Use Of Flexible Bronchoscopy Research Articles

The incidence of awake tracheal intubation in anesthetic practice is decreasing: a historical cohort study of the years 2014-2020 at a single tertiary care institution.

PurposeAwake tracheal intubation (ATI) is recommended in airway management guidelines when significant difficulty is predicted with airway management. Use of the technique may be declining, which may have implications for patient safety or for skills acquisition and maintenance. This historical cohort database study sought to determine if the use of ATI was decreasing in our adult tertiary care center.MethodsWith institutional research ethics board approval, we queried our anesthesia information management system for cases with ATI descriptors for each year from 2014 to 2020. Records of the retrieved cases were independently reviewed by all three authors to verify they met inclusion criteria for the ATI cohort prior to analysis for the primary outcome. Secondary outcome measures included airway device and route used for ATI, first attempt and ultimate success rates, and reported adverse issues recorded in cases of failed ATI or those requiring more than one attempt.ResultsA total of 692 cases of ATI were identified between 2014 and 2020. There was a statistically significant decrease in yearly ATIs over the seven-year study period (Chi square goodness of fit, P < 0.001), with ATI use decreasing by about 50%. First attempt success was significantly greater with use of flexible bronchoscopy vs video laryngoscopy to facilitate ATI (84% vs 60%; P < 0.001), while there was no difference in first attempt success with the oral vs nasal route (82% vs 82%; P = 1.0).ConclusionIn this single-center historical cohort study, the use of ATI decreased significantly from 2014 to 2020. Whether this decrease will result in morbidity or mortality related to airway management is currently unclear. Regardless, it has implications for training opportunities and maintenance of competence in performing the procedure.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12630-022-02344-8.

Use of Flexible Bronchoscopy in Foreign Body Aspiration.

Objective:Foreign body aspiration remains a serious health problem with a potential for severe consequences, and acute and chronic problems in children. It therefore demands immediate intervention. Rigid bronchoscopy has long been the method of choice for foreign body removal but is now being replaced by flexible bronchoscopy which offers reduced trauma and the ability to access distal bronchial regions. In the presented study we assessed the patients who underwent flexible bronchoscopy for foreign body removal in our clinic.Methods:We reviewed the records of 20 patients who underwent flexible bronchoscopy due to suspected foreign body aspiration and had a foreign body removed in our clinic. Patients were analyzed in terms of sociodemographic data, foreign bodies removed, method of foreign body removal, foreign body location and time to diagnosis.Results:Our study group included nine females and 11 males. The removed foreign body was organic in 19 of the 20 patients and inorganic in one patient. Hard organic food, such as hazelnuts, peanuts, seeds, almonds, and raw corn kernel were identified in 12 patients, a piece of fishbone in one patient and a piece of gelatin in another. The pieces of soft organic food identified were apple in one patient, egg in one patient, and boiled corn kernel in one patient and removed by suction. The foreign body was removed using forceps in nine patients, and a basket was used successfully in seven patients.Conclusion:Foreign bodies can be removed with minimal complication using flexible bronchoscopy, basket, and forceps in children.

Bronchoscopic Intra-Pleural Instillation of Fibrin Glue and Autologous Blood to Manage Persistent Air Leaks after Lung Resection.

Background: Persistent air leak is a common complication after lung resection causing prolonged length of stay and increased healthcare costs. Surgical intervention can be an option, but other more conservative approaches should be considered first. Here, we describe the use of flexible bronchoscopy to apply fibrin glue and autologous blood sequentially to the damaged lung. We named the technique “flexible thoracoscopy”. Methods: Medical records from patients with persistent air leaks after lung resection were collected retrospectively. Depending on the type of aerostasis that was performed, two groups were created: flexible thoracoscopy and surgery (thoracotomy). Flexible thoracoscopy was introduced at our institution in 2013. We entered the pleural space with a bronchoscope following the same surgical pathway that was used for tube thoracostomy. Perioperative characteristics and outcomes were analyzed using R software (ver. 3.4.4). Results: From 1997 to 2021, a total of 23 patients required an intervention for persistent air leaks. Aerostasis was performed via flexible thoracoscopy in seventeen patients (69%) and via thoracotomy in six patients (31%). The median age was 70 years (22–82). Twenty patients were males (87%). There was no difference in age, sex distribution, BMI, comorbidities and FEV1%. An ASA score of 3 was more represented in the flexible thoracoscopy group; however, no evidence of a difference was found when compared to the thoracotomy group (p = 0.124). Length of in-hospital stay and chest tube duration was also similar between groups (p = 1 and p = 0.68, respectively). Conclusions: Aerostasis achieved either by flexible thoracoscopy or by thoracotomy showed similar results. We believe that flexible thoracoscopy could be a valid alternative to facilitate minimally invasive treatments for persistent air leaks. Further studies are needed to confirm these results.

