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PubMed2006

Comparison of haemodynamic responses to orotracheal intubation with GlideScope videolaryngoscope and fibreoptic bronchoscope.

BACKGROUND AND OBJECTIVE: The GlideScope videolaryngoscope is a newly developed laryngoscope for tracheal intubation recently introduced into clinical anaesthesia. In this randomised clinical study, we compared the haemodynamic responses to orotracheal intubation using a GlideScope videolaryngoscope and a fibreoptic bronchoscope. METHODS: Fifty-six adult patients, ASA I-II scheduled for elective plastic surgery under general anaesthesia requiring orotracheal intubation were randomly allocated to either the GlideScope videolaryngoscope group or the fibreoptic bronchoscope group. After a standard intravenous anaesthetic induction, orotracheal intubation was performed. Noninvasive blood pressure and heart rate were recorded before and after induction, at intubation and for 5 min after intubation at 1 min intervals. RESULTS: As compared with the post-induction values the orotracheal intubations using a fibreoptic bronchoscope and a GlideScope videolaryngoscope resulted in the significant increases in blood pressures which did not exceed their baseline values. In the two groups, heart rates at intubation and within 2 min after intubation were significantly higher than their baseline values. However, there were no significant differences in blood pressures and heart rates at all time points, their maximal values and maximal percent changes during the observation and the times required to reach their maximal values between the two groups. CONCLUSIONS: The orotracheal intubations using a fibreoptic bronchoscope and a GlideScope videolaryngoscope produce similar haemodynamic responses.

Adolescent↗
PubMed1983

The surgeon's use of the rigid and flexible bronchoscopes in the diagnosis of bronchial carcinoma.

The results of a prospective study comparing the rigid and flexible fibreoptic bronchoscopic techniques in the diagnosis and assessment of bronchial carcinoma are reported. One hundred and nine patients underwent fibreoptic bronchoscopy and these were compared with a similar group of 111 patients in whom the rigid bronchoscope was used. Bronchoscopic diagnosis of malignancy was achieved in 73.4% of patients in the fibreoptic group and in 73% using the rigid bronchoscope.

Biopsy↗
PubMed2003

Pseudo-outbreak of Pseudomonas aeruginosa and Serratia marcescens related to bronchoscopes.

OBJECTIVE: To investigate an apparent outbreak involving simultaneous isolation of Pseudomonas aeruginosa and Serratia marcescens from bronchoalveolar lavage (BAL) samples. DESIGN: Retrospective and prospective cohort studies using chart review, environmental sampling, and ribotyping of all available isolates. Cleaning and disinfection procedures for the bronchoscopes were also evaluated. SETTING: A 380-bed private hospital in São Paulo, Brazil PATIENTS: Forty-one patients who underwent bronchoscopic procedures between December 1994 and October 1996 and from whom P. aeruginosa and S. marcescens were concomitantly isolated. Bronchoscopes and related items were microbiologically assessed. RESULTS: P. aeruginosa and S. marcescens were simultaneously isolated from BAL samples 12.6% of the time (41 of 324) during the epidemic period versus 1.8% of the time (1 of 54) in the pre-epidemic period (P = .035). Ribotyping revealed two strains of P. aeruginosa and one of S. marcescens that were isolated from BAL samples of patients with no signs of respiratory tract infection, suggesting a pseudo-outbreak. Evaluation of bronchoscope disinfection revealed that inappropriate methods were being used. Implementation of simple control measures resulted in a significant decrease in simultaneous isolation of these species. CONCLUSION: Prevention of pseudo-outbreaks requires meticulous use of preventive measures for infection-prone medical procedures.

Brazil↗
PubMed1996

Amplification of residual DNA sequences in sterile bronchoscopes leading to false-positive PCR results.

