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PubMed1984

Retention of intact cells on bronchoscopy brushes after cleaning.

Reusable nylon bristle bronchoscopy brushes were evaluated to assess whether cytologically recognizable cells could be retained on the bristles after conventional cleaning techniques. Twenty brushes were used during bronchoscopy; 5 brushes were inserted directly into freshly resected neoplasms. The brushes were then scrubbed and rinsed in chlorhexidine gluconate, iodine, and alcohol, and air dried. Several days later fresh cytologic specimens were prepared from the apparently clean brushes. Eighty percent of the cytologic specimens exhibited strands of mucus, most containing well-preserved alveolar macrophages, polymorphonuclear leukocytes, and ciliated epithelial cells. Although no malignant cells were retained, it is clear that conventional cleaning techniques are inadequate for the removal of cells and acellular debris. Consideration should be given to immersing brushes in acetylcysteine or employing disposable brushes.

Bronchoscopy↗
PubMed2002

Patient satisfaction with bronchoscopy.

We conducted a cohort study to characterize patient satisfaction with flexible bronchoscopy (FB) and to determine patient characteristics, care factors, and patient evaluations of bronchoscopy that are associated with a patient's willingness to return for repeat FB. Physicians and patients completed surveys between February 1997 and June 1998. Data from 481 patients were analyzed. Over 80% of the patients rated physicians as very good or excellent, but they were least satisfied with the information that they were provided about FB, waiting time before and after FB, and the FB environment. Seventy-one percent of the patients would definitely return, and 22% would probably return for a repeat FB. Better health status (odds ratio [OR] 1.4; 95% confidence interval [CI], 1.1-1.7), not being bothered by scope insertion (OR 2.0; 95% CI, 1.2-3.3), better rating of information quality (OR 1.2; 95% CI, 1.0-1.3), and better rating of physician quality (OR 1.1; 95% CI, 1.0-1.2) were associated with patients reporting that they would definitely return for a repeat FB. Although patient satisfaction with providers is high, there are specific patient and process of care factors that should be improved. Sicker patients may be at a risk of dissatisfaction with FB. Process of care measures that could improve satisfaction with FB include providing better information to patients and optimizing the experience of bronchoscope insertion.

Adolescent↗
PubMedDate not supplied

Flexible bronchoscopy in nonvisualized carcinoma of the lung.

Of 1,000 consecutive patients undergoing fiberoptic bronchoscopy, 331 eventually were proven to have primary lung cancer. Of the 331 carcinomas, 253 were beyond the visual range of the flexible bronchoscope. However, under fluoroscopic guidance, the diagnosis of carcinoma was established in 194 (76.7%) of these nonvisualized tumors. Cytologic analysis of brush specimens was more often positive for malignancy than specimens obtained by forceps biopsy. An expert cytologist and experienced bronchoscopy team are esential for a high percentage of reliable positive diagnoses in bronchogenic carcinoma.

Biopsy↗
PubMedDate not supplied

Pediatric flexible bronchoscopy.

We have utilized a prototype pediatric flexible bronchoscope to perform diagnostic and therapeutic procedures on pediatric patients ranging from 840 gm to 14 years of age. Flexible bronchoscopy, with appropriate instrumentation and careful attention to physiological requirements of the patient, is safe and effective in pediatric patients. The availability of new instrumentation promises to have as great an impact on pediatric pulmonology as the standard flexible bronchoscopes did on adult pulmonology. With this instrument, the indications for bronchoscopy may be considerably expanded.

Adolescent↗
PubMedDate not supplied

Fluorescence bronchoscopy. A new technique and further results.

