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At least 271 records · Page 15Linked to original sources
PubMed2001

Complications of bronchoscopically guided percutaneous dilational tracheostomy: beyond the learning curve.

OBJECTIVE: To assess the complication rate of bronchoscopically guided percutaneous dilational tracheostomy (PDT), with tracheal tube suture fixation and no elective tracheostomy tube exchange, after experience had been gained. DESIGN: Prospective clinical study. SETTING: Anaesthesiological ICU with mixed surgical and medical patients in a university hospital. PATIENTS: Hundred thirty-three mechanically ventilated patients (mean age: 54.8 years, range: 13-87 years) with indication for PDT, many with thrombocytopenia and/or coagulation deficits. INTERVENTIONS: Hundred thirty-six consecutive PDTs performed by residents under bronchoscopic guidance with stepwise dilation ( n=114, Ciaglia's conventional system) or conic dilation ( n=22, "Blue Rhino" approach) and supervision of experienced staff anaesthesiologists. Tracheostomy tubes were fixed to the skin with a suture and no routine exchange of tracheostomy tubes was performed. Complications were categorised and the results were also compared to an earlier prospective study. RESULTS: The incidence of tracheostomy tube-related complications (hypoxaemia, cannula misplacement, accidental decannulation, cuff rupture and hernia, or posterior tracheal wall lesion) was low (0.7%) and significantly less (6.2%, p=0.01) than in our earlier study. No patient died of PDT-associated complications. We recorded four (2.9%) clinically relevant bleeding episodes. Insertion of tracheal tubes was easy or only moderately difficult in 86.7%. CONCLUSION: With experience in performing PDT, fixation of the tracheal cannula, and omission of routine change of tracheostomy tubes complication rate of PDT is low.

Adolescent↗
PubMed2001

How safe is non-bronchoscopic bronchoalveolar lavage in critically ill mechanically ventilated children?

OBJECTIVE: To assess the safety of non-bronchoscopic bronchoalveolar lavage (NB-BAL) in critically ill mechanically ventilated children. SETTING: Paediatric intensive care unit in a tertiary children's hospital. METHODS: The data from 60 consecutive critically ill mechanically ventilated children who underwent NB-BAL was reviewed from November 1997 to December 1999. PRISM score prior to NB-BAL, observations at the time of NB-BAL and arterial blood gases, oxygenation index (OI), ventilator settings, haemodynamic variables and temperature taken at 1 h before, and 1 and 6 h after NB-BAL, were retrieved from the archived computerised database. RESULTS: Median age was 7 months (IQR 2.8-43 months) and median weight was 5.5 kg (IQR 4-14 kg). Four (7%) patients exhibited significant immediate complications, requiring escalation of respiratory or haemodynamic support. Forty-two (70%) patients had complete data for calculation of OI; there was no significant change in median OI at 1 and 6 h after NB-BAL. However 5 (12%) of these patients experienced an increase in OI of between 10 and 45 at 1 h post NB-BAL, which returned to baseline at 6 h post NB-BAL. Complications did not correlate with any of the available variables: baseline OI, PRISM score or with deterioration at the time of the procedure, although it was observed that four out of the six patients with baseline OIs of greater than 20 experienced complications. CONCLUSION: Non-bronchoscopic bronchoalveolar lavage in critically ill mechanically ventilated neonates and children is generally a well-tolerated procedure, but for some patients, in whom it was not possible to elucidate predictive factors, complications developed. All patients, particularly those with OIs of greater than 20, require careful monitoring during and after the procedure.

Blood Gas Analysis↗
PubMed2005

A strategy of sequential therapy with a bronchoscopic excision and thoracotomy for intra- and extrabronchial wall schwannoma: report of a case.