PCR has been used successfully for the direct detection of Mycobacterium tuberculosis in uncultured patient samples. Its potential is hindered by the risk of false-positive results as a result of either amplicon carryover of cross-contamination between patient samples. In the present study, we investigated whether residual amplifiable human or M. tuberculosis DNA could remain in sterile bronchoscopes and potentially be a cause of false-positive PCR results in subsequent patient samples. Sterilized bronchoscopes were flushed with sterile saline, and the collected eluate was submitted for PCR amplification of IS6110 sequences and exon 8 of the human p53 gene. Of a total of 55 washes of sterile bronchoscopes from two institutions, 2 (3.6%) contained amplifiable M. tuberculosis DNA and 11 (20%) contained residual human DNA. These findings indicate that residual DNA can remain in sterilized bronchoscopes and can be a source of false-positive PCR results.

Bronchoscopes↗
PubMed2000

Peripheral airway findings in chronic obstructive pulmonary disease using an ultrathin bronchoscope.

The authors performed bronchoscopic examination using an ultrathin bronchoscope to determine the characteristics of the peripheral airways in chronic obstructive pulmonary disease (COPD). The study population comprised 13 healthy control subjects, 10 patients with chronic bronchitis without airflow limitation, and 20 patients with COPD. The COPD patients were divided clinically into 10 with chronic bronchitis and 10 with pulmonary emphysema. The peripheral airways were examined using an ultrathin bronchoscope. In chronic bronchitis, peripheral airways of the 11th or 12th generation showed a high frequency of obstruction and mucosal changes such as granulation. In pulmonary emphysema, the peripheral airways frequently showed a net-like appearance of the bronchial epithelium and obstruction at the 11th or 12th generation. Morphological changes of the small airways in chronic obstructive pulmonary disease can be detected by an ultrathin bronchoscope, and this method is likely to be useful for investigating the small airways in vivo.

Adult↗
PubMed2005

Quantification of the magnification and distortion effects of a pediatric flexible video-bronchoscope.

BACKGROUND: Flexible video bronchoscopes, in particular the Olympus BF Type 3C160, are commonly used in pediatric respiratory medicine. There is no data on the magnification and distortion effects of these bronchoscopes yet important clinical decisions are made from the images. The aim of this study was to systematically describe the magnification and distortion of flexible bronchoscope images taken at various distances from the object. METHODS: Using images of known objects and processing these by digital video and computer programs both magnification and distortion scales were derived. RESULTS: Magnification changes as a linear function between 100 mm (x1) and 10 mm (x9.55) and then as an exponential function between 10 mm and 3 mm (x40) from the object. Magnification depends on the axis of orientation of the object to the optic axis or geometrical axis of the bronchoscope. Magnification also varies across the field of view with the central magnification being 39% greater than at the periphery of the field of view at 15 mm from the object. However, in the paediatric situation the diameter of the orifices is usually less than 10 mm and thus this limits the exposure to these peripheral limits of magnification reduction. Intraclass correlations for measurements and repeatability studies between instruments are very high, r = 0.96. Distortion occurs as both barrel and geometric types but both types are heterogeneous across the field of view. Distortion of geometric type ranges up to 30% at 3 mm from the object but may be as low as 5% depending on the position of the object in relation to the optic axis. CONCLUSION: We conclude that the optimal working distance range is between 40 and 10 mm from the object. However the clinician should be cognisant of both variations in magnification and distortion in clinical judgements.

Artifacts↗
PubMed1992

The flexible fiberoptic bronchoscopic shuttle.

The purpose of this paper is to describe a novel and practical technique for endobronchial catheter placement utilizing the flexible fiberoptic bronchoscope. Placement of endobronchial catheters via the flexible bronchoscope is limited by the small dimension of the bronchoscope's internal channel and frequently requires repeated manipulation to verify position endobronchially. We describe preliminary experience with a technique that we call the "bronchoscopic shuttle," which circumvents this limitation. The spectrum of possible clinical uses for this technique is discussed.

Brachytherapy↗
PubMed2004

Bronchoscope reprocessing and infection prevention and control: bronchoscopy-specific guidelines are needed.

