1
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Yano T. Impact and potential use of disposable single-use endoscopes. Dig Endosc 2023; 35:866-868. [PMID: 37313679 DOI: 10.1111/den.14596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/16/2023] [Indexed: 06/15/2023]
Affiliation(s)
- Tomonori Yano
- Department of Gastroenterology and Endoscopy, National Cancer Center Hospital East, Chiba, Japan
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2
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Yao A, Liu Z, He W, Rao H, Wang C, Xie S. Brochoscopic Airway Clearance Therapy vs. Conventional Sputum Aspiration: The Future of Flexible Brochoscopes in Intensive Care Units? Diagnostics (Basel) 2023; 13:3276. [PMID: 37892097 PMCID: PMC10606468 DOI: 10.3390/diagnostics13203276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: The aim of our study is to investigate the effectiveness of bronchoscopic airway clearance therapy (B-ACT) on severe pneumonia (SP) patients with invasive mechanical ventilation (IMV) in the intensive care unit (ICU). (2) Methods: Our study retrospectively enrolled 49 patients with sputum aspiration and 99 patients with B-ACT, and the latter were divided into the ≤once every 3 days group (n = 50) and >once every 3 days group (n = 49). (3) Results: We found most laboratory blood results were significantly improved in the B-ACT group as compared with those in sputum aspiration group (p < 0.05). Patients in the B-ACT group and those in ≤once every 3 days group also had significantly better survival to hospital discharge than those in their counterpart groups (Logrank p < 0.001). In patients with cardiopulmonary diseases or positive cultures for bacteria, the B-ACT group and those in the ≤once every 3 days group had significantly better survival outcomes to discharge than those in their counterpart groups (Logrank p < 0.001). B-ACT and the average frequency of ≤once every 3 days had significantly better impact on survival outcomes than their counterpart groups (HR: 0.444, 95% CI: 0.238-0.829, p = 0.011; HR: 0.285, 95% CI: 0163-0.498, p < 0.001). (4) Conclusions: In the future, flexible bronchoscopes may paly an important role in ACT for SP patients with IMV.
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Affiliation(s)
- Anjie Yao
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China;
| | - Zixuan Liu
- School of Medicine, Tongji University, Shanghai 200092, China; (Z.L.); (W.H.); (H.R.)
| | - Wenni He
- School of Medicine, Tongji University, Shanghai 200092, China; (Z.L.); (W.H.); (H.R.)
| | - Hanyu Rao
- School of Medicine, Tongji University, Shanghai 200092, China; (Z.L.); (W.H.); (H.R.)
| | - Changhui Wang
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China;
| | - Shuanshuan Xie
- Department of Respiratory Medicine, Shanghai Tenth People’s Hospital, School of Medicine, Tongji University, Shanghai 200072, China;
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3
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O'Reilly EM, Sweeney AM, Deasy KF, Kennedy MP. A Pilot Clinical Evaluation of a New Single Use Bronchoscope. J Bronchology Interv Pulmonol 2023; 30:381-382. [PMID: 36252187 DOI: 10.1097/lbr.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Kevin F Deasy
- Department of Respiratory Medicine, Cork University Hospital, Wilton
| | - Marcus P Kennedy
- Department of Respiratory Medicine, Cork University Hospital, Wilton
- College of Medicine and Health, University College Cork, Cork, Ireland
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4
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He S, Xie L, Liu J, Zou L. Single-use flexible bronchoscopes vs traditional reusable flexible bronchoscopes: a prospective controlled study. BMC Pulm Med 2023; 23:202. [PMID: 37296389 DOI: 10.1186/s12890-023-02478-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Single-use flexible bronchoscopes(SFB) eliminate the risk of bronchoscopy-related infection compared with traditional reusable flexible bronchoscopes(RFB). At present, there is no comparative study between SFB and RFB in the aspects of biopsy and interventional therapy. This study aims to explore whether SFB can perform complex bronchoscopic procedures such as transbronchial biopsies just like RFB. METHODS We conducted a prospective controlled study. A total of 45 patients who required bronchoscopic biopsy in our hospital from June 2022 to December 2022 were enrolled. The patients were divided into the SFB group and the RFB group, and routine bronchoscopy, bronchoalveolar lavage, and biopsy were performed respectively. Data on the time of routine bronchoscopy, the recovery rate of bronchoalveolar lavage fluid(BALF), biopsy time, and bleeding volume were collected. Then we used the two-sample t-test and the χ2 test to assess the performance differences between SFB and RFB. We also designed a questionnaire to compare the performance between SFB and RFB by different bronchoscope operators. RESULTS The routine examination time of SFB and RFB was 3.40 ± 0.50 min and 3.55 ± 0.42 min, respectively. There was no significant difference between the two groups (P = 0.308). The recovery rate of BALF was (46.56 ± 8.22) % in the SFB group and (47.00 ± 8.07) in the RFB group, without a significant difference between the two groups(P = 0.863). The biopsy time was similar(4.67 ± 0.51 min VS 4.57 ± 0.45 min) in both groups, with no significant difference(P = 0.512). The positive biopsy rate was 100% in both groups, with no significant difference. Overall, the bronchoscope operators were generally satisfied with SFB. CONCLUSION SFBs are non-inferior to RFBs in routine bronchoscopy, bronchoalveolar lavage, and biopsy. It is suggested that SFBs have a wider clinical application.
