1
|
Oruqaj G, Krombach G, Gattenloehner S, Herold S, Vadász I, Seeger W, Tello K, Hecker M. Adenomatous hyperplasia induced by chronic cherry pit retention mimicking an endobronchial tumor-case series and systematic review of literature. Front Med (Lausanne) 2024; 11:1404951. [PMID: 39086956 PMCID: PMC11288952 DOI: 10.3389/fmed.2024.1404951] [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] [Received: 03/21/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
Introduction Endobronchial foreign body aspiration is not common in adults, but it is a life-threatening event. Recurrent pneumonias by chronic retention of foreign body often lead to initial medical presentation of the patient. However, lymphoplasmacellular bronchitis with adenomatous hyperplasia and squamous epithelium metaplasia with complete or partial blockage of lobar bronchus mimicking lung tumor is rare in literature, and this particular condition is often misdiagnosed. Case presentation we report our experience in the diagnostic and management of two elderly patients with recurrent pneumonia, admitted in hospital for further examination. In both patients, with no history of aspiration, the cherry pit was detected during bronchoscopy and recanalization with flexible cryoprobe, surrounded by purulent secretion, occluding completely the right upper lobe in the first case, and partially the left lower lobe associated with persistent actinomycosis in the second case, with signs of local inflammation, bronchial adenomatous hyperplasia mimicking lung tumor at initial bronchoscopic examination. Histology showed a lymphoplasmacellullar bronchitis with adenomatous hyperplasia and squamous epithelium metaplasia because of chronic retention of foreign body. Conclusion Bronchoscopy examination should be considered in cases where there is an unresolved chronic cough with recurrent pneumonia or persistent actinomycosis in patients with high risk. Cryoprobe is a safe and feasible approach for treatment of airway obstructions due to chronic foreign body retention. Furthermore, relevant findings are discussed here, along with a review of the pathologic alterations and treatment modalities seen in chronic retention of foreign body and airway injury.
Collapse
Affiliation(s)
- Gani Oruqaj
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Gabriele Krombach
- Department of Radiology, University Hospital Giessen, Giessen, Germany
| | - Stefan Gattenloehner
- Department of Pathology, Justus-Liebig- University Giessen, Universities of Giessen and Marburg Lung Center (UGMLC), Giessen, Germany
| | - Susanne Herold
- Department of Internal Medicine V, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - István Vadász
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Werner Seeger
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Khodr Tello
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Matthias Hecker
- Department of Internal Medicine, Medical Clinic II, Universities of Giessen and Marburg Lung Center (UGMLC), Institute for Lung Health (ILH), Cardio-Pulmonary Institute (CPI), Member of the German Center for Lung Research (DZL), Giessen, Germany
| |
Collapse
|
2
|
Gipsman AI, Feld L, Johnson B, Needleman JP, Boas H, Lin N, DePasquale B, Pogoriler J, McDowell KM, Piccione JC. Eosinophilic plastic bronchitis: Case series and review of the literature. Pediatr Pulmonol 2023; 58:3023-3031. [PMID: 37606213 PMCID: PMC10928548 DOI: 10.1002/ppul.26650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/10/2023] [Accepted: 08/12/2023] [Indexed: 08/23/2023]
Abstract
Plastic bronchitis is a term used to describe group of life-threatening disorders characterized by the presence of large obstructing casts in the airways. Eosinophilic plastic bronchitis is a subtype of plastic bronchitis that occurs mainly in children and has not been well-described in the literature. Patients may have a history of asthma or atopy, but many do not. They often present with cough and wheezing, and frequently have complete collapse of one lung seen on imaging. The severity of presentation varies depending on the location of the casts, ranging from mild symptoms to severe airway obstruction and death. Bronchoscopy is often required to both diagnose and treat this condition. A variety of medical therapies have been used, although no formal studies have evaluated their efficacy. Symptoms may resolve after initial cast removal, but in some patients, cast formation recurs. Here, we report a case series of nine patients with eosinophilic plastic bronchitis and review the existing literature of this condition.
Collapse
Affiliation(s)
- Alexander I. Gipsman
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Lance Feld
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Brandy Johnson
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Joshua P. Needleman
- Pediatric Pulmonary Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Heather Boas
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Nancy Lin
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jennifer Pogoriler
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pathology and Laboratory Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Karen M. McDowell
- Division of Pulmonary Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Joseph C. Piccione
- Division of Pulmonary and Sleep Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
3
|
Husnain SMN, Sarkar A, Huseini T. Utility and Safety of Bronchoscopic Cryotechniques-A Comprehensive Review. Diagnostics (Basel) 2023; 13:2886. [PMID: 37761254 PMCID: PMC10530195 DOI: 10.3390/diagnostics13182886] [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: 05/31/2023] [Revised: 08/26/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Cryosurgical techniques are employed for diagnostic and therapeutic bronchoscopy and serve as important tools for the management of pulmonary diseases. The diagnosis of interstitial lung disease requires multidisciplinary team discussions after a thorough assessment of history, physical exam, computed tomography, and lung-function testing. However, histological diagnosis is required in selected patients. Surgical lung biopsy has been the gold standard but this can be associated with increased morbidity and mortality. Transbronchial lung cryobiopsy is an emerging technique and multiple studies have shown that it has a high diagnostic yield with a good safety profile. There is wide procedural variability and the optimal technique for cryobiopsy is still under investigation. There is emerging data that demonstrate that cryobiopsy is safe and highly accurate in the diagnosis of thoracic malignancies. Furthermore, cryorecanalization procedures are a useful adjunct for the palliation of tumors in patients with central airway obstruction. One should keep in mind that these procedures are not free from complications and should be carried out in a specialized center by a trained and experienced bronchoscopy team. We present a review of the literature on the diagnostic and therapeutic utility of bronchoscopy-guided cryosurgical procedures and their safety profile.
Collapse
Affiliation(s)
- Shaikh M. Noor Husnain
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Abhishek Sarkar
- Department of Internal Medicine, Division of Interventional Pulmonary Medicine, Westchester Medical Center, New York, NY 10595, USA
| | - Taha Huseini
- Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, WA 6150, Australia
| |
Collapse
|
4
|
Truitt BA, Kasi AS, Kamat PP, Fundora MP, Simon DM, Guglani L. Cryoextraction via flexible bronchoscopy in children with tracheobronchial obstruction. Pediatr Pulmonol 2023; 58:2527-2534. [PMID: 37350368 DOI: 10.1002/ppul.26540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/19/2023] [Accepted: 05/26/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Cryoextraction via flexible bronchoscopy (FB) can be used to alleviate airway obstruction due to blood clots, casts, mucus, and foreign bodies. There is limited literature regarding the utility of cryoextraction to restore airway patency in critically ill children, especially on extracorporeal membrane oxygenation (ECMO). The aims of this study were to describe the clinical course and outcomes of children who underwent cryoextraction via FB. METHODS A singlecenter retrospective review of children who underwent cryoextraction via FB between 2017 and 2021 was conducted. The analyzed data included diagnoses, indications for cryoextraction, respiratory support modalities, FB and chest imaging results, and outcomes. RESULTS Eleven patients aged 3-17 years underwent a total of 33 cryoextraction sessions via FB. Patients required ECMO (n = 9) or conventional mechanical ventilation (CMV) for pneumonia, pulmonary hemorrhage, pulmonary embolism, asthma exacerbation, and cardiorespiratory failure following cardiac surgery. One patient underwent elective FB and cryoextraction for plastic bronchitis. Indications for cryoextraction included airway obstruction due to tracheobronchial thrombi (n = 8), mucus plugs (n = 1), or plastic bronchitis (n = 2). Cryoextraction via FB was performed on patients on ECMO (n = 9) and CMV (n = 2) with 6 patients requiring ≥3 cryoextraction sessions for airway obstruction. There were no complications related to cryoextraction. Patient outcomes included partial (n = 5) or complete (n = 6) restoration of airway patency with ECMO decannulation (n = 5) and death (n = 4) due to critical illness. CONCLUSIONS Cryoextraction via FB is an effective intervention that can be utilized in critically ill children with refractory tracheobronchial obstruction to restore airway patency and to facilitate liberation from ECMO.
