Use Of Fiberoptic Bronchoscope Research Articles

Use of Fiber Optic Bronchoscope as Makeshift Choledochoscope for Intraoperative Cholangioscopy in Management of Hepatolithiasis, a Borrow from Anesthesia Cart – A Case Report

Use of Fiber Optic Bronchoscope as Makeshift Choledochoscope for Intraoperative Cholangioscopy in Management of Hepatolithiasis, a Borrow from Anesthesia Cart – A Case Report

A Comparative Study of Nasal Fiberoptic Intubation with Laryngeal Mask Airway Fiberoptic Intubation in Children with a Difficult Airway

Background: Considering that the gold standard for intubation in children with a difficult airway is the use of fiberoptic bronchoscopy, and few studies have evaluated its application in children, the present study aimed at comparing two bronchoscopic techniques of nasal fiberoptic tracheal intubation (FOI-Nasal) and fiberoptic intubation via laryngeal mask airway (FOI-LMA) in children with a difficult airway.
 Methods: A single-blind randomized clinical trial was performed on 40 six-month-old to six-year-old children that were divided into two groups each consisting of 20 patients. The participants were all candidates for elective surgery with clinical criteria for the anticipated difficult intubation. FOI-Nasal and FOI-LMA were performed in the first and second groups, respectively. Mean arterial pressure (MAP), heart rate (HR), and blood oxygen saturation levels (SpO2) were assessed and recorded before anesthesia (T1), immediately before bronchoscopy (T2), and immediately after intubation with endotracheal tube (T3). Moreover, ETCO2, the first successful insertion attempt, and the intubation time were recorded, as well.
 Results: The results of the present study revealed that parameters including MAP, HR, and SpO2 at times T1, T2, and T3 were not significantly different between the two groups after adjusting for potential confounding factors (P> 0.05). However, ETCO2 in FOI-Nasal group with a mean of 38.40 ± 3.57 was significantly higher than that of the FOI-LMA group with a mean of 34.35 ± 3.15 (P = 0.001). In addition, the intubation time in the FOI-LMA group with a mean of 32.40 ± 7.45 was significantly shorter than that of the FOI-Nasal group with a mean of 51.75 ± 9.97 (P <0.001). The success rate in the first attempt in the FOI-Nasal group with the value of 70% was lower than that of the FOI-LMA group with the value of 90%; however, this difference was not statistically significant (P> 0.05).
 Conclusion: According to the results of the present study, the intubation time in the FOI-LMA group was significantly shorter than that of the FOI-Nasal group. Moreover, the success rate of the first attempt in the FOI-LMA group was higher than that of the FOI-Nasal group. Therefore, it can be stated that FOI-LMA as compared to FOI-Nasal can be regarded as an easier technique, with a shorter intubation time, a higher success rate, and a greater stability of children’s hemodynamic parameters.

Recent advances in double-lumen tube malposition in thoracic surgery: A bibliometric analysis and narrative literature review.

Thoracic surgery has increased drastically in recent years, especially in light of the severe outbreak of the 2019 novel coronavirus disease (COVID-19). Routine "passive" chest computed tomography (CT) screening of inpatients detects some pulmonary diseases requiring thoracic surgeries timely. As an essential device for thoracic anesthesia, the double-lumen tube (DLT) is particularly important for anesthesia and surgery. With the continuous upgrading of the DLTs and the widespread use of fiberoptic bronchoscopy (FOB), the position of DLT in thoracic surgery is gradually becoming more stable and easier to observe or adjust. However, DLT malposition still occurs during transferring patients from a supine to the lateral position in thoracic surgery, which leads to lung isolation failure and hypoxemia during one-lung ventilation (OLV). Recently, some innovative DLTs or improved intervention methods have shown good results in reducing the incidence of DLT malposition. This review aims to summarize the recent studies of the incidence of left-sided DLT malposition, the reasons and effects of malposition, and summarize current methods for reducing DLT malposition and prospects for possible approaches. Meanwhile, we use bibliometric analysis to summarize the research trends and hot spots of the DLT research.