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Affiliation(s)
- Shuzhen He
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lihua Xie
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China.
| | - Jianming Liu
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Lijun Zou
- Department of Pulmonary and Critical Care Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
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5
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Gaffuri M, Capaccio P, Torretta S, Daga M, Zuccotti GV, Pignataro L. An Unusual Retained Choanal Foreign Body: A Possible Complication of COVID-19 Testing With Nasopharyngeal Swab. EAR, NOSE & THROAT JOURNAL 2023; 102:NP136-NP139. [PMID: 33634718 DOI: 10.1177/0145561321993933] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Testing for coronavirus disease 2019 is critical in controlling the pandemic all over the world. Diagnosis of severe acute respiratory syndrome coronavirus-2 infection is based on real-time polymerase chain reaction performed on nasopharyngeal swab. If not adequately performed, the viral specimen collection can be painful and lead to complications. We present a complication occurred during a nasopharyngeal swab collection performed in a noncooperative patient where the plastic shaft of the swab fractured during the procedure, resulting in swab tip retention deep into the nasal cavity. The foreign body was found endoscopically, stuck between the nasal septum and the superior turbinate tail at the upper level of the left choana and removed under general anesthesia in a negative pressure operating room with the health care personnel wearing personal protective equipment. Unpleasant complications like the one described can happen when the swab is collected without the necessary knowledge of nasal anatomy or conducted inappropriately, especially in noncooperative patients. Moreover, the design of currently used viral swabs may expose to accidental rupture, with risk of foreign body retention in the nasal cavities. In such cases, diagnosis and treatment are endoscopy-guided procedures performed in an adequate setting to minimize the risk of spreading of the pandemic.
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Affiliation(s)
- Michele Gaffuri
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
| | - Pasquale Capaccio
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Biomedical, Surgical and Dental Sciences, 9304University of Milan, Italy
| | - Sara Torretta
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
| | - Marco Daga
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
| | - Gian Vincenzo Zuccotti
- Department of Biomedical and Clinical Sciences Luigi Sacco, 9304University of Milan, Italy
| | - Lorenzo Pignataro
- 9339Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Otolaryngology and Head and Neck Surgery, Milan, Italy.,Department of Clinical Sciences and Community Health, 9304University of Milan, Italy
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6
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Deasy KF, Sweeney AM, Danish H, O'Reilly E, Ibrahim H, Kennedy MP. Single Use or Disposable Flexible Bronchoscopes: Bench Top and Preclinical Comparison of Currently Available Devices. J Intensive Care Med 2023; 38:519-528. [PMID: 36609193 PMCID: PMC10114257 DOI: 10.1177/08850666221148645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Data regarding the risk of infection related to reusable bronchoscopes, the global drive toward disposable technology and the COVID-19 pandemic have led to an increase in the use and production of single use or disposable bronchoscopes. An in-depth comparison of all available devices has not been published. METHODS A benchtop comparison of the Ambu®aScopeTM, Boston Scientific® EXALTTM Model B, the Surgical Company Broncoflex© Vortex, Pentax® Medical ONE Pulmo™, and Vathin® H-SteriscopeTM (all 2.8 mm inner dimension other than the Pentax single-use flexible bronchoscope (3 mm)) was undertaken including measurement of maximal flexion and extension angles, thumb force required and suction with and without biopsy forceps. Thereafter, preclinical assessment was performed with data collected including experience, gender, hand size, and scope preference. RESULTS The Vathin single-use flexible bronchoscope had the biggest range of tip movement from flexion to extension with and without forceps. The Boston single-use flexible bronchoscope required the maximal thumb force but had the least reduction of tip movement with forceps. The Boston single-use flexible bronchoscope significantly outperformed all other scopes including the standard Pentax scope and was the only scope capable of suctioning pseudo-mucus around the forceps. Although there was no significant difference in preference in the overall group, females and those with smaller hand size preferred the Pentax and males the Broncoflex single-use flexible bronchoscope. CONCLUSIONS Currently available single-use flexible bronchoscopes differ in several factors other than scope sizes and monitor including suction, turning envelope, and handle size. Performance in the clinical setting will be key to their success.
