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A prospective study of bronchoscopy for endotracheobronchial tuberculosis.

To clarify the role of bronchoscopy for endotracheobronchial tuberculosis (EBTB), we performed a prospective study in 45 patients with active pulmonary tuberculosis, in 15 (33%) of whom bronchoscopic findings related to EBTB were seen. The findings were classified into six types:edematous hyperemic, submucosal nodule, ulcerative (shallow and deep), polypoid, cicatrical, and compression type. Each of these types was related to the healing process and outcome after antituberculosis chemotherapy. Serial bronchoscopy revealed that lesions less advanced than the deep ulcerative type responded to chemotherapy; the deep ulcerative and polypoid types progressed to cicatrical bronchostenosis despite chemotherapy. In the follow-up of patients with lesions of the deep ulcerative and polypoid types, serial bronchoscopy after chemotherapy is recommended; these patients also require adjunctive therapy to prevent cicatrical bronchostenosis.

Biopsy↗

Esophageal atresia and tracheal stenosis: use of three-dimensional CT and virtual bronchoscopy in neonates, infants, and children.

OBJECTIVE: The objective of this study was to evaluate the use of three-dimensional CT and virtual bronchoscopy in the treatment of neonates, infants, and children with esophageal atresia and tracheal stenosis. CONCLUSION: Long-gap (n = 1) and short-gap (n = 5) esophageal atresia, long-segment stenosis (n = 2), patent poststenting trachea (n = 1), normal trachea without fistula (n = 1), and tracheal bronchus (n = 1) were studied. Fistulas between the lower esophagus and carina were noted in all six cases of esophageal atresia. All CT findings correlated with operative or bronchoscopy findings. Sensitivity and specificity were 100%. Three-dimensional CT and virtual bronchoscopy are accurate and useful techniques in the preoperative assessment of esophageal atresia and tracheal stenosis in neonates, infants, and children.

Bronchoscopy↗

Can CT replace bronchoscopy in the detection of the site and cause of bleeding in patients with large or massive hemoptysis?

OBJECTIVE: We assessed the capacity of chest radiography and CT to determine the cause and site of bleeding in patients with either large or massive hemoptysis compared with bronchoscopy. MATERIALS AND METHODS: We reviewed the chest radiographs, CT scans, and bronchoscopic findings in 80 patients with either large or massive hemoptysis who were admitted to our intensive care unit between January 1995 and June 1999. RESULTS: Findings on chest radiography were normal in only 13% of patients, of whom 70% had bronchiectasis. The chest radiographs revealed the site of bleeding in 46% of the patients and the cause in 35%, most of whom had tuberculosis or tumors. CT was more efficient than bronchoscopy for identifying the cause of bleeding (77% vs 8%, respectively; p < 0.001), whereas the two methods were comparable for identifying the site of bleeding (70% vs 73%, respectively; p = not significant). CONCLUSION: These data suggest that CT could replace bronchoscopy as the first-line procedure for screening patients with large and those with massive hemoptysis. However, these results must be confirmed in a prospective multicenter study.

Adult↗

Cytomegalovirus the predominant cause of pneumonia in renal transplant patients. A two-year study of pneumonia in renal transplant recipients with evaluation of fiberoptic bronchoscopy.

The microbiological etiology of pneumonia in 34 renal transplant patients with clinical and X-ray evidence of pulmonary parenchymal disease was studied. Fiberoptic bronchoscopy with bronchoalveolar lavage (BAL), transbronchial lung biopsy (TBB) and brushing was performed on 18 patients. Laboratory evaluation included histological and cytological methods, cultures for bacteria, fungus and virus and immunofluorescence techniques for the detection of Pneumocystis carinii, cytomegalovirus (CMV) and legionella. Serum samples were obtained concomitantly for antibody studies. CMV, the most common etiology, was considered to be the cause of disease in 18/34 patients. All but one of these patients had positive CMV isolates in culture on leucocytes. Pulmonary edema was found in 7 patients, bacterial pneumonia in 11 patients, P. carinii in 4 patients and Candida albicans in 1 patient. Multifactorial etiology was found in 12/34 cases. The overall mortality was 32%. Bronchoscopy gave correct diagnosis in 13/14 patients with infectious pulmonary diseases (93%). Bronchoscopy procedures were well tolerated and should be considered in transplant patients with evidence of pulmonary parenchymal disease.

Adult↗

Transmission of infection by gastrointestinal endoscopy and bronchoscopy.

