Experienced Bronchoscopists Research Articles

Prediction of patient discomfort during fibreoptic bronchoscopy

This study investigated the potential for predicting which patients would have a negative emotional reaction to bronchoscopy. A questionnaire was distributed to 120 patients who had undergone diagnostic fibreoptic bronchoscopy. A visual analog scale to evaluate the patient's discomfort was adopted. Multiple linear regression analysis was used to determine factors significantly influencing discomfort. The regression model included the following variables: age, gender, symptoms, smoking habits, proximal bronchial brushing, distal bronchial brushing, bronchial washing, proximal transbronchial biopsy, transbronchial lung biopsy, examination time, the bronchoscopist's experience, and the patient's anxiety level. The bronchoscopist's experience (P = 0.001) and the patient's anxiety level (P < 0.001) were variables that significantly influenced discomfort. These results suggest that discomfort decreased with the bronchoscopist's experience and increased with the patient's anxiety regarding bronchoscopy. The results suggest that subjective discomfort can be predicted both by the bronchoscopist's experience and by a questionnaire about the patient's anxiety level before bronchoscopy. Therefore, it is recommended that the patient's anxiety level be determined through the use of a questionnaire before bronchoscopy, and that more experienced bronchoscopists should take charge if the patient is judged as being excessively anxious. If experienced bronchoscopists are unavailable, the more anxious patient should receive more sedatives.

Bronchoscope reprocessing and infection prevention and control. Bronchoscopy-specific guidelines are needed

Chest 2004;125:307–314. Srinivasan A, Wolfeenden LL, Song X, Perl TM, Haponik EF. Study Summary: In this study, the investigators invited practicing bronchoscopists to complete a 22-question survey addressing infection control issues related to bronchoscopy. The survey was distributed to the participants in 2 bronchoscopy courses. Of 46 completed surveys included in the study, 12 (26%) were completed by medical directors of bronchoscopy suites and 34 (74%) were completed by attending bronchoscopists. On average, the participants performed 19 bronchoscopies per month. Overall, 65% of respondents were not aware of any national reprocessing guidelines. Medical directors of the bronchoscopy suites (45%) were no more aware of reprocessing guidelines than the attending bronchoscopists (31%). Eighteen (39%) participants were not aware of the reprocessing method in their own institution. Seventy-eight percent of respondents did not know local practices for at least 1 of the reprocessing questions. There were considerable variations in the local infection control practices. Only 46% of respondents reported keeping the record of using specific bronchoscope in an individual case. Thirty-two percent reported surveillance of bronchoscopy cultures, most commonly by infection control personnel. Thirty percent reported culturing bronchoscope as a routine infection control measure. Almost an equal proportion of respondents did know whether bronchoscopy culture surveillance is done in their institution. The authors concluded that experienced bronchoscopists are unfamiliar with national guidelines and local bronchoscope reprocessing practices. Comments: A contaminated bronchoscope could act as a vector for infection with serious clinical implications (N Engl J Med 2003;348:214–220, N Engl J Med 2003;348:221–227). The exact magnitude of this problem is unknown, partly as a result of difficulties in establishing a cause-and-effect relation between bronchoscopy and transmission of infection and partly as a result of lack of surveillance mechanism in most bronchoscopy suites. There are data to indicate that breaches from reprocessing guidelines are common (Am J Med 1992;92:257–261, Thorax 1997;52:709–713). The current study provides an important explanation for this problem; there is a general lack of awareness and familiarity with infection control recommendations, bronchoscope reprocessing guidelines, and local practices followed in individual bronchoscopy suites. The study raises several important issues. If directors and experienced bronchoscopists know so little about the reprocessing practices and guidelines, how much do fellows in training and bronchoscopy assistants know about this topic! The survey highlights marked variations in local reprocessing and surveillance practices. Less than half of the respondents reported keeping records of the specific bronchoscope used in an individual case. This information is critical for a subsequent epidemiologic investigation in an outbreak situation. Less than one third of respondents reported surveillance of bronchoscopy culture results in their institution. This kind of surveillance provides an important opportunity for early detection of an outbreak. On the contrary, 30% of respondents reported routine culture of bronchoscope, which is unnecessary as environmental surveillance cultures, including those from bronchoscopes are not required on a routine basis. The results from this study reinforce the need for all bronchoscopy personnel, including bronchoscopists, bronchoscopy assistants, nurses, and pulmonary fellows, to become familiar with the infection control issues surrounding bronchoscopy. Several publications, including a recent review, address this subject in considerable details (Am J Respir Crit Care Med 2003;167:1050–1056). The Association for Professionals in Infection control and Epidemiology Inc. (APIC) has published comprehensive guidelines for infection prevention and control in the endoscopy suite (AJIC Am J Infect Control 2000;28:138–155). These guidelines provide thorough and state-of-the-art information on recommended reprocessing procedures. Similar bronchoscopy-specific guidelines are needed in pulmonary literature. Several limitations of this study should be noted. The sample size was very small. Several critical questions pertaining to reprocessing steps were not asked. Some questions were unclear and could be interpreted in more than 1 way. The survey did not inquire who trains the personnel in charge of reprocessing bronchoscopes and how often such training is reinforced. Despite these limitations, the central message from this paper is absolutely critical to everyday practice of bronchoscopy and patient safety. It should serve as a wakeup call for all who are involved in organizing and implementing infection control policies and procedures in their bronchoscopy suites.

