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PubMedDate not supplied

[Use of tramal for prevention of motor hyperactivity during r fiber bronchoscopy in patients in the postoperative period].

The efficacy of tramal for preventing motor hyperactivity is assessed in patients on spontaneous respiration after surgery during fiber bronchoscopy under a short-acting hypnotic ethomidate. Group 1 consisted of 22 patients to whom 100 mg of tramal was injected intravenously 30 min before fiber bronchoscopy, group 2 of 10 patients subjected to fiber bronchoscopy without preliminary tramal. Ethomidate caused manifest 20-45-sec myoclonus in the distal parts of the upper and lower limbs in 80% of cases. Pretreatment with tramal (100 mg intravenously) decreased the severity and incidence of myoclonus to 18.2%, did not affect gas exchange, and stabilized hemodynamics during fiber bronchoscopy.

Adolescent↗
PubMed1998

[Use of laryngeal mask in bronchoscopy or bronchoscopic treatment].

Laryngeal mask which is widely used in clinical anesthesiology permits establishment of airway without tracheal intubation. Flexible bronchoscopy or bronchoscopic treatment using the laryngeal mask was evaluated to determine its safety, less invasiveness, and usefulness. Fifty-two patients underwent flexible bronchoscopy or bronchoscopic treatment using laryngeal mask 54 times. Bronchoscopy was performed under either local or general anesthesia. The laryngeal mask was positioned in the larynx, as a rule without a laryngoscope. A flexible bronchoscope was introduced into the airway, passed through the rubber slit at the tip of the laryngeal mask tube, and the examination was performed. Complications observed during the course of the examinations consisted of only two cases of poorly fitting laryngeal mask and one case of catching of a part of the epiglottis in the rubber slit at the tip of the laryngeal mask tube. Both cases were not particularly problematic. There were three patients with sore throat and one with an unpleasant feeling in the pharynx following the examination, however, all of these complaints resolved within three days after the examination. Laryngeal masks are less invasive and have very little effect on either the respiratory system or the circulatory system. They may be used safely even in aged patients and appears to be highly effective for diagnostic and therapeutic bronchoscopy.

Adolescent↗
PubMed1997

Bronchial foreign body: should bronchoscopy be performed in all patients with a choking crisis?

The aspiration of a bronchial foreign body (FB) remains a common pediatric problem with serious and sometimes fatal sequelae. The diagnosis is often delayed or overlooked. With the aim of determining a reliable clinical and/or radiologic finding to indicate the requirement for bronchoscopy, 100 patients admitted to our hospital because of FB aspiration who underwent rigid bronchoscopy were retrospectively studied. The clinical and radiologic data were compared with the bronchoscopy findings, which revealed that the history of a choking crisis was the clinical parameter that showed the highest sensitivity (97%) with high specificity (63%), and that other symptoms and radiology, even those with high sensitivity (88% and 85%, respectively), had low specificity (9%). We conclude that bronchoscopy should be performed in all patients with a history of a choking crisis even if they have normal radiologic findings and few symptoms.

Journal Article↗
PubMed1983

The effect of instrumentation with a telescope during bronchoscopy on arterial oxygen tension and acid-base balance.

The effect of instrumentation with a telescope during bronchoscopy on the arterial oxygen tension and acid-base status was studied in 17 unselected, anaesthetized patients using a ventilating technique based on Sanders' method (1). After ventilating the patients with a bronchoscope and a telescope in the trachea, in the left main bronchus or in the right main bronchus, the PaO2 value was always statistically significantly higher than after ventilating only with a bronchoscope. During the course of the bronchoscopy as well as after 1 h in the recovery room, the arterial acid-base status was within normal limits and the mean PaO2 value during bronchoscopy ranged from 175 to 240 mmHg (23.3-31.9 kPa) and was 138 mmHg (18.4 kPa) in the recovery room when the patients breathed about 35% oxygen in air. The present results suggest that instrumentation with a telescope during bronchoscopy ameliorates rather than impairs the ventilation and oxygenation of the patients.

Acid-Base Equilibrium↗
PubMed2004

Multidetector CT-generated virtual bronchoscopy: an illustrated review of the potential clinical indications.