Thoracic Anaesthesia Practices in Turkey: A Survey Study.

In this survey study, we aimed to investigate thoracic anaesthesia practices in Turkey. The survey was sent to the members of the Turkish Society of Anesthesiology and Reanimation by e-mail. Participants were asked to answer 35 questions about their thoracic anaesthesia practice. A total of 148 questionnaires were completed. Most of the participants preferred double-lumen endobronchial tube for one-lung ventilation. 69.6% of auscultation method and 45.9% of fiberoptic bronchoscope method were used to confirm the tube position. The most frequently used additional monitoring method was invasive blood pressure. Generally, intravenous anaesthetic agents were preferred for anaesthesia induction, and a combination of inhalation and intravenous agents was used for anaesthesia maintenance. Most of the participants used intraoperative lung-protective mechanical ventilation strategies. For postoperative analgesia, 75% of participants preferred regional analgesic techniques and 89.9% of them used routine opioid agents. In general, moderate amount of fluid was applied (57.4%), crystalloids were the first choice in fluid therapy, and intraoperative hypotension was generally treated with controlled intravenous fluid and vasoactive agents. The haemoglobin threshold value for blood transfusion was stated as 8 g dL-1 by 35.8% of participants. Our data showed that the anaesthesia management of thoracic surgery in Turkey is generally compatible with the current international guidelines. However, the following conclusion was reached: training on blood transfusion, the use of fiberoptic bronchoscope, regional techniques, and intraoperative additional monitoring would be beneficial, and a national consensus should be reached on the thoracic anaesthesia practice.

Short-Term Outcomes of Fiberoptic Bronchoscopy-guided Resection and Anastomosis Control in Thoracic Surgery.

In thoracic surgery practice, bronchial closure and anastomosis are relatively easy in technical terms; however, it is also the procedure that is most open to the development of complications with high morbidity. This study aimed to investigate the effect of simultaneous evaluation of bronchial closure under fiberoptic bronchoscopy guidance during lung resection on the development of complications. Patients aged over 18 years who underwent elective lung resection in our clinic between 2017 and 2021 were included in the study. Postoperative complications were recorded and statistically analyzed. The mean age of the patients was 61.4±10.4 years, and 267 patients were male (75.4%) and 87 (24.6%) were female. Thoracotomy was performed in 258 (72.9%) patients and lung resection with the video-assisted thoracoscopic surgery technique in 96 (27.1%) patients. During the follow-up, complications were observed during the first 30 days in 78 (22.0%) of the patients and later in 9 (2.5%). Surgical mortality occurred in 11 patients (3.1%), and the rate of readmission to the intensive care unit was 5.6% (n=20). We consider that the control of the resection line with the active use of fiberoptic bronchoscopy during surgery is important for the prevention of the development of bronchial morbidity. Complications in the early period can be reduced by ensuring that the remaining bronchus is not narrowed, there are no residual stump structures that may disrupt the bronchial line, such as cartilage, and bronchial washing is frequently undertaken.

Endoscopic Diagnosis and Treatment of Iatrogenic Ruptures of the Trachea

Abstract Respiratory tract trauma is not only the result of injuries to the chest and neck, but may be iatrogenic as well. Diagnosis of iatrogenic damage to the trachea is based on data from clinical and instrumental studies. Among the instrumental diagnostic measures, preference is given to early fibrobronchoscopy.The aim of the study is to assess the possibilities of fiberoptic bronchoscopy in the diagnosis of iatrogenic tracheal injuries. Materials and methods. This study analyzed the use of fiberoptic bronchoscopy in 51 patients with suspected iatrogenic damage to the trachea. For iatrogenic ruptures of the trachea, the location on the posterior (membranous) wall and the longitudinal direction (100%), as well as location in the lower and middle thoracic sections of the trachea (71.4%), are typical.Conclusion Bronchoscopy is a direct method for diagnosing this type of damage, which allows the location, size of the defect and tactics to be accurately determined.

