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Lu W, Li X, Wang S, Tu C, Qiu L, Zhang H, Zhong C, Li S, Liu Y, Liu J, Zhou Y. New Evidence of Microplastics in the Lower Respiratory Tract: Inhalation through Smoking. Environ Sci Technol 2023. [PMID: 37267095 DOI: 10.1021/acs.est.3c00716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
To investigate the relation of smoking and microplastic inhalation, we conducted a prospective study combining population-based and experimental work. Bronchoalveolar lavage fluid (BALF) samples from 17 smokers and 15 nonsmokers were collected in Zhuhai City, China. We simulated an active smoking model to explore the contribution of smoking to inhaled microplastics. The characteristics of microplastics in BALF samples and cigarette smoke were determined using laser direct infrared spectroscopy. We compared the differences between smokers and nonsmokers as well as between cigarette smoke and control groups. Microplastics were identified positive in all BALF samples. Smokers had higher concentrations of total microplastics (25.86 particles/g), polyurethane (11.34 particles/g), and silicone (1.15 particles/g) than nonsmokers. In the cigarette smoking simulation model, higher concentrations of total microplastics (9.99 particles/L), polyurethane (4.66 particles/L), and silicone (2.78 particles/L) were present in the cigarette smoke than those in the control group. We confirmed and extended the evidence on the presence of microplastics in the lower respiratory tract. These findings also provide new evidence on the relation between cigarette smoking and microplastic inhalation.
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Affiliation(s)
- Wenfeng Lu
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China
| | - Xiaoliang Li
- Zhuhai Center for Chronic Disease Control and Prevention, Zhuhai, Guangdong 519060, China
| | - Shuguang Wang
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China
| | - Changli Tu
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Lan Qiu
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China
| | - Han Zhang
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China
| | - Chenghui Zhong
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China
| | - Saifeng Li
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China
| | - Yuewei Liu
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Jing Liu
- Department of Pulmonary and Critical Care Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Yun Zhou
- State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
- School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong 511436, China
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Zhu W, Zhang Y, Shi J, Wang X, Li R, Liu J, Li P, Liu D, Luo F. Pre-operative nasal probe tests with adrenaline and lidocaine ease insertion during flexible bronchoscopy and reduce post-operative bleeding: a randomized controlled trial. Chin Med J (Engl) 2022; 135:1808-13. [PMID: 35838535 DOI: 10.1097/CM9.0000000000002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy; however, the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion. This study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis, improve the first-pass success rate and patients' tolerance, and reduce postoperative bleeding. METHODS This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October 2020. Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups: control group, simple cotton bud detection group (CD group), and adrenaline + lidocaine detection group (AD group). The primary outcome was the time to pass the glottis. Secondary outcomes included the first-pass success rate, the patients' tolerance scores, and post-operative bleeding. One-way analysis of variance, Kruskal-Wallis H test, Chi-squared test, Fisher's exact test, and Bonferroni's multiple comparison tests were used in this study. RESULTS In total, 189 men and 111 women were enrolled in this study, with a mean age of 55.72 ± 12.86 years. The insertion time was significantly shorter in the AD group than in the control group (18.00 s [12.00-26.50 s] vs . 24.00 s [14.50-45.50 s], P = 0.005). Both the AD (99% vs . 83%, χ2 = 15.62, P < 0.001) and CD groups (94% vs . 83%, χ2 = 5.94, P = 0.015) had a significantly higher first-pass success rate than the control group. Compared with the control group, post-operative bleeding (1% vs . 13%, χ2 = 11.06, P < 0.001) was significantly lower in the AD group. However, no significant difference was found in the patients' tolerance scores. CONCLUSIONS Pre-operative nasal cavity probe tests especially with adrenaline and lidocaine during flexible bronchoscopy can significantly reduce the time to pass the glottis, improve the first-pass success rate, and reduce post-operative nasal bleeding. Pre-operative nasal probe tests are recommended as a time-saving procedure for patients undergoing flexible bronchoscopy. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR), ChiCTR2000032668; http://www.chictr.org.cn/showprojen.aspx?proj=53321 .
