Rigid Bronchoscopy Research Articles

A Survey of Rigid Bronchoscopy Practices in India.

A Survey of Rigid Bronchoscopy Practices in India.

Flexible bronchoscopy-assisted removal of aspirated scarf pins from the tracheobronchial tree: the experience of 146 subjects.

Aspiration of scarf pins is a common problem in specific geographical locations where the Muslim population is high, especially in countries like Egypt, Bangladesh, Middle Eastern countries, and certain regions in India. This condition is also referred to as hijab-pin syndrome. We discuss the largest experience of flexible bronchoscopic extraction of aspirated scarf pins from the tracheobronchial tree. A multicenter retrospective observational study was conducted on 146 patients from 4 different centers in Egypt, Bangladesh, India, and Germany. Flexible bronchoscopy was successful in the extraction of aspirated scarf pins in all 146/146 patients with a 100% success rate. 136/146 (93.15%) patients were females, with the most common age group between 12 and 18 years (34.24%). 132/146 (90.4%) remembered the aspiration event before coming to the hospital. Cough was the predominant presenting symptom. (71.22%). In all 146 cases, the foreign body was identified on a standard chest X-ray. The left main bronchus was the most common site of aspiration, 67/146 (45.89%), followed by the right main bronchus, 56/146 (38.35%). 14 patients (9.58%) had a history of unsuccessful attempts to remove by rigid bronchoscopy, and flexible bronchoscopy was successful in these 14 (100%) patients who had a prior unsuccessful attempt to remove. The current series is the largest in literature and demonstrated an excellent success rate in the removal of the aspirated scarf pin.

Y Reverse: Modified technique in challenging airway management.

Self-expanding Y-metal stents (SEMS) are best suited lesions with involvement of the carina and proximal main bronchi; however, Y-stents can be difficult to place. These difficulties guided us to develop a modification of the classic technique that addresses some of the challenges during positioning. We present the Y reverse technique for Y stent insertion using a combination of rigid and flexible bronchoscopy. This retrospective study included 15 consecutive patients, suffering from tracheal-carina-lower main bronchi complex, hospitalized at the Thoracic Surgery Unit of the Vanvitelli University of Naples between October 2021 and October 2023. patients in which the length of the stenosis of the right bronchi was greater than that of the left bronchi, advanced oncological conditions, severe respiratory failure; exclusion criteria: Karnofsky scale with <40 points. All patients were admitted to the hospital and treated with Y-stent insertion using the modified technique Y reverse. The comparison between the group undergoing the Y reverse technique with the group undergoing the traditional positioning of the Y prosthesis has shown an improvement in respiratory function; prolongation of the mean survival time; improvement in SpO2 in spontaneous breathing; reduction mean time procedure. p < 0.05 was considered as statistically significant. Y Reverse is a safe and effective procedure that provides rapid symptom relief in individuals who have critical central airway obstruction near the distal portion of the trachea, carina, and main right and left bronchi.

Transcutaneous carbon dioxide monitoring in children undergoing rigid bronchoscopy: a prospective blinded observational study.

Anesthetic management during rigid bronchoscopy in children can be challenging, and continuous end-tidal carbon dioxide (EtCO2) monitoring is often unachievable. Transcutaneous carbon dioxide (TcCO2) monitoring is strongly correlated with the partial pressure of carbon dioxide (PaCO2) and EtCO2. We aimed to investigate the incidence of hypercapnia in children undergoing rigid bronchoscopy. We enrolled patients aged < 18yr scheduled for rigid bronchoscopy in a prospective observational study. We recorded TcCO2 values from anesthesia induction to the postanesthesia care unit (PACU) stay. We ended monitoring when TcCO2 reached values ≤ 50mm Hg. The operating room (OR) team was blinded to the TcCO2. The outcome of primary interest was the incidence of hypercapnia (TcCO2 > 50mm Hg) in the OR. Other outcomes were the incidences of hypercapnia in the PACU and severe hypercapnia (TcCO2 > 90mm Hg), factors possibly related to hypercapnia (patient, surgery, or anesthesia factors), and the incidence of perioperative adverse events. A total of 30 patients were enrolled. The median [interquartile range (IQR)] age was 3.5 [1.5-8.0] yr. The incidence of hypercapnia was 100% in the OR and 60% in the PACU. Five cases (17%) presented with severe hypercapnia in the OR. The highest median [IQR] TcCO2 was 69 [61-79] mm Hg. The most common adverse event was oxygen desaturation (57%, 17/30). Patients with severe hypercapnia had long stays in the PACU. Hypercapnia was a frequent event in children undergoing rigid bronchoscopy and severe hypercapnia was associated with a long PACU stay. Further studies are needed to assess the utility of TcCO2 monitoring in guiding ventilatory interventions during these cases.

