Interventional Bronchoscopic Procedures Research Articles

Practices and perspectives on advanced diagnostic and interventional bronchoscopy among pediatric pulmonologists in the United States.

Advanced diagnostic bronchoscopy includes endobronchial ultrasound (EBUS) guided transbronchial lung and lymph node biopsies, CT navigation and robotic bronchoscopy. Interventional bronchoscopy refers to procedures performed for therapeutic purposes such as balloon dilation of the airway, tissue debulking, cryotherapy, removal of foreign bodies and insertion of endobronchial valves [1]. For adult patients, these procedures are standard of care [2, 3]. Despite a lack of formalized training, there are numerous case reports and case series describing the use of advanced diagnostic and interventional bronchoscopy techniques in children. The safety and feasibility of EBUS-TBNA, cryotherapy techniques, endobronchial valves among other techniques have been demonstrated in these publications [1, 4-9]. We sought to better understand the current practices and perspectives on interventional and advanced bronchoscopy among pediatric pulmonologists through surveys sent to pediatric teaching hospitals across the United States. We received 43 responses representing 28 programs from 25 states. The highest bronchoscopy procedure volume occurred in the 0-5 years age group. Among our respondents, 31% self-identified as a pediatric interventional/advanced bronchoscopist. 79% believe that advanced and interventional training is feasible in pediatric pulmonology and 77% believe it should be offered to pediatric pulmonary fellows. This is the first study to characterize current practices and perspectives regarding advanced diagnostic and interventional bronchoscopy procedures among pediatric pulmonologists in the United States. Pediatric interventional pulmonology (IP) is in its infancy and its beginnings echo those of the adult IP where only certain centers were performing these procedures.

Tracheobronchopathia Osteochondroplastica: A Rare Cause of Difficult Intubation

Tracheobronchopathia osteochondroplastica is a rare benign airway disorder which is characterised by submucosal nodules projecting into the tracheo-bronchial lumen usually involving the cartilaginous portions of the tracheo-bronchial tree or larynx. The condition is usually asymptomatic but can rarely present with difficulty during endotracheal intubation or rarely with obstructive airway complications. Bronchoscopic appearance is usually sufficient to make the diagnosis, and tissue biopsies are seldom required. No specific treatment is required in asymptomatic patients. However, interventional bronchoscopy procedures or surgery may be helpful in symptomatic cases.

Airway complications in lung transplantation.

Airway complications (ACs) after lung transplantation remain an important source of morbidity and mortality despite significant advances in the surgical technics, leading to increased cost, and decrease quality of life. The incidences of ACs after lung transplantation range from 2% to 33%, even though most transplant centers have reported rates in the range of 7% to 8%. However, the reported rate of ACs has been inconsistent as a result of a lack of standardized airway definitions and grading protocols before the recent 2018 International Society for Heart and Lung Transplantation (ISHLT) proposed consensus guidelines on ACs after lung transplantation. The ACs include stenosis, perioperative and postoperative bronchial infections, bronchial necrosis and dehiscence, excess granulation tissue, and tracheobronchomalacia (TBM). Anastomosis infection, necrosis, or dehiscence typically develops within the first month after lung transplantation. The most frequent AC after lung transplantation is bronchial stenosis. Several risk factors have been proposed to the development of ACs after lung transplantation, including surgical anastomosis techniques, hypoperfusion, infections, donor and recipient factors, immunosuppression agents, and organ preservation. ACs might be prevented by early recognition of the airway pathology, using advance medical management, and interventional bronchoscopy procedures. Balloon bronchoplasty, cryotherapy, laser photo resection, electrocautery, high-dose endobronchial brachytherapy, and bronchial stents placement are the most frequent interventional bronchoscopic procedures utilized for the management of ACs.

Secondary pulmonary malignancies requiring interventional bronchoscopic procedures.

