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Nigerian Journal of Clinical Practice Apr 2023Flexible bronchoscopy (FB) is a safe and commonly performed procedure in pulmonary medicine. Bronchoscopy literature mainly focusing on technical aspects. However, data...
BACKGROUND
Flexible bronchoscopy (FB) is a safe and commonly performed procedure in pulmonary medicine. Bronchoscopy literature mainly focusing on technical aspects. However, data on patients satisfaction and bronchoscopy is rare.
AIM
To evaluate levels and factors affecting patient satisfaction with flexible bronchoscopy (FB).
SUBJECTS AND METHODS
This prospective study, conducted between June 2017 and May 2019 at King Abdulaziz University Hospital (Jeddah, Saudi Arabia), included all consecutive diagnostic bronchoscopies for adult patients. Patient willingness to return for another bronchoscopy (definitely not, probably not, unsure, probably would, or definitely would) was used as the indicator of satisfaction. Patients ranked their experiences with doctors, nurses, and process of care using a 5-choice scale (poor, fair, good, very good, or excellent).
RESULTS
A total of 351 patients participated in this study. Overall, patients were highly satisfied with their doctors, nurses, and process of care. However, only 34.1% of patients indicated that they would return for another FB if necessary. Predictors of return for FB were younger age (<65 years), university education, use of midazolam and higher doses of fentanyl >100 mcg, and inpatient setting. Logistic regression demonstrated that younger age (P = 0.005) and inpatient setting (P = 0.02) were significantly linked to willingness to return for bronchoscopy.
CONCLUSIONS
Patient satisfaction with bronchoscopy was lower in our study compared to other studies, despite high ratings of doctors' and nurses' skills. Elderly patients and patients with outpatient bronchoscopies were less likely to return and should therefore be approached with extra care. Physicians can improve FB-related patient experiences by decreasing discomfort during bronchoscope insertion and by improving topical anesthesia.
Topics: Adult; Humans; Aged; Patient Satisfaction; Prospective Studies; Bronchoscopy; Midazolam; Fentanyl
PubMed: 37203118
DOI: 10.4103/njcp.njcp_545_20 -
Respirology (Carlton, Vic.) Sep 2020Bronchoscopic sampling of PPL was significantly advanced by the development of the endobronchial ultrasound guide sheath method in the 1990s. Since then, a range of... (Review)
Review
Bronchoscopic sampling of PPL was significantly advanced by the development of the endobronchial ultrasound guide sheath method in the 1990s. Since then, a range of technical and procedural techniques have further advanced diagnostic yields. These include the use of thinner bronchoscopes with better working channel diameters, understanding the importance of peripheral transbronchial needle aspiration, and virtual bronchoscopic assistance. These have enabled better sampling of smaller and more technically challenging lesions including ground-glass nodules. Most recently, robotic bronchoscopy has been developed which, among other refinements, allows fine control of visual bronchoscopic navigation by replacing movements directed by the hand with electronic consoles and trackballs, and innovatively integrate virtual with real bronchoscopic pathways. The requirement for PPL diagnosis and treatment is expected to increase with more chest CT performed as part of CT screening programmes.
Topics: Bronchoscopes; Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Endosonography; Humans; Lung; Lung Neoplasms; Robotic Surgical Procedures; Solitary Pulmonary Nodule
PubMed: 32103596
DOI: 10.1111/resp.13791 -
Tuberkuloz Ve Toraks Jun 2021Oxygen desaturation is a significant event during bronchoscopy. In this study, it was aimed to identify factors related to oxygen desaturation during flexible...
INTRODUCTION
Oxygen desaturation is a significant event during bronchoscopy. In this study, it was aimed to identify factors related to oxygen desaturation during flexible bronchoscopy (FB) and Endobronchial ultrasound (EBUS).
MATERIALS AND METHODS
From 16 April 2019 to 14 February 2020, 196 consecutive patients (146 FB and 50 EBUS) undergoing bronchoscopy were evaluated retrospectively. The patients' oxygen saturations were monitored on admission and during the procedure by finger pulse oximetry. Desaturation was defined as saturation below 90%. Demographic characteristics, comorbidities, types of interventions, vitals before and during the procedure, amount of saturation decline, and sedative agents used were recorded. The data obtained were compared between the desaturated and non-desaturated groups in both FB and EBUS. We evaluated the risk factors for desaturation during bronchoscopic procedures.
