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Liu Q, Zhong Q, Liu X. Resection of a tumor causing severe main airway stenosis by using endobronchial occluder and rigid bronchoscopy. Asian J Surg 2024:S1015-9584(24)00915-1. [PMID: 38734550 DOI: 10.1016/j.asjsur.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/30/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024] Open
Affiliation(s)
- Qian Liu
- Department of Anesthesiology, First People's Hospital, Zigong, Sichuan, China.
| | - Qing Zhong
- Department of Anesthesiology, People's Hospital, Jianyang, Sichuan, China
| | - Xiaomei Liu
- Department of Operating Room, First People's Hospital, Zigong, Sichuan, China
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Lin C, Huang H, Song L, Zhao X, Zeng J, Li L, Ge Q, Li R, Wu Z. Treatment of malignant airway obstruction with Y-shape sigma stent loaded with I 125 seeds installed via rigid bronchoscopy. BMC Pulm Med 2024; 24:201. [PMID: 38658897 PMCID: PMC11040968 DOI: 10.1186/s12890-024-03012-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/12/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE To summarize and analyze the safety and efficacy of a Y-shape Sigma stent loaded with I125 in patients with inoperable malignant main airway obstruction. METHODS This study was approved by the Institutional Ethics Committee, and a written informed consent was obtained from each participant. A Y-shape Sigma stent loaded with I125 was placed under vision from rigid bronchoscopy. The primary endpoint was alleviation of symptoms and improvement of Karnofsky Performance Status (KPS) score, and the secondary endpoint was complications and technical success. RESULTS From November 2018 through June 2023, total 33 patients with malignant airway obstruction were palliatively treated by installing Y-shape Sigma stents loaded with I125. The airway lumen was immediately restored and the average airway opening significantly increased to 70 ± 9.4% after the procedure from baseline 30.2 ± 10.5% (p < 0.05). Average KPS score was improved from baseline 30.0 ± 10.0 to 70.0 ± 10.0 (p < 0.05) as well as PaO2 from baseline 50.1 ± 15.4 mmHg to 89.3 ± 8.6 mmHg (p < 0.05). The technical success rate of placing the stent in this study was 73%, and adverse events or complications including bleeding, I125 loss, and airway infection occurred during or after the procedure. CONCLUSION Placement of Y-shape Sigma stents under vision from rigid bronchoscopy in the patients with malignant airway obstruction is feasible and it immediately alleviates dyspnea and significantly improves quality of life.
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Affiliation(s)
- Chunlong Lin
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China.
| | - Hesong Huang
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Lixia Song
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Xixi Zhao
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Jialing Zeng
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Lun Li
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Qilong Ge
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Rui Li
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
| | - Zhiyuan Wu
- Department of Respiratory, Yueyang Municipal Hospital of Hunan Normal University, 263 Baling East Road, 414000, Yueyang, Hunan, China
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Li D, Yang N, Dong J, Wang J, Cui X, Yu H, Liu Y. Comparison of rigid bronchoscopy and flexible bronchoscopy for the management of foreign body aspiration in children. Am J Otolaryngol 2024; 45:104092. [PMID: 38043300 DOI: 10.1016/j.amjoto.2023.104092] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/08/2023] [Accepted: 10/12/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To compare clinical outcomes of flexible and rigid bronchoscopies for the management of foreign body aspiration (FBA) in different airway locations, especially in unilateral main bronchus, in children, so as to provide some suggestions to assist clinical decisions. METHODS The medical records of children diagnosed with FBA in Qingdao Women and Children's Hospital Affiliated to Qingdao University from January 2020 to June 2022 were retrospectively reviewed. The following information was collected: demographics, radiological findings, endoscopic findings, foreign body locations, duration of operation, operation cost, and intraoperative and postoperative complications. RESULTS 182 children were included in the study with the median age of 1.3 years (interquatile range, 1.0-1.8). Among whom, 124 cases (68.1 %) were male and 58 cases (31.9 %) were female. 11 cases (6.0 %) had the foreign bodies located in the trachea (larynx to carina), 3 cases (1.6 %) located in the trachea and lower bronchus, 1 case (0.5 %) located in bilateral main bronchus, 135 cases (74.2 %) located in unilateral main bronchus, 4 cases (2.2 %) located in main and lobar bronchus, and 28 cases (15.4 %) located in the lobar or segmental bronchus. Among all the included children, 84 cases (46.2 %) received rigid bronchoscopy (RB) and 98 cases (53.8 %) received flexible bronchoscopy (FB). 131 cases with the foreign bodies located in unilateral main bronchus received one type of bronchoscopy (RB or FB). They were divided into two groups according to the location of foreign body relative to the midpoint of main bronchus, the proximal bronchus group and the distal bronchus group. In the proximal bronchus group, duration of operation using RB and FB was 15 (12.5-27.5) min and 15 (14.5-30.0) min, respectively (Z = 0.000, P = 1.000). The intraoperative and postoperative complication rate using RB and FB was 15.4 % and 9.1 %, respectively (χ2 = 0.008, P = 0.927). Operation cost of FB was significantly higher than that of RB (t = -13.396, P = 0.000). In the distal bronchus group, duration of operation using RB was 20 (13.5-25.0) min, which was drastically shorter than that of FB (25 (20.0-35.0) min) (Z = -2.947, P=0.003). Operation cost of FB was still found to be significantly higher than RB (t = -20.456, P=0.000). No significant difference was found in complication rate of RB (14.3%) compared to FB (8.3%) (χ2=0.251, P=0.616). CONCLUSIONS When foreign bodies are lodged in unilateral main bronchus, RB could be chosen as the first-choice procedure with advantages in duration of operation and operation cost, especially for patients in China. Regardless of duration of operation and operation cost, FB is also a safe and efficient therapeutic procedure to remove inhaled foreign bodies in children, except for those located in the trachea and asphyxiating foreign bodies.
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Affiliation(s)
- Da Li
- Qingdao Women and Children's Hospital, China
| | - Nana Yang
- Qingdao Women and Children's Hospital, China
| | - Jinye Dong
- Qingdao Women and Children's Hospital, China
| | - Jinju Wang
- Qingdao Women and Children's Hospital, China
| | - Xin Cui
- Qingdao Women and Children's Hospital, China.
| | - Hailing Yu
- Qingdao Women and Children's Hospital, China
| | - Yuxin Liu
- Qingdao Women and Children's Hospital, China
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Goussard P, Eber E, Venkatakrishna S, Janson J, Schubert P, Andronikou S. Bronchoscopy findings in children with congenital lung and lower airway abnormalities. Paediatr Respir Rev 2024; 49:43-61. [PMID: 37940462 DOI: 10.1016/j.prrv.2023.10.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Congenital lung and lower airway abnormalities are rare, but they are an important differential diagnosis in children with respiratory diseases, especially if the disease is recurrent or does not resolve. The factors determining the time of presentation of congenital airway pathologies include the severity of narrowing, association with other lesions and the presence or absence of congenital heart disease (CHD). Bronchoscopy is required in these cases to assess the airway early after birth or when intubation and ventilation are difficult or not possible. Many of these conditions have associated abnormalities that must be diagnosed early, as this determines surgical interventions. It may be necessary to combine imaging and bronchoscopy findings in these children to determine the correct diagnosis as well as in operative management. Endoscopic interventional procedures may be needed in many of these conditions, ranging from intubation to balloon dilatations and aortopexy. This review will describe the bronchoscopic findings in children with congenital lung and lower airway abnormalities, illustrate how bronchoscopy can be used for diagnosis and highlight the role of interventional bronchoscopy in the management of these conditions.
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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, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jacques Janson
- Division of Cardiothoracic Surgery, Department of Surgical Sciences, 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, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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He Z, Hou J, Li Y, Li Y, Zeng W, Liu W. Analysis of clinical outcomes and prognosis of patients with early bronchogenic lung cancer after treatment of rigid bronchoscopy combining fiberoptic bronchoscopy: a single-center retrospective study. Expert Rev Med Devices 2024; 21:257-263. [PMID: 38131192 DOI: 10.1080/17434440.2023.2298711] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/06/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES To investigate the clinical value of rigid bronchoscopy combined with fiberoptic bronchoscopy in patients with early bronchogenic lung cancer who underwent sleeve lobectomy. METHODS A retrospective study was performed on 76 patients with early bronchogenic lung cancer admitted to our center from March 2016 to March 2017. Patients in the control group received conventional sleeve lobectomy (n = 38), while patients in the observation group underwent sleeve lobectomy by using rigid bronchoscopy combining fiberoptic bronchoscopy (n = 38). We compared perioperative period indicators and the recovery of pulmonary function indexes one month after the operation were compared in two groups. The prognosis of the patients were also analyzed. RESULTS Compared with the control group, the intraoperative blood loss, operation duration and airway reconstruction duration in the observation group were significantly reduced. The total incidence of perioperative complications was markedly lower in the observation group than in the control group. The percentage of DLCO% was significantly improved in the observation group. The relapse-free survival (RFS) in the observation group was remarkably longer than in the control group. CONCLUSION Rigid bronchoscopy combined with fiberoptic bronchoscopy is beneficial to improve the clinical outcome and prognosis of patients with early bronchogenic lung cancer more effectively.
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Affiliation(s)
- Zhengbing He
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| | - Juhua Hou
- Department of School of Clinical Medicine, Yiyang Medical College, Yiyang, China
| | - Yong Li
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| | - Yu Li
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
| | - Wei Zeng
- Department of General Practice, Yiyang Medical College Affiliated Hospital, Yiyang, China
| | - Wenguang Liu
- Department of Pulmonary and Critical Care Medicine, Yiyang Central Hospital, Yiyang, China
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Messina G, Di Filippo V, Capasso F, Puca MA, Leonardi B, Grande M, Rainone A, Leone F, Vicario G, De Gregorio S, Cerullo G, Ponticiello A, Pirozzi M, Farese S, Zotta A, Natale G, Messina G, Vicidomini G, Fiorelli A, Ciardiello F, Fasano M. Modified blade: an interventional option in rigid bronchoscopy for non-resectable benign tracheal stenosis. J Cardiothorac Surg 2024; 19:73. [PMID: 38331792 PMCID: PMC10851474 DOI: 10.1186/s13019-024-02576-3] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/30/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Benign tracheobronchial stenosis is a abnormal tracheal lumen narrowing that may incur progressive dyspnea and life-threatening hypoxemia. There is no consensus on which patients should be treated with endoscopic or surgical method. This study investigates the outcomes of bronchoscopic dilatation in the treatment of benign tracheal stenosis using a device equipped with a blade to cut the stenotic lesions with dense fibrosis. MATERIALS AND METHODS The procedure was carried out in an operating room under general anesthesia. All patients were intubated with a Rigid Bronchoscope (RB) placed just above the stenosis. Through Rigid Bronchoscopy combined modalities were used as needed: radial incisions of the mucosal stenosis with blade at the levels of 4, 8 and 12 o'clock, with back and forth movements, then the stenotic area was dilated more easily with a rigid bronchoscope. Dilatation was performed by passing the RB of increasing diameter through stenotic areas and then Balloon dilatation of increasing diameter. There were no complications during the procedure. RESULT We conducted an observational, retrospective, single-centre study in the Thoracic Surgery Unit of the University of 'Luigi Vanvitelli' of Naples from November 2011 to September 2021. We included all consecutive patients with benign tracheal stenosis inoperable. During the study period, 113 patients were referred to our department with benign tracheal stenosis inoperable. 61 patients were treated with the blade. During the follow-up, a recurrence of the stenosis was observed in 8 patients in the first month and in 4 patients in the third month. Instead in the patients treated with the use of laser (52 patients), during the follow-up a recurrence was observed in 16 patients in the first month and in 6 patients in the third month; no patient relapsed after 6 months and after 1 year. Long term successful bronchoscopic management with blade was attained by 99% in simple and 93% in mixed stenosis and in complex type stenosis. CONCLUSION Our study underlines the importance of the use of the blade in bronchoscopic treatment as a valid conservative approach in the management of patients with inoperable benign tracheal stenosis as an alternative to the use of the laser, reducing the abnormal inflammatory reaction in order to limit recurrences.