Background In this study, we aimed to share our singlecenter experience and to investigate the effect of interventional bronchoscopic procedures on secondary pulmonary malignancies in terms of complications, success, and survival rates. Methods A total of 83 patients (42 males, 41 females; mean age: 57.8±15.2 years; range, 18 to 94 years) with secondary pulmonary malignancies who underwent interventional bronchoscopic procedures between January 2009 and December 2019 were retrospectively reviewed. Data including demographic and clinical characteristics of the patients, complications, and success and survival rates were recorded. Results The most common secondary pulmonary malignancies were kidney and thyroid tumors with the complaints of cough, shortness of breath, and hemoptysis. The mean duration before the diagnosis was 34.7±52.8 (range, 0.1 to 219.3) months, and the mean survival after the diagnosis were 10±13.1 (range, 0.2 to 44.4) months. A total of 92% of the patients had an airway obstruction of >50% and the interventional bronchoscopic procedures such as argon plasma coagulation, laser, cryo, and mechanical resection were successful in achieving airway patency. Laser application was found to significantly improve survival (p=0.015). Acute complication rate was 8.4% and mortality rate was 0%. Conclusion In patients with tracheobronchial lesions due to secondary pulmonary malignancies, interventional bronchoscopic procedures, regardless of the stage of the disease, provide rapid palliation in life-threatening symptoms such as dyspnea and hemoptysis due to airway obstruction, prolonging patient"s survival and gain time for additional treatments to take effect for primary disease.

SAFETY OF LARYNGEAL MASK AIRWAY USE WITH GENERAL ANASTHESIA DURING INTERVENTIONAL BRONCHOSCOPIC PROCEDURES

SESSION TITLE: Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: General anesthesia can be used with more advanced bronchoscopy procedures to help with patient tolerance and outcomes for procedures that may be more prolonged . The use of endotracheal tubes prevents complete evaluation of the trachea and upper airway for some procedures, while a laryngeal mask airway (LMA) can help provide a protected airway for deeper sedation and anesthesia and improve upper airway visualization. The purpose of our study is to evaluate the safety, efficacy profile, and outcomes of using LMA for upper airway management during interventional bronchoscopy procedures under general anesthesia. METHODS: We performed a retrospective, single center chart review, analyzing data from 295 patients undergoing bronchoscopic procedures between August 2017-October 2018. Of the 290 patients who had general anesthesia for their procedures, 117 patients (41%) had an LMA placed during their procedures. Almost all those procedures were convex probe EBUS bronchoscopies. RESULTS: Our patient population was 46% male; 48% white, 52 % were African-American and 1% were Hispanic . The median age was 68 years-old and average BMI mean was 28. Many patients have multiple medical comorbidities, with ASA -2 in 21 % , ASA-3 in 67% , and ASA-4 in 12% of the patients. Procedure times averaged 71 minutes in LMA group, and 81 minutes in non-LMA group. Seven (6 %) patients had their LMA changed to ETT to complete their procedures due to inadequate ventilation. There were no cardiac complications (acute coronary syndrome, decompensated heart failure) following anesthesia. One patient had hypoxic respiratory failure that required hospital admission for 1 day. One patient had post procedure nausea. Transient intra-procedural hypotension did happen in 13 patients (15%) that resolved by the end of the procedure with use of IVF fluid and small dose of IV vasopressors. CONCLUSIONS: In general, there were no difficulties with airway maintenance during the procedures. All of the procedures were able to be completed without interruption or delay and recovered without significant incident. LMA is a safe device to use during general anesthesia with interventional bronchoscopies procedures even with advanced ASA scores. CLINICAL IMPLICATIONS: During Interventional bronchoscopic procedures ( especially convex probe EBUS), LMA uses provide safe and feasible method to manage the upper airway during general anesthesia. DISCLOSURES: No relevant relationships by Ammar Alqaid, source=Web Response No relevant relationships by Rishi Arora, source=Web Response No relevant relationships by David Chambers, source=Web Response No relevant relationships by Allen Elster, source=Web Response No relevant relationships by Paul Fisher, source=Web Response Site Investigator for EMPROVE relationship with Olympus-Spiration Please note: $1001 - $5000 Added 06/15/2020 by Robert Holladay, source=Web Response, value=Grant/Research Support Site Investigator for DAS 181 relationship with Ansun pharmaceutical Please note: $1001 - $5000 Added 06/15/2020 by Robert Holladay, source=Web Response, value=Grant/Research Support No relevant relationships by Aditya Sithamraju, source=Web Response