OBJECTIVE: To review reports on the transmission of infections by flexible gastrointestinal endoscopy and bronchoscopy in order to determine common infecting microorganisms, circumstances of transmission, and methods of risk reduction. DATA SOURCES: Relevant English-language articles were identified through prominent review articles and a MEDLINE search (1966 to July 1992); additional references were selected from the bibliographies of identified articles. STUDY SELECTION: All selected articles related to transmission of infection by gastrointestinal endoscopy or bronchoscopy; 265 articles were reviewed in detail. DATA SYNTHESIS: Two hundred and eighty-one infections were transmitted by gastrointestinal endoscopy, and 96 were transmitted by gastrointestinal endoscopy, spectrum of these infections ranged from asymptomatic colonization to death. Salmonella species and Pseudomonas aeruginosa were repeatedly identified as the causative agents of infections transmitted by gastrointestinal endoscopy, and Mycobacterium tuberculosis, atypical mycobacteria, and P. aeruginosa were the most common causes of infections transmitted by bronchoscopy. One case of hepatitis B virus transmission via gastrointestinal endoscopy was documented. Major reasons for transmission were improper cleaning and disinfection procedures; the contamination of endoscopes by automatic washers; and an inability to decontaminate endoscopes, despite the use of standard disinfection techniques, because of their complex channel and valve systems. CONCLUSIONS: The most common agents of infection transmitted by endoscopy are Salmonella, Pseudomonas, and Mycobacterium species. To prevent endoscopic transmission of infections, recommended disinfection guidelines must be followed, the effectiveness of automatic washers must be carefully monitored, and improvements in endoscope design are needed to facilitate effective cleaning and disinfection.

Bronchoscopes↗

Bronchoscopy of cetaceans.

Bronchoscopy is a standard diagnostic and therapeutic procedure in respiratory medicine and has been performed on many animal species. Cetaceans suffer considerable morbidity and mortality from lower respiratory tract infections, and it is very difficult to sample lower respiratory tract secretions for microbiology and other analyses. We report our experience on performing fiberoptic bronchoscopy in three bottle-nosed dolphins (Tursiops truncatus) and one false killer whale (Pseudorca crassidens), which should help other clinicians in performing bronchoscopy in cetaceans.

Animals↗

Bronchoscopy in intensive care.

Fiberoptic bronchoscopy has revolutionized the practice of modern pulmonary medicine. It is estimated that as many as 98% of all bronchoscopies are currently performed using the flexible instrument, and most bronchoscopists have never been trained in the technique of rigid bronchoscopy.

Bronchoalveolar Lavage Fluid↗

A fiberoptic bronchoscopy assistant program.

The increased popularity of bronchoscopy performed outside the operating room has created a need for the bronchoscopy assistant service. The Stanford (Calif) University service is described here as a guide for departments establishing a bronchoscopy assistant service or restructuring an existing one.

Allied Health Personnel↗

Interactive navigation and bronchial tube tracking in virtual bronchoscopy.

An interactive virtual environment for simulation of bronchoscopy is developed. Medical doctor can safely plan their surgical bronchoscopy using the virtual environment without any invasive diagnosis which may risk the patient's health. The 3D pen input device of the system allows the doctor to navigate and visualize the bronchial tree of the patient naturally and interactively. To navigate the patient's bronchial tree, a vessel tracking process is required. While manual tracking is tedious and labor-intensive, fully automatic tracking may not be reliable. We propose a semi-automatic tracking technique called Intelligent Path Tracker which provides automation and enough user control during the vessel tracking. To support an interactive frame rate, we also introduce a new volume rendering acceleration technique, named as IsoRegion Leaping. The volume rendering is further accelerated by distributed rendering on a TCP/IP-based network of low-cost PCs. With these approaches, a 256 x 256 x 256 volume data of human lung, can be navigated and visualized at a frame rate of over 10 Hz in our virtual bronchoscopy system.

Bronchoscopy↗

[Setting up written informed consent for fiberoptic bronchoscopy in the pneumology units of Spanish hospitals].

