Number Of Bronchoscopies Research Articles

Flexible and Rigid Bronchoscopy for Critically Ill Children on Extracorporeal Membrane Oxygenation.

We aim to describe our experience with bronchoscopy to diagnose and relieve tracheobronchial obstruction in anticipation of decannulation in children on extracorporeal membrane oxygenation (ECMO) support. A retrospective cohort study of children on ECMO between 1/2018 and 12/2022. A total of 107 children required ECMO support during the study period for cardiac (n = 48, 45%), pulmonary (n = 38, 36%), or cardiopulmonary dysfunction (n = 21, 20%). Thirty-seven (35%) patients underwent 99 bronchoscopies while on ECMO. Most (76%, n = 75) experienced no improvement or worsening of chest radiography 24 hours following bronchoscopy. Clinical improvement in tidal volumes 48 hours after the first bronchoscopy was noted in 13/25 patients with available data (p = 0.05). Adverse events were seen in 18 (49%) patients who underwent bronchoscopy, including pneumothorax (n = 8, 22%), pneumonia (n = 7, 19%), pulmonary hemorrhage (n = 6, 16%), and sepsis (n = 5, 14%). ECMO courses were longer (25.4 ± 37.2 vs 6.1 ± 8.8 days, p < 0.0001) and more likely to be complicated by pneumonia (p = 0.0004) and sepsis (p = 0.047) in patients who underwent bronchoscopy compared with those who did not. Adverse events following bronchoscopy were associated with the number of bronchoscopies (p = 0.0003) and the presence of obstructive materials but not with the type of bronchoscopy or indication for ECMO. Mortality rates were similar between patients who underwent bronchoscopy and those who did not. Children requiring bronchoscopy represent a subset of the sickest children on ECMO. Bronchoscopy may provide benefit in children with persistent cardiopulmonary failure who could not otherwise be decannulated. Adverse events are associated with the number of bronchoscopies and the presence of obstructive material. 4 Laryngoscope, 134:4134-4140, 2024.

A foreign body complicated by tracheal perforation in the esophagus of a two-year-old child (clinical observation)

Foreign bodies in the gastrointestinal tract remain one of the significant problems in pediatric practice. Ingestion of foreign bodies is typical for children of all ages, but especially for the first 5 years of life. Due to the anatomical features of children, foreign bodies are often located at the level of the first physiological narrowing – in 68% of cases. The mortality rate from foreign bodies is 1%, but with the development of severe complications, this figure increases to 45%. A disc-shaped battery is the most dangerous one for health, as it is capable of causing local infiltrative-necrotic changes, perforation of the esophagus. Disc-shaped batteries as FB (foreign body) form up to 10% of the total number of foreign bodies of the gastrointestinal tract in children. Unfortunately, parents do not immediately seek medical help, since the symptoms indicating the presence of FB are often absent or may manifest as non-specific symptoms. Endoscopic examination serves as a key method in the diagnosis of ingested FB among children and its removal less than 24 hours after ingestion, since any delay reduces the probability of successful intraluminal extraction. This article discusses the clinical observation of a prolonged presence of a foreign body in the esophagus of a toddler child. The clinical course manifested itself in the form of nonspecific symptoms, a foreign body was detected only after a number of studies and was removed by endoscopic method. During the examination of the patient, in addition to the chest X-ray, esophagogastroduodenoscopy and a number of bronchoscopies were performed. Accessible and highly informative methods of instrumental diagnostics available in each clinic of the regional scale, today remain the first stage of the diagnosis of foreign bodies.

Impact of the COVID-19 pandemic on lung cancer diagnosis in the region of Marrakech-Safi, Morocco