Endobronchial management of malignant central airway obstruction: the first 6-year single center experience

Objectives: Central airway obstruction (CAO) develops in 20-30% of lung malignancies during the disease. The symptoms related to obstruction often result in poor quality of life and poor prognosis. Interventional bronchoscopic treatments are now recommended in guidelines to improve quality of life and symptom palliation in this patient group. In our study, we aimed to determine the efficacy and safety of our methods in the malignant CAO caused by endobronchial exophytic tumors. Methods: Between May 2012 and August 2018, 432 endobronchial debulking procedures were performed in 388 patients with symptomatic malignant CAO due to endobronchial exophytic or mixed lesions. Results: Primary lung tumors were the most common cause of airway stenosis (84.0%). The most common debulking technique was argon plasma coagulation assisted mechanical debridement (APC+MD) (79.9%). Airway patency was achieved with additional stents (10.2%) in the operations. The success rate of airway patency was 85.5% in APC+MD method, 75.6% in cryorecanalisation method, 91.7% in electrocautery assisted MD method, 100% in MD method and overall success rate was 85.4%. Stent use rate was significantly higher in the stenosis around main carina (42.9%) than in other localizations (p < 0.001). The overall serious complication rate was 2.1%. Procedure-related dead rate was 0.2%. Conclusions: Endobronchial treatment of malignant CAO with interventional bronchoscopic procedures is effective and safe. The first 6 years of experience in our interventional pulmonary clinic show that it has similar characteristics with the world experience in the endobronchial treatment of malignant CAO.

In the evaluation of tracheobronchial lesions, MDCT virtual bronchoscopy with fiber optic bronchoscopy comparison

Objective: The aim of this study is compare multislice CT VB and FOB to assess tracheobronchial lesions with multislace CT VB. Material and Methods: In the period between September 2012 and August 2013 found indications for bronchoscopy and the total of 44 patients underwent FOB and FOB MDCT-SB were included in the study to be evaluated. All patients underwent VB and/or FOB. In both methods, tracheobronchial tree were divided into 18 separate segments. FOB virtual bronchoscopic findings as the gold standard method to assess the results were considered. Accordingly, positive and negative predictive values of MDCT for VB, sensitivity, selectivity and specificity values were calculated. Results: Patient ages 1 and 79 (mean: 53 ± 16) of the patients ranged from 7 (16%) female and 37 (84%) were men. In FOB 16 narrowing, 9 congestion, four external compression, 11 mucosal abnormalities were found and in the VB 12 narrowing, 16 obstruction, 8 external compression detected. None of the 11 mucosal findings in the FOB could not be determined in VB. Patients detect in FOB 25 cases were detected in VB; two patients with lesions on the FOB, although not detected in the VB (false negative). In 14 cases both FOB and endoluminal lesion was detected in the VB. FOB lesions not seen in the VB lesion in 5 cases (false positive). According to these values, sensitivity 92%, specificity 73%, positive predictive value (PPV) of 82%, negative predictive value (NPV) 87%, Accuracy: 84%, respectively. Conclusion: Both mucosal biopsies should not be made to give details because of disadvantages such as virtual bronchoscopy fob is not an alternative for the moment. However tracheobronchial tumor research, interventional bronchoscopic procedures and biopsy guidance, foreign body aspiration of the initial assessment, tracheal injury is evaluation and treatment planning, obstructive lesions of the distal show, stenosis evaluation of endobronchial abnormalities characterization and postoperative follow-up issues of virtual bronchoscopy, constantly evolving detector technology and software when placed through the right indications for routine use will take time, we believe that the rightful place.