Multidetector computed tomography-generated virtual bronchoscopy (VB) is a recent technical development that allows visualisation of the lumen and wall of the trachea and proximal part of the bronchial tree. A dynamic image is produced that resembles what is seen with fibreoptic bronchoscopy (FB). Although the technique has not yet reached daily clinical practice and it can never replace FB, performing VB can be useful in well-defined clinical situations. In this paper, the value and limitations of virtual bronchoscopy will be reviewed, to illustrate the potential role of virtual bronchoscopy in the evaluation of trachea and bronchial tree pathology.

Biopsy↗
PubMed1983

Flexible fiberoptic bronchoscopy and laryngoscopy in infants and children.

A pediatric flexible fiberoptic bronchoscope was employed in the examination and/or therapy of 164 infants and children ranging in age from 1 day to 16 years. Ninety-two bronchoscopies and 72 laryngoscopies were performed without any mortality or significant morbidity; 78% of laryngoscopies and 35% of bronchoscopies were performed in children under 2 years of age. The instrument was helpful in terms of diagnosis, as a tool for aspirating secretions and resolving atelectasis, and as a guide for surgical intervention. It is concluded that flexible fiberoptic bronchoscopy is a safe procedure in small infants and children and serves as an important aid in the diagnosis and therapy of disorders of the respiratory tract in this age group. However, caution should be expressed in its use in children with compromised ventilation, bradycardia or bleeding diathesis. Moreover, in suspected foreign body aspiration, the rigid-open tube bronchoscopy should be employed.

Adolescent↗
PubMed1992

Rhodotorula rubra contamination in fiberoptic bronchoscopy.

Rhodotorula rubra was recovered in 18 bronchoscopic specimens from 15 patients from May to November 1987. One hundred and twenty-one bronchoscopies were performed during that period by two bronchoscopists (W. W.; R.D.) at Letterman Army Medical Center in San Francisco. Isolation of R rubra occurred in 11 bronchoalveolar lavage (BAL) specimens, four bronchial washes, and three transbronchial biopsies. Clinical infection was not present in any of these patients, although five were immunocompromised hosts. After a stepwise infection control review of the laboratory, the bronchoscopy suite, bronchoscopists, and the fiberoptic bronchoscope failed to recover the organism, a systematic evaluation of the cleaning procedure was undertaken. We discovered that replacement of the suction valve and the rubber biopsy valve on the biopsy channel immediately after cleaning allowed moisture to accumulate in these areas. Removal of both the suction valve and biopsy valve during periods of nonuse resulted in adequate drying of the biopsy channel and eradication of contamination from December 1987 to May 1990 (350 bronchoscopies). Epidemiologic and infection control surveillance is critical for bronchoscopy, especially when possible pathogens are recovered by BAL in the immunocompromised patient.

Bronchoalveolar Lavage Fluid↗
PubMed1998

[Results and complications of fiber bronchoscopy in HIV positive patients].

Fibreoptic bronchoscopy is an established diagnostic procedure for HIV-associated pulmonary infections. We retrospectively evaluated the diagnostic effectivity and safety of fibreoptic bronchoscopy with bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) in 153 patients with late-stage HIV infection and clinical signs of pulmonary infection or abnormal chest radiograph. Bronchoscopy leads to diagnosis in 82.4% and changed therapy in 54%. 45 patients (30%) were found to have pneumocystis carinii pneumonia (PCP), the most common bronchoscopic finding, followed by bacterial lung disease (29.3%). BAL had a sensitivity of 78% for PCP. Diagnostic yield of BAL for PCP was higher in patients without previous treatment (positive results in 82%) with regard to PCP independend of the prior treatment. Serious complication occurred in 22 cases (pneumothorax: 6 (3.9%), bleeding: 12 (7.8%), hypoxaemia: 4 (2.6%)). High serum levels of lactate dehydrogenase (LDH) correlated with pulmonary complications like pneumothorax. Age, sex and kind of pulmonary infection did not influence complication rates. 6 (3.9%) episodes of spontaneous pneumothorax occurred in the further course, 3 of them concurrently with PCP or prior history of PCP. We conclude that fibreoptic bronchoscopy is of great value for diagnosing pulmonary infection in HIV-seropositive patients. TBB provides incremental diagnostic information not available from BAL, especially in patients pretreated with cotrimoxazol or pentamidin. For that reason we believe that TBB should be performed in these patients.

AIDS-Related Opportunistic Infections↗
PubMed1980

Fiberoptic bronchoscopy in bacteriologic assessment of lower respiratory tract secretions. Importance of microscopic examination.