A new method of fluorescence bronchoscopy is presented which uses a standard light source and a special filter combination to permit the carrying out of fluorescence bronchoscopy with a surface marking method by means of inhaling a fluorescein solution. Normal mucous membrane, or mucous membrane with no histological change other than inflammation, which is cleansed by ciliary activity, does not usually fluoresce for a period longer than about two hours after the inhalation. There were, it is true, 13 false positive fluorescence out of 52 fluorescing areas in the mucous membrane. Correctly recorded were 39 cases of positive, ie, visible tumors, metaplasias, accumulation of mucous glands in the epithelium, and mucous membrane which had undergone a neoplastic change in the sense of a lymphangitis carcinomatosa or a mucous membrane carcinosis; these all caused fluorescence. The false negative results amounted to only two nonfluorescing tumors and one metaplasia. These diagnoses arise from the first 100 patients examined by this method. the fact must be especially emphasized that out of the 58 carcinoma cases, there were 7 where neoplastic changes in the mucous membrane were diagnosed by the fluorescence technique, although they had not been recognized macroscopically either by the naked eye or by the Hopkins optical technique.

Biopsy↗
PubMedDate not supplied

Bronchoscopy in the staging and evaluation of head and neck carcinoma.

There is no consensus of opinion regarding the use of routine bronchoscopy, either rigid or flexible, to evaluate patients with primary squamous cell carcinomas of the upper aerodigestive tract for the possibility of second synchronous primary cancers. Whereas there is certainty of the effectiveness of this endoscopy in patients with questionable lesions or masses on chest radiographs, the value of this procedure in the face of a normal, unequivocal chest radiograph remains questionable. Six patients with primary carcinomas in the upper head and neck region and normal chest radiographs were among 98 patients evaluated within the past 6 months by triple endoscopy. In three instances, a small (less than 2 cm) lesion was discovered in the tracheobronchial tree, utilizing rigid diagnostic bronchoscopy. In three other patients with positive cytology from bronchial washings, a lung primary carcinoma has not been discovered. These presumed false-positive findings add a watchword of warning. The observation of these patients provides evidence to support the routine panendoscopic evaluation of all patients with squamous cell carcinomas of the head and neck. A valid study to identify subgroups at risk to develop these cancers should be encouraged.

Aged↗
PubMed1995

Trade-off between airway resistance and optical resolution in pediatric rigid bronchoscopy.

Contemporary pediatric rigid bronchoscopy reflects the culmination of years of work by prominent endoscopists aided by technical developments in optical physics and refinements in optical lens manufacturing. Improved neonatal and pediatric care has allowed survival of premature infants, many with bronchopulmonary diseases. Rigid bronchoscopy in these infants is demanding and has necessitated the development of miniaturized telescopic bronchoscopes. This study documents airway pressures through bronchoscopes with and without endoscopic telescopes, analyzes and quantitates optical resolution, discusses the trade-offs between these instruments in airway resistance and optical resolution, and makes recommendations regarding which combinations of endoscopes and bronchoscopes provide the best resistance and resolution profiles. We conclude that the size 1.9-mm endoscopic telescope provides the most favorable resistance and resolution profile for the size 2.5 to 3.0 bronchoscopes, the 2.8-mm telescope is ideal for the 3.5 bronchoscope, and the 4.0-mm telescope works best with the 4.0 and larger bronchoscopes. Furthermore, optical forceps and side-channel forceps used during bronchial foreign body removal cause little change in airway resistance.

Airway Resistance↗
PubMed1985

Pediatric flexible bronchoscopy and its application in infantile atelectasis.

Forty-six pediatric flexible fiberoptic bronchoscopies were done on 29 infants under 1 year of age, including a 2.3-kg 1-week-old infant girl, and 17 small children between 1 and 2 years of age with persistent unilobar or multilobar atelectasis and declining PaO2 or rising PaCO2. Atelectasis resolved in all 29 infants (100%) and 10 of 17 (59%) small children after direct visualization, bronchial washing, and removal of mucous plugs and/or secretions using a flexible fiberoptic bronchoscope (FFB). The procedure was not associated with any mortality or significant morbidity. Only one infant experienced minor epistaxis and another had transient minimal stridor. None of the 17 small children developed complications. The procedure resulted in resolution of respiratory distress and cough within 24 hours, as well as early hospital discharge in all patients regardless of complete or partial radiographic expansion. Arterial blood gases were improved or normalized in 16 patients. When utilized for selective aspiration of mucous plugs or bronchial secretions, pediatric flexible bronchoscopy is particularly helpful in children with segmental or lobar atelectasis.