Airway Procedures

There has been a marked increase in the number and complexity of airway procedures performed both in the operating room and procedural areas. The anesthesiologist is challenged with establishing a patent shared airway and maintaining adequate gas exchange in patients with compromised airways and/or respiratory function. This review presents a general approach to the patient presenting for an airway procedure and highlights the commonly occurring complications. Airway fire, bleeding, and airway disruption or obstruction may occur. Some of the newer interventional bronchoscopic procedures are introduced, with emphasis on anesthetic implications. A more detailed discussion surrounds the anesthetic management of central airway obstruction and airway stenting. This review contains 8 figures, 5 tables, 30 references. Key Words: anesthesia for flexible bronchoscopy, anesthesia for rigid bronchoscopy, airway stenting, bronchoscopy, central airway obstruction, interventional pulmonology, total intravenous anesthesia, ventilation

Airway Procedures

There has been a marked increase in the number and complexity of airway procedures performed both in the operating room and procedural areas. The anesthesiologist is challenged with establishing a patent shared airway and maintaining adequate gas exchange in patients with compromised airways and/or respiratory function. This review presents a general approach to the patient presenting for an airway procedure and highlights the commonly occurring complications. Airway fire, bleeding, and airway disruption or obstruction may occur. Some of the newer interventional bronchoscopic procedures are introduced, with emphasis on anesthetic implications. A more detailed discussion surrounds the anesthetic management of central airway obstruction and airway stenting. This review contains 8 figures, 5 tables, 30 references. Key Words: anesthesia for flexible bronchoscopy, anesthesia for rigid bronchoscopy, airway stenting, bronchoscopy, central airway obstruction, interventional pulmonology, total intravenous anesthesia, ventilation

P1.05-22 New Methods of Brachyradiotherapy Catheter Stabilization in the Airways

Endobronchial brachytherapy(EBBT) is mainly used for palliation of obstructive symptoms, most commonly for malignancies located in the central airways (ei. trachea and main bronchi). However, the EBBT has a curative potential in those tumors, which are small to moderate in size, are not metastasized to the lymph nodes and are other wisely untreatable. Typically, EBBT is indicated in patients diagnosed with locally advanced non-small cell lung carcinoma (NSCLC) in the central airways. Endobronchial brachytherapy, as other methods of interventional bronchoscopic procedures such as use of laser, cryo or electrotherapy, and variations of mechanical airways passage maintenance, should not be understood as a marginal option from the modalities list. All of these mentioned methods are complementary and by a combination, one can achieve satisfactory clinical results Two new methods of brachyradiotherapy catether fixation are described . First one utilises unique star-shaped fixation device manually made from Microtech stent holding 5Fr probe in the center of airways. In the second case the brachytherapy catheter was fixed in the designated position in the trachea using a Novatech-Dumon stent (20x40 mm) and consecutively, single-dose brachytherapy of 8 Gy was applied. . In both our referred cases, the patients undergone procedure of HDR-EBBT without any complication with the use of a fixation devices which kept an afterloading probe in selected area of the airways and allowed a symmetrical radiation distribution In our presented case studies local control of intraluminal tumor growth has been achieved with the HDR-EBBT. In the case of our first patient along with surgery and cryotherapy and in the other case along with the third-line chemotherapy based on docetaxel.

Recent advances in interventional pulmonology procedures

The diagnostic ability and specificity of interventional bronchoscopy procedures has been renovated in the past decade. The evaluation of abnormal thoracic findings including lung nodules and masses, mediastinal lymphadenopathy, and pleural diseases has been revolutionized using these techniques, minimizing the need for more invasive procedure especially in patients with compromised lung functions.

Interventional bronchoscopy inthe management of thoracic malignancy.

