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PubMed1982

The value of bronchoscopy in establishing the etiology of pneumonia in renal transplant recipients.

Fifty-two episodes of fever and new pulmonary infiltrates were evaluated prospectively in 51 renal allograft recipients. Thirty-nine flexible fiberoptic bronchoscopies were performed in the diagnostic evaluation of these infiltrates. Specific etiologic diagnoses were obtained in 30 (77%) of the patients. This information was clinically useful, as defined by preset criteria, in 21 (54%) of the patients and definitive but not clinically useful in an additional 9 (23%). In the remaining 9, it was neither definitive nor clinically useful. Microbiology brush specimens were useful in establishing etiologic diagnoses in 12 (44%) of the 27 patients in whom it was performed. Transbronchial lung biopsies yielded specific etiologic diagnoses in 9 (53%) of the 17 biopsies obtained. Complications related to the bronchoscopic procedure occurred in 2 patients (5% of total bronchoscopies). No prolonged morbidity was noted. We conclude that fiberoptic bronchoscopy is a safe, useful procedure, and should be considered early in the diagnostic evaluation of pulmonary infections in renal transplant recipients.

Aspergillosis↗
PubMed1985

Comparison of computerized tomography with fiberoptic bronchoscopy in identifying endobronchial abnormalities in patients with known or suspected lung cancer.

Determining the presence and extent of endobronchial involvement is an important part of the evaluation of patients with known or suspected lung cancer. Bronchoscopy is accepted as the best technique for such an evaluation. We have studied the potential usefulness of computerized tomography (CT) for examining the airways by retrospectively comparing CT scans with fiberoptic bronchoscopy findings in 53 patients with known or suspected lung cancer undergoing both tests during the same hospitalization. We have found CT to be moderately accurate in predicting the presence of airway abnormalities (sensitivity from 63 to 85%, specificity form 61 to 77%) but inaccurate in defining the type of abnormality seen at bronchoscopy (localized mucosal abnormality, endobronchial mass, or extrinsic compression). We feel that CT, using standard techniques, should not be relied on for the identification of endobronchial abnormalities in patients with known or suspected lung cancer.

Bronchoscopy↗
PubMed1986

A ten-year experience with fiberoptic bronchoscopy for mycobacterial isolation. Impact of the Bactec system.

From January 1974 to December 1983, positive mycobacterial isolates from all sources were reviewed to determine the impact of fiberoptic bronchoscopy (FB) on retrieval and identification of these organisms. There were 112 patients with positive cultures obtained during FB, 25 with Mycobacterium tuberculosis and 87 with mycobacteria other than tuberculosis (MOTT). We reviewed the results of prebronchoscopy and postbronchoscopy sputum specimens, bronchial washings, brushings, and transbronchial biopsy to determine the yield from each specimen in patients with M. tuberculosis. The bronchial washings provided positive cultures in 24 of 25 and were exclusively positive in 10 of 25 (40%). We also reviewed the clinical presentation, chest roentgenogram, bronchoscopy findings, and culture data for the 87 patients with MOTT isolated. The isolation of MOTT from bronchoscopy specimens increased throughout the study, most notably with the introduction of a rapid radiometric method (the Bactec system) for the recovery of mycobacteria to our laboratory in June 1983. Active disease could be established in only 13 of 87 cases (15%). Our findings confirm the sensitivity of Bactec in the isolation of MOTT from bronchoscopic specimens. The Bactec system, on the other hand, does not differentiate saprophytic colonization from clinical disease. To avoid expensive, time-consuming biochemical identification necessary to evaluate these MOTT isolates, careful selection of patients prior to obtaining mycobacterial cultures during FB is a critical factor.

Bacteriological Techniques↗
PubMedDate not supplied

Ultraviolet-fluorescence bronchoscopy in early detection of bronchogenic carcinoma.