Impact of Target-Controlled Infusion (TCI) of Propofol on State- and Response-Entropy and Sedation Depth During Flexible Bronchoscopy

Background: The increasing use of flexible bronchoscopy for diagnostic and interventional purposes requires further knowledge on feasible sedation regimens. We investigated the potential benefit of Target- Controlled Infusion (TCI) of propofol on sedation depth. Methods: Fifty-four patients scheduled for elective flexible bronchoscopy were allocated to receive propofol sedation using either intermittent boluses or Target Controlled Infusion (TCI). Endpoints included Entropy monitoring to evaluate sedation depth, sedation quality and the total amount of propofol. Results: There were no significant differences between both cohorts regarding the number of adverse sedation-related events. The mean applied dose of propofol was significantly higher in the Target-Controlled Infusion group (405±249 mg vs. 324±94 mg, p=0.015). Until patients reached loss of consciousness (LOC), State Entropy (SE) and Response Entropy (RE) levels were comparable among both sedation regimens. During the procedure, both parameters decreased to significantly lower levels in the TCI-cohort (SE: 77.7±13.2 vs. 88.8±8.6 (p=0.002) and RE: 69±12.6 vs. 79±8.7 (p=0.005)). Examination conditions, as rated by proceduralists and assisting nurses, were superior in the TCI-cohort. In addition, restraining measurements, due to uncontrolled movement during the examination needed to be applied more often to patients in the bolus cohort (body restraint: 26 (96%) vs. 18 (67%), p=0.005). Conclusion: Target-Controlled Infusion of propofol complies with the requirements of flexible bronchoscopy by providing a deep and steady level of sedation without impairing patient’s safety. In addition, there is evidence that overall sedation quality is superior, both for bronchoscopist and assisting staff.

Airway recommendations for perioperative patients during the COVID-19 pandemic: a scoping review.

PurposeNumerous guideline recommendations for airway and perioperative management during the COVID-19 pandemic have been published. We identified, synthesized, and compared guidelines intended for anesthesiologists.SourceMember society websites of the World Federation of Societies of Anesthesiologists and the European Society of Anesthesiologists were searched. Recommendations that focused on perioperative airway management of patients with proven or potential COVID-19 were included. Accelerated screening was used; data were extracted by one reviewer and verified by a second. Data were organized into themes based on perioperative phase of care.Principal findingsThirty unique sets of recommendations were identified. None reported methods for systematically searching or selecting evidence to be included. Four were updated following initial publication. For induction and airway management, most recommended minimizing personnel and having the most experienced anesthesiologist perform tracheal intubation. Significant congruence was observed among recommendations that discussed personal protective equipment. Of those that discussed tracheal intubation methods, most (96%) recommended videolaryngoscopy, while discordance existed regarding use of flexible bronchoscopy. Intraoperatively, 23% suggested specific anesthesia techniques and most (63%) recommended a specific operating room for patients with COVID-19. Postoperatively, a minority discussed extubation procedures (33%), or care in the recovery room (40%). Non-technical considerations were discussed in 27% and psychological support for healthcare providers in 10%.ConclusionRecommendations for perioperative airway management of patients with COVID-19 overlap to a large extent but also show significant differences. Given the paucity of data early in the pandemic, it is not surprising that identified publications largely reflected expert opinion rather than empirical evidence. We suggest future efforts should promote coordinated responses and provide suggestions for studying and establishing best practices in perioperative patients.Study registrationOpen Science Framework (https://osf.io/a2k4u/); date created, 26 March 2020.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12630-022-02199-z.

Retrospective Review of Flexible Bronchoscopy in Pediatric Cancer Patients.

