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At least 955 records · Page 53Linked to original sources
PubMed1997

Utility of fiberoptic bronchoscopy in bone marrow transplant patients.

Fiberoptic bronchoscopy (FOB) has been reported to have a high diagnostic yield and to be safe in BMT patients with pulmonary infiltrates. At our institution, BMT patients with respiratory symptoms and/or pulmonary infiltrates had a thoracic CT and bronchoalveolar lavage (BAL). Transbronchial biopsy (TBBx) was considered if the platelet count could be raised to >30 x 10(9)/l. From March 1993 to August 1995, 52 patients had 68 FOBs (42 BAL + TBBx, 26 BAL only) for 60 episodes of clinical pneumonia. Patients' characteristics were: 38 males, mean age 42 years, and 39 allogeneic BMTs. Of the 68 FOBs, 47 were performed to evaluate diffuse infiltrates, 10 were done on mechanically ventilated patients, and 50 of the FOBs were preceded by a platelet transfusion. Thirty-one percent of FOBs (21 FOBs, 19 patients) were diagnostic. Twenty-four percent of FOBs (11 diagnostic FOBs, six nondiagnostic FOBs) changed therapy. Ten complications (15%) occurred in 10 FOBs (five acute respiratory failure, three pneumothoraces, one nose bleed, one death). Hospital and 6-month survival based on episodes of clinical pneumonia were 47 and 32%, respectively. Patients who had a diagnostic FOB or a FOB that changed treatment did not have better hospital or 6-month survival compared to patients who had FOBs that were nondiagnostic or did not change treatment. FOB in our BMT patient population, had a low diagnostic yield (31%), infrequently changed treatment (24%), a significant complication rate (15%) and was not associated with improved patient survival. The role of routine diagnostic FOB in BMT patients with pulmonary infiltrates and/or respiratory symptoms should be reevaluated.

Adolescent↗
PubMed1999

Haemoptysis in patients with a normal chest radiograph: bronchoscopy-CT correlation.

The exact role of fibre-optic bronchoscopy (FOB) and CT of the chest in the diagnosis of patients presenting with haemoptysis and a normal or non-localizing chest radiograph has not been clearly defined. A study was designed to evaluate 50 patients presenting with haemoptysis and a normal or non-localizing chest radiograph using FOB and high-resolution computed tomography (HRCT). A definitive diagnosis was established in 17 (34%) patients. The aetiologies included bronchiectasis (24%), bronchial adenoma (6%), tuberculosis (2%) and bronchitis (2%). The diagnosis was made by HRCT in 15 (30%) patients, while FOB was diagnostic in five (10%) patients. The diagnosis was made by HRCT and FOB in all patients with focal airway abnormalities. Therefore, HRCT effectively delineated abnormalities of both the central and peripheral airways. It is concluded that CT should be obtained prior to FOB in all patients presenting with haemoptysis and a normal or non-localizing chest radiograph.

Adenoma↗
PubMed2002

Paediatric flexible bronchoscopy.

Flexible bronchoscopy is an emerging diagnostic, therapeutic and supportive procedure used in paediatric respiratory medicine. Despite the improvements in instruments and anaesthetic support for this procedure, supervised training, strict quality-control measures and ongoing research are essential to ensure standards of safe practice and judicial use of the procedure.

Anesthesia↗
PubMed2001

Fibre-optic bronchoscopy in adults: a position paper of The Thoracic Society of Australia and New Zealand.

Fibre-optic bronchoscopy in adults is a common procedure in clinical respiratory practice. Under controlled conditions it is safe, resulting in relatively few significant adverse events. The present position paper updates guidelines previously published by The Thoracic Society of Australia and New Zealand and is based on evidence obtained by searching the Medline and Embase databases. The level of evidence to support recommendations is indicated in the text. Where no evidence has been found, the guidelines reflect the opinions of the authors. Specific recommendations are made regarding sedation and anaesthesia, the cleaning of bronchoscopes and the training of bronchoscopists.