A 69-year-old woman was admitted with dyspnea on effort and left lung atelectasis on chest X-ray. Fiberoptic bronchoscopy revealed a complete obstruction of the left main bronchus due to a polypoid lesion. This lesion was diagnosed to be a schwannoma arising from the left lower bronchus. Bronchoscopic treatments were performed with electrosurgical snaring and the intratumoral injection of 99.5% ethanol. These treatments were performed once per week for 4 weeks, then were followed with a one-time application of semiconductor laser cautery. These treatments opened the airway and restored the left lung expansion. However, a residual tumor remained at the bifurcation of the left basal bronchus and B6. A cautious follow-up was conducted because schwannoma is a potentially benign tumor. A follow-up bronchoscopic examination at 21 months revealed a regrowth of the residual tumor. A complete resection using a left S6 sleeve segmentectomy was thus performed. The pathologic diagnosis of the tumor was benign schwannoma. There were no complications and no evidence of disease recurrence has been observed after the surgery.

Aged↗
PubMed2026

Clinical performance of the Abbott RealTime Mycobacterium tuberculosis (MTB) PCR on bronchoscopic specimens for diagnosing pulmonary tuberculosis.

PURPOSE: We evaluated the performance of the Abbott RealTime Mycobacterium tuberculosis (MTB) PCR (RT MTB) on bronchoscopic specimens using conventional culture as the reference standard in a low-Tuberculosis (TB) prevalence setting. METHODS: A total of 6,988 specimens (4,682 bronchial aspirates [BAS] and 2,306 bronchoalveolar lavages [BAL]) from 4,118 patients with suspected pulmonary TB were included. When BAS and BAL specimens from the same bronchoscopy procedure were available, these were mixed 1:1 prior to culture inoculation and PCR testing. Following processing, specimens were inoculated into a Löwenstein-Jensen and a Bactec MGIT 960 tube and incubated at 37 °C for 3 months and at 35 °C for 8 weeks, respectively. RT MTB was performed as indicated by the manufacturer. RT MTB targets the insertion sequence IS6110 and the protein antigen B (PAB) gene, both highly conserved within the Mycobacterium tuberculosis complex. Whole genome Next generation sequencing of clinical MTBC isolates was performed when indicated. RESULTS: Among the 104 culture-positive specimens, 84 (1.2%) were detected by PCR. Additionally, 16 specimens (0.3% of all samples), from 16 patients, were PCR-positive despite negative culture results. Conversely, 20 specimens (0.4% of all samples), from 19 patients, were culture-positive but not detected by PCR. No significant differences were found between PCR-positive and PCR-negative specimens with respect to the number of IS6110 copies per isolate or PAB gene sequences (P = 0.69). Finally, there were 4,683 specimens (97.4%) from the remaining 4,014 patients tested PCR-negative/Culture-negative. Following the resolution of discrepancies based on clinical grounds the sensitivity and specificity of RT MTB were 83.9% (CI 95%, 76.0-90.0) and 99.9% (CI 95%, 99.9-99.9), respectively. These results exceed the minimum performance requirements defined in the WHO Target Product Profiles for molecular TB diagnostics. Although RT MTB is not a point-of-care test but rather a moderate-complexity automated NAAT, it is recommended by WHO as part of the Abbott RealTime MTB/MTB RIF-INH testing algorithm, in which MTBC detection by RT MTB is followed by reflex testing with the MTB RIF/INH assay for detection of rifampicin and isoniazid resistance. CONCLUSION: RT MTB shows a good performance on bronchoscopic specimens.

Mycobacterium tuberculosis↗
PubMed1985

Pleuroscopy in the diagnosis of pleural effusion using a fiberoptic bronchoscope.

Forty patients with undiagnosed pleural effusions were investigated by pleuroscopy, using a fiberoptic bronchoscope. Pleural biopsies diagnostic of tuberculosis were obtained in 17 cases, and in 12 of these tubercle bacilli were cultured from the pleural fluid. Pleural biopsy at thoracoscopy is superior to the percutaneous intercostal route and for this purpose the fiberoptic bronchoscope is preferable to the rigid thoracoscope.

Adolescent↗
PubMed1983

Use of a bronchoscopic protected catheter technique in the clinical evaluation of a new antibiotic.

