ObjectiveThe number of patients using direct oral anticoagulants (DOACs) has recently increased. However, the association between DOAC use and bronchoscopy (BS) safety has not been elucidated. This study examined the association between BS and DOAC use and safety.MethodsUsing data from the Japanese Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2022, patients taking DOACs who underwent BS (n=603, DOAC group) and those who did not (n=187,827, non-DOAC group) were identified. Then, 1:4 matched-pair cohort analyses were performed based on the institution, sex, age, and treatment year. The primary outcome was all-cause in-hospital mortality. The secondary outcomes were 28-day mortality, mechanical ventilation use, pneumothorax, bleeding, and thromboembolism after BS.ResultsA total of 603 and 2,320 patients taking and not taking DOAC, respectively, were identified via matching. The all-cause in-hospital mortality rates in the DOAC and non-DOAC groups were 12.1% and 5.8%, respectively. In a multivariable logistic regression analysis, the DOAC group had a significantly higher all-cause in-hospital mortality rate than the non-DOAC group (odds ratio = 2.84, 95% confidence interval = 1.77-4.55). Secondary and composite outcomes (mechanical ventilation, pneumothorax, bleeding, and thromboembolism after BS combined) were more frequent in the DOAC group than in the non-DOAC group.ConclusionDOACs were associated with mortality and complications in patients undergoing BS. Further studies comparing BS outcomes between patients with and without DOAC treatment are necessary.

The objective: to evaluate the diagnostic effectiveness of computed tomographic navigation (CTn), bronchoscopic navigation (BN) in transbronchial biopsy (TBB) of peripheral lesions in the lungs.Subjects and Methods. An analysis of CT navigation data during bronchoscopy (BS) of 201 patients (Ctn Group) with peripheral lung formations (area of interest) was carried out. The advancement of bronchoscope to the area of interest during bronchoscopy was performed under CT navigation with VBN playing the major role. Comparison was made to the group (CG) of 195 patients in whom no CT navigation was used.Results. The overall bronchoscopy effectiveness using CT navigation and bronchoscopic navigation was statistically significantly higher versus the cases when they were not used, 95/201 (47.2%) vs. 65/195 (33.3%), χ² =7.98; p<0.01. Bronchoscopy effectiveness in the CTn and CG Groups differed significantly for lesion in the lung measuring >1 to ≤2 cm (46.9% vs. 28.2%; pz=0.008) and lesions ≤1 cm (28.0% vs. 12.9%; pz=0.048). For large lesion >2 to ≤3 cm, the differences did not reach statistical significance. There were significant differences in bronchoscopy effectiveness between the CTn and CG Groups when lesions were localized in the middle (61.2% vs. 35.8%; pz=0.008) and peripheral (32.0% vs. 22.2%; pz=0.048) zones of the lung. With lesions located in the central part and at its boundaries, the differences between the groups were not significant. When CT navigation and virtual bronchoscopy were used, the presence of connection to the bronchus significantly increased the likelihood of successful bronchoscopy (OR=6.35; 95% CI 3.43-11.78) than in the absence of one.

Hospital volume and outcomes following bronchoscopy in patients with interstitial lung disease: A retrospective observational study using a national inpatient database in Japan

BackgroundHigher rates of diagnosis of pulmonary Mycobacterium avium-intracellulare complex (MAC) disease by bronchoscopy (BS) in patients who could not diagnose by sputum cultures have been suggested, but the detailed utility of BS, especially in combination with anti-glycopeptidolipid-core IgA antibodies (anti-MAC Ab), is still unclear.MethodsA total of 111 patients at our hospital with suspected MAC who underwent BS because they were sputum-negative from April 2018 to March 2022 were analyzed prospectively. These patients were also divided into two groups, anti-MAC Ab-positive and anti-MAC Ab-negative, and compared.ResultsA total of 111 patients underwent BS, though 95 (38.0%) of 250 enrolled patients were sputum smear/culture-positive. The age of the 111 patients was 69.14 (31.0–89.0) years, and 90 (81.0%) were female; 69 (62.2%) of 111 patients were either smear-positive (n = 42, 37.8%) or culture-positive (n = 27, 24.3%) by BS. Of the total 111 patients, 69 (62.2%) were anti-MAC Ab-positive and 57 (82.6%) of 69 patients were also positive by BS. In contrast, only 12 (28.6%) of the 42 anti-MAC Ab-negative patients were positive by BS. The sensitivity and specificity of anti-MAC Ab for positive by BS were 82.6% and 71.4%, respectively, and the area under the curve (AUC) on receiver-operating characteristic (ROC) curve analysis was 0.807.ConclusionBS and anti-MAC Ab showed similar usefulness to confirm the diagnosis in patients who could not be diagnosed by sputum examination, but pulmonary MAC disease was strongly suspected based on chest radiography/CT findings. These two examinations were correlated, and their combination appeared to provide more accurate diagnosis and earlier therapy.

