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PubMed2002

Culturing bronchial washings obtained during bronchoscopy fails to add diagnostic utility to culturing the bronchoalveolar lavage fluid alone.

A retrospective analysis was performed to determine whether cultures of bronchial washings (BW) obtained during bronchoscopy added to the diagnostic efficiency of cultures of bronchoalveolar lavage fluid (BAL) alone. Results of BW and BAL cultures submitted from 268 patients over a 7-month period were compared. The isolation of an organism from the BW but not from the BAL occurred in only 17.4% of cases. Moreover, the vast majority of those organisms consisted of yeasts or molds of questionable clinical significance that did not prompt a change in antimicrobial therapy. Culturing the BAL specimen alone would have resulted in an efficiency of 97.0% (95% confidence interval 94.2-98.7%) for the isolation of clinically relevant pathogens identified from bronchoscopic specimens. These results suggest that the submission of BW obtained during the BAL procedure for culture evaluation not only fails to add diagnostic value, but may also result in unnecessary laboratory evaluations and provide misleading information to clinicians.

Adolescent↗
PubMed1997

Cocaine balloon aspiration: successful removal with bronchoscopy.

Ingestion of balloons containing illicit substances along with the potential toxic sequelae associated with these ingestions have been described in the literature. This report describes the successful bronchoscopic retrieval of a cocaine balloon after aspiration. A 39-year-old man was witnessed swallowing several balloons that were thought to contain heroin. Shortly after ingestion, the patient became unconscious and required nasotracheal intubation. Before intubation, several balloons were removed from the oropharynx. Naloxone 4 mg was administered en route to the emergency department (ED). Following naloxone, the patient awoke and became agitated and combative. On arrival in the ED, midazolam, succinylcholine, and vecuronium were required to manage his combativeness. Vital signs were: heart rate, 130 beats/min; blood pressure, 128/86 mm Hg; respirations, 12 breaths/min; temperature, 96.5 degrees F. A balloon and balloon tip were removed during lavage. Whole bowel irrigation with a polyethylene glycol electrolyte solution was initiated. A right upper lobe infiltrate was identified on chest X-ray and aspiration of a balloon was suspected. At bronchoscopy, a small yellow, intact balloon visualized in the basilar segment of the right lower lobe was removed. Toxicologic analysis of the balloon contents found cocaine. The rest of the patient's hospital course was unremarkable and he was discharged 5 days after admission. This case brings to light the potential concerns, such as respiratory compromise, associated with aspiration of small balloons in the body stuffer. Additionally, the potential for the development of toxicity if the balloon ruptures and toxin absorption occurs through through the lungs should be considered. Emergency physicians and toxicologists should be aware of this significant complication of packet ingestion in the body packer or stuffer and be prepared to intervene early during the course of the patient's treatment.

Adult↗
PubMed2000

[Fiberoptic bronchoscopy during noninvasive positive-pressure ventilation in patients with chronic obstructive lung disease with hypoxemia and hypercapnia].

OBJECTIVES: To assess the feasibility and safety of non invasive positive-pressure ventilation (NIPPV) via a face mask to performing fiberoptic bronchoscopy (FOB) in patients with COPD contraindicating FOB in spontaneous ventilation. STUDY DESIGN: Clinical, prospective, open, non comparative trial of feasibility. PATIENTS: Ten consecutive COPD patients (71 +/- 5 year-old, PaO2 = 53 +/- 13 mmHg and PaCO2 = 67 +/- 11 mmHg), without any sign of acute respiratory failure, admitted to the intensive care unit for pneumonia requiring a bronchoalveolar lavage (BAL). Including were: PaO2 < 70 mmHg despite nasal O2 delivered at 3 L.min-1, PaCO2 > 50 mmHg, improvement of SpO2 with NIPPV before FOB. METHODS: Topical anaesthesia of the nose and pharynx was obtained with a 5% lidocaine spray. NIPPV was administered using a ventilatory support system Evita 4 (Dräger) applied through a full facial mask secured to the patient with elastic straps. Patients were first allowed to acclimate for 5 min with NIPPV (IPAP = 16 cmH2O, EPAP = 0 and trigger of 0.3 cm H2O while a FIO2 kept at 0.7). A T-adapter Medisize (Péters) was attached to the facial mask. The tip of the FOB was inserted through the nose. Topical anaesthesia of the vocal cords was obtained with 1% lidocaine solution (3 mL). The FOB was inserted into the trachea up to a bronchial sub-segment. BAL was performed by instillation of 100 mL of saline solution. After FOB, the NIPPV was maintained for 5 min. Heart rate, SpO2 were measured continuously and arterial pressure at 2 min intervals. Arterial blood gas values were obtained just prior NIPPV and after 15 min and 60 min NIPPV disconnection. RESULTS: FOB duration was 11 +/- 4 min. SpO2 significantly improved during FOB (from de 91 +/- 4.7% to 97% +/- 1.7) without decrease of oxygen saturation lower than 90%. There were no changes in PaCO2 and PaO2 during the hour following the end of procedure. FOB under NIPPV was performed in all patients without complications and was very well tolerated in eight patients. After NPPV disconnecting, one patient required again NIPPV for 15 min. No patient required endotracheal intubation within 24 hours. All patients survived. CONCLUSION: Application of NIPPV during FOB is a safe technic for maintaining adequate gas exchange in hypoxaemic and hypercapnic COPD patients not in acute respiratory failure. After the end of the procedure a close surveillance in the intensive care unit is essential.