Anesthesia for Posterior Tracheopexy in Pediatric Patients.

Tracheobronchomalacia refers to an abnormally excessive collapse of the trachea and/or bronchi during exhalation. In the pediatric population, tracheobronchomalacia is increasingly recognized as a cause of morbidity and mortality. Historically, options for medical management and surgical intervention were limited, and patient outcomes were poor. Over the last decade, select US pediatric institutions have devoted significant resources to the establishment of dedicated surgery and anesthesia teams and the development of novel techniques for the successful identification, assessment, and surgical correction of tracheobronchomalacia in a highly complex subset of the pediatric population. The close communication, collaboration, and evolution of anesthesia techniques to meet the unique requirements of new surgical procedures have greatly improved patient safety and optimized outcomes. More than 800 cases have been performed across 2 US pediatric institutions using these techniques. This article reviews the posterior tracheopexy procedure, a newer but increasingly common surgery designed to address tracheobronchomalacia, and provides an overview of related anesthesia considerations and unique challenges. In addition, this article describes novel anesthesia techniques developed specifically to facilitate optimal diagnosis of tracheobronchomalacia and intraoperative management of posterior tracheopexy and similar airway surgeries. These include methods to safely enable 3-phase rigid dynamic bronchoscopy for accurate tracheobronchomalacia diagnosis, recurrent laryngeal nerve monitoring during cervical and thoracic surgical dissection, continuous intraoperative bronchoscopy to enable real-time images during airway reconstruction, and intraoperative assessment of airway repair adequacy to ensure successful correction of tracheobronchomalacia.

Endoscopic Removal of Uncovered Metallic Airway Stents.

Self-expandable uncovered metallic stents (SEUMS) have been used in benign tracheobronchial stenosis. Stent complications may require risky removal due to SEUMS integration in the tracheobronchial wall. Our study aims to report techniques, including a novel one, and outcomes of SEUMS removal by rigid bronchoscopy. We studied a case series of 7 patients from a tertiary medical center, who underwent SEUMS removal from 2017 to 2022. SEUMS removals were performed through rigid bronchoscopy. We used a new technique with bronchoscopic hook scissors to gradually dissect the stent from the airway wall. Nine SEUMS were removed from 7 patients. The mean duration of stenting was 7 years (5 to 12y). Indications for stent removal included mostly recurrent pulmonary infections, obstructive granulation tissue, and stents' fractures. We used the usually described technique in the literature known as the "piecemeal fashion" without dissection in 4 SEUMS removals and a new dissection technique in 5 procedures. We reported one major intraoperative complication using the former technique in the form of tracheal tear with mediastinal breach, while we did not experience any major complications with the later one. One patient died 8 days after surgery from respiratory failure. Dissection and "piecemeal fashion techniques" can be used to remove SEUMS by rigid bronchoscopy even after long-term stenting. SEUMS removal is a very risky procedure and must be performed by a trained operator. Patients should be aware of possible severe complications.

A novel case of simultaneous tracheal stenting and endobronchial valve (EBV) deployment for tracheal stenosis and persistent air leak guided by an endobronchial collateral ventilation assessment system and digital chest drain in malignant esophageal carcinoma.