OBJECTIVES: To assess the implantation and quality of written IC in the pulmonology units of Spanish hospitals. METHOD: A descriptive study was initiated with a nation-wide mail and/or telephone survey of 117 Spanish hospitals to determine whether or not written ICs were signed before fiberoptic bronchoscopy. If the respondents answered affirmatively, a copy of the form was requested for evaluation. Evaluation criteria were a) whether IC was specific for fiberoptic bronchoscopy, and if it was, b) whether it contained information as well as a declaration of consent, and c) whether the information and declaration were adequate, fulfilling minimum requirements. RESULTS: Seventy-three pulmonology units (60%) responded and 49 of them (67.1%) reported that they obtained written ICs while 24 (32.9%) did not. Of the 49 departments that reported asking for written IC, 41 (83%) used forms that were specific for fiberoptic bronchoscopy and 8 (17%) used nonspecific forms. The 41 units with specific IC forms submitted papers containing both information and declaration sections. The information was adequate in 10 cases (24%) and the declaration was appropriate in 17 (41%); only 6 (14%) had both adequate information and an appropriate declaration. CONCLUSIONS: Written ICs are increasingly common and are present in 67% of the pulmonology units that responded to the questionnaire. The low number of forms meeting minimum requirements is remarkable. It would be useful to design an IC form that respects our specific sociocultural context for use nation-wide in Spain.

Bronchoscopy↗

[Anesthesia in interventional bronchoscopy].

Interventional rigid bronchoscopy requires the same careful anesthetic management as any type of surgery. Furthermore, access to airways for both endoscopist and anaesthetist raises difficult problems. Hypoventilation with its consequences is a major risk, especially for patients with impaired ventilatory capacity. General anesthesia warrants controlled or assisted mechanical ventilation, without precise spirometric monitoring because of air leakage. Discussion of indications between both operators is needed. Careful preoperative evaluation is required. Ultra short intravenous anesthetic agents are chosen for a rapid recovery of consciousness and ventilation. Ventilation is generally manually assisted or delivered by high frequency jet ventilation. Flexible fiberoptic bronchoscopy is systematically performed before extubation. Interventional rigid bronchoscopy is ideally performed in an operating room or an adjacent area or in an intensive care unit in case of complication. Postoperative supervising in a recovery room is mandatory.

Anesthesia↗

Therapeutic bronchoscopy.

Endoscopic therapy has been used extensively in every field of medicine. The bronchial tree is no exception. The rigid bronchoscope was mainly used for foreign body extraction and hemostasis from and in the bronchial tree. With the evolution of flexible fiberoptic bronchoscope, the scope of therapeutic bronchoscopy has widened. The principles of therapeutic bronchoscopy, the various indications and brief description of such procedures like laser-bronchoscopy, endo-bronchial brachytherapy, management of airway strictures, its role in management of hemoptysis and foreign body removal have been reviewed.

Airway Obstruction↗

The effects of remifentanil on haemodynamic stability during rigid bronchoscopy.

We examined the effect of remifentanil on the haemodynamic response to rigid bronchoscopy in 22 adult ASA 2-4 patients, randomly allocated to receive 1.0 microg.kg-1 remifentanil over 1 min followed by 0.5 microg.kg-1.min-1 (remifentanil group) or 2.0 microg.kg-1 fentanyl followed by a saline infusion (control group). Following the initial infusion, all patients received a sleep dose of propofol followed by rocuronium 0.6 mg.kg-1 and their lungs were ventilated using a Sander's injector attached to the rigid bronchoscope. Direct arterial blood pressures, heart rate and ST segment changes on the CM5 lead configuration of the electrocardiograph were measured at 1-min intervals from before induction of anaesthesia until the end of bronchoscopy. Arterial pressures and heart rate were similar in the two groups before and after induction of anaesthesia. Remifentanil attenuated the haemodynamic response to bronchoscopy (p < 0.05 for increases in arterial pressures and heart rate). Four patients in the remifentanil group had ST segment depression compared with eight patients in the control group, but this was not statistically significant.

Adult↗

Laser bronchoscopy: experience at Siriraj Hospital.

Laser bronchoscopy is a major procedure employed in intervention bronchoscopy. From August 1998 to August 2000, 20 patients with endobronchial lesions were treated by this procedure in the Respiratory and Tuberculosis Division of the Department of Internal Medicine, Siriraj Hospital. Of 16 malignant lesion, a good response was obtained in 78 per cent (7 out of 9) of lesions in the proximal right main bronchus with failure to open any of the 3 completely obstructed lesions at the left distal bronchus. The results of treatment of malignant lesions in the trachea and carina were acceptable. Good results were obtained from all 4 benign endobronchial obstructions. No complications arose in this study. This small series demonstrates the benefit of laser bronchoscopy in patients with high risk endobronchial obstructive lesions.

