Interventional Bronchoscopy Research Articles

Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial

Tranexamic acid (TA) is an antifibrinolytic drug currently used systemically to control bleeding. To date, there have been no prospective studies of the effectiveness of inhaled TA for the treatment of hemoptysis. The goal of this study was to prospectively assess the effectiveness of TA inhalations (ie, nebulized TA) for hemoptysis treatment. This analysis was a double-blind, randomized controlled trial of treatment with nebulized TA (500mg tid) vsplacebo (normal saline) in patients admitted with hemoptysis of various etiologies. Patients with massive hemoptysis (expectorated blood > 200mL/24 h) and hemodynamic or respiratory instability were excluded. Mortality and hemoptysis recurrence rate were assessed at 30days and following 1 year. Forty-seven patients were randomized to receive TA inhalations (n= 25) or normal saline (n= 22). TA was associated with a significantly reduced expectorated blood volume starting from day 2 of admission. Resolution of hemoptysis within 5days of admission was observed in more TA-treated patients than in those receiving placebo (96%vs50%; P< .0005). Mean hospital length of stay was shorter for the TA group (5.7 ± 2.5days vs7.8 ± 4.6days; P= .046), with fewer patients requiring invasive procedures such as interventional bronchoscopy or angiographic embolization to control the bleeding (0%vs18.2%; P= .041). No side effects were noted in either group throughout the follow-up period. In addition, a reduced recurrence rate was noted at the 1-year follow-up (P= .009). TA inhalations can be used safely and effectively to control bleeding in patients with nonmassive hemoptysis. ClinicalTrials.gov; No.: NCT01496196; URL: www.clinicaltrials.gov.

BRONCHOSCOPIC INTERVENTION FOR TREATMENT OF RESPIRATORY FAILURE DUE TO ENDOBRONCHIAL TUMOR

SESSION TITLE: Lung Cancer 3 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Airway obstruction from endobronchial tumors is a cause of morbidity and mortality in about 20-30% of lung cancer cases (1). Respiratory failure due to airway obstruction can prevent these patients from receiving standard treatment including chemotherapy, radiation or immunotherapy. Therapeutic bronchoscopy can effectively relieve obstructions in a timely manner with different techniques. CASE PRESENTATION: 56-year-old female who was diagnosed with metastatic lung adenocarcinoma about 10 months ago and received chemotherapy and radiation presented to emergency department with symptoms of progressive dyspnea and palpitations with duration of about two weeks. On presentation she had severe hypoxemia and chest imaging showed whole right lung collapse. A few weeks prior to this presentation patient had good functional status, and was able to walk several blocks. A computerized tomography (CT) scan about 1 month ago showed the known right upper lobe and right hilar mass (3.0 and 4.2 cm in largest diameters respectively) with adequate lung volumes bilaterally. The patient continued to decompensated with respiratory failure and altered mental status. Assessment by Interventional pulmonology found the patient would be a good candidate for endoluminal tumor ablation and stent placement. A flexible bronchoscopy revealed an endobronchial tumor in right main stem bronchus with complete obstruction The endobronchial lesion was partially excised with a snare cautery and cryoablation. The bronchoscope was then passed into the bronchus intermedius and balloon dilatation was performed in right main stem and bronchus intermedius, followed by placement of a 40 by 12 mm tracheobronchial stent with post stent lumen size of 80% of normal. Repeat CT scan showed stent in place, and re-expansion of entire right lung. There was significant improvement in functional status soon after the procedure and she was back to her baseline activities with no need for any oxygen supplementation. She was able to receive her planned chemotherapy thereafter. DISCUSSION: Timely use of ablation techniques and stent placement can be an effective way in maintaining airway patency and improve overall functional status. (2) In review of our patient's eligibility criteria for intervention it was noted her functional status prior to admission was good and the duration of respiratory symptoms was less than 4 weeks. Furthermore, existence of patent airways distal to the obstructed site was evident in prior images which increased the likelihood of re-expansion. Other factors such as lack of other underlying lung disease, pulmonary embolism, pleural effusions or heart failure made bronchoscopic intervention likely to be successful. CONCLUSIONS: Airway obstruction can contribute to high morbidity and mortality rates in patients with lung cancer. Bronchoscopic interventions can be used to treat respiratory failure in carefully selected patients. Reference #1: Ernst, A., Feller-Kopman, D., Becker, H. D., & Mehta, A. C. (2004, June 15). Central airway obstruction. American Journal of Respiratory and Critical Care Medicine. https://doi.org/10.1164/rccm.200210-1181SO Reference #2: Theodore, P. R. (2009). Emergent Management of Malignancy-Related Acute Airway Obstruction. Emergency Medicine Clinics of North America. W.B. Saunders. https://doi.org/10.1016/j.emc.2009.01.009 DISCLOSURES: No relevant relationships by Rahul Nair, source=Web Response No relevant relationships by Ali Sadoughi, source=Web Response