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Huang X, Ai P, Wei C, Sun Y, Wu A. Comparison of the Effects of Esketamine/Propofol and Sufentanil/Propofol on the Incidence of Intraoperative Hypoxemia during Bronchoscopy: Protocol for a Randomized, Prospective, Parallel-Group Trial. J Clin Med 2022; 11:4587. [PMID: 35956202 DOI: 10.3390/jcm11154587] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 07/29/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Propofol, ketamine, and sufentanil are the most commonly used anesthetics during bronchoscopy, alone or in combination, for sedation. Esketamine is an s-enantiomer of ketamine racemate and has both sedative and analgesic effects. Esketamine does not inhibit respiration and maintains hemodynamic stability. This study aims to compare the clinical efficacy of esketamine/propofol with sufentanil/propofol for patients during bronchoscopy. METHODS Patients undergoing bronchoscopy will be randomly assigned to receive either sufentanil/propofol (sufentanil group; n = 33; sufentanil: 0.2 μg/kg) or esketamine/propofol (esketamine group; n = 33; esketamine: 0.2 mg/kg) for sedation and analgesia. Intraoperative clinical information, general anesthetic drug dosage, the incidence of intraoperative hypoxemia, total time of hypoxemia, awakening time, delirium, nausea and vomiting, adverse reactions, and patient satisfaction will be collected. DISCUSSION Hypoxia has detrimental effects on patients with respiratory disease. Ameliorating hypoxemia in patients undergoing bronchoscopy is critical. Our results will provide effective sedation with esketamine in patients undergoing bronchoscopy. TRIAL REGISTRATION Chinese clinical trial registry: ChiCTR2200058990.
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Professional Committee on Respiratory Equipment Technology of Chinese Medical Equipment Association, Expert Group on Technical of Domestic Electromagnetic Navigation Bronchoscopy. [Expert Consensus on Technical Specifications of Domestic Electromagnetic Navigation Bronchoscopy System in Diagnosis, Localization and Treatment (2021 Edition)]. Zhongguo Fei Ai Za Zhi 2021; 24:529-37. [PMID: 34412766 DOI: 10.3779/j.issn.1009-3419.2021.101.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Electromagnetic navigation bronchoscopy (ENB) is a novel type of bronchoscopy based on electromagnetic positioning technique combined with virtual bronchoscopy, three-dimensional computed tomography (CT) imaging and respiratory gating technique, which has been widely applied in clinic practice. In recent years, the domestic electromagnetic navigation system has also been developed rapidly, and its effectiveness and safety in the diagnosis, localization, and treatment of peripheral pulmonary lesions have been initially verified. In order to optimize and standardize the technical specifications of domestic ENB and guide its application in clinical practice, the consensus statement has been organized and written in a collaborative effort by the Professional Committee on Respiratory Equipment Technology of Chinese Medical Equipment Association and the Expert Group on Technical of Domestic Electromagnetic Navigation Bronchoscopy.
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Ramayanam S, Puchalski J. Flexible Bronchoscopy Biopsy Tools and Techniques to Optimize Diagnostic
Yield: A Contemporary Review. CRMR 2021. [DOI: 10.2174/1573398x17666210716101940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Flexible bronchoscopy is essential in diagnosing many pathologic conditions,
and tools such as lavage and biopsies using brushes, forceps, and needles are paramount to
success.
Introduction:
Bronchoscopists worldwide are routinely confronted with questions about such tools
regarding the type, size, utility, costs, safety, anticipated yield, and others. Does the underlying suspected
condition matter to the choice of instruments used? What is the anticipated outcome for benign
versus malignant diseases? These and other questions are raised daily by bronchoscopists.
Methods:
Pubmed was reviewed for research in the English language pertaining to diagnostic bronchoscopy.
The literature is conflicting on the benefits of the types of tools available. The success of
brush biopsies, forceps, and transbronchial needle aspiration is only partially dependent on the size
of the instrument used or its other characteristics. Multiple biopsies are needed, and different approaches
may be complementary in some circumstances.
Results:
By understanding the factors that involve in a biopsy, the bronchoscopist is more likely to
be successful when a crucial diagnosis is mandatory.
Conclusion:
This review aims to be a reference to bronchoscopists everywhere as they contemplate
their approach to flexible diagnostic bronchoscopy.
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Affiliation(s)
- Snehamayi Ramayanam
- Department of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 15 York St, LCI
100, USA
| | - Jonathan Puchalski
- Department of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, 15 York St, LCI
100, USA
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Matus I, Raja H. Protocolized Thoracic Ultrasonography in Transbronchial Lung Cryobiopsies: A Potential Role as an Exclusion Study for Pneumothorax. J Bronchology Interv Pulmonol 2019; 26:172-8. [PMID: 30124515 DOI: 10.1097/LBR.0000000000000541] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Widespread implementation of transbronchial lung cryobiopsy (TBLCB) in the diagnostic approach to diffuse parenchymal lung disease has prompted a call for standardization of technique to optimize safety and diagnostic yield. Thoracic ultrasound (TUS) is proving effective in detecting postconventional transbronchial biopsy pneumothorax (PTX). However, TUS does not obviate the need for chest radiography (CXR) which quantifies and guides treatment of PTX. To our knowledge, this is the first experience evaluating TUS's reliability to rule-out PTX post-TBLCB in diffuse parenchymal lung disease. METHODS Retrospective analysis of patients undergoing TBLCB. A standardized pre-TBLCB/post-TBLCB TUS was performed to detect the presence or absence of sliding lung (SL). TUS' findings were then compared with CXR performed at 1 hour after TBLCB. RESULTS A total of 24 patients' records reviewed. In total, 21 of 24 patients had SL in all lung zones on TUS before and after TBLCB, with a negative CXR for PTX in all 21 patients. The negative predictive value was 100% (95% confidence interval, 84%-100%). Three patients did not have SL in all lung zones on TUS, of which 2 showed the absence of SL in all lung zones on both pre-TBLCB and post-TBLCB TUS, with negative CXR for PTX. 1 of the 3 showed SL in all zones pre-TBLCB and in only 2 zones post-TBLCB. CXR confirmed PTX in this 1 patient. CONCLUSION Our study demonstrates a 100% negative predictive value for the exclusion of PTX via TUS' verification of SL. The practical value of TUS post-TBLCB may lie in its application as a rule-out study, thereby avoiding CXR.