Adenocarcinoma↗

Comparison of direct vision and video imaging during bronchoscopy for pediatric airway foreign bodies.

Rigid ventilation bronchoscopy is a most useful means of detecting and removing foreign bodies in the airway. We performed a retrospective study of 114 children who had undergone such a procedure during a 12-year period. During bronchoscopy, 48 of these patients had been examined under direct vision and 66 by videotape recording. We found that the positive rate on first-look direct vision was 93.8% and the positive rate on first-look video imaging was 89.4%. The lower positive rate during the first-look examination by video imaging might be attributable to the facts that it is safer and that it provides a better visual field, which can encourage operators to choose video ventilation bronchoscopy, either as a diagnostic or therapeutic tool. In addition, three foreign-body-negative patients in the direct-vision group under-went a second procedure, and a foreign body was found in all three. Only one of the video-imaging patients under-went a second procedure, and no foreign body was found. The difference in the positive rates after the second procedure was statistically significant (p < 0.05). This might be attributable to the higher success rate with video imaging following the first procedure, which significantly reduced the need for a second look and the possibility of overlooked or residual foreign bodies. The condition of the mucosa postprocedurally was described in every case after video imaging but after only 41.7% of the direct-vision cases--a statistically significant difference (p < 0.001). Video imaging provides the physician with a clear, magnified view of the area under examination. It allows for later review of the videotape when necessary, and it reduces the risk that residual foreign-body material will remain in the airway.

Bronchoscopy↗

[Flexible bronchoscopy].

BACKGROUND: Bronchoscopic examination is an established method, most often performed by lung doctors, yet still mandatory in the training of specialists in otolaryngology. Little has so far been published on the safety and diagnostic and therapeutic value of this procedure in our country. MATERIAL AND METHODS: Specialists or residents in otolaryngology performed 140 flexible bronchoscopies in 132 consecutive patients during 1993-2000. Local anaesthesia was used in 132 and general anaesthesia in 8. There were 59 outpatient and 81 inpatient procedures. The medical records were examined retrospectively. RESULTS: The indication for bronchoscopy was suspected cancer in 98 cases. At the time of the examination 78 patients had intrathoracic malignant disease. Diagnostic sensitivity in bronchogenic cancer (n = 65) was 71%. Diagnostic sensitivity when tumour was endoscopically visible (n = 41) and non-visible (n = 37) was 85 % and 49% respectively. No cancer was found in patients with haemoptysis as the only symptom (n = 11). No serious complications occurred. INTERPRETATION: Bronchoscopy, including examination for malignant disease was performed safely and with good results. The number of bronchoscopic examinations on non-cancer or classical otolaryngologic patients would probably be too low to maintain the skills and secure good education in our department.

Adolescent↗

Bronchoscopy for pulmonary hygiene in the intensive care unit.

The safety and ease of fiberoptic bronchoscopy recommends its use in the intensive care unit. In critically ill patients, the procedure may be a valuable diagnostic or therapeutic tool. In most instances, the diagnostic indications are well defined. The therapeutic indications for bronchoscopy, however, are more controversial. They center around using the bronchoscope for removal of secretions, mucus plugs and reversing atelectasis in mechanically ventilated patients. This report examines the small but definite risk of therapeutic bronchoscopy in mechanically ventilated patients.

Adult↗

[Manipulation, premedication, and chemoprophylaxis for fiberoptic bronchoscopy].

Manipulation, premedication, and chemoprophylaxis for fiberoptic bronchoscopy vary among institutions. We analyzed the actual conditions by means of a questionnaire distributed to 29 institutions. With regard to premedication, a combination of atropine sulfate and sedatives, such as hydroxyzine hydrochloride, was the most common method. In cases with heart disease and elderly subjects, a lower dosage or omission of atropine was common. In cases with marked anxiety, narcotics were prescribed. Bronchofiberscopic examination was performed under local anesthesia at all institutions. Lidocaine 4% was used for anesthesia of the orolarynx, and 2% was used for the tracheobronchus. For prophylaxis of infection, 19 of 29 institutions prescribed antibiotics routinely or under certain circumstances. ECG was used in 14 institutions, and percutaneous oxygen monitoring in 5 institutions. It is concluded that the manipulation and premedication for fiberoptic bronchoscopy vary between institutions. It is necessary to determine more efficacious and safer methods for fiberoptic bronchoscopy.

Anesthesia, Local↗