The still unsatisfactory prognosis of bronchogenic carcinoma prompted the search for possibilities of better early and detailed diagnosis. This led us to the idea of UV-fluorescence bronchoscopy. The patient inhales 5 ml of an aqueous 5% solution of fluorescein, together with a beta2 stimulator, 10-15 minutes before the bronchoscopy, by means of a pressure inhaler. While the normal mucous membrane cleanses itself by virtue of ciliary action (secretions containing fluorescein are expectorated or drawn off during the bronchoscopy), carcinoma, carcinomatous lymphangiosis, superficial tumor infiltrations and nonciliated metaplasias are stained. These places fluoresce in UV light, even when they cannot be observed with the naked eye or with an optical system. In this way, they are made visible for directed biospy. Malignant changes not discernible by means of the methods hitherto employed can thus be diagnosed and sites determined with greater accuracy for proposed resection.

Bronchi↗
PubMedDate not supplied

Gas scavenging during bronchoscopy under general anesthesia.

Prevention of exposure of the endoscopist to high levels of anesthetic gases during bronchoscopy was attempted experimentally in dogs by a scavenging system. Results were compared with exposure during the conventional technique of anesthetic gas administration for clinical bronchoscopy using the rigid open ventilating bronchoscope. The scavenging system consisted of a vacuum pump applied to the open ventilating rigid bronchoscope sidearm connection during intratracheal administration of nitrous oxide, , oxygen, and halothane gas mixture. Gas samples were taken from the trachea, the proximal end of the bronchoscope, and the endoscopist's breathing zone, and analyzed by gas chromatography. Findings indicate that halothane anesthesia for bronchoscopy administered by conventional techniques is a source of air pollution in the operating room and exposes the endoscopist to subanesthetic levels of halothane that may affect psychomotor functioning. The use of the gas scavenging system lowered the concentrations of halothane and nitrous oxide at the endoscopist's breathing zone to a level at which inhalation for short periods has no clinical effects, while the concentrations of the anesthetics and oxygen in the trachea were maintained at a satisfactory level.

Air Pollutants, Occupational↗
PubMed2004

Sputum versus bronchoscopy for diagnosis of Pseudomonas aeruginosa biofilms in cystic fibrosis.

The present authors hypothesised that bronchoscopy with protected specimen brush may sample biofilm-forming bacteria adherent to the airway wall, whereas traditional sputum collection may not. Pseudomonas aeruginosa obtained from sputum, bronchoalveolar lavage and protected brush, taken from the right upper lung bronchus of 12 adult patients with cystic fibrosis, were compared. Retrieved bacteria were genotyped, and grown in planktonic cultures and as biofilms, and susceptibilities to individual antibiotics and to antibiotic combinations were determined. Bacterial cultures obtained using bronchoscopy did not yield any new strains of bacteria that were not also found in sputum. A total of 10 patients (83%) had a single strain of P. aeruginosa found using sputum, bronchoalveolar lavage and protected brush techniques, and two patients (17%) had two strains recovered in sputum, but only one strain was recovered using bronchoscopic techniques. Susceptibility to single antibiotics and to antibiotic combinations were not different between planktonically or biofilm-grown bacteria derived from sputum, as compared to those obtained by bronchoalveolar lavage and protected brush. In conclusion, sputum collection provides as much information as bronchoscopy for characterising the genotype and antibiotic susceptibility of chronic Pseudomonas aeruginosa infection in patients with stable cystic fibrosis.

Adult↗
PubMed2005

Use of continuous positive airway pressure during flexible bronchoscopy in young children.

Young children are at increased risk for hypoxaemia and hypercapnia during flexible bronchoscopy due to the small size and increased collapsibility of their airways. Various strategies are used to prevent hypoventilation and to provide oxygen during the procedure. The aim of this study was to assess the impact of continuous positive airway pressure (CPAP) on ventilation during flexible bronchoscopy in infants and young children. Tidal breathing was measured in 16 spontaneously breathing and deeply sedated children, aged 3-25 months, by ultrasound spirometry via an airway endoscopy mask. Measurements were made with the tip of the bronchoscope positioned in the pharynx with no CPAP, and in mid-trachea with 0, 5 and 10 cmH2O of CPAP. Transition of the bronchoscope through the vocal cords was associated with significant decreases of tidal volumes (5.0+/-0.5 versus 3.4+/-0.5 mL.kg(-1)), peak tidal expiratory flows (78+/-12 versus 52+/-10 mL.s(-1)) and peak tidal inspiratory flows (98+/-15 versus 66+/-12 mL.kg(-1)). CPAP (5-10 cmH2O) induced almost complete reversal of these changes. In conclusion, it is shown here that flexible bronchoscopy in spontaneously breathing young children is associated with significant decreases in tidal volume and respiratory flow. These changes are largely reversible with continuous positive airway pressure.

