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1.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(11): 947-952, 2020 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-33137861

RESUMO

Objective: To explore the clinical characteristics of non-tuberculous mycobacterium(NTM) pulmonary disease complicated with tracheobronchial lesions. Methods: From January 2014 to December 2018, there were 1 006 patients who were admitted to Guangzhou Chest Hospital for the first time and received examination by bronchoscopy. A total of 89 patients with complete data were selected, including 40 males and 49 females, aged 20 to 85 years, with 46 patients (52%) aged 60 years or older. The clinical symptoms and signs of the patients were analyzed with chest imaging, bronchoscopy and pathological examination results. Comparisons between groups were made by Chi-square test and t test. Results: The number of patients with NTM complicated with tracheobronchial lesions accounted for 8.9%(89/1 006) of those hospitalized with NTM and received bronchoscopy during the same period. Clinical symptoms included cough and sputum (89/89), different degrees of hemoptysis or blood sputum (52/89), and shortness of breath (50/89). Chest CT showed that 72 cases (72/89, 81%) had lung lesions involving more than 3 lung fields, and 83 cases (93%) had bronchiectasis and 63 cases (63/89, 71%) with cavities. Pulmonary atelectasis was shown in 45 cases (45/89, 51%). By bronchoscopy, 39 cases (39/89, 44%) were diagnosed as tuberculous lesions involving bilateral upper bronchi, while lesions of the right lower bronchus was found in 27 cases (27/89, 30%).The percentage of patients with multilobar bronchial involvement was 50.6%(45/89). The morphological characteristics of the bronchial lesions included scar stenosis or atresia in 63 cases (63/89, 71%), hyperemia and edema in 46 cases (46/89, 52%), and multiple types of lesions in 48 cases (48/89, 54%). Conclusions: Patients with NTM lung disease complicated with tracheobronchial inflammatory lesions did not have specific manifestations clinically. Lung lesions are extensive, often accompanied by bronchiectasis and cavity formation. Endoscopic changes were mostly manifested as multilobar tracheobronchial involvement characterized by scar stenosis, congestion and edema, mainly involving bilateral upper bronchi and the right lower bronchus.


Assuntos
Brônquios/patologia , Infecções por Mycobacterium não Tuberculosas/patologia , Traqueia/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Brônquios/diagnóstico por imagem , Broncoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Micobactérias não Tuberculosas , Traqueia/diagnóstico por imagem , Adulto Jovem
2.
BMC Pulm Med ; 20(1): 275, 2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33092563

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an ongoing pandemic that profoundly challenges healthcare systems all over the world. Fever, cough and fatigue are the most commonly reported clinical symptoms. CASE PRESENTATION: A 58-year-old man presented at the emergency department with acute onset haemoptysis. On the fifth day after admission, he developed massive haemoptysis. Computed tomography (CT) angiography of the chest revealed alveolar haemorrhage, more prominent in the left lung. Flexible bronchoscopy confirmed bleeding from the left upper lobe, confirmed by a bronchial arteriography, which was successfully embolized. Nasopharyngeal swabs (NPS) tested for SARS-CoV-2 using real-time polymerase chain reaction (RT-PCR) repeatedly returned negative. Surprisingly, SARS-CoV-2 was eventually detected in bronchoalveolar lavage (BAL) fluid. CONCLUSIONS: Life-threatening haemoptysis is an unusual presentation of COVID-19, reflecting alveolar bleeding as a rare but possible complication. This case emphasises the added value of bronchoscopy with BAL in the diagnostic work-up in case of high clinical suspicion and negative serial NPS in patients presenting with severe symptoms.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Hemoptise/virologia , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Doença Aguda , Betacoronavirus , Líquido da Lavagem Broncoalveolar/virologia , Broncoscopia , Angiografia por Tomografia Computadorizada , Hemoptise/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Nasofaringe/virologia , Pandemias
3.
Medicine (Baltimore) ; 99(43): e22772, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120787