Collapse
Affiliation(s)
- Brittany A Truitt
- Division of Pediatric Pulmonology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Ajay S Kasi
- Division of Pediatric Pulmonology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Pradip P Kamat
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Michael P Fundora
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Dawn M Simon
- Division of Pediatric Pulmonology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Lokesh Guglani
- Division of Pediatric Pulmonology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| |
Collapse
|
5
|
Jeong JH, Kim J, Choi CM, Ji W. Clinical Outcomes of Bronchoscopic Cryotherapy for Central Airway Obstruction in Adults: An 11-Years' Experience of a Single Center. J Korean Med Sci 2023; 38:e244. [PMID: 37582494 PMCID: PMC10427217 DOI: 10.3346/jkms.2023.38.e244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 04/12/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Although bronchoscopic cryotherapy (BC) is a pragmatic modality for recanalization of central airway obstruction (CAO), the risk of complications, such as bleeding, remains a concern. This study aimed to present the clinical outcomes of BC and evaluate the factors associated with its complications. METHODS In this retrospective study, we reviewed the medical records of patients who underwent BC for CAO at the Asan Medical Center, South Korea. Most sessions were conducted via flexible bronchoscopy under moderate sedation. A multivariate logistic regression analysis was used to identify the factors associated with the success rate and complications. RESULTS BC was performed in 262 sessions in 208 patients between January 2009 and December 2020. The most common cause of cryotherapy was recanalization of the endobronchial tumor related CAO (233/262, 88.9%). More than partial re-establishment of airway patency was achieved in 211 of 233 (90.6%) sessions. The success rate did not differ significantly in the multivariate logistic regression analysis. The most common complication was intrabronchial bleeding (78/233, 35.5%); however, severe bleeding occurred only in one case (0.4%). Univariate and multivariate logistic regression analyses revealed that diabetes mellitus (odds ratio [OR] = 2.820, P = 0.011), respiratory failure before BC (OR = 3.546, P = 0.028), and presence of distal airway atelectasis (OR = 0.417, P = 0.021) were independently associated with moderate to severe intrabronchial bleeding, while the histologic type of tumor was not related to bleeding. BC for CAO caused by blood clot or foreign body was successful in most cases, and there were no complications. CONCLUSION BC is an efficient and relatively safe intervention for patients with CAO. Our findings suggest that diabetes, respiratory failure before BC, and the absence of distal airway atelectasis may be risk factors of moderate to severe intrabronchial bleeding.
Collapse
Affiliation(s)
- Jong Hwan Jeong
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Pulmonology and Allergy, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jiwon Kim
- 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
| | - Wonjun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| |
Collapse
|
6
|
Goussard P, Eber E, Venkatakrishna S, Frigati L, Janson J, Schubert P, Andronikou S. Intrathoracic tuberculosis: Role of interventional bronchoscopy in diagnosis. Paediatr Respir Rev 2023; 45:23-29. [PMID: 36621398 DOI: 10.1016/j.prrv.2022.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Tuberculosis (TB) is the leading cause of death from a single infectious agent globally. Mortality is related to the delay in diagnosis and starting treatment. According to new guidelines it is very important to classify pulmonary tuberculosis (PTB) as severe or not severe disease due to the difference in treatment duration. Bronchoscopy is the gold standard for assessing the degree of airway compression and obstruction in paediatric PTB. Paediatric bronchoscopy has evolved from a primarily diagnostic procedure to include interventional bronchoscopy for diagnostic purposes. Endobronchial ultrasound (EBUS) has increased the potential of sampling mediastinal lymph nodes both for histological diagnosis and microbiological confirmation.
Collapse
Affiliation(s)
- Pierre Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Shyam Venkatakrishna
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa Frigati
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Jacques Janson
- Department of Surgical Sciences, Division of Cardiothoracic Surgery, Stellenbosch University, and Tygerberg Hospital, Tygerberg, South Africa
| | - Pawel Schubert
- Division of Anatomical Pathology, Tygerberg Hospital, National Health Laboratory Service, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Savvas Andronikou
- Department of Pediatric Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
7
|
Murashita M, Oyasu T, Kodate A, Matsuura Y, Sadamoto Y, Endo A, Bando K, Sageshima H, Tsuchida T. A case of plastic bronchitis with a remarkable response to steroids. Respir Med Case Rep 2023; 43:101850. [PMID: 37124059 PMCID: PMC10139978 DOI: 10.1016/j.rmcr.2023.101850] [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: 01/08/2023] [Revised: 04/04/2023] [Accepted: 04/10/2023] [Indexed: 05/02/2023] Open
Abstract
Plastic bronchitis can cause fatal airway obstruction. An 85-year-old woman with no medical history presented to the emergency department of our hospital with progressing respiratory failure and hemoptysis. Bronchoscopy revealed a fibrin-type cast thrombus in the trachea, and plastic bronchitis was diagnosed. Initial treatment involved airway thrombus removal, and the patient survived. However, bleeding persisted for 6 days, and respiratory status showed slight improvement despite ventilatory management. Steroids were administered for concomitant acute respiratory distress syndrome, and there was marked improvement in both airway hemorrhage and respiratory failure. The patient was extubated, the steroid dose was reduced, and no rebleeding was observed. The patient was discharged from the hospital 1 month after the onset of symptoms. Blood tests were positive for the myeloperoxidase-anti-neutrophil cytoplasmic antibody; however, no biopsy was performed, and no specific symptoms were observed. A definitive diagnosis was therefore not reached. The causes of plastic bronchitis are numerous, and there are no standardized diagnostic criteria or treatment guidelines for this condition. The present case suggests that steroids may be effective in some patients with plastic bronchitis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Takumi Tsuchida
- Corresponding author. Department of Emergency and Critical Care Medicine, Sapporo City General Hospital, Department of Emergency Medicine, N11W13 Chuo-ku, Sapporo, 060-8604, Japan.