Bronchoscopy↗
PubMed1998

Melanoptysis as a complication of fibreoptic bronchoscopy.

The case is presented of a coal miner with bilateral masses of progressive massive fibrosis, who developed acute cavitation following fibreoptic bronchoscopy and biopsies. Indeed, immediately upon bronchoscopy with transbronchial biopsy, there was expectoration of abundant melanoptysis. Three days later, the chest radiograph showed a cavity and the patient again coughed up black material, in the context of pulmonary infection. One week later, there was complete emptying of the conglomerate mass. To the authors' knowledge, this is the first reported case of a conglomerate mass of progressive massive fibrosis which cavitated as a result of bronchoscopy.

Biopsy↗
PubMed1993

The role of staging bronchoscopy in the preoperative assessment of a solitary pulmonary nodule.

In order to assess the role of a staging fiberoptic bronchoscopy in the preoperative assessment of an indeterminate solitary pulmonary nodule (SPN), we reviewed our experience in 33 SPNs identified among 1,269 bronchoscopies performed at the Albert Einstein Medical Center between 1985 and 1989. All lesions were less than 4 cm in greatest diameter and were not associated with symptoms of weight loss, chest pain, hemoptysis, localized wheezing, or hoarseness. A tissue diagnosis was established in 25 patients, 23 of whom had a malignant SPN. This study failed to detect a single case in which a fiberoptic bronchoscopic examination of the airway discovered a lesion that would preclude surgery and potentially curative resection. We recommend the abandonment of a staging bronchoscopy in the evaluation of a patient with an indeterminant SPN in whom history, physical examination, laboratory, and imaging studies fail to document contraindications to surgery. No additional useful information is derived and a substantial cost savings to the patient can be realized if the procedure is eliminated.

Adenocarcinoma↗
PubMed1995

Using bronchoscopy and biopsy to diagnose early inhalation injury. Macroscopic and histologic findings.

OBJECTIVE: To learn the value of bronchoscopy and biopsy in the early diagnosis of inhalation injury ARDS. SETTING: Burn Center, CHU Saint-Antoine, Paris, France. DESIGN: 130 consecutively admitted burn patients were bronchoscoped on admission. MEASUREMENTS: The appearance of the bronchial tree was recorded, and biopsies were taken from spurs of the proximal and distal branches of the right bronchi. RESULTS: Either bronchoscopy or biopsy was positive in 46 cases. Twenty three of 44 patients with chemical inhalation injury developed ARDS (52%). Of 83 negative cases only 6 developed ARDS (7%). CONCLUSION: Bronchoscopy with biopsy is useful in predicting the development of ARDS in burn patients.

Adult↗
PubMed1995

Music improves patient comfort level during outpatient bronchoscopy.

STUDY OBJECTIVE: To determine the effect of music during bronchoscopy on patient perception of the procedure. DESIGN: Prospective randomized trial. SETTING: University-based bronchoscopy suite. PATIENTS: Twenty-one patients received music (M+), and 28 patients served as controls (M-). MEASUREMENTS AND RESULTS: Physiologic responses, subjective patient perceptions, and administered medications were monitored. After the procedure, the technician and the physician both rated their impression of the patients' comfort levels to see how accurately they correlated with actual patient reports. There was no difference in physiologic responses between the M+ and M- groups. The M+ patients reported significantly greater comfort (p = 0.02) and less cough (p = 0.03) than the M- group, while there was no difference in reported dyspnea P = 0.21). Both physicians and technicians were very inaccurate in their assessments of patient level of comfort. Medications given did not differ for the two groups. CONCLUSION: Music during bronchoscopy is a simple and inexpensive nonpharmacologic way to improve patient comfort.

Adult↗
PubMed1997

Therapeutic rigid bronchoscopy allows level of care changes in patients with acute respiratory failure from central airways obstruction.

