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Kim H. Rigid Bronchoscopy for Post-tuberculosis Tracheobronchial Stenosis. Tuberc Respir Dis (Seoul) 2023; 86:245-250. [PMID: 37102275 PMCID: PMC10555523 DOI: 10.4046/trd.2023.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 04/28/2023] Open
Abstract
The healing process of tracheobronchial tuberculosis (TB) results in tracheobronchial fibrosis causing airway stenosis in 11% to 42% of patients. In Korea, where pulmonary TB is still prevalent, post-TB tracheobronchial stenosis (PTTS) is one of the main causes of benign airway stenosis causing progressive dyspnea, hypoxemia, and often life-threatening respiratory insufficiency. The development of rigid bronchoscopy replaced surgical management 30 years ago, and nowadays PTTS is mainly managed by bronchoscopic intervention in Korea. Similar to pulmonary TB, tracheobronchial TB is treated with combination of anti-TB medications. The indication of rigid bronchoscopy is more than American Thoracic Society (ATS) grade 3 dyspnea in PTTS patients. First, the narrowed airway is dilated by multiple techniques including ballooning, laser resection, and bougienation under general anesthesia. Then, most of the patients need silicone stenting to maintain the patency of dilated airway; 1.5 to 2 years after indwelling, the stent could be removed, this has shown a 70% success rate. Acute complications without mortality develop in less than 10% of patients. Subgroup analysis showed successful removal of the stent was significantly associated with male sex, young age, good baseline lung function and absence of complete one lobe collapse. In conclusion, rigid bronchoscopy could be applied to PTTS patients with acceptable efficacy and tolerable safety.
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Affiliation(s)
- Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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2
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Vannucci J, Capozzi R, Vinci D, Ceccarelli S, Potenza R, Scarnecchia E, Spinosa E, Romito M, Napolitano AG, Puma F. Concomitant Intubation with Minimal Cuffed Tube and Rigid Bronchoscopy for Severe Tracheo-Carinal Obstruction. J Clin Med 2023; 12:5258. [PMID: 37629301 PMCID: PMC10455797 DOI: 10.3390/jcm12165258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/28/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Our aim was to report on the use of an innovative technique for airway management utilizing a small diameter, short-cuffed, long orotracheal tube for assisting operative rigid bronchoscopy in critical airway obstruction. METHODS We retrospectively reviewed the clinical data of 36 patients with life-threatening critical airway stenosis submitted for rigid bronchoscopy between January 2008 and July 2021. The supporting ventilatory tube, part of the Translaryngeal Tracheostomy KIT (Fantoni method), was utilized in tandem with the rigid bronchoscope during endoscopic airway reopening. RESULTS Indications for collateral intubation were either tumors of the trachea with near-total airway obstruction (13), or tumors of the main carina with total obstruction of one main bronchus and possible contralateral involvement (23). Preliminary dilation was necessary before tube placement in only 2/13 patients with tracheal-obstructing tumors (15.4%). No postoperative complications were reported. There was one case of an intraoperative cuff tear, with no further technical problems. CONCLUSIONS In our experience, this innovative method proved to be safe, allowing for continuous airway control. It enabled anesthesia inhalation, use of neuromuscular blockage and reliable end-tidal CO2 monitoring, along with protection of the distal airway from blood flooding. The shorter time of the procedure was due to the lack of need for pauses to ventilate the patient.
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Affiliation(s)
- Jacopo Vannucci
- Department of Thoracic Surgery and Lung Transplantation, University of Rome Sapienza, Policlinico Umberto I, 00161 Rome, Italy
| | - Rosanna Capozzi
- Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy; (R.C.); (D.V.); (S.C.); (R.P.); (E.S.); (E.S.); (M.R.); (A.G.N.); (F.P.)
| | - Damiano Vinci
- Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy; (R.C.); (D.V.); (S.C.); (R.P.); (E.S.); (E.S.); (M.R.); (A.G.N.); (F.P.)
| | - Silvia Ceccarelli
- Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy; (R.C.); (D.V.); (S.C.); (R.P.); (E.S.); (E.S.); (M.R.); (A.G.N.); (F.P.)
| | - Rossella Potenza
- Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy; (R.C.); (D.V.); (S.C.); (R.P.); (E.S.); (E.S.); (M.R.); (A.G.N.); (F.P.)
| | - Elisa Scarnecchia
- Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy; (R.C.); (D.V.); (S.C.); (R.P.); (E.S.); (E.S.); (M.R.); (A.G.N.); (F.P.)
