Search

Author(s): Samar M. Abdel Twab (corresponding author) [1]; Fagr F. Abdo [1]; Maha S. El Derh [1] INTRODUCTION Bronchoscopy commonly produces hypoxaemia. The partial pressure of oxygen (PaO[sub.2] ) usually [...], Background and Aims: This trial aimed to assess the safety and efficacy of oxygenation using a high-flow nasal cannula (HFNC) compared with the standard apnoeic oxygenation technique during foreign body (FB) removal by a rigid bronchoscope. Methods: A prospective, blinded, randomised, controlled trial was conducted on subjects planned for FB removal by a rigid bronchoscope. Inclusion criteria were male and female patients aged between 10 and 40 years. The primary outcome was the lowest oxygen saturation level monitored by pulse oximeter during the procedure, and the secondary outcome was the incidence of postoperative atelectasis. Results: Nearly 64 patients were randomised into either HFNC oxygenation (N = 32) or apnoeic oxygenation (N = 32) group. There were no significant differences between the studied groups regarding age, gender, weight, or cardiovascular variables. Intraoperative oxygen saturation was 4 higher in the HFNC group at different times. The end-tidal carbon dioxide measured on induction and after termination by 15 min showed no significant differences between the two groups; however, it was significantly higher in the apnoeic oxygenation group immediately after the procedure, after 5 min, and after 10 min of termination. No adverse effects from the increased end-tidal carbon dioxide were reported. Conclusion: HFNC was superior to apnoeic oxygenation technique in maintaining oxygenation status in patients undergoing rigid bronchoscopy for FB removal. Keywords: Apnoea, bronchoscopes, nasal cannulae

Author(s): Nadine May [sup.1] [sup.2] , Christa Niehaus-Gebele [sup.1] [sup.2] , Frank Reichenberger [sup.1] [sup.2] , Jürgen Behr [sup.1] [sup.2] , Wolfgang Gesierich [sup.1] [sup.2] [sup.3] Author Affiliations: (1) Klinik [...], Background Evidence for bronchoscopic lung volume reduction (BLVR) is based on phase 2 studies and small randomized controlled trials with in- and exclusion criteria defining a therapeutic window and contraindications. Little is known about the applicability in routine clinical practice. Aim Which percentage of patients with severe emphysema referred to a specialized treatment center for BLVR is ultimately suitable for interventional bronchoscopic treatment? What is the relevance of the different contraindications? Methods Retrospective evaluation of emphysema patients referred to Asklepios Fachkliniken Munich-Gauting for BLVR between January 2014 and June 2015. Results 138 patients were referred for evaluation of BLVR. 38 patients (27.5%) underwent BLVR procedures (valves n = 18; coils n = 18; thermal vapor ablation n = 2). 100 patients (72.5%) were deemed not eligible for BLVR based on the following contraindications: 34% emphysema morphology and emphysema-related findings (severe homogeneous emphysema, extensive pleuropulmonary adhesions, postinflammatory scaring with natural volume reduction, giant bullae), 16% active smoking; 9% pulmonary function not within indication range; 8% unexpected CT findings (nodules, cancer, interstitial disease); 8% chronic ventilatory failure; 8% patient refused BLVR; 5% relevant comorbidity; 5% frequent exacerbations, 3% preserved quality of life, 4% other. Conclusion BLVR is a therapeutic option for highly selected patients. In our cohort, one in four could be treated. These data highlight the limitations of BLVR under real-life conditions.

Background: Endobronchial ultrasound (EBUS) features like nodal size, margins, central hilar structure and necrosis have high accuracy for predicting lymph node (LN) malignancy. However, their clinical application remains limited because [...]

Author(s): Nitu Puthenveettil (corresponding author) [1]; Jerry Paul [1]; Shanmitha Ravichandran [1]; Anupama Rajan [2] Sir, An anaesthesiologist may encounter unanticipated complications during endotracheal intubation.[1,2] We report a case of [...]