The use of flexible bronchoscopy (FB) with bronchoalveolar lavage (BAL) to diagnose and manage pulmonary complications has been shown to be safe in adult cancer patients, but whether its use is safe in pediatric cancer patients remains unclear. Thus, to describe the landscape of FB outcomes in pediatric cancer patients and to help define the populations most likely to benefit from the procedure, we undertook a retrospective review of FBs performed in patients younger than 21 years treated at our institution from 2002 to 2017. We found that a greater volume of total fluid instilled during BAL was significantly associated with increased probabilities of positive BAL culture (p=0.042), positive bacterial BAL culture (p=0.037), and positive viral BAL culture (p=0.0496). In more than half of the FB cases, findings resulted in alterations in antimicrobial treatment. Our study suggests that for pediatric cancer patients, FB is safe, likely provides diagnostic and/or therapeutic benefits, and has implications for treatment decisions.

Flexible bronchoscopy in Ghana: initial experience in a tertiary hospital.

Introductionthe use of flexible bronchoscopy in developing countries is limited. We report our initial experience and outcome with the use of flexible bronchoscopy at the Tamale Teaching Hospital in Ghana. This is the first reported case series of flexible bronchoscopy in Ghana.Methodsa retrospective review of patients who had flexible bronchoscopy from 2017-2019 was analyzed. Patient demographics and outcomes were summarized using frequency distribution and percentages.Resultswe performed flexible bronchoscopies in 33 patients with mean age of 43 years. All patients were symptomatic at the time of presentation with the most common symptoms being chest pain (63.6%), dyspnea (57.6%) and cough (48.5%). The indication for bronchoscopy in most of the cases were suspected malignancy in 16 (48.5%) followed by infection 9 (27.3%), trauma 4 (12.1%) and others 4 (12.1%). We observed abnormal bronchoscopic findings in 25 (75.8%) of the cases with most of the pathologies in the right main bronchus. Twelve patients had toilet bronchoscopy, 6 had biopsy, 5 had no intervention and 4 patients had bronchoalveolar lavage (BAL). Culture and sensitivity results were available for 11 patients, of which 7 patients had negative results. Thirteen (13) malignancies and 11 inflammatory/infectious diseases were diagnosed in this case series. The mean procedure time was 32 minutes with mean hospital stay of 7 days. There was no complication or mortality in our series. Conclusion: flexible bronchoscopy is a safe procedure and indispensable in Ghana where there is an increasing incidence of lung diseases.

Tracheobronchial foreign body aspiration in children aged ≤ 2 years: the use of flexible bronchoscopy and urology stone retrieval basket in emergency setting

Objective: Tracheobronchial aspiration of foreign body in children is an emergency that can lead to major complications. In the last years flexible bronchoscopy has gained popularity for foreign bodies retrieval in the pediatric population, yet the small size of the pediatric airway and of the flexible bronchoscope channel limit the availability of instruments during the procedure. Aim of this paper is to describe our experience in treating foreign bodies tracheobronchial aspiration in children aged 2 years or less by means of flexible bronchoscope and an urology stone retrieval basket. Methods: A review of endoscopic foreign bodies removal by means of flexible bronchoscopy and urology stone retrieval basket has been carried out in children ≤ 2 years that presented at the Emergency Room of our hospital from 2005 to 2019. In the paper, we analyze characteristics of patients, timing of bronchoscopy, instruments and operative management. Results: There were 25 patients with a mean age of 20 ± 3.8 months. Organic material was the most frequent observed foreign body. Association of main bronchus and distal bronchi was the preferred site of the foreign body in 19 patients and the right side of the bronchial tree was involved in 17 cases. Complications occurred in one case. Mean operation time was 37 ± 20 minutes. Conclusions: The use of flexible bronchoscope can be helpful in handling endoscopic removal of tracheobronchial foreign bodies in toddlers. The use of the urology stone retrieval basket resulted very effective in all shapes of foreign bodies and/or when the object was located in the distal bronchi.