| | - Emilio Spinosa
- Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy; (R.C.); (D.V.); (S.C.); (R.P.); (E.S.); (E.S.); (M.R.); (A.G.N.); (F.P.)
| | - Mara Romito
- Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy; (R.C.); (D.V.); (S.C.); (R.P.); (E.S.); (E.S.); (M.R.); (A.G.N.); (F.P.)
| | - Antonio Giulio Napolitano
- Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy; (R.C.); (D.V.); (S.C.); (R.P.); (E.S.); (E.S.); (M.R.); (A.G.N.); (F.P.)
| | - Francesco Puma
- Department of Thoracic Surgery, University of Perugia Medical School, Ospedale Santa Maria della Misericordia, 06134 Perugia, Italy; (R.C.); (D.V.); (S.C.); (R.P.); (E.S.); (E.S.); (M.R.); (A.G.N.); (F.P.)
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Jeong BH, Lee SH, Kim HH, Yoon HI, Eom JS, Park YS, Cho J, Lee T, Kim SJ, Cho HJ, Park CK, Ko Y, Kwon YS, Kim C, Ji W, Choi CM, Seo KH, Nam HS, Kim H. Trends and an Online Survey on the Use of Rigid Bronchoscopy in Korea. J Korean Med Sci 2023; 38:e13. [PMID: 36647216 PMCID: PMC9842492 DOI: 10.3346/jkms.2023.38.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/20/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although almost all interventional pulmonologists agree that rigid bronchoscopy is irreplaceable in the field of interventional pulmonology, less is known about the types of diseases that the procedure is used for and what difficulties the operators face during the procedure. The purpose of this study is to evaluate what diseases rigid bronchoscopy is used for, whether it is widely used, and what challenges the operators face in Korea. METHODS We enrolled 14 hospitals in this retrospective cohort of patients who underwent rigid bronchoscopy between 2003 and 2020. An online survey was conducted with 14 operators to investigate the difficulties associated with the procedure. RESULTS While the number of new patients at Samsung Medical Center (SMC) increased from 189 in 2003-2005 to 468 in 2018-2020, that of other institutions increased from 0 to 238. The proportion of SMC patients in the total started at 100% and steadily decreased to 59.2%. The proportion of malignancy as the indication for the procedure steadily increased from 29.1% to 43.0%, whereas post-tuberculous stenosis (25.4% to 12.9%) and post-intubation stenosis (19.0% to 10.9%) steadily decreased (all P for trends < 0.001). In the online survey, half of the respondents stated that over the past year they performed less than one procedure per month. The fewer the procedures performed within the last year, the more likely collaboration with other departments was viewed as a recent obstacle (Spearman correlation coefficient, rs = -0.740, P = 0.003) and recent administrative difficulties were encountered (rs = -0.616, P = 0.019). CONCLUSION This study demonstrated that the number of patients undergoing rigid bronchoscopy has been increasing, especially among cancer patients. For this procedure to be used more widely, it will be important for beginners to systematically learn about the procedure itself as well as to achieve multidisciplinary consultation.
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Affiliation(s)
- Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hwan Hee Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jung Seop Eom
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Young Sik Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jaeyoung Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Taehoon Lee
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Seung Joon Kim
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeong Jun Cho
- Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chan Kwon Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yousang Ko
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Yong-Soo Kwon
- Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea
| | - Changhwan Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hyun Seo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hae-Seong Nam
- Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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4
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Muacevic A, Adler JR, Vailati P, Morana G, Crisafulli E, Sartori G, Castaldo N, Fantin A. Removal of a Tracheal Mesh Stent: How I Do It. Cureus 2022; 14:e32140. [PMID: 36601173 PMCID: PMC9805538 DOI: 10.7759/cureus.32140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
Abstract
We illustrate how to remove a stent from the tracheal lumen 12 years after its deployment. Maintaining the stent in situ for a long time degrades the stent materials, making it fragile and very difficult to manipulate. A rigid bronchoscopy approach was chosen for the treatment of this case. We describe the preparation of the intervention and its execution step by step.
