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Chest Nov 2018New technology has resulted in bronchoscopy being increasingly used for diagnosing pulmonary lesions. Reported yield from these procedures varies widely with few... (Randomized Controlled Trial)
Randomized Controlled Trial
Standard Bronchoscopy With Fluoroscopy vs Thin Bronchoscopy and Radial Endobronchial Ultrasound for Biopsy of Pulmonary Lesions: A Multicenter, Prospective, Randomized Trial.
BACKGROUND
New technology has resulted in bronchoscopy being increasingly used for diagnosing pulmonary lesions. Reported yield from these procedures varies widely with few randomized clinical trials. This study compares the diagnostic yield of a thin bronchoscope and radial endobronchial ultrasound (R-EBUS) with standard bronchoscopy and fluoroscopy (SB-F) in lung lesions.
METHODS
Patients presenting for diagnostic bronchoscopic evaluation at five centers were randomized to undergo SB-F or R-EBUS with a thin bronchoscope (TB-EBUS). If SB-F was nondiagnostic, crossover to the TB-EBUS arm was allowed. Data on patient demographics, radiographic features, and final pathologic or radiographic follow-up were collected. Statistical comparisons were made by Fisher exact test, χ test, and Student t test. Bivariate and multivariate analyses were performed to determine predictors of diagnostic yield.
RESULTS
One hundred and ninety-seven patients were included in the final analyses. There was no difference in demographics, lesion size, or location between study arms. The average lesion size was 31.2 mm (SD, 10.8 mm). Bronchoscopy was diagnostic in 87 patients (44%). Although the diagnostic yield was higher in the TB-EBUS arm compared with the SB-F arm (49% vs 37%), this difference was not statistically significant (P = .11). Among those with nondiagnostic bronchoscopic findings in the standard arm, 87% (n = 46) crossed over to TB-EBUS, resulting in a diagnosis in seven additional patients (15% of 46).
CONCLUSIONS
Bronchoscopy with or without a thin scope and R-EBUS had a poor diagnostic yield for pulmonary lesions. Future work should focus on improvements in technique and technology advances that ensure a higher likelihood of obtaining a diagnosis.
Topics: Aged; Bronchoscopy; Clinical Decision-Making; Female; Fluoroscopy; Humans; Image-Guided Biopsy; Lung Neoplasms; Male; Middle Aged; Multimodal Imaging; Patient Selection; Reproducibility of Results; Ultrasonography, Interventional
PubMed: 30144421
DOI: 10.1016/j.chest.2018.08.1026 -
Annual Review of Medicine Jan 2024Interventional pulmonary medicine has developed as a subspecialty focused on the management of patients with complex thoracic disease. Leveraging minimally invasive... (Review)
Review
Interventional pulmonary medicine has developed as a subspecialty focused on the management of patients with complex thoracic disease. Leveraging minimally invasive techniques, interventional pulmonologists diagnose and treat pathologies that previously required more invasive options such as surgery. By mitigating procedural risk, interventional pulmonologists have extended the reach of care to a wider pool of vulnerable patients who require therapy. Endoscopic innovations, including endobronchial ultrasound and robotic and electromagnetic bronchoscopy, have enhanced the ability to perform diagnostic procedures on an ambulatory basis. Therapeutic procedures for patients with symptomatic airway disease, pleural disease, and severe emphysema have provided the ability to palliate symptoms. The combination of medical and procedural expertise has made interventional pulmonologists an integral part of comprehensive care teams for patients with oncologic, airway, and pleural needs. This review surveys key areas in which interventional pulmonologists have impacted the care of thoracic disease through bronchoscopic intervention.
Topics: Humans; Pulmonary Medicine; Bronchoscopy; Thoracic Diseases
PubMed: 37827195
DOI: 10.1146/annurev-med-050922-060929 -
Panminerva Medica Sep 2019Over the last decades, the use of flexible bronchoscopy has greatly increased in intensive care, anesthesia and thoracic surgery for diagnostic purpose, management of... (Review)
Review
Over the last decades, the use of flexible bronchoscopy has greatly increased in intensive care, anesthesia and thoracic surgery for diagnostic purpose, management of critical patients and to facilitate airway management for tracheal intubation, one lung ventilation and lung transplant management. The huge availability of endoscopic instruments and devices for airway management has amplified indications and possibilities for bronchoscopic procedures performed by intensive care physicians, anesthesiologist, endoscopists, and surgeons too. These practices need adequate technical skills that can be acquired only through defined learning pathways. This manuscript summarizes the indications and the competencies needed to perform bronchoscopic procedures in intensive care, anesthesia and thoracic surgery settings.
