Complications Of Bronchoscopy Research Articles

Indications, Efficacy, and Complications of Pediatric Bronchoscopy: A Retrospective Study at a Tertiary Center.

Background Bronchoscopy is an essential procedure for evaluating, diagnosing, and treating pediatric respiratory diseases. In this study, we demonstrate the indications and contraindications of bronchoscopy done in a tertiary referral hospital, Al Qassimi Woman's and Children's Hospital (AQWCH) in Sharjah, United Arab Emirates (UAE), in order to achieve better service. This study aims to evaluate patients' characteristics, diagnostic and therapeutic indications, and complications of bronchoscopy. Material and method This retrospective chart review included children aged between one day and 13 years, admitted to AQWCH, who underwent bronchoscopy (rigid or flexible) procedures between January 2018 and December 2019. All patients were identified by using a computerized search of hospital discharge diagnosis, which was codified as "pediatric bronchoscopy, flexible, rigid, bronchoalveolar lavage". The main study outcome measure was to evaluate patients' characteristics, diagnostic or therapeutic indications, bronchoalveolar lavage (BAL) analysis, as well as complications of bronchoscopy at AQWCH. Results There were 72 pediatric bronchoscopies (rigid and flexible) performed in patients aged less than 13 years old; the reason for bronchoscopy procedure was diagnostic in 51% and both diagnostic and therapeutic in 49%. Cough was the most common symptom (n=53; 74%), and chest recession was the most common clinical finding (n=46; 64%). Foreign body aspiration was the main indication (n=23; 32%), followed by stridor (26%). Consolidation was the most common radiological finding. Foreign body was the common finding, seen in 25% of bronchoscopies, followed by tracheomalacia in 17%. The suspected diagnosis was confirmed in 89%, and management change was needed in 54% of patients. The main complication during the procedure was desaturation (26%), and cough was the main post-bronchoscopy complication (14%). BAL was done for 28 (39%) patients, in which BAL culture was positive in 75%.Rigid bronchoscopy was done when foreign body aspiration was suspected based on positive history in 70%, abnormal physical examination in 60%, and chest X-ray abnormalities in 39% of patients. Sensitivity and specificity for patient history, physical examination, and chest X-ray were 80% and 83%, 66% and 60%, and 40% and 66 %, respectively. Conclusion Bronchoscopy is an important tool for evaluating, diagnosing, and treating pediatric respiratory diseases. While it is a safe procedure, it still needs a careful selection of patients as it is invasive.

Comparison of high-flow nasal cannula and conventional oxygen therapy for high-risk patients during bronchoscopy examination: protocol for a randomized controlled trial

IntroductionHigh-flow nasal cannula (HFNC) has been proven to improve oxygenation and avoid intubation in hypoxemic patients. It has also been utilized during endoscopy examination to reduce the incidence of hypoxia. However, little is known about the effects of HFNC versus conventional oxygen therapy (COT) on oxygenation during bronchoscopy examination via nasal route; particularly, no study has compared the use of HFNC with that of COT at similar FIO2 for patients who have high-risk factors of desaturation during bronchoscopy examination.Methods and analysisThis randomized controlled trial will be implemented in four academic centers in China. Patients who have high-risk factors including hypoxemia, hypercapnia, morbid obesity, and narrow airway will be enrolled to use HFNC or COT during bronchoscopy examination. In the HFNC group, the initial gas flow will be set at 50 L/min with a fraction of inspired oxygen (FIO2) at 0.45, if the patient tolerates, the flow can be increased to 60L/min at most, while in the COT group, oxygen flow will be set at 6 L/min via a conventional nasal cannula. After 5 min pre-oxygenation, the bronchoscope will be inserted via the nasal route. Vital signs, oxygenation (SpO2), and transcutaneous CO2 (PtCO2) will be continuously monitored. The primary outcome is the incidence of hypoxemia, defined as SpO2 < 90% for 10 s during bronchoscopy examination, and secondary outcomes include the need for treatment escalation and adverse events.DiscussionHypoxia is a common complication of bronchoscopy, our study attempted to demonstrate that HFNC may reduce the probability of hypoxia during bronchoscopy in high-risk patients. The results will be disseminated through peer-reviewed journals and national and international conferences.Trial registrationhttp://www.chictr.org.cn/: ChiCTR2100055038. Registered on 31 December 2021.