Dynamic change of Mycoplasma pneumoniae pneumonia in hospitalized children in a general hospital: a 3-year retrospective analysis

BackgroundThe epidemiology and economic burden of hospitalized community-acquired pneumonia (CAP) children due to MP is still poorly understood. This study aimed to investigate the dynamic changes of Mycoplasma pneumoniae pneumonia (MPP) in children in a general hospital.MethodsA total of 2011 CAP children aged 1–16 years hospitalized at Peking University Third Hospital from 2017 to 2019 were enrolled by cross-sectional study for the retrospective analysis of the clinical data mainly including seasonal distribution of MPP, hospital stay, severity, complications, use of flexible bronchoscopy, and hospitalization costs. The dynamic changes of CAP and MPP children within 3 consecutive years and the differences between the MPP group and non-MPP groups were compared.ResultsThe proportion of CAP children among hospitalized children was 32.4%, 38.5%, and 39.5% in 2017, 2018, and 2019, respectively, showing an upward trend (P<0.05).The prevalence rate of MPP was highest in the third quarter (30.2%) and the fourth quarter (39.2%) and lowest in the second quarter (13.2%) (χ2=51.8, P<0.05). Compared with the non-MPP group, the MPP group had significantly higher incidence of severe pneumonia (19.4% vs. 12.0%, χ2=20.99), incidence of complications (16.1% vs. 6.5%, χ2=48.24), proportion of patients undergoing flexible bronchoscopy (38.4% vs. 9.0%, χ2=252.79), and hospitalization costs (all P<0.05), along with significantly longer hospital stay (6 vs. 4 days, z=−11.131). A dynamic comparison of the clinical characteristics of MPP in 3 years showed that the number of children with MPP increased significantly in preschoolers in 2018 (37.3%) and in school-aged or older children in 2019 (53%) (P<0.05). MPP peaks occurred in August 2018 and November 2019. The total hospitalization costs, examination fees, and non-medication treatment costs increased significantly (the z values were 35.24, 46.79, and 9.64, respectively; P<0.05) year by year among MPP children; there was no significant difference in the medication cost over these 3 years (z=4.81, P>0.05).ConclusionsThe proportions of severe pneumonia, complications, and use of flexible bronchoscopy as well as the hospitalization days and costs are higher in MPP children. General hospitals should develop integrated clinical quality control programs for MPP children, so as to optimize the allocation of medical resources.

Interventional Bronchoscopy.

For over 150 years, bronchoscopy, especially flexible bronchoscopy, has been a mainstay for airway inspection, the diagnosis of airway lesions, therapeutic aspiration of airway secretions, and transbronchial biopsy to diagnose parenchymal lung disorders. Its utility for the diagnosis of peripheral pulmonary nodules and therapeutic treatments besides aspiration of airway secretions, however, has been limited. Challenges to the wider use of flexible bronchoscopy have included difficulty in navigating to the lung periphery, the avoidance of vasculature structures when performing diagnostic biopsies, and the ability to biopsy a lesion under direct visualization. The last 10-15 years have seen major advances in thoracic imaging, navigational platforms to direct the bronchoscopist to lung lesions, and the ability to visualize lesions during biopsy. Moreover, multiple new techniques have either become recently available or are currently being investigated to treat a broad range of airway and lung parenchymal diseases, such as asthma, emphysema, and chronic bronchitis, or to alleviate recurrent exacerbations. New bronchoscopic therapies are also being investigated to not only diagnose, but possibly treat, malignant peripheral lung nodules. As a result, flexible bronchoscopy is now able to provide a new and expanding armamentarium of diagnostic and therapeutic tools to treat patients with a variety of lung diseases. This State-of-the-Art review succinctly reviews these techniques and provides clinicians an organized approach to their role in the diagnosis and treatment of a range of lung diseases.

Usefulness of flexible bronchoscopy for securing the airway in traumatic tracheal perforation during tracheostomy with development of tracheo-esophageal fistula

Usefulness of flexible bronchoscopy for securing the airway in traumatic tracheal perforation during tracheostomy with development of tracheo-esophageal fistula