RESULT
The mean age of those who underwent FB was higher (62 [52-68] years vs. 55 [44-65] years, p= 0.05), and males were more frequent (54%, vs 19.2%, p<0.001) in the desaturated group. In FB, short lavage was more frequent in the non-desaturated group (28.8% vs. 9.5%, p<0.001). In EBUS, hypertension, diabetes mellitus and thyroid diseases were higher, and duration of procedure was longer (p= 0.02, p= 0.04, p= 0.01 and p<0.001 and p= 0.01, respectively), and SpO2 decline during procedures was higher (11% vs. 1% in FB, 18% vs. 3% in EBUS, p<0.001, each) in the desaturated group.
CONCLUSIONS
This study suggested that baseline SpO2 and SpO2 decline during procedures as well as sex, hypertension, and concomitant endocrine - metabolic diseases, duration of procedure were factors associated with desaturation in patients who had undergone FB and EBUS.
Topics: Age Factors; Aged; Bronchi; Bronchoscopy; Diabetes Mellitus; Humans; Hypertension; Hypoxia; Male; Middle Aged; Oxygen; Sex Factors; Ultrasonography
PubMed: 34256504
DOI: 10.5578/tt.20219803 -
Nature Communications Jan 2024The unequal distribution of medical resources and scarcity of experienced practitioners confine access to bronchoscopy primarily to well-equipped hospitals in developed...
The unequal distribution of medical resources and scarcity of experienced practitioners confine access to bronchoscopy primarily to well-equipped hospitals in developed regions, contributing to the unavailability of bronchoscopic services in underdeveloped areas. Here, we present an artificial intelligence (AI) co-pilot bronchoscope robot that empowers novice doctors to conduct lung examinations as safely and adeptly as experienced colleagues. The system features a user-friendly, plug-and-play catheter, devised for robot-assisted steering, facilitating access to bronchi beyond the fifth generation in average adult patients. Drawing upon historical bronchoscopic videos and expert imitation, our AI-human shared control algorithm enables novice doctors to achieve safe steering in the lung, mitigating misoperations. Both in vitro and in vivo results underscore that our system equips novice doctors with the skills to perform lung examinations as expertly as seasoned practitioners. This study offers innovative strategies to address the pressing issue of medical resource disparities through AI assistance.
Topics: Adult; Humans; Bronchoscopes; Artificial Intelligence; Pilots; Robotics; Bronchoscopy
PubMed: 38172095
DOI: 10.1038/s41467-023-44385-7 -
Respiration; International Review of... 2017The use of simulators in a training programme for technically challenging procedures has the advantages of lowering the risk of patient complications while helping the... (Review)
Review
BACKGROUND
The use of simulators in a training programme for technically challenging procedures has the advantages of lowering the risk of patient complications while helping the trainees with the initial part of their learning curve.
OBJECTIVES
The aim of this study was to perform a systematic review of simulation-based training in flexible bronchoscopy and endobronchial ultrasound (EBUS).
METHODS
We identified 1,006 publications in the PubMed database and included publications on flexible bronchoscopy below the carina and EBUS involving hands-on simulation-based training. Publications were excluded if they were written in languages other than English, if paediatric airways were involved or if they were not journal articles. The screening process was performed by 2 individuals, and a third reviewer made the final decision in case of disagreement.
RESULTS
We included 30 publications. The studies included participants of varying experience and most commonly used a virtual reality simulator as a training modality. Assessment of the participants' skills was based on simulator metrics or on an assessment tool. Some studies included performance on patients for assessment of the operator after training on a simulator.
CONCLUSIONS
Simulation-based training was demonstrated to be more efficient than the traditional apprenticeship model. Physical models and virtual reality simulators complement each other. Simulation-based education should be based on a mastery learning approach and structured as directed self-regulated learning in a distributed training programme.
Topics: Bronchoscopy; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Humans; Simulation Training
PubMed: 28343219
DOI: 10.1159/000464331 -
Annals of the Royal College of Surgeons... Apr 2024Inhalation of foreign bodies represents a potentially fatal emergency in both adults and children. Chest x-ray, in isolation, is neither sensitive nor specific. Rigid...
INTRODUCTION
Inhalation of foreign bodies represents a potentially fatal emergency in both adults and children. Chest x-ray, in isolation, is neither sensitive nor specific. Rigid bronchoscopy represents the gold standard to diagnose and retrieve paediatric foreign bodies. Cases are encountered infrequently, creating anxieties about their management. Little is known about the confidence in, and maintenance of, rigid bronchoscopy skills by ear, nose and throat teams.
METHODS
A 15-question survey was completed by 50 practising otolaryngology consultants in England.
