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At least 649 records · Page 36Linked to original sources
PubMed2004

Threshold selection in virtual bronchoscopy: phantom study and clinical implications.

PURPOSE: To investigate the effect of the threshold selection on the apparent diameter of a virtual bronchus and the virtual wall morphology and to examine the parameters that can affect the selection of the appropriate threshold for virtual bronchoscopy with single slice computed tomography. MATERIAL AND METHODS: A bronchial phantom containing plastic tubes simulating the airways of the tracheobronchial tree was constructed. The diameters of the virtual images of these tubes were measured using various thresholds for two different materials surrounding the tubes: air and water. These measurements were correlated with the density in HU of the walls. Furthermore, data from 20 virtual bronchoscopies in patients were retrospectively analyzed in the same way. RESULTS: The diameter of a virtual bronchus is strongly affected by the selected threshold. The appropriate threshold for accurate diameter representation depends on the density of the bronchial wall. CONCLUSION: Our results suggest that in clinical practice a single threshold value cannot be used for imaging all segments of the tracheobronchial tree. While a value of -520 is appropriate for the trachea and lobar segments, values down to -720 could be needed on the level of segmental and subsegmental bronchi. At these levels, a threshold value about 65 HU more negative than the value where the artificial holes appear on the virtual bronchial walls could be used.

Bronchoscopes↗
PubMed1981

Safety, usefulness and acceptability of fibreoptic bronchoscopy in the elderly.

The safety and usefulness of fibreoptic bronchoscopy in the elderly was assessed retrospectively in 204 consecutive patients aged 70 and over. One third of patients were examined as day cases. A bronchial tumour was seen in 67% patients, and biopsies showed malignancy in 78% of these cases. Certain knowledge of a diagnosis of bronchial carcinoma helped in the management of the elderly patient. Fibreoptic bronchoscopy proved to be safe in the presence of marked ventilatory impairment. A prospective questionnaire study in 114 patients showed that most patients found the procedure acceptable and would agree to a repeat if necessary and this was largely independent of age.

Aged↗
PubMed1978

Premedication with lorazepam for bronchoscopy under general anaesthesia.

Lorazepam 3 or 4 mg i.m. was given to 100 patients as premedication before bronchoscopy under thiopentone-suxamethonium anaesthesia. Forty-nine of the patients assessed as anxious received oral lorazepam as preoperative night sedation also. Lorazepam was an effective night sedative. Forty-two of the 49 patients slept well and were calm and co-operative in the morning. Following the i.m. injection of lorazepam, 64% of patients had complete lack of recall for 4--10 h following premedication. Only 5% recalled correctly a simple objective test of memory initiated in the anaesthetic room. The frequency of recall was higher in those who consumed alcohol regularly and in females. There was one case of awareness during bronchoscopy in a patient who received only a small dose of lorazepam (2.8 mg per 70 kg). Side-effects were minimal and patient acceptance was impressive. These results show an advance on previous studies using pethidine and diazepam. Further improvement is needed, particularly in adjusting the dose of lorazepam to body weight and to factors such as age, sex and alcohol intake.

Adolescent↗
PubMed2000

Carbon dioxide elimination during high-frequency jet ventilation for rigid bronchoscopy.

Oxygen saturation and carbon dioxide values should be monitored during high-frequency jet ventilation (HFJV). Modern transcutaneous PCO2 (PtcCO2) measurement allows the estimation of ventilation efficiency. We studied how tests of lung function could predict carbon dioxide elimination during HFJV. Lung function tests from 180 adult patients undergoing rigid bronchoscopy were analysed as factors affecting carbon dioxide elimination. The lung function test results showed a significant relationship with the efficiency of carbon dioxide elimination; the greatest impairment of carbon dioxide elimination was found in patients with combined abnormalities of lung function. Further factors associated with difficult carbon dioxide elimination were male gender and elevated body weight. Of the patients investigated, 72% had normal carbon dioxide elimination, whereas in 23% hypercapnia could be avoided only by increasing the driving pressure. The prevalence of abnormal preoperative lung function test results predicts (sensitivity 76%, positive predictive value 27%) impaired carbon dioxide elimination during jet ventilation and rigid bronchoscopy.

Adolescent↗
PubMed1987

Accelerated idioventricular rhythm during flexible fiberoptic bronchoscopy.