SUCCESSFUL REMOVAL OF A DENTAL CROWN WITH CRYOTHERAPY AND RIGID BRONCHOSCOPY

SESSION TITLE: Tuesday Fellows Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Aspiration of foreign bodies occurs most frequently in extremes of age, and these bodies are commonly lodged in the segment of the right middle lobe.1 Foreign body aspiration in adults is associated with such risk factors as alcoholism, drug abuse, mental retardation, and neuromuscular conditions. The most common foreign bodies aspirated are food and broken fragments of teeth.1,2 Foreign body aspiration can cause such complications as atelectasis, obstructive pneumonitis, bronchial stenosis, and endobronchial actinomycosis.3 CASE PRESENTATION: Our patient is a 47yo M with a known history of epilepsy who presented after his primary care physician found a foreign body on chest x-ray (CXR). One year prior to presentation he had a seizure and a dental crown was dislodged from his front tooth. He immediately experienced wheezing, and minor shortness of breath, but this resolved within days. Nine months later he began to have chest pain, worse in the mornings and with inspiration, moderate in severity, and associated with cough and fever. He was treated with multiple rounds of antibiotics as an outpatient for presumed bronchitis. CXR revealed what was believed to be his crown and a right upper lobe post-obstructive pneumonia. He underwent flexible bronchoscopy, which noted complete occlusion of the entrance of the right upper lobe with granulation tissue surrounding the crown. In order to facilitate the removal of the foreign body, rigid bronchoscopy was used. Forceps failed to grasp the crown, and it was successfully removed with the cryoprobe. During the retrieval the crown was dislodged and moved to the right lower lobe where it was finally removed from the patient. He was noted to have purulent drainage coming from the right upper lobe after removal of the foreign body. He did present to the emergency room three days later for pneumonia and acute hypoxemic respiratory failure. CXR noted diffuse interstitial infiltration and he was admitted for treatment. DISCUSSION: Cryoadhesion has been an effective means of removing foreign bodies, and this modality has been successful with various objects. The cryoprobe has been shown to be most useful with objects that have a high water content given to its ability to obtain sub-zero temperatures in a matter of seconds. CONCLUSIONS: Rigid bronchoscopy has benefit over flexible for centrally located foreign bodies, large amount of granulation tissue, or objects that require manipulation. Complications from rigid bronchoscopy include pneumothorax, bleeding, and hypoxia. Patient selection and the skill level of the operator are crucial in preventing adverse outcomes.2 Reference #1: Oke V., Vadde R., Munigikar P., et al. Use of flexible bronchoscopy in an adult for removal of an aspirated foreign body at a community hospital. Journal of Community Hospital Internal Medicine Perspectives. 2015;5(5):28589. Reference #2: Baharloo F, Veyckemans F, Francis C, Biettlot MP, Rodenstein DO. Tracheobronchial foreign bodies: Presentation and management in children and adults. Chest. 1999;115:1357–62. Reference #3: Folch E, Mehta AC. Foreign body aspiration and flexible bronchoscopy. In: Flexible Bronchoscopy. 3rd edition: Wang KP, , Mehta AC, Turner JF. Chichester, Wiley-Blackwell. 2012, pp 238–49. DISCLOSURES: No relevant relationships by Benjamin Batson, source=Web Response No relevant relationships by Ximena Solis, source=Web Response No relevant relationships by Andres Yepes, source=Web Response

DOZ047.105: Minimally invasive surgical approach for posterior tracheobronchopexy to treat severe tracheobronchomalacia

Abstract Purpose Posterior tracheobronchopexy directly addresses membranous airway intrusion in severe tracheobronchomalacia (TBM). Our experience of posterior tracheobronchopexy through an open approach in a large series of patients has been previously reported by us. This study aimed to review lessons learned from our initial series of posterior tracheobronchopexy through a minimally invasive surgical approach. Methods A retrospective review of all patients with symptomatic TBM who underwent video-assisted or robot video-assisted thoracoscopic posterior tracheobronchopexy between October 2016 and January 2019 was carried out. Results Fourteen patients underwent video-assisted (n = 4) or robotic video-assisted (n = 10) thoracoscopic posterior tracheobronchopexy (age range: 8 months–19 years). Two patients had a history of esophageal atresia (type C) repair; none of the other patients had undergone prior operations. Two patients required open conversion to achieve the desired precision of suture placement. Operative times ranged from 4.5 to 15 hours, depending on the additional procedures performed. The intraoperative bronchoscopic evaluation demonstrated marked improvement in airway patency of all patients at the conclusion of each case. Patients were hospitalized 2 to 7 days, with 0 to 4 days for ICU observation. One patient with bronchopulmonary dysplasia and diffuse TBM, including segmental bronchi, required longer hospitalization and prolonged mechanical ventilation support. Follow-up after surgery ranged from 1 to 27 months. Three patients required subsequent anterior aortopexy and tracheopexy. In these three cases, dynamic tracheobronchoscopy showed that posterior tracheopexy remained intact; nonetheless, anterior airway support was still required to prevent dynamic anterior airway collapse. Conclusions The thoracoscopic approach for posterior tracheobronchopexy, while challenging, can be applied in children with severe TBM. As experience is gained, more complicated procedures and reoperative cases are possible. The simultaneous use of flexible bronchoscopy is mandatory to confirm precision by providing luminal visualization during suture placement. Thoracoscopic surgery with robotic assistance can eliminate some technical limitations of the video-assisted approach by providing an easier platform for very complicated suturing angles.