Topics: Anesthesiology; Bronchoscopy; Clinical Competence; Critical Care; Endoscopy; Humans; Intensive Care Units; Intubation; Intubation, Intratracheal; Lung Transplantation; Thoracic Surgery
PubMed: 30394713
DOI: 10.23736/S0031-0808.18.03565-6 -
Annals of Anatomy = Anatomischer... May 2021The development in interventional respiratory medicine entails the need of bronchial anatomical knowledge, whose variations assume their greatest importance nowadays.... (Observational Study)
Observational Study
The development in interventional respiratory medicine entails the need of bronchial anatomical knowledge, whose variations assume their greatest importance nowadays. The aim of this study was to describe the frequency of these variations and to analyze the bronchial lengths, barely registered before in literature. This observational descriptive study (from June 2018 until April 2019) was conducted in a sample of 17 pairs of lungs, which were dissected and measured at the Cadaver Donation Centre (Universidad Complutense, Madrid), and a second sample of 50 bronchoscopies, performed at the San Carlos Clinic Hospital, which were analyzed during the procedure. Our results show that there are no significant differences in the incidence of variations by sex in any of both samples, and neither in the average length of any bronchus by sex nor lobar pattern. Left main bronchus presents the longest length and left upper lobe bronchus the shortest. The highest percentage of variations is contained in the right lower lobe (25.4%), and the most frequent variation in the subsuperior bronchus (B*) (19.4%). The middle lobe and the left lower lobe present the lowest percentage of variations (11.9%). Only 37.3% of the pairs of lungs/patients did not have any anatomical variation in the general sample. Despite of the small size of the sample, results show a high percentage of variations and a minority of completely normal pairs of lungs, which invites us to reflect about the probable high prevalence of variations in the general population. Further studies with greater samples are needed to confirm our hypothesis.
Topics: Anatomic Variation; Bronchi; Bronchoscopy; Cadaver; Humans; Trachea
PubMed: 33515691
DOI: 10.1016/j.aanat.2021.151677 -
PloS One 2022The bronchoscopy (BS) experience provokes anxiety amongst some patients. It can have a negative impact on the course of the procedure and on the willingness of patients...
BACKGROUND
The bronchoscopy (BS) experience provokes anxiety amongst some patients. It can have a negative impact on the course of the procedure and on the willingness of patients to undergo the next BS in the future.
OBJECTIVE
We aimed to identify factors influencing patients' satisfaction with BS.
METHODS
The prospective study had been conducted between January and June 2019. It included patients hospitalized in our Department, who underwent elective BS. Patients assessed their anxiety and satisfaction level before and after BS using the Visual Analogue Scale (VAS). Data concerning the course of the bronchoscopy was collected.
RESULTS
The median level of anxiety prior to the procedure was moderate, higher in women (p<0.0001). The majority of patients (116/125, 93%) were satisfied with appropriate information before the procedure. Almost one-third of the interviewees (39/125, 31%) declared complete satisfaction (VAS = 0) with their procedure, 17 patients (14%) were dissatisfied (VAS >5/10). Overall 113 (90%) patients declared unconditional consent for future bronchoscopy. Multivariate linear regression analysis revealed two factors affecting patients' satisfaction with bronchoscopy: anxiety prior to BS (standardized regression coefficient β = 0.264, p = 0.003) and discomfort (β = 0.205, p = 0.018). Neither age, degree of amnesia, duration of the procedure nor its type added any significant value as factors affecting patient satisfaction. The most common factors inducing patients' discomfort during BS were local anesthesia of the throat (56/125, 45%) and cough (47/125, 38%).
CONCLUSIONS
Low anxiety level before bronchoscopy and reduced discomfort during the procedure are associated with better patient satisfaction. Thus, it is important to reduce patient anxiety and discomfort during the procedure.