Background: Triple normal lymph nodes (LNs), appearing benign on computed tomography, positron emission tomography and endobronchial ultrasonography (EBUS), have a less than 6% probability of malignancy. We hypothesized that targeted [...]

Byline: Thun-How Ong (1), Philip Eng (1) Keywords: Massive hemoptysis Bronchial artery embolisation Intensive care Bronchoscopy Abstract: Abstract Objectives. Massive hemoptysis can cause airway or hemodynamic compromise requiring intensive care. We reviewed the management and outcome of this group of patients in our institution. Design. Retrospective analysis. Setting. Medical intensive care unit (MICU) in a tertiary care hospital. Patients. Patients (29 patients with 31 episodes) who were admitted to the MICU for massive hemoptysis (greater than 300 ml/24 h or requiring intubation) between August 1997 and April 2001. Management. Patients were intensively monitored and electively intubated if there was danger of airway compromise. Fiberoptic bronchoscopy was performed to assess the site of bleeding and patients had bronchial artery embolisation if deemed suitable. Patients in whom bleeding could not be controlled were referred for emergency surgery. Results. In 26/31 (84%) episodes, patients required intubation. Bronchoscopy was more helpful in localising the bleeding (site of bleeding identified in 90%) than chest X-ray alone (identified site of bleeding in 64%). Bleeding was stopped with medical therapy in 8/31 (26%) patient 16/31(51%) patients were successfully treated with embolisation. Only four (13%) patients went for emergency surgery, of whom one died. Overall in-hospital mortality was 4/31 patients (13%). Over a 2 year follow-up, 6/27 (22%) survivors had recurrent hemoptysis and another 4 (15%) died of unrelated causes. Conclusions. Intensive care and monitoring with endotracheal intubation, when necessary, are useful in massive hemoptysis. Bronchoscopy should be performed to help localise the bleeding site. Embolisation is a suitable first-line treatment for massive hemoptysis, reserving emergency surgery for cases where the above measures are insufficient to control bleeding. Author Affiliation: (1) Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Outram Road, Singapore169608, Singapore Article History: Received Date: 18/12/2001 Accepted Date: 11/10/2002 Article note: Electronic Publication

Byline: Massimo Antonelli (1), Mariano Pennisi (1), Giorgio Conti (1), Giuseppe Bello (1), Salvatore Maggiore (1), Vincenzo Michetti (1), Franco Cavaliere (1), Rodolfo Proietti (1) Keywords: Noninvasive positive pressure ventilation Helmet Pneumonia Bronchoscopy Hypoxemia Acute respiratory failure Abstract: Abstract Objective. To evaluate the feasibility and safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) during noninvasive positive pressure ventilation (NPPV) delivered by helmet in patients with acute respiratory failure (ARF) and suspected pneumonia. Design and setting. Prospective, clinical investigation in a general intensive care unit (ICU) of a university hospital. Patients and participants. Four adult patients with ARF who underwent NPPV via the helmet and required fiberoptic BAL for suspected pneumonia. Interventions. NPPV was delivered through the helmet in the pressure support ventilation mode. The specific seal connector placed in the plastic ring of the helmet allowed the passage of the bronchoscope, maintaining assisted ventilation. Arterial blood gas levels, pH, oxygen saturation, respiratory rate, heart rate, and mean arterial blood pressure were monitored during the study. Results. Helmet NPPV avoided gas exchanges deterioration during FOB and BAL, with good tolerance. During the procedure heart rate increased by 5% and mean arterial blood pressure by 7% over baseline these levels returned to prebronchoscopic values immediately after the withdrawal of the bronchoscope. Endotracheal intubation was never required during the 24 h after the procedure. BAL yielded diagnostic information in three of four patients. Conclusions. NPPV through the helmet allows a safe diagnostic FOB with BAL in patients with hypoxemic ARF, avoiding gas exchange deterioration, and endotracheal intubation. Electronic supplementary material is available if you access this article at http://dx.doi.org/10.1007/s00134-002-1554-5. On that page (frame on the left side), a link takes you directly to the supplementary materials. Author Affiliation: (1) Istituto di Anestesiologia e Rianimazione, Universita Cattolica del Sacro Cuore, Policlinico A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy Article History: Received Date: 09/06/2002 Accepted Date: 09/10/2002 Article note: Electronic Publication

