Effects Of Fiberoptic Bronchoscopy Research Articles

Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury: a prospective clinical study.

Fiberoptic bronchoscopy (FB) plays an important role in making the diagnosis of nosocomial pneumonia and resolving lobar atelectasis in critically injured trauma patients. It has been shown to be a safe procedure with only occasional complications. However, in patients with head injuries, FB can lead to intracranial hypertension. Sustained increases in intracranial pressure (ICP) leads to poor outcome in these patients. Because of this, a prospective study was done not only to assess the effect of FB on ICP and cerebral perfusion pressure (CPP) in patients with brain injuries, but also to identify a regimen of sedation and anesthesia that could prevent significant increases in ICP during FB. Twenty-six FB were performed in 23 patients with ICP monitors or ICP monitors and ventriculostomy drains in place for Glasgow Coma Scale score < 8 or management of postcraniotomy trauma. FB was performed to aid in the diagnosis of nosocomial pneumonia or to aid in resolving lobar atelectasis. Before FB, all patients received a standard anesthetic regimen consisting of vecuronium (10 mg), morphine sulfate (4 mg), and midazolam (2.5 mg). Patients with diminished cranial compliance, defined as ICP > 10 mm Hg, also received a nebulizer treatment of 3 mL of 4% lidocaine before FB. All patients were preoxygenated with FIO2 = 1.0 for 10 minutes. Intracranial pressure, mean arterial pressure, and CPP were monitored continuously throughout the procedure. These same variables were also recorded at baseline and at 2-minute intervals during the procedure. The time to return to baseline ICP was also recorded. The mean ICP at baseline (immediately before FB) was 12.6 mm Hg. After introduction of the bronchoscope, the ICP rapidly increased in 21 procedures (81%) and the mean highest ICP was 38.0 mm Hg. There was also a concomitant increase in mean arterial pressure such that there was no substantial change in CPP. The mean lowest CPP was 73.1 mm Hg. The average time for return of ICP to baseline was 13.9 minutes. In the subgroup of patients with ICP > 10, attempting to blunt the tracheal stimulation by anesthetizing the trachea with 4% nebulized lidocaine did not seem to be successful. The mean highest ICP in this subgroup was 41.8 mm Hg. The CPP changed in a similar manner, as the mean lowest CPP was 74.0 mm Hg. The mean time to return to baseline was 12.5 minutes. No patient had acute neurologic deterioration secondary to FB. Although FB is an important procedure in the pulmonary care of head injured patients, it produces substantial, but transient, increases in ICP and should be used with caution in patients with diminished cranial compliance. Sedation, analgesia, paralysis, and topical tracheal anesthesia did not completely prevent the rise in ICP. Although no acute deterioration in condition occurred, secondary brain injury caused by localized cerebral ischemia is certainly possible. Because of the substantial increases in ICP, herniation may be precipitated in an occasional patient. Further study is needed to identify a regimen that will confer protection.

The Effect of Fiberoptic Bronchoscopy on Cerebral Hemodynamics in Patients With Severe Head Injury

Concerns exist about the effect of flexible fiberoptic bronchoscopy (FFB) on intracranial pressure (ICP). We studied the effect of FFB on cerebral hemodynamics in patients with severe head injury. Prior to FFB, patients were anesthetized and muscle relaxants were given as necessary to eliminate coughing. Comparisons were made of mean arterial pressure (MAP), ICP, and cerebral perfusion pressure (CPP) prior to, during, and after FFB, as well as comparisons of mean cerebral hemodynamic values in an 8-hour period before and after FFB. Observations were made of changes in neurologic status post-FFB. Surgical intensive care unit of Level 1 Trauma Center. Fifteen patients with severe head injury in whom ICP was monitored and who required FFB for diagnosis of nosocomial pneumonia or treatment of lobar collapse. Pre-FFB ICP averaged 14.3 mm Hg (range, 6 to 26 mm Hg). During FFB, patients experienced a mean increase in ICP of 13.5 mm Hg above basal values (p = 0.0001). At peak ICP, MAP increased from a baseline of 92.3 mm Hg (SD +/- 16.1) to 111.5 mm Hg (+/- 13.9). Mean CPP was 83.7 mm Hg at peak ICP (range, 52 to 121 mm Hg), a 14.0% increase over baseline. The ICP and MAP returned to basal levels following bronchoscopy. No patient had a clinically significant increase in ICP or demonstrated any deterioration in Glasgow Coma Scale score or neurologic examination findings post-FFB. Although FFB causes an increase in ICP in patients with severe head injury, MAP also rises, and an adequate CPP is maintained. The ICP returns to basal levels after the procedure. When properly performed, FFB does not adversely affect neurologic status in patients with severe head injury.