Use of fiberoptic bronchoscopy to acquire pulmonary secretions has been shown to yield unreliable bacterial cultures. However, microscopic examination of such material has received little attention. In this study, 69 bronchoscopies were evaluated. Clinical assessment of the presence of a lower respiratory tract infection was made and cultures obtained. In addition, each specimen was analyzed with a Gram-stained smear. The Gram-stained smears of these specimens correlated extremely well with the clinical assessment. In 67 of the 69 cases, bronchoscopy yielded material whose Gram-stained smear accurately reflected the presence or absence of a pyogenic infection. In patients with lower respiratory tract infections, the smear also predicted the likely category of the causative organism. This study suggests that microscopic examination of lower respiratory tract secretions helps make fiberoptic bronchoscopy a potentially useful alternative in the evaluation of bacterial lung infections.

Bacterial Infections↗
PubMed1998

[Basic principles of LIFE--autofluorescence bronchoscopy. Results of 194 examinations in comparison with standard procedures for early detection of bronchial carcinoma--overview].

BACKGROUND: Conventional bronchoscopy in the identification of preneoplasias and carcinoma in situ (CIS) has been inadequate to date. Tissue autofluorescence was found to differentiate normal mucosa from dysplastic or carcinomatous bronchial mucosa. This principle resulted in the development of the LIFE System (Light Imaging Fluorescence Endoscope, Xillix Techn., Vancouver, BC), now in routine use worldwide at 35 centres. In a prospective multicentric study in North America the relative sensitivity for diagnosing intraepithelial neoplasias of combined white light (WLB) and LIFE bronchoscopy in 173 at-risk patients was 6.3 as compared to WLB alone. A similar European multicentric study will be completed by spring of 1998. PATIENTS AND RESULTS: We report on our experience with the routine use of the LIFE System over 23 months. 194 examinations (165 patients) were performed. Moderate to severe dysplasias and in situ carcinomas were diagnosed with a relative sensitivity of 2.7 by the combined WLB-LIFE examination as compared to WLB alone. CONCLUSION: Autofluorescence bronchoscopy as a routine investigation without need of photosensitizers in patients with a high risk for lung cancer can lead to a substantial increase in the detection rate of CIS and moderate to severe dysplasias compared to white light bronchoscopy alone.

Adult↗
PubMed1998

Bronchoscopy and laryngoscopy findings as indications for tracheotomy in the burned child.

OBJECTIVE: To determine possible indications for tracheotomy in the burned child based on bronchoscopic and laryngoscopic findings. DESIGN AND SETTING: A retrospective case study of all patients admitted to a tertiary children's burn center. PARTICIPANTS: All children admitted with burn inhalation injury between 1990 and 1995 (n = 211). INTERVENTION: All patients underwent laryngoscopy and bronchoscopy and 19 underwent tracheotomy, with 5 tracheotomy tubes placed emergently. MAIN OUTCOME MEASURES: Observations during laryngoscopy and bronchoscopy included erythema, edema, carbonaceous material, ulcerations, and bronchial mucous casts. The supraglottis, glottis, and subglottis were analyzed separately, when possible. Any sepsis resulting from tracheotomy was determined. Complications, such as glottic webs, subglottic stenosis, and tracheomalacia, were noted. RESULTS: Indications for tracheotomy included 6 for airway obstruction, 6 for prolonged intubation, 6 for pulmonary cleansing, and 1 for endotracheal tube complications (subglottic stenosis). When examined by bronchoscopy and laryngoscopy, 17 of 19 children had significant airway edema, 10 had carbonaceous material in the airway, and 3 had ulcerations in the airway. CONCLUSIONS: Tracheotomy is indicated in the burned child when significant airway edema is present. Failure to place a tracheotomy tube in these cases leads to a high incidence of immediate tracheotomies (26%). There was no evidence of clinically significant infection attributable to tracheotomy. The number of airway complications due to tracheotomy was no higher than from endotracheal intubation.

Airway Obstruction↗
PubMed1992

Experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage as a diagnostic tool in children with AIDS.

