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Chronic respiratory failure – pathophysiology
Published in Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein, Pulmonary Rehabilitation, 2020
Mafalda Vanzeller, Marta Drummond, João Carlos Winck
Diagnostic bronchoscopy and tissue biopsies are an integral part of the investigation of respiratory diseases and should be regarded as complementary tests. Fibreoptic bronchoscopy is usually an outpatient procedure, performed with local anaesthesia or sedation. Oxygen supplementation by nasal cannula to maintain the SaO2 at 90% or greater is recommended, as the procedure can cause PaO2 fall. Oxygen saturation monitoring by pulse oximetry and oxygen supplementation shall continue post-procedure, according to patient need, especially if in presence of CRF. Bronchoscopy is mainly used to investigate or confirm the possibility of carcinoma and its operability, and also to diagnose interstitial lung diseases. The use of imaging and flexible instruments at bronchoscopy allows sampling of distal bronchi or lung parenchyma that cannot be seen directly. A diagnosis at bronchoscopy does not just depend on tissue sampling, as many abnormal appearances are characteristic. It is particularly useful in excluding endobronchial abnormalities.
Tracheal Chondrosarcoma
Published in Wickii T. Vigneswaran, Thoracic Surgery, 2019
Alison Coogan, Lia Jordano, Michael J. Liptay, Christopher W. Seder
Diagnosis of tracheal chondrosarcoma is best done by CT scan followed by flexible and rigid bronchoscopy [3,4]. A chest CT provides information regarding the size and extent of the tumor but may underestimate tracheal wall involvement [5]. Bronchoscopy allows better visualization of and ability to biopsy the tumor.
Otorhinolaryngology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Chris Jephson, C. Martin Bailey
With symptoms, signs or suspicion of foreign body inhalation, bronchoscopy should be performed by an experienced surgical, anaesthetic and nursing team. Distal foreign bodies occasionally require flexible endoscopy for retrieval and, very rarely, a thoracotomy may be required.
The bleeding risk and safety of multiple treatments by bronchoscopy in patients with central airway stenosis
Published in Expert Review of Respiratory Medicine, 2023
Congcong Li, Yanyan Li, Faguang Jin, Liyan Bo
There were also some limitations that should be noted in this study. First, there was some variability between the two groups (such as age and anesthesia type) that may influence the final analyses. Second, this study was retrospective and collected data from a single institution. Third, while exploring the risk factors related to the complications, there were also some factors that may have an effect on the safety of interventional bronchoscopy; however, due to a lack of related information, we could not analyze their influence. Additionally, due to the relatively rare nature of complications and a lack of adequate participants, the study lacked the statistical power to identify risk factors for every single complication. Therefore, we reported any complications as a composite outcome rather than specific types of complications, which may have resulted in bias (a risk factor for one type of complication may not be a risk factor for another). Fourth, the follow‑up period was relatively short, and a longer duration of assessment of the late complication was needed.
Complications and safety analysis of diagnostic bronchoscopy in COPD: a systematic review and meta-analysis
Published in Expert Review of Respiratory Medicine, 2022
Congcong Li, Tianyi Zhu, Debin Ma, Yan Chen, Liyan Bo
Information about the major complications of diagnostic bronchoscopy in patients with COPD was extracted and is shown in Table 2. The major complications were divided into 11 categories: hemoptysis requiring observation or intervention, pneumothorax, hemodynamic instability requiring vasoactive drugs, cardiac arrhythmias or cardiac arrest, respiratory failure or asphyxia, hypoxemia requiring termination of the procedure, ventilation upgrade, unplanned hospital admission or ICU transfer, hemothorax, death, and others [11]. Ninety-five patients were reported to have developed major complications. According to our analysis, the most common major complications of diagnostic bronchoscopy were respiratory failure or asphyxia, pneumothorax and hemoptysis requiring observation or intervention.
Factors associated with tracheostomy decannulation in patients with severe traumatic brain injury
Published in Brain Injury, 2020
Ryne Jenkins, Neeraj Badjatia, Bryce Haac, Richard Van Besien, John F. Biedlingmaier, Deborah M. Stein, Wan-Tsu Chang, Gary Schwartzbauer, Gunjan Parikh, Nicholas A. Morris
At our affiliated rehabilitation center, patients are evaluated by speech-language pathologists daily and one-on-one supervised speaking valve trials are attempted until seen by an otolaryngologist. Speech-language pathologists assess for adequate level of consciousness, effective cough, ability to manage secretions, adequate oxygenation, and swallowing function. All patients with tracheostomies are seen by an otolaryngologist upon admission to the rehabilitation center and when deemed appropriate for consideration of decannulation by the speech-language pathologist. On that evaluation, the tracheostomy is removed and a retrograde fiberoptic endoscopic evaluation of the vocal cords and subglottic space is performed. A bronchoscopy is also performed to evaluate the trachea and airways. If no pathology is seen, the tube is downsized to a cuffless 7 Portex. Nasal endoscopy is then performed to assess the upper airway and cords for sensation, motion, and secretions. If deemed appropriate, patients are placed on a one-week trial of daytime only plugging (capping) with pulse oximetry. The patient is then seen the following week by the otolaryngologist who repeats the endoscopic assessment. If appropriate, the patient is downsized to the smallest tube possible and left plugged for 24 h with continuous pulse oximetry. Following the 24 h plugging trial, if no desaturations, patients are decannulated.