EARLY SURGICAL INTERVENTION CAN BE NECESSARY: PERSISTENT MASSIVE HEMOPTYSIS DESPITE EMBOLIZATION AND BLOCKADE

SESSION TITLE: Critical Care 5 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Massive hemoptysis is a life-threatening condition due to the potential for asphyxiation or exsanguination. Commonly causes are bronchiectasis, bronchogenic carcinoma and infectious etiologies such as tuberculosis and pneumonia. Management involves localization of the bleeding source via bronchoscopy or computerized tomographic (CT) angiography with subsequent non-surgical or surgical intervention to control the bleeding. We present a case of massive hemoptysis secondary to bronchiectasis, unresponsive to bronchoscopic intervention and bronchial artery embolization (BAE), requiring definitive surgical lobectomy. CASE PRESENTATION: A 67-year-old male was admitted for evaluation of persistent hemoptysis in setting of moderate chronic obstructive pulmonary disease (COPD) and recent percutaneous biopsy of liver mass. Examination revealed rales in right lower lung base. CT of the thorax showed emphysematous changes with multiple blebs and lower-lobe honeycomb fibrotic thickening. Continued episodes of hemoptysis prompted bronchoscopic evaluation. Right lower lobe visualization revealed active bleeding from lateral and posterior segments. Despite epinephrine administration and iced saline lavage, bleeding persisted. Balloon tamponade with an endobronchial blocker was introduced into the right lower lobe and left in place. Interventional radiology consulted for arteriographic embolization. Balloon deflation after 24 hours revealed active persistent bleed. Cardiothoracic surgery was consulted and performed an emergent lobectomy. Gross pathology revealed no pleural disruption to support the notion that liver biopsy might have precipitated hemoptysis. Microscopy revealed reactive pneumocytes and significant airway ectasia. DISCUSSION: Angiography followed by BAE is the preferred management for massive hemoptysis in poor surgical candidates. In COPD both bronchiectatic and cryptogenic hemoptysis responds favorably to BAE. It has been reported as definitive treatment in both cystic and non-cystic fibrosis bronchiectasis. BAE is effective in controlling hemoptysis with success rates ranging from 70-90%. Recurrence rates vary from 10 to 57%.(1) Early recurrences occur secondary to lack of localization and inadequate embolization of all the feeding vessels. Despite high operative risks, our patient was managed with emergent lobectomy due to persistent bleeding. Emergent surgery in massive hemoptysis is associated with mortality rates up to 40%. BAE can be used as a bridge to stabilize patients before surgical treatment with an elective mortality rate 18%. (2) A retrospective analysis comparing the mortality and morbidity cohort of patients who underwent surgery after BAE vs those with early surgical intervention found no difference in outcomes.(3) CONCLUSIONS: Early surgical consultation is warranted for life-threatening massive hemoptysis in the setting of unsuccessful endobronchial blockade and BAE. Reference #1: Panda A, Bhalla AS, Goyal A. Bronchial artery embolization in hemoptysis: a systematic review. Diagn Interv Radiol. 2017;23(4):307-17. Reference #2: Fruchter O, Schneer S, Rusanov V, Belenky A, Kramer MR. Bronchial artery embolization for massive hemoptysis: long-term follow-up. Asian Cardiovasc Thorac Ann. 2015;23(1):55-60. Reference #3: Alexander GR. A retrospective review comparing the treatment outcomes of emergency lung resection for massive hemoptysis with and without preoperative bronchial artery embolization. Eur J Cardiothorac Surg. 2014;45(2):251-5. DISCLOSURES: No relevant relationships by Francis Christian, source=Web Response No relevant relationships by Sardar Ijaz, source=Web Response No relevant relationships by Kellie Jones, source=Web Response No relevant relationships by Erin Shirley, source=Web Response

MTE26.01 Onco-Pulmonologist

MTE26.01 Onco-Pulmonologist

Traitement endoscopique des fistules bronchopleurales

Bronchopleural fistula is an uncommon complication occurring especially following lung resection (pneumonectomy) and associated with high morbidity and mortality rates. The treatment is surgical but some studies reported bronchoscopic treatment. Localization and size of the fistula may indicate different endoscopic procedures. This overview described the different endoscopic procedures and their benefits.