OBJECTIVE: To report our experience with flexible fiberoptic bronchoscopy with bronchoalveolar lavage in children with the acquired immunodeficiency syndrome and acute lower respiratory tract disease. DESIGN: Retrospective study. SETTING: Children's Medical Center of Brooklyn, NY, a tertiary-level inner-city hospital. PARTICIPANTS: Eighty-five children with acquired immunodeficiency syndrome and acute lower respiratory tract disease. INTERVENTION: One hundred five flexible fiberoptic bronchoscopies with bronchoalveolar lavages. MEASUREMENTS/MAIN RESULTS: Infective agents were recovered in 88 procedures (84%). Potentially pathogenic bacteria were identified in 56 (56.6%) of 99 procedures. Viruses were found in 28 (29%) of 96 lavages, and fungi in 37 (41.6%) of 89 specimens. Pneumocystis carinii was identified in 22 (22.2%) of 99 specimens. Mycobacteria were isolated from 14 (14%) of 100 specimens. A serious complication occurred in only one procedure (0.95%). CONCLUSION: Flexible fiberoptic bronchoscopy with bronchoalveolar lavage is a safe and effective diagnostic procedure that identified infective agents in 80% of children with acquired immunodeficiency syndrome and concomitant acute lower respiratory tract disease.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Bronchoscopy in the blast injury patient.

HYPOTHESIS: Delayed presentation of secondary airway injury is a significant clinical entity following blast injury. DESIGN: Retrospective review. SETTING: Combat Support Hospital, Operation Iraqi Freedom. PATIENTS: Twenty-three blast injury patients with bronchoscopic evidence of secondary airway injury. MAIN OUTCOME MEASURES: Symptom development and time frame, bronchoscopic findings, and requirement for mechanical ventilation. RESULTS: All of the 23 patients presented within 12 hours of injury. Eleven patients (48%) arrived at the hospital after prior endotracheal intubation. The majority (17 patients [74%]) of patients had no carbonaceous sputum, singed nasal hair, or thoracic trauma that would suggest possible airway injury. Bronchoscopy revealed mucosal erythema and edema in 16 (70%) of the patients, 6 (23%) had additional airway carbonaceous deposits, and 5 (21%) had normal findings on initial bronchoscopy. Eight patients (35%) initially breathing spontaneously and demonstrating no thoracic trauma required intubation within 12 hours of admission owing to impending loss of airway patency. Bronchoscopy revealed significant airway edema (>50% patency loss) in 6 (75%) of these 8 patients, with additional carbonaceous deposits in 3 patients (38%). Patients requiring delayed intubation had a significantly greater respiratory rate on initial examination. CONCLUSIONS: Manifestation of secondary airway injury may be delayed up to 12 hours following blast injury. We believe that blast injury patients should be observed for at least 18 hours after injury or until edema has resolved and in a setting amenable to emergent airway support and rapid bronchoscopic evaluation at the earliest indication of possible airway compromise.

Blast Injuries↗
PubMed1998

Fatal pneumococcal sepsis following flexible bronchoscopy in an immunocompromised infant.

A 5-month-old boy who suffered from a leukocyte chemotactic defect underwent flexible bronchoscopy for persistent right upper lobe atelectasis and tachypnea. Ten hours after the procedure he developed fulminant sepsis, and he died 16 hrs after bronchoscopy. Streptococcus pneumoniae (serotype 23) grew from the bronchoalveolar lavage fluid and from the blood culture taken during the sepsis work-up. We, therefore, suggest administering prophylactic antimicrobial therapy immediately following bronchoscopy to immunosuppressed children, even when an acute respiratory infection is not suspected, in order to prevent bacteremia and sepsis.

Bronchoscopy↗
PubMed1983

Flexible fiberoptic bronchoscopy in metastatic cancer to the lungs.

Seventy-eight patients with metastatic cancer to the lungs underwent flexible fiberoptic bronchoscopy for diagnosis. The patients were divided into two groups by presenting radiographic pattern as: (I) diffuse linear interstitial infiltrations (55 patients); and (II) localized or multiple nodular opacities (23 patients). The diagnosis of cancer was established by bronchoscopy in both groups of patients with approximately equal frequency. In Group I, bronchoscopic biopsy results were positive in 34 patients (62%), cytology results were positive in 30 patients (55%), and 42 patients (76%) had a positive biopsy and/or cytology result. In group II, biopsy results were positive in 14 patients (61%), cytology results were positive in 8 patients (35%), and 15 (65%) patients had a positive biopsy and/or cytology result. Patients whose chest radiograph showed atelectasis, suggesting the presence of endobronchial metastases, were excluded from the study. However, endobronchial examination unexpectedly revealed metastatic endobronchial carcinoma in 9 patients, 4 in Group I and 5 in Group II. Fiberoptic bronchoscopy is a relatively simple and direct technique for the histologic diagnosis of metastatic cancer to the lungs. Endobronchial metastases are common, even when not suspected by radiographic examination.