Adult↗
PubMed2003

Prophylactic nasopharyngeal tube insertion prevents acute hypoxaemia due to upper-airway obstruction during flexible bronchoscopy.

Insertion of a nasopharyngeal tube (NT) is a highly effective approach to the management of acute hypoxaemia during flexible bronchoscopy (FB) in lung -transplant recipients. We noted that lung transplant recipients undergoing FB who had been treated previously with NT insertion had further episodes of oxygen desaturation (<90%), despite supplemental oxygen therapy. Prophylactic NT insertion prevented acute hypoxaemia in the majority of lung transplant recipients, with previously documented FB-related oxygen desaturation secondary to UAO. Additional jaw support may be needed in some patients with severe upper-airway obstruction.

Adult↗
PubMed1997

Oral and nasotracheal light wand guided intubation after failed fibreoptic bronchoscopy.

Fibreoptic bronchoscopic guided tracheal intubation is often the first choice for clinicians familiar with the technique, when faced with a patient in whom tracheal intubation presents known or possible difficulties. Regardless of the technique chosen, anticipated and unanticipated problems may arise. We report three patients with known difficult airways that illustrate the utility of light wand guided oral and nasotracheal intubation when tracheal intubation with fibreoptic bronchoscopy proved impossible.

Adolescent↗
PubMed2000

An evaluation of computed tomography as an aid to diagnosis in patients undergoing bronchoscopy for suspected bronchial carcinoma.

AIM: To determine whether computed tomography (CT) can predict the likelihood of obtaining a positive tissue diagnosis at fibreoptic bronchoscopy (FOB), or demonstrate an alternative means of achieving a tissue diagnosis, in patients presenting with a high clinical suspicion of primary bronchogenic carcinoma and an abnormal chest radiograph (CXR). MATERIALS AND METHODS: Sixty-two patients presenting with a high clinical suspicion of carcinoma and an abnormal CXR had chest and liver CT and FOB performed. All patients subsequently had histocytological confirmation of malignancy. Features recorded from the CTs included: the site and characteristics of a mass if present, and its relationship to adjacent airways; the presence of presumed metastatic disease; and a CT prediction of the likelihood of positive FOB was made. RESULTS: Of the patients, 41/62 (66%) had inoperable stage IIIb/IV disease. Fibreoptic biopsy yielded positive tissue diagnoses in 38/62 (61%). Computed tomography features predicting a positive FOB in this group included: ill-definition of the mass (12/15, 80%); a mass <4 cm from the origin of the nearest lobar bronchus (36/53, 68%); an endobronchial component of mass (22/24, 92%); a segmental or larger airway leading to the mass (30/35, 86%). Overall, CT had positive and negative predictive values for positive FOB of 85% and 78% respectively. The accuracy of the overall CT prediction of positive FOB was better than the accuracy of any of the individual factors. Seventeen of 62 (27%) patients had presumed metastatic disease suitable for percutaneous biopsy. CONCLUSION: Computed tomography is useful in predicting the likelihood of achieving positive histocytology at FOB. The overall CT prediction is superior to any of the individual CT features taken alone.Bungay, H. K. (2000). Clinical Radiology 55, 554-560.

Aged↗
PubMed2001

Influence of patient posture on oxygen saturation during fibre-optic bronchoscopy.

