Bronchoscopy In Intensive Care Unit Research Articles

Application effect of clinical nursing pathway in perioperative period of fiberoptic bronchoscopy in Intensive Care Unit.

article: Application effect of clinical nursing pathway in perioperative period of fiberoptic bronchoscopy in Intensive Care Unit - Minerva Surgery 2022 December;77(6):620-2 - Minerva Medica - Journals

Role of fiberoptic bronchoscopy in patients with respiratory complications in multispecialty intensive care units

Introduction: To determine the contribution and safety profile of flexible fiberoptic bronchoscopy in intensive care units in terms of therapeutic outcome in lung collapse patients. Methodology: Patients with respiratory complications from various speciality intensive care units were enrolled. After clinical and radiological evaluation, if conservative management fails, bronchoscopic intervention was considered. Bronchoscopy was performed according to British Thoracic Society guidelines after informed consent. Swivel-T-Tube adapter was used for the patients in mechanical ventilation. Data such as chest radiograph, arterial blood gas, Bacterial culture of tracheal and BAL secretions between before and after brochcoscopy (6 & 24 hrs) were analysed using standard SPSS software. Results: In our study 63 patients were enrolled, Most of the patients were in mechanical ventilation 85% (n=54/63). In our study, the indications for bronchoscopy were suspected atelectasis 57.1% (n=36), persistent pulmonary infiltrates 30% (n=27). In suspected atelectasis cases(n=36) bronchoscopic findings were mucous plug in 61%(n=22), blood clot in 11%(n=4) and purulent secretions 22% (n=8) and mucoid secretions in 5% ( n=2). Post brochoscopic chest radiograph of suspected ateletasis showed partial resolution in 38.8% (n=14) and complete resolution in 47.2% (n=17). Conclusion: In our study contribution of bronchoscopy played a vital role in therapeutic outcome. Patients had good response to bronchoscopy 85% improvement when intervened within 5 days of admission in ICU. No life threatening complications were encountered; hence bronchoscopy is safe in critically ill patients, if basic precautions are taken. Keywords: BAL and VAP; Fiberoptic bronchoscopy in intensive care units; Lung atelectasis in ICU; Safety of FOB in ICU.

S0555 A Novel Patient Oxygen Mask Apparatus for Environmental COVID-19 Protection During Upper Endoscopy

INTRODUCTION: Concerns over COVID-19 aerosol release during upper endoscopy has led to recommendations for negative pressure rooms, prolonged air-settling times and HEPA filtration machines. The resulting procedural inefficiency has led to prolonged patient wait times. Although N-95 masks can protect staff from viral exposure, potential environmental contamination remains an issue for room turnover times. Oxygen procedural masks were originally developed to avoid hypoxemia in patients undergoing bronchoscopy in intensive care units. It has been suggested that these devices be considered for patients undergoing upper GI endoscopy to reduce aerosol release, but to date, no studies have been performed to confirm their effectiveness in protecting the procedure room environment. METHODS: A procedural mask with three self-sealing ports that can accommodate almost any endoscope (Explorer, Intersurgical Berkshire, UK), was attached to a T- piece containing an oxygen inlet (Vyaire, Mettawa, IL) . The expiratory port was connected to a N-95 round anesthesia filter (Flo-Guard, Intersurgical ) to protect the environment from airborne pathogens. The procedural mask was applied to an adult CPR mannequin with elastic straps to ensure a secure fit. A fluorescent powder and mist ( Glo Germ Company, Moab, UT, USA) with particle sizes between 1 and 5um (SARS-COV-2 is 0.7-1.2um) was injected into the trachea of an adult CPR mannequin to simulate a cough. An endoscope was placed into one port of the mask and a suction catheter was placed into another opening to simulate an actual upper endoscopy. The degree of fluorescein staining on paper outside the mask was assessed with ultraviolet light detection in a darkened room. RESULTS: Preliminary results using our cough simulation model without a procedural mask revealed a widespread dissemination of fluorescent droplets, contaminating the surrounding area. The use of a patient procedural mask significantly reduced the aerosol dispersion and contamination surrounding the patient. CONCLUSION: Our preliminary findings provide proof-of-concept support for use of a patient procedural mask apparatus to reduce environmental exposure to cough-generated aerosols and droplet sprays during upper GI endoscopy. While the patient procedure mask provides environmental protection and may reduce the need for prolonged air-settling and HEPA filtration, it should not replace the appropriate use of personal protective equipment by endoscopy staff in case of patient procedural mask dislodgement.Figure 1.: Endoscope insertion into patient procedural mask with oxygen T piece and N-95 expiration filter.