Intubation with vivasight double-lumen tube versus conventional double-lumen tube in adult patients undergoing lung resection: A retrospective analysis.

ABSTRACTObjectives:The present study was designed to compare outcomes in patients undergoing thoracic surgery using the VivaSight double-lumen tube (VDLT) or the conventional double-lumen tube (cDLT).Design:A retrospective analysis of 100 patients scheduled for lung resection recruited over 21 consecutive months (January 2018–September 2019).Setting:Single-center university teaching hospital investigation.Participants:A randomized sample of 100 patients who underwent lung resection during this period were selected for the purpose to compare 50 patients in the VDLT group and 50 in the cDLT group.Interventions:After institutional review board approval, patients were chosen according to inclusion and exclusion criteria and we created a general database. The 100 patients have been chosen through a random process with the Microsoft Excel program (Microsoft 2018, Version 16.16.16).Measurements and Main Results:The primary endpoint of the study was to analyze the need to use fiberoptic bronchoscopy to confirm the correct positioning of VDLT or the cDLT used for lung isolation. Secondary endpoints were respiratory parameters, admission to the intensive care unit, length of hospitalization, postoperative complications, readmission, and 30-day mortality rate. The use of fiberoptic bronchoscopy was lower in the VDLT group, and the size of the tube was smaller. The intraoperative respiratory and hemodynamics parameters were optimal. There were no other preoperative, intraoperative, or postoperative differences between both groups.Conclusions:The VDLT reduces the need for fiberoptic bronchoscopy, and it seems that a smaller size is needed. Finally, VDLT is cost-effective using disposable fiberscopes.

Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units.

ABSTRACTBackgroundPercutaneous dilatational tracheostomy (PCDT) using fiber-optic bronchoscope (FOB) is a widely practiced technique, but its availability and cost remain a concern in nations with limited resources. Mini-surgical technique of PCDT incorporating minimal blunt dissection has shown improved results even without the use of FOB. The study is primarily intended to compare these two techniques and establish a safer cost-effective alternative to FOB-guided PCDTs.Patients and methodsThis randomized comparative study [registered (CTRI/2018/04/013191)] was conducted on 120 mechanically ventilated patients. In 60 patients, mini-surgical PCDT (group-M) was performed with 2 cm longitudinal skin incision and blunt dissection till pretracheal fascia without FOB guidance using Portex-Ultraperc™ sets. In remaining 60 patients, PCDT was performed under FOB vision with similar skin incision (without blunt dissection) using Portex-Ultraperc™ sets (group-F). Two techniques were compared with regard to procedural time and percentage of complications occurred during or after the procedure.ResultsProcedure time [group-M: 6.30 ± 1.28 minutes; group-F: 14.43 ± 1.84 minutes (p <0.001)] and mean blood loss [group-M: 5.33 ± 1.69 mL; group-F: 6.87 ± 3.11 mL (p = 0.001)] was significantly less in group-M. Higher incidence of desaturation [group-M: 16.7%; group-F: 35% (p = 0.022)] was noted in group-F, whereas arrhythmias [group-M: 21.7%; group-F: 6.7% (p = 0.018)] were higher in group-M. There was no statistical difference in incidence of pneumothorax and subcutaneous emphysema. There was no incidence of posterior tracheal wall perforation in any of the patients.ConclusionMini-surgical technique is a faster alternative of FOB-guided PCDT with comparable incidence of complications. It can safely be used in intensive care units (ICUs) where FOB is not available.Clinical trial registration numberCTRI/2018/05/014307Name of registryClinical Trials Registry of India (CTRI), URL—http://ctri.nic.in How to cite this articleKumar A, Kohli A, Kachru N, Bhadoria P, Wadhawan S, Kumar D. Fiber-optic Bronchoscope-guided vs Mini-surgical Technique of Percutaneous Dilatational Tracheostomy in Intensive Care Units. Indian J Crit Care Med 2021;25(11):1269–1274.