We prospectively compared the usefulness of a bronchoscopic protected catheter technique with the results from sputum cultures in the evaluation of moxalactam, a new beta-lactam antibiotic. The significance of a given isolate on protected catheter culture was determined by quantitative bacteriology. 32 patients with community-acquired pneumonia were enrolled in the study and 31 grew common lower respiratory tract pathogens from their protected catheter specimen. The most common single pathogens recovered were Streptococcus pneumoniae (11 patients) and Haemophilus influenzae (2). Mixed flora, predominantly anaerobes, were isolated from 15 patients, and 3 patients had mixed aerobic infections. All seven bacteremic cases had the identical organism isolated from the protected catheter specimen, confirming the accuracy of the technique. Comparisons with sputum cultures showed that the predominant organism on sputum culture was the same as that obtained from the protected catheter culture in only 13% of the cases. Sputum cultures revealed either no pathogen or a different pathogen in 23 cases, and no sputum could be obtained in 4. Compared to cultures of expectorated sputum, we found the protected catheter bronchoscopic culture technique to have the following advantages in the bacteriologic evaluation of moxalactam: 1) greater accuracy and sensitivity in bacteremic patients; 2) accurate delineation of the bacteriology of infections; and 3) a higher percentage of patients with evaluable bacteriology leading to greater efficiency during the investigation.

Bacteria↗
PubMedDate not supplied

Fiber-optic bronchoscopic guidance for intubating a neonate with Pierre-Robin syndrome.

The Pierre-Robin anomalad features micrognathia, glossoptosis, and frequently a cleft palate. Tracheal intubation may be challenging and sometimes impossible. Reported is a case in which a tracheal guide wire was passed via the suction port of a flexible pediatric bronchoscope. The bronchoscope was then removed, and an endotracheal tube was threaded over the wire. The technique is safe and allows rapid endotracheal intubation in pediatric patients with difficult upper airways.

Airway Obstruction↗
PubMed2003

Quantitative tracheal lavage versus bronchoscopic protected specimen brush for the diagnosis of nosocomial pneumonia in mechanically ventilated patients.

BACKGROUND: No gold standard method exists for the diagnosis of ventilator-associated pneumonia despite the availability of multiple techniques. METHODS: A prospective, crossover study was performed on mechanically ventilated patients meeting with suspected pneumonia. Eighteen paired samples were obtained on 15 patients, comparing the results of quantitative tracheal lavage (QTL) to bronchoscopic protected brush specimen (PSB) by quantitative culture and gram stain examination. RESULTS: The sensitivity, specificity, positive and negative predictive values, and accuracy are affected by the growth density threshold selected, and whether the same organisms are expected by both methods. There is a significant relationship between QTL and PSB (P = 0.0048; R = 0.632), gram stain and PSB (P <0.001; R = 0.791), and gram stain and QTL (P = 0.0125; R = 0.575), by Spearman rank order correlation. CONCLUSIONS: QTL may have a role for diagnosing and directing treatment of ventilator-associated pneumonia, allowing reservation of bronchoscopic PSB for secondary, high risk and refractory cases.

Adult↗
PubMed2006

Bronchoscopic procedures for emphysema treatment.

Emphysema is a debilitating lung disease continuing to be a major source of morbidity and mortality in the developed countries. Medical treatment is the mainstay of therapy and consists of smoking cessation, pulmonary rehabilitation, administration of bronchodilators and, when indicated, steroids and supplemental oxygen. Various surgical procedures have been promoted in the past to relieve dyspnoea and improve quality of life in patients with advanced emphysema; whilst early results were often encouraging, a sustained objective functional improvement was rarely achieved and most of those procedures were progressively abandoned. Despite controversies, LVRS has been shown to be beneficial to selected patients with end-stage emphysema when medical therapy has failed. There is no doubt that LVRS allows a significative functional improvement in a selected group of patients; however, it still carries a substantial morbidity, even if mortality is low at the centres with the larger experience. Patients with a most advanced functional deterioration show a higher surgical mortality and less impressive functional results, suggesting that LVRS should be considered more carefully in these situations. Bronchoscopic alternatives to the surgical approach have been recently proposed and some of them may play an important role in the future; in particular, the airway bypass and bronchoscopic lung volume reduction with one-way valves are certainly one step beyond on their way to clinical application. We hereby report the initial experimental and clinical experience with these new treatment options.