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Dhooria S, Chaudhary S, Ram B, Sehgal IS, Muthu V, Prasad KT, Aggarwal AN, Agarwal R. A Randomized Trial of Nebulized Lignocaine, Lignocaine Spray, or Their Combination for Topical Anesthesia During Diagnostic Flexible Bronchoscopy. Chest 2019; 157:198-204. [PMID: 31299247 DOI: 10.1016/j.chest.2019.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/20/2019] [Accepted: 06/27/2019] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The optimal mode of delivering topical anesthesia during flexible bronchoscopy remains unknown. This article compares the efficacy and safety of nebulized lignocaine, lignocaine oropharyngeal spray, or their combination. METHODS Consecutive subjects were randomized 1:1:1 to receive nebulized lignocaine (2.5 mL of 4% solution, group A), oropharyngeal spray (10 actuations of 10% lignocaine, group B), or nebulization (2.5 mL, 4% lignocaine) and two actuations of 10% lignocaine spray (group C). The primary outcome was the subject-rated severity of cough according to a visual analog scale. The secondary outcomes included bronchoscopist-rated severity of cough and overall procedural satisfaction on a visual analog scale, total lignocaine dose, subject's willingness to undergo a repeat procedure, adverse reactions to lignocaine, and others. RESULTS A total of 1,050 subjects (median age, 51 years; 64.8% men) were included. The median (interquartile range) score for subject-rated cough severity was significantly lower in group B compared to group C or group A (4 [1-10] vs 11 [4-24] vs 13 [5-30], respectively; P < .001). The bronchoscopist-rated severity of cough was also the least (P < .001), and the overall satisfaction was highest in group B (P < .001). The cumulative lignocaine dose administered was the least in group B (P < .001). A significantly higher proportion of subjects (P < .001) were willing to undergo a repeat bronchoscopy in group B (73.7%) than in groups A (49.1%) and C (59.4%). No lignocaine-related adverse events were observed. CONCLUSIONS Ten actuations of 10% lignocaine oropharyngeal spray were superior to nebulized lignocaine or their combination for topical anesthesia during diagnostic flexible bronchoscopy. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT03109392; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivani Chaudhary
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Babu Ram
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashutosh N Aggarwal
- 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.
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Centonze CP, Davenport MS, White ES, Kazerooni EA. Routine Chest Radiography for the Evaluation of Pneumothorax Following Bronchoscopy. Acad Radiol 2019; 26:585-590. [PMID: 31047101 DOI: 10.1016/j.acra.2018.11.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/14/2018] [Accepted: 11/17/2018] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES To determine the utility of routine postbronchoscopy chest radiography to detect pneumothorax. MATERIALS AND METHODS This retrospective quality improvement cohort study was approved by the Institutional Review Board. All outpatients (n = 1443) who underwent protocol-driven postbronchoscopy chest radiography in one health system from January 2010 to July 2017 were identified by electronic medical record query. The prevalence of pneumothorax (with 95% confidence intervals [CI]) and clinical outcome were determined following coded review of chest radiography reports and review of the electronic medical record. The effect of smoking and lung disease on risk of pneumothorax was determined with Chi Square tests. RESULTS Of 1443 subjects undergoing interventional bronchoscopy, 6% (93/1443) were current smokers, 35% (505/1442) were former smokers, and 35% (540/1443) had known lung disease. Pneumothorax prevalence was 3.4% (49/1443; 95% CI: 2.6%-4.5%) following any intervention and 4.1% (42/1032; 95% CI: 3.9%-5.5%) following transbronchial intervention. In those without known pre-existing pneumothorax or a confirmed false positive diagnosis, the real overall pneumothorax rate was 2.9% (42/1443; 95% CI: 2.1%-3.9%). The risk of pneumothorax did not differ based on smoking history (p = 0.99) or history of lung disease (p = 0.19). Of 49 subjects with pneumothorax, 13 were symptomatic, and 10 had a change in management including chest tube placement (N = 2), inpatient admission (N = 3), and/or observation (N = 7). No pneumothorax-related intervention was performed in asymptomatic patients. CONCLUSION Pneumothorax following interventional outpatient bronchoscopy is uncommon, usually asymptomatic, and often clinically insignificant. Asymptomatic postbronchoscopy patients are very low risk and may not need routine imaging.
