fungal infection, 148 (13.1%) patients had colonization, and 921 (81.7%) patients did not have fungal infection. The radiological findings of the patients that were indicative of fungal infection before bronchoscopy were observed as consolidation in 391 (34.7%) and nodule in 413 (36.6%). Fungal growth in bronchoscopic cultures was found in 186 (16.4%) patients, and the most common fungus was Candida albicans (C. albicans) in 110 (9.7%). The treatment was not changed according to the culture results in the patients. No treatment was initiated in the other 108 (98.2%) patients with C. albicans. One hundred and sixty-five (88%) of all fungal growths were detected in the BAL/bronchial lavage fluid. While 29 (45%) of them had not received antifungal treatment before, antifungal treatment was started after bronchoscopy.
CONCLUSIONS
C. albicans was isolated the most among all bacterial and fungal agents in all patient groups that were immunosuppressed or not at a routine bronchoscopy unit. Diagnostic bronchoscopic sampling should be performed at the early stages of clinically or radiologically suspected fungal illness.
Topics: Bronchoalveolar Lavage Fluid; Bronchoscopy; Humans; Immunocompromised Host; Retrospective Studies
PubMed: 35362301
DOI: 10.5578/tt.20229903 -
The Pan African Medical Journal 2017
Topics: Biopsy; Bronchoscopy; Female; Humans; Middle Aged; Sarcoidosis, Pulmonary
PubMed: 28674571
DOI: 10.11604/pamj.2017.26.178.11763 -
Chest Jul 2013Simulation-based bronchoscopy training is increasingly used, but effectiveness remains uncertain. We sought to perform a comprehensive synthesis of published work on... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Simulation-based bronchoscopy training is increasingly used, but effectiveness remains uncertain. We sought to perform a comprehensive synthesis of published work on simulation-based bronchoscopy training.
METHODS
We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011. We included all original studies involving health professionals that evaluated, in comparison with no intervention or an alternative instructional approach, simulation-based training for flexible or rigid bronchoscopy. Study selection and data abstraction were performed independently and in duplicate. We pooled results using random effects meta-analysis.
RESULTS
From an initial pool of 10,903 articles, we identified 17 studies evaluating simulation-based bronchoscopy training. In comparison with no intervention, simulation training was associated with large benefits on skills and behaviors (pooled effect size, 1.21 [95% CI, 0.82-1.60]; n=8 studies) and moderate benefits on time (0.62 [95% CI, 0.12-1.13]; n=7). In comparison with clinical instruction, behaviors with real patients showed nonsignificant effects favoring simulation for time (0.61 [95% CI, -1.47 to 2.69]) and process (0.33 [95% CI, -1.46 to 2.11]) outcomes (n=2 studies each), although variation in training time might account for these differences. Four studies compared alternate simulation-based training approaches. Inductive analysis to inform instructional design suggested that longer or more structured training is more effective, authentic clinical context adds value, and animal models and plastic part-task models may be superior to more costly virtual-reality simulators.
CONCLUSIONS
Simulation-based bronchoscopy training is effective in comparison with no intervention. Comparative effectiveness studies are few.
Topics: Bronchoscopy; Clinical Competence; Computer Simulation; Education, Medical, Continuing; Humans
PubMed: 23370487
DOI: 10.1378/chest.12-1786