This study was designed to investigate the effect of posture on oxygen saturation during fibre-optic bronchoscopy (FOB). Thirty-eight consecutive patients requiring diagnostic FOB were randomized into two groups according to the initial posture in which the FOB was performed. In group 1 (20 patients), FOB was commenced supine, and in group 2 (18 patients) in a semi-recumbent position (45 degrees from horizontal). Sedation with midazolam was titrated according to clinical response. All patients received atropine 0.6 mg intravenously and topical lignocaine. Observations of peak, trough and plateau oxygen saturation and pulse rate were recorded during six study periods, each lasting 3 min. Periods 1 and 2 were pre- and post-sedation without supplemental oxygen, respectively. The bronchoscope was then inserted into the distal end of the trachea and observations taken during periods 3 and 4 (no supplemental oxygen) and periods 5 and 6 (2 l oxygen by nasal cannulae). In group 1, posture was changed from supine to semi-recumbent from periods 3-4 and reversed in periods 5 and 6. In group 2, posture changes were in reverse sequence. Patients with initial oxygen saturation of less than 90% or showing a fall below 85% during FOB were excluded. Five patients from each group were withdrawn because of hypoxia. In both groups, oxygen saturation fell significantly (P<0.001) following sedation. There was no significant change in saturation (peak, trough or plateau) with change in posture from supine to semi-recumbency (group 1) or the reverse (group 2). These correspond to periods 3-4 and 5 6 in both groups. Supplemental oxygen was associated with a significant rise in oxygen saturation in both postures, attaining levels close to presedation levels.

Adult↗
PubMed2002

Investigative bronchoscopy and endobronchial biopsy is well tolerated in hyperreactive asthma patients.

The tolerability of 57 non-smoking asthma patients inhaling salbutamol as needed (ATS, 18--60 years, 60% < or = FEV1 < or =100%, PD15FEV1 <0.4 mg histamine) to fibreoptic bronchoscopy (FOB) and endobronchial biopsy was studied. The FOB was done in local Lignocaine anaesthesia, and from five to eight biopsy specimens were taken from the bronchial mucosa of the right lung. The tolerability was measured as cough/bronchospasm during the procedure (from 0 = normal to 3 = interrupted procedure), success of the procedure, and untoward occurrences. Twenty-seven of the 57 patients (48%) had no cough or bronchospasm during the FOB (score 0). Few coughs of no importance (score 1) were documented in 23 patients (40%). Seven patients (12%) had cough and/or bronchospasm interfering with the FOB procedure (score 2). The FOB procedure was not interrupted because of cough and/or bronchospasm (score 3) in any patient. Scores of cough and/or bronchospasm diminished progressively with the increase of PD15FEV1 histamine. The success of the procedure was 100%. Two patients had untoward medical occurrences requiring additional rescue medication (3.5%). In conclusion, we found that hyperreactivity predicts cough and/or bronchospasm during the FOB. Cough and/or bronchospasm are frequently observed during the bronchial procedure, but they are mild and of minor clinical importance. An investigational endobronchial procedure can be successfully performed in mildly or moderately obstructive asthmatic patients, even in cases with severe bronchial hyperreactivity.

Adolescent↗
PubMed2000

Pneumonia in the immunocompromised host: the role of bronchoscopy and newer diagnostic techniques.

The microbiology laboratory plays an essential role in the laboratory diagnosis of pneumonia in the immunocompromised host. Both the diversity of underlying or predisposing host conditions that increase risk for pneumonia and the variety of microbial agents that may be etiologically responsible make the laboratory's role in the diagnostic process a challenging one. In addition, the laboratory has a number of diagnostic tools available for detection of etiologic agents including conventional stains and cultures as well as newer tests relying on antigen detection and molecular techniques. Respiratory specimens available for testing are also diverse and are often obtained by the use of fiberoptic bronchoscopy, but may be complemented by use of blood samples when dissemination is likely or more recently by urinary antigen testing in select cases. Given the large number of variables in the design of a diagnostic approach to pneumonia in the immunocompromised host, it is critical that laboratorians and clinicians cooperate in the development of protocols that are cost effective and appropriate to their specific clinical settings.

AIDS-Related Opportunistic Infections↗
PubMed2001

[Does the inhalation of a 1% L-menthol solution in the premedication of fiberoptic bronchoscopy affect coughing and the sensation of dyspnea?].

