Fiberoptic Bronchoscopy In Patients Research Articles

ED50 of ciprofol combined with sufentanil for fiberoptic bronchoscopy of different patient populations with pulmonary tuberculosis

BackgroundCiprofol is a promising sedative. This study aims to explore the median effective dose (ED50) of ciprofol in inhibiting responses to fiberoptic bronchoscopy in patients with pulmonary tuberculosis (PTB) of different genders and ages when combined with 0.15 μg/kg sufentanil, and to evaluate its efficacy and safety, providing a reference for the rational use of ciprofol in clinical practice.MethodsPTB patients who underwent bronchoscopy examination and treatment at The Third People’s Hospital of Changzhou between May 2023 and June 2023 were selected and divided into four groups using a stratified random method. All patients received intravenous injection of 0.15 μg/kg sufentanil followed by injection of the test dose of ciprofol according to Dixon’s up-and-down method. The initial dose of ciprofol in all four groups was 0.4 mg/kg, with an adjacent ratio of 1:1.1. The next patient received a 10% increase in the dose of ciprofol if the previous patient in the same group experienced positive reactions such as choking cough, frowning, and body movements during the endoscopy. Otherwise, it was judged as a negative reaction, and the next patient received a 10% decrease in the dose of ciprofol. The transition from a positive reaction to a negative reaction was defined as a turning point, and the study of the group was terminated when seven turning points occurred. Hemodynamic parameters, oxygen saturation and adverse reactions were recorded at different time points in all groups. The Probit regression analysis method was used to calculate the ED50 of ciprofol in the four groups and compare between the groups.ResultsThe ED50 of ciprofol combined with 0.15 μg/kg sufentanil for bronchoscopy in the four groups were 0.465 mg/kg, 0.433 mg/kg, 0.420 mg/kg and 0.396 mg/kg, respectively.ConclusionThe ED50 of ciprofol used for fiberoptic bronchoscopy varied among PTB patients of different genders and ages.Trial registrationThe Chinese Clinical Trial Registry, ChiCTR2300071508, Registered on 17 May 2023.

Is there a role for fibreoptic bronchoscopy in patients presenting with haemoptysis and negative CT? A systematic review and meta-analysis

IntroductionHaemoptysis can be a feature of lung cancer and patients are typically fast-tracked for evaluation with chest radiography, contrast-enhanced CT and fibreoptic bronchoscopy (FOB).ObjectiveWe aim to explore whether FOB should...

Analysis of clinical outcomes and prognosis of patients with early bronchogenic lung cancer after treatment of rigid bronchoscopy combining fiberoptic bronchoscopy: a single-center retrospective study

ABSTRACT Objectives To investigate the clinical value of rigid bronchoscopy combined with fiberoptic bronchoscopy in patients with early bronchogenic lung cancer who underwent sleeve lobectomy. Methods A retrospective study was performed on 76 patients with early bronchogenic lung cancer admitted to our center from March 2016 to March 2017. Patients in the control group received conventional sleeve lobectomy (n = 38), while patients in the observation group underwent sleeve lobectomy by using rigid bronchoscopy combining fiberoptic bronchoscopy (n = 38). We compared perioperative period indicators and the recovery of pulmonary function indexes one month after the operation were compared in two groups. The prognosis of the patients were also analyzed. Results Compared with the control group, the intraoperative blood loss, operation duration and airway reconstruction duration in the observation group were significantly reduced. The total incidence of perioperative complications was markedly lower in the observation group than in the control group. The percentage of DLCO% was significantly improved in the observation group. The relapse-free survival (RFS) in the observation group was remarkably longer than in the control group. Conclusion Rigid bronchoscopy combined with fiberoptic bronchoscopy is beneficial to improve the clinical outcome and prognosis of patients with early bronchogenic lung cancer more effectively.

Reliability of Flexible Fiberoptic Bronchoscopy in Patients with Low Oxygen Saturation

Reliability of Flexible Fiberoptic Bronchoscopy in Patients with Low Oxygen Saturation

Inhibition of stress and spontaneous respiration: Efficacy and safety of monitored anesthesia care by target-controlled infusion remifentanil in combination with dexmedetomidine in fibreoptic bronchoscopy for patients with severe tracheal stenosis.