The bronchoscopy (BS) experience provokes anxiety amongst some patients. It can have a negative impact on the course of the procedure and on the willingness of patients to undergo the next BS in the future. We aimed to identify factors influencing patients' satisfaction with BS. The prospective study had been conducted between January and June 2019. It included patients hospitalized in our Department, who underwent elective BS. Patients assessed their anxiety and satisfaction level before and after BS using the Visual Analogue Scale (VAS). Data concerning the course of the bronchoscopy was collected. The median level of anxiety prior to the procedure was moderate, higher in women (p<0.0001). The majority of patients (116/125, 93%) were satisfied with appropriate information before the procedure. Almost one-third of the interviewees (39/125, 31%) declared complete satisfaction (VAS = 0) with their procedure, 17 patients (14%) were dissatisfied (VAS >5/10). Overall 113 (90%) patients declared unconditional consent for future bronchoscopy. Multivariate linear regression analysis revealed two factors affecting patients' satisfaction with bronchoscopy: anxiety prior to BS (standardized regression coefficient β = 0.264, p = 0.003) and discomfort (β = 0.205, p = 0.018). Neither age, degree of amnesia, duration of the procedure nor its type added any significant value as factors affecting patient satisfaction. The most common factors inducing patients' discomfort during BS were local anesthesia of the throat (56/125, 45%) and cough (47/125, 38%). Low anxiety level before bronchoscopy and reduced discomfort during the procedure are associated with better patient satisfaction. Thus, it is important to reduce patient anxiety and discomfort during the procedure.

Coronavirus disease 2019 (COVID-19) is a worldwide pandemic that had emerged in China since December 2019. The disease affects all age groups, with clinical manifestations in the spectrum from asymptomatic to rapidly lethal multi-organ failure, mainly involving the respiratory system. Diagnosis is confirmed mainly by a positive real-time polymerase chain reaction (PCR) nasopharyngeal swab. It is highly recommended to avoid performing invasive procedures in COVID-19 subjects to prevent the potential for dissemination of the pathogen. Treatment consists in particular of respiratory support and symptom relief. Dexamethasone is widely used with encouraging response. There were no cases in the literature that were diagnosed with positive reverse transcription-polymerase chain reaction (RT-PCR) testing only from fluid of involved organs, while repeated nasopharyngeal swabs returned negative for COVID-19. We here describe a case of COVID-19 that presented with moderate-severe pulmonary involvement, diagnosed by RT-PCR testing from broncho-alveolar lavage, while several nasopharyngeal swabs were consistently negative. The patient experienced no improvement under wide-spectrum antibiotics administered initially, and greatly improved after receiving systemic corticosteroids. One can realize from our case that COVID-19 could not be ruled out upon repeated negative RT-PCR nasopharyngeal swabs, and in subjects with highly suspected COVID-19, it is justified to perform invasive procedures, but still using maximal protective measures. J Med Cases. 2021;12(6):217-219 doi: https://doi.org/10.14740/jmc3679

Recent years have been marked by significant progress in pediatric science, including pediatric pulmonology and endoscopy, which has led to significant advances in the diagnosis, treatment and prevention of respiratory diseases in children. The algorithm for choosing the optimal research method, which gives the most complete spectrum of information of interest, has been determined; highlights the modern ideas about the preparation and methods of anesthesia during bronchoscopic manipulations in children

BackgroundThe aim of the present study was to propose a new approach for 3D computed tomography (CT) airway evaluation-guided endobronchial blocker placement in pediatric patients, and to determine its efficiency in clinical application.MethodsA total of 127 pediatric patients aged 0.5–3 years who were scheduled for elective thoracic surgery using one-lung ventilation (OLV) were randomized into the bronchoscopy (BRO) group and the CT group. The degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, and hoarseness after tracheal extubation; duration of postoperative mechanical ventilation, intensive care unit (ICU) stay and hospitalization; success rate of first blocker positioning; and required time and repositioning for successful blocker placement were compared between the 2 groups.ResultsThe degree of lung collapse, postoperative airway mucosal injury, pulmonary infection within 72 h after surgery, and hoarseness after tracheal extubation; duration of postoperative mechanical ventilation, ICU stay and hospitalization; success rate of first blocker positioning; and required time and repositioning for successful blocker placement were similar between the 2 groups (all P>0.05).ConclusionsFor pediatric patients undergoing surgery with OLV, preoperative 3D CT airway evaluation could be used to guide endobronchial blocker placement, with a blocking efficiency similar to that of BRO-guided blocker placement.