Animals↗
PubMed2004

Bronchoscopic surfactant administration preserves gas exchange and pulmonary compliance after single lung transplantation in dogs.

BACKGROUND: Surfactant abnormalities have been implicated in reperfusion injury and respiratory failure in lung transplantation. METHODS: We investigated the efficacy of bronchoscopic administration of a bovine natural lung surfactant extract (Alveofact) to improve gas exchange and lung mechanics after heterologous left lung transplantation in foxhounds (+4 degrees C ischemia for 24 hours, conservation with Euro-Collins solution). Animals received either no surfactant therapy (untreated controls, n = 6) or 50 mg/kg body weight (prior to explantation, only graft) and 200 mg/kg body weight Alveofact (immediately after reperfusion, both lungs, n = 6). After lung transplantation, separate but synchronized ventilation of each lung was performed in a volume-controlled, pressure-limited mode for 12 hours, with the animals prone. Small catheters were inserted into the pulmonary veins of both the graft and the recipient's native lung for separate blood gas analysis. In the control group, marked protein leakage, influx of neutrophils into the alveolar space, and pulmonary edema formation (extravascular lung water; wet/dry ratio) were encountered in the transplanted lung but only to a very minor extent in the recipient's native lung. RESULTS: Lung compliance values and arterial oxygenation progressively deteriorated in the transplanted but not in the native lungs. Pulmonary hemodynamics did not change significantly. Surfactant administration did not significantly influence the development of reperfusion edema, protein leakage, and neutrophil influx into the grafts. However, surfactant restored the surface activity and the gas exchange (PaO2/FIO2 of 201.2 +/- 20.2 mm Hg vs 119.8 +/- 21.7 mm Hg in controls; P <.05) in the transplanted lungs, and compliance was markedly improved in the surfactant-treated animals (18.8 +/- 1.8 mL/mbar vs 11.5 +/- 1.6 mL/mbar in the controls; P <.05). CONCLUSION: Bronchoscopic surfactant administration does not prevent leukocyte influx or vascular leakage but does protect against respiratory failure and improves lung mechanics in single lung transplantation in dogs.

Animals↗
PubMed2005

Bronchoscopic intralesional injection of triamcinolone acetonide treated against bronchial obstruction caused by peanut aspiration.

We encountered a case of obstructive pneumonia 1 month after peanut aspiration. Bronchoscopic examination revealed obstruction of the right basal bronchus with immature granulation tissue due to the peanut aspiration. Despite antibiotic treatment, the obstruction had not been resolved. To relieve the bronchial obstruction, bronchoscopic intralesional injection of triamcinolone acetonide was performed without any complications. Seven days after injection, the bronchial obstruction had resolve. In conclusion, intralesional injection of triamcinolone acetonide may play a role in one of the non-surgical repairs against obstruction due to foreign body aspiration.

Aged↗
PubMed2001

Postoperative fluorescence bronchoscopic surveillance in non-small cell lung cancer patients.