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Affiliation(s)
- Gaetana Messina
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy.
| | - Vincenzo Di Filippo
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Francesca Capasso
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Maria Antonietta Puca
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
- Highly Specialized Medical-Surgical Department, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Campania, Italy
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
- Nutrition Science, University of Foggia, Foggia, Italy
- Pneumology Unit, Hospital of Caserta, Caserta, Italy
| | - Beatrice Leonardi
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Mario Grande
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Anna Rainone
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Francesco Leone
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Giuseppe Vicario
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Simona De Gregorio
- Highly Specialized Medical-Surgical Department, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | - Giuseppe Cerullo
- Highly Specialized Medical-Surgical Department, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Campania, Italy
| | | | - Mario Pirozzi
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Stefano Farese
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Alessia Zotta
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Giovanni Natale
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | | | - Giovanni Vicidomini
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, Università Degli Studi Della Campania "Luigi Vanvitelli", Via Pansini 5, 80131, Naples, Campania, Italy
| | - Fortunato Ciardiello
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
| | - Morena Fasano
- Oncology, Department of Precision Medicine, Università Della Campania "L. Vanvitelli", Naples, Campania, Italy
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Pozailov S, Goldbart A, Aviram M, Maimon MS, Dizitzer Hillel Y, Gatt D, Raviv I, Avraham S, Kaplan O, Tsaregorodtsev S, Golan-Tripto I. Foreign body aspiration score (FOBAS)-a prospectively validated algorithm for the management and prediction of foreign body aspiration in children. Eur J Pediatr 2024; 183:815-825. [PMID: 38017338 DOI: 10.1007/s00431-023-05347-9] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/30/2023]
Abstract
Foreign body aspiration (FBA) is a common cause of pediatric morbidity, but a standardized protocol to guide decision-making about bronchoscopy is lacking. We aimed to validate a new Foreign body aspiration score (FOBAS) for the pediatric emergency department (ED). Patients aged 0-18 years referred to the ED for suspected FBA were prospectively enrolled. FOBAS was calculated according to clinical features of a choking episode, sudden cough, exposure to nuts, absence of fever and rhinitis, stridor, and unilateral auscultatory and radiological findings. FBA risk was evaluated based on the total score (low, 1-3; moderate, 4-6; high, 7-10). Low-risk children were discharged from the ED and followed clinically. Moderate-risk children were hospitalized and evaluated by a pediatric pulmonologist, and high-risk children were referred directly for therapeutic bronchoscopy. Among the 100 enrolled children (59% males; median age 20 [interquartile range 11-39] months), a foreign body was diagnosed in 1/49 (2%), 14/41 (34.1%), and 9/10 (90%) with low, moderate, and high FOBAS, respectively (P < .001). Logistic regression indicated a higher risk for FBA with higher scores. The odds ratio for each additional point was 2.75 (95% confidence interval 1.78-4.24), and FOBAS showed a high predictive value for FBA (area under the curve 0.89). FOBAS implementation significantly reduced the rate of negative bronchoscopies, from 67.4% annually during 2016-2019 to 50% in 2020 (P = .042). CONCLUSION FOBAS reliably predicts FBA in cases of suspected FBA and improves management and in-hospital decision-making. WHAT IS KNOWN • Foreign body aspiration is a major cause of pediatric morbidity and mortality. • Currently, there is no unified protocol for children referred to the emergency department for suspected FBA, therefore, a well-defined algorithm is needed to improve the decision-making process. WHAT IS NEW • The pediatric Foreign body aspiration score (FOBAS) is a new, prospectively validated clinical score that shows high sensitivity and specificity for the presence of FBA in children. • FOBAS reduces unnecessary admissions and invasive procedures and leads to better clinical outcomes.
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Affiliation(s)
- Shani Pozailov
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviv Goldbart
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Micha Aviram
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Michal S Maimon
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yotam Dizitzer Hillel
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva, Israel
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petach Tikvah, Israel
| | - Dvir Gatt
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Raviv
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shir Avraham
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Or Kaplan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Pediatric Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesiology and Intensive Care, Soroka University Medical Center, Beer-Sheva, Israel
| | - Inbal Golan-Tripto
- Department of Pediatrics, Soroka University Medical Center, Beer-Sheva, Israel.
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer-Sheva, Israel.
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8
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Fukuyama K, Funakoshi Y. Intratracheal recurrence of thymoma 7 years after complete resection. Interdiscip Cardiovasc Thorac Surg 2023; 37:ivad164. [PMID: 37802888 PMCID: PMC10576636 DOI: 10.1093/icvts/ivad164] [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] [Received: 03/14/2023] [Revised: 09/14/2023] [Accepted: 10/05/2023] [Indexed: 10/08/2023]
Abstract
A 66-year-old woman with a massive anterior mediastinal tumour was diagnosed with type B2 thymoma. After 2 courses of chemotherapy, extended thymectomy and partial resection of the lung and large vessels were performed, and the tumour was completely resected. The patient received no postoperative therapy. Seven years after the surgery, follow-up chest computed tomography showed a papillary soft tissue tumour in the trachea almost obstructing the airway. Intratracheal tumour resection was performed under rigid bronchoscopy, and the pathological diagnosis of intratracheal recurrence of thymoma was made. The patient received postoperative radiotherapy and has remained alive without disease progression 9 months after the second operation.
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Affiliation(s)
- Kaoru Fukuyama
- Department of Thoracic Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yasunobu Funakoshi
- Department of Thoracic Surgery, Osaka General Medical Center, Osaka, Japan
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Doi Y, Ekuni S. Anesthetic management of inguinal hernia in an ex-premature infant with subglottic stenosis: a case report. JA Clin Rep 2023; 9:60. [PMID: 37700065 PMCID: PMC10497473 DOI: 10.1186/s40981-023-00652-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND We report the anesthetic management of inguinal hernia repair for an infant with subglottic stenosis. A previously scheduled operation had been cancelled due to unexpected airway trouble during the induction. CASE PRESENTATION A boy was born at 24 weeks of gestation and his trachea was intubated for 45 days. At 16 months old, surgery for inguinal hernia was planned, but cancelled due to unexpected narrow airway, and subglottic stenosis was first suspected. At 17 months old, he was transferred to us for inguinal hernia surgery. After careful discussion between the surgical team and the anesthesiologists, a strategy to manage this patient was developed. He underwent open hernia surgery under spinal anesthesia and diagnostic rigid bronchoscopy under tubeless general anesthesia separately, which revealed low-grade stenosis and some subglottic cysts. The postoperative course was uneventful. CONCLUSION Interdepartmental discussion weighing risks and benefits may deduce the safest and most appropriate anesthesia method.
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Affiliation(s)
- Yumi Doi
- Department of Anesthesia, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka, 5691192, Japan.
- Pediatric Perioperative Center, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka, 5691192, Japan.
| | - Satoshi Ekuni
- Department of Anesthesia, Takatsuki General Hospital, 1-3-13 Kosobe-Cho, Takatsuki, Osaka, 5691192, Japan
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Smith CB, Pitts L, Postigo M. Tracheal stenting by rigid bronchoscopy in right lateral decubitus position in an awake patient. Heliyon 2023; 9:e18678. [PMID: 37576236 PMCID: PMC10415654 DOI: 10.1016/j.heliyon.2023.e18678] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 06/17/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
Rigid bronchoscopy is a common procedure for central airway obstructions (CAO). Many patients with advanced lesions causing CAO have tenuous, positionally dependent respiratory status which requires additional procedural considerations. This case report describes a 57-year-old man with high grade epithelioid angiosarcoma of the right lung and pleura who underwent placement of a tracheal stent by rigid bronchoscopy in the novel procedural conditions of right lateral decubitus, semi-sitting position with dexmedetomidine, midazolam, and propofol for moderate sedation. Dexmedetomidine, which is currently in use for flexible bronchoscopy due to its analgesic, anxiolytic, and antisialogogue properties performed ideally and should be further evaluated for this indication.
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Affiliation(s)
- Clarissa B. Smith
- The University of Kansas Health System, Department of Internal Medicine, Mailstop 1022 3901 Rainbow Boulevard, Kansas City, KS, 66160, United States
| | - Lucas Pitts
- The University of Kansas Health System, Division of Pulmonary, Critical Care, and Sleep Medicine, United States
| | - Maykol Postigo
- The University of Kansas Health System, Division of Pulmonary, Critical Care, and Sleep Medicine, United States
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11
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Salguero BD, Agrawal A, Lo Cascio CM, So M, Chaddha U. How risky is it to remove an airway stent? Respir Med 2023; 216:107320. [PMID: 37301524 DOI: 10.1016/j.rmed.2023.107320] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/07/2023] [Accepted: 06/07/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Airway stent removal has traditionally been associated with a high complication rate. Most studies on stent removal are over a decade old, prior to newer anti-cancer therapies, and by including non-contemporary and uncovered metal stents, may not reflect the current practices. We review our experience at Mount Sinai Hospital to report outcomes of stent removal with more contemporary practices. METHODS A retrospective review was carried out of all the airway stent removals performed between 2018 to 2022, in adult patients with benign or malignant airway diseases. Stents inserted and removal for stent trials for tracheobronchomalacia were excluded from the final analysis. RESULTS Forty-three airway stents removals in 25 patients were included. Twenty-five (58%) stents were removed in 10 patients with benign diseases, and 18 (42%) stents were removed in the remaining 15 patients with malignant diseases. Patients with benign disease were more likely to have their stent removed (OR 3.88). 63% of the stents removed were silicone. The most common reasons for stent removal were migration (n = 14, 31.1%) and treatment response (n = 13, 28.9%). Rigid bronchoscopy was used in 86% of cases. Ninety-eight percent of removals were accomplished in a single procedure. The median time to removal of stents was 32.5 days. Three complications were noted: hemorrhage (n = 1, 2.3%) and stridor (n = 2, 4.6%); one not directly related to the stent removal. CONCLUSIONS Covered metal or silicone airway stents, in the era of contemporary stents, better cancer-directed therapies and surveillance bronchoscopies, can be removed safely with the use of rigid bronchoscopy.
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Affiliation(s)
- Bertin D Salguero
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, Morningside and West Hospitals, New York, NY, USA.
| | - Abhinav Agrawal
- Division of Pulmonary, Critical Care and Sleep Medicine, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Christian M Lo Cascio
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Matsuo So
- Department of Medicine, Icahn School of Medicine at Mount Sinai Beth Israel, New York, NY, USA
| | - Udit Chaddha
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Chettri MN, Das S, Sharma HS, Bhutia MP, Rai R. Rigid Bronchoscopy-Brief Insight and Encounters in a Tertiary Hospital. Indian J Otolaryngol Head Neck Surg 2023; 75:1016-1019. [PMID: 37274974 PMCID: PMC10234998 DOI: 10.1007/s12070-022-03295-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022] Open
Abstract
A brief insight of Rigid Bronchoscopy and methodology in current times in a tertiary care centre and a series of 3 recent unusual encounters of foreign body removed through rigid bronchoscopy.