BACKGROUND: It has been recommended that bronchoscopists familiarize themselves with national recommendations for bronchoscope reprocessing practices, but the extent of guideline awareness is unclear. METHODS: We distributed a survey to practicing bronchoscopists at two meetings. Questions addressed infection control issues related to bronchoscopy and specific reprocessing recommendations. RESULTS: A total of 46 surveys were completed by medical directors of bronchoscopy suites (26%) and attending bronchoscopists (74%) who had graduated from medical school a median of 22 years ago and performed a median of 19 procedures per month. Sixty-five percent of respondents, including 55% of directors, were not familiar with national reprocessing recommendations, and 39% did not know the approach to reprocessing at their own institution. Respondents who did > 20 procedures per month trended toward being more likely to be aware of guidelines (54% vs 26%, p = 0.09) and were less likely to answer "do not know" to more than one question about specific reprocessing details (25% vs 70%, p = 0.003). Seventy-eight percent of respondents did not know local practices for at least one of the reprocessing details. Forty-six percent of respondents stated their institutions followed recommendations that records be kept of the specific bronchoscope used in each case. CONCLUSIONS: Many experienced bronchoscopists are unfamiliar with national guidelines and local practices related to bronchoscope reprocessing. Publication of bronchoscope-specific, comprehensive reprocessing guidelines in the pulmonary literature may help increase familiarity with this crucial process.

Bronchoscopes↗
PubMed2005

Endobronchial ultrasonography guidance for transbronchial needle aspiration using a double-channel bronchoscope.

STUDY OBJECTIVES: Endobronchial ultrasonography (EBUS) is used as guidance for transbronchial needle aspiration (TBNA), and real-time imaging of the needle position cannot be confirmed with a single-channel bronchoscope. We assessed the usefulness of EBUS-guided TBNA using a double-channel bronchoscope (EBUS-D), which provides real-time needle position, and compared it with EBUS-guided TBNA using a single-channel bronchoscope (EBUS-S). DESIGN: Randomized, comparative prospective study. SETTING: Hiroshima City Hospital, a tertiary-referral teaching hospital. PATIENTS: Between January 2000 and August 2003, 55 patients with intrathoracic lymphadenopathy were included. Patients were randomized to undergo EBUS-D (n = 30) or EBUS-S (n = 25). METHODS: EBUS-D: The EBUS probe and TBNA catheter were inserted simultaneously through a double-channel bronchoscope. Once the needle placement in the lesion was confirmed by EBUS, TBNA was performed. EBUS-S: The EBUS probe was removed after the determination of the penetration site. Then, the TBNA catheter was inserted and TBNA was performed. RESULTS: All the lymph nodes could be visualized with EBUS in each group of patients. In the EBUS-D group, the TBNA needle was visualized as a hyperechoic point on the real-time EBUS image. The diagnostic accuracy rate of EBUS-D and EBUS-S were statistically significantly different (97% vs 76%, respectively; p = 0.025). On second attempt of TBNA, the diagnostic rate of the EBUS-D group was superior to that of the EBUS-S group (85.7% vs 33.3%, respectively; p = 0.036). The mean number of penetrations was 1.24 in the EBUS-D group and 1.36 in the EBUS-S group. No complications were observed in the EBUS-D group, but a self-limiting hemorrhage occurred in a patient in the EBUS-S group. CONCLUSION: EBUS-D is useful for diagnosing intrathoracic lymphadenopathy, and the obtained specimen with real-time confirmation of the needle is directly proportional to an accurate diagnosis.

Aged↗
PubMed1978

[Advantages of blood gas analyses of an improved ventilation bronchoscope (author's transl)].

During bronchoscopy in elder patients the development of respiratory acidosis is a hazard. A new and improved ventilation bronchoscope decreases the risk, which was demonstrated by blood gas analyses. This bronchoscope differs from those normally used in the following ways: 1. An inflatable cuff on the outer tube seals the bronchoscope like a breathing tube against the trachea. 2. This bronchoscope, although in the endobronchial position, improves the ventilation of the contraleateral lung aided by wider side holes lying above the bifurcation. 3. Jet-ventilation can be employed.

