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PubMed1997

Implantation of Accuflex and Strecker stents in malignant bronchial stenoses by flexible bronchoscopy.

Silicone and metal stents are available for the treatment of malignant bronchial stenoses. This project sought to compare the self-expanding nitinol Accuflex stent (Boston Scientific Corp; Watertown, Mass) with the passively expandable tantalum Strecker stent (Boston Scientific Corp; Watertown, Mass), both implanted by flexible bronchoscopy under local anesthesia and sedation. In 51 patients with malignant bronchial stenosis, 14 nitinol and 51 tantalum stents were used and stenoses of 75 to 100% were treated. The intervention was successful in all but one patient; a mean patency of 93% was achieved. In the follow-up period, the probability of survival was significantly lower in patients with total bronchus occlusion than in patients with stenotic alterations (44 vs 109 days; p<0.05). In 10 patients, lung function analysis after stent implantation revealed a significant increase in PaO2 (65 vs 71 mm Hg; p<0.01), inspiratory vital capacity (2.5 vs 2.7 L; p<0.05), and FEV1 (1.8 vs 2.0 L; p<0.05). Mucus retention was the main (39%) adverse factor in the early phase after stent implantation, whereas tumor penetration became the most frequent problem (67%) in the later phase. Recanalizing interventions were necessary in 18% of the cases in which tumor penetration occurred. Stent distortion occurred in 12 patients with Strecker and in none with Accuflex stents. In comparison to the Strecker stent, the self-expanding Accuflex stent is preferable owing to its excellent flexibility and faster delivery system. Both types of stents could be sufficiently deployed within the lesion and allowed for highly precise positioning. Furthermore, no general anesthesia was required. The fiberbronchoscopic mode of implantation under sedation is very efficient even for tumor patients with severe impairment of their physical and respiratory condition.

Alloys↗
PubMed1997

Myocardial ischemia in sedated patients undergoing fiberoptic bronchoscopy.

STUDY OBJECTIVE: To study the incidence of myocardial ischemia and related hemodynamic alterations in sedated patients undergoing fiberoptic bronchoscopy (FOB). DESIGN: Prospective study. SETTING: Tertiary care, university hospital. PATIENTS: Twenty-nine patients, age 50 years or older, undergoing elective FOB. INTERVENTIONS: Myocardial ischemia was assessed by continuous ECG monitoring beginning 30 min before, and until 2 h after FOB. MEASUREMENTS AND RESULTS: During FOB, there was a significant rise in heart rate (89+/-3 [mean+/-SE] to 120+/-4 beats/min) and fall in oxygen saturation (95+/-1 to 90+/-1%). There was no significant rise in systolic or diastolic BP. Five patients (17%) had myocardial ischemia during FOB that lasted 20+/-8 min. Their demographic and pre-FOB characteristics were not different from the other patients. Compared to baseline values, a significant rise in heart rate, a fall in oxygen saturation, and no significant change in BP were observed during FOB in patients, both with or without ischemia. Although not statistically significant, ischemia was associated with more protracted procedures. CONCLUSIONS: Myocardial ischemia may develop in elderly patients undergoing FOB. This observation encourages the routine use of ECG and oximetry during FOB, allowing for early intervention to prevent the dangerous combination of hypoxia, tachycardia, and myocardial ischemia. Moreover, this study suggests that methods to ensure oxygenation during FOB should be adhered to, and that the routine administration of atropine should be reconsidered.

Anesthesia, Inhalation↗
PubMed1999

Coronary spasm and cardiac arrest from carcinoid crisis during laser bronchoscopy.

Bronchoscopic manipulation of an endobronchial carcinoid can precipitate a carcinoid crisis. Coronary artery spasm is an uncommon manifestation of carcinoid crisis, and has never been reported as a complication of flexible bronchoscopy. We report a case of a 10-year-old girl who developed coronary artery spasm and cardiac arrest during neodymiumyttrium aluminum garnet (Nd-YAG) laser photoresection of an endobronchial carcinoid. Recognition of this unusual presentation of a carcinoid crisis is important as the treatment approach differs from standard resuscitation protocols.

Bronchial Neoplasms↗
PubMed2000

Screening for lung cancer revisited and the role of sputum cytology and fluorescence bronchoscopy in a high-risk group.