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Ray A, Agarwal S, Biswas S, Sinha S. A study on factors determining dose of topical lignocaine during broncho-alveolar lavage by spray-as-you-go technique: A single centre observational study. Drug Discov Ther 2019; 13:89-95. [DOI: 10.5582/ddt.2019.01012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Animesh Ray
- Department of Medicine, All India Institute of Medical Sciences
| | - Samagra Agarwal
- Department of Medicine, All India Institute of Medical Sciences
| | - Sagnik Biswas
- Department of Medicine, All India Institute of Medical Sciences
| | - Sanjeev Sinha
- Department of Medicine, All India Institute of Medical Sciences
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Ninan N, Wahidi MM. Basic Bronchoscopy: Technology, Techniques, and Professional Fees. Chest 2019; 155:1067-1074. [PMID: 30779915 DOI: 10.1016/j.chest.2019.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/16/2022] Open
Abstract
Flexible bronchoscopy has evolved over the last few decades, allowing chest physicians to use advanced high-definition scopes to inspect the airways and perform various sampling techniques. Although the techniques of basic bronchoscopic sampling have not changed dramatically, documentation requirements, coding, and billing have become more complex and require a better understanding on the part of the proceduralists and practice administrators. Areas in need of attention include learning about the multiple endoscopy rule, appropriate use of modifiers, and recent changes to the Current Procedural Terminology codes, associated work relative value units for moderate sedation, and therapeutic aspiration of secretions. This article describes basic bronchoscopic procedures and the principles needed for their coding and billing.
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Affiliation(s)
- Neil Ninan
- Interventional Pulmonology Service, Touro Infirmary-LCMC Health, New Orleans, LA
| | - Momen M Wahidi
- Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University Medical Center, Durham, NC.
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Abstract
AIMS: Flexible bronchoscopy is a common procedure performed in pulmonary medicine, critical care, and thoracic surgery. In this study, we aimed to assess the prevalence and predictors of anxiety in patients undergoing diagnostic bronchoscopy. METHODS: This is a prospective study conducted at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. All patients undergoing diagnostic bronchoscopy filled the State-Trait Anxiety Inventory questionnaire before the procedure. Bronchoscopy was performed either through the mouth or the nose, based on the bronchoscopist preference. Lidocaine (1%–2%) spray was used for administering topical anesthesia. Results were collected, and statistical analysis was performed using t-test to measure statistically significant (P < 0.05). RESULTS: A total of 117 patients participated in this study. High anxiety score was found in 45% of the patients. Older patients significantly showed higher anxiety score than younger patients (53 years vs. 46 years, P = 0.034). Similarly, patients with higher body mass index (BMI) showed a statistically significant increase in anxiety score (28 vs. 25, P = 0.041). Premedication with pethidine significantly reduced the anxiety levels (26.9% vs. 73.1%, P = 0.031). Logistic regression demonstrated that old age and outpatient settings were significant predictors of higher anxiety scores. CONCLUSION: Diagnostic bronchoscopy can cause high anxiety in many patients. Prebronchoscopy anxiety assessment can help bronchoscopists to anticipate the anxiety levels of patients, and then further use it to tailor sedation requirements. Special attention should be given to older patients, patients with high BMI, and the ones undergoing bronchoscopy in outpatient settings.
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Affiliation(s)
- Ahmed A Aljohaney
- Department of Internal Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Valentini I, Lazzari Agli L, Michieletto L, Innocenti M, Savoia F, Del Prato B, Mancino L, Maddau C, Romano A, Puorto A, Corbetta L, Fois A. Competence in flexible bronchoscopy and basic biopsy technique. Panminerva Med 2018; 61:232-248. [PMID: 30394711 DOI: 10.23736/s0031-0808.18.03563-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Diagnostic bronchoscopy and tissue sampling techniques using forceps (endobronchial biopsy [EBB] and transbronchial biopsies [TBB]) or needle aspiration (transbronchial needle aspiration-TBNA), all performed with a flexible bronchoscope, are the basic elements of any interventional procedure. The flexible fibrobronchoscopy allows the visualization of the airways and is used both for diagnostic and therapeutic purposes. The working channel of both fibrobronchoscopes with optical fibers and videobronchoscopes, even if of relatively small diameter, allows the insertion of various diagnostic and therapeutic accessories. Fiber optic systems have been widely replaced by video cameras using a miniaturized charge-coupled device camera positioned at the end of the scope that provides electronic transmission of images to a monitor. The indications for both diagnostic and therapeutic fibrobronchoscopy derive from a correct evaluation of symptoms and objective signs of the patient and from the correct interpretation of imaging methods. Although bronchoscopy techniques keep evolving at a rapid pace, basic procedures such as bronchoalveolar lavage, transbronchial lung biopsy, and transbronchial needle aspiration still play a key role in pulmonary disease diagnostics, and therefore, these methods must still be part of the training of interventional pulmonologists. Trainees will acquire a thorough knowledge of thoracic anatomy and become skilled in the interpretation of thoracic imaging, after which they will be given a theoretical and practical training course on virtual reality simulators, on animal or cadaver models, the effectiveness of which has been fully demonstrated by scientific studies. Specific DOPS tests have been developed for a qualitative evaluation of procedures on simulators, on animal models and on the patient.