Postintubation tracheal stenosis

Postintubation tracheal stenosis (PITS) is an iatrogenic complication seen increasingly often as the number of intensive care unit (ICU) bed multiply, the indications for endotracheal intubation expand and disease awareness rises. PITS has a clinical severity spectrum ranging from asymptomatic cases to patients requiring urgent interventional procedures. It should therefore always be considered in the differential diagnosis in patients with a history of intubation who present with the complaint of difficult breathing. The golden standart for diagnosis is fiberoptic/rigid bronchoscopy. Even though tracheal resection and end-to-end anastomosis (TRA) is the preferred traetment, in some selected cases and in the patients who are not candidates for surgery, bronchoscopic interventions can be life saving, temporizing until surgery is possible and even be curative.

Lung volume reduction with endobronchial coils for patients with emphysema.

The lung volume reduction coil treatment is a minimally invasive bronchoscopic treatment option for emphysema patients who suffer from severe hyperinflation. The treatment is aimed at a large group of patients where lung volume reduction surgery and bronchoscopic lung volume reduction using endobronchial valves are no option, or alternatively, can be offered as a bridge to lung transplantation. The nitinol coil exhibits a shape memory effect and is biologically inert. The lung volume reduction coil procedure is performed in two separate treatment sessions, targeting one lobe per session, with the contralateral lobe being treated 4 to 8 weeks after the first session. In one treatment session, around 10 to 14 coils, thereby treating an entire lobe, are being placed. Selecting optimally treated, symptomatic chronic obstructive pulmonary disease (COPD) patients with emphysema and severe hyperinflation, while avoiding significant airway disease such as asthma, chronic bronchitis and bronchiectasis, is key to achieve treatment success. Three randomized clinical trials investigating lung volume reduction coil treatment have been published until now, reporting the results of 452 treated patients up to 12 months after coil treatment. Lung volume reduction coil treatment results in significant improvement of pulmonary function outcomes and quality of life in patients with severe hyperinflation. The most common complications of lung volume reduction coil treatment are: COPD exacerbations, pneumonia, Coil Associated Opacity and an increased risk of pneumothorax. The purpose of this article is to describe the coil technique and review the available literature regarding effect, safety and future perspectives of lung volume reduction with coils for emphysema patients.

Interventional Bronchoscopy: What is Possible and What Makes Sense?

Interventional bronchoscopy plays a significant role in the treatment of various pulmonary diseases. Different endoscopic therapeutic modalities are available for the management of central airway obstruction (CAO) that represent a common indication for interventional bronchoscopy. The latest development in the field of CAO management are biodegradable stents, that would maintain the airway patency over time, then gradually degrade and vanish from the airway. Other indications for interventional bronchoscopy are chronic obstructive pulmonary disease (COPD), emphysema, asthma and chronic bronchitis. Thereby, various techniques of endoscopic lung volume reduction (ELVR) that address at hyperinflation reduction extend the therapeutic spectrum of patients with severe emphysema. Targeted lung denervation that aims a persistent bronchodilation present an area of current research in the field of COPD and asthma. In patients with chronic bronchitis, cryospray therapy that is performed within clinical trials may reduce the amount of secretion.

High-Frequency Jet Ventilation in Nonintubated Patients.