This study aimed to determine the effective concentration of target-controlled infusion (TCI) of remifentanil used to inhibit stress during the treatment of severe tracheal stenosis with fibreoptic bronchoscopy and to evaluate the monitored anesthesia care (MAC) by remifentanil. 60 patients with severe tracheal stenosis who underwent fibreoptic bronchoscopy was performed. Dexmedetomidine was initially administered at a bolus dose (0.8 mcg/kg), followed by a 0.5 mcg/(kg⋅h) continuous infusion. Remifentanil was administered by TCI. The effective concentration (EC) of remifentanil was titrated by the improved sequential method, and 30 patients were included. The EC95 of remifentanil was set as the plasma target concentration to evaluate the safety of the MAC, and another 30 patients were included. The half effective effect-chamber concentration of remifentanil (EC50) was 2.243 ng/ml, and the EC95 was 2.710 ng/ml. Among the 30 patients who received an EC95 of remifentanil as the target concentration, one patient was remedied by injecting propofol, the score of Ramsay sedation was three. The incidence of subclinical hypoxemia (SPO2 of 90-95%) was 30%, the incidence of moderate hypoxemia (SPO2 of 75-89%, ≤60 s) was 20 and 86.7% of patients with oxygen saturation was less than 95% returned to normal by awakening. The satisfaction score of the operator was nine, the satisfaction score of the anesthesiologist was eight, the satisfaction score of the patients was 10, the rate of patient willingness to re-accept the procedure was 93.3% and the circulation was stable during the operation. MAC using TCI of remifentanil with continuous pumping dexmedetomidine can effectively inhibit the stress response to fibreoptic bronchoscopy in patients with severe tracheal stenosis while maintaining spontaneous breathing. Under the anesthesia management of an experienced anesthesiologist, it provides a reference to tracheoscopic anesthesia of autonomous breathing. [http://www.chictr.org.cn/], identifier [ChiCTR 2100043380].

Nursing Coordination of Fiberoptic Bronchoscopy in Patients with General Anesthesia

Nursing Coordination of Fiberoptic Bronchoscopy in Patients with General Anesthesia

Painless fiberoptic bronchoscopy in patients with COVID-19: analysis of 33 cases

To investigate the necessity, safety and feasibility of painless fiberoptic bronchoscopy in patients with coronavirus disease 2019 (COVID-19). We retrospectively analyzed the clinical characteristics of 33 patients diagnosed with COVID-19 who received painless fiberoptic bronchoscopy in Wuhan First Hospital. The general demographic and clinical data of the patients including age, gender, and ASA classification were collected. The patients received intravenous anesthesia with topical airway anesthesia with lidocaine. The changes in the vital signs of the patients were recorded before, during and after the procedure. The cough intensity of the patients during bronchoscopy were evaluated, and the adverse reactions within 24 h after the procedure were observed. The health status of the medical staff carrying out the procedure was also monitored. The 33 patients with ASA class Ⅱ to Ⅳ included 19 male and 14 female patients with an average age of 63.58±11.85 years. The lowest SpO2 of the patients during bronchoscopy was (94.8±4.3)%, which was significantly lower than that before the procedure [(99.1±1.3)%, P < 0.05] but was restored to more than 95% after such treatment as holding the jaw to open the airway or face mask positive-pressure ventilation. Bronchoscopy was completed successfully in all the patients, and 28 patients (84.85%) had mild cough during the procedure. None of the patients had obvious complications related to anesthesia. While performing the procedure, all the medical staff used third-level protection and facial protection with powered air-purifying respirators (PAPR), and the patients' face were covered with single-use sterile medical plastic curtains that were originally intended for collecting flushing fluid during arthroscopic procedures. No medical personnel was diagnosed with COVID-19 at the end of the study. For patients with COVID-19, painless techniques can be valuable during bronchoscopy, and this procedure can be safe and feasible under third-level protection.

Fiberoptic bronchoscopy versus video laryngoscopy guided intubation in patients with craniovertebral junction instability: A cinefluroscopic comparison.

Background: Manipulation during endotracheal intubation in patients with craniovertebral junction (CVJ) anomalies may cause neurological deterioration due to underlying instability. Fiberoptic-bronchoscopy (FOB) is better than video laryngoscope (VL) for minimizing cervical spine movement during intubation. However, evidence suggesting superiority of FOB in patients with CVJ instability is lacking. We prospectively compared dynamic movements of the upper cervical spine during intubation using FOB with VL in patients with CVJ anomalies.Methods: A prospective, randomized, and clinical trial was conducted in 62 patients of American Society of Anaesthesiologist Grade I-II aged between 12 and 65 years with CVJ anomalies. Patients were randomized for intubation under general anesthesia with either VL or FOB. The intubation process was done with application of skeletal traction and recorded cinefluroscopically. The dynamic interrelationship of bony landmarks (horizontal, vertical, and diagonal distances between fixed points on posterior C1 and C2) was analyzed to indirectly calculate alteration of the upper cervical spinal canal diameter (at CVJ). Atlanto-dental interval (ADI) was calculated wherever possible.Results: The alteration in canal diameter (using bony landmarks) at CVJ during intubation was not significant with the use of either VL or FOB (P > 0.05). In 41 patients, where ADI could be measured, ADI was reduced (increased spinal canal diameter) in a greater number of patients in VL group when compared to FOB group (P < 0.05).Conclusion: Using rigid skull traction, intubation under general anesthesia with VL offers similar advantage as FOB in terms of the spinal kinematics in patients with CVJ anomalies/instability. Nevertheless, greater number of patients intubated with VL may have an advantage of increased cervical spinal canal diameter when compared to FOB.