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Affiliation(s)
| | | | | | | | - Francesca Savoia
- Unit of Pneumology, ULSS 2 Marca Trevigiana, Treviso Hospital, Treviso, Italy
| | - Bruno Del Prato
- Department of Bronchial Endoscopy and Emergency Pneumology, Cardarelli Hospital, Naples, Italy
| | - Laura Mancino
- Institute for Oncological Study, Prevention, and Networking (ISPRO), Florence, Italy
| | - Cristina Maddau
- Unit of Pneumology, San Giuseppe Moscati Hospital, Avellino, Italy
| | | | - Antonella Puorto
- Clinic of Pneumology, Sassari University Hospital, Sassari, Italy
| | - Lorenzo Corbetta
- Unit of Interventional Pneumology, Careggi University Hospital, Florence, Italy
| | - Alessandro Fois
- Clinic of Pneumology, Sassari University Hospital, Sassari, Italy
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Madan K, Biswal SK, Mittal S, Hadda V, Mohan A, Khilnani GC, Pandey RM, Guleria R. 1% Versus 2% Lignocaine for Airway Anesthesia in Flexible Bronchoscopy Without Lignocaine Nebulization (LIFE): A Randomized Controlled Trial. J Bronchology Interv Pulmonol 2018; 25:103-10. [PMID: 29346249 DOI: 10.1097/LBR.0000000000000458] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The ideal concentration of lignocaine for topical anesthesia in bronchoscopy remains investigational. In this randomized, double blind study, we compared 1% versus 2% lignocaine for topical anesthesia. METHODS Consecutive patients undergoing bronchoscopy were randomized to receive either 1% or 2% lignocaine solution by spray-as-you-go technique. All received 10% lignocaine spray to the oropharynx along with nasal 2% lignocaine gel. Nebulized lignocaine was not administered. Primary outcomes were operator-rated overall procedural satisfaction, visual analogue scale (VAS)-rated and operator-rated cough, VAS. Secondary objectives were total lignocaine dose administered, patient-rated pain on faces pain scale, cumulative dose of lignocaine and procedural complications. RESULTS A total of 500 patients (250 in each group) were randomized. Baseline characteristics were comparable. Operator-rated overall procedural satisfaction, VAS (72.05±20.16 and 72.20±21.96 in 1% and 2% group respectively; P=0.93) and operator-rated cough, VAS [1% group: 19.1 (12.6-34.6) and 2% group: 20.6 (12.5-36.9); P>0.05] were similar between the 2 groups. Cumulative dose of lignocaine used in 2% lignocaine group was greater (220.89±12.96 mg in 1% and 319.55±19.32 mg in 2% group; P<0.001). Patients receiving sedation were comparable between the 2 groups. (10% in 1% lignocaine group and 6% in 2% lignocaine group; P=0.13). Minor complications occurred in 2 patients in each group. CONCLUSION One percent lignocaine in flexible bronchoscopy is as efficacious as 2% lignocaine when administered using the spray as you go technique without concurrent lignocaine nebulization, at a significantly lower total dose of lignocaine administered.