Lung cancer is an epidemic disease that is underrepresented in the research funding for early detection and chemoprevention arenas. Screening programs have been discouraged for both financial and political reasons. Yet, increasing evidence suggests that screening and early detection may improve outcome in lung cancer. Sputum cytology examination has been shown in several studies to lead to detection of lung cancer at an earlier stage, resulting in an improved 5-year survival rate. Monoclonal antibody detection, fluorescence bronchoscopy, and low-dose spiral CT increase diagnostic sensitivity and improve the ability to localize early-stage lesions. Utilizing these new techniques and improving the definition of high-risk groups may improve the success and cost-effectiveness of early detection based on sputum cytology. The ultimate goal of improving long-term survival in lung cancer will be achieved only when cancer can be detected in its early stages and lesions can be localized in large numbers. Advances in the last 15 years offer an encouraging vision for the value of early detection and effective treatment for lung cancer.

Bronchoscopy↗
PubMed2000

Catamenial hemoptysis from tracheobronchial endometriosis: reappraisal of diagnostic value of bronchoscopy and bronchial brush cytology.

OBJECTIVES: To analyze the clinical data of four patients with a diagnosis of tracheobronchial endometriosis, and to reappraise the diagnostic value of bronchoscopy and bronchial brush cytology in these patients. METHODS: We conducted a retrospective study of four patients with documented tracheobronchial endometriosis treated at National Taiwan University Hospital from 1994 to 1998. The complete histories, diagnostic time interval, results of physical examinations, laboratory data, bronchoscopic findings, cytologic results, chest radiographs, and chest CT of these patients were analyzed. RESULTS: These patients tend to be younger and nonmultiparous as compared to other patients with thoracic endometriosis. Bronchoscopic examination performed within 1 day or 2 days of menses disclosed multiple purplish-red submucosal patches bilaterally that bled easily when touched. Cytologic evaluation of the brushing specimens demonstrated clusters of small cuboid cells consistent with an endometrial origin. Follow-up bronchoscopic examination in the middle of the menstrual cycle showed disappearance of the previous tracheobronchial lesions. The mean diagnostic interval was 3.25 months. All four patients were successfully treated with danazol therapy. CONCLUSIONS: Tracheobronchial endometriosis consists of a special subgroup of patients with thoracic endometriosis. Proper timing of bronchoscopic examination plays an important diagnostic role in these patients. Cytologic features as well as cyclic changes in bronchoscopic findings are sufficient to warrant the diagnosis. The results of treatment with danazol in these patients seemed favorable.

Adult↗
PubMed2001

Hemoptysis in patients with renal insufficiency : the role of flexible bronchoscopy.

STUDY OBJECTIVES: To assess the indications, yield, and therapeutic impact of flexible bronchoscopy (FB) in patients with hemoptysis and renal insufficiency. DESIGN: Retrospective cohort analysis. SETTING: Tertiary-care university hospital. PATIENTS: Thirty-four patients over a 7.5-year period who underwent FB to evaluate hemoptysis in the setting of renal insufficiency (ie, serum creatinine level, > 1.5 mg/dL). MEASUREMENTS AND RESULTS: The etiology of hemoptysis was undetermined in 41% of cases. Defined causes of bleeding included infections (29%), pulmonary renal syndromes (15%), airway injury (9%), and pulmonary embolism (6%). No specific bleeding site was identified, but FB lateralized hemorrhaging to one lung in 24% of patients. FB results influenced therapy in 29% of patients overall and in 8% of patients without respiratory tract infection. The hospital survival rate was 47% and did not differ based on the presence or absence (presence vs absence) of the following variables: a defined etiology for hemoptysis (45% vs 50%); lateralized bleeding (38% vs 50%); or management alterations prompted by other FB findings (50% vs 46%). Factors associated with survival included the onset of bleeding prior to hospital admission (80% vs 33%; p = 0.02), the absence of respiratory failure requiring mechanical ventilation at the time of FB (90% vs 29%; p = 0.002), and lack of prohemorrhagic factors (other than uremia) such as disseminated intravascular coagulation, recent treatment with warfarin, heparin, or antiplatelet agents (78% vs 33%; p = 0.05). During the 6 months following hospital discharge, hemoptysis recurred in 14% of patients, and 5 patients died, for an overall mortality rate of 62%. CONCLUSIONS: These data suggest that FB in hospitalized patients with hemoptysis and renal insufficiency, and without radiographic findings suggesting neoplastic disease, has a low yield and limited impact. Whether FB influences outcome in selected patients in this setting requires prospective investigation.