A randomised trial on the therapeutic effectiveness of bronchoalveolar lavage under fiberoptic bronchoscopy in patients with severe lung infection living in the Tibetan plateau area.

People living in plateau areas are prone to upper respiratory tract infections and secondary lung infections. The current study aimed to explore the effects of bronchoalveolar lavage under fiberoptic bronchoscope for the treatment of patients with severe pulmonary infection living in plateau areas. 148 patients with severe lung infection admitted to the intensive care unit of Shigatse People's Hospital (Shigatse, Tibet Autonomous Region, China) between July 2019 and January 2021 were enrolled. Patients were randomly assigned to the observational group or the control group. For all patients, basic clinical data including sex, age, body mass index (BMI), blood pressure, diabetes history, stroke history, presence or absence of chronic obstructive pulmonary disease, lung infection (gram-positive bacterial infection, gram-negative bacterial infection, fungal infection, acute lung abscess), surgical history, and postoperative inhalation injury. were collected. The control group received conventional treatment, and the observational group received bronchoalveolar lavage under fiberoptic bronchoscopy. Pearson's correlation was used to analyze the correlations between bronchoalveolar lavage under fiberoptic bronchoscopy and inflammatory factors levels. Logistic regression was used to investigate the correlation between bronchoalveolar lavage under fiberoptic bronchoscopy and the effectiveness of the treatment. Before treatment, no significant difference existed in the basic data of the observational group and the control group. After treatment, the parameters of respiratory mechanics and inflammatory factors in the 2 groups were significantly improved compared with those before treatment (P<0.05). At the same time, in the observational group, the clinical parameters were significantly higher than those of the control group, and the levels of inflammatory factors were significantly lower than those of the control group (all P<0.05). After full adjustment for age, sex, BMI, gram-negative infection, diabetes, and acute lung abscess, compared with the control group, the therapeutic effectiveness in the observational group was increased by 23% (OR =1.23, 95% CI: 1.09-1.51, P=0.007). For patients with severe lung infection who are resident in high altitude areas, compared with conventional treatments, bronchoalveolar lavage under fiberoptic bronchoscopy can significantly improve chest, lung, and total dynamic compliance, as well as reduce the levels of the inflammatory factors procalcitonin (PCT) and transforming growth factor-β, thus increasing the effectiveness of the treatment.

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.

A Prospective Study of Clinical Profile and Role of Fiber Optic bronchoscopy in Patients with Sputum Negative for AFb with undiagnosed lung lesions in Chest X-Ray

A Prospective Study of Clinical Profile and Role of Fiber Optic bronchoscopy in Patients with Sputum Negative for AFb with undiagnosed lung lesions in Chest X-Ray

Noninvasive ventilation with add-on fiberoptic bronchoscopy in patients with chronic obstructive pulmonary disease

Introduction Noninvasive ventilation (NIV) is a valuable treatment for acute respiratory failure, which has many advantages and lessens the risk of tracheal intubation with its associated complications. Retained bronchial secretions are one of the most common causes of NIV failure and even can contraindicate its use. Aim The aim was to assess the therapeutic utility of fiberoptic bronchoscopy as an add-on therapy in patients with acute respiratory failure on NIV, in a trial to decrease the possibility of invasive ventilation. Patients and methods Patients with COPD were divided randomly into two groups: group I (20 patients) was subjected to NIV and medical therapy, and group II (20 patients) was subjected to NIV, medical therapy, and fiberoptic bronchoscopy for suctioning the retained secretions while on NIV. The cardiorespiratory parameters and complications were recorded during and after the procedure. Results A total of 26 (65%) male and 14 (35%) female patients were enrolled in the study, with mean age of 47.55±11.56 years (range: 27–68 years). The mean duration of bronchoscopy was 3.5–7 min (range: 5.2±1.2 min) with no major complications. The amount of the aspirated secretions was 17.55±5.96 ml (range: 9–29 ml). There was significant difference on follow-up between the two groups regarding mean pH, PaO2/FiO2, and PaCO2, with more obvious improvement in group II than group I and with better outcome. Conclusion Bronchoscopy on NIV in patients with COPD with acute respiratory failure and copious bronchial secretions can be an alternative to intubation with all its associated risks.