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Affiliation(s)
- Mohonish N. Chettri
- Present Address: Department of ENT Head and Neck Surgery, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, 5Th Mile Tadong, Gangtok, Sikkim 737102 India
| | | | | | - Meyong P. Bhutia
- Department of Anaesthesia, Sikkim Manipal University, Gangtok, Sikkim 737102 India
| | - Ram Rai
- Department of Anaesthesia, Sikkim Manipal University, Gangtok, Sikkim 737102 India
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13
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Truong B, Luu K. Diagnostic clues for the identification of pediatric foreign body aspirations and consideration of novel imaging techniques. Am J Otolaryngol 2023; 44:103919. [PMID: 37201356 DOI: 10.1016/j.amjoto.2023.103919] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 04/30/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To better understand the diagnosis of foreign body aspiration by elucidating key components of its clinical presentation. METHODS This is a retrospective cohort study of pediatric patients with suspected foreign body aspiration. We collected information regarding demographics, history, symptoms, physical exam, imaging, and operative findings for rigid bronchoscopies. An evaluation of these findings for an association with foreign body aspiration and the overall diagnostic algorithm was performed. RESULTS 518 pediatric patients presented with 75.2 % presenting within one day of the inciting event. Identified history findings included wheeze (OR: 5.83, p < 0.0001) and multiple encounters (OR: 5.46, p < 0.0001). Oxygen saturation was lower in patients with foreign body aspiration (97.3 %, p < 0.001). Identified physical exam findings included wheeze (OR: 7.38, p < 0.001) and asymmetric breath sounds (OR: 5.48, p < 0.0001). The sensitivity and specificity of history findings was 86.7 % and 23.1 %, physical exam was 60.8 % and 88.4 %, and chest radiographs was 45.3 % and 88.0 %. 25 CT scans were performed with a sensitivity and specificity of 100 % and 85.7 %. Combining two components of the diagnostic algorithm yielded a high sensitivity and moderate specificity; the best combination was the history and physical exam. 186 rigid bronchoscopies were performed with 65.6 % positive for foreign body aspiration. CONCLUSION Accurate diagnosis of foreign body aspiration requires careful history taking and examination. Low-dose CT should be included in the diagnostic algorithm. The combination of any two components of the diagnostic algorithm is the most accurate for foreign body aspiration.
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Affiliation(s)
- Brandon Truong
- School of Medicine, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94122, USA.
| | - Kimberly Luu
- Department of Otolaryngology-Head and Neck Surgery, Division of Pediatric Otolaryngology, University of California, San Francisco, 505 Parnassus Avenue, San Francisco, CA 94122, USA.
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14
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Ding L, Su X, Yang D, Yao H, Xiao L. Risk factors for difficult removal of tracheobronchial foreign bodies in children by rigid bronchoscopy. Int J Pediatr Otorhinolaryngol 2023; 168:111539. [PMID: 37023557 DOI: 10.1016/j.ijporl.2023.111539] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE To characterize the risk factors for difficult removal of tracheobronchial foreign body (FB) by rigid bronchoscopy in children. METHODS We retrospectively analyzed clinical data of 1026 pediatric patients (age: 0-18 years) diagnosed with tracheobronchial FB between September 2018 and August 2021. All patients underwent rigid bronchoscopy as the first intervention at our hospital. RESULTS Children aged 1-3 years accounted for 83.7% cases in our cohort. The most common symptoms were cough and wheeze. FBs were more frequently found in the right bronchus, and trachea FBs accounted for only 8.19% cases. The success rate of rigid bronchoscopy in a single attempt was 97.27%. 12.18% of the cases were defined as difficult removal of FB. On univariate analysis, age, CT findings (pneumonia), type of FB, diameter of FB, FB location, granulation tissue formation, and the seniority of the surgeon were identified as risk factors for difficult removal of tracheobronchial FBs. On multivariate analysis, age ≥3 years, FB diameter ≥10 mm, FBs located in left bronchus, multiple FBs, granulation tissue, and the seniority of surgeon (<3 years, ≥5 years) were independent risk factors for difficult removal. CONCLUSIONS Age, FB diameter, location of FB, granulation tissue formation, and the seniority of the surgeon were risk factors for difficult removal of FBs by rigid bronchoscopy.
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Affiliation(s)
- Ling Ding
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiujing Su
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Dazhi Yang
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongbing Yao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ling Xiao
- Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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16
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Goussard P, Eber E, Venkatakrishna S, Frigati L, Janson J, Schubert P, Andronikou S. Complicated intrathoracic tuberculosis: Role of therapeutic interventional bronchoscopy. Paediatr Respir Rev 2023; 45:30-44. [PMID: 36635200 DOI: 10.1016/j.prrv.2022.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
In recent years bronchoscopy equipment has been improved with smaller instruments and larger size working channels. This has ensured that bronchoscopy offers both therapeutic and interventional options. As the experience of paediatric interventional pulmonologists continues to grow, more interventions are being performed. There is a scarcity of published evidence in the field of interventional bronchoscopy in paediatrics. This is even more relevant for complicated pulmonary tuberculosis (PTB). Therapeutic interventional bronchoscopy procedures can be used in the management of complicated tuberculosis, including for endoscopic enucleations, closure of fistulas, dilatations of bronchial stenosis and severe haemoptysis. Endoscopic therapeutic procedures in children with complicated TB may prevent thoracotomy. If done carefully these interventional procedures have a low complication rate.
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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
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17
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Wiemers A, Vossen C, Lücke T, Freitag N, Nguyen TMTL, Möllenberg L, Pohunek P, Schramm D. Complication rates in rigid vs. flexible endoscopic foreign body removal in children. Int J Pediatr Otorhinolaryngol 2023; 166:111474. [PMID: 36753891 DOI: 10.1016/j.ijporl.2023.111474] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/17/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023]
Abstract
While foreign body aspiration remains a frequent and preventable cause of morbidity and mortality in children, recommendations on the appropriate removal technique do often not match the lived practice and expertise of the performing examiners. As there is a scarcity of data regarding success and complication rates of the procedure, the aim of this study was to set up a classification system for procedure-related complications, prospectively record and analyze them. Specialists in the field of foreign body removal contributed cases anonymously. Information regarding procedural details of the bronchoscopy, type, and severity of complications as well as patient characteristics were classified and recorded. Correlations were calculated using Pearson's Chi Square test. A total of 314 rigid and 178 flexible bronchoscopies were compared. Complications were categorized and their severity was defined by the anesthesiologist's assessment of whether to interrupt or terminate the procedure. The overall complication rate was similar in rigid vs. flexible bronchoscopy (19.1% vs. 24.2%, p = 0.232), while respiratory complications occurred significantly less frequent during rigid bronchoscopy (9.2% vs. 16.3%, p = 0.025). This is the largest pediatric case collection recording and comparing complications between rigid and flexible foreign body removal. The higher rate of respiratory complications in flexible bronchoscopy has been shown for the first time and validates some of the concerns about its use for foreign body removal. Flexible bronchoscopy is a safe procedure when extended respiratory monitoring and the possibility of an immediate switch to a secured airway are assured.
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Affiliation(s)
- Anna Wiemers
- Ruhr University Bochum, Children's Hospital St. Josef-Hospital, Bochum, Germany.
| | - Christina Vossen
- Städtische Kliniken Mönchengladbach, Elisabeth Krankenhaus, Rheydt, Germany
| | - Thomas Lücke
- Ruhr University Bochum, Children's Hospital St. Josef-Hospital, Bochum, Germany
| | - Nadine Freitag
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Thi Minh Thao Lea Nguyen
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Leon Möllenberg
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Petr Pohunek
- Pediatric Department, Charles University Prague and University Hospital Motol, Prague, Czech Republic
| | - Dirk Schramm
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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18
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Chebib E, Benoit C, Van Den Abbeele T, Teissier N. PEANUTS: a national survey on the management of pediatric tracheobronchial foreign bodies. Eur J Pediatr 2023; 182:591-600. [PMID: 36394648 DOI: 10.1007/s00431-022-04706-2] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 10/25/2022] [Accepted: 11/08/2022] [Indexed: 11/18/2022]
Abstract
To assess the different types of management of pediatric foreign body aspirations in order to help define guidelines, depending on clinical presentation. A national survey in France was emailed to all 30 university-affiliated departments of otolaryngology-head and neck surgery and pediatric pulmonologists in France. Data concerning the center and the experience of each participant were collected in order to define an "senior expert" group with experience of extracting more than 10 foreign bodies and a "junior/non-expert" group. Both groups answered questions concerning five clinical cases of foreign body aspiration of different severities. Ninety-eight participants answered this survey (75 otolaryngologists and 23 pulmonologists), representing 28 of the 30 university-affiliated departments in France with a completion rate of 89%. Responses of the senior expert group were similar for clear-cut situations, such as an asymptomatic child with a low probability of foreign body aspiration and for a symptomatic child with respiratory distress. However, for intermediate situations, management varied significantly according to the physician when considering clinical, radiological, and surgical management. In comparison to the senior expert group, the junior non-expert group seemed more precautious in the management of foreign body aspiration for intermediate cases, in particular, concerning the time at which extraction was performed. Conclusion: The management of foreign body aspiration depends on the physician's experience and the center's habits. In order to optimize patient care for foreign body aspiration, we suggested a management algorithm based on the senior expert group responses. What is Known: • Foreign body aspirations (FBA) are dreaded by pediatricians, pediatric otolaryngologists, and pulmonologists particularly because of the potential fatal outcome. • However, consensus concerning their management is not clearly defined in the literature. What is New: • This study is the first to evaluate the management of foreign body aspirations (FBA) from the clinical assessment by the emergency medicine physician to the extraction of the foreign body. • A management algorithm was designed and secondarily validated by the SE group to help to emergency medicine physician and specialist to manage FBA.
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Affiliation(s)
- Emilien Chebib
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medicine, Paris University, 48 Boulevard Sérurier, 75019, Paris, France.
| | - Charlotte Benoit
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medicine, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Thierry Van Den Abbeele
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medicine, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
| | - Natacha Teissier
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medicine, Paris University, 48 Boulevard Sérurier, 75019, Paris, France
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19
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Wadhera R, Sehrawat U, Hooda S, Wadhera S. Evaluate the Role of Rigid Bronchoscopy in Tracheo-Bronchial Foreign Bodies. Indian J Otolaryngol Head Neck Surg 2022; 74:5177-5181. [PMID: 36742744 PMCID: PMC9895146 DOI: 10.1007/s12070-021-03053-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/27/2021] [Indexed: 02/07/2023] Open
Abstract
Tracheobronchial foreign bodies continue to present challenges to practitioners worldwide. The major issues involve the accurate diagnosis and speedy and safe removal of the foreign bodies. The aim of this study was to to assess an epidemiological data regarding airway foreign bodies in patients presenting to our institute and to assess the role of rigid bronchoscopy for diagnosis and management of cases of foreign body aspiration. Study was conducted between December 2015 and July 2021 in Otorhinolaryngology and Head and Neck Surgery Department. 200 patients who underwent rigid bronchoscopy in above period for suspected foreign body aspiration was included in the study. All the parameters was recorded and analysed in an attempt to define the epidemiology, clinical presentation, management and associated morbidity. Descriptive statistical analysis was done using SPSS software version 22 of Windows 7. Tracheo-bronchial foreign bodies (TFB) were more common in pediatric age group. 80% of our patients with TFB were aged less than 3 years. Most common symptom was cough (70%) and the commonest sign was diminished unilateral breath sounds (72%). Peanut was the commonest (45%) foreign body. Most common site of lodgement of TFB was right main bronchus (49%). TFB aspiration is always accidental and sudden with high mortality. It is a life threatening condition and needs urgent intervention. Rigid bronchoscopy under general anesthesia represents a safe and effective tool in the management of TFB aspiration.
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Affiliation(s)
- Raman Wadhera
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana India
| | - Usha Sehrawat
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana India
| | - Sachin Hooda
- Department of Otorhinolaryngology, Pt. B.D. Sharma PGIMS, Rohtak, Haryana India
| | - Sarthak Wadhera
- Department of General Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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20
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Mardani P, Ebrahimi K, Shahriarirad R, Geramizadeh B, Kamran H, Niknam T, Khosravi MB, Vatankhah P. Tracheal myoepithelioma resected by using rigid bronchoscopy: a case report and review of the literature. J Cardiothorac Surg 2022; 17:125. [PMID: 35606819 PMCID: PMC9128258 DOI: 10.1186/s13019-022-01880-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Endotracheal tumors are rare in the respiratory system. Myoepitheliomas are benign tumors, which are rarely reported in the respiratory system. Herein, we report a rare case of endotracheal myoepithelioma, which was resected by rigid bronchoscopy.