Evaluation of Virtual Reality Bronchoscopy as a Learning and Assessment Tool

Background: Conventional training in bronchoscopy involves a trainee performing on a real patient under supervision. This method of training is not only expensive, but there is also potential for increased patient discomfort. Simulators permit the acquisition of necessary technical skills required for the procedure. Virtual reality (VR) has been an integral part of training in aviation, and the application of this technology in medical training needs to be evaluated. Objective: This study was conducted to evaluate the efficacy of a VR bronchoscopy simulator as a learning and assessment tool. Methods: The bronchoscopic simulator (HT Medical Systems, Maryland, USA) is a VR computer programme. The simulator has the ability to assess competence by a set of parameters, which formed the data for the study. Nine novices without previous bronchoscopic experience formed the study group (group 1). Nine experienced bronchoscopists having performed between 200 and 1,000 bronchoscopies formed the other group (group 2). We assessed the efficacy of the system as a learning tool by studying whether there was a significant difference between the first and subsequent sessions of the subjects from group 1 and by comparing the performance of the two groups. Statistical analysis was done using the Mann-Whitney U test and the Wilcoxon signed ranks test. Results: There was a significant difference in performance between the first attempt of group 1 and the performance of the experts in terms of percentage of segments visualised and number of wall collisions and the economy of performance. Among the subjects from group 1, there was a significant improvement in percentage of segments visualised by the third attempt (p = 0.04), in the economy of performance by the sixth attempt (0.008) and in the number of wall collisions by the sixth attempt (0.024). When each attempt of the novices was compared with the performance of group 2, the significance in the difference of the percentage of segments studied (p = 0.09) and the economy of performance disappeared by the third attempt (0.06), while the difference in the number of wall collisions disappeared by the fifth attempt (p = 0.06). Conclusions: This study has been able to establish the face, construct and content validity of the simulator and the potential for it to be an effective training tool.

Incidence of Pneumothorax after Fiberoptic Bronchoscopy (FOB) in Community-Based Hospital; Are Routine Post-procedure Chest Roentgenograms Necessary

PURPOSE: Fiberoptic Bronchoscopy (FOB) is a relatively safe procedure with minimal complications. However, the need to obtain a routine post-FOB chest roentgenogram (CXR) to rule out pneumothorax remains controversial and is dependent on the bronchoscopists’ bias. Our aim is to assess the incidence of post-FOB pneumothorax in a community hospital setting without pulmonary/critical care fellowship program, where all of the FOB's are done by experienced bronchoscopists, and determine the need for routine post-FOB CXR.

Relevance of Training in Transbronchial Fine-Needle Aspiration Technique

Transbronchial fine-needle aspiration (TBFNA) is a valuable and low-risk procedure that provides access to mediastinal nodes. To learn if increased experience improved TBFNA performance, we compared overtime TBFNA diagnostic yields between a skilled bronchoscopist and another without experience on TBFNA technique. We found higher TBFNA yields in the experienced bronchoscopist (p < 0.001); however, after some experience, the TBFNA reliability improved (p < 0.02) and the use of the procedure increased (p < 0.0001). Thus, to achieve acceptable TBFNA results, a training period is required that we estimate in about 50 procedures.

Is It Time to Reevaluate the Airway Management of Tracheoesophageal Fistula?

Is It Time to Reevaluate the Airway Management of Tracheoesophageal Fistula?

Respiratory injury in the burned patient. The role of flexible bronchoscopy.

The purpose of the study was to investigate the role of flexible bronchoscopy in the management of patients admitted to a busy Regional burns unit, with particular reference to possible smoke inhalation injury. The basic procedure employed was that used in routine bronchoscopy for the diagnosis of bronchial carcinoma, with modification of the premedication required in view of the shorter duration of the technique and the lack of a requirement for bronchial biopsy. We have found the procedure easy to perform, well tolerated by the patients and not associated with any complications. It provides additional information not otherwise available, which can influence the subsequent management of the patient. An experienced bronchoscopist and additional personnel skilled in resuscitation techniques are required. It should be performed in patients with clear evidence of smoke inhalation injury and in particular with facial burns in order to visualise the extent of airway injury, remove debris and give some indication of the likelihood of subsequent complications such as acute upper airways obstruction.

Aspirating bronchoscope for the general surgeon, obstetrician, and anesthetist.

Over the last 10 yr. the problem of postoperative atelectasis, the problem of the patient with aspirated vomitus, and similar problems have become more generally appreciated. Indeed, the literature contains an ever increasing volume of material on such emergencies, but a discussion of them is beyond the scope of this paper. However, as a result of the more general appreciation of these emergencies, my associates and I have noted an ever increasing number of inquiries from former students and residents, located where experienced bronchoscopists are not available, as to what instruments they should buy to care for their patients. Many of these men are working at places where financial resources are limited, and in more than one communication the request has included a desire for information concerning the absolute minimum of equipment needed for bronchoscopic examination. With these factors in mind, that is, (1) reducing the equipment to a minimum