OBJECTIVE: To determine whether emergency rigid bronchoscopic intervention, including Nd-YAG laser resection or stenting, immediately affected the need for continued mechanical ventilation or intensive care level of support in critically ill patients with acute respiratory failure from malignant or benign central airways obstruction. DESIGN: Retrospective review of medical records of all patients with acute respiratory failure and malignant or benign tracheobronchial obstruction necessitating intubation, mechanical ventilation, or hospitalization in the ICU prior to referral for therapeutic bronchoscopy. SETTING: University of California San Diego, a tertiary care institution specialized in airway management. PATIENTS: Medical records of 32 patients with malignant or benign central airways obstruction requiring admission to the ICU prior to rigid bronchoscopic intervention between January 1994 and April 1996. INTERVENTIONS: Emergent rigid bronchoscopy with dilatation, Nd-YAG laser resection, or silicone stent insertion performed in the operating room under general anesthesia. RESULTS: Thirty-two patients with central airways obstruction requiring emergent hospitalization in the ICU were referred for therapeutic rigid bronchoscopy. Airway strictures were caused by benign disease in 18 patients, and by primary bronchogenic lung cancer in 14. Of the 19 patients who were mechanically ventilated, bronchoscopic intervention allowed immediate discontinuation of mechanical ventilation in 10 (52.6%). Twenty-five patients had indwelling artificial airways (12 endotracheal tubes, 13 tracheotomy tubes). Two, however, were considered tracheotomy-dependent because of neuromuscular disease. Of the remaining 23 patients, immediate extubation or decannulation was possible in seven (30.4%). Of seven patients with no indwelling airway, five (71.4%) were immediately transferred to a lower level of care after intervention. Of the 32 total patients, 20 (62.5%) were immediately transferred to a lower level of care immediately after intervention. CONCLUSIONS: Emergency laser resection or stent insertion can favorably affect health-care utilization in patients with acute respiratory distress from central airways obstruction. Treatment may be lifesaving and allows successful withdrawal from mechanical ventilation, hospitalization in a lower level of care environment, relief of symptoms, and extended survival in critically ill patients. In patients with regionally advanced cancer, the palliative nature of this procedure postpones death by respiratory distress and may prompt consideration for institution of conservative comfort measures to reduce patient suffering.

Bronchial Diseases↗
PubMed1998

Localization of bronchial intraepithelial neoplastic lesions by fluorescence bronchoscopy.

BACKGROUND: In the treatment of lung cancer, the best outcome is achieved when the lesion is discovered in the intraepithelial (preinvasive) stage. However, intraepithelial neoplastic lesions are difficult to localize by conventional white-light bronchoscopy (WLB). OBJECTIVE: To determine if autofluorescence bronchoscopy, when used as an adjunct to WLB, could improve the bronchoscopist's ability to locate and remove biopsy specimens from areas suspicious of intraepithelial neoplasia as compared with WLB alone. METHOD: A multicenter clinical trial was conducted in seven institutions in the United States and Canada. WLB followed by fluorescence examination with the light-induced fluorescence endoscopy (LIFE) device was performed in 173 subjects known or suspected to have lung cancer. Biopsy specimens were taken from all areas suspicious of moderate dysplasia or worse on WLB and/or LIFE examination. In addition, random biopsy specimens were also taken from other parts of the bronchial tree. RESULTS: The relative sensitivity of WLB + LIFE vs WLB alone was 6.3 for intraepithelial neoplastic lesions and 2.71 when invasive carcinomas were also included. The positive predictive value was 0.33 and 0.39 and the negative predictive value was 0.89 and 0.83, respectively, for WLB+LIFE and WLB alone. CONCLUSION: Autofluorescence bronchoscopy, when used as an adjunct to standard WLB, enhances the bronchoscopist's ability to localize small neoplastic lesions, especially intraepithelial lesions that may have significant implication in the management of lung cancer in the future.

Adult↗
PubMed1998

Can chest CT decrease the use of preoperative bronchoscopy in the evaluation of suspected bronchogenic carcinoma?

