Role Of Fiberoptic Bronchoscopy Research Articles

Role of fiberoptic Bronchoscopy in diagnosis of smear negative pulmonary TB

Role of fiberoptic Bronchoscopy in diagnosis of smear negative pulmonary TB

Role of Fiberoptic Bronchoscopy and Utility of Bronchial Washings and Brushings in the Diagnosis of Lung Diseases

Transbronchial lung biopsy via fiberoptic bronchoscope is an extremely useful technique by which bronchial as well as lung biopsies along with brushings and washings can be easily and safely taken. Fiberoptic bronchoscopy (FOB) was performed and biopsies were done in 250 patients. In addition, bronchial brushings and washings were also taken in 140 and 115 cases, respectively. Adequate material was obtained in 242 cases. The cases were broadly classified into neoplastic and nonneoplastic categories. Malignancies and specific granulomatous diseases, tuberculosis and sarcoidosis were the main diseases diagnosed. Brushings showed a sensitivity of 88.2% and a specificity of 98.9% for the diagnosis of neoplasms. On the other hand, washings had only a 34.9% sensitivity and a 98.6% specificity in diagnosing neoplastic disorders. We concluded that FOB is a safe and effective tool in the diagnostic work-up of suspected malignancies and neoplastic lung diseases.

ROLE OF FIBEROPTIC BRONCHOSCOPY IN SPUTUM NEGATIVE PATIENTS

Background:Tuberculosis continues to be the one of the most common global health problems for more than a century. Fiberoptic bronchoscopy may be very useful in diagnosing cases who have no sputum or whose sputum smear is negative for Acid-Fast bacilli. The current study aims to assess the role of fiberoptic bronchoscopy in sputum smear negative under NTEP and radiologically suspected cases of pulmonary tuberculosis. Methods:This study was conducted in our institution in clinico-radiological suspected cases of pulmonary tuberculosis patients in whom two sputum smear for acid fast bacilli by Zeihl-Neelsen stain under NTEP was negative. Fiberoptic bronchoscopy was performed in all these patients and samples taken were sent for investigations. Result:Fiberoptic bronchoscopy was performed in a total of 110 patients of presumptive pulmonary tuberculosis whose sputum for AFB smear was negative. Out of 110 patients, 65.45% were male and 35.55% were female. Fever was the most common presenting symptom and was found in 93.64% patients. Radiographically, pulmonary consolidation was bilateral in 63.34% cases while was unilateral in 36.36% cases. The total yield of FOB came out to be 59.1% in which BAL for AFB smear was positive in 43.63% cases, BAL for Mtb culture was positive in 54.54% cases while, BAL for PCR was found to be positive in 59.09% cases. Conclusion:Fiberoptic bronchoscopy may be useful in rapid diagnosis and early treatment initiation thereby, reducing the risk of transmission of the disease. The findings of the study indicated that fiberoptic bronchoscopy is a useful method to diagnose the cases of sputum negative radiologically suspected symptomatic patients of tuberculosis.

Role of fiberoptic bronchoscopy in patients with respiratory complications in multispecialty intensive care units

Introduction: To determine the contribution and safety profile of flexible fiberoptic bronchoscopy in intensive care units in terms of therapeutic outcome in lung collapse patients. Methodology: Patients with respiratory complications from various speciality intensive care units were enrolled. After clinical and radiological evaluation, if conservative management fails, bronchoscopic intervention was considered. Bronchoscopy was performed according to British Thoracic Society guidelines after informed consent. Swivel-T-Tube adapter was used for the patients in mechanical ventilation. Data such as chest radiograph, arterial blood gas, Bacterial culture of tracheal and BAL secretions between before and after brochcoscopy (6 & 24 hrs) were analysed using standard SPSS software. Results: In our study 63 patients were enrolled, Most of the patients were in mechanical ventilation 85% (n=54/63). In our study, the indications for bronchoscopy were suspected atelectasis 57.1% (n=36), persistent pulmonary infiltrates 30% (n=27). In suspected atelectasis cases(n=36) bronchoscopic findings were mucous plug in 61%(n=22), blood clot in 11%(n=4) and purulent secretions 22% (n=8) and mucoid secretions in 5% ( n=2). Post brochoscopic chest radiograph of suspected ateletasis showed partial resolution in 38.8% (n=14) and complete resolution in 47.2% (n=17). Conclusion: In our study contribution of bronchoscopy played a vital role in therapeutic outcome. Patients had good response to bronchoscopy 85% improvement when intervened within 5 days of admission in ICU. No life threatening complications were encountered; hence bronchoscopy is safe in critically ill patients, if basic precautions are taken. Keywords: BAL and VAP; Fiberoptic bronchoscopy in intensive care units; Lung atelectasis in ICU; Safety of FOB in ICU.