Acidosis, Respiratory↗
PubMed1978

[An improved bronchoscope (author's transl)].

This bronchoscope differs from those normally used in the following ways: 1. In the endobronchial position the bronchoscope makes possible improvement in ventilation of the contralateral lung by increasing the area of the side-openings above the bifurcation. - 2. An inflatable cuff on the outer tube seals the bronchoscope against the trachea like a breathing tube. - 3. Jet-ventilation van be employed when the bronchoscope is open.

Bronchoscopes↗
PubMed1982

Bronchoscopic extraction of aspirated foreign bodies in children.

New instruments and techniques have refined the art of extracting aspirated foreign bodies from children. During a five-year period at the University of New Mexico, Albuquerque, bronchoscopic extractions were successful in 40 of 41 children (98%). The extractions were performed with the patient under general anesthesia, using a pediatric ventilating bronchoscope that contained the Hopkins rod-lens system. Two methods of extraction were used, depending on the shape of the foreign object: the Fogarty balloon technique for spherical objects, and the forceps technique for flat objects. Using these techniques, most foreign bodies (80%) were removed on the first or second pass of the bronchoscope. Because bronchoscopic extraction is a delicate procedure and carries a risk of cardiorespiratory arrest, it should be performed by endoscopists and anesthesiologists who are skilled with this procedure in children.

Bronchi↗
PubMed1999

Bronchoscopic staging of squamous cell carcinoma of the upper thoracic esophagus.

OBJECTIVE: To identify bronchoscopic findings that predict resectability of squamous cell carcinoma of the upper thoracic esophagus. DESIGN: Tracheobronchoscopy was performed in patients with squamous cell carcinoma of the thoracic esophagus to assess the infiltration of the tracheobronchial tree by the tumor and predict the resectability. Bronchoscopic records were matched with clinical outcome and intraoperative findings. SETTING: University hospital, tertiary care referral center. PATIENTS: A total of 113 patients with supracarinal esophageal carcinoma underwent bronchoscopy as part of the preoperative staging. In 47 patients the bronchoscopy was repeated after a regimen of neoadjuvant chemotherapy. INTERVENTION: A total of 160 bronchoscopies performed by the same operator. MAIN OUTCOME MEASURES: Bronchoscopic records matched with clinical outcome and intraoperative findings. RESULTS: Including patients before and after neoadjuvant chemotherapy, 27 of the 46 with no bronchoscopic abnormalities were operated on: in 24 (89%) of them radical surgical resection was possible. Among the 22 patients with a slight compression on the tracheobronchial tree admitted to surgery, a radical surgical resection was possible in 20 cases (91%). In none of the 5 patients with compression/deviation associated with fixation of the tracheobronchial tree but no mucosal infiltration who underwent surgery was a radical surgical resection possible because of tracheobronchial infiltration. CONCLUSIONS: Compression of the tracheobronchial tree does not necessarily mean infiltration by esophageal carcinoma. If the compression is slight and the mobility of the tracheobronchial tree is normal, a radical esophagectomy is possible in 91% of patients.

Adult↗
PubMed2000

The diagnosis of ventilator-associated pneumonia using non-bronchoscopic, non-directed lung lavages.