Background: The dreadful consequences of the COVID-19 pandemic put an unprecedented pressure on health-care services in Morocco. Lung cancer (LC) patients represent a vulnerable population highly affected by the pandemic. Studies on lung cancer diagnosis during an epidemic are lacking. We analyzed the impact of COVID-19 on lung cancer diagnosis in the region of Marrakech-Safi where lung cancer incidence continues to rise. Materials and Methods: We compared the clinical features of newly diagnosed lung cancer cases in the Mohammed VI University Hospital Center between March and December 2020 with lung cancer cases diagnosed during the same period in the past 3 years and the year after. Results: A total of 352 patients were diagnosed with lung cancer from March through December, 2017–2021. During the pandemic, the number of lung cancer hospitalization dropped by 36% from the previous years, moreover the number of bronchoscopies and other biopsies performed decreased significantly in 2020 (p &lt; 0.000).Lung cancer patients in Group2 had a significant longer pre-hospital delay with a mean of 7, 02±2,06 months and higher performance status score 3-4 (64,6%) compared to the other Groups 1,3 (p &lt; 0.000).In the second and third groups more lung cancer patients seems to be exposed to second-hand smoke comparing to the first group with (27,4%) in 2017-2019 vs (52,1%) and (69,2%) in 2020 and 2021 respectively(p &lt; 0.000). However no differences concerning tumor staging has been described between the 3 groups with most patients being classified as stage IVA-IVB through all the years (2017-2019: 73,9% vs. 2020: 85,4% vs 2021: 80,8%, p=0,151). Conclusion: The COVID-19 pandemic was responsible of a significant decrease in newly diagnosed LC cases with less bronchoscopies and biopsies being performed. No significant difference has been noted regarding tumor staging but LC patients seemed to have higher performance status score in 2020.

Impact of the COVID-19 pandemic on the trajectory of the number of bronchoscopies performed in a tertiary hospital in Kyoto city.

The coronavirus disease 2019 (COVID-19) pandemic has restricted many medical practices. We aimed to investigate the impact of the COVID-19 pandemic on the number of bronchoscopies, outpatients, and hospital admissions. We retrospectively analyzed the number of outpatients, admissions, and bronchoscopies performed between March 2020 and May 2022. We defined "Peak month of the pandemic," "Wave of the pandemic," "Month in the wave," and "Period of a state of emergency" for each analysis. In the first year of the COVID-19 pandemic, analysis of variance (ANOVA) in linear mixed models indicated significant effects of "month in each wave" on the number of bronchoscopies (P = .003), outpatients (P = .041), and admissions (P = .017). The number of outpatients, admissions, and bronchoscopies was significantly influenced by the first wave of the COVID-19 pandemic. In contrast, in the second year of the COVID-19 pandemic, a mixed-ANOVA indicated significant effects of "month in each wave" only on the number of outpatients (P = .020) but no significant effects on the number of bronchoscopies (P = .407) and admissions (P = .219). During the second year of the pandemic, the number of bronchoscopies and admissions was not significantly affected by the waves of the pandemic. There were no significant differences in the number of admissions and bronchoscopies between the fourth and sixth waves. Although the number of bronchoscopies was found to be significantly affected in the early stages of the COVID-19 pandemic, the impact of the pandemic was much more limited thereafter.

Donor substance use and lung transplantation: A single center experience

BackgroundLung transplantation (LT) demand outpaces supply. Consequently, extended criteria for donor selection are used, resulting in LT from donors with a history of substance use (SU). The aim of this study is to assess the association between donor SU and short-term LT outcomes. MethodsWe obtained recipient and donor data for LTs performed between January 2014 to January 2019 from electronic health records and the United Network for Organ Sharing (UNOS) database. We defined SU as cigarette/e-cigarette smoking, illicit SU (cannabis, cocaine, opioids, amphetamines), or heavy alcohol use (2+ alcoholic drinks per day). Our primary outcome was late high-grade primary graft dysfunction (PGD), which we defined as grade 2-3 PGD between 48-72 hours post-LT. Secondary outcomes included mechanical ventilation (MV) hours, intensive care unit (ICU) length of stay (LOS), hospital LOS, number of bronchoscopies, cumulative acute rejection (CAR) score in the first year after LT, and overall survival (OS). ResultsA total of 352 LTs were included in this study. On multivariable regression, we found that any donor cigarette smoking was associated with increased odds of late high grade PGD (p=0.021), while any donor cannabis use was associated with reduced odds of late high grade PGD (p=0.002). There was no association between any donor SU and secondary outcomes. ConclusionsDonor cigarette use was associated with higher risk for PGD. Our findings may suggest a history of donor cannabis use and other illicit SU are not associated with PGD or worse OS.