Effects of fiberoptic bronchoscopy on raspiratory gasses in arterial blood

Effects of fiberoptic bronchoscopy on raspiratory gasses in arterial blood

Effect of Bronchoalveolar Lavage on Gas Exchange in Patients with Diffuse Lung Disease and Respiratory Failure

The effect of fiberoptic bronchoscopy with bronchoalveolar lavage (BAL) on arterial oxygenation was examined in 22 patients with acute respiratory failure requiring mechanical ventilatory support. Arterial blood gases were determined immediately prior to BAL and at 15, 60, 120, and 360 minutes following BAL. PaO2/FIO2 decreased at 15 minutes and continued to decrease to approximately 33% below the baseline value at 2 hours. PaO2/FIO2 then remained constant over the remainder of the 6-hour study period. No substantial changes in FIO2, level of positive end-expiratory pressure, or intravenous pressor requirements occurred during the period of observation. Patients with lower pre-BAL PaO2/FIO2 ratios showed the least reduction in PaO2/FiO2 following BAL The BAL was diagnostic in 9 of 22 (41%) patients ( Pneumocystis carinii pneumonia in 5, bacterial pneumonitis in 2, and neoplastic involvement of the lung in 2). BAL was associated with mild deterioration of gas exchange but did not require significant changes in ventilatory or hemodynamic support for the 6-hour interval studied.

Diagnosis of pulmonary disease in acquired immune deficiency syndrome (AIDS). Role of bronchoscopy and bronchoalveolar lavage.

The effectiveness of fiberoptic bronchoscopy with the addition of bronchoalveolar lavage (BAL) was evaluated in 72 patients with the acquired immune deficiency syndrome (AIDS) and parenchymal pulmonary disease. The diagnostic yield varied for different pathogens and was 94% (45/48 cases) for Pneumocystis carinii, 67% (14/21 cases) for cytomegalovirus, and 62% (8/13 cases) for Mycobacterium avium intracellulare. Of the 11 cases of documented Kaposi's sarcoma in the lung parenchyma, none were diagnosed from bronchoscopy, although characteristic endobronchial lesions were seen in 6 cases. Overall, the yield of bronchoscopy for all pathogens was 65%. Both transbronchial biopsy and BAL had high independent yields (88 and 85%, respectively) for diagnosing P. carinii pneumonia but combining the procedures gave the best yield. Cytomegalovirus was most often diagnosed from examination and culture of the BAL. Recovery of Mycobacterium avium intracellulare was highest with culture of both washings and lavage. Neither granuloma nor organisms were seen on examination of histologic specimens. Bronchoscopy with BAL was well tolerated with few complications even in 5 patients with thrombocytopenia and 10 patients requiring mechanical ventilation. Sixteen patients (22%) had an increase in temperature after the procedure without hypotension or sepsis and 1 patient (1.5%) had a moderate pulmonary hemorrhage after transbronchial biopsy. Fiberoptic bronchoscopy with BAL is a safe procedure with a high diagnostic yield in AIDS patient with lung disease.

The Effects of Fiberoptic Bronchoscopy With and Without Atropine Premedication on Pulmonary Function in Humans

Pulmonary function studies, including arterial blood gas analysis, were performed in 21 patients undergoing fiberoptic bronchoscopy. Eight received premedication with atropine and 13 did not. In the atropine-treated group there was no significant deterioration in pulmonary function immediately after bronchoscopy compared with baseline. Compared with the values obtained after topical lidocaine anesthesia, however, there was a decrease in peak expiratory flow rate (PEFR) (20 ± 20%), forced expiratory volume in one second (FEV 1.0) (11 ± 12%), forced expiratory flow between 25 and 75% of vital capacity (FEF 25–75) (22 ± 16%), and forced expiratory flow at 75% of exhaled vital capacity (FEF 75) (28 ± 38%) and an increase in residual volume (RV) (16 ± 19%). In the no-atropine group, postbronchoscopy values showed a decrease in PEFR (13 ± 19%), forced vital capacity (FVC) (13 ± 19%), FEV 1.0 (14 ± 16%), and oxygen partial pressure (Pa O 2 ) (11 ± 9%) and an increase in RV (19 ± 31%) and alveolar-arterial oxygen pressure gradient (Δ aaPo 2) (91 ± 129%) compared with baseline values. In this group also, topical lidocaine anesthesia resulted in a decrease in FVC compared with baseline. We conclude that the deleterious effect of bronchoscopy on pulmonary function is counterbalanced by the beneficial effect of atropine and that atropine is therefore a useful premedication for fiberoptic bronchoscopy.