Evaluation of the Use of Fiberoptic Bronchoscopy Following Rigid Bronchoscopy in Foreign Body Aspiration

Background: Foreign body aspiration (FBA) is a life-threatening problem that can be lethal in some cases. It usually occurs in children between 1–3 years old. Bronchoscopy is the best way for recognition, treatment and management of this problem. We aimed to evaluate the use of fiberoptic bronchoscopy after rigid bronchoscopy in foreign body aspiration in pediatric population. Materials and Methods: 275 pediatric patients with a history of choking were entered to this cross-sectional study, from August 2015 to September 2018. The study was done in a Dr. Sheikh hospital, Mashhad, Iran. The age and gender of the patients were recorded individually. Rigid bronchoscopy was done for all patients. After that, fiberoptic bronchoscopy was performed immediately or 72 hours after the first procedure based on the patients' symptoms, time and personnel conditions. Data were analyzed by the SPSS software version 16.0. Results: Among 275 patients, 175 cases (63.6%) were male. The patients' age was 3 months to 15 years old. In rigid bronchoscopy, 85 cases had no foreign body and in 190 cases, foreign body was found. In 43 cases fiberoptic bronchoscopy found a residual organic material in spite of negative rigid bronchoscopy.The most residual organic material pertained to 0-3 year age group and the cases with residue in males were more than females. There was a significant difference between FBA and age and gender (p <0.001). Conclusion: FBA in airway branches may not be seen by rigid bronchoscope due to the limited access to the distal branches. We suggest fiberoptic bronchoscopy as a complementary management along with rigid bronchoscopy to investigate distal branches, especially if the foreign body is soft in material.

Emergency Treatment and Nursing Care of a Patient with Multiple Injuries and Right Main Bronchus Rupture

Objective: To investigate the rescue and nursing process of a trauma patient with multiple injuries and rupture of the right main bronchus. Methods: A patient with multiple injuries and rupture of the right main bronchus admitted to the emergency department of the Shenzhen Hospital of the University of Hong Kong was selected as the research object on December 11, 2019. Results: In this case, the medical team treated the patient under the guidance of ATLS (Advanced Traumatic Life Support), and for the first time in our department, we used bronchoscopy to replace the double-lumen endotracheal tube for left lung single-lung ventilation, finally the patient was successfully treated. Conclusion: Through a literature search, it is found that the main bronchus rupture is less common in clinical practice. In the trauma group, the use of fiberoptic bronchoscopy and the replacement of a double-lumen tracheal tube for left lung single-lung ventilation can improve the treatment rate of such patients and is worthy of clinical application.

Diagnostic And Therapeutic Uses Of A Novel Metallic Conduits Set And Fiber Optic Bronchoscope In Undiagnosed Pleural Diseases

Since thoracoscopy needs special instruments, training and higher cost it is sparingly used modality in our country. We have designed and manufactured a specialized set of metallic conduits to facilitate the use of Fiber Optic Bronchoscope (FOB) as thoracoscope (Patent Application No 1066/MUM/2012 published on14/12/2012; and Application No 1400/MUM/2012 published on16/11/12). (Fog No 1). Here is the report of these procedures performed in bronchoscopy rooms. Our pleuroscopy conduits have greatly facilitated the use of Fiber optic bronchoscope as thoracoscope in diagnosis and therapeutics of pleural diseases with acceptable complications.