Comparison of the accuracy of three methods measured the length of the right main stem bronchus by chest computed tomography as a guide to the use of right sided double-lumen tube

BackgroundThe variation of right main stem bronchus leads to the orifice of the right upper lobe bronchus may be obstructed or increase the incidence of malposition intraoperatively when the right sided double-lumen tube is used. Therefore, the aim of this study was to compare the accuracy of three methods measured the length of the right main stem bronchus via chest computed tomography as a guide to the use of right sided double-lumen tube.MethodsIn this study, 168 adult patients undergoing left sided thoracic surgery were included. All these patients were allocated to carina-proximal (C-P) group, carina-distal (C-D) group and carina-carina (C-C) group. The position of endobronchial cuff observed via Fiberoptic bronchoscopy after successful initial placement and after turning the patients to the lateral decubitus position, as well as the incidence of malposition of right sided double-lumen tube intraoperative were recorded to assess the accuracy of three methods in predicting the position of right sided double-lumen tube.ResultsThe distance between the carina to the proximal margin of the right upper lobe orifice, carina to the distal margin of the right upper lobe orifice and carina to the first right interlobar carina of the right upper lobe orifice were 17.2 ± 2.3 mm, 25.4 ± 3.7 mm and 28.5 ± 3.1 mm (P < 0.05). In the C-D group, the number of endobronchial cuffs seen to be herniating out of the carina, the number of bronchoscopies during initial placement and on the lateral position, the number of total malposition intraoperative and the number of reposition manoeuvres intraoperative were significantly less than the C-P group or the C-C group (P < 0.05).ConclusionsThe length of the right main stem bronchus measured by the carina to distal margin of right upper lobe orifice method was more accurate than the other two methods in guiding the use of right sided double-lumen tube.Trials registrationClinical Trials. gov. no. NCT04127903. Registered at https://register.clinicaltrials.gov on 16/10/2019.

Comparative aspects of respiratory support via laringeal air ducts and endotracheal tube for video-assisted onkothoracic operations

To improve patient 's recovery after video-assisted thoracoscopic lobectomies (VATSL) by laryngeal mask using. This is a comparative analysis of 74 patients underwent VATSL. In 37 patients anaesthesia consisted of sevoflurane and fentanyl, myorelaxant, respiratory support via independent ventilation of either lung. In another 37patient 's anaesthesia protocol included respiratory support performed via laryngeal mask, propofol infusion and epidural analgesia with ropivacaine 0,2% and fentanyl. During the operation in both groups we evaluated hemodynamic, arterial blood gases, leukocytes, glucose and cortisol blood level, time to consciousness restoration (Aldrete-score) and time to discharge from ICU and duration of hospital stay, frequency of complications. Patients with ventilation through laryngeal mask showed a statistically lower stress-reaction, avoided bronchoscopy with BAL and frequency of complications. Duration of inhospital stay in patients with laryngeal mask was 7±1,3 days; in intubated patients was 11±3,2 days. In case of ventilation through the laryngeal mask hyper dynamic state of circulation, glycemia, leukocytes, cortisol blood level and arterial blood pH were lower, whereas Pa CO₂ increase. The number of bronchoscopy with BAL and time to discharge from ICU and from hospital not having risk of postoperative complications --lower.

Aspiration in a specialised weaning unit--an underestimated problem

This retrospective case series shows that 45 % of patients aspirated straight after removal of the tracheal cannula. The present case series includes 82 patients with long-term mechanical ventilation (LTMV) admitted to a specialised weaning unit. Aspiration was proven after patients sipped water coloured with patent blue V. Colour was detected with a bronchoscope after passing through the tracheostoma and directed toward the VC. The aspiration rate in this study is in good agreement with other reports in the literature.We could find no significant statistical differences concerning age (p = 0.97), gender (47 % vs. 49), number of bronchoscopies (p = 0.91) and comorbidities (p = 0.326) between patients with and without aspiration. The duration of the stay at the ward and the duration of ventilation as well as the parameter Hb at the time of admission (p = 0.566), CO2(p = 0.288/p = 0.716), HCO3 (p = 0.915/p = 0.612) and CRP (p = 0.402/p = 0.523) at the time of admission and discharge also showed no significant differences.The Kaplan Meier curves show a considerable divergence between patients with and without aspiration. However, the Log Rank Test (p = 0.348) and the univariate Cox Regression (HR 1.4, 95 % CI 0.689 - 2.849) were not significant. We believe that this can be attributed to the event rate, which was too low in our collective. This trend to a higher mortality of patients with aspiration might be due to weakness of the respiratory muscles when there is reduced coughing. Proof of aspiration in these patients is only one aspect of a multidimensional problem. Larger, prospective cohort studies are needed to show whether aspiration can serve as a prognostic marker.