Fibreoptic bronchoscopy in patients with acute respiratory distress syndrome

Fibreoptic bronchoscopy in patients with acute respiratory distress syndrome

Endotracheal Administration of Sufentanil and Tetracaine During Awake Fiberoptic Intubation

Combined use of local anesthetics and low-dose opioids enhances the effects of local anesthetics. This study aimed to evaluate the efficacy of combined administration of sufentanil and tetracaine through the cricothyroid membrane during awake nasal intubation using fiberoptic bronchoscopy in patients with difficult airways. Forty patients were divided into 2 groups: group A received endotracheal administration of 25 μg of sufentanil and 2 mL of 1% tetracaine mixture; group B received endotracheal administration of 2 mL 1% tetracaine and routine local anesthetic sprays followed by slow intravenous injection of 25 μg of sufentanil. The results showed that endotracheal intubation was safely completed in all patients and vital signs including blood pressure, heart rate, and pulse oxygen saturation were not significantly different between groups A and B. However, time required for local anesthesia to take effect, time required to complete intubation, cough reflex, patient tolerance during intubation, and hemodynamic indices were significantly better in group A than in group B. In conclusion, our results suggest that endotracheal administration of sufentanil combined with tetracaine is safe, effective, and feasible in the context of awake nasal intubation using fiberoptic bronchoscopy.

Anatomical and histopathological airway abnormalities detected during fiberoptic bronchoscopy in patients with mediastinal lymphadenopathy

BackgroundThe diagnosis in cases of mediastinal and hilar lymphadenitis without parenchymal involvement of the lung is often difficult. Mediastinal lymphadenopathy may be due to a variety of benign or malignant reasons. Hence, it is important to establish a diagnosis and differentiate benign from malignant lymph nodes. Aim of the workTo study the usefulness of fiberoptic bronchoscopy in diagnosis of patients with mediastinal lymphadenopathy. Patients and methodsThe present study included 30 patients with mediastinal lymphadenopathy. All were subjected to written informed consent, full history taking, full clinical examination, tuberculin skin test, chest X-ray and CT chest. Fiberoptic bronchoscopy including autofluorescence bronchoscopy with mucosal biopsies, TBNA and bronchial lavage were also obtained. Results46.7% of the study patients were diagnosed as malignancy, 20% diagnosed as sarcoidosis, 10% diagnosed as TB, 3.33% diagnosed as reactive lymphadenitis and 20% were undiagnosed. Observed anatomical airway abnormalities included vocal cord paralysis (16.7%), tracheal compression (3.3%), widening of main or second carina (80%) and mucosal abnormalities (46.7%) in the form of nodules, infiltration with tumour tissue and unhealthy mucosa. Bronchial mucosal biopsy was the most useful method of diagnosis (56.7%) followed by TBNA (30%) and finally BAL (13.3%). AFB has no cost effective value over WLB in detection of malignant lesions. ConclusionThe best diagnostic yield was obtained by combination of bronchial mucosal biopsy and TBNA techniques.

42 The value of fibre-optic bronchoscopy in patients with haemoptysis and non-diagnostic CT scans

42 The value of fibre-optic bronchoscopy in patients with haemoptysis and non-diagnostic CT scans

A modified bite block for fibreoptic bronchoscopy in patients with face and neck scars

Although special intubating airwaydevices are designed to solve these issues, they are difficultto insert in awake patients with a severely limited mouthopening. In burn patients, head and neck movements arealso limited by scar contractures, and these airway devicescan occasionally make fibroscopy difficult because theirdistal opening may move from the glottis or even face theposterior pharyngeal wall.