Aged↗
PubMedDate not supplied

[Transient fever after fiberoptic bronchoscopy--a prospective study].

INTRODUCTION: The Fiberoptic bronchoscopy (BRF) is an essential tool in diagnosis and therapy of respiratory diseases. The occurrence of transient fever after BRF has been documented in some studies. Its meaning hasn't yet been clarified. AIM: Determine the incidence of fever and bacteriemia in the 24 hours after BRF and identify its predictive factors. MATERIAL AND METHODS: Ninety one outpatients and forty hospitalised patients were prospectively studied in the 24h after BRF to assess the appearance of fever (T>38 masculine C) and positive hemocultures. Statistical analysis were performed using SPSS and the significance was considered when pearson chi2 was < 0,005. RESULTS: Referring outpatients / hospitalised patients, 68% / 85% were males, 85% / 52,5% denied previous respiratory diseases, mean age was 54 +/- 16,5 years / 59 +/- 15,4 years, 38,5% / 55% were smokers. Transient fever was observed in 12% / 12,5% patients. Positive hemocultures were found in four patients (3 outpatients and 1 hospitalised). None hospitalised patients showed radiological changes, in 7,5% cases white blood cells count rised >50%. We didn't found statistically significant association between appearance of fever after BRF and age, dental caries, smoking habits, systemic disease, presence of endoscopic lesions and endoscopic techniques performed. CONCLUSION: Transient fever following BRF is a common event and in majority of cases is not associated with bacteriemia. No statistical significant association was found between fever event and any of the studied factors.

Bacteremia↗
PubMedDate not supplied

[Plasma concentration of lidocaine during bronchoscopy].

Lidocaine is commonly used for local anesthesia during fiberoptic bronchoscopy (FOB). It has been suggested that the total dose of lidocaine should be limited to 300-400 mg (or < 8.2 mg/kg). Lidocaine toxicity is directly correlated with its concentration in the blood and a threshold above which the side effects become more likely has been put at a plasma level of 5 microg/ml. The aim of our study was to determine plasmatic lidocaine concentrations (PLC), how often the PLC fall into the potentially toxic range and its correlation with adverse reactions. PLC were recorded in 30 patients undergoing FOB. Lidocaine was administered as a 2% gel, 10% spray and 2% solution. Venous blood samples were taken before the beginning of local anesthesia and at 20, 30 and 40 min thereafter. The mean total amount of lidocaine administered was 746.3 +/- 159.5 mg (11.6 +/- 3.1 mg/kg). Before the beginning of anesthesia, no significant levels of lidocaine were measurable in the patients. PLC were 3.2 +/- 1.7 (g/ml at 20 min., 3.3 +/- 1.7 microg/ml at 30 min. and 3.0 +/- 1.5 microg/ml at 40 min. The PLC exceeded toxic levels in 6 patients, but no complications were observed. Our data show that although the amount of lidocaine used in this study exceeded the recommended highest dose, no subjects had signs of toxicity. A maximum dose of lidocaine for topical anesthesia should be determined despite the fact that an average total dose superior to 400 mg appears to be safe in patients undergoing FOB.

Adolescent↗
PubMedDate not supplied

CT-guided transthoracic needle biopsy following indeterminate fiberoptic bronchoscopy in solitary pulmonary nodules.