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5
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Kim SH, Chang B, Ahn HJ, Kim JA, Yang M, Kim H, Jeong BH. Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside. Medicina (B Aires) 2022; 58:medicina58121762. [PMID: 36556963 PMCID: PMC9782846 DOI: 10.3390/medicina58121762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/27/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Objective: Although rigid bronchoscopy is generally performed in the operating room (OR), the intervention is sometimes emergently required at the intensive care unit (ICU) bedside. The aim of this study is to evaluate the safety of rigid bronchoscopy at the ICU bedside. Materials and Methods: We retrospectively analyzed medical records of patients who underwent rigid bronchoscopy while in the ICU from January 2014 to December 2020. According to the location of rigid bronchoscopic intervention, patients were classified into the ICU group (n = 171, cases emergently performed at the ICU bedside without anesthesiologists) and the OR group (n = 165, cases electively performed in the OR with anesthesiologists). The risk of intra- and post-procedural complications in the ICU group was analyzed using multivariable logistic regression, with the OR group as the reference category. Results: Of 336 patients, 175 (52.1%) were moribund and survival was not expected without intervention, and 170 (50.6%) received invasive respiratory support before the intervention. The most common reasons for intervention were post-intubation tracheal stenosis (39.3%) and malignant airway obstruction (34.5%). Although the overall rate of intra-procedural complications did not differ between the two groups (86.0% vs. 80.6%, p = 0.188), post-procedural complications were more frequent in the ICU group than in the OR group (24.0% vs. 12.1%, p = 0.005). Severe complications requiring unexpected invasive management occurred only post-procedurally and were more common in the ICU group (10.5% vs. 4.8%, p = 0.052). In the fully adjusted model, the ICU group had increased odds for severe post-procedural complications, but statistical significance was not observed (odds ratio, 2.54; 95% confidence interval, 0.73-8.88; p = 0.144). Conclusions: Although general anesthesia is generally considered the gold standard for rigid bronchoscopy, our findings indicate that rigid bronchoscopy may be safely performed at the ICU bedside in selective cases of emergency. Moreover, adequate patient selection and close post-procedural monitoring are required to prevent severe complications.
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Affiliation(s)
- Sang Hyuk Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea
| | - Boksoon Chang
- Department of Pulmonary, Allergy and Critical Care Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul 05278, Republic of Korea
| | - Hyun Joo Ahn
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Jie Ae Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Mikyung Yang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Hojoong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Correspondence: ; Tel.: +82-2-3410-3429; Fax: +82-2-3410-3849
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Bartlett-Pestell S, May J, Sharma A, Alonzo S, Barnes N, Madden BP. A 12-year experience in endobronchial intervention using rigid bronchoscopy - account of a tertiary referral centre. Monaldi Arch Chest Dis 2022; 92. [PMID: 35347973 DOI: 10.4081/monaldi.2022.2161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/03/2022] [Indexed: 11/22/2022] Open
Abstract
We describe our experience of rigid bronchoscopy and endobronchial intervention at a single tertiary centre over a 12-year period. All rigid bronchoscopy procedures between July 2008 and July 2020 (inclusive) were reviewed. All procedures were performed in cardiothoracic theatres by a designated team under general anaesthesia. 2135 rigid bronchoscopies were performed on 1301 patients aged between 18 and 93 years. Complications occurred in 24 (1.12%) procedures. There was one fatality (0.05%). Haemorrhage >100mls occurred in seven (0.33%) all of which were successfully managed endobronchially. Ten procedures (0.5%) were complicated by pneumothorax and an intercostal drain was required for eight. Five patients required intensive care admission post operatively, all of whom were subsequently discharged from hospital. One patient had stent migration. To the best of our knowledge, this is amongst the largest single centre collection of data available for endobronchial intervention using rigid bronchoscopy. We show that rigid bronchoscopy is a safe and effective procedure when performed in a high-volume specialist centre with designated lists involving a specialist multidisciplinary team.
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Affiliation(s)
- Sam Bartlett-Pestell
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - James May
- Department of Cardiothoracic Surgery, St. George's Hospital, Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - Ashutosh Sharma
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - Sunshine Alonzo
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - Natalie Barnes
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
| | - Brendan P Madden
- Department of Cardiothoracic Surgery, St George's University Hospital NHS Foundation Trust, London.