Bronchoscopy in Intensive Care Unit

Bronchoscopy in Intensive Care Unit

Bronchoscopy in Intensive Care Unit

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Analysis on utility and efficacy of fiberoptic bronchoscopy in intensive care unit

To evaluate the utility and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU). From Aug 2013 to Aug 2014, out of 492 patients admitted into Beijing Haidian Hospital ICU, 86 patients were included according to the study. Data including age, sex, APACHE, SAPS and Disease type, were processed using SPSS16.0. A total of 104 FOBs were performed in 86 patients P who were admitted to the ICU. FOB was useful in 64% of diagnostic procedures and 81% of therapeutic procedures, with an overall utility of 72%. The utility according to pneumonia in 32 cases, utility of 51%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 20 cases, utility of 75%; airway exploration in 18 cases, utility of 75%; hemoptysis in 3 cases, utility of 100%; and difficult airway intubation in 5 cases, utility of 100%. A decrease in pulse-oximeter oxygen saturation (SpO2) of >5% during FOB was present in 65% cases. Mean SpO2 before FOB was 94.0%±5.2%. During the procedure, the mean lowest SpO2 was 86.8%±8.4% (P<0.000 1) and the mean postprocedural SpO2 was 93.0%±4.5% (P=0.82). The other minor complications were present in 3.9% of cases. FOB has a great application field for the patients in ICU. The utility and safety of this operation is credible.

Role of Fiberoptic Bronchoscopy in Intensive Care Unit

Since its introduction in daily medical practice in the late 20th century, flexible bronchoscopy has had an increasing role in the everyday life of the pulmonologist. Not only for diagnosis, but also for therapeutic interventions, it has achieved widespread use and is now performed in a diversity of clinical scenarios. For several reasons, from easy performance in trained hands to versatility, diagnostic reliability, and safety, flexible bronchoscopy is now widely accepted and increasingly used in the management of critically ill patients. The knowledge of the unique features of intensive care unit patients, as well as indications and contraindications for the procedure, is paramount in achieving optimal results, while minimizing potential risks and complications. Performing bronchoscopy in an unstable patient, often on mechanical ventilation, requires awareness of the specific pathophysiological impact of the procedure. This in turn determines respiratory and cardiovascular derangements frequently observed during the procedure. This article reviews indications, pathophysiology, technical aspects, complications, and contraindications of flexible bronchoscopy in the critical care patient.

Bonne pratique de la fibroscopie bronchique chez le patient ventilé

Practice of fiberoptic bronchoscopy in intensive care units is not associated with major adverse effects but need particular attention in mechanically-ventilated patients. To avoid worsening ventilation particularly in hypoxemic patients, a difference in external diameters of bronchoscope and endotracheal tube is important as well as a modification of the settings of the alarms in the ventilator. The number of fiberoptic bronchoscopy performed during non invasive ventilation is increasing and the first reports suggest a good tolerance of this procedure. However, indications of bronchoscopy need to be carefully evaluated as well as the balance safety/benefit in these patients. Studies are warranted to precise and improve the tolerance of fiberoptic bronchoscopy in these conditions.

Bronchoscopy in intensive care units.

Many situations exist imposing the use of bronchoscopy in intensive care units (ICU). There are many diagnostic and therapeutic indications. Interventional bronchoscopy represents a group of endoscopic techniques used in emergency or during the handling of different situations of airway obstruction. These situations seem quite frequent in paediatric ICU. This field has been developed with the availability of small endoscopes on the market and progress in instrumental and anaesthetic techniques.