Byline: Martin Beiderlinden (1), Martin Karl Walz (2), Andreas Sander (1), Harald Groeben (1), Jurgen Peters (1) Keywords: Bronchoscopy Complications Tracheostomy tube fixation Suture Tracheal ring fracture Abstract: Objective: To assess the complication rate of bronchoscopically guided percutaneous dilational tracheostomy (PDT), with tracheal tube suture fixation and no elective tracheostomy tube exchange, after experience had been gained. Design: Prospective clinical study. Setting: Anaesthesiological ICU with mixed surgical and medical patients in a university hospital. Patients: Hundred thirty-three mechanically ventilated patients (mean age: 54.8 years, range: 13--87 years) with indication for PDT, many with thrombocytopenia and/or coagulation deficits. Interventions: Hundred thirty-six consecutive PDTs performed by residents under bronchoscopic guidance with stepwise dilation (n=114, Ciaglia's conventional system) or conic dilation (n=22, 'Blue Rhino' approach) and supervision of experienced staff anaesthesiologists. Tracheostomy tubes were fixed to the skin with a suture and no routine exchange of tracheostomy tubes was performed. Complications were categorised and the results were also compared to an earlier prospective study. Results: The incidence of tracheostomy tube-related complications (hypoxaemia, cannula misplacement, accidental decannulation, cuff rupture and hernia, or posterior tracheal wall lesion) was low (0.7%) and significantly less (6.2%, p=0.01) than in our earlier study. No patient died of PDT-associated complications. We recorded four (2.9%) clinically relevant bleeding episodes. Insertion of tracheal tubes was easy or only moderately difficult in 86.7%. Conclusion: With experience in performing PDT, fixation of the tracheal cannula, and omission of routine change of tracheostomy tubes complication rate of PDT is low. Author Affiliation: (1) Abteilung fur Anasthesiologie und Intensivmedizin, Universitatsklinikum Essen, Hufelandstrasse 55, 45122 Essen, Germany (2) Klinik fur Chirurgie und Zentrum fur Minimal Invasive Chirurgie, Kliniken Essen-Mitte, Henricistrasse 92, 45136 Essen, Germany Article History: Received Date: 13/06/2001 Accepted Date: 12/10/2001 Article note: Electronic Publication

Byline: O. Noizet (1), F. Leclerc (1), S. Leteurtre (1), A. Brichet (2), G. Pouessel (1), A. Dorkenoo (1), C. Fourier (1), R. Cremer (1) Keywords: Plastic bronchitis Cast bronchitis Airways foreign body Pneumomediastinum Status asthmaticus Abstract: Objective. To report two children admitted to our emergency department with respiratory failure, one for status asthmaticus with pneumomediastinum and requiring mechanical ventilation and the other for high suspicion of foreign body aspiration. Interventions. Bronchoscopy revealed obstructive plugs and permitted their extraction and their identification as bronchial casts after the immersion in normal saline. Allergy was suspected in the first one, and Hemophilus influenzae infection was present in the second. The outcome was favorable. Conclusions. Plastic bronchitis is an infrequent cause of acute life-threatening respiratory failure that can mimic foreign body aspiration or status asthmaticus. Bronchoscopic extraction must be performed urgently in the case of severe obstruction. This entity is probably underestimated as the casts with their specific ramifications are difficult to recognize. We recommend the immersion in normal saline of all plugs discovered in children with predisposing diseases mainly represented by infections, allergy, acute chest syndrome, and congenital cardiopathies. Author Affiliation: (1) Pediatric Intensive Care Unit, University Hospital of Lille, 59037, Lille, France (2) Department of Pulmonology, University Hospital of Lille, 59037, Lille, France Article History: Received Date: 22/01/2002 Accepted Date: 13/11/2002 Article note: Electronic Publication