Bronchoscopy↗
PubMed1989

Pediatric bronchoscopy. A report of methodology and results.

Data for this article were obtained from a retrospective analysis of 386 pediatric bronchoscopies from 1979 through 1986. Endoscopic procedures were carried out under general anesthesia using a rigid open bronchoscope. There were 235 boys (61%) and 151 girls (39%). The mean age was 2 years, 3 months. Eight percent of the girls were under 1 month of age, compared with only 4 percent of the boys. The lightest patient weighed 650 g. In children under 1 year of age, the most common indications were dyspnea (32%) and anomaly or suspicion of anomaly (20%). In children over 1 year of age suspected foreign body (32%) and recurrent respiratory infections (30%) were the most common indications. In 15 percent of patients, laryngomalacia and/or an abnormal epiglottis was confirmed. Subglottic stenosis, congenital or acquired, was confirmed in 9 percent and tracheal compression in 12 percent of cases. Seventeen percent of the children showed totally normal findings. There were only eight complications in the whole series and no death or cardiac arrest. The authors confirm the safety of bronchoscopy when careful attention is paid to preoperative investigations, selection of the instruments used, and postoperative care.

Adolescent↗
PubMed1980

Anaesthesia for bronchoscopy: examination of a standard technique.

An anaesthetic technique for bronchoscopy is described, based on increments of methohexitone given in strict relation to body weight and time, suxamethonium being used to produce relaxation. There was no awareness in the 75 patients studied, while the recovery was rapid and unrelated to the duration of bronchoscopy. The efficacy of small aliquots of lignocaine in reducing injection pain was the same whether given before, or mixed with, the initial methohexitone injection. Other sequelae relating to the anaesthetic technique were minimal.

Adult↗
PubMed1985

Patient comfort and plasma lignocaine concentrations during fibreoptic bronchoscopy.

In a preliminary prospective study, eleven outpatients undergoing fibreoptic bronchoscopy using a titrated dose of topical lignocaine anaesthesia were studied. Patient comfort, lignocaine dosage and resultant plasma concentrations were measured at four stages during the procedure. Large total doses, mean 512 (SD 55) mg lignocaine, were frequent and systemic absorption was unpredictable with two patients having plasma concentrations in the toxic range (greater than 5 micrograms/ml). Peak plasma concentrations, mean 2.3 (SD 1.4) micrograms/ml, occurred 30 to 40 minutes after commencement of topical application and coincided with completion of the procedure. No correlation was found between the individual dose of lignocaine administered and either the resultant plasma concentration or patient comfort scores. In an effort to minimise potential lignocaine toxicity, a fixed total dose technique (lignocaine 370 mg) was studied in a further twenty-one patients. No change in patient comfort scores and no toxic plasma concentrations were observed. Mean completion plasma concentration was 2.0 (SD 1.0) micrograms/ml. No clinical toxicity was observed in either group. Fibreoptic bronchoscopy in both groups using topical lignocaine anaesthesia without premedication or intravenous supplementation was well tolerated.

Administration, Oral↗
PubMedDate not supplied

The role of bronchoscopy in patients with HIV disease.

Pulmonary involvement is a frequent feature of patients infected with the human immunodeficiency virus (HIV). Pneumocystis carinii pneumonia (PCP) is still the commonest AIDS defining diagnosis despite the advent of effective prophylaxis and antiretroviral treatment. Other pulmonary manifestations of AIDS, including tuberculosis, may pose a greater problem in the future. The clinical manifestations of HIV-disease are many and varied, and changing as the disease is modified by therapeutic interventions. With specific and increasingly effective treatments the need for definitive diagnosis is obvious. Fibreoptic bronchoscopy is a well established tool for the diagnosis of HIV-related pulmonary complications. This article aims to give an account on the use of bronchoscopy in a unit providing care for many HIV seropositive patients.