High-frequency jet ventilation (HFJV) is a convenient method for providing ventilation during fiberoptic bronchoscopy. We describe an incipient approach of high-frequency jet ventilation via the working channel of a flexible bronchoscope for nonintubated patients who suffer from hypoxemia during bronchoscopy. The aim of this study was to test the efficacy of this incipient approach and determine the possible complications related to it. Sixteen patients who had oxygen saturation below 70% that did not resolve with nasal oxygen for 20 s during interventional bronchoscopy were included in the study. High-frequency jet ventilation was administrated via the working channel of a bronchoscope for 3 min. Arterial blood gas circumscriptions were compared before and after jet ventilation. Oxygen saturation increased to >90% in all patients 30 s after jet ventilation. Mean arterial oxygen saturation pressure increased from 54.84 to 111.98 mmHg with jet ventilation (p=0.0001). Arterial carbon dioxide tension decreased after jet ventilation. The body mass index had no consequential effect on arterial carbon dioxide pressure after jet ventilation in our patients (p=0.1). Complications such as pneumothorax and working channel damage were not observed. High-frequency jet ventilation via the working channel of the bronchoscope is a novel method that can provide optimal ventilation with minimal complications to nonintubated patients suffering from hypoxemia during bronchoscopy. This method also reduces the duration of bronchoscopy procedures.

Professor Richard Whyte: who should be doing interventional bronchoscopy?

Professor Richard Whyte: who should be doing interventional bronchoscopy?

Management of benign central airway obstruction

There are a variety of etiologies of benign central airway obstruction, including traumatic, inflammatory, infectious, and systemic disorders. Presentation with non-specific respiratory symptoms often leads to delayed identification and management. Therapeutic strategies include bronchoscopic and surgical interventions; however, recurrence of airway obstruction leads to significant morbidity and mortality. We present a review of the etiology, diagnosis and management of several causes of benign airway obstruction.

Bronchoscopic Lung Volume Reduction: A 2018 Review and Update.

Bronchoscopic lung volume reduction (BLVR) procedure has expanded the treatment spectrum of patients with end-stage emphysema. These treatments include valve, coil, thermal vapor ablation, bio-lung volume reduction, targeted lung denervation, and airway bypass stent. This short review provides an up-to-date information on BLVR treatments, their clinical benefits, and an overview of complications. BLVR treatments generally affect dyspnea by reducing hyperinflation and residual volume (RV). Benefits of treatment are associated with improvement in lung function parameters (forced expiration volume in the first second, total lung capacity, RV, and 6-minute walking test) and quality of life. Serious potential pulmonary complications, such as pneumothorax, pneumonia, respiratory failure, and chronic obstructive pulmonary disease exacerbation, may also occur after BLVR treatment. In addition to these, low-cost BLVR methods, such as autologous blood and fibrin glue, are in the developmental stage. Bronchoscopic lung volume reduction treatments are a promising method with positive results for patients with severe emphysema. The widespread use of these techniques, inadequate selection of patients, and non-critical and, therefore, unsuccessful use of BLVR in non-specialist centers lead to a false negative impression of the effectiveness of these techniques. In addition to these considerations, it is obvious that these treatments, which are quite expensive, are burdening social health systems. The reduction of costs or the development of lower-cost treatment methods is important for the future and for the availability of treatments.

Angulated Stents-A Novel Stent Improvisation to Manage Difficult Post-tuberculosis Bronchial Stenosis.

Post-tuberculosis bronchostenosis (PTBS), a complication of endobronchial tuberculosis is currently treated by bronchial stenting. However, in cases of angulated bronchial stenoses, difficulty is often encountered in stent insertion and maintenance, resulting in stent migration, granulation tissue overgrowth, and restenosis. To accommodate the angulated alignment of the stenosis, we devised an "angulated stent"-a novel improvisation of the conventional stent via splicing and suturing to achieve a resultant angulated shape. A retrospective review was undertaken to evaluate the performance of this stent. Among 283 PTBS patients who underwent interventional bronchoscopy at our center from 2004 to 2014, 21 were treated with at least one angulated stent. Clinical outcomes, including the stenting duration were investigated. After a median follow-up of 26 months, stent removal was successful in 7 (33.3%) out of 21 patients. In patients managed with angulated stents, the median duration to stent change or eventual removal was longer than those treated with straight tube stents (392 days vs. 86 days; p < 0.05). Angulated stents are a feasible treatment option in patients with angulated PTBS by reducing complications and prolonging the stent-changing interval.

