Interventional Pulmonology Research Articles

Robotic-assisted Bronchoscopy and Cone-beam CT: A Retrospective Series.

Robotic-assisted Bronchoscopy and Cone-beam CT: A Retrospective Series.

Nurse Initiative Driven Project Results in Increased Patient Satisfaction Scores

<h3>Introduction</h3> Since acquiring Interventional Pulmonary procedures within the last year, patient satisfaction scores showed consistent opportunities for improvement in discharge preparedness. <h3>Identification of the problem</h3> During Shared Governance discussions, it was determined that electronic medical record discharge instructions did not include procedure specific information. This lead to frustration amongst the staff due to being unable to answer the patient's questions. <h3>QI question/Purpose of the study</h3> The purpose of the study was to increase patient preparedness for discharge, including questions specific to what to do for bleeding, infection, pain, and patient perception of being prepared for recovery/discharge. <h3>Methods</h3> The Post Anesthesia Care Unit nurses collaborated with Endoscopy procedure nurse to develop specific procedure discharge instructions. The discharge instructions were then given to the head of the Interventional Pulmonology department for approval. Once approved, the discharge instructions were uploaded into the EPIC EMR system. A tip sheet was developed on how to attach the new discharge instructions to the patient After Visit Summary as a reference. Additionally, the Endoscopy procedure nurse developed and provided education to the PACU staff to increase understanding of the Interventional Pulmonary procedures. <h3>Outcomes/Results</h3> Patient satisfaction scores in the below categories increased within the three month implementation period: - Prepare for Recovery: 75 percent to 100 percent - Bleeding: 75 percent to 84.2 percent - Pain 58: percent to 100 percent - Infection: 58.3 percent to 88.9 percent Additionally, our post- procedure phone calls and surveys reported less concerns. <h3>Implications for perianesthesia nurses and future research</h3> Our Shared Governance reviews patient satisfaction scores and reports on a regular basis, thus leading to this idea for interdisciplinary collaboration. We are looking to further review other specialties that would benefit from enhanced discharge education for patients.

Nonmalignant Pleural Effusions.

Although the potential causes of nonmalignant pleural effusions are many, the management of a few, including complicated pleural infections and refractory heart failure and hepatic hydrothoraces, can be challenging and requires the assistance of interventional pulmonologists. A pragmatic approach to complicated parapneumonic effusions or empyemas is the insertion of a small-bore chest tube (e.g., 14-16 Fr) through which fibrinolytics (e.g., urokinase and alteplase) and DNase are administered in combination. Therapeutic thoracenteses are usually reserved for small to moderate effusions that are expected to be completely aspirated at a single time, whereas video-assisted thoracic surgery should be considered after failure of intrapleural enzyme therapy. Refractory cardiac and liver-induced pleural effusions portend a poor prognosis. In cases of heart failure-related effusions, therapeutic thoracentesis is the first-line palliative therapy. However, if it is frequently needed, an indwelling pleural catheter (IPC) is recommended. In patients with hepatic hydrothorax, repeated therapeutic thoracenteses are commonly performed while a multidisciplinary decision on the most appropriate definitive management is taken. The percutaneous creation of a portosystemic shunt may be used as a bridge to liver transplantation or as a potential definitive therapy in nontransplant candidates. In general, an IPC should be avoided because of the high risk of complications, particularly infections, that may jeopardize candidacy for liver transplantation. Even so, in noncandidates for liver transplant or surgical correction of diaphragmatic defects, IPC is a therapeutic option as valid as serial thoracenteses.

Therapeutic Bronchoscopy in Benign Central Airway Obstruction

Benign central airway obstruction (BCAO) may occur in patients with post-intubation, tracheostomy, tuberculosis and non-tuberculosis infections, tracheal wall abnormalities, endobronchial benign tumors, vascular abnormalities, benign thyroid tumors and external mechanical compression. The management of BCAO is based on the underlying disease and requires multidisciplinary joint decisions from interventional pulmonology, thoracic surgery, radiology and anesthesia. Therapeutic bronchoscopy for the management of BCAO emergencies includes balloon dilation, stents and lasers.