Competences in bronchoscopy for Intensive Care Unit, anesthesiology, thoracic surgery and lung transplantation.

Over the last decades, the use of flexible bronchoscopy has greatly increased in intensive care, anesthesia and thoracic surgery for diagnostic purpose, management of critical patients and to facilitate airway management for tracheal intubation, one lung ventilation and lung transplant management. The huge availability of endoscopic instruments and devices for airway management has amplified indications and possibilities for bronchoscopic procedures performed by intensive care physicians, anesthesiologist, endoscopists, and surgeons too. These practices need adequate technical skills that can be acquired only through defined learning pathways. This manuscript summarizes the indications and the competencies needed to perform bronchoscopic procedures in intensive care, anesthesia and thoracic surgery settings.

Bronchoscopy in critical care

### Key points In recent years, the use of flexible bronchoscopy (FB) has increased in critical care and anaesthesia. It has become a standard of care for examining, diagnosing, and managing critical care patients, and an important adjunct in anaesthetic management of airway problems. Improved knowledge and awareness of the anatomy and physiology of the procedure facilitates appropriate, safe, and effective use of the bronchoscope. This article focuses on FB, with only occasional reference to the techniques involved in rigid bronchoscopy, which are generally beyond the scope of this article. In 1897, Gustav Killian, a German laryngologist and ‘the father of bronchoscopy’, viewed the trachea and main bronchi through the larynx via a rigid oesophagoscope, and removed a foreign body.1 In 1904, Chevalier Jackson added an electric light source at the distal end, and a suction channel. In the 1960s, Shigeto Ikeda, a Japanese physician, introduced the first fibreoptic bronchoscope. By the end of the 1980s, Asahi Pentax Company integrated a charge-coupled device, permitting video monitoring of the airway and heightening its educational and clinical benefits.2 Over time, a range of various sizes and lengths have been introduced for use across different patient populations. There are two main types of bronchoscopes: rigid and flexible. Rigid bronchoscopy uses a straight metal tube with …

Usefulness of flexible bronchoscopy in children with suspected pulmonary tuberculosis who have difficulty in sputum expectoration

Purpose: To assess the usefulness of flexible bronchoscopy in patients with suspected pulmonary tuberculosis (PTB) who have diffi-culty in sputum expectoration. Methods: The subjects of this study were patients who were suspected of PTB and visited the Division of Pediatric Pulmonology at a tertiary hospital from April 2006 to March 2016. PTB suspects were determined by clinical symptoms, radiologic findings, and im-munologic studies. We aimed to examine the value and safety of bronchoscopy in diagnosis and differential diagnosis of PTB in PTB- suspected patients. The diagnostic criteria for PTB were defined when Mycobacterium tuberculosis was cultured in the sputum speci-men or in the bronchial washing fluid. Results: A total of 19 PTB suspects were included. One patient was diagnosed with PTB by using the sputum study. However, the re-maining 18 patients could not expectorate sputum or showed no evidence of Mycobacterium tuberculosis infection from the spu-tum study. Of the 18 patients, 15 underwent bronchoscopy. After bronchoscopy, 6 patients were diagnosed with PTB and 9 patients were diagnosed with Mycoplasma, viral, or fungal pneumonia, and tumors. For antituberculous drug resistance, there were 1 case of isoniazid (INH) resistance and 1 case of concurrent resistance to INH and prothionamide. There was no multidrug-resistant tubercu-losis. None of the patients had significant complications due to bronchoscopy. Conclusion: Flexible bronchoscopy appears to be a definitive and safe procedure for the differential diagnosis of patients suspect-ing PTB in children who have difficulty expectorating sputum. (Allergy Asthma Respir Dis 2017;5:287-293)

