Bronchoscopic Suction Research Articles

Conversion of the bronchial tree into a conforming electrode to ablate the lung nodule in a porcine model

BackgroundRadiofrequency ablation (RFA) is one of the treatment options for lung nodules. However, the need for exact delivery of the rigid metal electrode into the center of the target mass often leads to complications or suboptimal results. To overcome these limitations, a concept of conforming electrodes using a flexible material has been tested in this study.MethodsA bronchoscopy-guided RFA (CAROL) under a temperature-controlled mode was tested in in-vivo and ex-vivo porcine lungs. Gallium-based liquid metal was used for turning the bronchial tree into temporary RF electrodes. A customized bronchoscopy-guided balloon-tipped guiding catheter (CAROL catheter) was used to make the procedure feasible under fluoroscopy imaging guidance. The computer simulation was also performed to gain further insight into the ablation results. Safety was also assessed including the liquid metal remaining in the body.ResultsThe bronchial electrode injected from the CAROL catheter was able to turn the target site bronchial air pipe into a temporally multi-tined RF electrode. The mean volume of Gallium for each effective CAROL was 0.46 ± 0.47 ml. The ablation results showed highly efficacious and consistent results, especially in the peripheral lung. Most bronchial electrodes were also retrieved by either bronchoscopic suction immediately after the procedure or by natural expectoration thereafter. The liquid metal used in these experiments did not have any significant safety issues. Computer simulation also supports these results.ConclusionThe CAROL ablation was very effective and safe in porcine lungs showing encouraging potential to overcome the conventional approaches.

Study of the effect of added bronchoscopic suction to routine treatment of ventilator associated pneumonia patients in surgical ICU.

Comparing BAL and antibiotic therapy with antibiotic therapy itself for treating VAP patients in ICU. In this randomized clinical trial, the first group was treated using antibiotics and closed-suction was performed daily, using 50 cc of sterile normal saline. The second group was treated with antibiotics and daily closed-suction with 50 cc of sterile normal saline, plus bronchoscopic suction every other day. Patients of both groups were followed and investigated one, 3, 7, and 10 days after initial diagnosis. Mean blood leukocyte count and body temperature was measured in groups one (no bronchoscopy) and two (with bronchoscopy) in first, 3rd, 7th, and 10th days which was higher in the second group. Mean treatment status was also measured using APACHE II index. There was also a statistically significant difference in 3rd day (p-value < 0.05). There was also no difference in final culture result or mortality rate between two groups. According to the results of this study like lower body temperature, higher leukocyte count reduction, and lower APACHE II scores in the second group, treated with bronchoscopic suction, adding bronchoscopy seems to be more useful than normal method.

Arnold\u2013Chiari malformation type I and the posterior dislocation of the odontoid process aggravate prolonged weaning in a patient with severe viral pneumonia: a case report

BackgroundProlonged and difficult weaning is associated with higher rates of complications and mortality. Therefore, it is important to identify the associated factors.Case presentationWe describe our experience with a 37-year-old man diagnosed with severe viral pneumonia (influenza A). He presented with acute respiratory failure type I on admission. During intubation, his blood pressure and heart rate decreased, and epinephrine and norepinephrine were administered. Although his clinical condition improved 8 days after intensive care unit (ICU) admission, he experienced difficulty weaning. He remained conscious but had a poor spontaneous cough with sputum production and weak limb muscle strength. His cough reflex was absent during bronchoscopic sputum suction, and he used abdominal breathing during the T-tube test. Magnetic resonance imaging revealed an Arnold–Chiari malformation type I, posterior dislocation of the odontoid process, and syringomyelia, with compression and deformation of the medulla and high cervical cord. The patient was successfully weaned from the ventilator at 20 days after ICU admission.ConclusionsArnold–Chiari malformation type I and posterior dislocation of the odontoid process, which aggravate medullary compression and increase the risk of cervical nerve injury, might be a rare factor affecting prolonged weaning in critical illness.