Topics: Anesthesia, Local; Anxiety; Bronchoscopy; Female; Humans; Patient Satisfaction; Prospective Studies
PubMed: 36201528
DOI: 10.1371/journal.pone.0274377 -
BioMed Research International 2016The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared... (Review)
Review
The indications for rigid bronchoscopy for interventional pulmonology have increased and include stent placements and transbronchial cryobiopsy procedures. The shared airway between anesthesiologist and pulmonologist and the open airway system, requiring specific ventilation techniques such as jet ventilation, need a good understanding of the procedure to reduce potentially harmful complications. Appropriate adjustment of the ventilator settings including pause pressure and peak inspiratory pressure reduces the risk of barotrauma. High frequency jet ventilation allows adequate oxygenation and carbon dioxide removal even in cases of tracheal stenosis up to frequencies of around 150 min; however, in an in vivo animal model, high frequency jet ventilation along with normal frequency jet ventilation (superimposed high frequency jet ventilation) has been shown to improve oxygenation by increasing lung volume and carbon dioxide removal by increasing tidal volume across a large spectrum of frequencies without increasing barotrauma. General anesthesia with a continuous, intravenous, short-acting agent is safe and effective during rigid bronchoscopy procedures.
Topics: Adult; Anesthesia, General; Barotrauma; Bronchoscopy; Carbon Dioxide; High-Frequency Jet Ventilation; Humans; Lung; Lung Volume Measurements
PubMed: 27847813
DOI: 10.1155/2016/4234861 -
European Respiratory Review : An... Sep 2010Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the... (Review)
Review
Since the introduction of the flexible fibreoptic bronchoscope in the late 1960s there have been relatively few technological advances for three decades, aside from the development of a white light video bronchoscope with a miniature charge-coupled device built in its tip replacing the fibreoptics. White light flexible videobronchoscopy with its ancillary devices (forceps biopsy, bronchial brushing, bronchoalveolar lavage, bronchial washings and transbronchial needle aspiration) has long been the only established diagnostic bronchoscopic technique. With the advances in microtechnology over the past two decades, recent technical developments such as autofluorescence bronchoscopy and endoscopic ultrasound allow better evaluation of endobronchial, mediastinal and parenchymal lesions.
Topics: Bronchoscopes; Bronchoscopy; Equipment Design; Humans; Lung Diseases
PubMed: 20956198
DOI: 10.1183/09059180.00005710 -
Ear, Nose, & Throat Journal Aug 2018Acute croup is a common admitting diagnosis for pediatric patients. If a patient is not responding to medical management for presumed croup, the otolaryngology team is...
Acute croup is a common admitting diagnosis for pediatric patients. If a patient is not responding to medical management for presumed croup, the otolaryngology team is occasionally consulted for direct laryngoscopy and bronchoscopy (DLB) to rule out tracheitis or another airway pathology. We conducted a study to determine if inpatient DLB in acute croup is safe and efficacious and to correlate preoperative vital signs with intraoperative findings. We reviewed the charts of 521 patients with an admitting diagnosis of acute tracheitis, acute laryngotracheitis, or croup. Of this group, 18 patients-11 boys and 7 girls, aged 1 month to 3.3 years (mean: 1.3 yr)-had undergone inpatient DLB. Comorbidities, complications, and level of care were also analyzed. Five patients (28%) had gastrointestinal reflux disease (GERD), and 4 had previously undergone intubation (22%). Eleven patients (61%) had concurrent airway pathology, 7 of whom (39%) required operative intervention. Preoperative mean body temperature and the increase in mean temperature were significantly higher in tracheitis patients than in the non-tracheitis patients. Preoperative change in respiratory rate was elevated when another airway pathology was present (p = 0.047). Only patients who were in the intensive care unit (ICU) preoperatively were intubated in the operating room, and only 1 patient required a postoperative escalation in the level of care. Our study found that performing inpatient DLB in patients hospitalized with croup is reasonably safe and provides a sufficient yield for identifying tracheitis or other airway pathology in selected populations. Preoperative vital signs can be suggestive of tracheitis or additional unexpected airway pathology. Recurrent croup, a history of GERD or previous intubation, and preoperative admission to the ICU increase the yield of DLB.