Bronchoscopy↗
PubMed2001

Pediatric fiberoptic bronchoscopy with a laryngeal mask airway.

BACKGROUND AND OBJECTIVES: Bedside flexible fiberoptic bronchoscopy (FFB) with sedation has been recognized as a diagnostic modality in children. In certain circumstances, general anesthesia with endotracheal intubation is advocated. This study evaluates the usefulness of the laryngeal mask airway (LMA) as an alternative to endotracheal intubation during pediatric FFB. DESIGN, SETTING, AND PATIENTS: Between July 1995 and June 2000, we studied 92 children (51 girls; age range, 1 through 15 years) in the operating theater of a major tertiary children's hospital. The LMA was used in children with atelectasis, diffuse infiltrates, and those who required BAL under general anesthesia. The size of the LMA was chosen to accommodate a bronchoscope appropriate for the child's weight and age. RESULTS: Procedures were well tolerated, no complications were observed, and oxygen saturation exceeded 95% in all patients. Major findings included mucoid impaction and purulent bronchial secretions, and BAL was successfully accomplished in all individuals. CONCLUSIONS: Diagnostic BAL or extraction of mucous plugs should be accomplished with optimal control of the airway under general anesthesia. The use of the LMA during FFB is safe, provides excellent patient comfort, and should be utilized as an alternative to endotracheal intubation.

Adolescent↗
PubMed2001

Prospective randomized trial comparing oxygen administration during nasal flexible bronchoscopy : oral vs nasal delivery.

STUDY OBJECTIVES: To determine the optimal method of delivering supplemental oxygen during flexible bronchoscopy (FB). DESIGN: Prospective study. SETTING: University medical center. PATIENTS: Ninety-seven consecutive patients undergoing outpatient nasal FB during a 7-month period. INTERVENTION: During FB, delivery of oxygen was alternated weekly and administered by nasal cannula either nasally (52 patients) or orally (45 patients). Prior to the procedure, patients completed a questionnaire regarding oral or nasal breathing preferences, history of sinus disease, allergy history, and perceived degree of nasal congestion. RESULTS: Comparison of oxygen delivery groups demonstrated no significant difference in oxygen requirements (4.1 L/min nasal vs 3.8 L/min oral, p = 0.63), overall saturation nadir (90.9% nasal vs 91.4% oral, p = 0.85), or average saturation (95.8% nasal vs 95.7% oral, p = 0.57). No correlation between subjective symptoms or sinus or allergy history was found for oxygen requirements, average saturation, or saturation nadir. CONCLUSIONS: These data suggest that during nasal FB, no discernible difference exists between administration of oxygen using cannulas placed either nasally or orally.

Bronchoscopy↗
PubMed2002

Noninvasive positive-pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy.

OBJECTIVE: We have reported previously on the use of noninvasive positive-pressure ventilation (NPPV) to assist spontaneous breathing in high-risk hypoxemic patients (i.e., PaO(2)/fraction of inspired oxygen [FIO(2)] ratio, < or = 100) who are undergoing diagnostic fiberoptic bronchoscopy (FOB). The efficacy of this intervention in patients with less severe forms of hypoxemia (i.e., PaO(2)/FIO(2) ratio, < 200) is unknown. PATIENTS AND METHODS: Twenty-six patients with PaO(2)/FIO(2) ratios < or = 200 who required bronchoscopic BAL for suspected nosocomial pneumonia were entered into the study. Thirteen patients were randomized during FOB to receive NPPV, and 13 patients were randomized to receive conventional oxygen supplementation by Venturi mask. The primary end points were changes in the PaO(2)/FIO(2) ratio during FOB and within 60 min of terminating the procedure. RESULTS AND OUTCOME: At study entry, the two groups were similar in terms of age, simplified acute physiologic score II values, and cardiorespiratory parameters. During FOB, the mean (+/- SD) PaO(2)/FIO(2) ratio increased by 82% in the NPPV group (261 +/- 100 vs 139 +/- 38; p < 0.001) and decreased by 10% in the conventional oxygen supplementation group (155 +/- 24 to 139 +/- 38; p = 0.23). Sixty minutes after undergoing FOB, the NPPV group had a higher mean PaO(2)/FIO(2) ratio (176 +/- 62 vs 140 +/- 38; p = 0.09), a lower mean heart rate (91 +/- 18 vs. 108 +/- 15 beats/min; p = 0.02), and no reduction in mean arterial pressure in comparison to a 15% decrease from the baseline in the control group. One patient in the NPPV group and two patients in the control group required nonemergent intubation. Major bacterial isolates included Staphylococcus aureus (7 of 30 isolates; 23%) and Pseudomonas aeruginosa (12 of 30 isolates; 40%). CONCLUSION: In patients with severe hypoxemia, NPPV is superior to conventional oxygen supplementation in preventing gas-exchange deterioration during FOB with better hemodynamic tolerance.