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7
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Chen X, Zhou Y, Yu H, Peng Y, Xia L, Liu N, Lin H. Feasibility analysis of flexible bronchoscopy in conjunction with noninvasive ventilation for therapy of hypoxemic patients with Central Airway Obstruction: a retrospective study. PeerJ 2020; 8:e8687. [PMID: 32296598 PMCID: PMC7150544 DOI: 10.7717/peerj.8687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Interventional bronchoscopy for hypoxemic patients with central airway obstruction (CAO) is typically performed under general anesthesia. This approach poses remarkable challenge for both bronchoscopist and anesthesiologist. Noninvasive ventilation (NIV) during flexible bronchoscopy (FB) has been successfully used in hypoxemic patients, but rarely in the treatment of hypoxemic patients with CAO. OBJECTIVE To evaluate the feasibility of therapeutic FB assisted with NIV for therapy of hypoxemic patients with CAO. METHOD Twenty-nine hypoxemic CAO patients treated with FB from December 2010 to May 2016 in our hospital were retrospectively reviewed, either aided with NIV under sedation (NIV group ) or through artificial airway under general anesthesia (control group). Interventional procedures included balloon dilation, electrocautery and argon plasma coagulation. RESULT Fifteen patients were enrolled in the NIV group and 14 in the control group. The success rate (93.3% VS 92.9%, p = 1.0), procedure time (60.5 ± 4.2 min VS 67.8 ± 5.6 min, p = 0.31) and oxygenation improvement between the two groups have no significant difference. Less reduction of systolic blood pressure and heart rate during procedure was observed in the NIV group. The NIV group showed shorter admission time before procedure than the control group (35.1 ± 4.6 h VS 55.6 ± 5.6 h, p < 0.01). In addition, procedure fee in the NIV group was significantly less than that in the control group (540.7 ± 62.8$ VS975.4 ± 69.5$, p < 0.0001). CONCLUSION FB assisted with NIV is a safe, efficient and economic method for therapy of selected hypoxemic patients with CAO.
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Affiliation(s)
- Xiaoke Chen
- Department of Respiratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yiping Zhou
- Department of Respiratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Haiqiong Yu
- Department of Respiratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Yue Peng
- Department of Anesthesia, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Liping Xia
- Department of Respiratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Nian Liu
- Department of Respiratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hairong Lin
- Department of Respiratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
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8
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Characterization of Applied Forces and Torques During Rigid Bronchoscopy Intubation. J Bronchology Interv Pulmonol 2020; 27:246-252. [DOI: 10.1097/lbr.0000000000000671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Flannery A, Daneshvar C, Dutau H, Breen D. The Art of Rigid Bronchoscopy and Airway Stenting. Clin Chest Med 2018; 39:149-167. [DOI: 10.1016/j.ccm.2017.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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10
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Briault A, Dutau H. [Rigid bronchoscopy]. Rev Mal Respir 2018; 35:578-581. [PMID: 29395565 DOI: 10.1016/j.rmr.2017.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 02/09/2017] [Indexed: 12/17/2022]
Affiliation(s)
- A Briault
- Clinique universitaire de pneumologie, CHU de Grenoble, boulevard de la Chantourne, 38700 La Tronche, France
| | - H Dutau
- Service d'oncologie thoracique, maladies de la Plèvre, pneumologie interventionnelle, hôpital Nord, AP-HM, chemin des Bourrely, 13000 Marseille, France.
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11
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Tan J, Kirthinanda D, Yu DE, Poopalalingam R, Kothandan H. Anaesthesia and peri-interventional morbidity of rigid bronchoscopy: A retrospective analysis. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Jerry Tan
- Department of Anaesthesia, Outram Road, Singapore General Hospital, Singapore, 169608, Singapore
| | - Dinoo Kirthinanda
- Singhealth Residency Program, Ministry of Health Holdings, Singapore, 099253, Singapore
| | - Dawen Esther Yu
- Duke-National University of Singapore Graduate Medical School, Singapore
| | - Ruban Poopalalingam
- Department of Anaesthesia, Outram Road, Singapore General Hospital, Singapore, 169608, Singapore
| | - Harikrishnan Kothandan
- Department of Anaesthesia, Outram Road, Singapore General Hospital, Singapore, 169608, Singapore
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12
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Bite Block for Interventional Pulmonology: Novelty at No Cost. J Bronchology Interv Pulmonol 2016; 23:e42-e43. [PMID: 27764013 DOI: 10.1097/lbr.0000000000000317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Stahl DL, Richard KM, Papadimos TJ. Complications of bronchoscopy: A concise synopsis. Int J Crit Illn Inj Sci 2015; 5:189-95. [PMID: 26557489 PMCID: PMC4613418 DOI: 10.4103/2229-5151.164995] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Flexible and rigid bronchoscopes are used in diagnosis, therapeutics, and palliation. While their use is widespread, effective, and generally safe; there are numerous potential complications that can occur. Mechanical complications of bronchoscopy are primarily related to airway manipulations or bleeding. Systemic complications arise from the procedure itself, medication administration (primarily sedation), or patient comorbidities. Attributable mortality rates remain low at < 0.1% for fiberoptic and rigid bronchoscopy. Here we review the complications (classified as mechanical or systemic) of both rigid and flexible bronchoscopy in hope of making practitioners who are operators of these tools, and those who consult others for interventions, aware of potential problems, and pitfalls in order to enhance patient safety and comfort.