Efficacy of premedication with intranasal dexmedetomidine for removal of inhaled foreign bodies in children by flexible fiberoptic bronchoscopy: a randomized, double-blind, placebo-controlled clinical trial

BackgroundTracheobronchial foreign body aspiration in children is a life-threatening, emergent situation. Currently, the use of fiberoptic bronchoscopy for removing foreign bodies is attracting increasing attention. Oxygen desaturation, body movement, laryngospasm, bronchospasm, and breath-holding are common adverse events during foreign body removal. Dexmedetomidine, as a highly selective α2-adrenergic agonist, produces sedative and analgesic effects, and does not induce respiratory depression. We hypothesized that intranasal dexmedetomidine at 1 μg kg − 1 administered 25 min before anesthesia induction can reduce the incidence of adverse events during fiberoptic bronchoscopy under inhalation general anesthesia with sevoflurane.MethodsIn all, 40 preschool-aged children (6–48 months) with an American Society of Anesthesiologists physical status of I or II were randomly allocated to receive either intranasal dexmedetomidine at 1 μg·kg − 1 or normal saline at 0.01 ml kg− 1 25 min before anesthesia induction. The primary outcome was the incidence of perioperative adverse events. Heart rate, respiratory rate, parent-child separation score, tolerance of the anesthetic mask, agitation score, consumption of sevoflurane, and recovery time were also recorded.ResultsFollowing pre-anesthesia treatment with either intranasal dexmedetomidine or saline, the incidences of laryngospasm (15% vs. 50%), breath-holding (10% vs. 40%), and coughing (5% vs. 30%) were significantly lower in patients given dexmedetomidine than those given saline. Patients who received intranasal dexmedetomidine had a lower parent–child separation score (P = 0.017), more satisfactory tolerance of the anesthetic mask (P = 0.027), and less consumption of sevoflurane (38.18 ± 14.95 vs. 48.03 ± 14.45 ml, P = 0.041). The frequency of postoperative agitation was significantly lower in patients given intranasal dexmedetomidine (P = 0.004), and the recovery time was similar in the two groups.ConclusionsIntranasal dexmedetomidine 1 μg·kg− 1, with its sedative and analgesic effects, reduced the incidences of laryngospasm, breath-holding, and coughing during fiberoptic bronchoscopy for FB removal. Moreover, it reduced postoperative agitation without a prolonged recovery time.Trail registrationThe study was registered with the Chinese Clinical Trial Registry (registration number: ChiCTR1800017273) on July 20, 2018.

Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations.

Background and AimCritically ill patients on mechanical ventilation undergo tracheostomy to facilitate weaning. The practice in India may be different from the rest of the world and therefore, in order to understand this, ISCCM conducted a multicentric observational study “DIlatational percutaneous vs Surgical tracheoStomy in intEnsive Care uniT: A practice pattern observational multicenter study (DISSECT Study)” followed by an ISCCM Expert Panel committee meeting to formulate Practice recommendations pertinent to Indian ICUs.Materials and methodsAll existing International guidelines on the topic, various randomized controlled trials, meta-analysis, systematic reviews, retrospective studies were taken into account to formulate the guidelines. Wherever Indian data was not available, international data was analysed. A modified Grade system was followed for grading the recommendation.ResultsAfter analyzing the entire available data, the recommendations were made by the grading system agreed by the Expert Panel. The recommendations took into account the indications and contraindications of tracheostomy; effect of timing of tracheostomy on incidence of ventilator associated pneumonia, ICU length of stay, ventilator free days & Mortality; comparison of surgical and percutaneous dilatational tracheostomy (PDT) in terms of incidence of complications and cost to the patient; Comparison of various techniques of PDT; Use of fiberoptic bronchoscope and ultrasound in PDT; experience of the operator and qualification; certain special conditions like coagulopathy and morbid obesity.ConclusionThis document presents the first Indian recommendations on tracheostomy in adult critically ill patients based on the practices of the country. These guidelines are expected to improve the safety and extend the indications of tracheostomy in critically ill patients.How to cite this articleGupta S, Dixit S, Choudhry D, Govil D, Mishra RC, Samavedam S, Tracheostomy in Adult Intensive Care Unit: An ISCCM Expert Panel Practice Recommendations. Indian J Crit Care Med 2020;24(Suppl 1):S31–S42.