Study of Indications and Early Complications of Bronchoscopy at TUH- Lattakia During 2020 – 2021

Flexible bronchoscopy is a major diagnostic and therapeutic tool employed largely in respiratory medicine. This study was designed to determine the indications and outcome of a bronchoscopic workup at Tishreen University Hospital during the period from March 2020 to March 2021. All patients undergoing flexible bronchoscopy were subjected to full history and clinical examination, and data about patient's demographic details, indications for bronchoscopy, sedation given, specimen obtained and results of the investigation, and complications encountered were recorded. The study results revealed that of 176 bronchoscopies, 171 (97.2%) were diagnostic, and the remaining five (2.8%) were therapeutic. The mean age of patients was 54.3 ± 11.8 years, with males constituting the majority, 71.6%. Malignancy and hemoptysis were the two main indications for bronchoscopy (34.1% and 27.8%, respectively). The overall complication rate was 5.7%. The complications included bleeding in five cases, hypoxemia in three cases, laryngeal spasm in two cases, and hypertension in one case. There were no deaths related to the procedures. The overall diagnostic yield was 61.4%. Malignancy was confirmed in 70% of suspected cases; endobronchial malignancies were diagnosed in 30 patients (93.7%) out of 32 who had a macroscopically visible tumor. Tuberculosis was diagnosed in 69.2% of suspected cases, whereas bacterial pneumonia was diagnosed in 62.5%. Bronchoscopy diagnosed 81.8% of patients with lobar atelectasis. The diagnostic yield was 47% for hemoptysis. Our results confirm that flexible bronchoscopy is a valuable diagnostic tool, with a low rate of complications, particularly in patients with lung cancer. The diagnostic yield in our locality is almost similar to that reported in other series.

Association between blood pressure and the risk of biopsy-induced endobronchial hemorrhage during bronchoscopy

BackgroundHemorrhage is one of the most common complications of bronchoscopy. Although several hemorrhage risk factors have been proposed, it remains unclear whether blood pressure affects the onset of biopsy-induced endobronchial hemorrhage.Methods We conducted a retrospective cohort study of 643 consecutive adults with lung cancer over an approximately 4-year period (from January 2014 to February 2018) at a large tertiary care hospital. Patients were divided into the hemorrhage group and the non-hemorrhage group based on endobronchial biopsy (EBB) findings. The association between systolic pressure (SP), diastolic pressure (DP), mean arterial pressure (MAP), pulse pressure (PP), PP to DP ratio (PP/DP) and the risk of EBB-induced hemorrhage was evaluated using multivariate regression analysis and smooth curve fitting adjusted for potential confounding factors.ResultsThe EBB-induced bleeding incidence was 37.8% (243/643) in our cohort. An independent association was found between PP/PD and the EBB-induced hemorrhage risk (per 1 SD, adjusted odds ratio, 0.788; 95% confidence interval, 0.653-0.951). The multivariate regression analysis performed using quartiles of PP/DP revealed that lower level of PP/DP ratio was related to a higher risk of EBB-induced hemorrhage (P for trend <0.05) after adjustment for potential confounders. However, no association was observed between SP, DP, MAP, PP and EBB-induced hemorrhage.ConclusionsLow PP/DP was the independent risk factor for biopsy-induced endobronchial hemorrhage during bronchoscopy in patients with lung cancer.

