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Bronchoscopic intubation of patients with trismus.

Endotracheal intubation of patients with limited bite opening is a serious task for the caring physician. Blind intubation can be frustrating and, very often, unsuccessful. Tracheostomy, even under ideal conditions, can create serious complications. Fiberoptic bronchoscopy has opened up a new era in intubation of patients with trismus. In this article, we discuss an organized illustrated procedure for intubation of such patients. We have used this procedure successfully in 16 patients over the last sixteen months in our craniofacial unit, with no complications and no failures.

Bronchoscopy↗

Clinical diagnosis of massive hemoptysis using the fiberoptic bronchoscope.

Pulmonary resection, when possible, is the conventional treatment of massive hemoptysis. Alternatives include bronchial artery embolization, Fogarty catheter balloon tamponade, and pharmacologic approaches. We used endotracheal intubation and flexible bronchoscopy to locate the bleeding site in three of four patients with massive hemoptysis. These cases are used to review the etiology of massive hemoptysis and the usefulness of flexible bronchoscopy to localize the source of hemorrhage.

Adult↗

Effectiveness of continuous positive airway pressure in the treatment of bronchomalacia in infants: a bronchoscopic documentation.

Continuous positive airway pressure (CPAP) was used to treat severe respiratory distress in four infants with bronchomalacia. Fiberoptic bronchoscopy diagnosed the area of bronchomalacia, documented the effects of CPAP on the airway, and helped determine an effective level of CPAP. CPAP immediately decreased respiratory distress, and was correlated with improved airway patency in the formerly collapsed airways. All four infants, including three who had required prolonged mechanical ventilation, maintained spontaneous ventilation on CPAP.

Bronchial Diseases↗

Blood clots mimicking peripheral intrabronchial tumors in patients with hemoptysis: CT and bronchoscopic findings.

We report radiographic and clinical findings in two cigarette-smoking patients presenting with hemoptysis. On CT, both patients had peripheral intrabronchial masses together with parenchymal opacities. Bronchoscopy revealed the intrabronchial masses to be blood clots and the parenchymal opacities to correspond to areas of parenchymal hemorrhage. Our cases are novel in that both bronchial and parenchymal sequelae of hemorrhage were simultaneously visualized by CT. Also, our findings suggest that bronchial blood clots should be included in the differential diagnosis of peripheral intrabronchial lesions, notably in patients presenting with hemoptysis.

Adult↗

Bronchoscopic detection of bronchogenic carcinoma in cases of pneumonia.

This study was undertaken to determine what factors would be useful in making a decision to do bronchoscopy to look for an obstructing carcinoma in cases of pneumonia. The study showed that in pneumonia limited to one lobe of the lung, which occurs in a heavy smoker over 50 years of age, and which does not have complete resolution by chest roentgenogram after three weeks of antibiotic therapy, bronchoscopy gives a very high positive yield for tumor when an obstructing bronchogenic carcinoma is present. Sputum cytology should be done routinely in patients with pneumonia limited to one lobe, but according to our study tumor cells will be found in only about 30% of patients having an obstructing carcinoma.

Age Factors↗