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Affiliation(s)
| | - Anne-Marie Sweeney
- Department of Respiratory Medicine, 57983Cork University Hospital, Cork, Ireland
| | - Hammad Danish
- Department of Respiratory Medicine, 57983Cork University Hospital, Cork, Ireland
| | - Emily O'Reilly
- Department of Respiratory Medicine, 57983Cork University Hospital, Cork, Ireland
| | - Hisham Ibrahim
- Department of Respiratory Medicine, 57983Cork University Hospital, Cork, Ireland
| | - Marcus Peter Kennedy
- Department of Respiratory Medicine, 57983Cork University Hospital, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland
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7
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Wayne MT, Valley TS, Arenberg DA, De Cardenas J, Prescott HC. Temporal Trends and Variation in Bronchoscopy Use for Acute Respiratory Failure in the United States. Chest 2023; 163:128-138. [PMID: 36007595 PMCID: PMC9859725 DOI: 10.1016/j.chest.2022.08.2210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND National data on bronchoscopy for the evaluation of acute respiratory failure are lacking, and the limited available data suggest wide variation in use. RESEARCH QUESTION How commonly is bronchoscopy performed among hospitalizations with acute respiratory failure? How has use changed over time and across hospitals? STUDY DESIGN AND METHODS This was an observational cohort study of adult hospitalizations (2012-2018) treated with invasive mechanical ventilation (IMV) using the National Inpatient Sample, which represents 97% of all hospitalizations in the United States. We measured the proportion of hospitalizations treated with IMV who underwent bronchoscopy and assessed trends in bronchoscopy use over time. Multilevel linear regression models were used to quantify hospital-level variation, adjusting for differences in patient and hospital characteristics. RESULTS We identified 6,101,070 IMV-treated hospitalizations (2012-2018), of whom 609,405 underwent bronchoscopy; among hospitalizations receiving bronchoscopy, mean age was 61 years, 41.8% were women, and in-hospital mortality was 30.8%. The percentage of IMV-treated hospitalizations receiving bronchoscopy increased from 9.5% (95% CI, 9.1%-9.9%) in 2012 to 10.8% (95% CI, 10.4%-11.2%) in 2018 (P < .001 for difference). In 2018, bronchoscopy use varied from 0% to 57.1% among 1,787 hospitals, and in multilevel models adjusted for patient and hospital characteristics, 16.0% of the variation was explained at the hospital level. The median OR was 2.13 (95% CI, 2.05-2.21), indicating 113% increased odds of receiving bronchoscopy if moving from a lower-use to a higher-use hospital. INTERPRETATION Bronchoscopy use among hospitalizations treated with IMV has increased over time. The large variation in use of bronchoscopy across hospitals suggests potentially unwarranted practice variation and need for further studies to clarify which patients benefit from bronchoscopy.
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Affiliation(s)
- Max T Wayne
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI.
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Douglas A Arenberg
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI
| | - Jose De Cardenas
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; Section of Thoracic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Hallie C Prescott
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
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8
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Infection control in the bronchoscopy suite: effective reprocessing and disinfection of reusable bronchoscopes. Curr Opin Pulm Med 2023; 29:21-28. [PMID: 36354125 DOI: 10.1097/mcp.0000000000000925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE OF REVIEW With advancements in technology, flexible bronchoscopes have become thinner in diameter and in need of more thorough reprocessing to prevent infection transmission than ever before. Many experienced bronchoscopists are not aware of the critical steps involved in effective bronchoscope reprocessing and we hope to bridge this gap by describing this process in detail. RECENT FINDINGS Bronchoscope reprocessing includes several distinct steps (precleaning, leak testing, manual cleaning, visual inspection, terminal reprocessing, rinsing and drying). Each step is comprehensive and needs to be carried out systematically by trained personnel. Failure of any step can lead to serious downstream events such as outbreaks and pseudo-outbreaks. Some experts now recommend sterilization when feasible, although high-level disinfection remains the minimum standard. We also will review some literature on the utility of borescopes, automated endoscope reprocessors and disposable bronchoscopes. SUMMARY Our article will focus on the most recent recommendations for effective reprocessing and disinfection of reusable bronchoscopes.