Portable fibrobronchoscopic treatment for non-severe ischemic stroke-associated pneumonia patients with dysphagia: a pilot study

ABSTRACTObjective: To investigate the efficacy and safety of portable fibrobronchoscopy on the non-severe ischemic stroke-associated pneumonia (SAP) patients with dysphagia.Methods: A total of 86 non-severe ischemic SAP patients with dysphagia were randomly and equally divided into the treatment group and control group. The control group was given routine sputum suction, anti-infection drugs, and sputum-reducing drugs. The treatment group was treated with fiber-optic bronchoscopic sputum suction and alveolar lavage, and drug treatment same as the control group. The blood gases, inflammatory factors, clinical pulmonary infection score (CPIS), adverse reactions, and modified Rankin Scale (mRS) were compared.Results: The blood gases, serum inflammatory factors including procalcitonin (PCT), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α), and CPIS in the treatment group were superior to those in control group (P < 0.05). No significant difference was found in the incidence of adverse reactions between the two groups (P > 0.05). The mRS scores of the treatment group were significantly lower than those of control group 3 months after discharge.Conclusion: Sputum suction and alveolar lavage with portable fibrobronchoscope can significantly improve the hypoxia and pulmonary infections, reduce the inflammatory response, and thus improve the prognosis, rendering suction and alveolar lavage with portable fibrobronchoscope as a safe and effective treatment for non-severe ischemic SAP patients with dysphagia.

The benefit of daily sputum suction via bronchoscopy in patients of chronic obstructive pulmonary disease with ventilators: A randomized controlled trial.

Background:To compare the clinical values of bronchoscopic sputum suction and general sputum suction in respiratory failure patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) combined with sequential invasive–noninvasive mechanical ventilation at the pulmonary infection control (PIC) window (period of lower sputum production, with thinner viscosity and lighter color, and alleviated clinical signs of infection).Methods:Patients with AECOPD-induced respiratory failure received orotracheal intubation mechanical ventilation and were randomly divided into bronchoscopic sputum suction group or general sputum suction group, and who were then treated with sequential invasive–noninvasive mechanical ventilation at PIC window (both groups). Baseline data, postoperative blood gas conditions, and postoperative clinical parameters of the patients such as appearance of PIC window, time of invasive ventilation, total time of ventilation, hospital stay, weaning success rate, reintubation rate, ventilator-associated pneumonia (VAP) incidence, and fatality rate were measured to compare the effect of 2 different ways of sputum suction.Results:There was no significant difference in baseline characteristics, postoperative blood gas conditions, between 2 groups (all P > .05). Nevertheless, the bronchoscopic sputum suction group showed earlier appearance of PIC window, shorter time of invasive ventilation, total time of ventilation and hospital stay, lower reintubation rate, VAP incidence and fatality rate, and higher weaning success rate than the general sputum suction group (all P < .05).Conclusion:Bronchoscopic sputum suction combined with sequential invasive–noninvasive mechanical ventilation at PIC window showed clinical effects in treating respiratory failure patients with AECOPD.

Death after Bronchoscopic Biopsy of a Pulmonary Artery Aneurysm Mimicking Bronchial Polyp

Pulmonary artery aneurysms (PAAs) are rare, and massive hemoptysis can lead to death if appropriate diagnosis and treatment is not provided. PAAs can be of congenital, acquired, or idiopathic origin, and the clinical symptoms are various. Among all reported cases, one-third of the patients died due to rupture. Optimal treatment or guidelines for PAAs remain uncertain. Herein, we report autopsy findings from a woman with PAA. The patient was taking medication for tuberculosis. On bronchoscopy, a polypoid lesion was found, suspected to be an inflammatory polyp. Biopsy was performed and massive bleeding into the airway occurred. The bleeding could not be controlled by bronchoscopic suction, and cardiac arrest occurred 30 minutes after biopsy; the patient subsequently died. Autopsy revealed a round, calcified PAA in the bronchus of the right middle lobe; the end of the PAA was torn. Hypovolemic signs, including weak postmortem lividity and pallor of the skin and conjunctivae, were observed. Visual inspection and histopathological examination of the right lung revealed tuberculosis and congestion. Cases related PAA are not uncommon, but autopsy cases of death occurring after biopsy of PAA mimicking bronchial polyps are rarely reported.

A magnet built on bronchoscopic suction for extraction of tracheobronchial headscarf pins: a novel technique and review of a tertiary centre experience.