BACKGROUND: Fiberoptic bronchoscopy (FOB) is frequently used to diagnose and stage bronchogenic carcinoma (BC). However, the value of FOB in diagnosis/staging BC presenting as a pulmonary nodule or mass (PNM) is controversial. Since chest CT is usually obtained in these patients, it may be used in patient selection for preoperative FOB. OBJECTIVE: Evaluation of the role of chest CT in determining the predictive value of FOB in diagnosing/staging a PNM, by comparing the results of CT and bronchoscopy. DESIGN: Retrospective review of chest CTs and medical records. PATIENTS: Consecutive patients with BC between 1992 and 1994 who had diagnostic FOB and CT in our institution, but without radiographic evidence of (1) pulmonary atelectasis, (2) endobronchial tumor or narrowing of the central airways, and (3) the PNM abutting the central airways. RESULTS: Sixty-four patients met the selection criteria. The size of the PNM ranged from 1.5 to 10 cm; the size was < or = 4 cm in 62 patients. FOB provided a diagnosis in 22 patients. Bronchoscopy detected endobronchial lesions in 11 patients (17%); 3 had lesions in more than one lobe. In three patients, the PNM was <3 cm. The radiographically undetected endobronchial tumor increased the tumor stage in only two patients. The "CT bronchus" sign had a positive and negative predictive value of 75% and 68%, respectively. CONCLUSIONS: (1) In this study, CT failed to detect endobronchial tumor in 11 of 64 patients (17%). Because of the implications of a new staging system, more studies are necessary before abandoning staging FOB. (2) The CT bronchus sign has a very high positive and negative predictive value in the use of diagnostic FOB and should be used to guide the method of biopsy of a PNM.

Bronchoscopes↗
PubMed1998

The role of atropine premedication in fiberoptic bronchoscopy using intravenous midazolam sedation.

OBJECTIVE: Atropine premedication is widely used for fiberoptic bronchoscopy and may help by drying secretions, producing bronchodilatation, or preventing vasovagal reactions. The objective of this study was to see whether atropine premedication is really of practical benefit when patients are sedated with i.v. midazolam. DESIGN: In a double-blind study, patients were randomly allocated to receive i.m. atropine (0.6 mg) or saline placebo (1 mL) as premedication 30 to 60 minutes before they were sedated with progressive doses of i.v. midazolam until judged to be lightly asleep. SETTING: A District General Hospital in England. PARTICIPANTS: One hundred consecutive patients referred for bronchoscopy. MEASUREMENTS AND RESULTS: Samples taken during the procedure were washings for microbiology and cytology and brushings for cytology and biopsy, but no transbronchial biopsies. Peak flow readings were recorded before premedication and before the start of the procedure. During the procedure an estimate was made of pharyngeal and tracheobronchial secretions, bleeding, use of saline to wash out secretions, and local anesthetic needed to control coughing. Patients were monitored for saturation and cardiac rhythm. There was no significant bronchodilatation after premedication in either group, nor were there differences in secretions, use of saline, tracheobronchial bleeding, desaturation, and arrhythmias. More local anesthetic was needed to control coughing in the placebo group (mean 357 mg vs 331 mg in the atropine group, p=0.02), but this was not of practical significance. CONCLUSION: When intravenous midazolam sedation is used for bronchoscopy, atropine premedication is not of benefit.

Atropine↗
PubMed1998

Quality assessment through patient self-report of symptoms prefiberoptic and postfiberoptic bronchoscopy.

STUDY OBJECTIVE: To apply the principles of quality improvement to measure the frequency and severity of symptoms that result from fiberoptic bronchoscopy (FOB), and to identify opportunities to improve FOB practice by identifying factors about patients and the process of care that predict these symptoms. DESIGN: Concurrent longitudinal cohort study. PATIENTS: Four hundred ninety-three adult patients who underwent FOB. MEASUREMENTS AND RESULTS: Patients completed questionnaires just prior to FOB and again at 48 h postprocedure. Patients were asked to rate the severity of nose pain, throat pain, swallowing pain, and chest pain, and the frequency of coughing, hemoptysis, phlegm, shortness of breath, wheezing, difficulty swallowing, fever, and chills. Symptom severity was reported on a four-point ordinal scale. FINDINGS: Significant worsening was found for nose pain, throat pain, swallowing pain, and hemoptysis. Shorter patients experienced more throat pain and hemoptysis, and longer procedure time predicted nose pain and hemoptysis. CONCLUSIONS: Bronchoscopy causes nose pain, throat pain, swallowing pain, and hemoptysis to a larger extent than previously has been recognized. There are opportunities to improve the patient experience with bronchoscopy by using smaller bronchoscopes in shorter patients, shortening the procedure length, and reanesthetizing the nares in longer procedures.