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Dang X, Hu W, Yang Z, Su S. Dexmedetomidine plus sufentanil for pediatric flexible bronchoscopy: A retrospective clinical trial. Oncotarget 2018; 8:41256-41264. [PMID: 28476033 PMCID: PMC5522299 DOI: 10.18632/oncotarget.17169] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/22/2017] [Indexed: 12/04/2022] Open
Abstract
Several studies have reported the use of dexmedetomidine (DEX) plus opioids for flexible bronchoscopy in both adults and children. To determine whether DEX plus sufentanil (SF) is safe for children, 142 children undergoing flexible bronchoscopy were assigned to one of three groups, each of which received the same SF loading dose and similar DEX and SF maintenance doses, but different loading doses of DEX: DS1 (DEX 0.5 μg·kg–1), DS2 (DEX 1.0 μg·kg–1), and DS3 (DEX 1.5 μg·kg–1). The Ramsay sedation scale was maintained at 3 in all groups. Results showed that anesthesia onset time was shorter, and the perioperative hemodynamic profile was more stable, in the DS3 group. The number of intraoperative movements was also lowest in the DS3 group. The time to first dose of rescue midazolam and lidocaine was significantly longer, but the total corresponding accumulated doses were lower in the DS3 group. Although the time to recovery prior to discharge from the post anesthesia care unit was longer, the overall incidence of tachycardia was lower in the DS3 group, and it received the highest bronchoscopist satisfaction score among the three groups. We therefore conclude that high-dose DEX plus SF can be safely and efficaciously used in children undergoing flexible bronchoscopy.
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Affiliation(s)
- Xiujing Dang
- Department of Anesthesiology, Qilu Children's Hospital of Shandong University, Jinan, Shandong, 250022, P.R. China
| | - Weidong Hu
- Department of Anesthesiology, Qilu Children's Hospital of Shandong University, Jinan, Shandong, 250022, P.R. China
| | - Zhendong Yang
- Department of Anesthesiology, Qilu Children's Hospital of Shandong University, Jinan, Shandong, 250022, P.R. China
| | - Shiyu Su
- Department of Anesthesiology, The Fifth People's Hospital of Jinan, Jinan, Shandong, 250022, P.R. China
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de Lima A, Kheir F, Majid A, Pawlowski J. Anesthesia for interventional pulmonology procedures: a review of advanced diagnostic and therapeutic bronchoscopy. Can J Anaesth 2018; 65:822-836. [PMID: 29623556 DOI: 10.1007/s12630-018-1121-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/17/2018] [Accepted: 01/17/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Interventional pulmonology is a growing subspecialty of pulmonary medicine with flexible and rigid bronchoscopies increasingly used by interventional pulmonologists for advanced diagnostic and therapeutic purposes. This review discusses different technical aspects of anesthesia for interventional pulmonary procedures with an emphasis placed on pharmacologic combinations, airway management, ventilation techniques, and common complications. SOURCE Relevant medical literature was identified by searching the PubMed and Google Scholar databases for publications on different anesthesia topics applicable to interventional pulmonary procedures. Cited literature included case reports, original research articles, review articles, meta-analyses, guidelines, and official society statements. PRINCIPAL FINDINGS Interventional pulmonology is a rapidly growing area of medicine. Anesthesiologists need to be familiar with different considerations required for every procedure, particularly as airway access is a shared responsibility with pulmonologists. Depending on the individual case characteristics, a different selection of airway method, ventilation mode, and pharmacologic combination may be required. Most commonly, airways are managed with supraglottic devices or endotracheal tubes. Nevertheless, patients with central airway obstruction or tracheal stenosis may require rigid bronchoscopy and jet ventilation. Although anesthetic approaches may vary depending on factors such as the length, complexity, and acuity of the procedure, the majority of patients are anesthetized using a total intravenous anesthetic technique. CONCLUSIONS It is fundamental for the anesthesia provider to be updated on interventional pulmonology procedures in this rapidly growing area of medicine.
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Affiliation(s)
- Andres de Lima
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Fayez Kheir
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Division of Pulmonary Diseases, Critical Care and Environmental Medicine, Tulane University Health Sciences Center, New Orleans, LA, USA
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John Pawlowski
- Department of Anesthesia, Division of Thoracic Anesthesia, Beth Israel Deaconess Medical Center, Harvard Medical School, 1 Deaconess Road, Boston, MA, 02215, USA.
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17
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Abstract
This review will focus on the infectious etiologies and more common noninfectious causes of lower respiratory tract syndromes among major immunosuppressed populations. The changing epidemiology of infections in the era of highly active antiretroviral therapy (HAART) in the case of HIV-positive patients and the impacts of both newer immune-suppressant therapies and anti-infective prophylaxis for other immunocompromised hosts will be discussed, with emphasis on diagnostic approaches and practice algorithms.