Effect of fiberoptic bronchoscopy on respiratory performance in patients with chronic airways obstruction.

Lung volumes, airway resistance, expiratory flow rates, distribution of ventilation, and arterial blood gases were measured before and after fiberoptic bronchoscopy in 13 patients with moderately severe chronic airways obstruction and in 10 healthy non-smoking controls. Arterial blood gases were also monitored serially during the procedure. Arterial oxygen tension (Pao2) fell during fiberoptic bronchoscopy in both patients and controls whereas arterial carbon dioxide tension and pH remained unchanged. Control subjects had no change in lung mechanics after fiberoptic bronchoscopy. However, the patients consistently developed increased airway obstruction after fiberoptic bronchoscopy. Within 24 hours after bronchoscopy lung function in the patients returned to baseline values, except for the residual volume which remained abnormally high. The topical application of lignocaine (Lidocaine) for local anesthesia before fiberoptic bronchoscopy produced no effect on lung mechanics in nine patients and 10 controls, but Pao2 decreased in both the patient and control groups. These results indicate that fiberoptic bronchoscopy consistently inpairs lung mechanics and gas exchange in patients with chronic airways obstruction but that the impairment is mild and reversible. Lignocaine administration as well as the intubation procedure contribute to the fall in Pao2 which occurs both in the patients and in subjects without pre-existing lung disease.

Arterial Blood Gas Changes in Fiberoptic Bronchoscopy During Mechanical Ventilation

In the enthusiasm which has accompanied widespread use of the flexible fiberoptic bronchoscope, it was not initially appreciated that arterial hypoxemia was a potential danger during routine diagnostic procedures. 1 King EG Expanding diagnostic and therapeutic horizons –fiberoptic bronchoscopy.. Chest. 1973; 63: 301 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar However, several recent reports have documented drops in oxygen tension (Pao2) in most patients during fiberoptic bronchoscopie examination. 2 Kleinholz EJ Fussell J McBrayer R Arterial blood gas studies during fiberoptic bronchoscopy.. Am Rev Resp Dis. 1973; 108: 1014 PubMed Google Scholar , 3 Karetzky MS Garvey JW Brandstetter RD Effect of fiberoptic bronchoscopy on arterial oxygen tension.. NY State J of Med. January 1974; (Part I): 62-63 PubMed Google Scholar , 4 Albertini R Harrel JH Moser KM Hypoxemia during fiberoptic bronchoscopy.. Chest. 1974; 65: 117-118 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar , 5 King EG Communication to the Editor.. Chest. 1974; 65: 117-118 Abstract Full Text Full Text PDF PubMed Google Scholar Karetzky and associates 3 Karetzky MS Garvey JW Brandstetter RD Effect of fiberoptic bronchoscopy on arterial oxygen tension.. NY State J of Med. January 1974; (Part I): 62-63 PubMed Google Scholar found decreases in Pao2 from 2 to 21 mm Hg (average 12 mm Hg) during all of 14 consecutive diagnostic bronchoscopic examinations, while Albertini et al 4 Albertini R Harrel JH Moser KM Hypoxemia during fiberoptic bronchoscopy.. Chest. 1974; 65: 117-118 Abstract Full Text Full Text PDF PubMed Scopus (46) Google Scholar observed a drop of from 4 to 38 mm Hg (average 20 mm Hg) in each of 16 patients studied. While the mechanism for this hypoxemia has not been precisely defined, both loss of effective tidal volume through suctioning and bronchial lavage, 5 King EG Communication to the Editor.. Chest. 1974; 65: 117-118 Abstract Full Text Full Text PDF PubMed Google Scholar and ventilation-perfusion imbalance initiated by mechanically-triggered reflex mechanisms, 3 Karetzky MS Garvey JW Brandstetter RD Effect of fiberoptic bronchoscopy on arterial oxygen tension.. NY State J of Med. January 1974; (Part I): 62-63 PubMed Google Scholar have been proposed.