The efficiency of a clinical pathway to guide combined applications of interventional pulmonology in undiagnosed pleural effusions

The diagnostic procedure of pleural effusion (PEs) is challenging due to low detection rates and numerous aetiologies. Hence, any attempt to enhance diagnosis is worthwhile. We present a clinical pathway to guide combined application of interventional pulmonology (IP) for tracing causes of undiagnosed PEs. Subjects with undiagnosed PEs were identified in the Hospital Information System of Dalian Municipal Central Hospital from January 1, 2012, to December 31, 2018. Eligible subjects were divided into a group of combined tests and a group of medical thoracoscopy (MT). Optimal and subsequent diagnostic tests were performed depending on the guidance of the clinical pathway by matching profitable chest lesions with the respective adaptation. As the guidance of clinical pathway, common bronchoscopy would be preferentially selected if pulmonary lesions involved or within the central bronchus, EBUS-TBNA was favoured when pulmonary lesions were adjacent to the central bronchus or with the enlarged mediastinal/hilar lymph nodes, guided bronchoscopy would be preferred if pulmonary nodules/masses were larger than 20 mm with discernible bronchus signs, CT-assisted transthoracic core biopsy was preferred if pulmonary nodules were less than 20 mm, image guided cutting needle biopsy was the recommendation if the pleural thickness was larger than 10 mm and pulmonary lesions were miliary. MT was preferred only when undiagnosed PEs was the initial symptom and pulmonary lesions were miliary or absent. A total of 83.57% cases of undiagnosed PEs were eligible for the clinical pathway, and 659 and 216 subjects were included in the combined tests and MT groups, respectively, depending on the optimal recommendation of the clinical pathway. The total diagnostic yields in the combined tests and MT groups were 95.99% and 91.20%, respectively, and the difference in total diagnostic yield was statistically significant (χ2 = 7.510, p = 0.006). Overall, clinical pathway guidance of the combined application of IP is useful for tracing the causes of undiagnosed PEs. The diagnostic yield of undiagnosed PEs is significantly increased compared with that of MT alone.

A case series of interventional pulmonology in the era of coronavirus disease 2019

Abstract The coronavirus disease 2019 (COVID-19) pandemic is still ongoing, and respirology associations globally are updating and releasing guidelines to provide appropriate care for health care workers and patients. The virus can become airborne if aerosol-generating procedures (AGPs) are performed. Interventional pulmonology procedures were performed on 63 patients within the period of March–May 2020. During this pandemic, personnel involved per procedure is limited, personal protective equipment level 3 is utilized in AGPs, and level 2 personal protective equipment is used in non-AGPs. The majority of patients were male (54%) and were aged 30–49 years (35%). Bronchoscopy was the most frequent procedure performed (62%). The most common pulmonary conditions in these patients were pneumonia, pleural effusion, and lung mass/consolidation (all 24%). There were seven (11%) patients diagnosed as having probable COVID-19. Interventional pulmonology procedures can still be performed in the era of COVID-19 pandemic.

Role of chest ultrasound in management of exudative pleural effusion

Background: During the planning and execution of diagnostic and therapeutic procedures, thoracic ultrasonography is an appropriate imaging tool for the interventional pulmonologist (IP). Aim of the work: to determine whether or not thoracic ultrasonography should be used in the management of exudative pleural effusion. Patients and Methods: One hundred patients with exudative pleural effusion were included in a prospective interventional analytical study. During this study, the patients underwent ultrasonographic examination and evaluation to guide various diagnostic manoeuvres. These manoeuvres included diagnostic thoracentesis, tru cut needle biopsy from pleural or underlying lung or mediastinal lesions, and thoracoscopic assistance. In addition to assisting in therapeutic operations (such as therapeutic thoracentesis, installation of pleural drains, and pleurodesis), ultrasound was also used for prognostic reasons (post-pleural drainage assessment, pleural drain follow up, non-expandable lung prediction, and pleurodesis success detection). Results: 70 patients underwent ultrasound-guided diagnostic procedures, including diagnostic thoracentesis in 19 patients, biopsy from pleural, lung, or mediastinal lesions in 30 patients, and thoracoscopic assistance in 21 patients in order to select the appropriate type of intervention, either medical thoracoscopy (MT) or video-assisted thoracoscopic surgery (VATS).

Malignant Central Airway Obstruction: What's New?