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18
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Botana-Rial M, Leiro-Fernández V, Núñez-Delgado M, Álvarez-Fernández M, Otero-Fernández S, Bello-Rodríguez H, Vilariño-Pombo C, Fernández-Villar A. A Pseudo-Outbreak of Pseudomonas putida and Stenotrophomonas maltophilia in a Bronchoscopy Unit. Respiration 2016; 92:274-278. [DOI: 10.1159/000449137] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/15/2016] [Indexed: 11/19/2022] Open
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19
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Izbicki G, Romem A, Arish N, Cahan C, Azulai H, Chen-Shuali C, Tennenhaus E, Bar-Yosef Z, Zlotkevich E, Rokach A. Avoiding Routine Chest Radiography after Transbronchial Biopsy Is Safe. Respiration 2016; 92:176-81. [PMID: 27591769 DOI: 10.1159/000448688] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 07/25/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fiberoptic bronchoscopy (FOB) with transbronchial biopsy (TBB) is complicated by a pneumothorax in 1-4% of cases. Performance of routine post-TBB chest radiography (CXR) results in an extremely low diagnostic yield but nevertheless is the common clinical practice prevailing today. It has previously been suggested that routine post-TBB CXR could be avoided in asymptomatic patients. OBJECTIVE The objective of this study was to prospectively assess the feasibility and safety of this approach. METHODS The study group included 201 consecutive patients who underwent FOB with TBB at our institution between January 2009 and September 2014. All subjects completed a preprocedural, a 2-hour postprocedural, and a 24- to 48-hour postprocedural symptom questionnaire (chest pain, dyspnea, and cough). Post-TBB CXR was ordered by the treating physician only if indicated. All cases of pneumothorax were documented. Additionally, the following information was recorded: sex, age, immune status, indication for FOB, total number of biopsies done, lobe sampled, and pulse oxygen saturation. RESULTS Sixteen CXRs were ordered by the treating physician due to suspected pneumothorax (8%). Early-onset pneumothorax (i.e. within 2 h of TBB) was diagnosed radiologically in 6 patients (3%). Two late-onset pneumothoraxes (1%) were diagnosed more than 24 h after TBB. No pneumothoraxes of clinical significance were diagnosed among asymptomatic patients without significant oxygen desaturation events. CONCLUSIONS Among asymptomatic patients without significant desaturation events, pneumothorax is rare and usually of negligible clinical significance. Therefore, performance of routine CXR after TBB is not necessary and can be safely avoided in this category of patients.
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Affiliation(s)
- Gabriel Izbicki
- Pulmonary Institute, Shaare Zedek Medical Center, Jerusalem, Israel
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20
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Fuehner T, Fuge J, Jungen M, Buck A, Suhling H, Welte T, Gottlieb J, Greer M. Topical Nasal Anesthesia in Flexible Bronchoscopy--A Cross-Over Comparison between Two Devices. PLoS One 2016; 11:e0150905. [PMID: 26978775 PMCID: PMC4792394 DOI: 10.1371/journal.pone.0150905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/20/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Topical airway anesthesia is known to improve tolerance and patient satisfaction during flexible bronchoscopy (FB). Lidocaine is commonly used, delivered as an atomized spray. The current study assesses safety and patient satisfaction for nasal anesthesia of a new atomization device during outpatient bronchoscopy in lung transplant recipients. Methods Using a prospective, non-blinded, cross-over design, patients enrolled between 01-10-2014 and 24-11-2014 received 2% lidocaine using the standard reusable nasal atomizer (CRNA). Those enrolled between 25-11-2014 and 30-01-2015, received a disposable intranasal mucosal atomization device (DIMAD). After each procedure, the treating physician, their assistant and the patient independently rated side-effects and satisfaction, basing their responses on visual analogue scales (VAS). At their next scheduled bronchoscopy during the study period, patients then received the alternative atomizer. Written consent was obtained prior to the first bronchoscopy, and the study approved by the institutional ethics committee. Results Of the 252 patients enrolled between 01-10-2014 and 30-01-2015, 80 (32%) received both atomizers. Physicians reported better efficacy (p = 0.001) and fewer side effects (p< = 0.001) for DIMAD in patients exposed to both procedures. Among patients with one visit, physicians and their assistants reported improved efficacy (p = 0.018, p = 0.002) and fewer side effects (p< = 0.001, p = 0.029) for the disposable atomizer, whereas patients reported no difference in efficacy or side effects (p = 0.72 and p = 0.20). No severe adverse events were noted. The cost of the reusable device was 4.08€ per procedure, compared to 3.70€ for the disposable device. Discussion Topical nasal anesthesia via a disposable intranasal mucosal atomization device (DIMAD) offers comparable safety and patient comfort, compared to conventional reusable nasal atomizers (CRNA) in lung transplant recipients. Procedural costs were reduced by 0.34€ per procedure. Trial Registration clinicaltrials.gov NCT02237651
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Affiliation(s)
- Thomas Fuehner
- Department of Internal Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
- * E-mail:
| | - Jan Fuge
- Department of Internal Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
| | - Meike Jungen
- Department of Internal Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
| | - Anna Buck
- Department of Internal Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
| | - Hendrik Suhling