Case presentation A 36-year-old man, presenting with chest pain, dyspnea, stridor, and hemoptysis, was referred to our center with radiological features of near-total tracheal obstruction due to mass. Fiberoptic bronchoscopy with argon plasma coagulation and rigid bronchoscopy with grasper forceps was utilized to resect the mass. Pathological evaluation of the mass demonstrated myoepithelioma. The patient was discharged in good condition. Now, after 6 months, the patient is symptom-free with no evidence of tumor recurrence or re-growth. Conclusions Despite being extremely rare, myoepithelioma should be considered a possible differential diagnosis for endotracheal tumors. Fiberoptic and rigid bronchoscopy management is an effective method for the resection of endotracheal tumors.
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Affiliation(s)
- Parviz Mardani
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kamyar Ebrahimi
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Shahriarirad
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Research Center (STRC), Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hooman Kamran
- Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. .,Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Tahmoores Niknam
- Pulmonary and Thoracic Ward, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Bagher Khosravi
- Department of Anesthesiology, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Pooya Vatankhah
- Department of Anesthesiology, Abu-Ali Sina Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
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Chebib E, Lemarteleur V, Azalé M, Deneufbourg L, Ceccaldi PF, Teissier N. Step-by-step development and evaluation of a 3D printed home-made low-cost pediatric tracheobronchial tree for foreign body aspiration extractions. Int J Pediatr Otorhinolaryngol 2022; 153:111040. [PMID: 35026720 DOI: 10.1016/j.ijporl.2022.111040] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The management of foreign body aspirations (FBA) is dreaded by pediatric physicians due to the high risk of respiratory distress and a potential fatal outcome, favored by a lack of experience of young specialists. Furthermore, there has been an increasing requirement for low-cost simulation. The aim was to describe the step-by-step manufacturing process and to validate a low-cost, easily home-made training model of pediatric tracheo-bronchial tree (pTBT) for simulation-based training in order to teach young physicians to practice foreign body (FBA) extractions. METHODS A simulator was designed in order to reproduce the physical and esthetic properties of a pTBT. The production cost of a single simulator was estimated. The simulator was then tested by experienced physicians using a rigid bronchoscope. A manufacturing manual of the simulator is hereby presented. A group of 7 experienced pediatric otolaryngologists performed a FBA extraction in the conditions of installation of an operating room. RESULTS The result of the survey showed a high fidelity of the simulator in mimicking the biological esthetics and physical properties of a pTBT during a FBA extraction (mean 4.3 ± 0.8). The total cost of the custom-made simulator is about 20.5 € ($23.4) for the production of the first simulator. CONCLUSIONS A highly realistic and easily reproducible pediatric tracheo-bronchial tree simulator is presented and can therefore be used during simulation-based training.
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Affiliation(s)
- Emilien Chebib
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medecine, University of Paris, Paris, France; Simulation Department of University of Paris, Paris, France.
| | | | - Mehdi Azalé
- Department of Anaesthesia and Intensive Care, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medecine, University of Paris, Paris, France
| | | | | | - Natacha Teissier
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Faculty of Medecine, University of Paris, Paris, France
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22
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Zarrouki S, Marouf R. Mini-invasive endoscopic approach to tracheal inflammatory myofibroblastic tumor in a young woman: A case report. Ann Med Surg (Lond) 2022; 73:103208. [PMID: 35070283 PMCID: PMC8767228 DOI: 10.1016/j.amsu.2021.103208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/09/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Inflammatory myofibroblastic tumor (IMT) of the trachea is rare tumor mostly found in children and young adults. CASE REPORT We report a case of a 28 year-old woman who presented chronic isolated coughing. Chest CT scan showed a tracheal tumor. Rigid bronchoscopy allowed the complete removal of the tumor, and histology confirmed the diagnosis of IMT. 12 months follow-up found no recurrence. DISCUSSION IMT is a rare tumor exhibiting both benign and aggressive behaviour. The endoscopic approach of tracheal should be considered when there is a minimal tracheal wall invasion. CONCLUSION Through this case, we want to emphasise the role of rigid bronchoscopy in the complete removal of endotracheal IMT.
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Affiliation(s)
- Sara Zarrouki
- Thoracic Surgery Departement, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Rachid Marouf
- Thoracic Surgery Departement, Mohammed VI University Hospital Center, Oujda, Morocco
- Mohammed First University, Faculty of Medicine and Pharmacy, Oujda, Morocco
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23
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Ershadi R, Rafieian S, Sarbazzadeh J, Vahedi M. Tracheal stenosis following mild-to-moderate COVID-19 infection without history of tracheal intubation: a case report. Gen Thorac Cardiovasc Surg 2021. [PMID: 34813004 DOI: 10.1007/s11748-021-01747-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 10/05/2021] [Accepted: 11/14/2021] [Indexed: 11/14/2022]
Abstract
Laryngotracheal stenosis is a major side effect of intubation in patients with Coronavirus 2019 (COVID-19). However, no study has since reported tracheal stenosis in patients with COVID-19 without a history of tracheal intubation. The current study reports a 77-year-old male patient with the COVID-19 infection but without a history of tracheal intubation diagnosed with distal tracheal stenosis. Tracheal stenosis was successfully treated with rigid bronchoscopy. This study reported the first case of tracheal stenosis due to viral tracheitis associated with COVID-19 infection. However, further studies are required to investigate this speculation.
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24
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Abdelmalak BB, Gildea TR, Doyle DJ, Mehta AC. A Blueprint for Success: A Multidisciplinary Approach to Clinical Operations within a Bronchoscopy Suite. Chest 2021; 161:1112-1121. [PMID: 34774820 DOI: 10.1016/j.chest.2021.11.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 10/27/2021] [Accepted: 11/07/2021] [Indexed: 11/17/2022] Open
Abstract
Building an efficient facility for advanced bronchoscopic procedures involves many considerations. This review places particular emphasis on anesthesiology services, based on experience at a tertiary/quaternary care referral academic medical center. Topics include equipment requirements, applicable clinical standards and multidisciplinary collaboration. Patient flow arrangements for both outpatients and inpatients, from pre-operative care to discharge/disposition are highlighted. The importance of effective business planning, personnel training, leadership, communication, teambuilding, quality of care and patient safety are also discussed.
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Affiliation(s)
- Basem B Abdelmalak
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH.
| | | | - D John Doyle
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Atul C Mehta
- Respiratory Institute, Cleveland Clinic, Cleveland, OH
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25
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Hameed S, Reddy Y M. A Tertiary Care Centre Experience on the Management of Paediatric Tracheobronchial Foreign Body During the COVID 19 Pandemic. Indian J Otolaryngol Head Neck Surg 2021; 74:3473-3480. [PMID: 34631495 PMCID: PMC8490142 DOI: 10.1007/s12070-021-02880-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022] Open
Abstract
Tracheobronchial foreign body aspiration (FBA) is a life threatening emergency most commonly seen among paediatric age group that requires immediate therapeutic intervention. The purpose of this study is to report our experience on management of these aspirated foreign body (FB) with rigid bronchoscopy during the COVID 19 pandemic. This is a retrospective study which included 100 children less than 17 years of age, diagnosed with suspected FBA and underwent rigid bronchoscopy for its removal between March 2020 and March 2021. Guardians of all female children with history of FBA, had to go through medicolegal enquiry considering the possibility of female infanticide. Analysis of data was made of the demographic details, characteristics and location of the aspirated FB, treatment modalities and difficulties encountered. Among the 100 patients included in the study, 67% were under 3 years of age. The male to female ratio was 2.23:1. 69% of the FB’s were most frequently found in the right main bronchus. 63 cases of the removed FB were organic materials such as nuts. Tracheobronchial FB’s should be suspected in children who have sudden onset of cough and respiratory distress, even when physical and radiographic evidence is absent. Mortality due to FBA is preventable by early intervention with bronchoscopy. During the Covid 19 pandemic before performing any emergency procedure, prior preoperative planning and use of personal protective equipment is important, considering the very high risk of transmission of the virus due to aerosol generation.
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Affiliation(s)
- Shaul Hameed
- Department of Otorhinolaryngology, Head and Neck Surgery, Govt. ENT hospital, Osmania Medical College, Hyderabad, 500095 India
| | - Mounika Reddy Y
- Department of Otorhinolaryngology, Head and Neck Surgery, Govt. ENT hospital, Osmania Medical College, Hyderabad, 500095 India
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26
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Costa-Roig A, Martín F, Diéguez I, Escrig R, Fonseca R, Barrios JE, Pérez-Tarazona S, López J, Ibáñez I, Gutiérrez C, Vila JJ. Management of congenital and acquired airway pathologies in newborns by a cross-disciplinary committee at a third level hospital. Cir Pediatr 2021; 34:180-185. [PMID: 34606697] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Neonatal airway examination through flexible/rigid bronchoscopy has proved to be useful in the presence of persistent stridor and extubation failure, as well as to assess complications following cardiac surgery. At our institution, these examinations are carried out by a pulmonologist, a neonatologist, an otorhinolaryngologist, and a pediatric surgeon from the pediatric airway committee, established in 2014. OBJECTIVE To analyze the airway examinations performed in neonates during their stay at the neonatology/neonatal intensive care unit since the airway committee was established. MATERIAL AND METHODS A retrospective study of the airway examinations conducted in neonates from 2015 to 2019 was carried out. Clinical and demographic data, number of examinations, indications, findings, and complications were collected. Results are presented as mean and standard deviation. Statistical significance was established at p < 0.05. RESULTS 92 airway examinations were analyzed in 51 patients (54.9% of whom were female). 51% of the patients were premature. Extubation failure and persistent respiratory symptoms following successful extubation were the most frequent indications for airway examination (35.3%). Stratification by gestational age or weight at birth was not associated with an increased risk of pathological findings at examination (p > 0.05). The most frequent finding was vocal cord paralysis (n = 14; 27.5%). In 10 patients (19.6%), no pathological findings were observed. CONCLUSION Airway examination is useful in patients with stridor to identify vocal cord paralysis following extubation failure. It also allows congenital airway pathologies to be diagnosed and treated. The number of examinations with no pathological findings was similar to that reported in international series.
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Affiliation(s)
- A Costa-Roig
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - F Martín
- Neonatology Department and Pediatric Neonatal Intensive Care Unit. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - I Diéguez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - R Escrig
- Neonatology Department and Pediatric Neonatal Intensive Care Unit. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - R Fonseca
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J E Barrios
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - S Pérez-Tarazona
- Pediatric Pulmonology Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J López
- Pediatric Pulmonology Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - I Ibáñez
- Pediatric Otorhinolaryngology Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - C Gutiérrez
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
| | - J J Vila
- Pediatric Surgery Department. La Fe University and Polytechnic Hospital. Valencia (Spain)
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27
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Das S, Thangavel S, Raja K, Saxena SK. A Trip Down the Bronchus- A Tracheostomy Complication in COVID Pandemic. Indian J Otolaryngol Head Neck Surg 2021; 74:3098-3101. [PMID: 34458128 PMCID: PMC8380296 DOI: 10.1007/s12070-021-02813-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/08/2021] [Indexed: 11/04/2022] Open
Abstract
Foreign body of the trachea and the bronchus are critical emergencies which can lead to life threatening complications. But the advent of the 2019 novel corona virus disease, pandemic has dramatically changed the comfort of these procedures since aerosol generating medical procedures pose a risk and spread of infection to the health care workers. Even the patients are uncomfortable visiting the hospital due to the fear of acquiring the COVID infection.A 41-year-old obese female with grade 4 subglottic stenosis status post tracheostomy presented with foreign body Fuller’s tracheostomy tube flange in the right bronchus during the COVID 19 pandemic. The patient had delayed presentation to the hospital due to fear of getting exposed to COVID and poor access to health care facilities due to lockdown imposed in various places in the nation. The patient was tested for COVID and taken up for surgery where rigid bronchoscopy and foreign body removal was done via the tracheostoma. The details of the procedure, challenges faced during the procedure, the effect of the COVID pandemic on the patients and hospital staffs are discussed. The complications of the broken tracheostomy tube can be most efficiently dispelled by proper tube care by the attenders and frequent tube change.