Malignant central airway obstruction (MCAO) is a debilitating and life-limiting complication that occurs in an unfortunately large number of individuals with advanced intrathoracic cancer. Although the management of MCAO is multimodal and interdisciplinary, the task of providing patients with prompt palliation falls increasingly on the shoulders of interventional pulmonologists. While a variety of tools and techniques are available for the management of malignant obstructive lesions, advancements and evolution in this therapeutic venue have been somewhat sluggish and limited when compared with other branches of interventional pulmonary medicine (e.g., the early diagnosis of peripheral lung nodules). Indeed, one pragmatic, albeit somewhat uncharitable, reading of this article's title might suggest a wry smile and shug of the shoulders as to imply that relatively little has changed in recent years. That said, the spectrum of interventions for MCAO continues to expand, even if at a less impressive clip. Herein, we present on MCAO and its endoscopic and nonendoscopic management-that which is old, that which is new, and that which is still on the horizon.

ULTRA-LOW DOSE CONE-BEAM CT INCREASES POSITIVE DIAGNOSIS RATE OF PERIPHERAL NODULE BRONCHOSCOPY WHILE IMPROVING RADIATION SAFETY

TYPE: Late Breaking Abstract TOPIC: Procedures PURPOSE: Cone-beam CT (CBCT) can be used during electromagnetic navigation bronchoscopy (ENB) to improve accuracy and safety of biopsy. Although the added value of CBCT is recognized, there are concerns about radiation exposure. We investigate the impact of a ultra-low-dose CBCT protocol. METHODS: A single institution, retrospective, comparative study of CBCT-ENB for biopsies using two radiation protocols (standard (Gp1) vs ultra-low-dose (Gp2)). We estimated the total E, E attributed to CBCT (E1) and E attributed to fluoroscopy (E2) per lesion from the dose-area-product (conversion factor 0.16 mSv/Gy·cm2). Secondary outcomes were number of CBCT runs and positive diagnosis (PD) rate. RESULTS: From Jan 2015-22, 386 patients (mean age 68.3) underwent CBCT-ENB for biopsy of 452 pulmonary lesions (mean size 19.5 mm): Gp1 121 patients with 138 lesions, Gp2 258 patients with 306 lesions. Total E was 4.85 mSv (Gp1) vs 1.72 mSv (Gp2) (64.5% decrease, p<0.01). E1 was 3.57 mSv (Gp1) vs 1.46 mSv (Gp2) (p<0.01) and E2 was 1.28 mSv (Gp1) vs 0.29 mSv (Gp2) (p<0.01). The number of CBCT runs increased from 3.65 to 5.68 (55.6% increase, p<0.01, dose-per-CBCT-run 0.98 mSv vs 0.26 mSv). PD rate increased from 61.7% to 72.0% (16.7% increase, p=0.05). CONCLUSIONS: The ultra-low dose protocol reduced radiation exposure compared to standard dose protocol. This allowed for more CBCT runs, more accurate tool positioning, and an improved diagnostic rate. CLINICAL IMPLICATIONS: Ultra-low dose CBCT not only reduces radiation exposure, but allows more iterative CBCT runs and improved diagnostic rate and should be adopted more widely. DISCLOSURE: Funded student internship at Philips Image Guided Therapy Systems (Best, The Netherlands) (applies to submitter). Two co-authors are employee's of Philips Image Guided Therapy Systems (Best, The Netherlands). KEYWORD: Interventional pulmonology

A Multicenter Study Assessing Interventional Pulmonary Fellow Competency in Electromagnetic Navigation Bronchoscopy.

BackgroundCurrent medical society guidelines recommend a procedural number for obtaining electromagnetic navigational bronchoscopy (ENB) competency and for institutional volume for training.ObjectiveTo assess learning curves and estimate the number of ENB procedures for interventional pulmonology (IP) fellows to reach competency.MethodsWe conducted a prospective multicenter study of IP fellows in the United States learning ENB. A tool previously validated in a similar population was used to assess IP fellows by their local faculty and two blinded independent reviewers using virtual recording of the procedure. Competency was determined by performing three consecutive procedures with a competency score on the assessment tool. Procedural time, faculty global rating scale, and periprocedural complications were also recorded.ResultsA total of 184 ENB procedures were available for review with assessment of 26 IP fellows at 16 medical centers. There was a high correlation between the two blinded independent observers (rho = 0.8776). There was substantial agreement for determination of procedural competency between the faculty assessment and blinded reviewers (kappa = 0.7074; confidence interval, 0.5667–0.8482). The number of procedures for reaching competency for ENB bronchoscopy was determined (median, 4; mean, 5; standard deviation, 3.83). There was a wide variation in the number of procedures to reach competency, ranging from 2 to 15 procedures. There were six periprocedural complications reported, four (one pneumomediastinum, three pneumothorax) of which occurred before reaching competence and two pneumothoraces after achieving competence.ConclusionThere is a wide variation in acquiring competency for ENB among IP fellows. Virtual competency assessment has a potential role but needs further studies.