Adult↗
PubMed2002

Management of acute hypoxemia during flexible bronchoscopy with insertion of a nasopharyngeal tube in lung transplant recipients.

STUDY OBJECTIVES: To assess the utility of nasopharyngeal tube insertion in the management of hypoxemia during flexible bronchoscopy (FB) in lung transplant recipients, and to determine the incidence and risk factors of upper-airway obstruction (UAO) leading to significant hypoxemia during FB. SETTING: Heart-lung transplant unit of a university hospital. PATIENTS AND METHODS: Ninety-six lung transplant recipients (47 men and 49 women; mean +/- SD age, 41.4 +/- 13.1 years) underwent 714 FB procedures from January 1997 to May 2000. INTERVENTION: A fall in oxygen saturation (< or = 90%) in patients receiving 6 L/min of oxygen via nasal prongs was treated with insertion of a nasopharyngeal tube, continued oxygen supplementation, and withdrawal of the bronchoscope to the trachea. If oxygen desaturation persisted at < 90% despite additional oxygen administration via a 7F catheter placed either just above the larynx or in the proximal trachea, the bronchoscope was withdrawn, reversal of sedation was administered, and bag and mask ventilation was instituted until satisfactory spontaneous ventilation was achieved. RESULTS: Forty-six patients (47.9%) were treated with nasopharyngeal tube insertion on 102 occasions at a mean duration of 168 +/- 178 days after lung transplantation. In 90 of 102 procedures (88.2%), significant hypoxemia due to UAO was successfully treated with nasopharyngeal tube insertion. The mean oxygen saturation after nasopharyngeal tube insertion was 97 +/- 3%. Male gender, increase in body mass index after lung transplantation, and presence of obstructive sleep apnea were significant factors associated with the need for nasopharyngeal tube insertion during FB in lung transplant recipients. CONCLUSIONS: Significant oxygen desaturation during FB in lung transplant recipients is mainly due to UAO. Insertion of a nasopharyngeal tube is a novel and a highly effective approach to the management of acute hypoxemia during FB.

Adult↗
PubMed2003

Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia.

STUDY OBJECTIVES: To determine whether distraction therapy with nature sights and sounds during flexible bronchoscopy (FB) reduces pain and anxiety. DESIGN: Randomized controlled trial. SETTING: Teaching hospital in Baltimore, MD. PATIENTS: Consecutive adult patients (n = 80) undergoing FB with conscious sedation. INTERVENTION: Nature scene murals were placed at the bedside, and patients were provided a tape of nature sounds to listen to before, during, and after the procedure. Patients assigned to the control group were not offered either the nature scene or the sounds. MEASUREMENTS AND RESULTS: The primary outcomes were patient ratings of pain control (a 5-point scale ranging from poor to excellent) and anxiety. In a multivariate ordinal logistic regression model, the odds of better pain control were greater in the intervention patients than in the control patients (odds ratio [OR], 4.76; 95% confidence interval [CI], 1.35 to 16.7), after adjustment for age, gender, race, education, health status, and dose of narcotic medication. Older patients and patients with better health status reported significantly less pain. There was no difference in patient-reported anxiety between the two groups (OR, 0.87; 95% CI, 0.39 to 1.96). CONCLUSIONS: Distraction therapy with nature sights and sounds significantly reduces pain in patients undergoing FB. Although the precise mechanism of this beneficial effect requires further investigation, clinicians should consider this nonintrusive strategy in addition to standard analgesic medications in patients undergoing painful, invasive procedures.