| |
Collapse
|
8
|
Schramm D, Freitag N, Kötz K, Iglesias-Serrano I, Culebras-Amigo M, Koblizek V, Pérez-Tarazona S, Cases Viedma E, Srikanta JT, Durdik P, Darwiche K, Rubak S, Stafler P. Cryotherapy in the paediatric airway: Indications, success and safety. Respirology 2022; 27:966-974. [PMID: 36054726 DOI: 10.1111/resp.14353] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 08/15/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Cryotherapy in interventional bronchoscopy is a new treatment modality, which has recently been made available for the paediatric airway. Lack of experience and safety concerns have led to hesitant adaptation. The aim of this study was to assess indications, success rates and complications of airway cryotherapy in children. METHODS Bronchoscopists from medical centre performing cryotherapy in patients between 0 and 18 years were invited to participate in a prospective study based on an online questionnaire. Patient and participant data were collected between June 2020 and June 2021. RESULTS A total of 69 cryotherapy procedures were performed in 57 patients a for three main indications: Biopsy (30), restoration of airway patency (23) and foreign body aspiration (16). The overall success rate was 93%, the remaining 7% were performed for foreign body removal and required a switch of technique. Restoration of airway patency was successfully applied in various pathologies, including mucus plugs, bronchial casts and post traumatic stenosis. The diagnostic yield of transbronchial biopsies was 96%. No severe complications were encountered; one pneumothorax following a cryobiopsy required a chest drain for 48 h. No child was admitted to intensive care or died from a procedural complication. CONCLUSION In this largest paediatric case collection to date, cryotherapy was safe and carried a high success rate. Cryobiopsy compares favourably to the widely used forceps biopsy and could replace it in the future. Paediatric bronchoscopists are encouraged to add cryotherapy to their armamentarium of airway interventions.
Collapse
Affiliation(s)
- Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Karsten Kötz
- Queen Silvias Children Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ignacio Iglesias-Serrano
- Unitat de Pneumologia Pediàtrica i Fibrosi Quística, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Vladimir Koblizek
- Department of Pneumology, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Prague, Czechia
| | | | - Enrique Cases Viedma
- Respiratory Endoscopy Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - J T Srikanta
- Pediatric Interventional Pulmonology, Allergy and Sleep Medicine, Aster CMI and RV Hospitals, Bengaluru, India
| | - Peter Durdik
- Pediatric Department, University Hospital Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
| | - Kaid Darwiche
- Department for Interventional Pneumology, Ruhrlandklinik-West German Lung Center, University Medicine Essen, Essen, Germany
| | - Sune Rubak
- Department of Pediatrics and Adolescents Medicine, Danish Center of Pediatric Pulmonology and Allergology, University Hospital of Aarhus, Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Patrick Stafler
- Pediatric Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
9
|
Ayats-Vidal R, Vásquez-Pérez A, Gallego-Díaz M, Rosell A, Valdesoiro-Navarrete L, Tazi-Mezalek R. Successful removal of distal persistent foreign body airway with CO2 cryotherapy in a child. Respir Med Case Rep 2022; 36:101594. [PMID: 35242515 PMCID: PMC8866066 DOI: 10.1016/j.rmcr.2022.101594] [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] [Received: 07/20/2021] [Revised: 01/23/2022] [Accepted: 01/24/2022] [Indexed: 12/02/2022] Open
Abstract
We report a case of a nine-year-old boy with clinical evidence of foreign body (FB) aspiration with 3 months of delay in diagnosis. The bronchoscopy found soft tissue FB with surrounding inflamed granulation tissue at the entrance to the lateral segmental bronchus. Repeated attempts to remove the FB with flexible forceps were unsuccessful due to friable FB and granulation tissue. Ablation of the granulation tissue using nitrous oxide cryotherapy was then successfully performed and the distal and organic FB was extracted. Early diagnosis is important for minimizing granulation tissue development which complicates FB removal. Cryotherapy with a flexible bronchoscope is an option if organic FB cannot be removed using conventional bronchoscopic instrumentation.
Collapse
|
10
|
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.
Collapse
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.)
| |
Collapse
|
11
|
Xu B, Wu L, Bi J, Liu J, Chen C, Lin L, Chen C, Qiu F, Shang S. Management of Inedible Airway Foreign Bodies in Pediatric Rigid Bronchoscopy: Experience From a National Children's Regional Medical Center in China. Front Pediatr 2022; 10:891864. [PMID: 35813380 PMCID: PMC9256913 DOI: 10.3389/fped.2022.891864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/20/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED The aim of this study is to analyze the characteristics of inedible airway foreign bodies in pediatric rigid bronchoscopy to facilitate the improvement of management and technology. This retrospective analytical study was performed from January 2017 to June 2020. All admissions of pediatric patients (age<18 years) with foreign-body aspiration diagnosis codes ([ICD]-10:T17 300, T17 400, T17 500 and T17 900) and procedure codes (33.7801) were extracted. Age, sex, preoperative history and imaging data, surgical records, length of hospital stay, reoperations and postoperative complications were included. Data were analyzed with SPSS 20. A total of 1237 patients were hospitalized and underwent rigid bronchoscopy. Forty-five (3.6%) patients with inedible foreign bodies in the airway were confirmed. There were no significant differences in sex, time of onset and length of hospital stay between the inedible and edible foreign body groups, except for age and a definite history of foreign body aspiration (P = 0.000). Coughing, wheezing and fever were the common clinical symptoms in all patients. The following were the common locations of inedible foreign bodies: right bronchus (22/45), left bronchus (18/45), trachea (3/45) and larynx (2/45). The most frequent inedible foreign bodies were parts of a pen (15/45), a light-emitting diode (7/45) and plastic parts of toys (6/45). Vocal cord injury and a laryngeal web were observed in one case each. CONCLUSION Rigid bronchoscopy is the method of choice for the removal of inedible foreign bodies. Adequate preoperative assessment to rely on CT scans, skillful operation techniques to avoid damaging and active management of postoperative complications are important for the success of the procedure.
Collapse
Affiliation(s)
- Bin Xu
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Lei Wu
- Department of Pulmonology, Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Jing Bi
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Jia Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Cao Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Lexi Lin
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Chao Chen
- Department of Radiology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Fei Qiu
- Department of Otorhinolaryngology-Head and Neck Surgery, Department of Endoscopy Center, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| | - Shiqiang Shang
- Department of Clinical Laboratory, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, China
| |
Collapse
|
12
|
Green A, Puri N, Kouch M, Wolfe Y, Balakrishnan A, Abramian O, Boujaoude Z, Abouzgheib W. Cryotherapy: A Safe Approach to Pulmonary Hemorrhage During VV-ECMO. J Investig Med High Impact Case Rep 2022; 10:23247096221074590. [PMID: 35152803 PMCID: PMC8848090 DOI: 10.1177/23247096221074590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/16/2021] [Accepted: 01/01/2022] [Indexed: 11/20/2022] Open
Abstract
The number of hospitals with veno-venous extracorporeal membrane oxygenation (VV-ECMO) capabilities is expanding. To support an ECMO program, centers must be equipped to handle associated complications such as pulmonary hemorrhage. We describe a case series of 4 patients with life-threatening pulmonary bleeding and central airway obstruction. A therapeutic approach of anticoagulation cessation coupled with cryoextraction via flexible bronchoscopy led to successful restoration of airway patency without any adverse events. A low threshold to stop anticoagulation with a strong consideration of bronchoscopy with cryotherapy for pulmonary toilet should be done in patients with pulmonary hemorrhage during VV-ECMO.