- Department of Internal Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
| | - Tobias Welte
- Department of Internal Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
| | - Jens Gottlieb
- Department of Internal Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
| | - Mark Greer
- Department of Internal Medicine, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL)
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Kaur H, Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. A Randomized Trial of 1% vs 2% Lignocaine by the Spray-as-You-Go Technique for Topical Anesthesia During Flexible Bronchoscopy. Chest 2015; 148:739-745. [PMID: 25811287 DOI: 10.1378/chest.15-0022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The optimal concentration of lignocaine to be used during flexible bronchoscopy (FB) remains unknown. This randomized controlled trial compared the efficacy and safety of 1% and 2% lignocaine solution for topical anesthesia during FB. METHODS Consecutive patients were randomized to receive either 1% or 2% lignocaine solution through the bronchoscope by the "spray-as-you-go" technique. The primary outcome of the study was the assessment of cough by the operator and the patient using the visual analog scale (VAS) and pain assessment using the faces pain rating scale. The secondary outcomes included total lignocaine dose, oxygenation status, adverse reactions related to lignocaine, and others. RESULTS Five hundred patients were randomized (median age, 51 years; 71% men) 1:1 to either group. The median operator VAS score for cough was significantly higher (25 vs 21, P = .015) in the 1% group; however, the patient VAS score was not significantly different (32 vs 27, P = .065). The pain rating was similar between the two groups. The median cumulative dose of lignocaine was significantly higher in the 2% group (397 mg vs 312 mg, P = .0001; 7.1 mg/kg vs 5.7 mg/kg, P = .0001). About 28% of patients in the 2% group exceeded the maximum recommended dose (> 8.2 mg/kg) of lignocaine. No adverse event related to lignocaine overdose was seen in either group. CONCLUSIONS One percent lignocaine was found to be as effective as 2% solution for topical anesthesia during FB, albeit at a significantly lower dose as the latter. Thus, 1% lignocaine should be the preferred concentration for topical anesthesia during FB. TRIAL REGISTRY ClinicalTrials.gov; No.: NCT01955824; URL: www.clinicaltrials.gov.
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Affiliation(s)
- Harpreet Kaur
- 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
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheeraj Gupta
- 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.
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22
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Abstract
The recent advances in diagnostic pulmonary procedures have revolutionized the evaluation of abnormal thoracic findings including lung nodules and masses, mediastinal lymphadenopathy, and pleural diseases. Bronchoscopies with endobronchial ultrasonography and electromagnetic navigation are examples of new technology that has significantly improved the specificity and sensitivity of these procedures in diagnosis and staging of lung cancer without the need for more invasive procedures. This report describes the different diagnostic pulmonary interventions providing a description of the procedures, their indications, diagnostic yield and drawback.
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Affiliation(s)
- Nassar Al-Zubaidi
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Ayman O Soubani
- Department of Internal Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
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23
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Affiliation(s)
- Kapil Dev Soni
- Department of Anesthesia and Critical Care (Trauma Centre), JPNA Trauma Centre, AIIMS, New Delhi, India
| | - Sukhen Samanta
- Department of Anesthesia and Critical Care (Trauma Centre), JPNA Trauma Centre, AIIMS, New Delhi, India
| | - Richa Aggarwal
- Department of Anesthesia and Critical Care (Trauma Centre), JPNA Trauma Centre, AIIMS, New Delhi, India
| | - Sujay Samanta
- Department of Critical Care Medicine, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Sanchez JF, Ghamande SA, Midturi JK, Arroliga AC. Invasive diagnostic strategies in immunosuppressed patients with acute respiratory distress syndrome. Clin Chest Med 2014; 35:697-712. [PMID: 25453419 DOI: 10.1016/j.ccm.2014.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Immunosuppression predisposes the host to development of pulmonary infections, which can lead to respiratory failure and the development of acute respiratory distress syndrome (ARDS). There are multiple mechanisms by which a host can be immunosuppressed and each is associated with specific infectious pathogens. Early invasive diagnostic modalities such as fiber-optic bronchoscopy with bronchoalveolar lavage, transbronchial biopsy, and open lung biopsy are complementary to serologic and noninvasive studies and assist in rapidly establishing an accurate diagnosis, which allows initiation of appropriate therapy and may improve outcomes with relative safety.
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Affiliation(s)
- Juan F Sanchez
- Pulmonary and Critical Care Medicine Division, Baylor Scott and White Healthcare, 2401 South 31st street, Temple, TX 76508, USA
| | - Shekhar A Ghamande
- Pulmonary and Critical Care Medicine Division, Baylor Scott and White Healthcare, 2401 South 31st street, Temple, TX 76508, USA
| | - John K Midturi
- Pulmonary and Critical Care Medicine Division, Baylor Scott and White Healthcare, 2401 South 31st street, Temple, TX 76508, USA
| | - Alejandro C Arroliga
- Pulmonary and Critical Care Medicine Division, Baylor Scott and White Healthcare, 2401 South 31st street, Temple, TX 76508, USA.
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