Airway metal pins are one of the most commonly inhaled foreign bodies in Eastern societies in young females wearing headscarves. We innovated a modified bronchoscopic technique to extract tracheobronchial headscarf pins by the insertion of a magnet to allow an easy and non-traumatic extraction of the pins. The aim of this study was to assess the feasibility and safety of our new technique and compare it with our large previous experience with the classic bronchoscopic method of extraction of tracheobronchial headscarf pins. We performed a study comparing our retrospective experience of classic bronchoscopic extraction from February 2004 to January 2014 and prospective experience with our modified technique using the magnet from January 2014 to June 2015. An institutional review board and new device approval were obtained. Three hundred and twenty-six procedures on 315 patients were performed during our initial 10-year experience. Of them, 304 patients were females. The median age of our group was 13 (0-62). The median time from inhalation to procedure was 1 day (0-1022). After introducing our modified new technique using the magnet, 20 procedures were performed. Nineteen were females. The median time of the procedure and the need to forcefully bend the pin for extraction were in favour of the new technique in comparison with our classic approach (2 vs 6 min; P < 0.001) (2 patients = 20% vs 192 = 58%; P < 0.001). The conversion rate to surgery was also in favour of the modified technique but did not reach statistical significance (0 = 0% vs 15 = 4.8%; P = 0.32). All patients who underwent the modified technique were discharged home on the same day of the procedure. No procedural complications were recorded. All remain well on a follow-up period of up to 14 months. Bronchoscopic extraction of tracheobronchial inhaled headscarf pins using a novel technique using homemade magnets was safer and simpler in comparison with our large experience with the classic approach. We advise the use of this device (or concept) in selected patients in centres dealing with this problem.

Emerging resistance of higher antimicrobials and growing sensitivity of old antimicrobials against existing infections in burns

Background: The widespread resistance of microorganisms to antibiotics threatens to be a future medical disaster. Antimicrobial resistance among a wide variety of human bacterial and fungal burn wound pathogens, particularly nosocomial isolates, limits the available therapeutic options for effective treatment of burn wound infections Objective: To analyze the emergence of resistance to higher group of antibiotics and shift of sensitivity towards older group of antibiotics. Methods: The microbial colonization of wounds was studied from day of admission to date of discharge or date of expiry (2011-2014). The sampling included swabs taken from clinically deep areas of burn wounds prior to cleaning. Culture and sensitivity reports of urine, central line, bronchoscopic suction, catheter tips were not included in samples. Tissue biopsy during excision was included in the samples. Analysis done with the help of Chi-square test. Results: Initially after burn injury there is predominance of staphylococcal group followed by gram negative organism, after which there is a predominance of gram negative organism. In this study we observed an increase in resistance to higher group of antibiotics like imipenem (p>0.005) and increased susceptibility to polymyxin group of drugs (p<0.005). Conclusions: It suggests that prevention is better than cure. Developing resistance can be prevented by misuse of antibiotics, premature change of antibiotics and prevention of cross contamination. For effective prevention of developing resistance to higher antibiotics the burn centres should look in and bring a strict antibiotic policy.

Bronchial obstruction by tumor embolus of contralateral lung during pneumonectomy: report of a case

Bronchial obstruction due to a tumor embolus of the contralateral lung during pneumonectomy is an uncommon and fatal complication. According to previous cases, a bronchial balloon of double-lumen endotracheal tube (DLT) could prevent a dislodged tumor from traveling to the contralateral lung. We experienced a tumor embolism from the bronchus with cancer to the other bronchus despite applying DLT. A 59-year-old male with endobronchial lung cancer underwent a left pneumonectomy. One-lung ventilation was established by the right-sided DLT. After a left bronchial division, a sudden increase of peak airway pressure and reduction of the expired tidal volume to 50 ml was observed. Intraoperative fiberoptic bronchoscopy showed a near total obstruction of the right main bronchus due to tumor emboli. It was not possible to remove the tumor embolus through bronchoscopic suction and forceps. Therefore, we reopened the left bronchial stump and successfully extracted tumor embolus under bronchoscopic guidance.

Post-traumatic bronchial mucus plug leading to pneumonectomy

Background : Blunt trauma of the chest is not uncommon these days. By far, the most important cause of significant blunt chest trauma is motor vehicle accidents. Pedestrians struck by vehicles, falls from height, blast injuries and acts of violence are other causative mechanisms. Most of the blunt trauma cases need no operative intervention and can be managed by supportive procedures. Aim : We present a case of a 10-year old boy who had blunt trauma to chest due to fall from height. Findings : The patient was in respiratory distress and developed surgical emphysema and pneumothorax on the left side. He was managed by putting in a chest drain on the left side. Patient improved and was discharged .He again developed respiratory distress 15 days later. On bronchoscopic examination, an obstruction was found just distal to the carina in the left bronchus. Several futile attempts were made to retrieve the obstructing material. Hence, mucus plug was removed through left bronchotomy. There was no improvement in the ventilation of the left lung for 7 days. Bronchoscopic suction was done. All the measures failed and the lung remained collapsed. Patient underwent pneumonectomy as the last treatment option available in our hospital. At the time of reporting this case, patient was doing well. Conclusion : Chest physiotherapy helps in reducing lung collapse. If patient is reluctant to chest physiotherapy and coughing, it can lead to accumulation of respiratory secretions and formation of mucus plug. This mucus plug can cause collapse of the lung and ill consequences. Keywords : Trauma, atelectasis, pneumonectomy, bronchotomy, mucus plug