Adult↗
PubMed1999

Effect of music on state anxiety scores in patients undergoing fiberoptic bronchoscopy.

OBJECTIVE: To study the effect of music on state anxiety levels in patients undergoing flexible fiberoptic bronchoscopy (FFB). DESIGN: Randomized clinical trial using pretests, posttests, and two groups. SETTING: Pulmonary special-procedures unit of a tertiary-care referral center. PATIENTS: Sixty adult patients: 30 patients received music during bronchoscopy and 30 control subjects received no music. RESULTS: The study population had baseline state anxiety levels similar to those previously reported in surgical patients (42.6 +/- 13 vs 42.7 +/- 14; p value, not significant [NS]) and higher than those reported in normal working adults (42.6 +/- 13 vs 34.4 +/- 10; p < 0.001). Experimental and control groups were similar in patient and procedure-related characteristics and baseline pre-FFB state and trait anxiety scores. Although trait anxiety scores decreased significantly after the procedure (pooled post-FFB scores of 32.6 +/- 10 vs pre-FFB scores of 35.5 +/- 11; p < 0.001), no reductions were noted in state anxiety (pooled post-FFB scores of 42.8 +/- 13 vs pre-FFB scores of 42.6 +/- 13; p value, NS). More importantly, playing music through headphones during FFB did not result in a statistically or clinically significant reduction in either state or trait anxiety when compared to control subjects. CONCLUSION: Relaxation music administered through headphones to patients during flexible bronchoscopy does not decrease procedure-related state anxiety.

Anxiety↗
PubMed2000

Negative pressure ventilation vs external high-frequency oscillation during rigid bronchoscopy. A controlled randomized trial.

STUDY OBJECTIVES: To compare the effectiveness of two modalities of external ventilation during rigid bronchoscopy: intermittent negative pressure ventilation (INPV) and external high-frequency oscillation (EHFO). DESIGN: Prospective, controlled, randomized, nonblinded study. SETTING: University-affiliated hospital. PATIENTS: Seventy patients undergoing interventional rigid bronchoscopy for tracheobronchial lesions were enrolled into the study. INTERVENTIONS: Mechanical ventilation was performed by INPV or EHFO. When pulse oximetry was < 90%, manually assisted ventilation was delivered. MEASUREMENTS AND RESULTS: Arterial blood gases were sampled preoperatively and intraoperatively. Most patients in both groups had normal intraoperative PaCO(2) (mean, 43. 6 +/- 11.8 mm Hg under EHFO and 37.4 +/- 8.2 mm Hg under INPV; p = 0.012), and acidemia occurred in 9 of 35 patients of EHFO group and in 2 of 35 patients of INPV group (p = 0.049). Hypercapnia (PaCO(2) > 50 mm Hg) was observed in 10 patients under EHFO and in 2 with INPV (p = 0.026). Intraoperative mean PaO(2) was similar (101.4 +/- 52.9 mm Hg with EHFO and 124.2 +/- 50.3 mm Hg with INPV; p = 0.07), but O(2) supply was different (3.5 +/- 2.3 L/min during INPV and 8.5 +/- 6.2 L/min during EHFO; p < 0.001). Intraoperative hypoxemia (PaO(2) < 60 mm Hg) occurred in five patients with EHFO and two with INPV (p = 0.426). Three EHFO patients required manually assisted ventilation (mean, 0.2 +/- 0.9), but no INPV patient did (p = 0.142). CONCLUSIONS: External negative pressure ventilation appears to be a suitable choice during rigid bronchoscopy: both EHFO and INPV ensure effective ventilation and comfortable operating conditions in the majority of patients. Some patients may receive inadequate ventilation with EHFO, developing respiratory acidosis and requiring manually assisted ventilation. In comparison with INPV, EHFO requires a higher fraction of inspired oxygen.

Adult↗