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9
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What Have We Learned About Transmission of COVID-19: Implications for PFT and Pulmonary Procedures. Clin Chest Med 2022; 44:215-226. [PMID: 37085215 PMCID: PMC9678821 DOI: 10.1016/j.ccm.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Because of the potential for high aerosol transmission during pulmonary function testing and pulmonary procedures, performing these tests and procedures must be considered carefully during the coronavirus disease-2019 (COVID-19) pandemic. Much has been learned about the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by aerosols and the potential for such transmission through pulmonary function tests and pulmonary procedures, and subsequently preventative practices have been enhanced and developed to reduce the risk of transmission of virus to patients and personnel. This article reviews what is known about the potential for transmission of SARS-CoV-2 during pulmonary function testing and pulmonary procedures and the recommended mitigation steps to prevent the spread of COVID-19.
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10
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Campbell J, Pryor A, Docimo S. Transcystic Choledochoscopy Utilizing a Disposable Choledochoscope: How We Do It. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2022; 32:616-620. [PMID: 35960694 DOI: 10.1097/sle.0000000000001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Biliary disease is common occurrence and can make up a large portion of the practice of a general surgeon. Choledocholithasis is a common entity amongst those with biliary disease. Although modern trends favor endoscopic retrograde cholangiopancreatography (ERCP) and other imaging modalities for the diagnosis and management of choledocholithiasis, laparoscopic common bile duct exploration (LCBDE) is likely underutilized. METHODS A literature summary utilizing a PUBMED search was performed to provide an up-to-date account regarding the latest data on LCBDE. A video identifying and explaining the critical components of a LBCDE procedure is provided. RESULTS LCBDE is an underutilized procedure which offers equivalent clinical outcomes compared with ERCP along with a shorter length of stay and reduced costs. LCBDE is also noted to be an effective option for common bile duct stones in the setting of altered anatomy, such as a Roux-en-Y gastric bypass. CONCLUSION Although modern trends favor ERCP and other imaging modalities for the diagnosis and management of choledocholithiasis, LCBDE is likely underutilized by surgeons. LCBDE can provide many benefits to patients including avoidance of additional procedures, shorter length of stay, higher success rates, and less costs. Out video should act is a guide for those surgeons interested in implementation LCBDE in their practice.
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Affiliation(s)
- John Campbell
- General Surgery Resident, Stony Brook Medicine, Stony Brook, NY
| | - Aurora Pryor
- Surgery, Chief Bariatric, Foregut and Advanced GI Surgery, Vice Chair for Clinical Affairs, Stony Brook University
| | - Salvatore Docimo
- Surgery, University of South Florida, Morsani College of Medicine, Tampa, FL
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11
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Hogan D, Rauf H, Kinnear N, Hennessey D. The Carbon Footprint of Single-Use Flexible Cystoscopes compared to Reusable Cystoscopes. J Endourol 2022; 36:1460-1464. [PMID: 35607858 DOI: 10.1089/end.2021.0891] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Single-use devices for endourological procedures are becoming more popular. The environmental impact of single-use instruments is relatively unknown. This study aimed to compare the carbon footprint of single-use versus reusable flexible cystoscopes based on waste production and estimated carbon emissions. METHODS An analysis of the solid waste produced when using the aScope™ 4Cysto (Ambu®) single-use flexible cystoscope compared to the reusable Cysto-Nephro Videoscope CYF-VA2 (Olympus®) was performed. The solid waste generated was measured (grams) and recorded as either recyclable, landfill or contaminated, and CO2 produced by disposal, manufacture and cleaning was calculated. RESULTS 40 flexible cystoscopies (20 single-use and 20 reusable) were analysed. Median total weight of waste produced was 622g (IQR621-651) for the single-use cystoscope compared to 671.5g (IQR659-677.5) for the reusable cystoscope (p<0.0001). More waste was disposed of by incineration after single-use than reusable cystoscopy (496g [IQR495-525] vs 415g [IQR403-421.5], p<0.0001). However, more waste went to landfill after reusable cystoscopy (256g±0 vs 126g±0, p<0.0001). There was no difference in weight of waste produced based on the indication for cystoscopy (p=0.1570). A total of 2.41kg of CO2 (IQR 2.40-2.44) was produced per case for the single-use flexible cystoscope compared with 4.23kg of CO2 (IQR 4.22-4.24) for the reusable cystoscope (p<0.0001). CONCLUSION Environmental accountability is essential in modern healthcare. This study highlights that disposable flexible cystoscopes have a significantly lower impact on the environment in terms of carbon footprint and landfill. We propose that environmental impact studies should be a routine part of device development for a sustainable future.