POST-BRONCHOSCOPY UVULAR HEMATOMA

TOPIC: Procedures TYPE: Fellow Case Reports INTRODUCTION: Bronchoscopy can cause post-procedural throat discomfort due to oropharyngeal irritation. We report an unusual complication of bronchoscopy that resulted in a similar presentation. CASE PRESENTATION: A 31-year-old man with a history of myelodysplastic syndrome (MDS) complained of severe throat discomfort, difficulty swallowing, and hoarseness of voice a few minutes after undergoing bronchoscopy for bilateral lung infiltrates. He was thrombocytopenic at 31,000 prior to the procedure; normal coagulation profile; never been on anticoagulation or antiplatelet agents. Bronchoscopy was introduced through the Laryngeal mask airway (LMA), and the procedure lasted less than 15 minutes. Post-procedural suctioning was done.The patient noted hoarseness of voice and difficulty swallowing post-procedure. Physical examination revealed a swollen elongated uvula with a distally located hematoma. The patient received Solumedrol and admitted for observation, subsequently managed conservatively with Tylenol. DISCUSSION: Flexible bronchoscopy is a safe procedure with a low incidence of complications. Our patient had an unusual cause of throat discomfort post-bronchoscopy and he was found to have uvular hematoma secondary to uvular damage with laryngeal mask airway and post-procedural suctioning. CONCLUSIONS: Though uvular hematoma has been described in patients taking antiplatelet agents and with endotracheal intubation, it has not been previously reported in patients with moderate thrombocytopenia and LMA. Careful Suctioning should be done to avoid trauma in patients with thrombocytopenia. REFERENCE #1: Steven M. Weiss.et al. Complications of Fiberoptic Bronchoscopy in Thrombocytopenic Patients. Chest. Volume 104, Issue 4, October 1993, Pages 1025-1028. DISCLOSURES: No relevant relationships by Rajesh Kunadharaju, source=Web Response No relevant relationships by Hiwot Mengiste, source=Web Response No relevant relationships by Musa Saeed, source=Web Response

Bronchoscopy in intubated and non-intubated intensive care unit patients with respiratory failure

Bronchoscopy is one of the important tool for the pulmonary and critical care physicians to diagnose and treat various pulmonary conditions. It is increasingly being used by the intensivist due to its safety and portability. The utilization of bronchoscopy in the intensive care unit (ICU) has made the diagnosis and treatment of many conditions more feasible to intensivists. Sedation, topical or intravenous, usually helps better tolerate the procedure. However, the risks and benefits of bronchoscopy should be carefully considered in critically ill patients. The hypoxic patients in ICU pose a challenge as hypoxemia is one of the known complications of bronchoscopy, and this risk is exacerbated in patients with hypoxic respiratory failure. Bronchoscopy is relatively contraindicated in patients with severe hypoxemia and coagulopathy. However, bronchoscopy in hypoxic patients can have diagnostic as well as therapeutic implications. In patients with hypoxic respiratory failure, the use of non-invasive ventilation (NIV) during bronchoscopy has been shown to reduce the risk of intubation. On the other hand, bronchoscopy in mechanically ventilated patients is not contraindicated and has been widely used. Staying focused, monitoring vital signs closely, limiting the scope time in the airway, and understanding patient’s physiology may help decrease risk of complications. In this review, we discuss indications, techniques, complications, and yield associated with bronchoscopy in critically ill hypoxic patients.

Clinical role of bronchoalveolar lavage in dermatomyositis-associated interstitial lung disease.

To investigate the role of bronchoalveolar lavage (BAL) in DM-associated interstitial lung disease (ILD). We retrospectively reviewed the medical records of patients with DM-ILD who underwent bronchoscopy between October 2015 and September 2019. We then collated clinical features, laboratory data and bronchoscopy findings. The follow-up study was terminated on the 1 May 2020. A total of 113 DM-ILD patients were included in this study, including 27 patients with acute/subacute interstitial pneumonia (A/SIP) and 86 patients with chronic interstitial pneumonia (CIP). The A/SIP group had significantly lower proportions of lymphocytes and eosinophils in the bronchoalveolar lavage fluid (BALF) than the CIP group, but had a significantly higher proportion of neutrophils. Pathogens were discovered in BALF from 28 (24.8%) patients. Twenty-five (22.1%) patients commenced or changed antibiotic therapy on the basis of their bronchoscopy results. Lymphopenia and intensive care unit care were significantly associated with pathogen-positive BALF findings. Complications of bronchoscopy occurred in nine (8.0%) patients; fever (5.3%) was the most common complication. Twenty-five deaths (25/106, 23.6%) were observed during a mean follow-up of 22 months. Age, A/SIP and anti-MDA5 antibody were identified as independent predictors of a poor outcome, while mechanic's hands was an independent protective factor. However, cellular and pathogen findings in BALF had no significant influence on 30-day or overall mortality. Bronchoscopy is a relatively useful instrument to evaluate ILD in patients with DM, and BAL can improve the diagnosis of infection. However, cellular and pathogen findings from BALF had no significant influence on prognosis.