Recurrent Aspiration Pneumonia in a Missed Case of Broncho-Esophageal Fistula with Repaired Esophageal Atresia: Usefulness of Fiberoptic Bronchoscopy: A Case Report

: Broncho-esophageal fistula (BEF) is a rare congenital anomaly affecting the respiratory and upper gastrointestinal tract. The rarity makes its timely diagnosis very challenging. This study presents a rare case of missed congenital BEF in a six-year-old girl with repaired esophageal atresia in the neonatal period suffering from recurrent respiratory symptoms, choking, and respiratory distress following eating, resulting in vomiting or regurgitation for three years before admission. While the contrast esophagography and endoscopy had failed to diagnose her problem, the methylene blue test via an esophageal catheter observed by fiberoptic bronchoscopy could detect the presence of BEF reliably in the present case. Presenting this case can raise physicians’ knowledge of the diagnostic role of methylene blue test via fiberoptic bronchoscopy.

Severe odontogenic deep neck space infections: risk factors for difficult airways and ICU admissions.

The purpose of this retrospective study was to evaluate perioperative risk factors concerning difficult airway management, primary tracheostomy, and need for intensive care unit (ICU) admission in severe odontogenic space infections. Perioperative risk factors were retrospectively analyzed in 499 cases. Fisher's exact test and analysis of variance were performed to analyze associations between categorical and continuous variables. Univariate regression analysis was used for estimating predictors for ICU admission. A risk model for ICU admission was performed using multivariate regression analysis. Area-under-the-curve (AUC) was calculated by receiver-operating-characteristic (ROC) curve. Airway securing in patients with restricted mouth opening led to significant use of the video laryngoscope (p < 0.001) or fiberoptic bronchoscope (p < 0.001). The use of fiberoptic bronchoscopy was significantly increased in patients with dysphagia (p = 0.005) and dyspnea (p = 0.04). Four patients (0.8%) needed primary tracheostomy. ICU admission was significantly associated with higher levels of C-reactive protein (CRP, p = 2.78 × 10-5), white blood cell count (WBC, p = 0.003), dyspnea (p = 9.95 × 10-6), and higher body mass index (BMI, p = 0.0003). American Society of Anesthesiologists physical status (ASA PS) class III patients (p = 0.04) and the need for the use of a video laryngoscopy (p = 0.003) or fiberoptic bronchoscopy (p = 6.58 × 10-5) resulted in a more frequent ICU admission. The AUC of the model was 0.897. Difficult airway management was mainly dependent on limited mouth opening and elevated CRP. Elevated CRP, BMI, ASA PS III, and dyspnea were important risk factors for ICU admission. These predictors should be considered preoperatively for proper planning and preparation.

Long-Term Outcome of Metallic Stenting for Central Airway Involvement in Relapsing Polychondritis

Placement of uncovered self-expandable metallic stents was found to successfully alleviate critical airflow limitation in patients with relapsing polychondritis (RP) with central airway involvement by several reports. However, the long-term outcome of airway metallic stenting in patients with RP remain unclear. We retrospectively analyzed patients with RP who underwent airway metallic stenting with the use of fiberoptic bronchoscopy between September 1, 2009, and October 1, 2017, in Shanghai. Outcome measurements, including modified Medical Research Council (mMRC) dyspnea score, 6-minute walk distance (6MWD), spirometry, and bronchoscopic findings, as well as adverse events after stent placement, were collected. A total of 27 patients were included; the median patient age was 58 years (range: 41 to 74 years), and 19 weremen (70.4%). Nineteen uncovered self-expandable metallic stents were placed in the trachea and 39 in the main bronchi. The median follow-up time was 50.5 months (range: 6 to 100 months). The baseline forced expiratory volume in 1 second (FEV1) percentage predicted (%pred), FEV1/forced vital capacity (FVC), and peak expiratory flow (PEF) was 24.2 ± 3.7, 27.2 ± 5.6, and 0.99 ± 0.21 L/min, respectively. One day after the procedure, improvement from baseline in FEV1 %pred, FEV1/FVC, and PEF was 17.9± 8.9 (p= 0.001), 19.8 ± 10.9 (p= 0.002), and 0.69 ± 0.44 L/min (p= 0.001), respectively. Changes in the following variables were also statistically and clinically significant: 6MWD of 193.7 ± 83.4 m; mMRC dyspnea score of-1.2 ± 0.4 points (both p < 0.05). The improvements were maintained at 5 years: a mean change in FEV1 %pred, FEV1/FVC, PEF, 6MWD, and mMRC score was 19.5 ± 6.7, 13.9 ± 5.0, 0.82± 0.40 L/min, 134.7 ± 66.2 m, and-0.83 ± 0.29 points, respectively. Cough, foreign body sensation, mucus production, and granulomas were common adverse events,occurring in 48.1% (13 of 27), 40.7% (11 of 27), 29.6% (8 of 27), and 25.9% (7 of 27) of the subjects. However, noneof those complications were severe enough to requireurgent bronchoscopic interventions. Airway metallic stenting in patients with RP with central airway involvement resulted in long-term clinical benefits in lung function, exercise tolerance, and dyspnea with an acceptable safety profile.