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Affiliation(s)
- Donnacha Hogan
- Mercy University Hospital, 36860, Department of Urology, Grenville Place, Cork, Ireland;
| | - Hammad Rauf
- Mercy University Hospital, 36860, Department of Urology, Cork, Ireland;
| | - Ned Kinnear
- Austin Hospital, 96043, Department of Urology, Heidelberg, Victoria, Australia;
| | - Derek Hennessey
- Mercy University Hospital, 36860, Department of Urology, Cork, Ireland;
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12
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Lamb CR, Yavarovich E, Kang V, Servais EL, Sheehan LB, Shadchehr S, Weldon J, Rousseau MJ, Tirrell GP. Performance of a new single-use bronchoscope versus a marketed single-use comparator: a bench study. BMC Pulm Med 2022; 22:189. [PMID: 35550062 PMCID: PMC9095814 DOI: 10.1186/s12890-022-01982-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Single-use flexible bronchoscopes eliminate cross contamination from reusable bronchoscopes and are cost-effective in a number of clinical settings. The present bench study aimed to compare the performance of a new single-use bronchoscope (Boston Scientific EXALT Model B) to a marketed single-use comparator (Ambu aScope 4), each in slim, regular and large diameters. METHODS Three bronchoscopy tasks were performed: water suction and visualization, "mucus" mass (synthetic mucoid mixture) suctioned in 30 s, and "mucus" plug (thicker mucoid mixture) suction. Suction ability, task completion times, and subjective ratings of visualization and overall performance on a scale of one to 10 (best) were compared. All bronchoscopy tasks were completed by 15 physicians representing diversity in specialization including pulmonary, interventional pulmonary, critical care, anesthesia, and thoracic surgery. Each physician utilized the six bronchoscope versions with block randomization by bronchoscope and task. RESULTS Aspirated mean mass of "mucus" using EXALT Model B Regular was comparable to that for an aScope 4 Large (41.8 ± 8.3 g vs. 41.5 ± 5.7 g respectively, p = 0.914). In comparisons of scopes with the same outer diameter, the aspirated mean mass by weight of water and "mucus" was significantly greater for EXALT Model B than for aScope 4 (p < 0.001 for all three diameters). Mean ratings for visualization attributes were significantly better for EXALT Model B compared to aScope 4 (p-value range 0.001-0.029). CONCLUSION A new single-use bronchoscope provided strong suction capability and visualization compared to same-diameter marketed single-use comparators in a bench model simulation.
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Affiliation(s)
- Carla R Lamb
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA.
- Department of Medicine, Tufts Medical Center, Boston, USA.
| | - Ekaterina Yavarovich
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Vincent Kang
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
| | - Elliot L Servais
- Division of Thoracic Surgery, Lahey Hospital and Medical Center, Burlington, MA, USA
| | - Lori B Sheehan
- Division of Anesthesiology, Lahey Hospital and Medical Center, Burlington, MA, USA
- Department of Medicine, Tufts Medical Center, Boston, USA
| | - Sara Shadchehr
- Division of Pulmonary and Critical Care, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, MA, 01805, USA
- Department of Medicine, Tufts Medical Center, Boston, USA
| | - James Weldon
- Boston Scientific Corporation, Marlborough, MA, USA
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13
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Liang Z, Zhou G, Li Y, Pan F, Zeng J, Luan Z, Zhu Q, Xu Y, Zhang N, Xiang L, Jia Y, Sun G, Yang Y. Evaluation of a new developed disposable and portable bronchoscopy system. BMC Pulm Med 2022; 22:136. [PMID: 35395795 PMCID: PMC8990492 DOI: 10.1186/s12890-022-01933-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Bronchoscopy is critical in the treatment of patients with coronavirus disease (COVID-19), and its use is associated with the challenges of stringent sterilization and virus transmission risk. We developed a disposable and portable bronchoscope (YunSendo-R) and compared its safety and function with those of current reusable and single-use bronchoscopes using an animal model. Methods We compared the YunSendo-R system with a commercially available reusable bronchoscope (Olympus, BF-H290) and single-use bronchoscope (Ambu, Ambu® aScope3™). Eight physicians used the three types of bronchoscopes to operate on Guangxi Bama mini pigs. Each operator performed bronchoscopy and completed a 10-point Likert scale questionnaire for evaluating visual ability and manoeuvrability. Operation time and scores were collected. Results Operation time had no significant differences among the three bronchoscopes. In visual ability, the YunSendo-R bronchoscope showed superior performance to the Ambu bronchoscope in image clarity, colour contrast, and illumination (P < 0.05) and no significant difference in performance compared with the Olympus bronchoscope (P > 0.05). The YunSendo-R bronchoscope had similar manoeuvrability to the Olympus bronchoscope and better scope tip flexibility than the Ambu bronchoscope (P > 0.05). No relevant complications were reported. Conclusion We have developed a new bronchoscopy system with the advantages of disposability and portability, which was effective and safe in an animal model. It has better visual ability than the Ambu bronchoscope and similar visual ability and manoeuvrability to the Olympus bronchoscope. The YunSendo-R bronchoscope is a promising device for clinical practice, especially in reusable-endoscope-transmitted infectious diseases such as COVID-19.