Bronchoscopy↗
PubMedDate not supplied

Usefulness of induced sputum and fibreoptic bronchoscopy specimens in the diagnosis of pulmonary tuberculosis.

We investigated the diagnostic value of induced sputum (IS) and bronchial lavage (BL) specimens in patients with suspected pulmonary tuberculosis who had negative spontaneous sputum specimens or who were unable to produce sputum spontaneously. IS specimens and BL specimens obtained using flexible fibreoptic bronchoscopy from 55 patients were evaluated for the presence of acid-fast bacilli (AFB) and cultured for Mycobacterium tuberculosis. Positive results were found with IS smear in 23 patients, BL smear in 26 patients, and IS or BL culture in 42 patients. Culture of BL specimens had a higher sensitivity than IS or BL smears or culture of IS specimens. The highest sensitivity rate was obtained with a positive BL or IS culture (86%). For early diagnosis (a positive IS or BL smear), the sensitivity was 57%. IS has a higher sensitivity rate than spontaneous sputum for the detection of tuberculosis, and fibreoptic bronchoscopy is useful for the early diagnosis of tuberculosis when AFB are not detected in spontaneous or induced sputum specimens.

Adolescent↗
PubMed2002

Survey of flexible fibreoptic bronchoscopy in the United Kingdom.

The practice of flexible bronchoscopy is not standardized. Current guidelines are concerned primarily with safety aspects of the procedure. In view of this, and the authors' own observations of individual variation in preparation and technique, a national survey of bronchoscopic procedure was performed to assess physicians' methods. A structured questionnaire was mailed to 547 consultant physicians in adult respiratory medicine. Physicians' routines of patient preparation, drug therapy, sampling methods, and experience of complications with the flexible bronchoscope were assessed. A 60% response (328 physicians) was obtained. Patient consent was obtained by a junior doctor in 31% of replies. 205 (63%) physicians gave benzodiazepine sedation, 46 (14%) used opioid, and 38 (12%) administered both. Ninety-four (29%) physicians prescribed an antimuscarinic agent, and 235 (74%) gave antibiotics to patients with mechanical heart valves. Only 22% of physicians monitored electrocardiogram and 10% monitored blood pressure during all procedures. Marked variance was noted in sampling routines of suspected lung tumours. Physicians who used fluoroscopic guidance for transbronchial lung biopsy reported a significantly lower incidence of pneumothorax requiring drain insertion over the previous 12 months compared to those who did not (2.68 of 1000 versus 9.17 of 1000, (p<0.03)), but no difference in the total incidence of pneumothorax. Only 87 (27%) of responders had performed transbronchial needle aspiration sampling over the previous 12 months. The preparation and practice of flexible bronchoscopy varies greatly for each physician. Use of radiographical screening for performing transbronchial lung biopsy was associated with a lower likelihood of pneumothorax requiring chest tube drainage.

Bronchoscopy↗
PubMed2002

Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures.

Complications of flexible bronchoscopy (FB) were prospectively evaluated during 1,328 diagnostic procedures in children, not in intensive care units. A total 92.8% of the procedures were performed in conscious patients under sedation and 7.2% under deep sedation. Supplementary oxygen was provided in approximately 80% of cases via endoscopic face mask (n=783) or nasal prongs (n=290). At least one complication was recorded in 91 cases (6.9%). Minor complications (n=69; 5.2%) included moderate and transient episodes of desaturation (n=15), isolated excessive coughing (n=22), excessive nausea reflex with coughing (n=20), transient laryngospasm (n=6) and epistaxis (n=6). Major complications (n=22; 1.7%) included oxygen desaturation to <90%, either isolated (n=10) or associated with laryngospasm (n=6), coughing (n=4), bronchospasm (n=1), and pneumothorax (n=1). Major complications involving oxygen desaturation were associated with age <2 yrs (13 of 529 versus 8 of 778) and laryngotracheal abnormalities (7 of 85 versus 14 of 1,222). The overall frequency of complications was similar in conscious (6.7%) but sedated patients and patients under deep (7.3%) sedation. However, the frequency of transient desaturation was significantly higher in children undergoing FB under deep sedation. Transient fever after bronchoalveolar lavage was observed in 52 of 277 cases (18.8%). Flexible bronchoscopy is a safe procedure with <2% major complications. Careful analysis of indications and clinical status for each patient, and proper anaesthesia and monitoring during the examination ensure that the procedure is successful, with a minimum of complications.