RESULTS
Results show that almost 40% of otolaryngology consultants covering rigid bronchoscopy have not performed bronchoscopy in more than 5 years. Consultants raised concerns about the anaesthetic support and the speed of equipment assembly. Questions on clinical practice showed disparities in practice in the same scenario.
CONCLUSIONS
The authors advocate addressing many of the issues raised by the study with a greater availability of simulation courses and regular scheduled intradepartmental teaching days for all professionals involved. National guidelines on criteria for transfer to tertiary centres would improve the consistency of practice.
Topics: Child; Humans; Infant; Bronchoscopy; Consultants; Surveys and Questionnaires; Foreign Bodies; Otolaryngology; Retrospective Studies
PubMed: 37843132
DOI: 10.1308/rcsann.2023.0067 -
Respiratory Research Sep 2021During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure. To avoid desaturation... (Review)
Review
During flexible fiberoptic bronchoscopy (FOB) the arterial partial pressure of oxygen can drop, increasing the risk for respiratory failure. To avoid desaturation episodes during the procedure several oxygenation strategies have been proposed, including conventional oxygen therapy (COT), high flow nasal cannula (HFNC), continuous positive airway pressure (CPAP) and non-invasive ventilation (NIV). By a review of the current literature, we merely describe the clinical practice of oxygen therapies during FOB. We also conducted a pooled data analysis with respect to oxygenation outcomes, comparing HFNC with COT and NIV, separately. COT showed its benefits in patients undergoing FOB for broncho-alveolar lavage (BAL) or brushing for cytology, in those with peripheral arterial oxyhemoglobin saturation < 93% prior to the procedure or affected by obstructive disorder. HFNC is preferable over COT in patients with mild to moderate acute respiratory failure (ARF) undergoing FOB, by improving oxygen saturation and decreasing the episodes of desaturation. On the opposite, CPAP and NIV guarantee improved oxygenation outcomes as compared to HFNC, and they should be preferred in patients with more severe hypoxemic ARF during FOB.
Topics: Bronchoscopy; Humans; Lung Diseases; Noninvasive Ventilation; Observational Studies as Topic; Oxygen Inhalation Therapy; Oxygen Saturation; Pliability; Randomized Controlled Trials as Topic
PubMed: 34563179
DOI: 10.1186/s12931-021-01846-1 -
Pediatric Pulmonology May 2022To study the clinical characteristics and impact of bronchoscopy in children from developing countries, referred for cardiac surgery, through the "Save a Child's Heart"...
OBJECTIVES
To study the clinical characteristics and impact of bronchoscopy in children from developing countries, referred for cardiac surgery, through the "Save a Child's Heart" (SACH) organization.
METHODS
We performed a retrospective hospital-chart review of SACH children (0-18 years old) referred between 2006 and 2021 who underwent fiberoptic bronchoscopy. We examined demographics, congenital-heart-disease (CHD) types, bronchoscopy's indications and findings, subsequent recommendations, number of ventilation, and intensive-care-unit days. The primary outcome was percent changes in management and diagnosis, following the bronchoscopy. We included a control group matched-for-age and CHD type, who did not undergo bronchoscopy.
RESULTS
We performed 82 bronchoscopies in 68 children: 18 (26.5%) preoperatively; 46 (67.6%) postoperatively; and four (5.9%) both. The most prevalent CHDs were Tetralogy-of-Fallot (27.9%) and ventricular-septal-defect (19.1%). The main indications were persistent atelectasis (41%) and mechanical ventilation/weaning difficulties (27.9%). Bronchoscopic evaluations revealed at least one abnormality in 51/68 (75%) children. The most common findings were external airway compression (23.5%), bronchomalacia (19.1%), and mucus secretions (14.7%). Changes in management were made in 35 (51.4%) cases, with a major change made in 14/35 (40%) children. Compared to the control group, the children undergoing bronchoscopy were both ventilated longer (median 6 vs. 1.5 days, p < 0.0001) and stayed longer in the intensive care unit (median 1.5 vs. 18.5 days, p < 0.0001).
CONCLUSION
A bronchoscopy is an important tool in the diagnosis and management of the unique group of children from developing countries with CHD referred for cardiac surgery. The results of our study, reveal a more complicated clinical course in children requiring bronchoscopy compared to controls.