We evaluated the role of computed tomography (CT)-guided transthoracic needle biopsy (TNB) in patients with solitary pulmonary nodule and indeterminate flexible fiberoptic bronchoscopy (FOB). A review of 112 patients with solitary nodules under 3 cm in size who underwent TNB was carried out. A total of 48 patients had prior FOB with negative or indeterminate results. We reviewed the results of CT-guided TNB of these 48 patients with respect to the cytology results, nodule size and location, and complications of the procedure. Among the 48 patients who had FOB with indeterminate cytology, 32 were found to have malignant cytology on subsequent TNB. Among the remaining 16 patients, eight had diagnostic thoracotomy, which showed that six of the nodules were benign and two were malignant. The remaining eight patients who did not undergo surgery have been followed for more than 2 years, without evidence of growth. Results were not influenced by size or location. TNB offers a high yield for diagnosis in this patient population.

Biopsy, Needle↗
PubMed1994

Carbon dioxide laser bronchoscopy--a review of its use in the treatment of malignant tracheobronchial tumours in 142 patients.

We report our experience over an 8-yr period, 1984-1991, of the use of the carbon dioxide (CO2) laser in the treatment of otherwise inoperable malignant tracheobronchial lesions. In that period 142 patients (84 male, 58 female; median age 63 years) underwent 278 procedures. The trachea was the site of treatment in 44 patients, the carina in nine, a main bronchus in 80 and a lobar bronchus in nine. All resections were performed under general anaesthesia via a rigid bronchoscope. Symptomatic relief was obtained in 103 of the 116 patients whose main complaint was dyspnoea. Overall there was a mean improvement in forced expiratory volume in 1 s (FEV1) of 27%, in peak expiratory flow (PEF) of 22% and in forced vital capacity (FVC) of 7%. Most improvement in FEV1 and PEF was obtained by the treatment of tracheal lesions. Three patients died within 24 h of surgery and 30 day mortality was 18%. At a mean follow-up of 18.3 months the mean post-laser survival is 5 months. While the CO2 laser has limitations in the treatment of distal tumours when compared to the neodymium/yttrium aluminium garnet (Nd:YAG) laser, there was no higher incidence of complications. We have found CO2 laser bronchoscopy to be an effective palliation of inoperable malignant tumours particularly of the trachea and main bronchi.

Adult↗
PubMed1998

Serum concentrations of lignocaine and its metabolite monoethylglycinexylidide during fibre-optic bronchoscopy in local anaesthesia.

Fibre-optic bronchoscopy was performed in local anaesthesia using lignocaine. Serum concentrations of lignocaine and its active metabolite monoethylglycinexylidide (MEGX) were measured in 16 patients at regular intervals up to 120 min after administration. Lignocaine was administered as an aerosol in the upper respiratory tract and as a solution in the bronchial tree. The total dose of lignocaine ranged from 243 to 608 mg (2.4-8.0 mg kg-1 body weight). The dose of lignocaine given as an aerosol ranged from 163 to 508 mg (1.6-6.6 mg kg-1) and the dose given as a solution ranged from 60 to 180 mg (0.8-2.5 mg kg-1). The highest median serum lignocaine concentration, 10.5 mumol l-1, was measured 20 min after administration. None of the patients had toxic serum lignocaine levels (> 26 mumol l-1) or adverse effects. The highest median serum MEGX concentration, 1.7 mumol l-1, was measured 120 min after administration. The dose of lignocaine, expressed in mg per kg body weight correlated with serum lignocaine and serum MEGX (rs = 0.47 and rs = 0.39, respectively). Lignocaine is a clinically safe, local anaesthetic agent provided the total dose does not exceed 6-7 mg kg-1 body weight.

Aged↗
PubMed1998

Pulse oximetry at fibre-optic bronchoscopy in local anaesthesia: indication for postbronchoscopy oxygen supplementation?

The requirement for supplementary oxygen (O2) after fibre-optic bronchoscopy (FOB) was evaluated by means of pulse oximetry in 34 patients (19 men) of median age 62 years (range 28-85) who had had a diagnostic FOB. The patients were allocated at random into two groups, each of 17 persons, which were comparable concerning sex, age and the dose of benzodiazepine (diazepam tablets 10 mg 1 h before FOB and midazolam 2-5 mg i.v. during FOB) used for premedication. Patients in group 1 had lower pulmonary function (FEV1, FVC as a percentage of predicted values) than patients in group 2 (P < 0.02). The oxygen saturation of the haemoglobin (SpO2) in the tip of the index finger was recorded continuously for 30 min after the administration of oral diazepam, during FOB and for 120 min after the FOB procedure. All patients received nasal O2 supplement 21 min-1 during FOB. After FOB, O2 was discontinued in group 1, while group 2 continued to receive O2 21 min-1 for 120 min. The incidence of hypoxaemic episodes (SpO2 < or = 90% for a period of a minimum of > or = 12 s) after oral diazepam, before FOB, was similar in the two groups, 35%. After FOB, the incidence of hypoxaemic episodes was 88% in group 1 and 41% in group 2 (P < 0.01). The cumulated duration of hypoxaemia after FOB was a median of 30 s (range 0-7140) in group 1 and a median of 0 s (0-156) in group 2 (P < 0.0001). Impaired lung function (FEV1 < 75% of predicted value) was a risk factor for hypoxaemia. Postbronchoscopy, O2 supplement should be administered to sedated patients with impaired lung function until the patients have fully recovered.