Atelektasenentfaltung durch Atemunterstützung mit der Eisernen Lunge

Total atelectasis of the left lung occurred in a 61-year-old woman after several weeks ventilator-assisted breathing following an operation for ileus, when the tracheal cannula was removed. It was quickly replaced and artificial ventilation resumed. But despite daily bronchoscopic suction for three weeks the patient's state failed to improve (vital capacity 39%, arterial pO2 47 mm Hg, pCO2 37 mm Hg). Mechanical ventilation with an "iron lung" was therefore instituted over a six month period, at first for two hours daily (as an in-patient) and then weekly (as out-patient). During this time her condition and general state clearly improved. On re-hospitalization to remove the tracheal cannula her vital capacity was 75%, pO2 78 mm Hg and pCO2 38 mm Hg.

Minitracheotomy: a new interventional technique for treatment of sputum retention.

Sputum retention causing pulmonary atelectasis, secondary pneumonia, and respiratory failure is a frequent complication particularly in patients recovering from abdominal and thoracic surgery. Physiotherapy and conventional therapeutic means like blind tracheobronchial and bronchoscopic suction applied to prevent and treat postoperative respiratory complications have been shown to not be completely effective. Minitracheotomy is a new alternative method for the treatment of sputum retention. Endobronchial suction can be performed as often as required, using a thin uncuffed tube (ID 4.5 mm) which is inserted into the trachea through the cricothyroid membrane under local anaesthesia. Since respiration occurs normally through the nose, mouth, and larynx these patients retain speech and the ability to cough. Complications are rare. Endobronchial suction via minitracheotomy is minimally invasive, more comfortable, and at least as effective as conventional bronchoscopic suction. It therefore has become a routine method used in the treatment of postoperative sputum retention in high-risk patients in many intensive-care units.

Bronchoplastic surgery for lung cancer and the results

Fifty-nine patients with lung cancer underwent bronchoplastic surgery in our institute from September, 1965 to May, 1982. The post surgical stages of disease were as follows: 7 cases of Stage I disease, 7 cases of Stage II, 41 cases of Stage III, 4 cases of Stage IV. The bronchoplastic surgery performed included sleeve resection combined with lobectomy in 35, wedge resection combined with lobectomy in 11, reconstruction of the lower area of the trachea in 5, bronchial sleeve resection combined with pulmonary artery resection in 6 and bronchial wedge resection combined with pulmonary artery resection in 2. There was no case of operative mortality within 30 days after the operation. To prevent postoperative complications, careful techniques are required in suturing and postoperative bronchoscopic suction of intrabronchial secretion is necessary. The use of Dexon or Dexon S, polyglycolic acid sutures, showed good results. Adjuvant therapies were performed on 42 cases, including preoperative infusion of Mitomycin C into the bronchial arteries or postoperative irradiation or both. Twenty-eight of 59 were alive and well from 7 months to 16 years after the operations. The relative 5 year survival rates were 40.5 per cent in total cases and 46.5 per cent in those with squamous cell carcinomas. The prognosis of patients undergoing bronchoplasty was compared with that of patients undergoing lobectomy and pneumonectomy. There was a statistical difference between bronchoplasty and pneumonectomy.

The flexible bronchofiberscope in the intensive care unit (ICU)--the optimal postoperative care for the bronchial system.

Since 1974 about 6000 flexible bronchoscopies have been performed for early postoperative diagnostic and therapeutic reasons. Bronchoscopic suction is easy, quick, highly effective and does not provoke any epithelial changes. Indications for immediate bronchoscopic suction are suspected aspiration, deterioration in blood gas values, changes in the chest x-ray. Every ICU should be equipped with a flexible bronchoscope for immediate use.

Bronchoplastic procedures for lung cancer

Twenty patients with lung cancer have undergone bronchoplastic procedures September, 1965, to June, 1976 in our hospital. Bronchoplastic procedures are considered to be indicated for early cases of hilar lung cancer rather than for somewhat advanced cases. Endoscopic examination and roentgenograms of the bronchial arteries are needed to delineate resectional lines of bronchus, the former for deciding the mucosal extent and the latter the intrabronchial extent of the tumor. The bronchoplastic procedures we adopted were free from the risks and dangers generally accompanying the operation, and there were no postoperative deaths. For the prevention of postoperative complications, careful attention to suture technique is needed, and postoperative bronchoscopic suction of intrabronchial secretions is absolutely necessary. These procedures assure good quality of life postoperatively and improvement in the survival rate by preserving pulmonary function, enhancing curability, and increasing the operative indications. These advantages warrant high evaluation of the operation.