Topics: Adolescent; Bronchoscopy; Child; Child, Preschool; Developing Countries; Heart Defects, Congenital; Humans; Infant; Infant, Newborn; Pulmonary Atelectasis; Retrospective Studies
PubMed: 35212183
DOI: 10.1002/ppul.25869 -
Diagnosis and outcome of acute respiratory failure in immunocompromised patients after bronchoscopy.The European Respiratory Journal Jul 2019We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an... (Observational Study)
Observational Study
OBJECTIVE
We wished to explore the use, diagnostic capability and outcomes of bronchoscopy added to noninvasive testing in immunocompromised patients. In this setting, an inability to identify the cause of acute hypoxaemic respiratory failure is associated with worse outcome. Every effort should be made to obtain a diagnosis, either with noninvasive testing alone or combined with bronchoscopy. However, our understanding of the risks and benefits of bronchoscopy remains uncertain.
PATIENTS AND METHODS
This was a pre-planned secondary analysis of Efraim, a prospective, multinational, observational study of 1611 immunocompromised patients with acute respiratory failure admitted to the intensive care unit (ICU). We compared patients with noninvasive testing only to those who had also received bronchoscopy by bivariate analysis and after propensity score matching.
RESULTS
Bronchoscopy was performed in 618 (39%) patients who were more likely to have haematological malignancy and a higher severity of illness score. Bronchoscopy alone achieved a diagnosis in 165 patients (27% adjusted diagnostic yield). Bronchoscopy resulted in a management change in 236 patients (38% therapeutic yield). Bronchoscopy was associated with worsening of respiratory status in 69 (11%) patients. Bronchoscopy was associated with higher ICU (40% 28%; p<0.0001) and hospital mortality (49% 41%; p=0.003). The overall rate of undiagnosed causes was 13%. After propensity score matching, bronchoscopy remained associated with increased risk of hospital mortality (OR 1.41, 95% CI 1.08-1.81).
CONCLUSIONS
Bronchoscopy was associated with improved diagnosis and changes in management, but also increased hospital mortality. Balancing risk and benefit in individualised cases should be investigated further.
Topics: Aged; Bronchoscopy; Female; Hematologic Neoplasms; Hospital Mortality; Humans; Immunocompromised Host; Intensive Care Units; Logistic Models; Male; Middle Aged; Noninvasive Ventilation; Prospective Studies; Respiratory Insufficiency
PubMed: 31109985
DOI: 10.1183/13993003.02442-2018 -
BMC Pulmonary Medicine Jul 2021Partnership between anesthesia providers and proceduralists is essential to ensure patient safety and optimize outcomes. A renewed importance of this axiom has emerged...
Partnership between anesthesia providers and proceduralists is essential to ensure patient safety and optimize outcomes. A renewed importance of this axiom has emerged in advanced bronchoscopy and interventional pulmonology. While anesthesia-induced atelectasis is common, it is not typically clinically significant. Advanced guided bronchoscopic biopsy is an exception in which anesthesia protocols substantially impact outcomes. Procedure success depends on careful ventilation to avoid excessive motion, reduce distortion causing computed tomography (CT)-to-body-divergence, stabilize dependent areas, and optimize breath-hold maneuvers to prevent atelectasis. Herein are anesthesia recommendations during guided bronchoscopy. An FiO of 0.6 to 0.8 is recommended for pre-oxygenation, maintained at the lowest tolerable level for the entire the procedure. Expeditious intubation (not rapid-sequence) with a larger endotracheal tube and non-depolarizing muscle relaxants are preferred. Positive end-expiratory pressure (PEEP) of up to 10-12 cm HO and increased tidal volumes help to maintain optimal lung inflation, if tolerated by the patient as determined during recruitment. A breath-hold is required to reduce motion artifact during intraprocedural imaging (e.g., cone-beam CT, digital tomosynthesis), timed at the end of a normal tidal breath (peak inspiration) and held until pressures equilibrate and the imaging cycle is complete. Use of the adjustable pressure-limiting valve is critical to maintain the desired PEEP and reduce movement during breath-hold maneuvers. These measures will reduce atelectasis and CT-to-body divergence, minimize motion artifact, and provide clearer, more accurate images during guided bronchoscopy. Following these recommendations will facilitate a successful lung biopsy, potentially accelerating the time to treatment by avoiding additional biopsies. Application of these methods should be at the discretion of the anesthesiologist and the proceduralist; best medical judgement should be used in all cases to ensure the safety of the patient.
Topics: Anesthesia, General; Breath Holding; Bronchoscopy; Humans; Intraoperative Complications; Lung; Positive-Pressure Respiration; Pulmonary Atelectasis; Tomography, X-Ray Computed
PubMed: 34273966
DOI: 10.1186/s12890-021-01584-6