An update on the role of bronchoscopy in the diagnosis of pulmonary disease.

Bronchoscopy has evolved over the past few decades and has been used by respiratory physicians to diagnose various airway and lung diseases. With the popularization of medical check-ups and growing interest in health, early diagnosis of lung diseases is essential. With the development of endobronchial ultrasound, ultrathin bronchoscopy, and electromagnetic navigational bronchoscopy, bronchoscopy has been able to widen its scope in diagnosing pulmonary diseases. In this review, we have described the brief history, role, and complications of bronchoscopy used in diagnosing pulmonary lesions, from simple flexible bronchoscopy to bronchoscopy combined with several up-to-date technologies.

3D printed airway simulators: Adding a dimension to bronchoscopy training.

3D printed airway simulators: Adding a dimension to bronchoscopy training.

Predictors of Intraprocedural Respiratory Bronchoscopy Complications.

Sleep apnea can increase adverse outcomes during ambulatory surgery but not during gastrointestinal endoscopy. We hypothesize that STOP-BANG is associated with intraprocedural bronchoscopy respiratory complications. Consecutive patients undergoing bronchoscopy under moderate sedation were prospectively administered the STOP-BANG questionnaire. Participants were assessed for intraprocedural complications including hypoxemia (oxygen saturation≤85%), bradypnea (respiratory rate<8), premature procedure cessation as well as the use of nonrebreather mask, bag-mask ventilation, jaw lift/chin tilt, nasal/oral airway, and naloxone administration. Associations were assessed via logistic regression. Least absolute shrinkage and selection operator was used for multivariable model variable selection. The 223 participants-mean age 61.1±15.5 years, body mass index 25.4kg/m (interquartile range: 22.4 to 30.7), 50.7% female, and 45.3% inpatient-had a high rate of respiratory complications (37.7%). There were no associations between STOP-BANG score and respiratory complications [odds ratio (OR)=1.07, 95% confidence interval (CI): 0.92-1.25]. Asthma was protective in univariable models (OR=0.26, 95% CI: 0.04-0.98), whereas endobronchial ultrasound (OR=2.34, 95% CI: 1.35-4.10) and the number of procedure types (OR=1.24, 95% CI: 1.01-1.51) was associated with increased complications. The following factors were associated with respiratory complications in both multivariable and univariate analyses: increasing age (OR=1.28/decade, 95% CI: 1.03-1.61), baseline oxygen use per each liters per minute (OR=1.57, 95% CI: 1.21-2.09), and bronchoscopy duration (OR=1.20/10 min, 95% CI: 1.08-1.33). Bronchoscopy respiratory complications are common. STOP-BANG was not associated with increased immediate bronchoscopy complication risk. Increasing age, oxygen use, and bronchoscopy duration were associated with respiratory complications; increased vigilance in these circumstances may prevent complications.

Vital Complication of Bronchoscopy and Its Control

Vital Complication of Bronchoscopy and Its Control

Bradycardia Leading to Asystole, Induced by Transbronchial Cold Saline for Hemostasis, as a Complication of Bronchoscopy

Bradycardia Leading to Asystole, Induced by Transbronchial Cold Saline for Hemostasis, as a Complication of Bronchoscopy

Impact of a designed educational program on elderly patients undergoing flexible bronchoscopy