Interventional Pulmonology and Esophagus: Combined Endobronchial Ultrasound and Endoscopic Ultrasound for Mediastinal Staging.

Endoscopic ultrasound (EUS) techniques in addition to endobronchial ultrasound (EBUS) can lead to diagnosis and complete accurate staging of the mediastinum in a single session. This allows for decreased health care costs, less delay in diagnosis and treatment, reduced patient discomfort, and decreased morbidity compared with invasive surgical staging techniques. In comparison to conventional mediastinoscopy, the cost-effectiveness and reduced complication profile of the endoscopic approach has made this a superior initial step in the staging and diagnosis of lung cancer. Moreover, compared with EBUS alone, combined EUS and EBUS has significantly increased yield, as well as diagnostic sensitivity making a combined approach preferable as the emerging gold-standard technique for initial minimally invasive mediastinal staging. We discuss the advantage of using EUS in combination with EBUS and highlight techniques, lymph node landmarks, utility in staging and restaging of the mediastinum, roles in diagnosing mediastinal infections and granulomatous lesions, and future directions in endosonography.

Institutional analysis of intra- and post-operative tracheostomy management for risk reduction.

Determine variability in intra- and post-operative management of tracheostomies (trachs) at our institution as existing literature suggests that trachs are a frequent trigger for airway-related emergencies. Catalyze the development of an institution-wide protocols for trach care. A 39-question online survey was sent to 55 providers who perform open and percutaneous trachs at three of the hospitals within our large, urban, academic medical center. These providers were identified by surveillance of the operating room schedules for 1 year. The survey was completed by 40 of the 53 eligible providers (75.5%). Response rate by question varied. Respondents included members of all departments that perform trachs at our institution (Otorhinolaryngology, Trauma Surgery, Thoracic Surgery, General Surgery, Cardiovascular Surgery and Interventional Pulmonology).While most responses demonstrated uniformity in practice, notable variations included the following: 80% of percutaneous trach providers stated that morbid obesity was not a contraindication to performing a trach outside of the operating room (n = 20) while 58% of open trach providers stated that morbid obesity was a contraindication; only 35% of open trach providers perform a Bjork flap (n = 350). The survey also identified significant variability in practice with regards to timing of trach suture removal. Lack of uniformity was identified in several practices related to intra- and post-operative tracheostomy care. Results did, however, trend toward consensus in many areas. The results are being used to establish a more consistent approach to tracheostomy management across our institution to ensure standardization of practice amidst the rapidly evolving practices of trach placement. With ongoing evolution in the methods of trach placement and its management, the concepts put forth here will be a resource for health care providers at other institutions to consider intra-institutional analysis and establishment of practice standardization.

Marked safety and high diagnostic yield of freehand ultrasound-guided core-needle biopsies performed by pulmonologists.

BackgroundAdequate tissue sampling is fundamental for establishing a definitive diagnosis, assessing prognosis and tailoring therapy. Each of the methods for obtaining tissue (e.g., endoscopic, image guidance and surgical biopsies) results in a different diagnostic yield and complication rate profile.ObjectivesPresent feasibility, and assess safety and efficacy of freehand transthoracic ultrasound‐guided core‐needle biopsies (USGNB) of thoracic lesions performed by pulmonologist.MethodsA retrospective analysis study of ultrasound‐guided core‐needle biopsies of thoracic lesions performed at the Pulmonary Institute of Rabin Medical Center was conducted from September 2020 to October 2021. All core‐needle biopsies were performed under local anesthesia with guidance of Mindray TE7 2019 US system. Procedural variables including complications and pathological diagnostic yield were the primary end point. IRB 0671‐21‐RMC.ResultsIn total 91 biopsy procedures were analyzed in38 females and 53 males, average age 71.1 years. Twenty‐three (25.3%) cases were lung lesions, 7 (7.7%) – mediastinal, 13 (14.3%) – chest wall, 27 (29.7%) – pleural, and 21 (23.1%) supraclavicular lesions. Average lesion size was 51.6 mm, the largest in the mediastinum and the smallest in supraclavicular locations (97.7mm and 28.0 mm, respectively). Overall pathological diagnostic yield was 90%, highest success in chest wall (100%) and lowest in mediastinal biopsies (71.4%). We had only one complication –hemothorax resolved by chest tube drainage‐ accounting for only 1.1% complication rate.ConclusionSafety and efficacy were demonstrated in freehand US‐guided core‐needle biopsy of thoracic lesions performed by pulmonologists. We suggest thoracic ultrasound and USG‐CNB be part of training and clinical practice in interventional pulmonology.