BACKGROUND: Inhalation of l-menthol inhibits cough and has been shown to reduce respiratory discomfort associated with loaded breathing. We investigated the effect of the inhalation of a 1% l-menthol solution in the premedication of fiberoptic bronchoscopy (FB) on the frequency of cough and the irritability of the tracheobronchial mucosa during FB in a blinded, randomized and placebo controlled study. METHODS: 64 pat. (30-78 yrs, 55 males) underwent routine FB. Premediction: atropine and hydrocodone s.c., inhalation of oxybuprocain by means of a jet nebulizer, sedation on demand. Verum-group: inhalation of 3 ml 1% l-menthol-solution. Placebo-group: 3 ml 0.05% l-menthol (to provide the typical smell). Before and after inhalation peak respiratory flow (PEF) was registered, during FB the frequency of cough was measured. The bronchoscopist scored the irritability of the tracheobronchial mucosa using a visual analog scale. The patients answered a questionnaire addressing their perception of dyspnea and cough on the day after FB compared to the day before. RESULTS: The cough counts didn't show a significant difference between the groups. The irritability of the mucosa was increased in the verum group (main bronchus verum 62.2 +/- 22, placebo 48.6 +/- 23 [mm vissual analog scale, p = 0.03]). Cough and dyspnea reported by the patients decreased on the day after FB significantly compared to the day before (no difference between the groups). The inhalation of 1% l-menthol induced a significant increase of the PEF (verum 307 +/- 103 pre, 329 +/- 84 post [l/min, p = 0.003]) compared to placebo. CONCLUSIONS: The inhalation of 1% l-menthol did not enhance the tolerability of the FB. However, l-menthol induced a significant increase of the PEF immediately after inhalation. Finally sensation of dyspnea was decreased in both groups at the day post FB.

Administration, Inhalation↗
PubMed2004

Sedation for fiberoptic bronchoscopy: fewer adverse cardiovascular effects with propofol than with midazolam.

OBJECTIVE: To study the influence of the sedatives propofol and midazolam on cardiovascular parameters in patients undergoing fiberoptic bronchoscopy (FOB). METHODS: 100 patients without a history of cardiac disease undergoing diagnostic FOB were investigated in a prospective-randomized design. After premedication with intramuscular atropine (0.01 mg/kg BW) patients received sedation with either propofol (group P, n = 50) or midazolam (group M, n = 50). Heart rate, arterial oxygen saturation (psaO (2)) and non-invasive blood pressure were recorded prior to and immediately after induction of sedation, when at the level of vocal cords, during the interventional diagnostic procedure (IDP) and 15 min after the end of the FOB. RESULTS: The mean heart rate and systolic pressure were significantly lower in group P when compared with group M when at the level of vocal cords and during the IDP (p < 0.05). The total incidence of major arrhythmias was 10 % and the incidence of minor arrhythmias was 62 %. A decline in psaO (2) < 90 % occurred in 16 patients of group M and 5 patients of group P (p = 0.44). CONCLUSION: Propofol, when used as a sedative for FOB, is associated with lower hemodynamic side effects than in patients undergoing FOB with midazolam. In addition, it is well-tolerated by patients with pre-existing pulmonary disease. Even patients without a history of heart disease should be monitored for cardiac arrhythmia while undergoing FOB for pulmonary disease, especially patients with a FEV (1) of less than 50 % of the predicted value.

Anesthetics, Intravenous↗
PubMed2005

["Erlangen broncho-trainer" -- newly developed training model with physiological ventilation for interventional bronchoscopy].

BACKGROUND: Biosimulation models have proved their value in numerous training courses for endoscopic procedures and play an important role in education and further training, as well as in the introduction of new techniques. In the field of interventional bronchoscopy, the level of realism is increased when biological lung tissue is available not only in a collapsed state, but also with physiological expansion. METHODS/RESULTS: A new modification of the well-known Erlangen Endo-Trainer has been developed, involving a transparent cover that provides airtight closure of the thoracic cavity. An integrated vacuum pump creates low pressure in the interior of the model. This allows a training lung from the pig to be fully expanded and "physiologically ventilated", with adjustable intermittent inspiration and expiration phases. The breathing and completely expandable biological training lung from the pig not only provides better anatomical orientation thanks to the lung's full three-dimensional expansion, but with the convincing and realistic quality of the tissue it also provides a good practice facility for various types of bronchoscopic intervention. CONCLUSIONS: In an initial training course, the new system successfully allowed various diagnostic techniques to be practiced, such as bronchoalveolar lavage (BAL), transbronchial needle aspiration (TBNA), and peripheral forceps biopsies with transillumination guidance and interventional techniques such as foreign-body removal and electrocautery as well. These initial positive results are also encouraging for the future provision of training facilities in additional interventional techniques.