Role of Fiberoptic Bronchoscopy in the Rapid Diagnosis of Sputum Smear-negative Disseminated Tuberculosis with Pulmonary Miliary Infiltrates.

ObjectivesWe sought to evaluate the role of bronchoscopy-related procedures such as bronchoalveolar lavage (BAL), bronchial wash (BW), bronchial brush (B brush), transbronchial biopsy (TBB), and post-bronchoscopy sputum (PBS), alone or in combination, in the rapid diagnosis of negative sputum smear disseminated tuberculosis (TB).MethodsWe performed a secondary post hoc analysis of data collected from our previous study entitled "Disseminated tuberculosis among adult patients admitted to Hamad General Hospital, Qatar: A five-year hospital-based study" with a modified objective.ResultsWe identified 27 patients. BAL fluid was positive for acid-fast bacilli (AFB) smear in 7/27 (25.9%) patients and were culture-positive for Myobacterium tuberculosis in 17/27 (63.0%) cases, while BW collections were smear-positive in 9/27 (33.3%) cases and culture-positive for M. tuberculosis in 18/27 (66.7%) cases. TBB showed caseating granulomas in 10/16 (62.5%) cases and one case of non-caseating granuloma (6.3%). PBS was positive for AFB in 4/8 (50.0%) patients. The combination of these procedures enabled us to diagnose disseminated TB rapidly in 22 (81.5%) cases.ConclusionsBronchoscopy proved to be an effective method for the rapid diagnosis of disseminated TB in patients in whom sputum smear microscopy was negative.

Role of fiberoptic bronchoscopy in the diagnosis of pulmonary infiltrates in patients with hematological malignancies

RationalePatients with hematological malignancies are a special challenge to health care providers as they undergo a wide variety of immune-suppressive therapies. Both disease and therapy can cause complications. The lungs may be directly injured through infectious or toxic insults. Early identification of the nature of infiltrates will result in better outcome in the management of these patients. Fiberoptic bronchoscopy (FOB) may be a good tool for indentifying the infiltrate nature by using different diagnostic techniques like transbronchial lung biopsy (TBLB) and bronchoalveolar lavage (BAL).Patients and methodsThis study was performed over 6 months, in Kasr Al-Aini Hospital, Cairo University. It included 30 patients with hematological malignancies presenting with pulmonary infiltrates confirmed by computed tomography of the chest. All patients underwent history taking, clinical examination, and investigations included complete blood count and coagulation profile, BAL for culture and sensitivity, cytology examination, and TBLB.ResultsOverall diagnostic yield of FOB was 73.3% in this study. The diagnostic yield of FOB was higher for infectious (43.3%) than both noninfectious (20%) and mixed (10%) etiologies. The combined diagnostic yield of BAL for bacteriological examination and TBLB was higher than that of BAL for cytology examination. Bacteriological examination revealed a predominance for gram-negative bacteria in 62.5% of total culture and sensitivity.ConclusionThis study supports the role of FOB as the initial procedure of choice for identifying the nature of pulmonary infiltrates in patients with hematological malignancies. Because our results suggest that BAL and TBLB are complementary, we recommend performing TBLB whenever it is deemed safe. On the contrary, cytological examination of BAL fluids was not helpful in reaching a final diagnosis.