Adult↗
PubMed2003

Self-expandable metallic airway stents and flexible bronchoscopy: long-term outcomes analysis.

STUDY OBJECTIVE: s: To report and analyze our 6-year experience with implanting 112 self-expandable metallic stents (SEMSs) using flexible bronchoscopy (FB). DESIGN AND SETTING: Retrospective study, tertiary-care hospital. PATIENTS AND METHODS: The studied population consisted of 82 patients (mean age, 59.1 years; range, 37 to 83 years), who received SEMSs from 1995 to 2001 using Wallstent (Boston Scientific; Galway, Ireland) or Ultraflex (Boston Scientific) stents. RESULTS: The indications for stent placement were airway obstruction caused by neoplasia (lung carcinoma [CA], n = 50), airway complications of lung transplantation (LTx) [n = 11], and miscellaneous benign conditions (BCs) [n = 21]. The most frequent clinical presentations for the airway obstruction were moderate-to-severe dyspnea (80%) and coughing (45%). The median follow-up duration for the CA group was 42.0 days (range, 1 to 672 days), 329.0 days (range, 35 to 1,540 days) for patients receiving LTx, and 336.0 days (range, 7 to 2,184 days) for the patients with miscellaneous BCs. The observed complications included infection (15.9%), obstructive granulomas (14.6%), and migration (4.7%). The incidence of granulomas was significantly lower in the patients with CA (4.0%) vs LTx and BC groups (17.3% and 33.3% respectively; p = 0.002). All other assessed variables showed no difference between the three analyzed groups. No cases of mucus plugging or fatal hemoptysis were observed. Forty-four patients (53.7%) had no complications related to the SEMS. The incidence of complications was not related to the type of stent (Wallstent or Ultraflex) or SEMS version (covered or uncovered). Fourteen of the 16 patients (87.5%) who were receiving mechanical ventilation could be weaned after the procedure. There were no deaths related to SEMS placement. CONCLUSIONS: An SEMS is a safe and effective modality for malignant as well as selected benign airway obstruction. An SEMS is an acceptable therapeutic alternative in patients with central airway obstruction who are not considered good surgical candidates and are receiving mechanical ventilation. Careful patient selection is of outmost importance for a good outcome after airway stenting. Insertion using FB adds to the ease of the procedure.

Adult↗
PubMed2004

The efficacy of premixed nitrous oxide and oxygen for fiberoptic bronchoscopy in pediatric patients: a randomized, double-blind, controlled study.

STUDY OBJECTIVE: s: The aim of the study was to evaluate the efficacy and safety of premixed 50% nitrous oxide and oxygen on the quality of sedation and pain control during fiberoptic bronchoscopy (FB) in children. DESIGN: A prospective, randomized, double-blind study. SETTING: Pediatric pulmonary department in a pediatric tertiary university hospital. PATIENTS: One hundred five children aged 1 month to 18 years. INTERVENTIONS: Patients inhaled after sedation and local anesthesia either premixed 50% nitrous oxide and oxygen (nitrous oxide group) or premixed 50% nitrogen and oxygen (control group) during FB. MEASUREMENT AND RESULTS: The rate of failure was significantly greater in the control group (62%) than in the nitrous oxide group (21%, p = 0.00003). The efficacy of premixed 50% nitrous oxide and oxygen was also demonstrated with higher satisfaction scores (p = 0.000001), lower Children's Hospital of Eastern Ontario Pain Scores (p = 0.002), better visual analog scale ratings (p = 0.03), and improved behavior scores. Side effects were minor and similar in both groups. CONCLUSIONS: This study demonstrates the improved efficacy of sedation, pain control, and safety of premixed 50% nitrous oxide and oxygen for FB in children.

Adolescent↗
PubMed2004

Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates.