Application and nursing care of bronchoalveolar lavage by fiberoptic bronchoscopy in patients with mechanical ventilation

Objective To investigate the application and nursing care of bronchoalveolar lavage (BAL)by fiberoptic bronchoscopy in patients with mechanical ventilation. Methods 64 patients with mechanical ventilation in RICU were randomly divided into the control group and the observation group with 32 patients in each group. The patients in both groups were accepted anti-infection, atomization inhalation and other supportive treatments. The patients in the observation group were treated with BAL, and the patients in the control group accepted routine treatment. The therapeutic effects in the two groups were evaluated and compared. Results There was significant difference in the recovery rate and effective rate, the blood gas analysis compared with the control group was significantly improved, the time of pulmonary infection control window, mechanical ventilation, length of stay were shorter than the control group. The case number to remove ventilator successfully, organs failure and hospital mortality were less than the control group. Conclusions Fiberoptic bronchoscopy with BAL treatment could be safety and efficacy for patients with mechanical ventilation. Nursing intervention plays an important role and a good therapeutic effect for improving achievement ratio of BAL. Key words: Fiberoptic bronchoscopy; Mechanical ventilation; Respiratory failure; Nursing intervention

Fiber optic bronchoscopy in patients with acute hypoxemic respiratory failure requiring noninvasive ventilation - a feasibility study

IntroductionNoninvasive ventilation (NIV) is a standard procedure in selected patients with acute respiratory failure. Previous studies have used noninvasive ventilation to ensure adequate gas exchange during fiberoptic bronchoscopy in spontaneously breathing hypoxemic patients, thus avoiding endotracheal intubation. However, it is unknown whether bronchoscopy can be performed safely in patients with acute hypoxemic respiratory failure already in need of NIV prior to the decision for bronchoscopy.MethodsWe prospectively investigated 40 consecutive, critically ill, adult patients with acute hypoxemic respiratory failure (14 women, 26 men, age 61 ± 15 years, partial pressure for oxygen/fraction of inspired oxygen (PaO2/FiO2) < 300 under noninvasive ventilation, Simplified Acute Physiology scores (SAPS II) 47 ± 9.9 points). All patients required noninvasive ventilation prior to the decision to perform bronchoscopy (median 10.5 h; range 2.2 to 114). Blood gases, heart rate, blood pressure and ventilation were monitored before, during and up to 120 minutes after bronchoscopy.ResultsBronchoscopy could be completed in all patients without subsequent complications. Oxygen saturation fell to < 90% in two patients (5%), and the lowest value during the procedure was 84%. The mean PaO2/FiO2 ratio improved from 176 ± 54 at baseline to 240 ± 130 (P < 0.001) at the end of bronchoscopy and 210 ± 79 after 120 minutes. The transient mean partial pressure of carbon dioxide in the arterial blood (PaCO2) increase was 9.4 ± 8.1 mm Hg. Four patients (10%) required endotracheal intubation during the first eight hours after the procedure. Bronchoalveolar lavage yielded diagnostic information in 26 of 38 (68%) patients.ConclusionsIn critically ill patients with acute hypoxemic respiratory failure requiring noninvasive ventilation, bronchoscopy can be performed with an acceptable risk. Since these patients per se have a high likelihood of subsequent endotracheal intubation due to failure of NIV, bronchoscopy should only be performed by experienced clinicians.

Fiberoptic Bronchoscopy during Nasal Non-Invasive Ventilation in Acute Respiratory Failure

Background: Various methods have been described for safely performing fiberoptic bronchoscopy (FB) while applying non-invasive positive pressure ventilation (NIPPV) in patients with acute respiratory failure (ARF). Objectives: To evaluate the safety of a new method to perform FB in patients with ARF. Methods: Patients with ARF in whom FB was indicated were studied. The primary end-point was a mean drop in oxygen saturation (S_aO₂) after the procedure. During nasal NIPPV, FB was performed via the mouth using a bite block sealed with an elastic glove finger allowing bronchoscope insertion. Results: Thirty-five patients were included in the final study (63 ± 17 years, 74% men, P_aO₂/F_iO₂ ratio 168 ± 63). A total of 35 bronchoaspirates, 21 protected brushings, 11 bronchoalveolar lavages and 8 bronchial biopsies were done. The cardiorespiratory variables at the start and end of FB were: S_aO₂ 93 ± 3 to 94 ± 5%, heart rate 95 ± 17 to 99 ± 22 b.p.m. and respiratory rate 24 ± 11 to 25 ± 11 respirations/min. The lowest S_aO₂ value reached during the procedure was 86 ± 3% and the maximal ETCO₂ rise was 41 ± 4 mm Hg. Leakage was <50 ml/s in 32 patients. The clinical course was favorable in 66%. Invasive ventilation was necessary in 11%, 5 ± 4 days after FB. Twelve patients (33%) died 3 ± 2 days after FB as a result of their underlying disease. Conclusions: The system allowed to perform FB safely in patients with ARF. Although there is a relatively high rate of intubation and invasive mechanical ventilation due to illness severity, there was no worsening of oxygenation or complications attributable to the procedure.