Collapse
Affiliation(s)
- Adam Green
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Nitin Puri
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Michael Kouch
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | - Yanika Wolfe
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | | | | - Ziad Boujaoude
- Cooper Medical School of Rowan University, Camden, NJ, USA
| | | |
Collapse
|
13
|
Zhao Y, Zhang T, Yang N, Xu Y, Guo W. Efficacy and safety of CO 2 cryotherapy in the treatment of infants with tracheobronchial tuberculosis. Front Pediatr 2022; 10:984738. [PMID: 36299689 PMCID: PMC9591804 DOI: 10.3389/fped.2022.984738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/02/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the efficacy and safety of CO2 cryotherapy for lymph node fistula tracheobronchial tuberculosis (TBTB) in infants. PATIENTS AND METHODS A retrospective analysis was undertaken on seven patients with lymph node fistula tracheobronchial tuberculosis who underwent fiberoptic bronchoscopy (FB) interventional therapy in the respiratory department of Tianjin Children's Hospital from July 2012 to July 2020. The efficacy, safety, and prognosis of CO2 cryotherapy intervention for the treatment of lymph node fistula TBTB in infants were summarized and analyzed. RESULTS Seven patients with lymph node fistula TBTB were included in this study. Their ages ranged from 6-13 months. The course of the disease from onset to TBTB ranged from 20 to 70 days. The pathological diagnoses of seven cases by FB combined with tissue biopsy were lymph node fistula TBTB, of which 28.57% (two cases) were in the early stage of rupture and 71.43% (five cases) were in the rupture stage. All patients were treated with CO2 cryotherapy combined with foreign body forceps and local injection drugs based on systemic antituberculosis chemotherapy. Two patients were treated once with CO2 cryotherapy, and five were treated three times. According to the comparison of the clinical symptoms, imaging results, and endoscopic presentations before and after the intervention, six patients achieved clinical cure, and one achieved clinical improvement. No severe intraoperative or postoperative complications were observed. The clinical symptoms, endoscopic findings, radiological manifestations, and quality of life of all patients showed marked improvement. No recurrence occurred after 3-6 months of follow-up with FB. CONCLUSION CO2 cryotherapy can improve the treatment effect of lymph node fistula in infants with TBTB and reduce the incidence of complications. This treatment is safe and reliable in infants.
Collapse
Affiliation(s)
- Yidi Zhao
- Children's Clinical College of Tianjin Medical University, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Tongqiang Zhang
- Department of Pulmonology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Nan Yang
- Department of Imaging, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Yongsheng Xu
- Department of Pulmonology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| | - Wei Guo
- Department of Pulmonology, Tianjin Children's Hospital/Tianjin University Children's Hospital, Tianjin, China
| |
Collapse
|
14
|
Kallam EF, Kasi AS, Patki R, Silva GL, Simon DM, Caltharp S, Guglani L. Bronchoscopic interventions for plastic bronchitis in children without structural heart disease. Eur J Pediatr 2021; 180:3547-3554. [PMID: 34159443 DOI: 10.1007/s00431-021-04161-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/16/2021] [Accepted: 06/11/2021] [Indexed: 10/21/2022]
Abstract
Plastic bronchitis (PB) is a rare and life-threatening complication encountered in several disease states that leads to airway obstruction by branching casts. PB is most often reported in children with cyanotic congenital heart disease where recurrence is common, and mortality is high. There is limited data on optimal management strategies or recurrence of non-structural heart disease-related PB in children. We describe the clinical features, management, and outcomes in our cohort of children with non-structural heart disease-related PB. Among the 12 identified patients, asthma was the most common (67%) diagnosis. Ventilatory requirements ranged from room air to one patient who required extracorporeal membrane oxygenation (ECMO). Most patients (92%) required bronchoscopy, and cryotherapy was successfully utilized in two patients to relieve refractory obstructive airway casts. All patients received chest physiotherapy, and 11 patients were treated with two or more medications. There was one mortality despite ECMO, and one-third had recurrent PB, all of whom had asthma.Conclusion: Asthma is a risk factor for recurrent PB. Bronchoscopic interventions including cryotherapy are safe and effective treatment options in patients with refractory PB. What is Known: • Plastic bronchitis is a rare but life-threatening cause of airway obstruction caused by branching casts that are generally reported in patients with congenital heart disease. What is New: • In children without structural heart disease, asthma is a risk factor for recurrent plastic bronchitis. Cryotherapy via bronchoscopy is a safe and effective intervention in patients with refractory plastic bronchitis.
Collapse
Affiliation(s)
- Erin F Kallam
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Ajay S Kasi
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Rucha Patki
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - George Lucas Silva
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Dawn M Simon
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Shelley Caltharp
- Department of Pathology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - Lokesh Guglani
- Division of Pulmonology, Allergy/Immunology, Cystic Fibrosis and Sleep (PACS), Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA.
| |
Collapse
|
15
|
Ntiamoah P, Mukhopadhyay S, Ghosh S, Mehta AC. Recycling plastic: diagnosis and management of plastic bronchitis among adults. Eur Respir Rev 2021; 30:30/161/210096. [PMID: 34407979 DOI: 10.1183/16000617.0096-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/26/2021] [Indexed: 11/05/2022] Open
Abstract
Plastic bronchitis is a rare, underdiagnosed and potentially fatal condition. It is characterised by the formation and expectoration of branching gelatinous plugs that assume the shape of the airways. These airway plugs differ from the allergic mucin that characterises allergic bronchopulmonary aspergillosis and mucoid impaction of the bronchi. Plastic bronchitis is most often encountered in the paediatric population following corrective cardiac surgery, such as the Fontan procedure. It also occurs in adults. Plastic bronchitis in adults is rare, heterogeneous in its aetiology, and can lead to respiratory distress or even life-threatening airway obstruction. Plastic bronchitis in adulthood should not be overlooked, particularly in patients with chronic inflammatory lung diseases. This review presents current understanding of the presentation, aetiology, pathogenesis, pathology and management of plastic bronchitis in adults.
Collapse
Affiliation(s)
- Prince Ntiamoah
- Dept of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| | | | - Subha Ghosh
- Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Atul C Mehta
- Dept of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
16
|
Emergency Department Vacuum Extraction of an Obstructing Tracheal Foreign Body Using a Meconium Aspirator and Modified Endotracheal Tube. J Emerg Med 2021; 60:e81-e84. [PMID: 33483196 DOI: 10.1016/j.jemermed.2020.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/07/2020] [Accepted: 11/22/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND A meconium aspirator is a simple plastic adapter that allows for rapid suctioning of the trachea when attached to an endotracheal tube and a source of continuous negative pressure, as was historically done for suspected neonatal meconium aspiration. Adaptation of this technique for the emergent vacuum extraction of an obstructing tracheal foreign body in an adult has not been previously described. CASE REPORT We report the case of a 33-year-old woman with cardiorespiratory arrest after choking on food. Complete tracheal obstruction precluding oxygenation and ventilation due to aspirated chicken was diagnosed by emergency physicians and managed immediately with vacuum extraction using the technique described in this report. No additional airway interventions were necessary and the patient made a full neurologic recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Vacuum extraction using a meconium aspirator and modified endotracheal tube is a novel and potentially life-saving approach to the emergency management of airway obstruction after choking, especially if the foreign material is below the vocal cords and not amenable to manual extraction with a Magill forceps.