Early Endoscopic Dilation and Mitomycin Application in the Treatment of Acquired Tracheal Stenosis

Acquired airway stenosis is a common complication in children after periods of tracheal intubation. We reviewed our experience in the endoscopic treatment of these lesions. We performed a retrospective review of patients who presented acquired tracheal-subglottic stenosis (SGS) treated at our center from 2005 to 2012. We reviewed the etiology, age, clinical presentation, methods of diagnosis, number of bronchoscopies, angioplasty balloon dilations performed, and long-term results. A total of 18 patients (13 M, 5 F) were treated at our institution between 2005 and 2012. Median age at treatment was 3.5 months (range, 1-96 months). Of the 18 children, 16 children had SGS (all cases were postintubation), and 2 children presented tracheal stenosis (1 postintubation, 1 after tracheal surgery). Median intubation time was 30 days (range, 3-120 days). Extubation failure and stridor were the main clinical features. SGS were diagnosed as grade I in three patients, grade II in nine patients, and grade III in six patients. Bronchoscopy allowed diagnostic in all cases, and was followed by angioplasty balloon dilation, with a median of 2.5 (range, 1-5) sessions. In SGS grade I, the relation patient/number of dilations was 1; in SGS grade II 2.6, and in SGS grade III 3.5. Mitomycin was applied in 15 patients. No patients presented intraoperative complications or required reoperation. Median follow-up time was 36 months (range, 5-72 months) and no recurrence was noticed. Early endoscopic dilation with balloon shows as an effective and safe treatment in acquired tracheal and SGS.

A Feasibility and Efficacy Study on Bronchoscopy With a Virtual Navigation System

The purpose of this study was to evaluate the diagnostic accuracy of bronchoscopy with virtual bronchoscopy (VB) navigation. Forty-two consecutive patients with ≤30-mm diameter peripheral pulmonary shadows or lesions that were difficult or impossible to identify on plain x-rays regardless of size were selected. Before bronchoscopy, multidetector computed tomography was performed, and VB images were created. Then, ultrathin bronchoscopy was carried out with VB navigation followed by conventional 4-mm diameter bronchoscopy. Thirty-seven patients were finally enrolled. There were 12 re-examination cases in which earlier conventional bronchoscopy was nondiagnostic. Diagnosis was established in 28 patients (25 malignant and 3 benign lesions), with the diagnostic yield of 75.7% (sensitivity 86.2%, specificity 62.5%, positive predictive value 89.3%, negative predictive value 55.6%, and accuracy 81.1%). The diagnostic yield for lesions of diameter ≤20 mm, 21 to 30 mm, and ≥31 mm were 76.9%, 76.5%, and 71.4%, respectively, for all patients, and 90%, 84.6%, and 83.3%, respectively, for malignant cases. The diagnostic yield in patients who underwent re-examinations was 83.3% for all cases and 88.9% for malignant cases. Three patients had completely invisible shadows on x-ray fluoroscopy and all of these cases were diagnosed on bronchoscopy. No statistically significant difference was observed between the diagnostic yield for the different sizes, pathology, and number of bronchoscopies required. Bronchoscopy with VB navigation yielded high accuracy even for small peripheral pulmonary nodules and shadows that were difficult or impossible to identify on plain x-rays, even for patients in whom earlier conventional bronchoscopy was nondiagnostic.