Breast Neoplasms↗
PubMed1987

Diagnosis of pulmonary Kaposi's sarcoma with fiberoptic bronchoscopy and endobronchial biopsy. A report of five cases.

Fiberoptic bronchoscopy is a major tool in the diagnostic evaluation of pulmonary disease in patients with the Acquired Immune Deficiency Syndrome. Multiple opportunistic infections and Kaposi's sarcoma affect the lung in this disorder. In contrast to opportunistic infections, Kaposi's sarcoma is rarely reported to be diagnosed by means of bronchoscopy. This report describes five of seven patients in whom endobronchial lesions consistent with submucosal involvement by the tumor were seen, and Kaposi's sarcoma was diagnosed without complication. Kaposi's sarcoma must be considered in the differential diagnosis of pulmonary disease in patients with a proven extrapulmonary tumor focus, and fiberoptic bronchoscopy is the initial diagnostic procedure of choice. Endobronchial Kaposi's sarcoma may be a marker for parenchymal involvement by the tumor. Diagnosis of endobronchial Kaposi's sarcoma can be an important factor in decisions regarding therapy.

Adult↗
PubMedDate not supplied

Effective use of bronchoscopy and sputa in the diagnosis of lung cancer.

The records of 134 patients who underwent bronchoscopy at the Forbes Health System hospitals between January 1, 1982 and December 31, 1983 were reviewed. The number of pre- and postbronchoscopy sputa obtained on each patient, final diagnosis, and follow-up for 6 to 30 months were obtained. Tissue obtained at bronchoscopy yielded a diagnosis of malignancy in 71 of 84 (84.5%) patients who received that final diagnosis. Addition of postbronchoscopy sputa examination increased the yield to 73 of 84 (86.9%). Prebronchoscopy sputa contributed no diagnoses beyond those made by bronchoscopically obtained material. The cost to the patient of examining pre- and postbronchoscopy sputa in addition to bronchoscopically obtained cytologic and biopsy material is 70% higher than that of examining bronchoscopically obtained material alone. Indirect costs of increased hospital stay may also be significant. We propose early bronchoscopy without prebronchoscopy sputa in cases where there is clinical suspicion of lung cancer. Postbronchoscopy sputa should be obtained, but only processed for microscopic examination if the bronchoscopically obtained material does not yield a diagnosis.

Bronchoscopy↗
PubMed2007

Fiberoptic bronchoscopy and bronchoalveolar lavage for the evaluation of pulmonary disease in children with primary immunodeficiency and cancer.

BACKGROUND: Patients with childhood cancer or primary immunodeficiencies (PID) are at high risk for developing pulmonary infections and non-infectious complications. The broad differential diagnoses and the critical condition of these patients often drive physicians to start broad-spectrum antibiotic therapy before a definite diagnostic procedure is performed. A definite diagnosis may be achieved in these situations by fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL). PATIENTS AND METHODS: The records of 58 PIDs and cancer (immunocompromised group) pediatric patients who underwent 62 fiberoptic bronchoscopies between 2000 and 2004 were retrospectively reviewed and compared to 158 non-cancer patients who underwent 182 fiberoptic bronchoscopies during the same period. RESULTS: The overall diagnostic rate achieved by macroscopic inspection of purulent secretions or hemorrhage, abnormal cell count, and infectious agent isolation in the immunocompromised patients was 84%. A definite organism was recovered in 53.2% of the patients. Probable infection defined as purulent secretions or abnormal cell count without infectious agent isolation was diagnosed in another 21% of the patients. The rate of complications was 30.6%. In the control group, the overall diagnostic rate was 76.9% (n.s) and an infectious agent was demonstrated in 12.1% (P < 0.001). Probable infection was diagnosed in 24.2% (n.s) while the rate of complications was lower (15%) (P < 0.01). CONCLUSIONS: Rapid and accurate diagnoses were achieved in most procedures performed on immunocompromised patients. Although the rate of complications was higher in the immunocompromised group, they were usually very mild with no mortality. Based on these results, broncoalveolar lavage should be considered as an initial diagnostic tool in pediatric immunocompromised patients with pulmonary complications.

Adolescent↗