[Consensus guidelines for respiratory endoscopy issued by the Argentine Society of Bronchoesophagology]

Usefulness of flexible bronchoscopy outside the hospital setting

INTRODUCTION

Flexible bronchoscopy (FB) is a procedure usually carried out in the hospital setting. Occasionally, home hospitalized (HH) patients or those at long-term acute care facilities (LTACF) are not likely to be transferred to hospitals, either because they refuse to be transferred or because such transfer may be risky or complex. Under such circumstances, FB could be performed in both sites, especially in technically simple procedures or with a low complication rate.

OBJECTIVES

The purpose of this study was to assess whether FB carried out at LTACF or in the home is safe, useful, well tolerated, and free of complications.

PATIENTS AND METHODS

This study analyzed FB carried out at LTACF or in HH patients from October 2007 to November 2009. The procedures chosen were structural and functional assessment of the airway (SFAA) owing to potential tracheal stenosis, tracheomalacia, tracheo-esophageal fistula, phonation or swallowing disorders, and as earlier control to decannulation. Other techniques used were: aspiration of tracheobronchial mucus (ATBM), complex tracheostomy tube changes (TTC), tracheal prosthesis control (TPC), evaluation of mild hemoptysis (MH), and bronchoalveolar lavage (BAL). FB was carried out under local anesthesia. The endoscope entered through the nose, mouth, tracheostomy tube, and/or T-tracheal prosthesis.

RESULTS

Thirty-three FB were carried out in 25 LTACF patients: 33 SFAA, 3 MH, 3 TTC, 2 ATBM, 1 BAL, and 2 TPC. Ten FB were carried out in 8 HH patients: 10 SFAA, 4 TTC, and 7 ATBM. Procedures were well-tolerated. There was no evidence of complications.

CONCLUSIONS

FB carried out outside the hospital setting can be done safely and effectively, at least in a selected group of patients and carrying out selected procedures.

Bronchoscopy in children in South America

Bronchoscopy is an important tool in the study of the airway. Diagnostic and therapeutic uses are well described in the literature and standardisation of the technique is well defined. Most relevant publications on bronchoscopy come from Europe and the United States, and in some countries they are used as guidelines for local hospitals. In spite of the limited experience published from South America, and the scarcity of financial resources, important information and research pathways have been developed in paediatric bronchoscopy. The information in this review was compiled from local publications, case reports, review articles, brief reports and congress presentations to provide an overview and share the experience about bronchoscopy in South American children.

Bronchoscopic removal of foreign bodies from children in Bosnia and Herzegovina: experience with 230 patients

OBJECTIVES

To present the experience from an emerging country, in the bronchoscopic removal of foreign bodies in children.

METHODS

Retrospective analysis of medical records from 230 patients treated at the ENT Department, Tuzla University Hospital, Bosnia and Herzegovina, between January 1987 and December 1998.

RESULTS

Positive bronchoscopic findings were present in 136 (59.1%) cases. Right bronchus (53.7%) and left bronchus (30.1%) were the most frequent location of extracted foreign bodies. The types of extracted foreign bodies were organic in 114 (83.8%), non-organic in 12 (8.8%) and of an indefinite nature in ten (7.4%) cases. The most frequent type of foreign body was: pumpkin seed (23.4%), peanut (18.4%), bean (14.6%). The nature of the foreign body could not be determined in 7.4% cases: either because the foreign bodies were in the state of disintegration or were too small. Two children (0.87%) died during the bronchoscopy.

CONCLUSION

Aspiration of foreign body into tracheobronchial tree in children carries a high risk although prompt treatment of survivors is associated with low mortality. Health care education is the key to prevention.