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Affiliation(s)
- Zhixin Liang
- Department of Pulmonary and Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Guanzhou Zhou
- Institute of Digestive Diseases, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.,Medical College of Nankai University, Tianjin, 300071, China
| | - Yi Li
- Daichuan Medical (Shenzhen) Co., Ltd., Guangdong, 518000, China
| | - Fei Pan
- Institute of Digestive Diseases, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jiaqi Zeng
- Institute of Digestive Diseases, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.,Medical College of Nankai University, Tianjin, 300071, China
| | - Zhe Luan
- Institute of Digestive Diseases, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Qiang Zhu
- Department of Pulmonary and Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Yi Xu
- Department of Pulmonary and Critical Care Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Nana Zhang
- Institute of Digestive Diseases, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lei Xiang
- Laboratory Animal Center, Chinese PLA General Hospital, Beijing, China
| | - Yunxiao Jia
- Laboratory Animal Center, Chinese PLA General Hospital, Beijing, China
| | - Gang Sun
- Institute of Digestive Diseases, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Yunsheng Yang
- Institute of Digestive Diseases, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China. .,National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China.
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14
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Ho E, Wagh A, Hogarth K, Murgu S. Single-Use and Reusable Flexible Bronchoscopes in Pulmonary and Critical Care Medicine. Diagnostics (Basel) 2022; 12:174. [PMID: 35054345 PMCID: PMC8775174 DOI: 10.3390/diagnostics12010174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 02/04/2023] Open
Abstract
Flexible bronchoscopy plays a critical role in both diagnostic and therapeutic management of a variety of pulmonary disorders in the bronchoscopy suite and the intensive care unit. In the set-ting of the ongoing viral pandemic, single-use flexible bronchoscopes (SUFB) have garnered attention as various professional pulmonary societies have released guidelines regarding uses for SUFB given the concern for risk of viral transmission when using reusable flexible bronchoscopes (RFB). In addition to offering sterility, SUFBs are portable, easily accessible, and may be more cost-effective than RFB when considering the potential costs of treating bronchoscopy-related infections. Furthermore, since SUFBs are one time use, they do not require reprocessing after use, and therefore may translate to reduced cleaning and storage costs. Despite these advantages, RFBs are still routinely used to perform advanced diagnostic and therapeutic bronchoscopic procedures given the need for optimal maneuverability, handling, angle of deflection, image quality, and larger channel size for passing of ancillary instruments. Here, we review the published evidence on the applications of single-use and reusable bronchoscopes in bronchoscopy suites and intensive care units. Specifically, we will discuss the advantages and disadvantages of these devices as pertinent to fundamental, advanced, and therapeutic bronchoscopic interventions.
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Affiliation(s)
- Elliot Ho
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
| | - Ajay Wagh
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
| | - Kyle Hogarth
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
| | - Septimiu Murgu
- Section of Pulmonary and Critical Care Medicine/Interventional Pulmonology, Department of Medicine, The University of Chicago, Chicago, IL 60637, USA; (A.W.); (K.H.); (S.M.)
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15
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Patrucco F, Failla G, Ferrari G, Galasso T, Candoli P, Mondoni M, Piro R, Facciolongo NC, Renda T, Salio M, Scala R, Solidoro P, Mattei A, Donato P, Vaschetto R, Balbo PE. Bronchoscopy during COVID-19 pandemic, ventilatory strategies and procedure measures. Panminerva Med 2021; 63:529-538. [PMID: 34606187 DOI: 10.23736/s0031-0808.21.04533-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has changed bronchoscopy practices worldwide. Bronchoscopy is a high-risk aerosol-generating procedure with a potential for direct SARS-CoV-2 exposure and hospital-acquired infection. Current guidelines about personal protective equipment and environment considerations represent key competencies to minimize droplets dispersion and reduce the risk of transmission. Different measures should be put in field based on setting, patient's clinical characteristics, urgency and indications of bronchoscopy. The use of this technique in SARS-CoV-2 patients is reported primarily for removal of airway plugs and for obtaining microbiological culture samples. In mechanically ventilated patients with SARS-CoV-2, bronchoscopy is commonly used to manage complications such as hemoptysis, atelectasis or lung collapse when prone positioning, physiotherapy or recruitment maneuvers have failed. Further indications are represented by assistance during percutaneous tracheostomy. Continuous positive airway pressure, non-invasive ventilation support and high flow nasal cannula oxygen are frequently used in patient affected by Coronavirus Disease-2019 (COVID-19): management of patients' airways and ventilation strategies differs from bronchoscopy indications, patient's clinical status and in course or required ventilatory support. Sedation is usually administered by the pulmonologist (performing the bronchoscopy) or by the anesthetist depending on the complexity of the procedure and the level of sedation required. Finally, elective bronchoscopy for diagnostic indications during COVID-19 pandemic should be carried on respecting rigid standards which allow to minimize potential viral transmission, independently from patient's COVID-19 status. This narrative review aims to evaluate the indications, procedural measures and ventilatory strategies of bronchoscopy performed in different settings during COVID-19 pandemic.