Persistent air leak may complicate malignant disease of the thorax, causing significant morbidity and mortality. A 51-year-old male with a 30-pack-year history of smoking was diagnosed with metastatic esophageal carcinoma with invasion into the right upper lobe of the lung. He developed a large right hydropneumothorax complicated by empyema leading to persistent air leak despite the insertion of two chest drains. Computed Tomography imaging with 3-dimensional reconstruction showed severe tracheal compression from the enlarging esophageal tumour as well as bronchopleural fistulas in the right upper lobe. Rigid bronchoscopy with metallic tracheal stenting was performed. This was followed by localization and quantification of air leak with an endobronchial collateral ventilation assessment system and a digital chest drain to guide endobronchial valve placement, in a single operative procedure. This novel combination of interventional bronchoscopy techniques enabled successful transition to an ambulatory chest drain and subsequent hospital discharge.

An Investigation of the Pediatric Rigid Bronchoscopy Complication with three Different Anesthesia Regimes

Background: Foreign body aspiration is common in children and poses a significant risk of morbidity and mortality. Rigid bronchoscopy is the most common method for removing aspirated foreign bodies. Objectives: Anesthesiologists play a critical role in managing these procedures, aiming to find the best strategies with the fewest complications. This study aims to compare anesthesia-related complications during rigid bronchoscopy in children using muscle relaxants versus no muscle relaxants. Methods: In this clinical trial, 60 eligible children were randomly divided into three equal groups: SP: Spontaneous ventilation with sevoflurane and propofol; VA: Controlled ventilation with sevoflurane and atracurium; VR: Controlled ventilation with sevoflurane and rocuronium. At the end of anesthesia, complications such as cough, bucking, hypoxemia, laryngospasm, and bronchospasm were compared, along with the pulmonologist’s level of satisfaction, surgery duration, and total anesthesia time in the three groups. Results: The comparison between the SP, VR, and VA groups revealed the following: No significant difference was found in the incidence of cough and respiratory distress following foreign body aspiration among the three groups (P = 0.262 and P = 0.762, respectively); minimum oxygen saturation during rigid bronchoscopy differed significantly between the groups (P = 0.013); bucking during bronchoscopy was significantly more frequent in the SP group (P = 0.017); laryngospasm was significantly more common in the SP group compared to the other two groups (P = 0.004); agitation during recovery was significantly lower in the propofol (SP) group; pulmonologist satisfaction was highest in the VR group, followed by the VA group, with a significant difference compared to the SP group (P = 0.021); although the SP group experienced more frequent hypoxemia, the difference was not statistically significant; there was no significant difference in anesthesia or bronchoscopy duration across the three groups. Conclusions: The study results suggest that using muscle relaxants in rigid bronchoscopy offers several advantages, including fewer intraoperative complications such as bucking and laryngospasm. Additionally, controlled ventilation reduced the need for intravenous anesthetics and opioids, minimizing adverse effects and shortening recovery times.

Flexible versus Rigid Bronchoscopy for Tracheobronchial Foreign Body Removal in Children: A Comparative Systematic Review and Meta-Analysis.

The removal of foreign bodies (FBs) from the airways of children is a critical procedure that can avert serious complications. While both flexible and rigid bronchoscopy techniques are employed for this purpose, their comparative efficacy and safety remain subjects of debate. Therefore, we conducted this investigation to compare between both procedures. Studies comparing flexible to rigid bronchoscopy (n = 14) were identified by searching PubMed, Scopus, Web of Science, Cochrane Library, and Google Scholar. We performed comparative meta-analyses of reported presentation characteristics and clinical outcomes, using fixed- and random-effects models. A diverse range of FB types and locations were identified. No difference was observed in the success rate of FB removal between flexible and rigid bronchoscopy (logOR = 0.27; 95%CI: -1.91:2.45). The rate of negative first bronchoscopy was higher in the flexible compared to the rigid group (logOR = 2.68; 95%CI: 1.68:3.67). Conversion rates to the alternative method were higher in the flexible bronchoscopy group. The overall complication rates were similar between both methods; however, the risk of desaturation was significantly lower with flexible bronchoscopy (logOR = -2.22; 95%CI: -3.36:-1.08). Flexible bronchoscopy was associated with a shorter length of hospital stay. The choice of bronchoscopy technique should be tailored to individual case characteristics.