BACKGROUND: Second lung primaries occur at a rate of 1% to 3% per patient-year after complete resections for non-small cell lung carcinoma (NSCLC). Fluorescence bronchoscopy appears to be a sensitive tool for surveillance of the tracheobronchial tree for early neoplasias. METHODS: Patients who were disease-free after complete resection of a NSCLC were entered into a fluorescence bronchoscopy surveillance program. All suspicious lesions were biopsied along with two areas of normal mucosa to serve as negative controls. RESULTS: A total of 73 fluorescence bronchoscopies were performed after conventional bronchoscopy in 51 patients at a median of 13 months postresection. The majority (46 of 51) of patients had stage I or II NSCLC, whereas 10% (5 of 51) had stage IIIA. Three intraepithelial neoplasias and one invasive carcinoma were identified in 3 of 51 patients (6%), all current or former smokers. Of the four lesions identified, three were in the 20 patients with prior squamous cell carcinomas. No intraepithelial neoplasias were identified by white-light bronchoscopy, whereas two of three were detected by fluorescence examination. The one invasive cancer detected was apparent on both white-light and fluorescence bronchoscopic examinations. CONCLUSIONS: Surveillance with fluorescence bronchoscopy identified lesions in 6% of postoperative NSCLC patients thought to be disease-free. Patients with prior squamous cell carcinomas appear to be a population that may warrant future prospective study of postoperative fluorescence bronchoscopic surveillance.

Adult↗
PubMed1985

Extraction of large tracheal foreign bodies through a tracheostoma under bronchoscopic control.

Despite various technical manipulations through contemporary endoscopic equipment, large tracheal foreign bodies may be lost during bronchoscopic extraction, with a 1 to 2% in-hospital mortality. Recently, emergency tracheostomy was performed during bronchoscopy after a tracheal foreign body had become dislodged in the subglottic region causing blockage of the airway, and the results of this procedure provoked its deliberate application in a second patient. In 3 additional infants, aspirated tracheal T tubes (Montgomery tubes), which were producing acute respiratory distress, were brought from the carina to the performed tracheostoma under bronchoscopic manipulation and were withdrawn. Elective application of this simultaneous approach--tracheostomy with bronchoscopy--may decrease morbidity and mortality from large tracheal foreign bodies.

Airway Obstruction↗
PubMed1978

Fluoroscopically controlled transbronchial biopsy of solitary peripheral pulmonary lesions using the fibreoptic bronchoscope.

Experience of fluoroscopically controlled transbronchial biopsy using the fibreoptic bronchoscope in 30 patients with solitary lesions in the peripheral lung fields beyond bronchoscopic vision is described. At the time of submitting this paper for publication (30 January 1978) no account of the technique has been reported in the British literature. In 21 patients with a final diagnosis of bronchial carcinoma a positive biopsy diagnosis was obtained in 14 (67%). Five of seven patients (71%) with a final diagnosis of an inflammatory condition showed evidence of acute or chronic inflammation on biopsy. There were no complications. The procedure is indicated when a definitive diagnosis is required for management planning in clinically inoperable patients, or when a tissue diagnosis is particularly desired in an attempt to obviate the need for thoracotomy. The relative safety makes this the biopsy technique of choice for the evaluation of isolated peripheral pulmonary opacities.

Biopsy↗
PubMed1980

Experimental subglottic stenosis: histopathologic and bronchoscopic comparison of electrosurgical, cryosurgical, and laser resection.

Controversy continues over the optimal method of resecting subglottic stenosis. Electrosurgery, cryosurgery and laser resection have all had some clinical success. We sought to compare these treatment methods in experimentally-created subglottic stenosis. Subglottic strictures were created transbronchoscopically in newborn lambs by electrocoagulating a rim of mucosa. Four weeks later, all had 20 to 90% occlusion documented bronchoscopically. Control animals were found to have dense submucosal fibrosis in the cricoid area. Remaining experimental animals were treated with: (1) electrosurgical resection; (2) cryosurgical treatment; (3) Neodymium-yag (Nd:Yag) laser at 20 watts; (4) Nd:Yag laser with 40 watts; or (5) carbon dioxide laser at 10 watts. Animals from each group were sacrificed at 5 and 30 days postresection and the tracheas were examined grossly and microscopically. Animals sacrificed at 30 days postresection were bronchoscoped at weekly intervals. Cryosurgical and electrosurgical resection resulted in 1-3 mm of thermal damage adjacent to the margin of resection at 5 days post-treatment. Mucosal ingrowth and healing were rapid and there was no development of stenosis or damage to underlying structures. Use of the Nd:Yag laser resulted in 10-20 mm of surrounding damage in animals sacrificed at 5 days. At 30 days posttreatment, there was mucosal healing but extreme underlying damage and redevelopment of stenosis at the level of treatment. The carbon dioxide laser-treated animals showed thermal damage present up to 2 mm in depth from resected areas at 5 days post-treatment. Mucosal regeneration proceeded rapidly. This study indicates that electrosurgical and cryosurgical resection for experimental subglottic stenosis create minimal thermal damage and are associated with comparably acceptable rates of mucosal ingrowth and healing. The carbon dioxide laser created comparable to slightly decreased thermal damage but suffers at present from lack of optimal visualization of the subglottic lesion.