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Affiliation(s)
- Sauradeep Das
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
| | - Saranya Thangavel
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
| | - Kalaiarasi Raja
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
| | - Sunil Kumar Saxena
- Department of ENT, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Pondicherry, 605006 India
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28
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Sharifpour A, Hoseini A, Nekoukar Z, Banimostafavi ES, Fakhar M, Soleymani M, Zakariaei Z, Navaeifar MR, Rsouli K. The over diagnosed COVID-19 infection in an adult patient with foreign body aspiration. Ann Med Surg (Lond) 2021; 68:102653. [PMID: 34341688 PMCID: PMC8320400 DOI: 10.1016/j.amsu.2021.102653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 12/18/2022] Open
Abstract
Introduction and importance Foreign body aspiration (FBA) in adults may be asymptomatic or symptomatic. Fever and cough are the most common symptoms of Coronavirus infection and other causes of pneumonia. Regardless of the etiology of pneumonia, the first step in the treatment of FBA-associated pneumonia is to remove the foreign body from the airway. Case presentation A 32-year-old man was referred to our emergency department on October 26, 2020 with shortness of breath (SOB) and a cough. He was referred to the medical center with clinical suspicion of Coronavirus disease-19 (COVID-19), and his disease was treated considering COVID-19. Based on the persistence of his symptoms after discharge, he was referred to the hospital again, and the presence of a foreign body was confirmed by a rigid bronchoscopy, which was then removed. Clinical discussion Our patient did not remember any history of aspirating solid particles, choking, or any other high-risk conditions associated with aspiration. Also, he had no symptoms with the exception of cough and SOB before the first admission. It means that asymptomatic FBA can be tolerated and go undiagnosed, particularly in adults, and manifests as a secondary complication, such as pneumonia. Conclusion The FBA and other causal agents may mimic COVID-19 pneumonia. Consequently, FBA should be included in the COVID-19 differential diagnosis. The over diagnosed COVID-19 infection in an adult patient with foreign body aspiration. FBA and other causal agents may mimic COVID-19 pneumonia. Consequently, FBA should be included in the COVID-19 differential diagnosis. The taking comprehensive history, physical examination and purposeful paraclinical assessments helps to make the best decision for management of the patients.
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Affiliation(s)
- Ali Sharifpour
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran.,Pulmonary and Critical Care Division, Imam Khomeini Hospital, Iranian National Registry Center for Lophomoniasis (INRCL), Mazandaran University of Medical Sciences, Sari, Iran
| | - Aref Hoseini
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zahra Nekoukar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
| | - Elham Sadat Banimostafavi
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran.,Department of Radiology, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mahdi Fakhar
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran.,Pediatric Infectious Disease Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mostafa Soleymani
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zakaria Zakariaei
- Toxoplasmosis Research Center, Communicable Diseases Institute, Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran.,Toxicology and Forensic Medicine Division, Orthopedic Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Reza Navaeifar
- Pediatric Infectious Disease Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Kimia Rsouli
- Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
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29
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Guarino C, Cesaro C, La Cerra G, Lucci R, Cesaro F, Zamparelli E. Emergency rigid bronchoscopy and immunotherapy: successful combination in dramatic respiratory debut of pulmonary adenocarcinoma. Tumori 2021; 107:NP91-NP93. [PMID: 34134548 DOI: 10.1177/03008916211022834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Malignant central airway obstruction is a life-threatening condition that often causes respiratory failure. In many cases, treatment of tumor in rigid bronchoscopy must be performed urgently, soothing respiratory symptoms and improving patient quality of life, in many cases reducing time to and allowing application of oncologic therapies. Immuno-oncologic therapies target the immune system selectively and are therefore much less toxic than standard chemotherapies, sometimes leading to outstanding results in advanced cancers for which there were no effective treatments until a few years ago. This report shows the effect of the joint application of rigid bronchoscopy and targeted immunotherapy in an emergency scenario, resulting in an unexpected extraordinary therapeutic success.
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Affiliation(s)
- Carmine Guarino
- Unit of Bronchoscopy, Monaldi Hospital-A.O. Dei Colli of Naples, Napoli, Italy
| | - Cristiano Cesaro
- Unit of Bronchoscopy, Monaldi Hospital-A.O. Dei Colli of Naples, Napoli, Italy
| | - Giuseppe La Cerra
- Unit of Bronchoscopy, Monaldi Hospital-A.O. Dei Colli of Naples, Napoli, Italy
| | - Raffaella Lucci
- Unit of Pathological Anatomy, Monaldi Hospital-A.O. Dei Colli of Naples, Napoli, Italy
| | - Flavio Cesaro
- Unit of Emergency Medicine and Surgery and First Aid, C.T.O. Hospital, Napoli, Italy
| | - Enzo Zamparelli
- Unit of Anesthesia and Resuscitation, Monaldi Hospital-A.O. Dei Colli of Naples, Napoli, Italy
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30
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Golan-Tripto I, Mezan DW, Tsaregorodtsev S, Stiler-Timor L, Dizitzer Y, Goldbart A, Aviram M. From rigid to flexible bronchoscopy: a tertiary center experience in removal of inhaled foreign bodies in children. Eur J Pediatr 2021; 180:1443-1450. [PMID: 33389071 DOI: 10.1007/s00431-020-03914-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/14/2020] [Accepted: 12/17/2020] [Indexed: 01/06/2023]
Abstract
Rigid bronchoscopy is the procedure of choice for removal of inhaled foreign bodies. In this retrospective study, we assessed the safety and efficacy of flexible bronchoscopy use in the removal of inhaled foreign bodies in children. One hundred eighty-two patients (median age of 24 months, 58% males) underwent an interventional bronchoscopy for the removal of inhaled foreign body between 2009 and 2019, 40 (22%) by flexible, and 142 (78%) by rigid bronchoscopy. 88.73% of rigid and 95% of flexible bronchoscopies were successful in foreign bodies removal (p value = 0.24). Complication rate was higher among rigid bronchoscopy (9.2% vs. 0%, p = 0.047). From 2017 onwards, following the implementation of flexible bronchoscopy for foreign bodies removal, 64 procedures were performed, 33 (51.6%) flexible, and 31 (48.4%) rigid. Procedure length was shorter via flexible bronchoscopy (42 vs 58 min, p = 0.016). Length of hospital stay was similar.Conclusion: In our hands, flexible bronchoscopy is an efficient and safe method for removal of inhaled foreign bodies in children, with shorter procedure time and minimal complication rate. Flexible bronchoscopy could be considered as the procedure of choice for removal of inhaled foreign bodies in children, by an experienced multidisciplinary team. What is Known: • Rigid bronchoscopy is currently the gold standard for removal of inhaled foreign bodies in children. • Rigid bronchoscopy has a relatively high complication rate compared to flexible bronchoscopy. What is New: • Flexible bronchoscopy is a short, safe, and efficient procedure to remove inhaled foreign bodies in children, compared to rigid bronchoscopy. • Flexible bronchoscopy could be proposed as the procedure of choice for removal of inhaled foreign bodies in children, if an experienced operator is available.
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Affiliation(s)
- Inbal Golan-Tripto
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel. .,Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva, Israel.
| | - Dina Weinstein Mezan
- Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva, Israel
| | - Sergey Tsaregorodtsev
- Department of Anesthesia and Critical Care, Soroka University Medical Center, Beer Sheva, Israel
| | - Liran Stiler-Timor
- Department of ENT Surgery, Soroka University Medical Center, Beer Sheva, Israel
| | - Yotam Dizitzer
- Clinical Research Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Aviv Goldbart
- Department of Pediatrics, Soroka University Medical Center, Beer Sheva, Israel.,Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva, Israel
| | - Micha Aviram
- Pediatric Pulmonary Unit, Soroka University Medical Center, Beer Sheva, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer Sheva, Israel
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31
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Thakore S, Gupta N, Madan K, Bhatnagar S. Near ideal anesthetic technique for tracheal stenting in central airway obstruction with dexmedetomidine-ketamine infusion: a case report. Braz J Anesthesiol 2021; 71:447-450. [PMID: 33895217 PMCID: PMC9373335 DOI: 10.1016/j.bjane.2021.03.019] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 03/14/2021] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Abstract
Central airway obstruction presents as an emergency with dyspnea and stridor. Anesthetic management of rigid bronchoscopy-guided tracheal stenting is highly stimulating procedure requiring general anesthesia. But it may lead to life threatening airway obstruction and cardiovascular collapse after induction. Total intravenous anesthesia based on propofol-remifentanil is an optimal anesthetic technique, but remifentanil is not available in many countries. Although dexmedetomidine-ketamine has been used for procedural sedation, its use for rigid bronchoscopy in the setting of central airway obstruction has not been described in literature. We describe near ideal anesthetic technique for management of central airway obstruction using dexmedetomidine-ketamine combination.
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Affiliation(s)
- Sakshi Thakore
- Department of onco-Anesthesiology, DRBRAIRCH, AIIMS, New Delhi.
| | - Nishkarsh Gupta
- Department of onco-Anesthesiology, DRBRAIRCH, AIIMS, New Delhi.
| | - Karan Madan
- Department of Pulmonary and critical care medicine, AIIMS, New Delhi
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32
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Mahmood K, Wahidi MM, Shepherd RW, Argento AC, Yarmus LB, Lee H, Shojaee S, Berkowitz DM, Van Nostrand K, Lamb CR, Shofer SL, Gao J, Davoudi M. Variable Learning Curve of Basic Rigid Bronchoscopy in Trainees. Respiration 2021; 100:530-537. [PMID: 33849039 DOI: 10.1159/000514627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite increased use of rigid bronchoscopy (RB) for therapeutic indications and recommendations from professional societies to use performance-based competency, an assessment tool has not been utilized to measure the competency of trainees to perform RB in clinical settings. OBJECTIVES The aim of the study was to evaluate a previously developed assessment tool - Rigid Bronchoscopy Tool for Assessment of Skills and Competence (RIGID-TASC) - for determining the RB learning curve of interventional pulmonary (IP) trainees in the clinical setting and explore the variability of learning curve of trainees. METHODS IP fellows at 4 institutions were enrolled. After preclinical simulation training, all RBs performed in patients were scored by faculty using RIGID-TASC until competency threshold was achieved. Competency threshold was defined as unassisted RB intubation and navigation through the central airways on 3 consecutive patients at the first attempt with a minimum score of 89. A regression-based model was devised to construct and compare the learning curves. RESULTS Twelve IP fellows performed 178 RBs. Trainees reached the competency threshold between 5 and 24 RBs, with a median of 15 RBs (95% CI, 6-21). There were differences among trainees in learning curve parameters including starting point, slope, and inflection point, as demonstrated by the curve-fitting model. Subtasks that required the highest number of procedures (median = 10) to gain competency included ability to intubate at the first attempt and intubation time of <60 s. CONCLUSIONS Trainees acquire RB skills at a variable pace, and RIGID-TASC can be used to assess learning curve of IP trainees in clinical settings.
