Chronic respiratory failure – pathophysiology
Claudio F. Donner, Nicolino Ambrosino, Roger S. Goldstein in Pulmonary Rehabilitation, 2020
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.
Donor lung preservation
Wickii T. Vigneswaran, Edward R. Garrity, John A. Odell in LUNG Transplantation, 2016
During the donor lung retrieval procedure, accurate assessment of the lungs is important. Generally, bronchoscopy is performed to evaluate endobronchial abnormalities and secretions, hemorrhage, or the aspirated foreign material that is occasionally present. In our experience, purulent secretions are frequently found in brain-dead donors even after only short mechanical ventilation times. Purulent endobronchial secretions rarely represent serious pulmonary infection. In the vast majority of donors, endobronchial mucus can be removed by bronchoscopy. In the case of reappearance of purulent secretions after the initial bronchoscopy, macroscopic assessment of the lung parenchyma is necessary for further evaluation. Bronchoalveolar lavage (BAL) fluid should be preserved for microbiologic analysis. However, positive cultures from lung donor BAL fluid do not translate into postoperative infections in lung recipients.7
Role of invasive testing in ILD diagnosis
Muhunthan Thillai, David R Moller, Keith C Meyer in Clinical Handbook of Interstitial Lung Disease, 2017
FB has been used in the clinical setting for over 40 years and can be performed with a high degree of safety by appropriately trained clinicians and support personnel. Bronchoscopy is generally well-tolerated and can be performed under moderate sedation with topical anaesthesia. Key safety aspects include adequate subject monitoring (heart rate, electrocardiogram tracing, blood pressure, continuous pulse oximetry), pre-procedure assessment of risk factors (significant cardiopulmonary compromise, recent ischaemic cardiac events, bleeding diatheses, unstable medical conditions), adequate training in bronchoscopic procedures, and the ability to promptly respond to complications that may occur during or following the procedure. The upper and lower airways should be completely inspected to detect any mucosal abnormalities. Pre-procedure HRCT scanning can be very useful to target areas of the lung that are most likely to yield diagnostic specimens when performing lavage or lung biopsy (9,10).
Indications and complications of rigid bronchoscopy
Published in Expert Review of Respiratory Medicine, 2018
Bronchoscopy, in general, can be diagnostic or therapeutic. Often it is both. It is for therapeutic bronchoscopy where using the rigid technique is particularly important and often necessary. Use of rigid bronchoscopy for CAO makes the procedure not only safer but also more effective and efficient. In fact, in a subset of this population, rigid therapeutic bronchoscopy has been shown to improve survival. FB removal is often done with rigid bronchoscopy and certain FBs can be impossible to remove without it. We believe that every interventional pulmonology fellowship program must provide sufficient training in rigid bronchoscopy such that every interventional pulmonologist has adequate expertise in this procedure. The number of interventional fellowship training programs in the US is rising rapidly. A multi-society interventional pulmonology fellowship accreditation standard has been developed with input and approval of the American Association for Bronchology and Interventional Pulmonology, Association of Interventional Pulmonology Program Directors, American Thoracic Society, ACCP/CHEST, and the Association of Pulmonary and Critical Care Medicine Program Directors [72]. This will ensure that accredited interventional fellowship programs provide training in rigid bronchoscopy and other procedures that is at par with the established standards.
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.
Interventional bronchoscopy in adults
Published in Expert Review of Respiratory Medicine, 2018
Diana H Yu, David Feller-Kopman
Over the past decade, there have been significant advancements in the development and application of diagnostic instruments and technology for thoracic diseases. Advanced imaging techniques, such as electromagnetic navigational bronchoscopy (ENB), endobronchial ultrasound (EBUS – radial and convex), have revolutionized the approach to lung nodules and the evaluation of mediastinal/hilar adenopathy. Optical coherence tomography (OCT), confocal laser endomiscroscopy (CLE), and laser Raman spectroscopy (LRS) remain investigational, but have potential future diagnostic implications. Likewise, large, multicenter studies investigating the outcomes of therapeutic bronchoscopy have also furthered our understanding of the relative risks and benefits of these procedures. We provide updated evidence-based clinical review of these diagnostic and therapeutic bronchoscopic techniques in the modern era of IP.
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