Adult↗
PubMed1998

Rapid diagnosis of smear-negative pulmonary tuberculosis via fibreoptic bronchoscopy: utility of polymerase chain reaction in bronchial aspirates as an adjunct to transbronchial biopsies.

Fibreoptic bronchoscopy was performed on 190 patients with chest radiographic lesions and negative sputum smears for acid-fast bacilli. Aside from obtaining transbronchial biopsies for histological examination, bronchial aspirate specimens were also tested for Mycobacterium tuberculosis complex DNA by a conventional polymerase chain reaction (PCR) technique. Of 177 transbronchial biopsies performed, a diagnosis was found in 64 cases [43 cases of tuberculosis (TB), 17 cases of lung carcinoma and four cases of other infective/inflammatory diseases] giving a diagnostic yield of 36.2%. PCR was positive in 105 of 108 finally diagnosed cases of TB and 22 of 82 non-TB cases. The sensitivity, specificity, positive predictive value and negative predictive value of PCR when applied to bronchial aspirate specimens for diagnosing smear-negative pulmonary TB were 97.2%, 73.2%, 82.7% and 95.2% respectively. Therefore, detection of M. tuberculosis complex DNA in bronchial aspirates by PCR might have an adjunctive place to transbronchial biopsies in the rapid diagnosis of smear-negative pulmonary tuberculosis.

Adolescent↗
PubMed1997

Virtual bronchoscopy with perfluoronated hydrocarbon enhancement.

RATIONALE AND OBJECTIVES: Bronchoscopic computed tomography (CT) is limited by machine resolution and air-soft-tissue contrast. The objective of this study was to determine whether improving the contrast by using the contrast agent perflubron (PFOB) in the lung would improve the bronchoscopic CT technique and permit visualization of small airways. MATERIALS AND METHODS: Bronchoscopic CT was performed in an anesthetized 8-week-old New Zealand white rabbit before and after the endotracheal administration of PFOB. RESULTS: Bronchoscopic CT performed with PFOB permitted navigation of bronchi as small as 0.8 mm in diameter, which are much smaller than those that can be navigated without PFOB. CONCLUSION: In this example, the use of perfluorochemicals with bronchoscopic CT enhanced the capabilities of virtual bronchoscopy.

Animals↗
PubMed2003

[Techniques and complementary techniques. Fiberoptic bronchoscopy in mechanically ventilated children].

Fiberoptic bronchoscopy can be performed at the patient's bedside. This technique allows direct visualization of the upper and lower airways up to the segmental and subsegmental bronchi. Its most frequent indications are airway examination ot evaluate damage produced by toxins or the endotracheal tube, patency of the endotracheal tube and extubation failure. It is also used to obtain microbiological samples, facilitate intubation when difficult, aspirate airway sections or mucus plugs, perform bronchoalveolar lavage and administer drugs. With prior preparation, adequate monitoring and sedation, material according to the size of the patient and correct techniques, there are few complications. However, the procedure can produce trauma and obstruction of the airway, bronchial hemorrhage, barotrauma, loss of alveolar recruitment, bronchospasm, hypoxemia, bradycardia, and bronchopulmonary infection.

Bronchi↗
PubMed2004

[Fiberoptic bronchoscopy in childhood endobronchial tuberculosis].