BackgroundBronchoscopy is a frequently required procedure in the elderly due to the high prevalence of pulmonary diseases. Bronchoscopy is associated with fears, stress, and anxiety.AimTo evaluate the impact of an educational program on patient knowledge, anxiety level, difficulties, duration, and complications of bronchoscopy procedure in elderly patients.Patient and methodsOne hundred and fifty patients aged 60 years and older candidates for bronchoscopy were included. The patients were randomly divided into two equal groups: 75 patients received educational guideline (study group); 75 patients did not receive educational guideline (control group). Patient knowledge about bronchoscopy and anxiety level were assessed. The esigned educational program was applied to the study group on the day before the procedure. It included brochures with simple and brief instructions and pictures about bronchoscopy in Arabic language. It also includes the structure of the respiratory system, definition, indications and complications of bronchoscopy, patient preparation before, during and after the procedure, and patient’s precautions that should be taken during and after bronchoscopy.ResultsThere were insufficient knowledge and high anxiety scale about bronchoscopy. Knowledge score significantly increased and anxiety scale significantly decreased after providing the patients with educational program (P<0.001 for each). There was significant reduction in the duration of bronchoscopy procedure and the amount of anaesthesia used in the study than in the control group (P<0.001). Difficulties and discomfort were significantly lower in the study group.ConclusionBesides improving knowledge and reducing anxiety score, implementing the designed educational program increases tolerability, easiness and decrease problems related to bronchoscopy.

Complications and risk factors in pediatric bronchoscopy in a tertiary pediatric respiratory center.

The aim of this study was to evaluate frequency and severity of clearly defined complications of bronchoscopy in children that occur both during and after the procedure, and to identify potential risk factors. A retrospective single-center analysis of 670 elective bronchoscopies in 522 children aged 0-17 years during the time period of 2008-2012 was performed. Procedures in intensive care unit patients and children after lung transplantation were excluded. Mean patient age was 5.58 years, 61.5% had underlying chronic diseases. Intraprocedural complications occurred in 7.2% of all procedures; of these, hypoxemia was the most common, occuring in 4.8% of cases. Postprocedural adverse events were documented in 25.8%, the most frequent of which were fever in 14.2% and transient oxygen dependency in 13.4% of cases. No bronchoscopy related deaths occurred. Multivariate logistic regression was used to identify risk factors for (1) any complication, or (2) severe complications. Age below two years (OR 1.837 [1.224-2.757], P = 0.003) and primary ciliary dyskinesia (OR 4.821 [2.018-11.552], P < 0.001) significantly contributed to risk of any complication. Age below 2 years (OR 2.478 [1.072-5.728], P = 0.034) and underlying cardiovascular disease (OR 2.678 [1.013-7.077], P = 0.047) were independent risk factors for severe complications. Bronchoscopy in children is relatively safe. Nevertheless, adverse events can occur and knowledge of risk factors may help prevent complications.