Lord of the (Magnetic) Rings: Rigid Bronchoscopy for Aspirated Magnetic Foreign Bodies in Tertiary Bronchi

ObjectivesTo describe operative techniques using rigid bronchoscopy and ferromagnetic bronchoscopic equipment to retrieve magnetic foreign bodies in distal tertiary bronchi beyond the reach of traditional optical instrumentation.MethodsA 13‐year‐old presented to the Emergency Department following aspiration of three backing magnets from a magnetic nose ring. Chest radiographs demonstrated a 4 mm × 3 mm foreign body in the right lower lobe 0.5 cm from diaphragm on expiratory film. She was taken to the operating room for removal of an airway foreign body.ResultsThe foreign body was visualized with direct laryngoscopy followed by rigid bronchoscopy in the distal right lower tertiary bronchus. Attempts to pass optical instruments were limited both by distance of the object and size of instrumentation compared to the diameter of the tertiary bronchus. A salivary wire basket and ureteral stone retrieval basket were then passed with endoscopic visualization into the tertiary bronchus but were unable to engage the foreign body. An attempt was made to pass a 2 French Fogarty embolectomy catheter distally, but the catheter was too large to bypass the foreign body. Finally, ferromagnetic pulmonary rat tooth biopsy forceps were advanced into the tertiary bronchus and successfully attracted the magnetic foreign body for safe removal through our rigid bronchoscope.ConclusionWe present a novel method of utilizing ferromagnetic flexible bronchoscopic instruments to safely remove magnetic foreign bodies in the tertiary bronchi beyond the reach of traditional bronchoscopic instruments. Laryngoscope, 2024

Bispectral index monitoring: Optimizing anesthesia in rigid bronchoscopy.

This study investigates the application of bispectral index (BIS) monitoring in rigid bronchoscopy to enhance anesthetic delivery and patient outcomes, a topic that remains underexplored. A retrospective analysis of 155 patients undergoing elective rigid bronchoscopy under general anesthesia was conducted. Patients were divided into BIS-monitored and conventional anesthesia groups. Inclusion criteria were adults aged over 18 years with American Society of Anesthesiologists (ASA) physical status I-IV. No significant demographic differences were found between the groups. The BIS group showed significant reductions in propofol usage (231.40 ± 74.63 mg vs. 190.19 ± 91.83 mg, p= 0.003) and prednol dosage (94.27 ± 42.56 mg vs. 79.71 ± 18.97 mg, p= 0.020). Remifentanil administration approached statistical significance (56.99 ± 34.69 mcg vs. 45.36 ± 36.75 mcg, p= 0.055). No significant demographic differences were found between the groups. The BIS group showed significant reductions in propofol usage (231.40 ± 74.63 mg vs. 190.19 ± 91.83 mg, p= 0.003) and prednol dosage (94.27 ± 42.56 mg vs. 79.71 ± 18.97 mg, p= 0.020). Remifentanil administration approached statistical significance (56.99 ± 34.69 mcg vs. 45.36 ± 36.75 mcg, p= 0.055).

Determinants of positive rigid bronchoscopy for suspected organic foreign body aspiration in children younger than five years.

Rigid bronchoscopy is widely used for diagnosis and treatment of foreign body aspiration (FBA) in children, but negative results can be reported, especially with radiolucent organic FBA. This study aimed to evaluate the clinical features and pre-procedure predictors of organic FBA in children under 5years of age. Children aged less than 5years old who underwent rigid bronchoscopy for suspected organic FBA were retrospectively evaluated for demographics, history of aspiration, relevant clinical symptoms and signs, radiological findings, in addition to type and location of foreign body (FB). To determine the predictors of positive FBA, stepwise backward logistic regression was applied. A total of 228 children were included (69.7% boys). The mean age was 1.98 ± 1.07years. Foreign bodies were found in 202 cases (88.59%). Age ≤ 3years and history of witnessed choking had the highest sensitivity while diminished breath sounds had the highest specificity for diagnosing FBA. In multivariate analysis, witnessed choking, wheezy chest, diminished breath sounds, and respiratory distress were independently associated with increased risk of FBA. Children under 5years of age with suspected organic FBA have varied clinical and radiological findings. The history of choking, wheezy chest, diminished air entry, or respiratory distress increases the chance of positive rigid bronchoscopy in this age group.