Collapse
|
17
|
Tale S, Meitei SP, Prakash V, Negi A, Mishra M, Sindhwani G. Bronchoscopic Cryotherapy for Acute Hypoxemic Respiratory Failure in Three Mechanically Ventilated Patients: A Case Series. Indian J Crit Care Med 2021; 25:94-96. [PMID: 33603309 PMCID: PMC7874292 DOI: 10.5005/jp-journals-10071-23707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Endobronchial blood clots or mucus plugs can present with minimal symptoms or acute airway obstruction in the intensive care unit (ICU) patients. Acute airway obstruction can lead to rapid worsening of dyspnea owing to poor oxygenation due to collapse of the lung. Prompt recognition and treatment of this condition can translate into a successful outcome by decreasing morbidity and mortality and facilitating successful weaning of these patients. When conventional methods fail to relieve the obstruction, cryoextraction a novel technique, may prove to be a useful alternative for the removal of these clots and mucus plugs. Cryoextraction is best performed with rigid bronchoscopic intubation. However, in certain conditions, it may be used with a flexible fiberoptic bronchoscope (FOB) through an endotracheal tube, especially when bedside procedure is required in ICU patients. In this series, three cases are being discussed where bedside flexible bronchoscopy-guided cryoextraction was done leading to a successful resolution of acute hypoxemic respiratory failure. How to cite this article: Tale S, Meitei SP, Prakash V, Negi A, Mishra M, Sindhwani G. Bronchoscopic Cryotherapy for Acute Hypoxemic Respiratory Failure in Three Mechanically Ventilated Patients: A Case Series. Indian J Crit Care Med 2021;25(1):94–96.
Collapse
Affiliation(s)
- Sudheer Tale
- Department of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Soibam P Meitei
- Department of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Vipul Prakash
- Department of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Arjun Negi
- Department of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| | - Mayank Mishra
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Girish Sindhwani
- Department of Pulmonary and Critical Care Medicine, All India Institute of Medical Sciences, Rishikesh, India
| |
Collapse
|
18
|
Qiu Y, Zhang R. Perioperative respiratory distress in a child due to plastic bronchitis triggered by allergic reaction to sevoflurane. BMJ Case Rep 2020; 13:13/9/e236378. [PMID: 32948530 DOI: 10.1136/bcr-2020-236378] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Yongsheng Qiu
- Anesthesiology, Children's Hospital to Zhengzhou University, Zhengzhou, Henan, China
| | - Ran Zhang
- Anesthesiology, Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
| |
Collapse
|
19
|
Li Y, Williams RJ, Dombrowski ND, Watters K, Daly KP, Irace AL, Visner GA, Rahbar R, Fynn-Thompson F. Current evaluation and management of plastic bronchitis in the pediatric population. Int J Pediatr Otorhinolaryngol 2020; 130:109799. [PMID: 31812839 PMCID: PMC9187852 DOI: 10.1016/j.ijporl.2019.109799] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/20/2019] [Accepted: 11/22/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To describe a multidisciplinary approach for the treatment of plastic bronchitis (PB) in children. METHODS Retrospective chart review of children with PB between 1997 and 2017. Data regarding clinical presentation, diagnosis, management, and outcomes were analyzed. RESULTS Of 34 patients presenting with PB, 24 had single ventricle (SV) heart disease, 9 had pulmonary disease, and one had no underlying disease. Median (IQR: interquartile range) age at the time of PB diagnosis was 5.5 years (IQR: 9.0). Presenting symptoms included cough productive of casts (n = 27, 79%), wheezing (n = 5, 15%), dyspnea (n = 18, 53%), hypoxia (n = 31, 91%), and respiratory failure (n = 9, 26%). Diagnosis was made based on clinical evaluation, bronchoscopy findings, and/or pathology of casts. Treatment methods included bronchoscopy for cast removal (25% of SV patients, 91% of non-SV patients), chest physiotherapy (SV: 92%, non-SV: 45%), albuterol (SV: 79%, non-SV: 73%), inhaled steroids (SV: 75%, non-SV: 18%), nebulized hypertonic saline (SV: 29%, non-SV: 9%), nebulized heparin (SV: 8%, non-SV: 55%), nebulized tissue plasminogen activator (tPA; SV: 33%, non-SV: 9%), inhaled Dornase Alfa (SV: 54%, non-SV: 9%), antibiotics (SV: 46%, non-SV: 45%), systemic steroids (SV: 13%, non-SV: 45%), and lymphatic embolization (SV: 8%, non-SV: 45%). Of SV patients, 11 had no recurrence, 5 underwent heart transplantation, one awaits transplant, and 3 died due to cardiac disease. Three patients with respiratory disease had recurrent PB and one died from MRSA pneumonia. CONCLUSION PB is a highly morbid disease with limited treatment options. Bronchoscopy and chest physiotherapy for airway clearance are among the most-utilized therapies.
Collapse
Affiliation(s)
- Youjin Li
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Ryan J Williams
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Natasha D Dombrowski
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Karen Watters
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA
| | - Kevin P Daly
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA
| | - Alexandria L Irace
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Gary A Visner
- Department of Pediatrics, Harvard Medical School, Boston, MA, 02115, USA; Division of Pulmonary and Respiratory Diseases, Boston Children's Hospital, Boston, MA, 02115, USA
| | - Reza Rahbar
- Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Otolaryngology, Harvard Medical School, Boston, MA, 02115, USA
| | - Francis Fynn-Thompson
- Department of Cardiology, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Cardiac Surgery, Boston Children's Hospital, Boston, MA, 02115, USA; Department of Surgery, Harvard Medical School, Boston, MA, 02115, USA.