Educational AimsTo highlight the various methods of interventional bronchoscopy.To inform about the indications for palliation and curative bronchoscopy in lung cancer.Interventional bronchoscopy is a rapidly expanding field in respiratory medicine offering minimally invasive therapeutic and palliative procedures for all types of lung neoplasms. This field has progressed over the last couple of decades with the application of new technology. The HERMES European curriculum recommendations include interventional bronchoscopy skills in the modules of thoracic tumours and bronchoscopy [1]. However, interventional bronchoscopy is not available in all training centres and consequently, not all trainees will obtain experience unless they rotate to centres specifically offering such training.In this review, we give an overview of interventional bronchoscopic procedures used for the treatment and palliation of thoracic malignancy. These can be applied either with flexible or rigid bronchoscopy or a combination of both depending on the anatomical location of the tumour, the complexity of the case, bleeding risk, the operator’s expertise and preference as well as local availability. Specialised anaesthetic support and appropriately trained endoscopy staff are essential, allowing a multimodality approach to meet the high complexity of these cases.

Interventional bronchoscopy in the initial management of benign and malignant tracheal stenoses

Management of tracheal stenoses is inconsistent. Interventional bronchoscopy (IB) is one of the therapeutic options used. The aim of the study was to investigate the role of IB in the initial management of tracheal stenosis, evaluating the treatment strategies used and complications encountered. We prospectively recruited 30 patients presenting with bronchoscopically confirmed tracheal stenoses over 1 year. Twenty benign (six simple and 14 complex) and 10 inoperable malignant tracheal stenoses were studied. All except two patients underwent rigid IB with different modalities. Each patient was followed up for 6 months. All simple, 12 complex (not eligible for surgery), and all malignant stenoses were treated with 17 (mean of 2.83 per patient), 52 (mean of 4.33 per patient), and 39 (mean of 2.83 per patient) IB procedures, respectively, including 1, 10, and 8 stent placements, respectively, with overall good therapeutic response after IB. Two patients with complex stenoses were sent for surgery. During the first 6 months after stent insertion, stent migration occurred in 27 and 12% and obstruction by mucus secretions occurred in 64 and 37% of benign and malignant stenoses, respectively. Granuloma formation occurred in 45% of benign stenoses. Tumor in-growth occurred in 37% of malignant stenoses. All complications were non-life-threatening stent-related complications that were easily managed. During follow-up, two malignant patients died of disease progression. IB is a useful option in the management of simple benign and inoperable complex benign and malignant tracheal stenoses associated with a relatively high rate of non-life-threatening stent-related complications that were easily managed.

Critical airway obstruction: challenges in airway management and ventilation during therapeutic bronchoscopy.

Endobronchial interventions are used to alleviate symptoms of airway stenosis. The ventilatory management may be challenging during these procedures, and may influence the choice of airway device. We report our experiences from 902 procedures. Patients undergoing interventional bronchoscopy procedures were consecutively registered from 1999 to 2012. Critical airway obstruction (CAO) was defined as stridor, tracheal diameter <5 mm, stenosis of both the main bronchi, or clots/tumor fragments occluding the trachea or both main bronchi. Choice of airway, ventilation strategy, and survival are reported. Results are presented as median (interquartile range), and P≤0.05 was considered significant. A total of 561 patients underwent 902 interventional bronchoscopy procedures (mechanical debulking, laser resection, balloon dilatation, and stent placement). The procedures were performed using flexible bronchoscope through an endotracheal tube (68.2%) or laryngeal mask airway (10.4%), or by rigid bronchoscopy (9.3%). All patients were primarily ventilated by volume-controlled ventilation. CAO was classified in 60 procedures, with more frequent use of laryngeal mask airway (21.7%), and change of airway device in 20/60 procedures. The survival for patients with malignant disease with or without CAO was 100 and 182 days, respectively, with 90 days survival probability of 0.65 and 0.51 (P=0.14). Bronchoscopic treatment in patients with CAO may require a change of ventilatory and airway strategy during the procedure. Despite various challenges in the management of patients with CAO, the short-term survival in these patients is comparable to that in patients without CAO.

Anaesthesia Management During Interventional Bronchoscopic Procedures: Laryngeal Mask Airway or Rigid Bronchoscope.