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Affiliation(s)
- Kamran Mahmood
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA
| | - Momen M Wahidi
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA
| | | | - A Christine Argento
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lonny B Yarmus
- Department of Medicine, Interventional Pulmonology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Hans Lee
- Department of Medicine, Interventional Pulmonology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Samira Shojaee
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - David M Berkowitz
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Keriann Van Nostrand
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Carla R Lamb
- Division of Pulmonary and Critical Care Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Scott L Shofer
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University, Durham, North Carolina, USA
| | - Junheng Gao
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA
| | - Mohsen Davoudi
- Beckman Laser Institute, Division of Pulmonary and Critical Care Medicine, University of California Irvine, Irvine, California, USA
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Lee JY, Walsh KJ. Rigid bronchoscopy and tracheal resection in the management of tracheal chondrosarcoma: A case report. J Clin Anesth 2021; 71:110241. [PMID: 33765590 DOI: 10.1016/j.jclinane.2021.110241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/04/2021] [Accepted: 03/06/2021] [Indexed: 11/24/2022]
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Gan W, Xiao N, Feng Y, Zhou D, Hu J, Liu S, Zou J. Clinical analysis of tracheobronchial foreign body aspiration in children: a focus on external and intrinsic factors. BMC Surg 2021; 21:108. [PMID: 33658017 PMCID: PMC7927229 DOI: 10.1186/s12893-021-01089-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 02/03/2021] [Indexed: 02/08/2023] Open
Abstract
Background Tracheobronchial foreign body aspiration (TFBA) is a critical disease in children and is extremely dangerous, even life-threatening. The factors affecting the occurrence and prognosis of TFBA are complex. The purpose of this study is to examine the external and intrinsic factors affecting clinical features of TFBA in West China and propose potential effective intervention measures. Methods We retrospectively analyzed the clinical data of pediatric patients diagnosed with TFBA with foreign bodies (FBs) removed by rigid bronchoscopy under general anesthesia at the otolaryngology department from December 2017 to November 2018. The data included age, sex, clinical symptoms, type and location of FB, guardians, prehospital duration and residence of these pediatric patients. Results The ratio of males (72) to females (53) was 1.4:1. Children aged from 1 to 3 years accounted for 76% (95/125) of patients. Cough, continuous fever and dyspnea were the primary symptoms. The right primary bronchus was the most common location of FB detection by rigid bronchoscopy (67 cases, 53.6%). Organic FBs were most common in our study. Guardians of patients significantly differed in the rural (parents 16, grandparents 31) and urban (parents 52, grandparents 26) groups (χ2 = 12.583, p = 0.000). More children in the rural group than in the urban group had a treatment delay longer than 72 h. More children in the group with no history of FB aspiration (12, 25%) than in the group with prior FB aspiration had a treatment delay longer than 72 h. Conclusion Pediatric TFBA is a common emergency in otolaryngology. Age, sex, tracheobronchial anatomy and other physiological elements were defined as intrinsic factors, while guardians, residence, FB species and prehospital time were defined as external factors of TFBA. External and intrinsic factors both influence the occurrence and progression of TFBA. It is extremely important to take effective measures to control external factors, which can decrease morbidity and mortality.
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Affiliation(s)
- Weigang Gan
- Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Ning Xiao
- Health Management Center, Sichuan Provincial People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Yiyuan Feng
- Department of Otorhinolaryngology-Head and Neck Surgery, Qianwei People's Hospital, Sichuan, 614400, Leshan, People's Republic of China
| | - Danmei Zhou
- Department of Otorhinolaryngology-Head and Neck Surgery, Qianwei People's Hospital, Sichuan, 614400, Leshan, People's Republic of China
| | - Juanjuan Hu
- Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Shixi Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jian Zou
- Department of Otorhinolaryngology-Head and Neck Surgery, West China Hospital, West China School of Medicine, Sichuan University, Chengdu, Sichuan, People's Republic of China.
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Zeng J, Wu X, Chen Z, Zhang M, Ke M. Modified silicone stent for the treatment of post-surgical bronchopleural fistula: a clinical observation of 17 cases. BMC Pulm Med 2021; 21:10. [PMID: 33407326 PMCID: PMC7789393 DOI: 10.1186/s12890-020-01372-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bronchopleural fistula is a rare but life-threatening event with limited therapeutic options. We aimed to investigate the efficacy and safety of the modified silicone stent in patients with post-surgical bronchopleural fistula. METHODS Between March 2016 and April 2020, we retrospectively reviewed the records of 17 patients with bronchopleural fistula and who underwent bronchoscopic placement of the Y-shaped silicone stent. The rate of initial success, clinical success and clinical cure, and complications were analyzed. RESULTS Stent placement was successful in 16 patients in the first attempt (initial success rate: 94.1%). The median follow-up time was 107 (range, 5-431) days. All patients achieved amelioration of respiratory symptoms. The clinical success rate was 76.5%. Of the 14 patients with empyema, the daily drainage was progressively decreased in 11 patients, and empyema completely disappeared in six patients. Seven stents were removed during follow-up: four (26.7%) for the cure of fistula, two for severe proliferation of granulomatous tissue and one for stent dislocation. No severe adverse events (i.e. massive hemoptysis, suture dehiscence) took place. Seven patients died (due to progression of malignancy, uncontrolled infection, myocardial infarction and left heart failure). CONCLUSIONS The modified silicone stent may be an effective and safe option for patients with post-surgical bronchopleural fistula patients in whom conventional therapy is contraindicated.
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Affiliation(s)
- Junli Zeng
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Xuemei Wu
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Zhide Chen
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Meihua Zhang
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China
| | - Mingyao Ke
- Department of Respiratory Centre, The Second Affiliated Hospital of Xiamen Medical College, 566 Shengguang Road, Xiamen, 361000, Fujian Province, China.
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Agrawal SR, Gopi Shankar S, Joshi AA, Patekar S, Bradoo RA. Role of bronchoscopy and imaging in long-standing foreign body bronchus presenting as recurrent or non-resolving lower respiratory tract infection. Eur Arch Otorhinolaryngol 2021; 278:1477-81. [PMID: 33392759 DOI: 10.1007/s00405-020-06497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION A long-standing retained foreign body in the bronchus is unusual. In majority of cases, an adequate history is not obtained, the clinical picture is usually clouded by superadded pathological changes. CASE SERIES We report three cases of long-standing foreign body in the airway who presented with recurrent lower respiratory tract infection. Examination of respiratory system revealed no significant abnormality. Chest radiograph was normal. CT scan of the chest was useful to indicate endobronchial opacity in the airway suggestive of a foreign body. The patients underwent rigid bronchoscopy under general anesthesia for successful removal of the foreign body. CONCLUSION So the patients with non-resolving or recurrent lower respiratory symptoms in spite of medical treatment and without any obstructive findings must undergo diagnostic bronchoscopy evaluation and imaging.
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Kuipers ME, Dik H, Willems LNA, Hoppe BPC. Inflammatory myofibroblastic tumor of the lung: A rare endobronchial mass. Respir Med Case Rep 2020; 31:101285. [PMID: 33251104 PMCID: PMC7677118 DOI: 10.1016/j.rmcr.2020.101285] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/24/2020] [Accepted: 11/07/2020] [Indexed: 12/01/2022] Open
Abstract
A 42-year old male was referred with a 6-week history of new onset dyspnea. The patient had normal vital signs, no relevant medical history and the only abnormality was a left sided inspiratory wheeze. No abnormalities were seen on the chest X-ray. A bronchoscopy was performed which showed a well-circumscribed hypervasculated mass in the left main bronchus. A biopsy was taken, which was complicated after the procedure by dislocation of the mass and coughed up by the patient. Both samples were send for pathologic review. A contrast CT was performed which showed a localized remaining mass in the left main bronchus and no lymph node involvement. Pathological evaluation showed spindle-shaped cell proliferation with mitotic activity in the second larger tissue which could be consistent with an inflammatory myofibroblastic tumor (IMT), whereas the first biopsy sample only showed granulomatous inflammation. Following multidisciplinary review the diagnosis of IMT was made and a treatment plan was decided. Because of the localized position of the mass the patient was treated with laser coagulation via rigid bronchoscopy instead of surgery. Bronchoscopic review afterwards showed complete resolution of the mass and the dyspnea had resolved. This case highlights the difficulty of making the IMT-diagnosis and the option of treating it with laser coagulation via rigid bronchoscopy.
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Affiliation(s)
| | - Hans Dik
- Alrijne Hospital Leiderdorp, the Netherlands
| | | | - Bart P C Hoppe
- Leiden University Medical Center, the Netherlands.,Alrijne Hospital Leiderdorp, the Netherlands
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Wineski RE, Panico EC, Bailey LN, Cardenas AM, Grayson JW, Wiatrak BJ. Flat sticker as a mobile airway foreign body: A case report and review of the literature. Radiol Case Rep 2020; 15:2391-2395. [PMID: 32994848 PMCID: PMC7516169 DOI: 10.1016/j.radcr.2020.09.031] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/18/2022] Open
Abstract
Diagnosis of an airway foreign body in the setting of an unwitnessed aspiration event remains a challenge for physicians in the emergency setting. We describe a case of a 2-year-old male who presented to the emergency department with atypical symptoms resulting from ingestion and aspiration of a large, flat sticker. The airway foreign body remained in place for over 24 hours despite obtaining appropriate airway imaging, and the object was later removed without complication via rigid bronchoscopy in the operating room. Further review of this case and the current literature highlighted multiple lessons. Initial evaluations should combine a rigorous history and physical with strict guidelines on usage of multiple imaging modalities (eg, plain radiographs and CT). Imaging should be obtained with the patient devoid of all obstructive materials in multiple positions (eg, upright, supine, lateral) in order to maximize the physician's ability to positively diagnose airway foreign bodies prior to definitive treatment with rigid bronchoscopy.
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Affiliation(s)
- Robert E. Wineski
- Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham Medical Center
- Corresponding author.
| | - Emma C. Panico
- Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham Medical Center
| | - Luke N. Bailey
- Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham Medical Center
| | | | - Jessica W. Grayson
- Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham Medical Center
| | - Brian J. Wiatrak
- Department of Otolaryngology, Head and Neck Surgery, University of Alabama at Birmingham Medical Center
- Pediatric ENT Associates of Alabama, Children's of Alabama Hospital Birmingham, AL
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Goyal S, Jain S, Rai G, Vishnu R, Kamath GS, Bishnoi AK, Gaude Y, Kumara V, Joshi H, Reddy R. Clinical variables responsible for early and late diagnosis of foreign body aspiration in pediatrics age group. J Cardiothorac Surg 2020; 15:271. [PMID: 32993750 PMCID: PMC7526158 DOI: 10.1186/s13019-020-01314-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 07/16/2020] [Accepted: 09/21/2020] [Indexed: 12/03/2022] Open
Abstract
Background Incidence of foreign body aspiration has been noticed predominantly in age group ranging from 12 months-3 years. Foreign body in the trachea is a medical emergency as presentation is in respiratory distress. Obstruction of only one main or distal bronchus, leads to severe cough, choking sensation and breathlessness. Without early intervention, it can lead to collapse, consolidation and pneumonia of the affected lung. Methods We retrospectively analyzed 37 pediatric case records who presented from January 2014–December 2018 with foreign body aspiration. Our primary aim was to assess the parameters responsible for early and late diagnosis of foreign body aspiration. We concluded with a diagnostic algorithm for management of foreign body aspiration on the basis of this outcome. Results Around 32.5% came with a history of aspiration, 43% were referred from the primary centers with a suspicion for the same and the rest came to our tertiary care hospital directly. Those who presented within a week came with complaints of wet cough, wheeze and tachypnea. Furthermore, those who came in after a week had a dry cough and fever as their main complaint. Majority of ingested foreign bodies was a vegetative type (80%) as compared to the non –vegetative. Conclusion Unlike adults, foreign body aspiration in children is most commonly diagnosed on history, suspicion and clinical findings. Chest x ray has been the primary investigation of choice but in the majority of the cases it was normal with subtle changes. Early diagnosis is the key to avoid complication.