A Prospective Study of Clinical Profile and Role of Fiber Optic bronchoscopy in Patients with Sputum Negative for AFb with undiagnosed lung lesions in Chest X-Ray

A Prospective Study of Clinical Profile and Role of Fiber Optic bronchoscopy in Patients with Sputum Negative for AFb with undiagnosed lung lesions in Chest X-Ray

The Role of Fiberoptic bronchoscopy in Evaluating The causes of Undiagnosed Pleural Effusion

The Role of Fiberoptic bronchoscopy in Evaluating The causes of Undiagnosed Pleural Effusion

3-5 呼吸器内視鏡医と関連他科の連携 : 救急医療での特殊性(シンポジウム3 呼吸器内視鏡医と関連他科の連携)

3-5 呼吸器内視鏡医と関連他科の連携 : 救急医療での特殊性(シンポジウム3 呼吸器内視鏡医と関連他科の連携)

Role of fiberoptic bronchoscopy and BAL in assessment of the patients with non-responding pneumonia

BackgroundNon-responding pneumonia is usually a topic of interest for pulmonologists. Fiberoptic bronchoscopy (FOB) and bronchoalveolar lavage (BAL) may be an important tool in assessment of non-responding pneumonia. There is paucity of recent studies in this area. AimThis study aimed to assess the impact of early bronchoscopy and BAL in etiological diagnosis of the patients with non-responding pneumonia with special emphasis on efficacy of FOB and BAL in diagnosis. Settings and designA prospective, observational study was conducted in chest and medical microbiology and immunology departments, Zagazig University Hospitals. Patients and methodsThere were total 135 patients included in our study after fulfilling the criteria of non-responding pneumonia by clinical and laboratory parameters, patients were subjected to FOB and BALF microbiological, cytological, histopathological investigations. ResultsThe patients were 90 males and 45 females with a mean age of 47.6±12.2years. Unilateral lung involvement was seen in 108 (80%) patients, whereas bilateral involvement in 27 (20%) patients. Right upper lobe was the most commonly involved site (25.9%). In this study, bacterial pneumonia 83.71% was found to be the commonest etiology of non-resolving pneumonia, followed by bronchogenic carcinoma 13.3% and tuberculosis 2.96%. FOB was done for all patients. BAL fluid results were 88 positive, gram stain samples (65.1%), 4 BAL ZN stain and mycobacterial culture positive cases (2.96%), pyogenic organisms were isolated in 113 patients 83.71% by BAL fluid culture. Bronchoscopic biopsies were also performed in 18 cases. BAL fluid cytology was positive in 6 cases (33.3%), transbronchial forceps biopsy positive results were found in 10 cases (55.55%) and bronchial brushing showed positive results in 3 cases (16.66%). ConclusionsNRP is common and represents a difficult clinical problem as the cause may vary from a benign delay in recovery to life-threatening progressive pneumonia. A systematic approach to investigation and management is recommended with consideration of both infectious and non-infectious causes.

Role of bronchoscopy during non-invasive ventilation in hypercapnic respiratory failure

Non-invasive positive-pressure ventilation (NIPPV) is the first-line treatment for hypercapnic acute respiratory failure (ARF) secondary to COPD exacerbation in selected patients. Limited data exist supporting the use of fiberoptic bronchoscopy (FOB) during this clinical setting. The aim of this study is to assess the role of FOB during NIPPV in patients with decompensated COPD acute exacerbation.

Diagnoses Unveiled by Early Bronchoscopy in Children With Leukemia and Pulmonary Infiltrates

Pulmonary complications in children with leukemia often display nonspecific clinical and radiologic manifestations that lead to a delay in diagnosis. The role of fiberoptic bronchoscopy (FOB) and the proper time for its performance are controversial. The aim of our study was to evaluate the frequency and nature of specific diagnoses revealed by FOB. Children with leukemia submitted to FOB because of suspicion of pulmonary involvement (mainly pneumonia) were retrospectively analyzed. A total of 33 FOB procedures performed in 31 patients (20 males) with an average age of 9.4 years (range, 3.5 to 15 y) were evaluated. Microorganisms isolated from 21 (63.6%) bronchoalveolar lavage samples were mainly fungi including Candida in 13 cases (39.4%) and Aspergillus in 3 cases (9.1%). Isolation rate in 10 procedures performed within the first 3 days was 90%. Tracheobronchitis was present in > 50% of patients, pulmonary hemorrhage was seen in 7 (21.0%) patients, and leukemic infiltration was demonstrated in 2 patients (6.1%), among other conditions visualized by FOB. Complications of FOB were minimal and transient. Our study suggests that FOB is a useful and safe procedure in patients with leukemia and pulmonary infiltrates. The earlier the FOB was performed, the higher the isolation rate of causative agents. In addition, this procedure allowed the identification of noninfectious airway comorbidities. Further studies in regard to this issue are warranted.