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Affiliation(s)
- Filippo Patrucco
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità, Novara, Italy - .,Translational Medicine Department, University of Eastern Piedmont, Novara, Italy -
| | - Giuseppe Failla
- Interventional Pneumology Unit, Onco-Haematologic and Pneumo-Haematolgoic Department, AORN A. Cardarelli, Napoli, Italy.,Diagnostic and Therapeutic Bronchoscopy Unit, ARNAS Civico e Benfratelli, Palermo, Italy
| | - Giovanni Ferrari
- Pulmonology and Semi-Intensive Respiratory Units, Medical Department, AO Mauriziano, Torino, Italy
| | - Thomas Galasso
- Interventional Pneumology Unit, Thoraco-Cardio-Vascular Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Piero Candoli
- Interventional Pneumology Unit, Thoraco-Cardio-Vascular Department, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | - Michele Mondoni
- Pulmonology Unit, Cardio-Respiratory Department, Ospedale San Paolo, ASST Santi Paolo e Carlo, Milano, Italy
| | - Roberto Piro
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Nicola C Facciolongo
- Pulmonology Unit, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Teresa Renda
- Pneumology and Thoraco-Pulmonary Physiopathology Unit, Cardio-Thoraco-Vascular Department, Careggi Hospital, Firenze, Italy
| | - Mario Salio
- Respiratory Diseases Unit, Internistic Department, SS Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Raffaele Scala
- Pneumology Unit, Cardio-Thoraco-Neuro-Vascular Department, San Donato Hospital, Azienda USL Toscana Sud Est, Arezzo, Italy
| | - Paolo Solidoro
- Pneumology Unit, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza, Torino, Italy.,Medical Sciences Department, University of Turin, Italy
| | - Alessio Mattei
- Pneumology Unit, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza, Torino, Italy
| | - Paolo Donato
- Intensive Care Unit 1, Emergency Department, AOU Maggiore della Carità, Novara, Italy
| | - Rosanna Vaschetto
- Translational Medicine Department, University of Eastern Piedmont, Novara, Italy.,Intensive Care Unit 1, Emergency Department, AOU Maggiore della Carità, Novara, Italy
| | - Piero E Balbo
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità, Novara, Italy
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16
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Barron S, Kennedy MP. Can single-use bronchoscopes help prevent nosocomial COVID-19 infections? Expert Rev Med Devices 2021; 18:439-443. [PMID: 33891519 DOI: 10.1080/17434440.2021.1920924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction: The reduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has been achieved through numerous public health initiatives worldwide. In the hospital environment, certain high-risk procedures have the potential to cause transmission of the virus to health-care workers and nosocomial transmission to patients through different mechanisms including the generation of aerosols and fomite formation via contamination of medical devices.Areas covered: Aerosol-generating procedures such as bronchoscopy are considered high risk for SARS-CoV-2 transmission. As a result, single-use devices should be used where possible and changing to single-use flexible bronchoscopes has been advised by respiratory societies internationally. In this paper, we outline the rationale for this advice and have analyzed the evidence relating to the reduction in SARS-CoV-2 transmission arising from a switch to these single-use devices and the potential impact that this switch may have on the quality of pulmonology services.Expert opinion: In this paper, we outline the rationale for this advice and have analyzed the evidence relating to the reduction in SARS-CoV-2 transmission arising from a switch to these single-use devices and the potential impact that this switch may have on the quality of pulmonology services.