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Affiliation(s)
- Samarth Goyal
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India
| | - Shubhika Jain
- Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India
| | - Guruprasad Rai
- Department of Cardiothoracic and vascular surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India.
| | - Rajkamal Vishnu
- Department of Cardiothoracic and vascular surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India
| | - Ganesh Sevagur Kamath
- Department of Cardiothoracic and vascular surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India
| | - Arvind Kumar Bishnoi
- Department of Cardiothoracic and vascular surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India
| | - Yogesh Gaude
- Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India
| | - Vijaya Kumara
- Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India
| | - Harshil Joshi
- Department of Anesthesiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India
| | - Revanth Reddy
- Department of Cardiothoracic and vascular surgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, 576 104, India
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Patigaroo SA, Qazi SM, Ahmad R, Latoo MA, Dar NH, Showkat SA, Ali A. Pediatric Rigid Bronchoscopy for Tracheobronchial Foreign Bodies in Covid Times: Short Personal Experience. Indian J Otolaryngol Head Neck Surg 2020; 74:2729-2737. [PMID: 32953635 PMCID: PMC7492234 DOI: 10.1007/s12070-020-02143-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/08/2020] [Accepted: 09/07/2020] [Indexed: 12/20/2022] Open
Abstract
This case series of 5 patients of rigid bronchoscopy done for tracheobronchial foreign bodies is presented to readers to share my experience of doing rigid bronchoscopy during Covid Times from March to July 2020 specifically sharing experience on personal protection with local innovations during the procedure. Indications, intra-procedure modifications and other relevant things are also presented. The observations and experience are purely personal gained during these months and may be subjected to further research and in no way substitute the well established facts.
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Affiliation(s)
| | - Sajad Majid Qazi
- Department of ENT and HNS, Government Medical College, Srinagar, J&K India
| | - Rauf Ahmad
- Department of ENT and HNS, Government Medical College, Srinagar, J&K India
| | - Manzoor A Latoo
- Department of ENT and HNS, Government Medical College, Srinagar, J&K India
| | - Nisar Husain Dar
- Department of ENT and HNS, Government Medical College, Srinagar, J&K India
| | - Showkat A Showkat
- Department of ENT and HNS, Government Medical College, Srinagar, J&K India
| | - Ahsan Ali
- Department of ENT and HNS, Government Medical College, Srinagar, J&K India
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De Palma A, Brascia D, Fiorella A, Quercia R, Garofalo G, Genualdo M, Pizzuto O, Costantino M, Simone V, De Iaco G, Nex G, Maiolino E, Schiavone M, Signore F, Panza T, Cardinale F, Marulli G. Endoscopic removal of tracheobronchial foreign bodies: results on a series of 51 pediatric patients. Pediatr Surg Int 2020; 36:941-51. [PMID: 32468145 DOI: 10.1007/s00383-020-04685-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/20/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Rigid bronchoscopy (RB) is still considered the gold standard approach for the removal of airway foreign bodies (FBs) in children; however, flexible bronchoscopy (FOB) has recently been proposed both as diagnostic and therapeutic means. Our purpose was to evaluate the outcomes of FOB, associated with the Dormia basket, for the removal of FBs. METHODS Retrospective data about 124 children who underwent bronchoscopy for the suspicion of a FB aspiration between January 2008 and January 2019 in our department were collected. RESULTS In a total of 51 cases, FBs were removed through FOB or RB associated with forceps or Dormia basket. Male to female ratio was 1.8:1, mean age 30 ± 26.1 months. Thirty-four (67%) FBs were directly removed through FOB, in most of the cases using Dormia basket and twelve (23%) patients underwent RB. The overall left-versus-right distribution was 57% vs. 43%. The mean retrieval procedural time was 36.29 ± 24.99 min for FOB and 52.5 ± 29.74 min for RB; the success rate of the procedures was 97% vs. 67%. CONCLUSION FOB can be used not only as a diagnostic procedure, but also as the first method for the removal of airway FBs. The Dormia basket is a useful tool, especially to remove peripherally located FBs.
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Lachkar S, Couraud S, Salaün M, Roger M, Bota S, Guisier F, Thiberville L. Self-expanding metallic Y-stent compared to silicone Y-stent for malignant lesions of the main carina: A single center retrospective study. Respir Med Res 2020; 78:100767. [PMID: 32498021 DOI: 10.1016/j.resmer.2020.100767] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bifurcation stents are often required in patients with malignant airway obstruction or fistulization involving the main carina. The silicone Y stent is the most used but remains challenging to place. The self-expanding metallic Y (SEM) stent appears easy to use. The objective is to report the feasibility, efficacy, and tolerance of SEM Y stent compared to silicone Y stent in patients with malignant tumors involving the main carina. PATIENTS AND METHODS This retrospective single center study was performed between May 2004 and May 2017. All patients with malignant carina involvement treated with a bronchial Y stent were included. RESULTS Forty silicone Y stents and 38 SEM Y stents were placed. Seven stenting placements failed in the silicone Y group but none in the SEM Y stent group (P=0.008). The median duration of the procedure was 80min (25-210) in the silicone Y group and.50min (25-110min) in the SEM Y group (P=0.001). There was no significant difference in terms of early or late complications between the 2 groups. Nine silicone Y stents (26.5%) and 7 SEM Y stents (18.4%) were removed (P=0.4). The median survival time following stent insertion was 171 days (Interquartile range (IQR): 53-379) in the silicone Y group and 104 days (IQR: 53-230) in the SEM Y group. CONCLUSION If silicone Y stent remains the best solution for benign obstruction, SEM Y stent seems to be an easy alternative with no difference in terms of complication or ablation for malignant lesions involving the main carina.
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Affiliation(s)
- S Lachkar
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France.
| | - S Couraud
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France
| | - M Salaün
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France; Normandie University, UNIROUEN, QuantIF- LITIS EA 4108, Department of Pulmonology, Rouen University Hospital, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, 76000 Rouen, France
| | - M Roger
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France
| | - S Bota
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France
| | - F Guisier
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France; Normandie University, UNIROUEN, QuantIF- LITIS EA 4108, Department of Pulmonology, Rouen University Hospital, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, 76000 Rouen, France
| | - L Thiberville
- Department of Pulmonology, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, Rouen University Hospital, 1, rue de Germont, 76000, Rouen, France; Normandie University, UNIROUEN, QuantIF- LITIS EA 4108, Department of Pulmonology, Rouen University Hospital, Thoracic Oncology and Respiratory Intensive Care & CIC- CRB 1404, 76000 Rouen, France
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Holden VK, Ospina-Delgado D, Chee A, Parikh MS, Carreiro MM, Alape Moya D, Fernandez-Bussy S, Herth FJF, Majid A. Safety and Efficacy of the Tracheobronchial Bonastent: A Single-Center Case Series. Respiration 2020; 99:353-359. [PMID: 32259817 DOI: 10.1159/000506815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 12/20/2019] [Accepted: 02/24/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Tracheobronchial stents are widely used devices in interventional pulmonology; however, the current literature on the effectiveness and complication rates of the different types of stents is limited. OBJECTIVE We report the largest case series of airway Bonastent placement and describe the efficacy and early (<30 days) and late (≥30 days) complication rates. METHODS We performed a retrospective review of our prospectively collected database of patients who underwent therapeutic bronchoscopy with stent placement. All adult patients who had a tracheal/bronchial Bona-stent placed between July 1, 2017, and July 30, 2019, for any indication at our institution were included. The efficacy as well as intraoperative and short- and long-term complications of Bonastent placement were evaluated. RESULTS Sixty Bonastents were placed in 50 patients. The etiology was malignant in 90% of the cases, while 2 patients had a tracheoesophageal fistula. All procedures were performed via rigid bronchoscopy. The most common location for stent placement was the bronchus intermedius, followed by the trachea, in 32 and 30% of the cases, respectively. Seventy percent of the patients (35/50) had improvement of respiratory symptoms within 30 days. Twenty-eight stents (48%) were removed at a mean of 74 days. Seventeen patients (34%) died within 30 days of stent placement. The overall complication rate was 54% (27/50 patients) at a mean follow-up of 111 days. The stent-related complication rate was 23.3% (14/60 cases) within <30 days and 53% (18/34 cases) at ≥30 days. CONCLUSIONS The tracheobronchial Bonastent is effective for the treatment of patients with central airway obstruction and tracheoesophageal fistulae with an acceptable safety profile.
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Affiliation(s)
- Van Kim Holden
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA, .,Section of Interventional Pulmonology, Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA,
| | - Daniel Ospina-Delgado
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex Chee
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Mihir S Parikh
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Megan M Carreiro
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Alape Moya
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.,Division of General Internal Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | | | - Felix J F Herth
- Department of Pulmonary and Critical Care Medicine, Thoraxklinik-University of Heidelberg, Heidelberg, Germany
| | - Adnan Majid
- Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Murgu S, Laxmanan B, Stoy S, Egressy K, Chaddha U, Farooqui F, Brunner R, Hogarth K, Chaney M. Evaluation of Safety and Short-term Outcomes of Therapeutic Rigid Bronchoscopy Using Total Intravenous Anesthesia and Spontaneous Assisted Ventilation. Respiration 2019; 99:239-247. [PMID: 31851991 DOI: 10.1159/000504679] [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: 07/19/2019] [Accepted: 11/08/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND There is a paucity of published data regarding the optimal type of anesthesia and ventilation strategies during rigid bronchoscopy. OBJECTIVE The aim of our study is to report the procedural and anesthesia-related complications with rigid bronchoscopy using total intravenous anesthesia and spontaneous assisted ventilation. METHODS A retrospective review of patients undergoing therapeutic rigid bronchoscopy at the University of Chicago between October 2012 and December 2014 was performed. Data were recorded relating to patients' demographics, comorbidities, type of anesthesia, need for neuromuscular blockade (NMB), intraoperative hypoxemia, hypotension, perioperative adverse events, and mortality. RESULTS Fifty-five patients underwent 79 rigid bronchoscopy procedures; 90% were performed for malignant disease and 90% of patients had an American Society of Anesthesiologists (ASA) class III or IV. The majority (76%) did not require use of NMB. The most common adverse events were intraoperative hypoxemia (67%) and hypotension (77%). Major bleeding and postoperative respiratory failure occurred in 3.8 and 5.1% of procedures, respectively. There was no intraoperative mortality or cardiac dysrhythmias. The 30-day mortality was 7.6% and was associated with older age, inpatient status, congestive heart failure, home oxygen use, and procedural duration. Intraoperative hypoxemia, hypotension, and ASA class were not associated with 30-day mortality. The majority (94%) of patients were discharged home. The use of NMB did not impact outcomes. CONCLUSIONS This study suggests that therapeutic rigid bronchoscopy can be safely performed with total intravenous anesthesia and spontaneous assisted ventilation in patients with central airway obstruction, significant comorbidities, and a high ASA class. The only significant modifiable variable predicting the 30-day mortality was the duration of the procedure.
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Affiliation(s)
- Septimiu Murgu
- Medicine-Pulmonary/Critical Care, University of Chicago, Chicago, Illinois, USA,
| | - Balaji Laxmanan
- Pulmonary and Critical Care, Confluence Health, Wenatchee, Washington, USA
| | - Sean Stoy
- Pulmonary and Critical Care, North Memorial Health Hospital, Crystal, Minnesota, USA
| | - Katarine Egressy
- Pulmonary and Critical Care, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Udit Chaddha
- Pulmonary and Critical Care, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Ryan Brunner
- Anesthesiology, McLaren Macomb, Mount Clemens, Michigan, USA
| | - Kyle Hogarth
- Medicine-Pulmonary/Critical Care, University of Chicago, Chicago, Illinois, USA
| | - Mark Chaney
- Anesthesiology and Critical Care, University of Chicago, Chicago, Illinois, USA
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Miró I, Ibáñez V, Carazo E, Couselo M, Vila JJ. [Applicability of a clinical score in patients with suspected foreign body aspiration]. Cir Pediatr 2019; 32:172-176. [PMID: 31626400] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To validate the clinical score of Valdivieso et al. in the management of patients with suspected foreign body aspiration in a tertiary hospital. This score raises different scenarios according to the result: bronchoscopy, CT, observation or discharge. MATERIAL AND METHODS Retrospective study of patients who underwent a bronchoscopy due to suspected tracheobronchial foreign body between November-2015 and November-2018. The variables proposed by the score were collected (choking, stridor, wheezing, unilateral hypoventilation, altered chest X-ray and high-risk foreign body) and the score was calculated for each patient, analyzing the performance of the test using the ROC (Receiver Operating Characteristic) curve. RESULTS Bronchoscopy was performed in 81 patients with a mean age of 2.1 years (7 months-11 years), finding foreign body in 33.3%. The area under the ROC curve of the score was 0.803 (0.695-0.911). In 6 (22.2%) patients with confirmed foreign body the score initially indicated observation in 5 cases and discharge in 1. Excluding the 49 patients with unilateral altered auscultation or when there was a nut suspected, which in our environment are clear indications for bronchoscopy, the score correctly classified the remaining 32 patients, which would have reduced the rate of normal bronchoscopies from 66% to 45%. CONCLUSIONS The score in our sample presents a high diagnostic power but a non-negligible false negative rate. It has a special utility in patients who do not have unilateral altered auscultation and/or choking with nuts, allowing to reduce the rate of normal bronchoscopies.