Bezoars↗
PubMed2006

[Frequency of cytological procedures in diagnostic bronchoscopy of peripheral pulmonary modules and masses].

BACKGROUND: The combination of forceps biopsy and cytological methods improves the yield in diagnostic bronchoscopy of peripheral lung cancer. Transbronchial catheter aspiration seems to be an underutilized cytological technique, which is valuable and minimally invasive. We inquired for the frequency of cytological procedures and the importance of transbronchial catheter aspiration in comparison to transbronchial needle aspiration and bronchial brushing. METHODS: We sent questionnaires to 99 clinically practising and educating pulmonologists. RESULTS: The response amounted to 69 %. Nearly 79 % of the pulmonologists usually combine forceps biopsy with cytological procedures. Instead of 51 % bronchial brushing, transbonchial catheter aspiration as well as needle aspiration is the most applied cytological technique by only 28 % of the interrogated physicians. 47 % of the investigators practise bronchial washing and 27 % practise core roll preparations as a rule. CONCLUSIONS: Most of the specialized clinics in respiratory medicine in Germany add cytological methods to transbronchial forceps biopsy. This practice is pregnant with meaning because of a higher diagnostic yield while accuracy is likewise high. Unlike bronchial brushing transbronchial catheter aspiration and needle aspiration are underutilized for different reasons in spite of the fact, that these are the only procedures with a significant higher sensitivity in comparison to forceps biopsy.

Biopsy↗
PubMed1986

The use of high-frequency jet-ventilation in operative bronchoscopy.

The authors report on the use of HFJV in operative laser fibre-optic bronchoscopy, especially in combination with the laser technique. The method and initial results are discussed. Also high-risk patients can be treated with this method without the need for general anaesthesia.

Anesthesia, Local↗
PubMed1984

Flexible bronchoscopy in infants and children.

The authors describe the use of flexible bronchoscope in infants and children ranging in age from 20 hours to 17 years and in weight from 1.5 kg upwards. Bronchoscopy was carried out under local (17 cases) and general anesthesia (95 cases). Seventeen-six of the 95 examinations under general anesthesia were conducted using the jet-ventilation technique. The advantages and drawbacks of this technique are discussed. The authors list the indications which they regard as favoring the flexible tube rather than the rigid one, and emphasize the complementary nature of these 2 techniques in pediatrics.

Adolescent↗
PubMed1987

[Vagus death in foreign body bronchoscopy].

Vagus reflex death in foreign body bronchoscopy as a rare incident that severely incriminates medical work is described via a personal observation in an infant of 2 3/4 years of age. Typical symptoms are probably "thorax rigidity", sphincter-like stenosis of the bronchial lumina, paravertebral contraction atelectasis and catarrhal mucous membrane alterations of the respiratory tract. The bulb rhythm producing structures between the tractus solitarius and the nucleus ambiguus must be considered as origins of respiratory arrest.

Bronchi↗
PubMed1982

Flexible fiberoptic bronchoscopy: its role in diagnosis of lung lesions.

When a lesion is suspected to be primary or metastatic lung cancer or due to certain infiltrative processes, flexible fiberoptic bronchoscopy may be the best means of evaluating the bronchial tree and its adjacent lung parenchyma. The procedure is relatively noninvasive, can be done with the patient fully awake, and has limited contraindications and few complications.

Adult↗