Interventional bronchoscopy procedures are novel and effective modes of diagnosing and treating airway lesions. Airway management and ventilation are a major concern, especially when considering the fire hazard of ventilating during endobronchial thermal therapies. The aim of this study was to evaluate the usage of laryngeal mask airway (LMA) compared to rigid bronchoscopy for the ventilation of patients undergoing diagnostic or therapeutic interventional bronchoscopy procedures. During this prospective randomised clinical trial study, patients were randomly allocated to two groups for ventilation: LMA and rigid bronchoscopy. Vital signs, including blood pressure, heart rate and percentage of blood O2 saturation before and during the procedure, degree of sore throat after recovery and physician's satisfaction, were recorded. A total of 83 patients, including 45 in the "LMA" and 38 in the "rigid" groups, were enrolled in this study. Their mean age was 51±17 years, and 59 (71%) were male. There was a statically significant difference between "rigid" and "LMA" categories regarding the decrease in O2 during the procedure in proportion to baseline figures (p=0.028). Haemodynamic parameters were better maintained using LMA compared to rigid bronchoscopy. Laryngeal mask ventilation maintains better oxygenation and haemodynamic stability and ensures physicians' and patients' satisfaction regarding ease of use, airway access and fewer complications compared to rigid bronchoscopy. Therefore, LMA can be introduced as a reliable alternative for ventilation during interventional airway procedures.

Holmium:YAG laser bronchoscopy ablation of benign and malignant airway obstructions: an 8-year experience

Patients suffering from severe tracheobronchial obstruction are vulnerable to dyspnea, respiratory failure, obstructive pneumonia, and death. Treatment with a holmium:YAG laser, an alternative to the neodymium:YAG laser, may provide symptomatic relief. This is the largest case series to date describing the application of the holmium:YAG laser via bronchoscopy for benign and malignant obstructive disease. The data were retrospectively collected from 99 patients, with either benign or malignant tracheobronchial obstruction, who underwent 261 interventional bronchoscopy procedures in the operating room with laser ablation between January 2004 and November 2011. Categorical variables were analyzed with the chi-square and Fisher's exact tests as appropriate in contingency tables, whereas Student's t-test was performed for comparison of continuous variables. Patient follow-up was concluded on September 15, 2013. The holmium:YAG laser was used in 261 procedures performed on 99 patients with either benign or malignant disease. Symptomatic improvement was demonstrated in 90 % of all benign etiology cases and 77 % of all malignant etiology cases. Within the benign and malignant subgroups, improvement was dependent on anatomical location rather than etiology of the lesion. Complications occurred in 2.3 % of the procedures, with mortality in less than 1 % of procedures. Results confirm the usefulness and safety of the holmium:YAG laser in the treatment of patients with severe benign and malignant obstructive tracheobronchial obstructions. The holmium:YAG laser is an appealing alternative to the neodymium:YAG laser.

Training and practice in bronchoscopy a national survey in Italy.

Bronchoscopy is performed in a variety of different settings in Italy. The surveys conducted so far have highlighted the heterogeneity of the procedures and the frequent inability to adhere to the guidelines. The aim of this survey was to analyse procedures, training, and opinions of Italian respiratory physicians performing interventional bronchology in the clinical practice. The study was conducted retrospectively on 300 pulmonologists. From January to June 2008, these were invited to participate in an email survey to be sent out monthly to each participant for four consecutive months. Two hundred and one respiratory physicians took part in the study, most of whom (83.5%) work in either Pulmonology or Interventional Pulmonology Units. The year before the survey, 21.2% of the participants had performed fewer than 100 examinations, 42.3% 100 to 300, and 36.6% more than 300 bronchoscopies; 53.9% were familiar with the international guidelines on the topic. Among the responders, 34.1% had received less than 6 months training, 55.3% considered further training in rigid bronchoscopy, laser procedures and thoracoscopy, invaluable for their professional activity. Adequate training for transbronchial needle aspirates, was reported by 49.6% of respondents. Our data show that interventional bronchoscopy procedures are regularly performed according to current recommendations by over half of the Italian Pulmonologists participating in our survey. The need for more comprehensive basic education and training was put forward by the majority of physicians.