We report the case of a patient who developed severe hypoxemia and an unusual arrhythmia, accelerated idioventricular rhythm, during flexible fiberoptic bronchoscopy. Coronary artery disease was subsequently suspected despite an unremarkable history and physical examination, and confirmed by a thallium 201 imaging. The appearance of accelerated idioventricular rhythm during fiberoptic bronchoscopy should raise the possibility of underlying coronary artery disease.

Aged↗
PubMed1987

Jet ventilation in support of fiberoptic bronchoscopy.

Mechanical ventilatory support of bronchoscopic procedures by conventional volume-cycled ventilation (VCV) is technically difficult and can result in unreliable gas delivery or excessive alveolar pressure. An alternate support mode is jet ventilation through an open, uncuffed endotracheal tube. To quantitate gas delivery and airway pressures (Paw) during bronchoscopy using this technique, we used a mechanical-lung model and 15 human subjects. Jet ventilation pulsed gases at 60 to 100 cycle/min through a catheter in an uncuffed, jet endotracheal tube with a 5.9-mm (OD) bronchoscope in place. Inspiratory time was constant at 33% of cycle time, and jet-drive pressures ranged from 5 to 30 psi. In the mechanical-lung model, the jet technique provided up to 30 L/min of ventilation with mean airway pressures (Paw) always less than 10 cm H2O. In contrast, VCV with an inflated cuff, while providing similar levels of ventilation, resulted in substantial air trapping and over twice the Paw. VCV with a deflated cuff provided much lower levels of ventilation, although Paw levels were also low. These delivered minute ventilations, and Paw levels were similar in six normal volunteers jet ventilated through a 9-mm jet endotracheal tube with a bronchoscope in place. Finally, in nine patients requiring mechanical ventilatory support during bronchoscopic procedures, this jet technique provided alveolar ventilation (i.e., PaCO2) and Paw levels comparable to those obtained on baseline VCV before bronchoscopy.

Adult↗
PubMed2000

Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates.

OBJECTIVE: To analyze the impact of fiberoptic bronchoscopy and bronchoalveolar lavage (BAL) on guiding the treatment and intensive care unit (ICU) clinical outcome in neutropenic patients with pulmonary infiltrates admitted to the ICU. DESIGN: Prospective collection of data. SETTING: Medical ICU in a teaching hospital. PATIENTS: During a 6-yr period, we analyzed the results of 93 fiberoptic bronchoscopies plus BALs performed in 93 consecutive neutropenic ICU patients. We separated the patients into two groups according to the cause of neutropenia (high-dose chemotherapy [n = 41] or stem cell transplantation [SCT; n = 52]). RESULTS: Of the 93 BALs, 53 were performed to evaluate diffuse infiltrates and 42 were performed on mechanically ventilated patients. Forty-nine percent of BALs (46 patients) were diagnostic, with a significantly better yield in ICU patients with high-dose chemotherapy-induced neutropenia (26 of 41 BALs). The number of cases of proven infectious pneumonia was significantly higher in this group of ICU neutropenic patients. In patients who underwent SCT, diffuse infiltrates were statistically correlated with a negative result of BAL. Twenty-six patients who underwent diagnostic BALs changed therapy. Sixteen complications (17%) occurred with only two intubations. The overall mortality rate in the ICU and the mortality rate in mechanically ventilated neutropenic patients were 71% and 93%, respectively. In neutropenic patients who underwent SCT, the mortality rate was statistically higher in patients in whom no diagnosis was established. Patients who had a diagnostic BAL that changed therapy did not have an increased probability of survival compared with patients who had a BAL that did not change therapy. CONCLUSIONS: The use of routine diagnostic BAL in ICU neutropenic patients with pulmonary infiltrates is difficult to establish, even if BAL is helpful in the management of these critically ill patients. BAL in our ICU neutropenic patient population had an acceptable overall diagnostic yield (49%), which was higher in ICU patients with chemotherapy-induced neutropenia. Nevertheless, in the ICU, if BAL had a low complication rate, it had infrequently led to changed treatment and was not associated with improved patient survival.

Adult↗
PubMed1987

Early bronchoscopy as a predictor of ventilatory support for burned patients.