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Affiliation(s)
- I Miró
- Hospital Universitario y Politécnico La Fe. Valencia
| | - V Ibáñez
- Hospital Universitario y Politécnico La Fe. Valencia
| | - E Carazo
- Hospital Universitario y Politécnico La Fe. Valencia
| | - M Couselo
- Hospital Universitario y Politécnico La Fe. Valencia
| | - J J Vila
- Hospital Universitario y Politécnico La Fe. Valencia
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Marouf R, Hamraoui S, Alloubi I. [A neglected bronchial foreign body for 23 years]. Rev Mal Respir 2019; 36:1002-1007. [PMID: 31521433 DOI: 10.1016/j.rmr.2019.06.010] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 06/15/2019] [Indexed: 10/26/2022]
Abstract
Foreign body inhalation is a clinical emergency requiring prompt action to ensure speedy recovery and minimize the development of complications. It is more common in children than adults. We report a case of a neglected foreign body present in the bronchus of an adult for 23 years and treated as intermittent asthma. The diagnosis was revealed following the development of severe sepsis of a pulmonary origin. The foreign body was removed by rigid bronchoscopy, antibiotic therapy instituted and pre- and post-interventional respiratory physiotherapy carried out. Satisfactory progress was marked by the complete clearing of pulmonary suppuration, with only a small localized and asymptomatic focus of bronchial dilatation remaining. The persistence of chronic, unexplained respiratory complaints should prompt the use of imaging and endoscopy to exclude an endobronchial cause, especially to consider the possible presence of a previously unknown foreign body. Early diagnosis and intervention can help to avoid potentially serious complications.
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Affiliation(s)
- R Marouf
- Service de chirurgie thoracique et cardiovasculaire, CHU Mohammed VI, Oujda, Maroc.
| | - S Hamraoui
- Service de chirurgie thoracique et cardiovasculaire, CHU Mohammed VI, Oujda, Maroc
| | - I Alloubi
- Service de chirurgie thoracique et cardiovasculaire, CHU Mohammed VI, Oujda, Maroc
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Rabiou S, Alami B, Efared B, Lakranbi M, Harmouchi H, El-Amrani R, Serraj M, El-Bouazzaoui A, Ouadnouni Y, Kanja N, Smahi M. How thoracic surgeon manage tracheal tumors in African country? (Case series). Ann Med Surg (Lond) 2019; 44:13-19. [PMID: 31289669 PMCID: PMC6593208 DOI: 10.1016/j.amsu.2019.06.007] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/05/2019] [Accepted: 06/08/2019] [Indexed: 11/28/2022] Open
Abstract
Introduction Tracheal tumors are a rare pathological entity whose diagnosis is usually delayed by clinical latency. Surgery, which consists of a tracheal resection-anastomosis with or without reconstructive reconstruction, remains the treatment that ensures the best long-term survival. Methods This is a retrospective study about 8 patients admitted in the department of thoracic surgery of Hassan II's university hospital of Fes for tracheal tumors management during 7 years time (December 2010 to December 2017). Results There were 6 men and 2 women with an average age of 44.4 years ranged from 17 to 65 years, 4 were smokers. Dyspnea was the main trigger sign. Seven (7) have undergone bronchial fibroscopy diagnostic with a finding of budding process in 5 patients, the middle of the trachea is often concerned in 3 patients, obstructing the lumen of the trachea in almost all patients. The treatment in all patients was surgical with an intubation via the operative field, 4 trachea resection-anastomosis, 4 plasty (Lateral resection with V plasty, Kergin's plasty, Mattey's tracheobronchial anastomosis and widened V-resection to the carina). The most common histological type in our series was Adenoid Cystic Carcinoma in 2 of our patients. For the other patients we have found squamous cell carcinoma (1 case), adenocarcinoma (1 case), atypical carcinoid tumor (1 case), low grade mucoepidermoid carcinoma (1 case), an adenoma pleomorph (1 case) and endotracheal goiter (1 case). The operative follow-up was simple in 7 of our patients, all of whom underwent post-operative fibroscopy within an average of 9 days. Two cases of post-operative recurrent palsy had been observed, all of which had progressed well under treatment. We have noted 2 deaths, including one at day 4 post-operative, and the other died from complications of post-radiation tracheal stenosis. Back to 32 months' average follow-up, we have enregistered a case of a distant relapse by cervical lymph node metastasis in one patient, 5 years after surgery. Conclusion Primary tumors of the trachea remain of reserved prognosis with 5-year survival of 57% of all histological types combined. Computed tomodensitometry and tracheobronchial fibroscopy remain the means of reference exploration in the diagnosis and assessment of surgical resectability.
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Affiliation(s)
- Sani Rabiou
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Université de Niamey, Niger
| | - Badredine Alami
- Department of Radiology, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | | | - Marwane Lakranbi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | | | - Rim El-Amrani
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco
| | - Mounia Serraj
- Department of Pneumology, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacy, Université de Niamey, Niger
| | - Abderrahim El-Bouazzaoui
- Department of Anaesthesiology and Resuscitation A4, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Yassine Ouadnouni
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Nabil Kanja
- Department of Anaesthesiology and Resuscitation A4, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
| | - Mohamed Smahi
- Department of Thoracic Surgery, CHU Hassan II, Fez, Morocco.,Faculty of Medicine and Pharmacies, Université Sidi Mohamed Ben Abdellah, Fez, Morocco
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Vergnon JM, Huppert J. Removal of a mediastinal osteosynthesis screw by rigid bronchoscopy. Respir Med Res 2019; 75:29-31. [PMID: 31262425 DOI: 10.1016/j.resmer.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- J-M Vergnon
- Department of chest diseases and thoracic oncology, university hospital of Saint-Étienne, 42055, Saint-Étienne, France; UMR Inserm 1059 "Sainbiose" université de Lyon, université Jean-Monnet Saint-Étienne, UFR de médecine campus santé innovations, 10, rue de la Marandière, 42270 Saint-Priest-en-Jarez, France; Société de pneumologie de langue Française, 66 boulevard St-Michel, 75006 Paris, France.
| | - J Huppert
- Neuro-surgical unit, clinique du Parc, 42270 Saint-Priest-en-Jarez, France; Société Française de chirurgie rachidienne, 35760 Saint-Grégoire, France
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Kawahara I, Maeda K, Samejima Y, Kajihara K, Uemura K, Nomura K, Isono K, Morita K, Fukuzawa H, Nakao M, Yokoi A. Repair of type IV laryngotracheoesophageal cleft (LTEC) on ECMO. Pediatr Surg Int 2019; 35:565-8. [PMID: 30783751 DOI: 10.1007/s00383-019-04455-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE A type IV laryngotracheoesophageal cleft (LTEC) is a very rare congenital malformation. Type IV LTEC that extends to the carina have poor prognosis and are difficult to manage. We present our experience with surgical repair in such a case using extracorporeal membranous oxygenation (ECMO). METHODS A male infant, who was diagnosed with Goldenhar syndrome, showed severe dyspnea and dysphagia. Laryngoscopy indicated the presence of LTEC. The patient was transferred to our institute for radical operation 26 days after birth. Prior to surgery, a balloon catheter was inserted in the cardiac region of stomach through the lower esophagus to block air leakage, to maintain positive pressure ventilation. We also performed observations with a rigid bronchoscope to assess extent of the cleft, and diagnosed the patient with type IV LTEC. After bronchoscopy, we could intubate the tracheal tube just above the carina. Under ECMO, repair of the cleft was performed by an anterior approach via median sternotomy. RESULTS The patient was intubated via nasotracheal tube and paralysis was maintained for 2 weeks, using a muscle relaxant for the first 3 days. Two weeks after surgery, rigid bronchoscopy showed that the repair had been completed, and the tracheal tube was successfully extubated without tracheotomy. CONCLUSIONS Although insertion of a balloon catheter is a very simple method, it can separate the respiratory and digestive tracts. This method allowed for positive pressure ventilation and prevented displacement of the endotracheal tube until ECMO was established. As a result, we safely performed the operation and the post-operative course was excellent.
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Camuset J, Naccache JM, Dhalluin X, Febvre M, Wallyn F, Ouennoure O, Copin MC, Assouad J, Antoine M, Cadranel J, Fournier C. [Transbronchial cryobiopsy in diffuse interstitial lung diseases]. Rev Mal Respir 2019; 36:455-460. [PMID: 31005425 DOI: 10.1016/j.rmr.2018.10.618] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 01/21/2018] [Accepted: 10/18/2018] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In the diagnostic approach to interstitial lung disease (ILD), the use of transbronchial cryobiopsy (TBC) may offer an alternative to surgical lung biopsy (SLB). We report the diagnostic effectiveness and the safety of TBC in ILD based on the preliminary experience in two French university centers. METHODS Twenty four patients underwent TBC for the diagnosis of ILD in the operating room between 2014 and 2017. All the histological diagnoses obtained were then reviewed and validated during multidisciplinary discussions (MDD). RESULTS Patients had an average of 3 TBC.TBC samples were analyzable in 22/24 (91.7%) patients. In these, samples allowed a histological diagnosis to be made in 14/22 (63.6%) patients and a diagnosis with certainty in 13/22 (59%) after MDD. The overall diagnostic yield from TBC was 13/24 (54.2%). Nine (37.5%) patients had a pneumothorax. Five (20.8%) patients had a bleeding. There were no deaths. Taking into account a possible initial learning curve and considering only the 15 patients who had their TBC after 2015, we note that a diagnosis could be made after MDD for 12 of them, that is, 80%. CONCLUSION A prospective randomized study is needed to evaluate the technique in France in order to specify its diagnostic performance and its safety profile in comparison to SLB.
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Affiliation(s)
- J Camuset
- Service de chirurgie thoracique, hôpital Tenon, CHU, AP-HP, 4, rue de la Chine, 75020 Paris, France.
| | - J M Naccache
- Service de pneumologie, CHU, AP-HP hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - X Dhalluin
- Service d'endoscopie respiratoire, clinique de pneumologie, hôpital Calmette, pôle cardiovasculaire et pulmonaire, CHU Lille, 59000 Lille, France
| | - M Febvre
- Service de pneumologie, CHU, AP-HP hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - F Wallyn
- Service d'endoscopie respiratoire, clinique de pneumologie, hôpital Calmette, pôle cardiovasculaire et pulmonaire, CHU Lille, 59000 Lille, France
| | - O Ouennoure
- Service d'endoscopie respiratoire, clinique de pneumologie, hôpital Calmette, pôle cardiovasculaire et pulmonaire, CHU Lille, 59000 Lille, France
| | - M-C Copin
- Centre de biologie-pathologie, CHU Lille, 59000 Lille, France
| | - J Assouad
- Service de chirurgie thoracique, hôpital Tenon, CHU, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - M Antoine
- Service d'anatomo-pathologie, hôpital Tenon, CHU, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - J Cadranel
- Service de pneumologie, CHU, AP-HP hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
| | - C Fournier
- Service d'endoscopie respiratoire, clinique de pneumologie, hôpital Calmette, pôle cardiovasculaire et pulmonaire, CHU Lille, 59000 Lille, France
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