High-Dose Rate Endobronchial Brachytherapy for Post-Transplant Bronchial Stenosis- An Interdisciplinary Effort to Initiate a New Program

Recurrent granulation tissue or anastomotic stenosis cause major morbidity for patients undergoing lung transplantation. Common therapeutic options include bronchoscopic interventions (BI) like surgical debridement, cryotherapy, LASER coagulation, balloon bronchoplasty and stent placement. Small institutional experiences have suggested efficacy of endobronchial brachytherapy (EBB) for recurrent post-transplant bronchial stenosis (PTBS) which has an anti-inflammatory effect similar to it's use for keloids or heterotopic ossification. We describe our early experience initiating a high-dose rate (HDR) EBB program through an interdisciplinary collaboration and report efficacy benchmarks as defined by number of completed EBB, acute toxicity and treatment response (measured as mean reduction in number of BI- ‘BI-red’).

Clinical Effectiveness of High-Flow Nasal Cannula in Hypoxaemic Patients during Bronchoscopic Procedures.

BackgroundBronchoscopy is a useful diagnostic and therapeutic tool. However, the clinical use of high-flow nasal cannula (HFNC) in adults with acute respiratory failure for diagnostic and invasive procedures has not been well evaluated. We present our experiences of well-tolerated diagnostic bronchoscopy as well as cases of improved saturation in hypoxaemic patients after a therapeutic bronchoscopic procedure.MethodsWe retrospectively reviewed data of hypoxaemic patients who had undergone bronchoscopy for diagnostic or therapeutic purposes from October 2015 to February 2017.ResultsTen patients (44–75 years of age) were enrolled. The clinical purposes of bronchoscopy were for diagnosis in seven patients and for intervention in three patients. For the diagnoses, we performed bronchoalveolar lavage in six patients. One patient underwent endobronchial ultrasonography with transbronchial needle aspiration of a lymph node to investigate tumour involvement. Patients who underwent bronchoscopy for therapeutic interventions had endobronchial mass or blood clot removal with cryotherapy for bleeding control. The mean saturation (SpO2) of pre-bronchoscopy in room air was 84.1%. The lowest and highest mean saturation with HFNC during the procedure was 95% and 99.4, respectively. The mean saturation in room air post-bronchoscopy was 87.4%, which was 3.3% higher than the mean room air SpO2 pre-bronchoscopy. Seven patients with diagnostic bronchoscopy had no hypoxic event. Three patients with interventional bronchoscopy showed improvement in saturation after the procedure. Bronchoscopy was well tolerated in all 10 cases.ConclusionThis study suggests that the use of HFNC in hypoxaemic patients during diagnostic and therapeutic bronchoscopy procedures has clinical effectiveness.

Bronchoscope saline injection method (ME Hejazi Method) in ruptured peripheral and central pulmonary hydatid cysts: a case series

BackgroundThis paper mainly focuses on patients with ruptured pulmonary Echinococcus granulosus infections (alveolar hydatid disease), who suffered from ruptured alveolar hydatid cyst. In this study we aimed to remove these ruptured central and peripheral pulmonary hydatid cysts by the bronchoscopic saline injection method (ME Hejazi method). Case descriptionIn this retrospective study, we evaluated eight patients from an endemic area who were non-surgically treated for ruptured pulmonary hydatid cysts at Imam Reza hospital between 2016-2017. By the bronchoscopic saline injection method (ME Hejazi method), we extracted the entire hydatid cysts of all patients by fiber optic bronchoscopy for the detachment of the underlying membrane from the cavity wall. There were three female and five male patients, with a mean age of 40 ± 23 years (range 17–63 years). Ruptured cysts were located in the peripheral (2) and central (6) parts of the lungs. All of our experiences have been successful without any complications and residual cyst membrane. During the follow-ups, clinical and radiological recovery were seen in these patients.ConclusionsIn the peripheral ruptured hydatid cysts, accurate recognition and location of the cyst is essential and the blind approach is not recommended because it needs several bronchoscopic interventions. Therefore the Hejazi method will be a beneficial and suitable alternative method for surgery in the treatment of patients with ruptured pulmonary hydatid cyst with cyst membrane adhesions.

Interventional Bronchoscopy in King Hussain Medical Center (KHMC), Jordan : Methods Evaluation and Comparison

Interventional Bronchoscopy in King Hussain Medical Center (KHMC), Jordan : Methods Evaluation and Comparison

Review of lung sealant technologies for lung volume reduction in pulmonary disease.