Animals↗
PubMed2000

Bronchoscopic management of central airway obstruction.

OBJECTIVES: Patients with central airway obstruction are critically ill, with impending suffocation. They are seen with diverse anatomic and functional deficits caused by both benign and malignant obstructions. Such cases were reviewed to examine the indications, techniques, and outcomes of an algorithm approach to bronchoscopic management. METHODS: Between July 1992 and April 1996, 97 patients underwent bronchoscopic procedures for the management of central airway obstruction, and their cases were used for a retrospective review of the airway management. RESULTS: There were 48 male and 49 female patients, aged 13 to 85 years. There were 48 benign and 49 malignant pathologic conditions that gave rise to 108 stenoses. These were treated with 199 endoscopic procedures with an average of 1.7 interventions per endoscopy, including mechanical core-out (62), dilation (135), laser ablation (44), placement of brachytherapy catheters (9), and stent placement (88). Diagnoses included lung cancer, primary tracheobronchial tumors, tumors metastatic to the airway or mediastinum, and a variety of benign obstructions. In the group of 97 patients there were 2 (2%) perioperative deaths and 34 (34%) late deaths, 29 in the malignant group and 5 in the benign group. Median survival was 7.6 months (range 1 week-31 months). There were 7 (7%) complications among the group of 97, 4 in the malignant group, and 3 in the benign group. CONCLUSIONS: Endobronchial surgical techniques can be used safely and systematically for the relief of benign and malignant central airway obstructions; a diversity of approaches and interventions are required to produce and maintain palliation of airway symptoms.

Adolescent↗
PubMed1995

Bronchoscopic guidance makes percutaneous tracheostomy a safe, cost-effective, and easy-to-teach procedure.

BACKGROUND: We wanted to assess the efficiency of instituting a modified technique of percutaneous tracheostomy (PET) with bronchoscopic guidance. METHODS: During a 10-month period 48 consecutive trauma patients requiring tracheostomy were divided between a standard tracheostomy control group (ST) and a PET group. All patients were followed prospectively. The hospital charges were reviewed retrospectively. RESULTS: Age, gender, body habitus, and principal diagnosis were similar in the 21 ST patients and the 27 PET patients. All STs and 15 of the PETs were performed in the operating room (OR), and the 12 remaining PETs were done in the intensive care unit (ICU). Four patients in the ST group and six in the PET group died. One of these deaths occurred in a patient in the PET group with severe adult respiratory distress syndrome. Procedure time was shorter for PET (16 versus 45 minutes, p < 0.0001). Junior residents performed more PETs than STs (33% versus 10%), and PET was considered "easier" to perform than ST (81% versus 47%). Hospital charges for PET in the ICU were $3400 less per patient compared with ST or PET in the OR. CONCLUSIONS: PET was performed easily and safely in the OR and at the ICU bedside. PET required one-third the time of ST. Bronchoscopic supervision of PET may have contributed to the small number of complications and the educational experience of junior residents. PET in the ICU can reduce hospital charges significantly and avoids transport of patients to the OR. PET is as safe as ST and should be considered the procedure of choice for an ICU patient requiring an elective tracheostomy.

Adult↗