The safety and effectiveness of the treatment of refractory post-intubation subglottic stenosis using short bronchial Dumon stent: a pilot study.

Post-intubation subglottic stenosis (PI-SGS) is a fatal disease which could result in partial or complete narrowing of the airway. Although airway stenting is commonly used as an alternative treatment for PI-SGS patients unsuitable for surgery, complications including stent migration and excessive granulation tissue formation are frequently encountered. Additionally, tracheotomy is necessary in patients undergoing T-tube placement. Therefore, it is necessary to further enhance the effectiveness of airway stenting in refractory PI-SGS. In this study, we aimed to evaluate the safety and effectiveness of utilizing short bronchial Dumon (BD) stents in managing refractory PI-SGS. PI-SGS patients who were not suitable for surgery and in whom previous interventional treatments had proven ineffective were enrolled. Short BD stents were inserted via rigid bronchoscopy under general anesthesia. Complications and outcomes were assessed by follow-ups. Fourteen patients were included and successful stent insertion was achieved in all cases. The median diameter and length of stents was 12 (0.25) and 33.5 (5) mm, respectively. During the 6-month follow-up period, complications were reported in five patients. Granulation tissue formation was the most frequently observed complication (4 in 14 patients, 28.57%), followed by stent migration (2 in 14 patients, 14.29%). Out of the total participants, 11 patients (78.57%) demonstrated good tolerance to the stent, while 3 (21.43%) required stent removal. Among these three patients, two finally underwent subsequent T-tube insertion after the removal. Twelve patients (85.71%) avoided the tracheotomy and T-tube insertion. The utilization of short BD stents appears to be a safe and effective approach for managing refractory PI-SGS. The complications and tolerability are acceptable.

Anesthesia for an infant with congenital mediastinal mass: a case report

BackgroundGiant anterior mediastinal masses in infants are one of the most challenging cases faced in pediatric anesthesia practice. They can pose unique challenges for resection such as cardiovascular collapse on induction of anesthesia and injury to surrounding structures that maybe compressed or displaced. Principles that must be followed and kept in mind during removal of giant mediastinal mass include appropriate diagnostic imaging to define mass extent, airway control during induction, a multidisciplinary team approach including cardiothoracic for sternotomy, cannulation to institute cardiopulmonary bypass, otolaryngology for rigid bronchoscopy, preservation of neurovascular structure, and complete resection whenever possible. Our patient had a mass that weighed twice his whole body weight.Case presentationHere we present a 3-month-old Middle Eastern infant weighing 3.2 kg with a large congenital teratoma who presented to the emergency room with cyanosis and respiratory distress. During his hospital course, he underwent three procedures, two of them under light-to-moderate sedation: a diagnostic computer tomography scan followed by mass content drainage by interventional radiology (Figs. 1, 2). On the third day, he had a thoracotomy with complete tumor resection under general anesthesia with the help of an epidural for pain control (Fig. 3). The resected tumor weighed 2.5 kg, which was equal to twice the patient’s total body weight (Fig. 4). After the surgery, he was extubated in the operating room and discharged home 3 days later.Fig. 1Anterior–posterior chest x-ray showing the anterior mediastinal mass (AMM)Fig. 2Cross-section computed tomography (CT) showing large anterior mediastinal mass (AMM)Fig. 3Gross anatomy of the tumor before resectionFig. 4Gross anatomy of the removed tumorConclusionAnterior mediastinal mass patients can be challenging for the anesthesiologist. They need meticulous thorough perioperative assessment to determine the extent of compression on major intramediastinal structures and to predict the complications. Planning by multidisciplinary team and discussion with the family is important. These types of cases should be preferably operated on by an experienced team in a well-equipped operation room in tertiary care institutes.