Objective: Bronchoscopy is an invasive procedure that can cause a feeling of suffocation and cough. It may cause fear, discomfort, and anxiety in individuals. The aim of this research is to determine the fear and its causes before the procedure in patients undergoing bronchoscopy.

OBJECTIVE To study the clinical features of children with Mycoplasma pneumoniae pneumonia (MPP) and peripheral lymphocytopenia. METHODS A total of 310 MPP children who were hospitalized and underwent bronchoalveolar lavage from June 2018 to June 2019 were enrolled and divided into two groups: simple MPP group with 241 children (without peripheral lymphocytopenia) and MPP + peripheral lymphocytopenia group with 69 children. The two groups were compared in terms of clinical data and treatment outcome. RESULTS Compared with the simple MPP group, the MPP + peripheral lymphocytopenia group had significantly longer duration of fever and length of hospital stay and significant increases in C-reactive protein, lactate dehydrogenase, and Mycoplasma pneumoniae DNA copies in bronchoalveolar lavage fluid (P < 0.05). Compared with the simple MPP group, the MPP + peripheral lymphocytopenia group had significantly higher incidence rates of intrapulmonary consolidation, extrapulmonary complications, and serious lesions under bronchoscopy (erosion or sputum bolt) and a significantly higher proportion of patients with severe MPP (P < 0.05). CONCLUSIONS Children with MPP and peripheral lymphocytopenia tend to have more severe immunologic injury. Peripheral blood lymphocyte count may be used to evaluate the severity of MPP.

Background: Tuberculosis (TB) and sarcoidosis are two chronic, systemic, and granulomatous diseases that have similar pulmonary and extrapulmonary manifestations. Given the similarities between the two diseases, it is suggested that the Mycobacterium genome may play a role in sarcoidosis. Identification of Mycobacterium species isolated from sarcoidosis patients optimizes the treatment process of patients. The present study investigates biopsy tissue samples from patients with sarcoidosis for the presence of Mycobacterium in the tissues. Methods: This descriptive cross-sectional study was performed on all sarcoidosis patients referred to Masih Daneshvari Hospital during 2017–2018 (401 patients). All patients who were outpatients or hospitalized in the bronchoscopy ward of Masih Daneshvari Hospital underwent transbronchial needle aspiration (TBNA). The cause of the TBNA procedure in patients was the presence of bilateral hilar lymphadenopathy in patients. Out of 401 patients with sarcoidosis, five patients showed positive smear or culture for Mycobacterium and were excluded from the study. Finally, 396 patients were included in the study. Results: The majority of participants in the present study were female (56.1%) with a mean age of 48.2 years and a mean ACE index of 73.4. Hypertension was found in16.2% of patients with sarcoidosis. 16.4% of patients had hyperlipidemia and 4.3% of patients had a history of ischemic heart disease. Redness of the eyes was seen in 13.1% of patients and 12.4% of the patients had diabetes. Also, 43.4% of the patients had skin lesions. Out of a total of 396 patients with sarcoidosis in the present study, 3.5% of the lymph and lung tissues of sarcoidosis patients (who were not infected with Mycobacterium tuberculosis by clinical signs and culture) contained amplifiable MTB DNA. Conclusion: In the present study and many previous related studies, the Mycobacterium genome has been observed in lymph node samples of mediastinal nodes and lung tissue of sarcoidosis patients. One of the strengths of the present study, which can make the results very reliable, is the high sample size in this study. It is suggested that similar studies with the use of control groups in large samples, investigate the presence of the Mycobacterium genome and its type in sarcoidosis patients.