OBJECTIVES: (1)To assess the diagnostic utility of quantitative cultures of non-bronchoscopic lung lavage (NBL) in ventilator-associated pneumonia and evaluate the role of the Bacterial Index; (2) To assess the predictive value of NBL surveillance quantitative cultures in ventilated patients; (3) To evaluate the Clinical Pulmonary Infection Score (CPIS) system in ventilated patients. DESIGN: A prospective comparison of NBL with bronchoscopic bronchoalveolar lavage and protected specimen brush. SETTING: Three intensive care units in academic tertiary care centres. PATIENTS: 145 adults ventilated for 72 h, with and without clinical signs of pneumonia. INTERVENTIONS: Sampling of lower airway secretions by NBL, bronchoalveolar lavage and protected specimen brush. MAIN OUTCOME MEASURES: Diagnostic reliability of quantitative cultures, Bacterial Index and CPIS. RESULTS: 34 episodes of clinical ventilator-associated pneumonia were documented in 32 patients. 9 episodes were confirmed by concordant blood/pleural culture or post-mortem lung examination. Qualitative concordance of the predominant pathogen between sequential NBL: bronchoalveolar lavage and protected specimen brush was 83 %. Sensitivity and specificity of non-directed bronchial lavage at a threshold of 10(4) CFU/ml were 68 % and 70 % respectively (p = 0. 003) and were comparable with the bronchoscopic methods. However, the low positive predictive value of NBL indicates that quantitation in the absence of clinical signs is unlikely to be useful. Bacterial Index did not improve discriminatory power of quantitation compared with bacterial load of predominant organism. Mean CPIS for confirmed pneumonia cases was 8.4 +/- 1.01, significantly higher than for non-pneumonia observations (p = < 0.0001). CONCLUSION: NBL is a simple, safe, cheap, readily-available method of diagnosing ventilator-associated pneumonia with comparable diagnostic accuracy to bronchoscopic techniques. Quantitation of respiratory tract cultures can exclude pneumonia in patients with equivocal clinical signs. The diagnostic threshold should vary depending on the length of ventilation, likelihood of pneumonia and antibiotic administration. The Bacterial Index is a flawed mathematical device that has no contributory role in pneumonia diagnosis. The CPIS has some diagnostic role in selected cohorts of ventilated patients.

APACHE↗
PubMed2006

Bronchoscopic NdYAG laser treatment in lung cancer, 30 years on: an institutional review.

We review our 21-year experience in bronchoscopic NdYAG laser for lung cancer and the relevant literature. Patients totaling 1,159 received 2,235 bronchoscopic treatments. The pre-requisite for laser therapy was the presence of >50% obstruction of the bronchial lumen. We use the rigid bronchoscope, with the patient under general anaesthetic and application of laser in its non-contact mode. Two patients (0.17%) died following the procedure, and 4.8% had non-fatal complications. Four to 6 weeks after treatment there was a 48% increase in bronchial calibre and an increase of 27% (mean) in forced vital capacity and 15% (mean) in forced expiratory volume in one second, respectively. These paralleled symptomatic relief and chest X-ray improvement. Literature review indicated results similar to ours in those centres with high volume activity. Thirty years on, bronchoscopic YAG laser therapy of lung cancer still has an important role in palliation of patients with inoperable lung cancer, particularly those requiring immediate relief of bronchial obstruction.

Aged↗
PubMed2006

Bronchoscopic diagnosis of pulmonary infiltrates in granulocytopenic patients with hematologic malignancies: BAL versus PSB and PBAL.

BACKGROUND: Treatment of patients with hematologic malignancies is often complicated by severe respiratory infections. Bronchoscopy is generally to be used as a diagnostic tool in order to find a causative pathogen. OBJECTIVES: In a prospective study the combination of protected specimen brush (PSB) and protected bronchoalveolar lavage (PBAL) was compared with bronchoalveolar lavage (BAL) for evaluated feasibility and diagnostic yield in granulocytopenic patients with hematologic malignancies and pulmonary infiltrates. METHODS: All specimens from 63 bronchoscopic procedures (35 BAL and 28 PSB-PBAL) were investigated by cytological examination and various microbiological tests. If clinically relevant and feasible, based on the clinical condition and/or the presence of thrombocytopenia, lung tissue samples were obtained. RESULTS: The majority of the 58 included patients were diagnosed as having acute myeloid leukaemia and developed a severe neutropenia (BAL-group: 27 days; PSB-PBAL group: 30 days). Microbiological and cytological examination of 63 bronchoscopic procedures (35 BAL and 28 PSB-PBAL) yielded causative pathogens in 9 (26%) patients of the BAL-group and 8 (29%) patients of the PSB-PBAL group (PSB and PBAL 4 each). Aspergillus fumigatus was the pathogen most frequently (13%) detected. Using all available examinations including the results of autopsy, a presumptive diagnosis was established in 43% of the patients in the BAL group and 57% of those in the PSB-PBAL group; in these cases microbial aetiology was correctly identified in 67% and 57%, respectively. The complication rate was of these procedures were low, and none of the patients experienced serious complications due to the invasive techniques. CONCLUSIONS: Our results showed that modern bronchoscopic techniques such as PSB and PBAL did not yield better diagnostic results compared to BAL in granulocytopenic patients with hematologic malignancies and pulmonary infiltrates. In approximately half of the cases a presumptive diagnosis was made by bronchoscopic procedures.