ES 07.04 Endoscopic Options for Solitary Pulmonary Nodules

World-wide, aside from men in France, Spain and the Netherlands, peripherally located adenocarcinomas have now overtaken squamous cell carcinoma as the predominant lung cancer cell type. With the implementation of lung cancer screening programs using low dose CT and increasing use of CT imaging for clinical investigations, a large number of people are found to have lung nodules. In contrast to symptomatic lung cancer, the size of screening CT detected or incidental lung nodules suspicious of malignancy is much smaller. Over 75% of screening CT detected lung cancers are ≤20 mm with 20% to 47% of the lung cancers found in the first screening CT and 33% to 62% of lung cancers found in annual repeat screening CT are ≤10 mm.1-4 Because of the small size of these lesions, currently only 20% to 34% of screening CT detected lung cancers are diagnosed by endoscopy. The diagnostic yield of bronchoscopic biopsies is modest.1,2 In the real world setting, even with advanced bronchoscopic methods such as navigation bronchoscopy and radial ultrasound, the diagnostic yield of peripheral lung lesions is less than 60%.5,6 Several factors account for the suboptimal diagnostic yield. The diameter of the airways leading to the lesion may be smaller than the 1.4 mm diameter radial EBUS probe. The lesion may be eccentric rather than perpendicular to the biopsy forceps. Removable of the imaging probe from a guide sheath and re-insertion of biopsy forceps or needle may cause displacement or migration of the guide sheath to a different airway. To improve the diagnostic accuracy, other methods are being developed for endoscopic detection and biopsy of peripheral lung lesions ≤20 mm. Bronchoscopic transparenchymal approach to access peripheral lung nodules from more central airways and real time fluoroscopic transbronchial guidance systems are under evaluation.7,8 Flexible 21G peripheral needles are becoming commercially available for transbronchial aspiration or core biopsy. Small optical imaging probes < 0.5 mm that can be inserted within a 21G needle to confirm abnormal pathology in real time using optical frequency domain imaging9,10 or diffuse reflectance spectroscopy before taking a biopsy. These newer endoscopic approaches hold promise to improve diagnostic accuracy while maintaining the advantage of lower complication rates such as pneumothorax and bleeding compares to CT guided transthoracic lung biopsy. 1. National Lung Screening Research Team, Church TR, Black WC, et al. Results of initial low-dose computed tomographic screening for lung cancer. N Engl J Med. 2013 May 23;368(21):1980-91. 2. Aberle DR, DeMello S, Berg CD, et al. Results of the two incidence screenings in the National Lung Screening Trial. N Engl J Med 2013; 369(10):920-31. 3. McWilliams A, Tammemagi MC, Mayo et al. Probability of cancer in pulmonary nodules detected on first screening CT. N Engl J Med 2013;369:910-9.4. Horeweg N, van Rosmalen J, Heuvelmans MA, et al. Lung cancer probability in patients with CT- detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening. Lancet Oncol. 2014 Nov;15(12):1332-41. 5. Ost DE, Ernst A, Lei X, et al. AQuIRE Bronchoscopy Registry. Diagnostic yield and complications of bronchoscopy for peripheral lung lesions. Results of the AQuIRE Registry. Am J Respir Crit Care Med. 2016 Jan 1;193(1):68-77. 6. Ali MS, Trick W, Mba BI, et al. Radial endobronchial ultrasound for the diagnosis of peripheral pulmonary lesions: A systematic review and meta-analysis. Respirology. 2017; 22(3):443-453. 7. Herth FJ, Li S, Jiayuan Sun J, Nader D. Bronchoscopic TransParenchymal Nodule Access: Evaluation of safety and feasibility of Archimedes System. Am J Respir Crit Care Med 2017;195:A7597. 8. Stoy SP, Whitten PE, Al-Zubaidi A, Hogarth K. Bronchoscopic peripheral lung nodule navigation by a novel Live fluoroscopic overlay guidance technology. Am J Respir Crit Care Med 2017;195:A2865. 9. Tan KM, Shishkov M, Chee A, et al. Flexible transbronchial optical frequency domain imaging smart needle for biopsy guidance. Biomed Opt Express 2012; 3::1947-1954. 10. Pahlevaninezhad H, Lee AM, A. R, et al. Endoscopic Doppler optical coherence tomography and autofluorescence imaging of peripheral pulmonary nodules and vasculature. Biomedical Optics xpress. 2015; 6(10):4191-9. Endoscopic biopsy

Role of Bronchial Brush Cytology in Diagnosis of Central Bronchial Carcinoma

Background : Despite the advances in imaging techniques and treatment modalities, the prognosis of lung cancer remains poor, with five-year survival of 14% at early stages and less than 5% in locally advanced stages. Before starting treatment a clear distinction between small cell and nonsmall cell carcinoma must be made, for that histopathology remains the mainstay of confirmation of diagnosis. To combat the disease successfully, it should be diagnosed at earliest possible stage. If bronchial brush cytology yield comparable diagnostic specificity, then it may easy for the patient and physician to manage this fatal disease.Purpose : The study was designed to evaluate the diagnostic yield of bronchial brush cytology in central (endoscopically visible) bronchial carcinomaSubjects and methods: This cross sectional study was done in the Department of Medicine, and Respiratory Medicine units of Sylhet MAG Osmani Medical College Hospital, Sylhet during the period from July 2012 to June 2014.Thirty seven patients with clinically suspected bronchial carcinoma were enrolled in this study fulfilling the inclusion and exclusion criteria. In all cases bronchial brush cytology and endo-bronchial biopsy were performed and results of both techniques were comparedReasults: The mean age of the patients with bronchial carcinoma was 59.65 (SD 12.95) years; 28 (75.7%) patients were 51 years or above with a ratio of male to female of 17.5:1. The sensitivity of bronchial brush cytology in the diagnosis of central bronchial carcinoma was 89.2% and that of endobronchial biopsy was 67.6%, no true negative cases were detected. Five (13.5%) patients developed respiratory distress and minor bleeding in 4 (10.8%) as a complications of bronchoscopy procedure.Conclusion: The diagnostic yield of bronchial brush cytology is non inferior to than that of endobronchial biopsy in the diagnosis of central bronchial carcinoma.J Bangladesh Coll Phys Surg 2017; 35(2): 68-74