Intubação seletiva do brônquio principal esquerdo em unidade de terapia intensiva neonatal

Selective neonatal left mainstem bronchial intubation to treat right lung disease is typically achieved with elaborate maneuvers, instrumentation and devices. This is often attributed to bronchial geometry which favors right mainstem entry of an endotracheal tube deliberately advanced beyond the carina.A neonate with severe bullous emphysema affecting the right lung required urgent non-ventilation of that lung. We achieved left mainstem bronchial intubation by turning the endotracheal tube 180° such that the Murphy's eye faced the left instead of the right, and simulated a left-handed intubation by slightly orientating the endotracheal tube such that its concavity faced the left instead of the right as in a conventional right-handed intubation.Urgent intubation of the left mainstem bronchus with an endotracheal tube can be easily achieved by recognizing that it is the position of the endotracheal tube tip and the direction of its concavity that are the chief determinants of which bronchus an endotracheal tube goes when advanced. This is important in critically ill neonates as the margin of safety and time window are small, and the absence of double-lumen tubes. Use of fiberoptic bronchoscope and blockers should be reserved as backup plans.

Usefulness of Fiber-optic Bronchoscopy in the Diagnosis of Pulmonary Diseases in Diabetic Patients: Experience in a Tertiary Care Hospital

Background: Fiber-optic bronchoscopy (FOB) is an invasive procedure performed to identify possible endobronchial lesions. Diabetic patients often present with non-resolving pneumonia and collapse, many of whom are elderly and smoker; thus always giving rise to the suspicion of malignancy.Methods: This observational study was performed from March 2009 to August 2013 in the Department of Internal Medicine and Pulmonology of BIRDEM General Hospital, Dhaka, Bangladesh; a 500 bedded tertiary care hospital dealing mostly with diabetic patients.Results: Out of 160 diabetic patients 126 (78.7%) were male, 34 (21.3%) were female. Mean age of the patients was – 57.2 ±10.8 years. The indications of bronchoscopy were collapse (38, 23.8%), non-resolving consolidation (55, 34.4%), mass lesion (38, 23.8%), hemoptysis (10, 6.2%) and others (19, 11.8%). Findings in the bronchoscopy were mitotic lesion (56, 35.0%), inflammatory lesion (50, 31.3%) and normal finding (54, 33.8%). Among 56 cases of mitotic lesion, bronchial biopsy was taken in 48 (85.7%) cases. Histopathology reports of bronchial biopsy were squamous cell carcinoma (18, 37.5%), large cell carcinoma (11, 22.9%), adenocarcinoma (7, 14.6%), small cell carcinoma (5, 10.4%), inflammatory lesion (4, 8.3%) and normal finding (3, 6.3%). Among 38 cases of collapse, mitotic lesion was found in 24 (63.2%) cases. Among 55 (100%) cases of non-resolving consolidation, mitotic lesion was found in 18 (32.5%), inflammation in 23 (41.8%) and normal findings in 14 (25.5%) cases.Conclusion: Bronchoscopy is an useful method to detect any endobronchial lesion in suspected cases of collapse or non-resolving pneumonia in diabetic patients and it can be the choice of investigation in non-resolving pneumonia.Birdem Med J 2016; 6(1): 18-21