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Affiliation(s)
- David L Stahl
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Kathleen M Richard
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University Medical Center, Columbus, Ohio, USA
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14
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Usefulness of Rigid Bronchoscopic Intervention Using Argon Plasma Coagulation for Central Airway Tumors. Clin Exp Otorhinolaryngol 2015; 8:396-401. [PMID: 26622961 PMCID: PMC4661258 DOI: 10.3342/ceo.2015.8.4.396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/17/2014] [Accepted: 08/08/2014] [Indexed: 12/05/2022] Open
Abstract
Objectives Argon plasma coagulation (APC) is a noncontact form of electrocautery that utilizes ionized argon as the electrical current. A rigid bronchoscopic use of APC for the management of central airway obstruction could be safe and rapidly effective. This study evaluated the usefulness of rigid bronchoscopy with APC for the management of central airway obstructions due to benign or malignant tumors. Methods Twenty patients with obstructing central airway tumors were retrospectively reviewed from February 2008 to February 2013 at Chonnam National University Hospital. All patients received rigid bronchoscopic tumor removal under general anesthesia. APC was applied before and after tumor removal. Results The median age of patients was 59 years (interquartile range [IQR], 51 to 67 years) and 70% were female. The causes of airway obstruction included malignancy (n=8) and benign tumor (n=12). Airway tumors comprised intraluminal lesions (n=11, 55%) and mixed intraluminal/extraluminal lesions (n=9, 45%). The median tumor size was 15 mm (IQR, 10 to 18 mm). The median degree of airway obstruction was significantly reduced after intervention (90% [IQR, 88% to 96%] vs. 10% [IQR, 0% to 20%], P<0.001). The median American Thoracic Society dyspnea grade (3 [IQR, 1 to 4] vs. 1 [IQR, 0 to 1], P<0.001) and forced expiratory volume in one second (1.03 L [IQR, 0.52 to 1.36 L] vs. 1.98 L [IQR, 1.57 to 2.64 L], P=0.004) were significantly improved after intervention. There were no procedure-related acute complications and deaths. Conclusion Rigid bronchoscopy with APC is an effective and safe procedure to alleviate central airway obstruction caused by tumors.
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Abstract
Airway complications after lung transplantation present a formidable challenge to the lung transplant team, ranging from mere unusual images to fatal events. The exact incidence of complications is wide-ranging depending on the type of event, and there is still evolution of a universal characterization of the airway findings. Management is also wide-ranging. Simple observation or simple balloon bronchoplasty is sufficient in many cases, but vigilance following more severe necrosis is required for late development of both anastomotic and nonanastomotic airway strictures. Furthermore, the impact of coexisting infection, rejection, and medical disease associated with high-level immunosuppression further complicates care.
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Affiliation(s)
- Michael Machuzak
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
| | - Jose F Santacruz
- Pulmonary, Critical Care and Sleep Medicine Consultants, Houston Methodist, Houston, TX 77030, USA
| | - Thomas Gildea
- Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Sudish C Murthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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16
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Nisi F, Galzerano A, Cicchitto G, Puma F, Peduto VA. Improving patient safety after rigid bronchoscopy in adults: laryngeal mask airway versus face mask - a pilot study. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:201-6. [PMID: 25995652 PMCID: PMC4425341 DOI: 10.2147/mder.s77995] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background There are still no clear guidelines in the literature on per procedural bronchoscopic management for anesthesiologists, and few relevant datasets are available. To obtain rapid recovery from anesthesia, it is often necessary to keep patients in the recovery room for several hours until they become clinically stable. In this study, we tested the hypothesis that the laryngeal mask airway (LMA) enables better respiratory and hemodynamic recovery than the oxygen face mask (FM) in patients undergoing rigid bronchoscopy. Methods Twenty-one patients undergoing elective bronchoscopy of the upper airway were randomized to ventilation assistance with FM or LMA after a rigid bronchoscopy procedure under general anesthesia. The primary endpoint was duration of post-surgical recovery and the secondary endpoints were postoperative hemodynamic and respiratory parameters. Assessment of the study endpoints was performed by an intensive care specialist blinded to the method of ventilation used. The statistical analysis was performed using the Fisher’s Exact test for nominal data and the Student’s t-test for continuous data. Results There was no statistically significant difference in post-procedural time between the two groups (P=0.972). The recovery parameters were significantly better in the LMA group than in the FM group, with significantly fewer desaturation, hypotensive, and bradycardic events (P<0.05). Conclusion We conclude that the LMA may be safer and more comfortable than the FM in patients undergoing rigid bronchoscopy.