Adult↗
PubMed2001

Bronchoscopic dilatation in the management of benign (non-transplant) tracheobronchial stenosis.

BACKGROUND: Tracheobronchial stenosis in the adult patient is a recognized postoperative complication of sleeve resection or lung transplantation, but also occurs in medical conditions such as sarcoidosis, tuberculosis, postintubation/tracheostomy or post-radiation. AIMS: To assess the response of bronchoscopic dilatation in the management of benign (non-transplant) tracheobronchial stenosis and the longevity of symptomatic relief. METHODS: Eight patients underwent bronchoscopic dilatation for benign (non-transplant) tracheobronchial stenosis. The indications were post-tuberculous bronchostenosis (n = 3), post-tracheostomy/endotracheal intubation strictures (n = 3), postradiation bronchostenosis (n = 1) and narrowing of the tracheal lumen following a muscle flap surgery for tracheoesophageal fistula (n = 1). RESULTS: Dilatation alone was effective in the management of four patients (50%). Two patients had stent placement postdilatation, one patient had tracheal resection and primary anastomosis and one patient had laser ablation for restenosis followed by balloon dilatation. All patients had clinical improvement. One patient was successfully weaned off mechanical ventilation and extubated. There was no procedure-related mortality and all patients were alive and well at the time of reporting, with a mean duration since procedure of 123 +/- 105 (range 8-340) weeks. The complications observed were granuloma formation at the site of laser excision and restenosis, each in one patient. CONCLUSIONS: Bronchoscopic dilatation is a safe and effective modality in the initial assessment and management of benign tracheobronchial stenosis. Stent placement and Nd:YAG laser therapy complement a dilatation procedure in the combined bronchoscopic treatment of benign tracheobronchial stenosis.

Adult↗
PubMed2004

[Endobronchial lipoma: successful therapy by bronchoscopical laser resection vs. surgery].

BACKGROUND: Endobronchial lipoma is a very rare benign lung tumor. Therapeutic alternatives are the interventional bronchoscopic laser resection or surgical treatment. METHODS: From 1996 to 2002 we diagnosed 16 patients with endobronchial lipoma in our institution. We examined the clinical data of the patients and their influence on the individual patient treatment. RESULTS: 14 (88 %) out of the 16 patients (60 +/- 14 y.) were male. Clinical symptoms were cough (81 %), dyspnea (75 %), pulmonary infiltration (63 %) and fever (31 %). In the right lung 11 lipomas (69 %) were located, in the left lung 5 lipomas (31 %). The distribution to main bronchus, upper lobe, middle lobe and lower lobe bronchus were 2 (12.5 %), 6 (37.5 %), 2 (12.5 %) und 6 (37.5 %). 14 (88 %) lipomas were found in the central airways, 2 were located in the periphery of the lung. All lipomas in the central airways were successfully treated by bronchoscopic laser therapy with a mean of 1.1 +/- 0.3 laser sessions. One patient died of concomitant bronchial carcinoma before therapy. Surgical treatment was only necessary in a very peripherally located huge lipoma and a lipoma with extensive parenchym destruction. CONCLUSIONS: Bronchoscopic laser resection should be considered as first line therapy in cases of endobronchial lipoma. It is safe, successful, rapid and less expensive compared to surgical resection. Surgery should only be indicated in patients with lipomas with very peripherally localisation or parenchym destruction, extrabronchial growth, suspected malignancy or technical problems at bronchoscopic resection.

Adult↗