| |
Collapse
|
20
|
Shanthikumar S, Steinfort DP, Ranganathan S. Interventional bronchoscopy in children: Planning the path ahead. Pediatr Pulmonol 2020; 55:288-291. [PMID: 31816189 DOI: 10.1002/ppul.24596] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 11/26/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Shivanthan Shanthikumar
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| | - Daniel P Steinfort
- Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia.,Department of Medicine, Royal Melbourne Hospital, The University of Melbourne, Parkville, Victoria, Australia
| | - Sarath Ranganathan
- Department of Respiratory and Sleep Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Respiratory Diseases, Murdoch Children's Research Institute, Melbourne, Australia
| |
Collapse
|
21
|
Schmidt LH, Schulze AB, Goerlich D, Schliemann C, Kessler T, Rottmann V, den Toom D, Rosenow F, Sackarnd J, Evers G, Mohr M. Blood clot removal by cryoextraction in critically ill patients with pulmonary hemorrhage. J Thorac Dis 2019; 11:4319-4327. [PMID: 31737317 DOI: 10.21037/jtd.2019.09.46] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Severe pulmonary hemorrhage is a life-threatening complication in critically ill patients. Due to tracheobronchial obstruction, ventilation is often impaired. Traditionally, rigid bronchoscopy is an option for recanalization. However, in comparison to flexible bronchoscopy, the application of rigid bronchoscopy is more complex. Against this background we evaluated the use of flexible cryo-probes for blood clot removal in critically ill patients. Methods Retrospectively, we identified 16 patients (median age: 60 years, 69% male patients), who suffered from severe airway obstruction due to blood clots. All patients required invasive ventilation and 11 patients depended on extracorporeal membrane oxygenation (ECMO). To remove blood clots, flexible bronchoscopic cryoextraction was performed in n=27 cases, whereas rigid bronchoscopy was only needed in two cases. Results Whereas in 9 cases single flexible cryoextraction was successful immediately, the procedure had to be repeated again in 7 patients. In all cases, tracheobronchial obstruction was treated with success and conditions of invasive ventilation were improved. In no case severe complications were observed. Conclusions In consideration of the underlying evaluation, we highly recommend flexible cryoextraction as both a safe and less complex technique for blood clot removal in critically ill patients.
Collapse
Affiliation(s)
- Lars Henning Schmidt
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Arik Bernard Schulze
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Dennis Goerlich
- Institute of Biostatistics and Clinical Research, Westfaelische Wilhelms-Universitaet Muenster, Muenster, Germany
| | - Christoph Schliemann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Torsten Kessler
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Veronika Rottmann
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Daniel den Toom
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Felix Rosenow
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Jan Sackarnd
- Department of Cardiovascular Medicine, Internal Intensive Care Medicine, University Hospital Muenster, Muenster, Germany
| | - Georg Evers
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| | - Michael Mohr
- Department of Medicine A, Hematology, Oncology and Pneumology, University Hospital Muenster, Muenster, Germany
| |
Collapse
|
22
|
David AP, Xu MJ, Rosbe KW, Meyer AK, Gesthalter YB, Chan DK. Cryoprobe retrieval of an airway foreign body: A case report and literature review. Int J Pediatr Otorhinolaryngol 2019; 125:79-81. [PMID: 31271971 DOI: 10.1016/j.ijporl.2019.06.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
We report a case of a 7-year-old boy with clinical and radiographic evidence of foreign body (FB) aspiration with a 2-week delay in diagnosis. The retrieval of the pushpin with traditional bronchoscopic instrumentation was made difficult by granulation tissue formation. A cryoprobe through a flexible bronchoscope was used to successfully remove the FB. To our knowledge, this is the first report of interventional bronchoscopy with a cryoprobe to remove a pushpin in a child under suspension laryngoscopy and spontaneous ventilation. A high index of suspicion is crucial for identifying FBs early and minimizing granulation tissue development which complicates FB removal.
Collapse
Affiliation(s)
- Abel P David
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States.
| | - Mary Jue Xu
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States
| | - Kristina W Rosbe
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States
| | - Anna K Meyer
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States
| | - Yaron B Gesthalter
- Division of Pulmonology, Department of Medicine, University of California, San Francisco, 400 Parnassus Avenue, San Francisco, CA, 94122, United States
| | - Dylan K Chan
- Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco, 2233 Post Street 3rd Floor, San Francisco, CA, 94115, United States
| |
Collapse
|
23
|
Engelhardt K, Pirolli T, Raman L, Abu-Hijleh M, Hupp S. Successful Use of Pulmonary Cryotherapy for Tracheobronchial Thrombus Extraction and Recanalization of the Tracheobronchial Tree During a Pediatric Venovenous Extracorporeal Membrane Oxygenation Run. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2019; 32:28-30. [PMID: 31508253 DOI: 10.1089/ped.2018.0911] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 12/19/2018] [Indexed: 11/13/2022]
Abstract
Impacted pediatric tracheobronchial thrombus is an uncommon diagnosis. There are no clearly proven therapeutic options for airway casts due to a similar process, plastic bronchitis. Cryotherapy, specifically cryoextraction, has shown potential as a therapeutic option in adults with tracheobronchial thrombus and cast. We describe the novel application of this method in a complex pediatric patient.
Collapse
Affiliation(s)
- Kevin Engelhardt
- Division of Pediatric Intensive Care, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.,Children's Health Dallas, Critical Care, Dallas, Texas
| | - Timothy Pirolli
- Department of Cardiothoracic Surgery, University of Texas Southwestern, Dallas, Texas.,Children's Health Dallas, Heart Center, Dallas, Texas
| | - Lakshmi Raman
- Division of Pediatric Intensive Care, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.,Children's Health Dallas, Critical Care, Dallas, Texas
| | - Muhanned Abu-Hijleh
- Pulmonary and Critical Care Medicine, University of Texas Southwestern, Dallas, Texas
| | - Susan Hupp
- Division of Pediatric Intensive Care, Department of Pediatrics, University of Texas Southwestern, Dallas, Texas.,Children's Health Dallas, Critical Care, Dallas, Texas
| |
Collapse
|
24
|
Plastic Bronchitis in an AIDS Patient with Pulmonary Kaposi Sarcoma. Case Rep Pulmonol 2018; 2018:9736516. [PMID: 30363701 PMCID: PMC6180928 DOI: 10.1155/2018/9736516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/18/2018] [Indexed: 11/17/2022] Open
Abstract
Plastic bronchitis is the expectoration of bronchial casts in the mold of the tracheobronchial tree. It is a rare occurrence of unknown etiology that has been primarily described in children with congenital heart disease. In this case report, we present the first reported case of plastic bronchitis in a patient with pulmonary Kaposi sarcoma and underlying HIV infection.
Collapse
|
25
|
Saladi L, Lvovsky D. Organized blood clot masquerading as endobronchial tumor: A review of management and recent advances. Respir Med Case Rep 2018; 24:165-169. [PMID: 29977787 PMCID: PMC6010643 DOI: 10.1016/j.rmcr.2018.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 01/01/2023] Open
Abstract
Central airway obstruction, a frequently encountered emergency, is usually associated with blood clots, tumors, foreign bodies or mucus plugs. Airway obstruction due to blood clots can be seen as a complication of lung malignancies, infections, bronchiectasis, arteriovenous malformations or pulmonary infarction. In patients with long standing blood clots, the thrombus gets organized and firmly adherent to the airway. The diagnosis is often misleading as these clots mimic tumors clinically and on imaging. Hemoptysis is the most common presenting symptom though many patients can be asymptomatic. Direct visualization with bronchoscopy is required to establish a diagnosis. Life-threatening respiratory impairment is an indication for emergent clot retrieval. Management of these blood clots, especially when organized, is challenging. Initial attempts at removal should include suctioning, lavage or forceps extraction. When unsuccessful, further management options include balloon catheter dislodgement, use of topical thrombolytics, rigid bronchoscopy and cryoextraction.