STUDY OBJECTIVE: To study the diagnostic role of flexible bronchoscopy (FB) in immunocompromised patients with pulmonary infiltrates. DESIGN: Prospective, observational study. SETTING: Tertiary care hospital. PATIENTS: A total of 104 consecutive non-HIV-infected immunocompromised patients with lung infiltrates in whom FB was performed. METHODS: The primary outcome measure was the diagnostic yield of FB, which was derived as the number of the diagnoses made using FB results divided by all final diagnoses. Final diagnoses were established using data from FB, surgical lung biopsy (SLB), and microbiology and serology testing, and by the clinical response to empiric therapy. We also studied the diagnostic yields of individual sampling procedures such as BAL, transbronchial biopsy (TBB), and protected-specimen brush (PSB) sampling. RESULTS: Overall, 128 diagnoses were made in 104 patients. The overall diagnostic yield of FB was 56.2% (95% confidence interval [CI], 47 to 64%). FB provided at least one diagnosis in 53 of 104 patients (51%; 95% CI, 40 to 62%). FB was more likely to establish the diagnosis when the lung infiltrate was due to an infectious agent (81%; 95% CI, 67 to 90%) than to a noninfectious process (56%; 95% CI, 43 to 67%; p = 0.011). The diagnostic yields of BAL (38%; 95% CI, 30 to 47%) and TBB (38%; 95% CI, 27 to 51%) were similar (p = 0.94). The diagnostic yield of PSB sampling was lower (13%; 95% CI 6 to 24%; p = 0.001) than that of BAL. The combined diagnostic yield of BAL and TBB (70%; 95% CI, 57 to 80%) was higher than that of BAL alone (p < 0.001). Finally, the diagnostic yield of FB with PSB sampling, BAL, and TBB was similar to that of FB with BAL and TBB. The complication rate from FB was 21% (95% CI, 15 to 31%). Minor bleeding (13%) and pneumothorax (4%) were the most common complications. CONCLUSIONS: FB has a high diagnostic yield in immunocompromised patients with pulmonary infiltrates. Based on our results, we recommend performing TBB in these patients, whenever possible.

Adult↗
PubMed2004

Interventional bronchoscopy for treatment of tracheal obstruction secondary to benign or malignant thyroid disease.

STUDY OBJECTIVES: Surgery is the treatment of choice for symptomatic tracheal obstruction due to benign or malignant thyroid disease. In case of inoperability, or when surgery is refused, few therapeutic alternatives are available. Interventional bronchoscopic procedures have only been reported anecdotally. The objective of this study is to evaluate the results of interventional bronchoscopic procedures in the treatment of severe tracheal obstruction due to thyroid disease. STUDY DESIGN: Retrospective cohort analysis. SETTING: University hospital, tertiary referral center. PATIENTS: Thirty consecutive patients referred for bronchoscopic treatment of benign (n = 17) or malignant (n = 13) thyroid-related upper airway obstruction due to tracheomalacia, extrinsic compression, and/or tracheal ingrowth. Indications for bronchoscopic treatment were medical or surgical inoperability, prevention or treatment of tracheomalacia, and refusal of surgery. There were no procedure-related complications. INTERVENTIONS: Rigid bronchoscopy with dilatation, stenting and/or Nd-YAG laser treatment, and clinical follow-up. MEASUREMENTS AND RESULTS: Subjective improvement, pulmonary function tests, early and late complications, and survival. In the benign group, immediate (100% relief of dyspnea) and long-term (88% relief of dyspnea) results were excellent after airway stenting (21 stents used in 17 patients). There was one unrelated death 1 week after stenting in a 98-year-old patient. There were 6% and 30% short-term and long-term complications, respectively, that could be managed endoscopically. In the malignant group, Nd-YAG laser treatment (n = 3) and stenting (n = 13) yielded immediate and long-term success in 92% of patients. There were 15% short-term and 8% long-term complications. Median survival time was 540 days. CONCLUSIONS: Interventional bronchoscopic procedures including Nd-YAG laser treatment and stenting are valuable alternatives to surgery in inoperable thyroid-induced tracheal obstruction, or when surgery is refused.

Aged↗
PubMed2004

The clinical utility of flexible bronchoscopy in the evaluation of chronic cough.