Vascular Air Embolism During Bronchoscopy Procedures- Incidence, Pathophysiology, Diagnosis, Management and Outcomes.

Vascular air embolism (VAE) is a rare, but potentially fatal complication of invasive medical or surgical procedures. It is a very rare complication of bronchoscopy and is most frequently reported with therapeutic bronchoscopy with Argon plasma coagulation (APC) or neodymium-doped yttrium aluminum garnet (Nd-YAG) laser. Despite being rare, as a result of its high chance of mortality and morbidity, it is imperative that physicians have high clinical suspicion to allow for early recognition and treatment. In this article, we provide a concise review of the incidence, pathophysiology, diagnosis management and outcomes of air embolism during bronchoscopy procedures.

The indications and role of paediatric bronchoscopy in a developing country, with high prevalence of pulmonary tuberculosis and HIV

ABSTRACTBackground: Bronchoscopy, an important investigation for the diagnosis and management of respiratory diseases, is widely used in high income countries. There is limited information on value of paediatric bronchoscopy in low and middle income countries (LMIC).Aims and Objectives: Aim was to describe the indications, findings and complications of bronchoscopy in a middle income country with a high prevalence of tuberculosis and HIV.Methodology: A retrospective analysis of a database over a 3.5 year period.Results: A total of 509 bronchoscopies were performed on neonates (2.3%) and children (median age = 18 months) of which 5.1% were HIV-infected. The main indications were: possible large airway compression 40%, complicated pneumonia (25%) and persistent stridor (15%). Pathology was observed in 64% of bronchoscopies. The most findings were lymph node compression of the airways (21%), and upper airway pathology (12%). Interventional procedures were performed in 112 cases (22%), the commonest being foreign bodies removal (30%), endobronchial lymph node enucleation (30%) and transbronchial needle aspiration (20%). No major complications.Conclusion: The diagnostic yield of paediatric bronchoscopy did not differ from high income countries emphasising the importance of paediatric bronchoscopy in the management of childhood lung disease in LMICs.

Bronchoscopy for foreign body aspiration and effects of nebulized albuterol and budesonide combination.

Objective:A foreign body aspiration in the tracheobronchial tree is a dangerous medical condition in the childhood period. Although rigid bronchoscopy is a safe procedure, it may cause complications. The aim of this study was to present our bronchoscopy experience and to evaluate the efficacy of pre-operative administration of nebulized albuterol and budesonide combination for reducing intra-operative complications in foreign body aspirated cases.Methods:In this retrospective study our pediatric cases in which a foreign body was removed from tracheobronchial tree in last 8 years were analyzed. After excluding the patients who needed emergent and negative bronchoscopies, the remaining clinically stable 84 patients were compared for the effects of preoperative administration of nebulized albuterol and budesonide combination on bronchoscopy complications.Results:There were 51 boys (60.3%) and 33 girls (39.7%). There were 38 children in the non-nebulized group and 46 children in the nebulized group. We found that the combined albuterol and budesonide nebulization decrease complications such as arterial oxygen desaturation (p<0.05), and bronchospasm (p<0.05) during the bronchoscopic intervention.Conclusion:Preoperative nebulization of albuterol and budesonide combination may decrease perioperative complications of bronchoscopy.

安全管理,緊急時の処置(気管支鏡セミナーより)

安全管理,緊急時の処置(気管支鏡セミナーより)