Emphysema is an incurable and underdiagnosed disease with obstructive ventilatory impairment of lung function. Despite decades of research, medical treatments available so far did not significantly improve the survival benefits. Different bronchoscopic methods for lung volume reduction (LVR) in emphysema were used in the past 2 decades aiming to close the airways serving the hyperinflated lung regions and to allow the gas in the more distal bullas to be absorbed. Sealants and adhesives can be natural/biological, synthetic and semisynthetic. In lung surgery, lung sealants are used to treat prolonged air leak, which is the most common complication. Sealants can also be applied in bronchoscopic lung volume reduction (BLVR) as they administer into the peripheral airways where they polymerize and act as tissue glue on the surface of the lung to seal the target area to cause durable permanent absorption atelectasis. Initial studies analyzed the efficacy of bronchoscopic instillation of a fibrinogen–thrombin complex solution in advanced emphysema. Future studies will analyze the effects of adding chondroitin sulfate and poly-L-lysine to thrombin–fibrinogen complex thus promoting fibroblast attachment, proliferation and scarring, causing bronchial fibrostenosis and preventing ventilation of the affected part of the lung. Modifications of these methods were later developed, and the efficacy of BLVR with other sealants was analyzed in clinical studies. Results from current studies using this treatment method are promising showing that it is effective in improving exercise tolerance and quality of life in patients with advanced emphysema. It seems that subjective benefits in dyspnea scores and quality of life are more marked than improvements in lung function tests. The safety profile of sealant techniques in BLVR was mostly acceptable in clinical studies. The definite conclusions about the effectiveness of sealant in BLVR could be difficult because only a small population was involved in the current studies. More randomized large controlled studies are needed in establishing the definite role of biological BLVR in the bronchoscopic treatment of emphysema.

Efficay and safety analysis of bronchoscopic interventional therapy in 33 children with severe refractory pneumonia

Objective To evaluate the efficacy and safety of the application of bronchoscopic interventional intervention in children with severe refractory pneumonia. Methods The study was based on case analysis of subjects diagnosed with severe refractory pneumonia and hence receiving bronchoscopic interventional therapy.The standards of clinical efficacy were set against clinical symptoms, microscopic manifestations and chest CT.Thirty-three children in Guiyang Children′s Hospital were selected as subjects during a time span from January 2015 to March 2017. Results Mucous hyperemia, swelling and secretion were observed in all the 33 subjects, among whom 100.0%(33/33 cases) were observed with tmucosal atrophy and longitudinal plica, 63.6%(21/33 cases) with mucosalerosion, 36.4%(12/33 cases) with proliferation of granulation tissue, 27.2%(9/33 cases) with plastic secretion plug, 18.2%(6/33 cases) with spiny change of fish bone, 18.2%(6/33 cases) with tracheobronchia stenosis, 15.2%(5/35 cases) with tracheobronchial malacia, 15.2%(5/35 cases) with tracheobronchial atresia and 9.1%(3/33 cases) with subglottic stenosis.All the 33 cases received different bronchoscopic pulmonary interventional therapy strategies accordingly.Nine subjects with plastic bronchitis secretion plug were treated with bronchoalveolar lavage and repeated clamping by tra-cheal foing; 5 subjects with occult foreign body were treated with argon plasma coagulation, basket-shaped foreign body forceps, cryotherapy or laser cutting; 1 case with subglottic stenosis, 5 cases with tracheobronchial malacia and 6 cases with tracheobronchial stenosis were treated with balloon dilatation; 2 cases with subglottic stenosis and 5 cases with tracheobronchial atresia received the combined therapy.As a result, 27 cases out of the 33 subjects were evaluated as complete resgonse and the rest were evaluated as partial response.In some cases, transient complications were observed during or after operation, which were well-handled and displeased.No serious complications were observed. Conclusion Based on a comprehensive understanding of the indications, contraindications and operation points of different bronchoscopic intervention modes, the strictly application of bronchoscopic interventional therapy accordingly in children with severe refractory pneumonia was proved to be effective and highly safe. Key words: Child; Severe refractory pneumonia; Bronchoscopic intervention treatment

Role of Therapeutic and Interventional Bronchoscopy in the Intensive Care Unit

Role of Therapeutic and Interventional Bronchoscopy in the Intensive Care Unit