Topics: Bronchoscopy; Child, Preschool; Croup; Diagnosis, Differential; Female; Humans; Infant; Laryngoscopy; Male; Patient Safety; Preoperative Care; Procedures and Techniques Utilization; Respiratory Tract Diseases
PubMed: 30138522
DOI: 10.1177/014556131809700805 -
BMC Cancer May 2022Bronchoscopy can be a distress for the patient. There have been few studies on the combination of sedatives and opioids. The aim of this study was to demonstrate the... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Bronchoscopy can be a distress for the patient. There have been few studies on the combination of sedatives and opioids. The aim of this study was to demonstrate the usefulness and safety of administration of the combination of midazolam and pethidine during bronchoscopy.
METHODS
In this prospective randomized single (patient)-blind study, we randomly assigned 100 patients who were scheduled to undergo bronchoscopy biopsy to receive treatment with either the midazolam/pethidine combination (combination group) or midazolam alone (midazolam group) during examinations. After the end of bronchoscopy, patients completed a questionnaire and the visual analogue scale was measured. The primary outcome was the patients' acceptance of re-examination assessed by visual analogue scale. We also assessed pain levels, vital signs, midazolam use, xylocaine use, and adverse events. Univariate analyses were performed using Fisher's exact test for categorical data, and the t-test or Mann-Whitney test was carried out for analysis of numeric data. All P-values were two-sided, and values < 0.05 were considered statistically significant.
RESULTS
We analyzed 47 patients in the combination group and 49 patients in the midazolam group. The primary outcome was a good trend in the combination group, but not significantly different (3.82 ± 2.3 in combination group versus 4.17 ± 2.75 in midazolam alone, P = 0.400). In the combination group, the visual analog scale score for pain during bronchoscopy was significantly lower (1.10 ± 1.88 versus 2.13 ± 2.42, P = 0.022), and the sedation level score per the modified observer's assessment of alertness/sedation scale was significantly deeper (3.49 ± 0.98 versus 3.94 ± 1.03, P = 0.031). Maximal systolic blood pressure during testing was significantly lower (162.39 ± 23.45 mmHg versus 178.24 ± 30.24 mmHg, P = 0.005), and the number of additional administrations of midazolam was significantly lower (2.06 ± 1.45 versus 2.63 ± 1.35, P = 0.049). There were also significantly fewer adverse events (30 versus 41, P = 0.036).
CONCLUSIONS
The combination uses of midazolam and pethidine for sedation resulted in significant improvements in the pain, blood pressure, additional use of midazolam, and safety during bronchoscopy among patients.
TRIAL REGISTRATION
This study was registered in the University Medical Hospital Information Network in Japan (UMINCTR Registration number: UMIN000032230 , Registered: 13/April/2018).
Topics: Bronchoscopy; Conscious Sedation; Humans; Meperidine; Midazolam; Pain; Prospective Studies; Single-Blind Method
PubMed: 35549904
DOI: 10.1186/s12885-022-09640-y -
Therapeutic Advances in Respiratory... Feb 2014Bronchial thermoplasty is a new treatment option for patients with severe bronchial asthma who remain symptomatic despite maximal medical therapy. The aim of this... (Review)
Review
Bronchial thermoplasty is a new treatment option for patients with severe bronchial asthma who remain symptomatic despite maximal medical therapy. The aim of this interventional therapy option is the reduction of smooth muscle in the central and peripheral airways in order to reduce symptomatic bronchoconstriction via the application of heat. A full treatment with bronchial thermoplasty is divided into three bronchoscopies. Randomized, controlled clinical trials have shown an increase in quality of life, a reduction in severe exacerbations, and decreases in emergency department visits as well as days lost from school or work. The trials did not show a reduction in hyperresponsiveness or improvement in forced expiratory volume in 1 s. Short-term adverse effects include an increase in exacerbation rate, an increase in respiratory infections and an increase in hospitalizations. In the 5-year follow up of the studies available there was evidence of clinical and functional stability of the treated patients. Further studies are necessary to identify an asthma phenotype that responds well to this treatment.
Topics: Animals; Asthma; Bronchi; Bronchial Hyperreactivity; Bronchoconstriction; Bronchoscopy; Catheter Ablation; Forced Expiratory Volume; Humans; Muscle, Smooth; Quality of Life; Randomized Controlled Trials as Topic; Severity of Illness Index
PubMed: 24334336
DOI: 10.1177/1753465813509302