Long‐term endotracheal tube foreign object and aspiration pneumonia following general anaesthesia in a dog

AbstractA 7‐year‐old, male, neutered German shepherd dog presented to the emergency room with a 5‐day history of respiratory distress, vomiting and hyporexia after an anaesthetised computed tomography and deep ear flush. The dog presented febrile (104.1°F), tachypnoeic (60 breaths per minute) and in respiratory distress. The dog was hospitalised on intravenous antibiotics and oxygen therapy. Radiographs were obtained 30 hours after presentation, which revealed a remnant of an endotracheal tube within the airway as well as aspiration pneumonia. Removal of the foreign object was successful using a rigid bronchoscope. The dog was discharged with supportive care and antibiotics, and continued to do well 9 months after the iatrogenic foreign body removal. This case report describes the retention of a large piece of an endotracheal tube for the longest period described in literature (6 days).

Percutaneous Tracheostomy Via Grigg's Technique in Children: Does Age and Size Matter?

Percutaneous tracheostomy is rarely performed in children, especially in infants. In the present study, we aimed to evaluate the complications and outcomes of PT via the Griggs technique according to the age and size of pediatric patients. This study included 110 PICU patients who underwent PT using the Griggs technique between 2012 and 2020. The patients were divided into six groups according to their age, demographic data, primary disease, mean duration of intubation before PT, mean duration of PICU and hospitalization after PT, complications, and decannulation outcomes were compared between these groups. The mean age and mean weight of the patients were 43.6 ± 58.9 months (1 month-207 months) and 14.6 ± 14.9 kg (2.6-65 kg), respectively. Mean intubation times before the procedures were 64.6 ± 40 days and 38.6 ± 37.9. Thirty-seven (33.6%) infants were under 6 months of age(Group 1). There were no intraoperative complications. Tracheostomy site stenosis was significantly greater in Group 1 than in the other age groups (p = 0.032). Granuloma formation and dermatitis incidence were similar in all age groups. PT is a safe and feasible procedure even in small infants. The accidental decannulation risk is lower than standard tracheostomy. Interacting with rigid bronchoscopy guidance is essential to perform a safer procedure. The first tracheostomy change after PT in small infants under 6 months of age, the possibility of tracheostomy site (stoma) stenosis should be considered. Level III Laryngoscope, 2024.

Subcutaneous fixation model for complex stenting of recurrent laryngotracheal stenosis

BackgroundA straight silicone stent can be used to treat proximal benign tracheal stenosis in non-surgical candidates. However, stent migration is a common complication when placed at a particular location and can lead to major complications. This case series of laryngotracheal stenosis reports a fixation method for straight silicone stents in the subglottic trachea (Stage 3 of the McCaffrey classification).MethodsThe medical charts of these patients scheduled for straight silicone stent placement with suture fixation between 2014 and 2020 at the CHU UCL Namur Hospital (Belgium) were retrospectively reviewed. The procedure was performed using a rigid bronchoscope. Details of the procedure were obtained from medical records.ResultsThis case series included six patients (males: 4, females: 2). The median patient age was 59 years. Two suture fixations were placed following previous silicone stent migration episodes, whereas the others were placed proactively to avoid this risk. All fixations were performed by the device Freka® Pexact II ENFIt®, originally developed for gastropexy in endoscopic gastrostomy. The sutures were subcutaneously buried.ConclusionsDuring the 6-month follow-up period, complications such as fixation issues and stent migration were reported despite the off-label use of the treatment. The straight silicone stent fixation technique used in this case series was simple and effective for securing the stent in upper benign tracheal stenosis.

Type and morphology affect the success rate of bronchoscopy for postintubation tracheal stenosis.