Endobronchial Ultrasound in the Evaluation of Lung Cancer: A Practical Review and Cost Analysis for the Practicing Pulmonologist

Flexible bronchoscopy remains an important tool in the staging, diagnosis, and treatment of primary and metastatic lung malignancies. Endobronchial ultrasound is a new technology utilized with bronchoscopy that has been shown to identify bronchial wall invasion by malignant tumors, aid in the fine needle aspiration of peripheral lung lesions and mediastinal/hilar lymph nodes, and determine the course of treatment in patients with pulmonary carcinoma in situ. The decision to invest both time and money in this technology is determined by several factors such as the cost of the equipment, reimbursement for the procedure, availability of training, the number of bronchoscopies one performs in a year, and access to endoscopic ultrasound and mediastinoscopy. This article reviews the literature to determine the utility of endobronchial ultrasound in the management of patients with lung cancer and to provide information to practicing pulmonologists that may aid in determining whether and where this technology fits into their clinical armamentarium.

Use of rigid and flexible bronchoscopy among pediatric otolaryngologists.

To explore how rigid and flexible bronchoscopy are used in pediatric otolaryngologic practice. Survey. Members of the American Society of Pediatric Otolaryngology who practice in the United States and Canada and were listed in the membership directory were eligible. Of the 206 members, 24 practicing outside the United States or Canada and 11 without an e-mail address or a fax machine were excluded. Hence, a questionnaire was e-mailed or faxed to 171 pediatric otolaryngologists. Questions concerned the practice setting, type and number of bronchoscopies, indications, complications, and medicolegal cases. Responses were received from 120 subjects (70.2%), with 3 retired and 2 practicing only otology, leaving 115 respondents who completed at least some of the questionnaire. Rigid and flexible bronchoscopy were performed by 72.7% (56/77) of those in academic settings and by 71.1% (27/38) of those in group or solo practices. In the last 12 months, approximately 10 454 total bronchoscopies were performed, with 2052 flexible and 9117 rigid bronchoscopies. Stridor, suspected foreign body inhalation, and laryngomalacia were the most common indications for bronchoscopy. Of the 83 respondents practicing rigid and flexible bronchoscopy, 25 (30.1%) used both instruments to manage complex or repeated foreign bodies, 25 (30.1%) used both to manage patients with cystic fibrosis, and 15 (18.1%) used both to manage simple foreign bodies. Complications were reported by 15.7% of the respondents, the most common being arrhythmia. Familiarity with a case resulting in medicolegal action was reported by 32.2% of the respondents. Rigid and flexible bronchoscopy have multiple uses in pediatric otolaryngologic practice. Also, flexible bronchoscopy appears to be emerging as a more frequently used diagnostic and therapeutic tool.

Comparison of a Modified Double-Lumen Endotracheal Tube with a Single-Lumen Tube with Enclosed Bronchial Blocker

This study compared the modified BronchoCath[R] double-lumen endotracheal tube with the Univent[R] bronchial blocker to determine whether there were objective advantages of one over the other during anesthesia with one-lung ventilation (OLV). Forty patients having either thoracic or esophageal procedures were randomly assigned to one of two groups. Twenty patients received a left-side modified BronchoCath[R] double-lumen tube (DLT), and 20 received a Univent[R] tube with a bronchial blocker. The following were studied: 1) time required to position each tube until satisfactory, placement was achieved; 2) number of times that the fiberoptic bronchoscope was required; 3) frequency of malpositions after initial placement with fiberoptic bronchoscopy; 4) time required until lung collapse; 5) surgical exposure ranked by surgeons blinded to type of tube used; and 6) cost of tubes per case. No differences were found in: 1) time required to position each tube (DLT 6.2 +/- 3.1 versus Univent[R] 5.4 +/- 4.5 min [mean +/- SD]); 2) number of bronchoscopies per patient (DLT median 2, range 1-3 versus Univent[R] median 3, range 2-5); or 3) time to lung collapse (DLT 7.1 +/- 5.4 versus Univent[R] 12.3 +/- 10.5 min). The frequency of malposition was significantly lower for the DLT [5] compared to the Univent[R] [15] (P < 0.003). Blinded evaluations by surgeons indicated that 18/20 DLT provided excellent exposure compared to 15/20 for the Univent[R] group (P = not significant). We conclude that in spite of the greater frequency of malposition seen with the Univent[R], once position was corrected adequate surgical exposure was provided. In the Univent[R] group the incidence of malposition and cost involved were both sufficiently greater that we cannot find cost/efficacy justification for routine use of this device. (Anesth Analg 1996;83:1268-72)