Percutaneous Tracheostomy: A Bedside Procedure.

Percutaneous tracheostomy is a bedside surgical procedure that creates an opening in the anterior tracheal wall. Tracheostomy is performed in patients expected to require mechanical ventilation for longer than seven to 10 days. This bedside percutaneous tracheostomy has been used since the late 1990s. Tracheotomy tubes are of various kinds like cuffed vs. uncuffed, fenestrated vs. unfenestrated, single lumen vs. double lumen, and metal vs. plastic. Its indications are categorized into emergency vs. elective. The most common emergency indication is acute airway obstruction, and the elective indication is prolonged intubation. There is no absolute contraindication, but a physician should consider severe hypoxia requiring high oxygen and coagulopathy. Percutaneous tracheostomy is a new technique requiring different skills. Advantages of percutaneous tracheostomy are as follows - it is performed at the bedside, procedural time is less, the cost is less, does not need operating schedule time. Percutaneous tracheostomy is generally performed by otolaryngologists, general surgeons, interventional pulmonologists, thoracic surgeons, or intensivists.

Classification of tracheobronchial tuberculosis in 252 children

Objective: To provide theoretical basis for early diagnosis and accurate bronchoscopic classification of tracheobronchial tuberculosis (TBTB) in children through analyzing the clinical characteristics, bronchoscopic classifications and treatment effect in children with TBTB. Methods: In this respective study, we collected clinical data of patients with TBTB who accepted bronchoscopies in Interventional Pulmonology Department of Beijing Children's Hospital Affiliated to Capital Medical University between January, 2006 and December, 2019. The basic data, including clinical manifestations, imaging features, bronchoscopic characteristics and effects of interventional therapy were analyzed. The results of the study were statistically described and analyzed using SPSS 22.0 statistical software for relevant data. Results: Total 252 children with TBTB were included in this study. The median age was 1.7 years (quartile: 0.8 years, 5.2 years). Analysis of the classification of TBTB showed that the percent of lymph node fistula type was 96.4% (243/252), ulcerative necrosis type 1.2%(3/252), granulation proliferation type 0.4% (1/252), and cicatricial stricture type 0.8% (2/252). In addition, 1.2% (3/252) of the cases showed the same bronchoscopic manifestations as lymph node fistula type, but it was not clear on imaging whether the caseous material in the lumen was caused by lymph node or lung erosion. Therefore, the "bronchial fistula type" was proposed. Conclusions: Lymph node fistula type of TBTB was the common in children. The classification of lymph node fistula mostly depended on imaging evidence, and this may lead to some uncertainty in classifying TBTB in cases with no imaging evidence of enlarged lymph nodes.

Should We Start With Navigation or Endobronchial Ultrasound Bronchoscopy?: Insights From Monte Carlo Simulations

Should We Start With Navigation or Endobronchial Ultrasound Bronchoscopy?: Insights From Monte Carlo Simulations

Pre- and post-COVID practice of interventional pulmonology in adults in Portugal

Introduction and objectivesThere is a lack of information regarding bronchoscopy practice in adults in Portugal. Our objective was to obtain an overview of the characteristics, resources, techniques and behaviors in national interventional pulmonology (IP) units, before and after SARS-CoV-2 outbreak. Materials and MethodsAn online survey was developed by an expert panel with a total of 46 questions comprising the specifications of each unit, namely physical space, equipment, staff, procedure planning, monitoring, technical differentiation, and numbers pre- and post-COVID-19. Forty-one interventional pulmonology centers were invited to participate between April and May 2021. Results37 units (90.2%) responded to the survey. The majority (64.9%) have a fully dedicated space with a weekly presence of ≥3 chest physicians (82.1%) and support of an anesthesiologist on specific days (48.6%). There is marked heterogeneity in the IP unit's equipment, and 56.8% acquired disposable bronchoscopes after COVID-19 pandemics. Pre-bronchoscopy hemogram, platelet count and coagulation tests are regularly asked by more than 90% of the units, even when deep sedation or biopsies are not planned. In 97.3% of cases, topical anesthesia and midazolam are utilized. Propofol (21.6%) and fentanyl (29.7%) are occasionally employed in some institutions. Most units use ancillary sampling techniques to diagnose central or peripheral lesions, with radial EBUS being used for guidance of distal procedures in 37.8% of centers, linear EBUS and EUS-B-FNA for mediastinal diagnosis and/or staging in 45.9% and 27.0% of units, respectively. Cryobiopsies are used by 21.6% of respondents to diagnose diffuse lung diseases. Rigid bronchoscopy is performed in 37.8% of centers. There was a decrease in the number of flexible (p < 0.001) and rigid (p = 0.005) bronchoscopies and an upscale of personal protective equipment (PPE) during the COVID-19 outbreak. ConclusionsIP units have variable bronchoscopic practices, but during the COVID-19 pandemic, they complied with most international recommendations, as elective procedures were postponed and PPE levels increased.