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Affiliation(s)
- Sarah Barron
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - Marcus Peter Kennedy
- Dept of Respiratory Medicine, Cork University Hospital, Cork, Ireland.,ASSERT Centre, University College Cork, Cork, Ireland.,College of Medicine and Health, University College Cork, Cork, Ireland
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17
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Sampsonas F, Kakoullis L, Karampitsakos T, Papaioannou O, Katsaras M, Papachristodoulou E, Kyriakou G, Bellou A, Tzouvelekis A. Bronchoscopy during the COVID-19 pandemic: effect on current practices and strategies to reduce procedure-associated transmission. Expert Rev Respir Med 2021; 15:773-779. [PMID: 33798401 DOI: 10.1080/17476348.2021.1913058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: Bronchoscopy and related procedures have unambiguously been affected during the Corona Virus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS COV-2). Ordinary bronchoscopy practices and lung cancer services might have changed over this pandemic and for the years to come.Areas covered: This manuscript summarizes the utility of bronchoscopy in COVID-19 patients, and the impact of the pandemic in lung cancer diagnostic services, in view of possible viral spread during these We conducted a literature review of articles published in PubMed/Medline from inception to November 5th, 2020 using relevant terms.Expert opinion: Without doubt this pandemic has changed the way bronchoscopy and related procedures are being performed. Mandatory universal personal protective equipment, pre-bronchoscopy PCR tests, dedicated protective barriers and disposable bronchoscopes might be the safest and simpler way to perform even the most complicated procedures.
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Affiliation(s)
- Fotios Sampsonas
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Loukas Kakoullis
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Theodoros Karampitsakos
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Ourania Papaioannou
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Matthaios Katsaras
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | | | | | - Aggeliki Bellou
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
| | - Argyrios Tzouvelekis
- Respiratory Medicine Department, Internal Medicine Division, University Hospital of Patras, Patras, Greece
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18
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Eber E, Goussard P. Bronchoscopy precautions and recommendations in the COVID-19 pandemic. Paediatr Respir Rev 2021; 37:68-73. [PMID: 33583721 PMCID: PMC7843245 DOI: 10.1016/j.prrv.2021.01.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 12/23/2022]
Abstract
As the airways of SARS-CoV-2 infected patients contain a high viral load, bronchoscopy is associated with increased risk of patient to health care worker transmission due to aerosolised viral particles and contamination of surfaces during bronchoscopy. Bronchoscopy is not appropriate for diagnosing SARS-CoV-2 infection and, as an aerosol generating procedure involving a significant risk of transmission, has a very limited role in the management of SARS-CoV-2 infected patients including children. During the SARS-CoV-2 pandemic rigid bronchoscopy should be avoided due to the increased risk of droplet spread. Flexible bronchoscopy should be performed first in SARS-CoV-2 positive individuals or in unknown cases, to determine if rigid bronchoscopy is indicated. When available single-use flexible bronchoscopes may be considered for use; devices are available with a range of diameters, and improved image quality and degrees of angulation. When rigid bronchoscopy is necessary, jet ventilation must be avoided and conventional ventilation be used to reduce the risk of aerosolisation. Adequate personal protection equipment is key, as is training of health care workers in correct donning and doffing. Modified full face masks are a practical and safe alternative to filtering facepieces for use in bronchoscopy. When anaesthetic and infection prevention control protocols are strictly adhered to, bronchoscopy can be performed in SARS-CoV-2 positive children.
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Affiliation(s)
- Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Auenbruggerplatz 34/2, A-8036 Graz, Austria
| | - Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
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19
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Goussard P, Pohunek P, Eber E, Midulla F, Di Mattia G, Merven M, Janson JT. Pediatric bronchoscopy: recent advances and clinical challenges. Expert Rev Respir Med 2021; 15:453-475. [PMID: 33512252 DOI: 10.1080/17476348.2021.1882854] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and interventional options.Areas covered: We provide a review of recent advances and clinical challenges in pediatric bronchoscopy. This includes single-use bronchoscopes, endobronchial ultrasound, and cryoprobe. Bronchoscopy in persistent preschool wheezing and asthma is included. The indications for interventional bronchoscopy have amplified and included balloon dilatation, endoscopic intubation, the use of airway stents, whole lung lavage, closing of fistulas and air leak, as well as an update on removal of foreign bodies. Others include the use of laser and microdebrider in airway surgery. Experience with bronchoscope during the COVID-19 pandemic has been included in this review. PubMed was searched for articles on pediatric bronchoscopy, including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years.Expert opinion: As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed. There is a scarcity of published evidence in this field. Courses for pediatric interventional bronchoscopy need to be developed. The COVID-19 experience resulted in safer bronchoscopy practice for all involved.
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Affiliation(s)
- P Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - P Pohunek
- Division of Pediatric Respiratory Diseases, Pediatric Department, 2nd Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - E Eber
- Department of Paediatrics and Adolescent Medicine, Head, Division of Paediatric Pulmonology and Allergology, Medical University of Graz, Graz, Austria
| | - F Midulla
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - G Di Mattia
- Department of Maternal Infantile and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - M Merven
- Department Otorhinolaryngology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - J T Janson
- Department of Surgical Sciences, Division of Cardio-Thoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
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