Inspection of the nasopharynx prior to fiberoptic-guided nasotracheal intubation reduces the risk epistaxis

BackgroundVarious complications may occur during nasotracheal intubation. This may include epistaxis and damage to the nasopharyngeal airway. We tested the hypothesis that the use of fiberoptic bronchoscopy (FOB)–guided intubation is superior to endotracheal tube (ETT) obturated with an inflated esophageal stethoscope. MethodsPatients were randomly assigned to 1 of 2 groups (n=22 each): either an FOB-guided intubation group or ETT obturated with an inflated esophageal stethoscope group. After the induction of general anesthesia, patients in the FOB group received an FOB inspection through the nostril without advancement of ETT. Then, after confirming the placement of the bronchoscope tip in the trachea, the lubricated ETT was advanced via the nostril to the trachea along the bronchoscope. In the obturated ETT insertion group, the proximal opening of the ETT was blunted with an inflated esophageal stethoscope. The ETT was inserted into the selected nostril and advanced blindly into the posterior oropharynx. Then, the esophageal stethoscope was removed and tracheal intubation was performed with the bronchoscope. The number of attempts for successful tracheal intubation, the degree of difficulty during insertion, and bleeding during bronchoscopy were recorded. Another anesthesiologist, blinded to the intubation method, estimated the severity of epistaxis 5minutes after the intubation and postoperative complications. ResultsThe FOB group had significantly less epistaxis during bronchoscopy, better navigability, and fewer intubation attempts and redirections. ConclusionFiberoptic-guided nasotracheal intubation was associated with less epistaxis. It also showed better navigability and less redirection rate. Therefore, FOB as an intubation guide is superior to ETT with an inflated esophageal stethoscope when intubating a patient via the nasotracheal route.

Inhalation injury after exposure to indoor fire and smoke: The Brazilian disaster experience

ObjectiveTo describe the pre-hospital, emergency department, and intensive care unit (ICU) care and prognosis of patients with inhalation injury after exposure to indoor fire and smoke. Materials and methodsThis is a prospective observational cohort study that includes patients admitted to seven ICUs after a fire disaster. The following data were collected: demographic characteristics; use of fiberoptic bronchoscopy; degree of inhalation injury; percentage of burned body surface area; mechanical ventilation parameters; and subsequent events during ICU stay. Patients were followed to determine the ICU and hospital mortality rates. ResultsWithin 24h of the incident, 68 patients were admitted to seven ICUs. The patients were young and had no comorbidities. Most patients (n=35; 51.5%) only had an inhalation injury. The mean ventilator-free days for patients with an inhalation injury degree of 0 or I was 12.5±8.1 days. For patients with an inhalation injury degree of II or III, the mean ventilator-free days was 9.4±5.8 days (p=0.12). In terms of the length of ICU stay for patients with degrees 0 or I, and patients with degrees II or III, the median was 7.0 days (5.0–8.0 days) and 12.0 days (8.0–23.0 days) (p<0.001), respectively. In addition, patients with a larger percentage of burned surface areas also had a longer ICU stay; however, no association with ventilator-free days was found. The patients with <10% of burned body surface area showed a mean of 9.2±5.4 ventilator-free days. The mean ventilator-free days for patients who had >10% burned body surface area was 11.9±9.5 (p=0.26). The length of ICU stay for the <10% and >10% burned body surface area patients was 7.0 days (5.0–10.0 days) and 23.0 days (11.5–25.5 days) (p<0.001), respectively. ConclusionsWe conclude that burn patients with inhalation injuries have different courses of disease, which are mainly determined by the percentage of burned body surface area.