Bronchial Rupture in a Child, with Subsequent Stenosis, Resection, and Anastomosis

A 2 1/2-year-old child was seen six days after she sustained a rupture of her right main bronchus. Because the diagnosis was not established until the sixth day after injury, repair was deferred for three weeks until the edema and acute inflammation had subsided. By repeated bronchoscopic and endotracheal suction, it was possible to maintain ventilation of the affected lung. Segmental bronchial resection was followed by uneventful recovery. In selected patients, deliberate delay in repairing bronchial rupture appears desirable.

Expectorants; guest editorial.

MOST MEN who have given thought to the term as drugs used for the purpose of increasing the respiratory tract fluid would agree that the term is unfortunate, since there is in it the implication that the effectiveness of such drugs can be measured in terms of the sputum produced. This is what Alstead 1 ( 1941 ) considered that he had done when he pronounced ammonium chloride ineffective as an expectorant because it had not increased expectoration. But when Holinger, Basch, and Poncher 2 (1941) collected respiratory tract fluid by means of postural drainage and bronchoscopic suction they found that the expectorant drugs liquefy the respiratory tract fluid quite appreciably. Boyd 3 (1954) pointed out that indirect measurement of the action of expectorants upon respiratory tract fluid through evaluation of their therapeutic efficacy against cough has resulted only in divergent conclusions, as was to have been expected. In the first

Early tracheotomy in secretional anoxia.

TRACHEOTOMY has been done since the Middle Ages, usually as a last resort and only for obstruction of the upper respiratory tract. Lee, Tucker, and Clerf 1 (1928) showed that postoperative pneumonias were the result of respiratory obstruction, with consequent atelectasis. Early promotion of coughing and early bronchoscopic suction relieved the obstruction. Durand 2 (1929) demonstrated the effectiveness of postural drainage in relieving pulmonary obstruction in poliomyelitis. The idea of a lower respiratory obstruction, which is the basis of secretional anoxia, was conceived at this time. Wilson 3 (1931) mentioned tracheotomy as a means of relieving lower respiratory obstruction. Figi 4 (1934) demonstrated that bronchopneumonia is a common complication of pulmonary obstruction and that death in most cases of lower respiratory obstruction was due to delay in performing a tracheotomy. Davison 5 (1936) mentioned tracheotomy for the relief of pulmonary obstruction in poliomyelitis. The actual reporting of results, however, was

Traumatic hemothorax

The problem of hemothorax has been presented from the standpoint of its pathology and management. The results of the experiences encountered in this war have cleared some doubt and uncertainty in regard to treatment and have offered many of us an opportunity to observe the pathology of hemothorax. The mortality and morbidity of chest wounds in this war has been greatly improved in this war by: (1) Excellent early primary surgery in the hospitals in the combat zone; (2) the availability of excellent endotracheal anesthesia; (3) the abundance of the chemotherapeutic agents penicillin and sulfanilamide; (4) the abundance and availability of blood and plasma; (5) the recognition of the value of postoperative endotracheal and bronchoscopic suction. Active treatment after careful evaluation, in the form of chest aspirations appears to give the best results as compared to conservative treatment. In the case in which bleeding continues a thoracotomy is indicated. In cases of large clotted hemothorax, thoracotomy and decortication offers a prompt return to a normal anatomical and physiological restoration of the involved lung.

THE INFLUENCE OF EXPECTORANTS AND GASES

The treatment of pulmonary or bronchial suppuration is a frequent task of the otolaryngologist who devotes a portion of his time to bronchology. His efforts in this field are identical to his efforts in the treatment of suppurative sinus disease, where they are directed toward restoring the normal physiologic function through establishing and maintaining adequate drainage. The mechanical drainage of the pathologic secretions in the bronchi is accomplished by the action of the cilia, the respiratory movements, the tussive squeeze of the cough reflex, the cough itself and, finally, expectoration. This drainage depends to a large degree on the liquefaction of these secretions by the action of the glands of the more normal bronchial mucosa. That these processes, both the cellular activity and the more gross mechanical ones, may be immeasurably aided by expectorants, by postural drainage and by bronchoscopic suction is well recognized. Means of increasing the efficiency of