Twenty-seven burned patients who had facial burns, hoarseness, or evidence of carbonaceous sputum or had been in a smoke-filled enclosed space underwent fiberoptic bronchoscopy at the time of admission. Airway severity was indexed (grades 1-5, grade 5 being the most severe). Fifteen nonsurvivors had a bronchoscopic index of 3.2 +/- 1.6 and 12 survivors an index of 3.4 +/- 1.2 (p greater than 0.05). No patient died of respiratory complications. Bronchoscopic index correlated poorly with the level of positive end expiratory pressure required to maintain oxygenation in any patient (r = 0.50). Likewise, bronchoscopic index did not correlate with duration of intubation in any survivor (r = 0.33). Immediate bronchoscopy after burn injury neither indicates the level of respiratory support that will be required nor predicts its duration.

Bronchoscopy↗
PubMed1975

Flexible fiberoptic bronchoscopy with general anesthesia in the poor-risk patient.

A study is presented of seven poor-risk patients who had bronchoscopy with a flexible fiberoptic bronchoscope and balanced general anesthesia. The cardiorespiratory status, as evidenced by arterial blood gas determinations, electrocardiographic findings, and blood pressure measurements, was improved and stabilized in all patients. Flexible fibeoptic bronchoscopy, combined with general anesthesia, has proved to be a reliable and safe procedure useful for both diagnosis and treatment in poor-risk patients.

Adult↗
PubMed1986

Flexible bronchoscopy in the diagnosis of Pneumocystis carinii pneumonia in patients with acquired immune deficiency syndrome.

Seventy-seven patients with acquired immune deficiency syndrome (AIDS) and suspected of having Pneumocystis carinii pneumonia (PCP) had flexible bronchoscopy. The diagnosis was established in 52 of the 54 patients (96%) who proved to have PCP. There was one false-positive result. The remaining 22 patients and the patient with the false-positive diagnosis had diseases other than PCP, or no diagnosis. Flexible bronchoscopy is a safe and sensitive diagnostic procedure in patients with PCP complicating AIDS, and is recommended as the first invasive diagnostic procedure when patients at risk for AIDS have acute pulmonary complications.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Bronchoscopy and esophagoscopy in children.

This review summarizes some of the most recent developments and areas of investigation in pediatric bronchoscopy and esophagoscopy. Applications of newer technology have allowed for improved diagnosis and therapy for many pediatric diseases. These applications include the use of bronchoscopy for the diagnosis of pulmonary diseases, assessment and therapy of airway obstruction, and management of the difficult intubation. Studies during the past year on esophagoscopy may change our approach to the diagnosis and management of esophageal varices and esophagitis, and evaluation after caustic ingestion.

Bronchoscopy↗
PubMed2004

Tracheal and central bronchial aerodynamics using virtual bronchoscopy and computational fluid dynamics.

Virtual bronchoscopy reconstructions of the airway noninvasively provide useful morphologic information of structural abnormalities such as stenoses and masses. In this paper, we show how virtual bronchoscopy can be used to perform aerodynamic calculations in anatomically realistic models. Pressure and flow patterns in a human airway were computed noninvasively. These showed decreased pressure and increased shear stress in the region of a stenosis.

Air Movements↗
PubMed2006

Patient-specific bronchoscopy visualization through BRDF estimation and disocclusion correction.

This paper presents an image-based method for virtual bronchoscope with photo-realistic rendering. The technique is based on recovering bidirectional reflectance distribution function (BRDF) parameters in an environment where the choice of viewing positions, directions, and illumination conditions are restricted. Video images of bronchoscopy examinations are combined with patient-specific three-dimensional (3-D) computed tomography data through two-dimensional (2-D)/3-D registration and shading model parameters are then recovered by exploiting the restricted lighting configurations imposed by the bronchoscope. With the proposed technique, the recovered BRDF is used to predict the expected shading intensity, allowing a texture map independent of lighting conditions to be extracted from each video frame. To correct for disocclusion artefacts, statistical texture synthesis was used to recreate the missing areas. New views not present in the original bronchoscopy video are rendered by evaluating the BRDF with different viewing and illumination parameters. This allows free navigation of the acquired 3-D model with enhanced photo-realism. To assess the practical value of the proposed technique, a detailed visual scoring that involves both real and rendered bronchoscope images is conducted.