BACKGROUND: Endobronchial tuberculosis is a classical manifestation of primary tuberculosis in childhood. Fiberoptic bronchoscopy (FB) is an ancillary diagnostic tool, but its utility and indications are not well established. OBJECTIVES: To analyze the FB performed over 11 years (1992-2003) in children with a diagnosis of tuberculosis and to review the literature. A further aim was to establish the current usefulness of FB in children with tuberculosis and propose criteria to determine the indications for FB in this population. METHODS: We report a retrospective series (n 5 16). FB was indicated in children who showed any of the following findings in chest roentgenogram: a) persistent parenchymal consolidation; b) lymphadenopathy and consolidation; c) hyperinsufflation (emphysema); d) atelectasias, and e) airway narrowing caused by lymphadenopathies. Published series on the topic were reviewed and six studies were suitable for comparison with our own. RESULTS: Endobronchial tuberculosis was found in seven children (43 %) and extrinsic compression was found in three (18 %). The microbiological results obtained from FB samples were not superior to those obtained from classical diagnostic methods. The sensitivity of the proposed criteria for suspicion of endobronchial tuberculosis was 71 %. Endoscopic findings justified a change in therapy in 50 % of the children (addition of corticoids or surgery) and this percentage was similar to that reported in other series. CONCLUSIONS: FB does not usually improve microbiological diagnosis of tuberculosis but can be useful when choosing the most appropriate therapy in children with suspected endobronchial tuberculosis. In some cases, computed tomography may make FB unnecessary, but in others this procedure can be therapeutic (obstruction due to caseum, atelectasias). Establishing the indications for FB in childhood tuberculosis is difficult, but the proposed criteria may be an acceptable guide to identifying which patients could benefit most from this procedure. Not all children with endobronchial tuberculosis require corticoids.

Antitubercular Agents↗
PubMed1997

Neonatal and paediatric fibre-optic laryngoscopy and bronchoscopy using the laryngeal mask airway.

Endoscopy of the upper airways in neonates and infants was traditionally been accomplished using rigid laryngoscopes and bronchoscopes. The laryngeal mask may be used both to control the airway for anaesthetic ventilation and to guide a fibre-optic endoscope to the laryngeal inlet and beyond. We report our experience with five neonatal and paediatric cases where fibre-optic laryngoscopy and bronchoscopy were performed through the laryngeal mask airway. All were cases in which standard rigid endoscopy had proved difficult with only a poor and restricted view of the laryngeal inlet being obtained due to the age of the infants, or abnormal anatomy of the upper airways. No problems have been encountered with maintenance of the airway or with endoscopic view obtained. In fact in neonatal patients, this technique has been found to be preferable with regard to safety and ease of use when compared to the ventilating bronchoscope. With the size 1 laryngeal mask airway it is not possible to simultaneously ventilate and endoscope the patient. Cases included, a vascular ring, Goldenhar's syndrome, laryngomalacia, supraglottis and vocal fold paresis. This technique provides a secure method of maintaining anaesthetic ventilation during airway endoscopy, and also a means of easily locating the glottis.

Bronchoscopy↗
PubMed2006

Modified neodymium-YAG laser in rigid bronchoscopy.

The use of laser bronchoscopy in the treatment of tracheobronchial stenosis has been reported in the past. It is generally safe and effective; however, the complications of haemorrhage, airway perforation, or airway fire are relatively frequent among less experienced surgeons. We illustrate a modified technique of laser probe location to simplify the laser ablation procedure.

Adult↗
PubMed2000

Intermittent capnography during high-frequency jet ventilation for prolonged rigid bronchoscopy.

BACKGROUND: Gas exchange during high-frequency jet ventilation (HFJV) for prolonged rigid bronchoscopy (RBS) is usually monitored by arterial blood gas analysis. Capnography of expired gases during brief HFJV discontinuation may be a reliable and noninvasive supplemental method. Capnography can be performed either for single breaths or with respiratory rate (RR) reduced to 10 x min(-1). The aim of this study was to demonstrate that capnography during short periods of HFJV discontinuation represents a reliable measure of PaCO2 during prolonged RBS. METHODS: We prospectively investigated 100 consecutive patients (75 male and 25 female) undergoing HFJV for RBS. HFJV was delivered through the rigid bronchoscope at the following settings: working pressure 1.2 bar, rate 100 x min(-1), FIO2 0.99, t(i)/t(tot)0.6. The light guiding channel ending at the distal tip of the rigid bronchoscope was used for gas sampling. Capnograms were assessed at 5 min intervals and compared to PaCO2 from arterial blood samples drawn simultaneously. The accuracy of single breath CO2 sampling was compared with sampling at RR=10 x min(-1). RESULTS: Mean duration of RBS was 30+/-21 min. A significant correlation between capnography (PetCO2) and arterial blood gas analysis (PaCO2) was observed, being r=0.90 for the RR= 10 x min(-1) method and r=0.91 for the single breath method. Mean difference between PaCO2 and PetCO2 was 0.37+/-0.2 kPa throughout the entire study period. No significant differences between single breath sampling or sampling at RR=10 x min(-1) were observed. CONCLUSION: Capnography performed during short periods of HFJV discontinuation reliably and noninvasively reflects PaCO2 during prolonged endoscopic procedures. Capnography during HFJV for RBS may reduce the frequency of arterial blood gas sampling, the duration of unmonitored intervals and costs.

Adult↗