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Affiliation(s)
- Fulvio Nisi
- Department of Anesthesiology, Intensive Care and Pain Therapy Centre, Perugia, Italy
| | - Antonio Galzerano
- Department of Anesthesiology, Intensive Care and Pain Therapy Centre, Perugia, Italy
| | - Gaetano Cicchitto
- Department of Pneumology and Respiratory Medicine, AO Santa Maria della Misericordia, Perugia, Italy
| | - Francesco Puma
- Department of Thoracic Surgery, AO Santa Maria della Misericordia, Perugia, Italy
| | - Vito Aldo Peduto
- Department of Anesthesiology, Intensive Care and Pain Therapy Centre, Perugia, Italy
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17
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Bronchoscopic management of patients with symptomatic airway stenosis and prognostic factors for survival. Ann Thorac Surg 2015; 99:1725-30. [PMID: 25818571 DOI: 10.1016/j.athoracsur.2015.01.061] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/17/2015] [Accepted: 01/27/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Interventional bronchoscopy is effective in the management of patients with symptomatic airway obstruction for both malignant and benign conditions. The main aim of this study is to report our experience with emergency interventional bronchoscopy in patients with symptomatic airway obstruction and identify prognostic factors for survival. METHODS This is a retrospective observational study of patients undergoing emergency interventional bronchoscopy over a 4-year period. Survival times were analyzed separately for patients with benign and malignant airway obstruction by the Kaplan-Meier method. RESULTS Between June 2009 and July 2013, 168 emergency interventional bronchoscopies were performed in 112 patients for airway obstruction. The median age was 63 years (range, 20 to 86), and 91 patients (54%) patients were female. Seventy-two cases (43%) had airway obstruction due to malignant disease. There were 3 in-hospital deaths (2.7%). Median survival of the study population was 5.6 months (range, 0 to 51) with a median follow-up of 7.3 months (range, 0 to 51). Median survival for patients with malignant airway obstruction was 3.5 months (range, 0 to 21), and 9.8 months (range, 0.1 to 51) for those with benign disease. Airway intervention facilitated palliative chemotherapy in 32 patients (44%) of those with malignant airway obstruction. At multivariate analysis in patients with malignant airway obstruction, presence of stridor (hazard ratio 1.919, 95% confidence interval: 1.082 to 3.404, p = 0.026) and not receiving postprocedure chemotherapy (hazard ratio 2.05, 95% confidence interval: 1.156 to 3.636, p = 0.014) were independent prognostic factors for death. CONCLUSIONS Emergency interventional bronchoscopy for airway obstruction is safe, relieved symptoms, and facilitated palliative chemotherapy, which improved survival.
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18
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Mitchell PD, Kennedy MP. Bronchoscopic management of malignant airway obstruction. Adv Ther 2014; 31:512-38. [PMID: 24849167 DOI: 10.1007/s12325-014-0122-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Indexed: 12/17/2022]
Abstract
Approximately one-third of patients with lung cancer will develop airway obstruction and many cancers lead to airway obstruction through meta stases. The treatment of malignant airway obstruction is often a multimodality approach and is usually performed for palliation of symptoms in advanced lung cancer. Removal of airway obstruction is associated with improvement in symptoms, quality of life, and lung function. Patient selection should exclude patients with short life expectancy, limited symptoms, and an inability to visualize beyond the obstruction. This review outlines both the immediate and delayed bronchoscopic effect options for the removal of airway obstruction and preservation of airway patency with endobronchial stenting.
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Affiliation(s)
- Patrick D Mitchell
- Department of Respiratory Medicine, Cork University Hospital, Wilton, Cork, Republic of Ireland
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