Algorithms↗
PubMed1976

Eelectrocardiographic findings during bronchoscopy. Use of the Sanders' ventilating attachment.

The incidence of cardiac dysrhytmias was investigated in 50 patients during bronchoscopy performed under general anaesthesia using the bronchoscope with Sanders ventilating attachment. The results were compared with similar investigations utilising alternative methods of anesthesia. Sinus tachycardia occurred frequently, but was less severe than during previous investigation. The incidence of dysrhytmias 16% overall, was less than with earlier methods. Only 2 patients (4%) exhibited a dysrhythmia of any significance. It is concluded that use of the Sanders ventilating attachment represents a genuine advance during anaesthesia for bronchoscopy.

Adult↗
PubMed1983

Respiratory injury in the burned patient. The role of flexible bronchoscopy.

The purpose of the study was to investigate the role of flexible bronchoscopy in the management of patients admitted to a busy Regional burns unit, with particular reference to possible smoke inhalation injury. The basic procedure employed was that used in routine bronchoscopy for the diagnosis of bronchial carcinoma, with modification of the premedication required in view of the shorter duration of the technique and the lack of a requirement for bronchial biopsy. We have found the procedure easy to perform, well tolerated by the patients and not associated with any complications. It provides additional information not otherwise available, which can influence the subsequent management of the patient. An experienced bronchoscopist and additional personnel skilled in resuscitation techniques are required. It should be performed in patients with clear evidence of smoke inhalation injury and in particular with facial burns in order to visualise the extent of airway injury, remove debris and give some indication of the likelihood of subsequent complications such as acute upper airways obstruction.

Adult↗
PubMed1985

Fibre-optic assessment of tracheal tube position. A comparison of tracheal tube position as estimated by fibre-optic bronchoscopy and by chest X-ray.

The distance between the tip of a tracheal tube and the carina was measured in twenty five patients who required tracheal intubation and artificial ventilation of the lungs. Two methods of evaluation of this distance--limited-optic bronchoscopy and chest X-ray--were compared. There was no significant difference between the distance measured by either method. The advantages of checking tracheal tube placement by fibre-optic bronchoscopy are discussed.

Adult↗
PubMed1990

A jet nebuliser for delivery of topical anesthesia to the respiratory tract. A comparison with cricothyroid puncture and direct spraying for fibreoptic bronchoscopy.

Topical anesthesia of the respiratory tract for fibreoptic bronchoscopy was compared, in a single-blind study, inhaled from a simple and inexpensive jet nebuliser, administered by cricothyroid injection or by a 'spray-as-you-go technique'. Each technique was supplemented by spraying lignocaine through the fibrescope and intravenous fentanyl-droperidol sedation. Inhaled nebulisation was successfully used for 96% (46 of 48) of patients, was safe, effective and acceptable to the patient and bronchoscopist. The cricothyroid injection method produced better conditions than nebulisation in patients who had diagnostic bronchoscopy. The nebuliser technique is as satisfactory as the spraying technique in patients for diagnostic bronchial lavage in whom bleeding from a cricothyroid puncture is unacceptable. Patients who used the nebuliser were more satisfied. This technique may also be a useful method for 'awake' intubation.

Administration, Inhalation↗
PubMed1993

Glycopyrrolate vs. atropine during anaesthesia for laryngoscopy and bronchoscopy.

As glycopyrrolate has been reported superior to atropine with respect to reduction of salivation, stability of cardiac rate and rhythm, and recovery, a comparison of these properties of the two drugs and placebo was made in 45 patients undergoing direct laryngoscopy and 45 patients undergoing bronchoscopy, in most cases followed by mediastinoscopy. When given i.m. 30 min before anesthesia (midazolam, alfentanil, thiopentone, and suxamethonium), the two test drugs were found to be equally potent regarding the antisialogogic effect. The same increase in heart rate after the test drugs was seen before induction, and during anaesthesia heart rate rose to the same level in the placebo group as the test groups. During anaesthesia, blood pressure was lowest in the atropine group. No differences could be demonstrated with respect to cardiac arrhythmias, possibly due to the small size of the material. The present study gives no reason for preferring either drug, and only the efficacy of both test drugs in controlling airway secretions provides an argument for using any anticholinergic drug when laryngoscopy or bronchoscopy is performed under the conditions of the present study.

Adult↗