Novel approaches to the patient with massive hemoptysis

Massive hemoptysis is a life-threatening condition with a high mortality when treated conservatively. Several modalities have been described in the treatment of hemoptysis with varying results. Endobronchial therapy has traditionally been performed with rigid bronchoscopy. This requires both specialized training and equipment that is not readily available in many centers. The role of fiberoptic bronchoscopy (FOB) is unclear in these situations but is more widely accessible. We describe three cases of the successful treatment of hemoptysis with FOB. These patients were treated with a combination of techniques described previously in the literature; however, these methods failed to result in cessation of the bleeding. Therefore, we employed alternative strategies not described in the literature, using oxidized regenerated cellulose with FOB alone as well as in conjunction with endobronchial placement of vascular embolization coils. These additional techniques may offer other options when rigid bronchoscopy or other modalities are not readily available.

Role of Fiberoptic Bronchoscopy in Intensive Care Unit

Since its introduction in daily medical practice in the late 20th century, flexible bronchoscopy has had an increasing role in the everyday life of the pulmonologist. Not only for diagnosis, but also for therapeutic interventions, it has achieved widespread use and is now performed in a diversity of clinical scenarios. For several reasons, from easy performance in trained hands to versatility, diagnostic reliability, and safety, flexible bronchoscopy is now widely accepted and increasingly used in the management of critically ill patients. The knowledge of the unique features of intensive care unit patients, as well as indications and contraindications for the procedure, is paramount in achieving optimal results, while minimizing potential risks and complications. Performing bronchoscopy in an unstable patient, often on mechanical ventilation, requires awareness of the specific pathophysiological impact of the procedure. This in turn determines respiratory and cardiovascular derangements frequently observed during the procedure. This article reviews indications, pathophysiology, technical aspects, complications, and contraindications of flexible bronchoscopy in the critical care patient.

Bronchoscopic Evaluation of Pulmonary Complications in Patients Undergoing Reduced-Intensity Versus Full-Intensity Transplants.

Pulmonary complications are common following hematopoietic stem cell transplantation (HSCT). The role of fiberoptic bronchoscopy with broncho-alveolar lavage (BAL) in recipients of reduced-intensity (RI) and full intensity (FI) transplants is now reported. Between January 2001-May 2008, 803 allogeneic transplants (212 RI, 591 FI) were performed on 784 patients at the University of Michigan Medical Center. Pulmonary complications, defined as eitherhypoxia > 24 hours, orclinical/radiographic features of pneumonitis, were identified in 313 (39.9%) patients post-transplant.Bronchoscopy was performed on 265 (84.7%) patients with pulmonary complications, including 69 patients undergoing RI transplants (median age 56 yrs, 10–68 yrs) and 196 patients undergoing FI transplants (median age 41 yrs, 1–64 yrs). The time to BAL was similar for recipients of RI when compared to recipients of FI transplant [median: 89 days (0–1854 days) vs. 104 days (7–1533 days)]. Pathogenic organisms were identified in 31.8% (RI) and 25.2% (FI) of BAL procedures. Invasive fungi were the most commonly identified organisms, identified on 48.1% (RI) and 45.2% (FI) of BALs in which pathogens were noted. The incidence of bacterial, viral (including CMV), and mycobacterial pulmonary infections were similar in recipients of RI and FI transplants. The frequency with which pathogens were identified varied with the timing of the bronchoscopy (see Table), with non-infectious pulmonary complications twice as likely to occur in the first 100 days post-transplant in FI than RI transplant recipients (p < 0.05). The BAL led to a change in medical management in 54.1% (RI) and 59.3% (FI) of cases respectively, with modifications in antimicrobial therapy in 38.8% (RI) and 42.1% (FI). The bronchoscopy led to modifications in immunosuppressive therapy in 27.1% (RI) and 27.6% (FI) of cases. BAL procedural related complications were rare in both groups, with pulmonary hemorrhage and transient hypoxemia occurring in < 2.5% of all patients undergoing a BAL.Conclusion: The incidence of pulmonary complications, as evaluated by bronchoscopy post HSCT, was similar for recipients of RI and FI conditioning regimen. Within the first 100 days post-transplant, non-infectious etiologies for pulmonary dysfunction were significantly more common in FI than RI patients. There were no other significant differences in the timing of pulmonary complications or the type of pathogenic organisms identified following a FI or RI transplant. Broncho-alveolar lavage is a safe procedure in patients following allogeneic transplants, altering medical management in over 50% of cases. Time post-transplant and % BAL with a pathogenic organism identifiedDay 0–100 *Day > 100TotalRI32.4%31.3%31.8%FI15.8%31.8%25.2%