Collapse
Affiliation(s)
- Lakshmi Saladi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Care Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
- Corresponding author.
| | - Dmitry Lvovsky
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Bronx Care Health System, 1650 Grand Concourse, Bronx, NY 10457, USA
- Icahn School of Medicine at Mount Sinai, USA
| |
Collapse
|
26
|
Unimodality and Multimodality Cryodebridement for Airway Obstruction. A Single-Center Experience with Safety and Efficacy. Ann Am Thorac Soc 2018; 13:856-61. [PMID: 26999041 DOI: 10.1513/annalsats.201508-486oc] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Cryodebridement (CD) refers to the removal of obstructive material from the lumen of the tracheobronchial tree by freezing with a cryoprobe, which is usually inserted through a flexible bronchoscope. This method of achieving instant recanalization of airways has been established for over 20 years, but published experience comprises limited case series. OBJECTIVES This study describes a single large-volume referral center experience, including clinical outcomes and safety profile. METHODS Electronic medical records of 156 patients who underwent bronchoscopic CD between December 2007 and March 2012 as the primary method to relieve airway obstruction were reviewed retrospectively. MEASUREMENTS AND MAIN RESULTS The most frequent cause of airway obstruction was malignancy (n = 88), with non-small-cell lung cancer and metastatic renal cell carcinoma being the most common etiologies. The site of obstruction was localized to the central airways in 63 patients (40%) and the distal airways in 44 patients (28%), and it was diffuse in 49 patients (32%). Bronchoscopic airway patency was achieved in 95% of patients, with the highest success rates found in those with obstruction localized in the central airways. Improvement in symptoms occurred in 118 (82%) of 144 symptomatic patients. Serious complications were reported in 17 patients (11%) and included respiratory distress, severe bleeding, airway injury, and hemodynamic instability. All patients responded to treatment, and no intra- or postoperative deaths were reported. CONCLUSIONS CD, when used alone or in combination with other endoscopic treatment modalities, appears to be safe and effective in treating endoluminal airway obstruction.
Collapse
|
27
|
Zheng J, Gao Y, Xu X, Kang K, Liu H, Wang H, Yu K. Correlation of bispectral index and Richmond agitation sedation scale for evaluating sedation depth: a retrospective study. J Thorac Dis 2018; 10:190-195. [PMID: 29600048 DOI: 10.21037/jtd.2017.11.129] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background This study aims to verify the correlation of bispectral index (BIS) and Richmond agitation sedation scale (RASS) for evaluating these and explore possibility of replacing RASS with BIS. Methods This retrospective cohort study consisted of 74 patients who were collected from the third Intensive Care Unit (ICU) ward of XXX Hospital between May 2012 and June 2015 in this retrospective study. Sedation levels were evaluated using the 10-grade RASS and were continuously monitored with a BIS monitor during the procedure every 5 minutes. BIS values and RASS scores were recorded. Results Patients were divided into dexmedetomidine (n=31) and midazolam (n=43) groups, and 342 paired data were collected. A statistically significant correlation existed between BIS values and RASS scores either in all patients undergoing flexible fiberoptic bronchoscopy (FFB) or in dexmedetomidine and midazolam groups at different time points. Correlation coefficient was higher in midazolam group compared with dexmedetomidine group at different time points (P<0.05). Conclusions A correlation was observed between BIS and RASS for evaluating depth of sedation in ICU patients undergoing FFB (P<0.05). Study results indicated that BIS monitoring is a meaningful tool, which can be applied as an adjunctive and alternative method to assess sedation, especially for high-risk patients who are prone to be under- or over-sedation.
Collapse
Affiliation(s)
- Junbo Zheng
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Yang Gao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Xiaoyu Xu
- Department of Critical Care Medicine, Hegang People's Hospital, Hegang 154100, China
| | - Kai Kang
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University, Harbin 150001, China
| | - Haitao Liu
- Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University, Harbin 150081, China
| | - Hongliang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University, Harbin 150086, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University, Harbin 150081, China.,Institute of Critical Care Medicine, Sino Russian Medical Research Center of Harbin Medical University, Harbin 150081, China
| |
Collapse
|
28
|
Coen M, Daniel L, Serratrice J. An adult case of plastic bronchitis: a rare and multifactorial disease. J Thorac Dis 2018; 10:E16-E19. [PMID: 29600096 DOI: 10.21037/jtd.2017.12.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Plastic bronchitis is a rare and potentially fatal disease. Mainly a disease of the pediatric age, a few adult cases occurring after cardiac surgery have been described. We describe a case of a 41-year-old man suffering from several episodes of acute dyspnea and cough with expectoration of mucous plugs in the context of chronic allergic airway inflammation. We believe that the occurrence of plastic bronchitis in adulthood should not be overlooked particularly in patients with chronic inflammatory lung disease.
Collapse
Affiliation(s)
- Matteo Coen
- Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Daniel
- Department of Pathology, La Timone University Hospital, Marseille, France
| | - Jacques Serratrice
- Department of Internal Medicine, Geneva University Hospitals, Geneva, Switzerland
| |
Collapse
|
29
|
Hewlett JC, Rickman OB, Lentz RJ, Prakash UB, Maldonado F. Foreign body aspiration in adult airways: therapeutic approach. J Thorac Dis 2017; 9:3398-3409. [PMID: 29221325 DOI: 10.21037/jtd.2017.06.137] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tracheobronchial foreign body (FB) aspiration is an uncommon but potentially life-threatening event in adults. Symptoms typically consist of a choking event followed by cough and dyspnea, however, these findings are inconsistent and symptoms may mimic more chronic lung diseases such as asthma or chronic obstructive pulmonary disease. Chest radiography and computed tomography can provide information regarding the location and characteristics of foreign bodies and aid in diagnosis. Bronchoscopy remains the gold standard for diagnosis and management of FB aspiration. The authors describe the typical clinical presentation, diagnostic evaluation, and bronchoscopic management of foreign bodies in adult airways with a focus on bronchoscopic techniques and potential complications of FB extraction.
Collapse
Affiliation(s)
- Justin C Hewlett
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Otis B Rickman
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert J Lentz
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Udaya B Prakash
- Department of Pulmonary and Critical Care Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Fabien Maldonado
- Division of Allergy, Pulmonary and Critical Care, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
30
|
Gao Y, Kang K, Liu H, Jia L, Tang R, Zhang X, Wang H, Yu K. Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients: A retrospective study. Medicine (Baltimore) 2017; 96:e7090. [PMID: 28640084 PMCID: PMC5484192 DOI: 10.1097/md.0000000000007090] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study aimed to investigate the clinical effectiveness of dexmedetomidine and midazolam for sedation of intensive care unit (ICU) patients requiring flexible fiberoptic bronchoscopy (FFB).This retrospective cohort study included 148 patients from the third ICU ward of the Second Affiliated Hospital of Harbin Medical University (Harbin, China) who received simultaneous invasive mechanical ventilation and FFB between March 2012 and December 2014. Patients were divided into dexmedetomidine (n = 72) and midazolam (n = 76) groups according to sedative mode. The sedative effects, incidence of adverse events, and bronchoscopist satisfaction scores were compared between groups.During FFB, total sedation time and total time of FFB were significantly shorter in the midazolam group (P < .001, respectively), with a lower percentage of these patients requiring propofol for remedial sedation (P < .001). The incidence of FFB-related adverse events (including bronchospasm, cough, and decreased oxygen saturation) was significantly higher in dexmedetomidine group compared with midazolam group (P = .007, .014 and .008, respectively). However, the incidence of other adverse events was not significantly different between groups. In addition, bronchoscopist satisfaction scores were significantly higher in the midazolam compared with dexmedetomidine group (7.72 ± 1.65 vs 7.08 ± 1.77; P = .030).For sedation of ICU patients during FFB, combination of midazolam and dexmedetomidine demonstrated an enhanced sedative effect, lower incidence of adverse events, and higher bronchoscopist satisfaction score compared with dexmedetomidine alone, thus represents a suitable alternative sedative for FFB patients.