Adolescent↗
PubMed2006

The clinical value of autofluorescence bronchoscopy for the diagnosis of lung cancer.

The aim of this study was to evaluate the role of autofluorescence bronchoscopy (AFB) in the routine work-up of lung cancer. Consecutive patients with atypical or suspicious cells in sputum or bronchial aspirate, no localising abnormality on chest radiography and nondiagnostic white-light bronchoscopic (WLB) results were recruited. WLB and AFB were performed sequentially during the same session. All abnormal areas detected by WLB, AFB or both were sampled and the biopsy specimens sent for histological examination. Sixty-two patients were recruited within the 32-month study period. Seventeen had no endobronchial lesion detected. Among the 45 patients with endobronchial lesions, 37 had lesions with a histopathological grade of mild dysplasia or less; of the eight patients who had a lesion with a histological grade of moderate dysplasia or worse, five were found to have lung cancer, two invasive lung cancer and three an intra-epithelial neoplasm (severe dysplasia). Lesions showing moderate dysplasia or worse were more commonly found in patients with suspicious cells than in those with atypical cells on sputum examination. AFB was more sensitive than WLB (91 versus 58%) at detecting these lesions, but less specific (26 versus 50%). A combination of white-light and autofluorescence bronchoscopy can increase the diagnostic yield of this invasive procedure in patients exhibiting abnormal sputum cytology.

Adult↗
PubMed1999

Bronchoscopy and bronchoalveolar lavage findings in cross-country skiers with and without "ski asthma".

Bronchial hyperresponsiveness to methacholine with asthma-like symptoms ("ski asthma") is frequent in elite cross-country skiers. To further the understanding of "ski asthma", 10 nonasthmatic, nonatopic controls and 30 adolescent elite skiers were investigated by bronchoscopy and bronchoalveolar lavage (BAL). Nine skiers were atopic without allergy symptoms. Compared with controls, the macroscopic inflammatory index in the proximal airways in skiers was three-fold greater (median (interquartile range) 3.0 (2.0-5.0) versus 1.0 (0.8-2.3), p=0.008). In the BAL fluid, skiers had significantly greater total cell (p<0.05) and percentage lymphocyte (p<0.01) and mast cell counts (p<0.05). Neutrophil and eosinophil counts were not significantly different and eosinophil cationic protein was not detected. Tumour necrosis factor-alpha and myeloperoxidase were detected in 12 (40%) and six (20%) skiers, respectively. In skiers with ski asthma, the inflammatory index was greater than in nonasthmatic skiers. Lymphocyte subtypes and activation markers, and concentration of albumin, fibronectin and hyaluronan were not different from those in controls. Cross-country skiers have a minor to moderate degree of macroscopic inflammation in the proximal airways at bronchoscopy and a bronchoalveolar lavage fluid profile which differs in several respects from healthy controls. Skiers with ski asthma tend to show even higher degrees of bronchial inflammation.

Adolescent↗
PubMed2006

Anesthetic management of a young adult with complex congenital heart disease and bronchopleural fistula for rigid bronchoscopy.

The number of adults with congenital heart disease and those who require anesthetic care are increasing. We describe the anesthetic management of a young adult with palliated complex congenital heart disease and a chronic postsurgical bronchopleural fistula for rigid bronchoscopy. Perioperative considerations in the care of patients with single ventricle physiology for noncardiac procedures are reviewed. Specific requirements for rigid bronchoscopy are discussed in addition to the anesthetic implications of a bronchopleural fistula and particular concerns in the patient with single ventricle physiology.

Adult↗