Prognostic factors for bronchoscopic electrocautery and/or argon plasma coagulation in patients with central airway obstruction

BackgroundSignificant portions of central airway stenosis patients present with unresectable disease. Using bronchotherapeutic procedures to maintain a patent airway and improve clinical symptoms and quality of life is a well-known armamentarium technique. AimTo assess the contribution of different physiological and pathological prognostic factors on the yield of endobronchial therapies (argon plasma coagulation (APC) and electrocautery) in patients with central airway obstruction whether derived from malignant or non-malignant etiology. Patients and methodsTwenty nine patients with central airway obstruction, 21 males and eight females, were recruited in the study. All the studied patients were categorized into malignant and non-malignant groups with different pathological varieties. Interventional bronchoscopic procedures were performed under general anesthesia. The flexible bronchoscope was either passed via an endotracheal tube or through the rigid bronchoscope. Collected data included patient demographics, evaluation of performance scale and quality of life status, evaluation of dyspnea, cough and hemoptysis scores before the interventional bronchoscopy and 1 day after the last session. Also the collected data included; length, size, localization and bronchoscopic appearance of the lesion. Duration of symptoms, duration of mechanical ventilation and the presence of collapse prior to the intervention were all recorded. Number of sessions and type of bronchoscopic modalities used were recorded. Spirometric pulmonary function tests were done before and 1day after the last session. ResultsComplete recanalization was achieved in (17/29) 58.6% of patients, while incomplete or partial recanalization was achieved in (12/29) 41.4% of patients. Using linear regression analysis of independent factors affecting patient outcome; it was found that the length of lesion followed by presence of collapse, duration of symptoms and lastly lesion localization whether localized or diffuse (P<0.0005), (P<0.011), (P<0.02) and (P<0.039) were the most independent factors affecting patient outcome. ConclusionFor favorable outcome, selection of patients with central airway obstructing lesions candidates for bronchoscopic argon plasma coagulation and/or electrocautery should rely on several factors including; age, duration of symptoms, performance scale, co-morbidities, pre-therapeutic FEV1%, presence of lung collapse, and length of the obstructing lesion, moreover its shape and localization.

Sugammadex reversal of rocuronium-induced neuromuscular block in interventional bronchoscopy procedures: a comparison with neostigmine

Sugammadex reversal of rocuronium-induced neuromuscular block in interventional bronchoscopy procedures: a comparison with neostigmine

The Electrosurgical Knife in an Optimized Intermittent Cutting Mode for the Endoscopic Treatment of Benign Web-like Tracheobronchial Stenosis

The established endoscopic treatment of web-like tracheobronchial stenosis is laser vaporization, but the appearance on the market of a new cutting mode with a lower coagulation effect has been proposed as an alternative to laser due to less injury to the tissue. Objectives To study the clinical and functional consequences, as well as the side effects of this technique. Afterwards, we investigated whether the use of an electrosurgical knife with this technique is as effective and convenient as an ND-YAG-laser. Patients and methods Between March 2005 and July 2007, included for study were 22 patients who had undergone 34 interventional bronchoscopy procedures with the VIO-300-D radiofrequency system, using a mode of the Endo-cut I program in conjunction with the reusable knife electrode. Results All of the patients treated (100%) presented improvements in their symptoms, in the tracheobronchial lumen diameter and in lung function, which were statistically significant. Symptom-free time was 157 ± 93 days. There was an overall decrease observed in mean obstruction ( P< .001 ). Improvements in FVC ( P=.01), raw ( P=.0016) and RV/TLC ( P=.01) were significantly significant. Less than 50% of the patients needed a second intervention. These patients were compared retrospectively with a similar group of 22 patients treated with Nd-YAG laser. The follow-up analysis showed that only 18% (4/22) of the patients treated with this new technique presented fibrin, compared with 41% (9/22) of those treated with laser therapy ( P < .001). Conclusion The use of this technique is effective for the treatment of benign web-like tracheobronchial stenosis as all the patients showed clinical and functional improvement, and less than 50% required a second intervention. In comparison with laser therapy, an advantage of this technique is that less fibrin is produced, probably due to the reduced anti-coagulation effect.