Collapse
Affiliation(s)
- Yang Gao
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University
| | - Kai Kang
- Department of Critical Care Medicine, the First Affiliated Hospital of Harbin Medical University
| | - Haitao Liu
- Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University
| | - Liu Jia
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University
| | - Rong Tang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University
| | - Xing Zhang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University
| | - Hongliang Wang
- Department of Critical Care Medicine, the Second Affiliated Hospital of Harbin Medical University
| | - Kaijiang Yu
- Department of Critical Care Medicine, the Cancer Hospital of Harbin Medical University
- Institute of Critical Care Medicine in Sino Russian Medical Research Center of Harbin Medical University, Harbin, China
| |
Collapse
|
31
|
Sehgal IS, Dhooria S, Behera D, Agarwal R. Use of cryoprobe for removal of a large tracheobronchial foreign body during flexible bronchoscopy. Lung India 2016; 33:543-5. [PMID: 27625452 PMCID: PMC5006338 DOI: 10.4103/0970-2113.188978] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Foreign body (FB) inhalation in the tracheobronchial tree is an infrequently encountered event in adults. The diagnosis is suspected in the presence of a clinical history of aspiration and the presence of respiratory symptoms. Management involves confirmation by flexible bronchoscopy, which may be both diagnostic as well as therapeutic. However, in certain situations including those with large FB, FB embedded in granulation tissue or FB with very smooth margins, rigid bronchoscopy may be superior to flexible bronchoscopy in the retrieval of the FB. An alternative to rigid bronchoscopy in such situations may be the use of a cryoprobe. Herein, we describe a patient with a large tracheobronchial FB causing a complete collapse of the left lung and hypoxemia. The FB was successfully extracted using a cryoprobe during flexible bronchoscopy, obviating the need for rigid bronchoscopy.
Collapse
Affiliation(s)
- Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Digambar Behera
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
32
|
Hammer J, Trachsel D, Nicolai T, Weiss M, Eber E. Caution to use bronchoscopic CO2 cryotherapy for foreign body removal in children. Pediatr Pulmonol 2016; 51:889-91. [PMID: 27128205 DOI: 10.1002/ppul.23450] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 04/11/2016] [Accepted: 04/12/2016] [Indexed: 11/09/2022]
Affiliation(s)
- Jürg Hammer
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, Switzerland
| | - Daniel Trachsel
- Division of Respiratory and Critical Care Medicine, University Children's Hospital Basel, Switzerland
| | - Thomas Nicolai
- Department of Pediatrics, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Markus Weiss
- Department of Anesthesia, University Children's Hospital Zurich, Switzerland
| | - Ernst Eber
- Division of Pediatric Pulmonology and Allergology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Austria
| |
Collapse
|
33
|
Bronchoscopic Cryotherapy. Clinical Applications of the Cryoprobe, Cryospray, and Cryoadhesion. Ann Am Thorac Soc 2016; 13:1405-15. [DOI: 10.1513/annalsats.201601-062fr] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
34
|
Panchabhai TS, Mukhopadhyay S, Sehgal S, Bandyopadhyay D, Erzurum SC, Mehta AC. Plugs of the Air Passages: A Clinicopathologic Review. Chest 2016; 150:1141-1157. [PMID: 27445091 DOI: 10.1016/j.chest.2016.07.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 05/22/2016] [Accepted: 07/06/2016] [Indexed: 02/07/2023] Open
Abstract
Although mucus is a normal product of the tracheobronchial tree, some diseases of the respiratory tract are characterized by unusually thick (inspissated) forms of mucus that accumulate within the airways. These are known as mucus plugs. The pathologic composition of these plugs is surprisingly diverse and, in many cases, correlates with distinctive clinical, radiologic, and bronchoscopic findings. The best-known conditions that involve mucus plugs are allergic bronchopulmonary aspergillosis, plastic bronchitis, and asthma. Other lung diseases occasionally associated with plugs within the airways include Aspergillus tracheobronchitis, hyper-IgE syndrome, exogenous lipoid pneumonia, pulmonary alveolar proteinosis, and chronic eosinophilic pneumonia. In this review, we describe and illustrate the bronchoscopic, pathologic, and imaging findings in respiratory disorders characterized by mucus plugs or plugs composed of other similar materials. Recognition of the characteristic appearance and differential diagnosis of mucus plugs will hopefully facilitate diagnosis and management of these diseases.
Collapse
Affiliation(s)
- Tanmay S Panchabhai
- Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ
| | | | - Sameep Sehgal
- Department of Pulmonary Medicine, the Respiratory Institute, Cleveland Clinic, Cleveland, OH
| | | | - Serpil C Erzurum
- Department of Pulmonary Medicine, the Respiratory Institute, Cleveland Clinic, Cleveland, OH; Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Department of Pulmonary Medicine, the Respiratory Institute, Cleveland Clinic, Cleveland, OH.
| |
Collapse
|
35
|
Sachdeva A, Pickering EM, Lee HJ. From electrocautery, balloon dilatation, neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser to argon plasma coagulation and cryotherapy. J Thorac Dis 2016; 7:S363-79. [PMID: 26807284 DOI: 10.3978/j.issn.2072-1439.2015.12.12] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Over the past decade, there has been significant advancement in the development/application of therapeutics in thoracic diseases. Ablation methods using heat or cold energy in the airway is safe and effective for treating complex airway disorders including malignant and non-malignant central airway obstruction (CAO) without limiting the impact of future definitive therapy. Timely and efficient use of endobronchial ablative therapies combined with mechanical debridement or stent placement results in immediate relief of dyspnea for CAO. Therapeutic modalities reviewed in this article including electrocautery, balloon dilation (BD), neodymium-doped:yttrium-aluminum-garnet (Nd:YAG) laser, argon plasma coagulation (APC), and cryotherapy are often combined to achieve the desired results. This review aims to provide a clinically oriented review of these technologies in the modern era of interventional pulmonology (IP).
Collapse
Affiliation(s)
- Ashutosh Sachdeva
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Edward M Pickering
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Hans J Lee
- 1 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, University Maryland, Baltimore, MD 21201, USA ; 2 Section of Interventional Pulmonology, Division Pulmonary/Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| |
Collapse
|