Alajbegovic, Katarina; Epler, Katharine; Stillwell, Terri; Popova, Antonia; Kohne, Joseph Author Information

This study analyzes the relationship between the mycobiome of the Lower Respiratory Tract (LRT) and the fungi in the domestic environment. Samples studied consisted of Broncho-Alveolar Lavage (BAL) from 45 patients who underwent bronchoscopy for different diagnostic purposes, and dust and air from the houses (ENV) of 20 of them (44.4%). Additionally, five bronchoscopes (BS) were also analyzed and negative controls were included for every procedure. All samples were processed for DNA extraction and cultures, which were performed in Sabouraud Dextrose and Potato Dextrose Agar. The fungal Internal Transcribed Spacer (ITS2) was sequenced by the Solexa/Illumina system and sequences were analyzed by QIIME 1.8.0 and compared with the UNITE Database for identification. The similarity between the two fungal communities (BAL and ENV) for a specific patient was assessed via the percentage of coincidence in the detection of specific operational taxonomic units (OTUs), and about 75% of co-occurrence was detected between the mycobiome of the LRT and the houses. Cultures confirmed the presence of the core mycobiome species. However, the low rate of isolation from BAL suggests that most of its mycobiome corresponds to non-culturable cells. This likely depends on the patient’s immune system activity and inflammatory status.

A PAN-POSITIVE, RAPIDLY PROGRESSIVE PULMONARY RENAL PUZZLER

The cause of acute dyspnea in chronic obstructive pulmonary disease is challenging. A 69-year old man complained of dyspnea, and cough. He had a diagnosis of chronic obstructive pulmonary disease for 6 years. Oxygen therapy started for respiratory failure. At the 6 th day of hospitalization, dyspnea progressively increased. Chest x-ray showed a right-sided radiolucency. The preliminary diagnosis was spontaneous pneumothorax but chest CT-scan demonstrated a space-occupying lesion in left main bronchus. The latter diagnosis was mucoid impaction but bronchoscopy revealed a malignant lesion. In conclusions, lung cancer can be a rare cause of acute dyspnea.

El papel de la broncoscopia flexible en la patología de vía aérea superior de pacientes inmunodeprimidos

During the evolving SARS-CoV-2 pandemic, occupational exposure and infection for first responders and health care workers remains a major concern across the globe [1]. Regional shortages in personal protective equipment (PPE), particularly high-level particulate filter masks such as N95, has led to creative interventions to reduce airborne viral exposure while caring for infected patients.

Systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate of bronchoscopy patients were recorded before anesthesia, at the beginning of operation, 15 minutes after the operation and at the end of anesthesia. SPSS20.0 software was used for statistical analysis. Univariate analysis of variance (AVOVA) was used to compare the general situation of patients between groups. The comparison of systolic blood pressure, diastolic blood pressure, mean arterial pressure and heart rate at each time point was performed by single variable analysis of variance (AVOVA), P &lt; 0.05 was statistically significant. These data reflect the change trend of vital signs after using different anesthetic drugs. It can provide reference for anesthesiologists in the face of different basic conditions of patients when choosing narcotic drugs.

To study the clinical effect of oral propranolol in the treatment of respiratory hemangioma in infants and young children. A retrospective analysis was performed from the chart review data of children with respiratory hemangioma treated by oral propranolol and diagnosed by bronchoscopy and laryngeal plain enhanced CT/MRI from November 2012 to December 2019. A total of 20 children were enrolled. All children had improvement in the symptoms of laryngeal stridor and dyspnea after oral administration of propranolol for 1-2 days. The median treatment time was 10 months (range 6-12 months). The median follow-up time was 10 months (range 3-15 months). Of the 20 children, 19 (95%) achieved regression of tumor, and 1 (5%) experienced an increase in tumor size during reexamination at 6 months after drug withdrawal and had no recurrence after the treatment with an increased dose of propranolol for 6 months. Only 1 child (5%) had adverse reactions, and 1 child (5%) was still under treatment. Oral propranolol can quickly relieve the symptoms such as dyspnea and achieve tumor regression, with few adverse events, and it is therefore an effective method for the treatment of respiratory hemangioma in infants and young children.

In pandemic times, medical staff is becoming a key resource in fighting the infection. To achieve the best medical care, relevant techniques and procedures have to be taught to medical staff while reducing the risk of infection. COVID patients often suffer from respiratory insufficiency and increased intrapulmonal secretion. A bronchoscopy is one of the standard procedures for resolving respiratory tract obstruction in intensive care medicine. On the downside, this procedure has a high potential for producing aerosol formations due to disconnections of the ventilator tubes, which creates an increased risk of infection to the medical staff. The indications for a bronchoscopy should be limited to the absolute minimum. This video gives a guidance for reducing personal infection risk without neglecting patient safety when performing a bronchoscopy.