STUDY OBJECTIVES: To assess the clinical utility of flexible bronchoscopy (FB) in the evaluation of patients with chronic cough and normal or nonlocalizing chest radiographic findings. DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Forty-eight patients with chronic cough and no other clinical or radiographic indications for FB who underwent the procedure from 1996 to 2001. RESULTS: Before FB, 45 patients had a chest radiograph and 21 patients had a chest CT performed. On visual inspection, 37 of 48 of the FB findings (82%) were normal, 9 were consistent with "bronchitis," one patient had a "small tracheal plaque," and one patient had "minimal arytentoid redundancy." Three of the 27 patients who had a microbiologic assessment performed during their FB demonstrated potentially pathogenic organisms. Antibiotic treatment based on culture data did not result in improvement in cough. Cytologic examination was performed in specimens from 33 patients; 1 patient was noted to have reactive squamous atypia, and the remainder were normal. The patient noted to have minimal arytenoid redundancy and the patient with a tracheal plaque each had another etiology for their cough identified, the treatment of which resulted in cough improvement. CONCLUSIONS: FB adds little to the diagnosis of chronic cough in the context of normal or nonlocalizing chest radiographic or CT findings. FB did not result in successful treatment alteration, nor did it contribute to the identification of the cough etiology.

Adult↗
PubMed2004

The yield of flexible fiberoptic bronchoscopy in pediatric intensive care patients.

STUDY OBJECTIVE: To evaluate the contribution of flexible fiberoptic bronchoscopy (FFB) and BAL to the clinical management of patients in a pediatric ICU (PICU). SETTING AND DESIGN: A retrospective study based on medical records in a six-bed pediatric ICU of a tertiary care children's hospital serving as a referral center for airway surgery. PATIENTS AND PARTICIPANTS: One hundred consecutive infants and children hospitalized in a PICU, who underwent FFB with or without BAL. MEASUREMENTS AND RESULTS: One hundred fifty-five procedures were performed, for the following causes: search for airways anatomic pathologies (114 of 155 procedures, 74%), including 55 procedures during the perioperative period of airway surgery; treatment of atelectasis (35 of 155 procedures, 22.5%); and BAL (30 of 155 procedures, 19%). Thirty-five percent of procedures had more than one cause. Airway pathology was observed in 79 of 114 procedures (69%). Management changed from conservative to surgical in 44 of 114 procedures (39%). In airway surgery cases, reoperation subsequent to postoperative FFB took place in 35%. BAL results changed antimicrobial treatment in 15 of 30 cases, with clinical improvement in 10 of 30 cases (33%). Treatment of atelectasis was successful in 26 of 35 cases (74.3%). No procedure-related mortality, life-threatening complications, or significant changes in patient status occurred. CONCLUSIONS: FFB is an important and safe procedure in very sick infants and children with a variety of respiratory diseases, and significantly contributes to their management. FFB should be considered to be a PICU staff expertise.

Adolescent↗
PubMed2005

Prefixed equimolar nitrous oxide and oxygen mixture reduces discomfort during flexible bronchoscopy in adult patients: a randomized, controlled, double-blind trial.

STUDY OBJECTIVES: Flexible bronchoscopy (FB) is an invasive procedure associated with patient discomfort and frequent nose pain. A simple sedation procedure that does not require the intervention of an anesthetist is of interest. The aim of this prospective, randomized, double-blind study was to assess efficiency of nitrous oxide inhalation on the reduction of FB-induced discomfort in adult patients. DESIGN AND SETTINGS: Two hundred six patients were randomized to receive either a prefixed equimolar nitrous oxide/oxygen mixture (N2O) or a prefixed equimolar nitrogen and oxygen mixture (control). The primary outcome was stress as assessed by pulse rate and systemic BP during the procedure. Secondary outcomes were self-assessed pain using a visual analog scale (VAS) and patient satisfaction based on a questionnaire. Adverse events were recorded. RESULTS: A significant increase in BP was observed only in the control group (p = 0.003), while pulse rate values did not differ between the two groups. As assessed by the VAS, pain was lower in the N2O group as compared to placebo (p = 0.02). Nose pain and cough were also significantly reduced by N2O. Adverse events, mostly anxiety, were reported in 10 patients. CONCLUSION: These results indicate that equimolar N2O inhalation is efficient in reducing patient discomfort and may be an alternative to general anesthesia.

Administration, Inhalation↗