The Role of Fiberoptic Bronchoscopy in the Diagnostic Algorithmof Solitary Pulmonary Nodule

The role of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodule is controversial. The aim of the study was to evaluate the results of routine bronchoscopy performed in patients with peripheral lung nodule of 5-40 mm in diameter. From 60 patients with peripheral lung nodule, who underwent routine diagnostic fiberoptic bronchoscopy between 2003 - 2005, we selected 36 patients in whom the final discrimination between malignant and benign tumor was achieved based on either pathological examination or radiological criteria (lack of growth within 2 years of radiological follow up). There were 22 (61%) patients with malignant tumor and 14 (39%) with benign nodule. All malignant tumors were lung carcinomas. In 10 of these patients we found macroscopic abnormalities during bronchoscopy and in 9 of them pathologic examination of specimens collected during the procedure could confirm malignant tissue. In two patients with benign lung nodule a second lung lesion (in different lung lobe) which proved to be lung cancer was identified during fiberoptic bronchoscopy. Sensitivity, specificity and diagnostic accuracy of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodules were 41%, 100%, and 64% respectively. Abandoning fiberoptic bronchoscopy in the diagnostic algorithm in patients with peripheral lung nodules seems unjustified, although its limitations should be taken into account.

Lung biopsy in immunocompromised children: When, how, and who?

Lung biopsy in immunocompromised children: When, how, and who?

Role of Fiberoptic Bronchoscopy in Conjunction with the Use of a Single Lumen Tube with Bronchial Blocker for Thoracic Anesthesia

Role of Fiberoptic Bronchoscopy in Conjunction with the Use of a Single Lumen Tube with Bronchial Blocker for Thoracic Anesthesia

Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study.

Fiberoptic bronchoscopy has been recommended to verify the position of double-lumen tubes (DLT), but this remains controversial. The authors studied the role of bronchoscopy for placing and monitoring right- and left-sided DLTs after blind intubation and after positioning the patient. Two hundred patients having thoracic surgery requiring DLT insertion were prospectively studied. "Blind" tracheal intubations were done with 163 left-sided and 37 right-sided disposable polyvinyl chloride Robertshaw tubes. Bronchoscopy was performed by a different anesthesiologist after intubation and conventional clinical verification of correct placement and after patient positioning for thoracotomy. A DLT was considered malpositioned when it had to be moved >0.5 cm to correct its position. Critical malpositions were those that might have affected patient safety or influenced the surgical procedure if left uncorrected. After "blind" DLT intubation, clinical evidence of malpositioning was found in 28 patients. This was confirmed by fiberoptic assessment. In 172 patients in whom placement was judged correct by clinical assessment, malpositioning was detected by bronchoscopy in 79 cases, 25 of which were critical. After patient positioning, DLTs were found to be displaced in 93 patients, 48 of which were critical. Right-sided DLTs were significantly more likely to be malpositioned than were left-sided DLTs. Two complications were related to unsatisfactory lung separation in the 200 patients studied. After blind intubation and patient positioning, more than one third of DLTs required repositioning. Routine bronchoscopy is therefore recommended after intubation and after patient positioning.

The role of fiberoptic bronchoscopy for diagnosis of pulmonary tuberculosis in patients at risk for AIDS

The role of fiberoptic bronchoscopy for diagnosis of pulmonary tuberculosis in patients at risk for AIDS