Usefulness of Flexible Bronchoscopy During Noninvasive Positive Pressure Ventilation in Severe Respiratory Failure: a Case Report

Usefulness of Flexible Bronchoscopy During Noninvasive Positive Pressure Ventilation in Severe Respiratory Failure: a Case Report

Combined use of flexible bronchoscopy and video laryngoscopy for endotracheal intubation in patients with King laryngeal tube in situ

Combined use of flexible bronchoscopy and video laryngoscopy for endotracheal intubation in patients with King laryngeal tube in situ

Foreign Body Inhalation in the Adult Population: Experience of 25,998 Bronchoscopies and Systematic Review of the Literature.

Foreign body aspiration is an uncommon entity in adults. Herein, we describe our experience with flexible bronchoscopy in the removal of tracheobronchial foreign bodies in adults. We also conducted a systematic review of the literature on the topic of foreign body inhalation in adults managed with flexible bronchoscopy. The bronchoscopy database (from 1979 to 2014) was reviewed for subjects > 12 y of age with a history of foreign body aspiration managed with flexible bronchoscopy. Demographic, clinical, and bronchoscopy data were collected and analyzed. PubMed was reviewed for studies describing the use of flexible bronchoscopy for foreign body extraction in adults. During the study period, a total of 25,998 flexible bronchoscopies were performed. Of these, 65 subjects (mean age of 32.8 y, 49 males) were identified who had undergone bronchoscopy for foreign body aspiration. Nonresolving pneumonia (30.6%), direct foreign body visualization (24.6%), and segmental collapse (18.4%) were the most common radiological abnormalities. Foreign bodies were identified in 49 cases during bronchoscopy and successfully removed in 45 (91.8%) subjects with no major complications. Metallic (41%) and organic (25.6%) foreign bodies were the most common. Shark-tooth (44.9%) and alligator (32.6%) were the most commonly used forceps in retrieving the foreign bodies. The systematic review yielded 18 studies (1,554 subjects with foreign body inhalation). In adults, the proportion of flexible bronchoscopy (6 studies, 354/159,074 procedures) performed for the indication of foreign bodies among the total flexible bronchoscopies was 0.24% (95% CI 0.18-0.31). The overall success of flexible bronchoscopy (18 studies, 1,185 subjects) for foreign body extraction was 89.6% (95% CI 86.1-93.2). Foreign body aspiration is a rare indication for flexible bronchoscopy in adults. Flexible bronchoscopy has a high success rate in removal of inhaled foreign body and can be considered the preferred initial procedure for management of airway foreign bodies in adults.

Application of flexible bronchoscopy in inhalation lung injury

BackgroundAs acute inhalational injury is an uncommon presentation to most institutions, a standard approach to its assessment and management, especially using flexible bronchoscopy, has not received significant attention.MethodsThe objective of this study is to evaluate the value of using flexible bronchoscopy as part of the evaluation and management of patients with inhalational lung injury. Twenty-three cases of inhalational lung injury were treated in our three hospitals after a fire in a residential building. The twenty cases that underwent bronchoscopy as part of their management are included in this analysis. After admission, the first bronchoscopy was conducted within 18-72 hours post inhalational injury. G2-level patients were reexamined 24 hours after the first bronchoscopy, while G1-level patients were reexamined 72 hours later. Subsequently, all patients were re-examined every 2-3 days until recovered or until only tunica mucosa bronchi congestion was identified by bronchoscopy.ResultsTwenty patients had airway injury diagnosed by bronchoscopy including burns to the larynx and glottis or large airways. Bronchoscopic classification of the inhalation injury was performed, identifying 12 cases of grade G1 changes and 8 cases of grade G2. The airway injury in the 12 cases of grade G1 patients demonstrated recovery in 2-8 days, in the airway injury of the 8 cases of grade G2 patients had a prolonged recovery with airway injury improving in 6-21 days averaged. The difference in recovery time between the two groups was significant (P <0.05).ConclusionsThe use of flexible bronchoscopy has great value in the diagnosis of inhalational injury without any complications. Its use should be incorporated into clinical practice.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1476676925108926