With advancements in respiratory interventional techniques, bronchoscopic intervention technology has emerged as a viable approach for managing postintubation tracheal stenosis (PITS). However, there was a paucity of research investigating the potential impact of stenosis characteristics and morphology (such as stenosis degree, length, type, and morphology) on bronchoscopic intervention treatment prognosis for PITS patients. This study was to assess the impact of various preoperative stenosis characteristic factors on the bronchoscopic cure rate among patients. This is a retrospective study analyzing the medical records of patients with PITS who received bronchoscopic intervention at the tertiary interventional pulmonology center. Among the cases, 115 individuals achieved a in a success rate of 79.86% for bronchoscopic intervention therapy and were assigned to Group S. On the other hand, 29 cases required surgical intervention, accounting for a surgical treatment rate of 20.14% and were assigned to Group F. The stenosis in the Group F predominantly exhibited irregular shapes with scar granulation accompanied by tracheal chondromalacia collapse. Patients in group S experienced fewer total procedures, rigid bronchoscopy treatment, intraoperative hypoxemia, needed emergency re-bronchoscopy in 24 h and transferred to ICU postoperatively. Patients with pure scar and granuloma, the rate of bronchoscopic success cure was higher than patients with scar granulation accompanied by tracheal chondromalacia (odds ratio: 8.208; 95% confidence interval: 2.755-24.459), and regular stenosis morphology was associated with a higher bronchoscopic success cure rate (odds ratio: 9.463; 95% confidence interval: 3.128-28.623). Irregular airway stenosis, chondromalacia or airway collapse are key factors affecting the success rate of bronchoscopic treatment for post-intubation tracheal stenosis. Level of evidence: 4 (historically controlled studies).

Airway exploration when suspected foreign body aspiration. Is it always indicated?

BackgroundForeign body aspiration (FBA) is an important cause of morbidity and mortality in pediatrics. Flexible or rigid bronchoscopy is the gold standard for its diagnosis and treatment. However, despite being a minimally invasive test, it is not without risk and, given the low specificity of symptoms involved, between 45 and 70 % of diagnostic bronchoscopies (DB) performed are normal. The aim of this paper is to develop a strategy in order to reduce this percentage. MethodsObservational, analytical, and retrospective study of DB performed for suspected FBA between 2018 and 2022. Demographic, clinical, and radiological data, bronchoscopy findings and complications were obtained. Results96 patients admitted to DB were analyzed. 72 out of 96 (75 %) were normal. The risk of presenting a foreign body was significantly higher in patients with suspected nuts, so DB should be always indicated. In patients with suspected other materials aspiration, a multivariate analysis was performed using logistic regression. Statistically significant association was found between dyspnea, asymmetric auscultation and abnormal chest radiography with the presence of a foreign body on the DB; AUC = 0.97 (95 % CI 92.4 %-100 %). The proposed algorithm establishes patients at high risk of FBA and therefore the DB is recommended, with a sensitivity of 100 % and a specificity of 87.2 %. ConclusionsThe application of the algorithm to patients with suspected aspiration of a foreign body other than nuts can facilitate the identification of patients with high risk of aspiration and reduce the percentage of negative DB.

A novel technique for conducting flexible bronchoscopy cryobiopsy under conscious sedation: An observational study.

Transbronchial lung cryobiopsy (TBCB) is a reliable method for obtaining histopathological findings in interstitial lung diseases. TBCB is traditionally performed during rigid bronchoscopy, positioning an endobronchial balloon blocker to facilitate bleeding management. Therefore, it can be challenging to implement in Centers without access to anesthesiologic support or dedicated beds for endoscopic procedures. We present a series of 11 patients who underwent 12 TBCBs using a flexible bronchoscope and a 5 Fr endobronchial blocker passing through an uncuffed endotracheal tube, under moderate sedation and spontaneous breathing. All procedures were carried out in an endoscopy suite, using fluoroscopy guidance but without requiring anesthesiologic assistance. TBCB was feasible in all cases, and it demonstrated similar or improved diagnostic yield (90.1%) and safety compared to rigid bronchoscopy. In 1 case, it was successfully repeated due to an inconclusive histological definition at the first attempt. The size of the samples was consistent with the literature, as it was the incidence of pneumothorax (16.6%). Four cases of moderate bleeding and 4 cases of severe bleeding were managed without further complications. To our knowledge, this is the first description of a technique allowing to perform TBCB through an artificial airway without need for either rigid bronchoscopy or general anesthesia. We believe this technique could make TBCB faster, cost-effective, and feasible even in resource-limited settings without compromising on safety. However, further studies are needed to validate these findings.