Interventional pulmonology during COVID times: A look back at the year gone by.

Background:The COVID-19 pandemic has created an unprecedented crisis, affecting every sphere of human life. A major challenge for health care workers (HCWs) is to care for patients with a highly contagious airborne disease, while making sure of their own safety. Interventional pulmonology (IP) procedures, like bronchoscopy, are particularly risky due to significant aerosol generation. Guidelines by several scientific bodies were framed on the precautions to be taken while performing IP procedures. We evaluated the IP procedures performed during the COVID-19 pandemic, and whether the precautions adopted proved adequate in preventing transmission amongst the HCWs involved in these procedures.Method:We performed a retrospective analysis of all patients who underwent IP procedures between March 2020 and November 2020, at a tertiary cancer hospital. We also evaluated the proportion of HCWs, who were involved in these procedures, and were affected by COVID-19, through their health care records.Results:We performed a total of 506 IP procedures. Two of the 18 HCWs, working in that unit, suffered from COVID-19 and recovered after a mild illness. Three HCWs were isolated with suspected infection but proved to be negative. The procedures in our IP unit were uninterrupted for the entire duration of the study period.Conclusion:IP procedures can be safely performed even in the presence of a highly contagious viral pandemic with adequate precautions.

Annual review of interventional pulmonology (2021)

In the last decade, interventional pulmonology has developed rapidly, and gradually become a mature subspecialty in modern respiratory medicine, playing a more and more important role in the diagnosis and treatment of respiratory diseases. Especially in recent years, with the development of the related technology, various new technologies of interventional pulmonology came out and are gradually applied to chronic respiratory diseases which were mainly treated with drugs before, greatly expanding the application field of interventional pulmonology. Here, we reviewed the new progress and up-to-date research achievements of interventional pulmonology from 2020 to 2021.

Efficacy and safety of EBUS-TBNA under conscious sedation with meperidine and midazolam.

BackgroundAccording to the guidelines, endobronchial ultrasound guided transbronchial needle aspiration (EBUS‐TBNA) is the technique of choice for the diagnosis of mediastinal involvement in lung cancer; it is also useful for other mediastinal malignancies and benign pathology. Nevertheless, there is still discussion about whether to perform it under general anesthesia or under conscious sedation.MethodsWe retrospectively analyzed the data of all patients who underwent EBUS‐TBNA under conscious sedation with up to 1 mg/kg of meperidine and up to 0.15 mg/kg of midazolam in the Interventional Pulmonology Unit of the Azienda USL‐IRCCS Santa Maria Nuova of Reggio Emilia during 2 consecutive years. Demographic data, indication for the procedure, duration, number of lymph node sampled, number of passes per station, diagnostic yield, drugs dosage, questionnaire score, and complications were collected.ResultsA total of 302 patients underwent EBUS‐TBNA, and 68% of the patients were males and the mean age was 65 ± 13 years old. The average duration of procedures was 24.4 minutes and the mean dosage of drugs was 4.32 ± 1.52 mg for midazolam and 50.86 ± 13.71 mg for meperidine. The mean number of lymph nodes sampled per patient was 1.75 ± 0.82, and each patient received an average of 4.71 ± 1.78 passes. A total of 90.7% of patients completed the procedures, 85% had adequate samples, and 94.4% of patients declared with Likert's questionnaire that they strongly agree to repeat the test if necessary.ConclusionEBUS‐TBNA performed under conscious sedation with meperidine and midazolam is feasible and well‐tolerated and has a similar diagnostic yield of that reported in literature.