RESUMO

Lung cancer is 1 of the leading causes of cancer-related deaths and bronchoscopy is an essential tool for the diagnosis. The diagnostic yield varies based on the characteristics of the lesion and bronchoscopic techniques employed. There is limited data regarding outcomes of patients suspected of thoracic malignancies with a non-diagnostic initial bronchoscopy. The goal of the study was to evaluate the outcomes of patients with a non-diagnostic bronchoscopy for suspected thoracic malignancies and to evaluate variables predictive of a diagnostic bronchoscopy.Retrospective analysis of adult patients at BronxCare Hospital Center who underwent bronchoscopy for suspected thoracic malignancy. The study period was January 2012 to February 2019. Exclusion criteria included patients who underwent only inspection bronchoscopy or bronchoalveolar lavage as the diagnostic yield for malignancy with these techniques is low. All other bronchoscopic procedures were included that is, endobronchial biopsies, transbronchial biopsies, and endobronchial ultrasound guided-transbronchial needle aspiration. Bronchoscopy was considered diagnostic when a specific histopathological diagnosis was established.311 patients underwent bronchoscopy to rule out malignancy. A diagnosis was obtained in 153 (49.2%) patients, 81 (52.9%) had primary lung cancer and 14 (9.15%) other malignancies. 158 (50.8%) patients had initial non-diagnostic bronchoscopy; 86 (54.43%) were lost to follow up. Of the remaining 72 (45.57%) patients, radiological resolution or stability was observed in 51 (70.8%) patients. Primary lung cancer was found in 13 (18.05%) patients and other malignancies in 5 (6.94%). Predictive of a diagnostic bronchoscopy was the performance of endobronchial biopsies and endobronchial ultrasound guided-transbronchial needle aspiration.This study highlights some of the barriers to the timely diagnosis of thoracic malignancies. Following patients with a non-diagnostic procedure as well as all those patients with diagnosed malignancies it of the utmost importance. In patients available for follow up, close to 25% of additional cases with treatable malignancy could be identified and patients diagnosed with cancer could receive timely treatment.


Assuntos
Broncoscopia/estatística & dados numéricos , Neoplasias Torácicas/diagnóstico por imagem , Neoplasias Torácicas/patologia , Idoso , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
4.
Medicine (Baltimore) ; 99(43): e22561, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120743

RESUMO

Although sedation for bronchoscopy improves patient comfort, there is a risk of oversedation in elderly patients. Only a few studies have evaluated the efficacy and safety of sedation for bronchoscopy in elderly patients.This study retrospectively analyzed records of 210 patients who underwent transbronchial brushing and/or biopsy under midazolam sedation at National Hospital Organization Omuta National Hospital between June 2017 and October 2019. Patients were administered 1 mg midazolam following 10 mL 4% lidocaine inhalation. When sedation was insufficient, 0.5 mg midazolam was administered additionally. Diagnostic yield, incidence of complications, amount of oxygen supplementation, decreases in percutaneous oxygen saturation (SpO2), changes in blood pressure, and degree of comfort were analyzed.Patients were divided into the elderly (n = 102) and non-elderly (n = 108) groups. No significant differences were observed in diagnostic yield and procedure time between the 2 groups, and no severe adverse events were noted in the elderly group. The degree of comfort during bronchoscopy was significantly higher in the elderly group. In patients administered < 2 mg midazolam, the amount of oxygen supplementation and decreases in SpO2 were significantly smaller in the elderly group compared to the non-elderly group.The risk of adverse events related to midazolam sedation in bronchoscopy does not increase with age, and sedation improves comfort during flexible bronchoscopy in elderly patients. Moreover, a total dose of midazolam <2 mg is safe for elderly patients undergoing bronchoscopy.


Assuntos
Broncoscopia , Sedação Consciente , Hipnóticos e Sedativos/uso terapêutico , Midazolam/uso terapêutico , Conforto do Paciente , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Oxigênio/sangue , Oxigenoterapia/estatística & dados numéricos , Estudos Retrospectivos
5.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1556-1559, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018289

RESUMO

Because of the significance of bronchial lesions as indicators of early lung cancer and squamous cell carcinoma, a critical need exists for early detection of bronchial lesions. Autofluorescence bronchoscopy (AFB) is a primary modality used for bronchial lesion detection, as it shows high sensitivity to suspicious lesions. The physician, however, must interactively browse a long video stream to locate lesions, making the search exceedingly tedious and error prone. Unfortunately, limited research has explored the use of automated AFB video analysis for efficient lesion detection. We propose a robust automatic AFB analysis approach that distinguishes informative and uninformative AFB video frames in a video. In addition, for the informative frames, we determine the frames containing potential lesions and delineate candidate lesion regions. Our approach draws upon a combination of computer-based image analysis, machine learning, and deep learning. Thus, the analysis of an AFB video stream becomes more tractable. Using patient AFB video, 99.5%/90.2% of test frames were correctly labeled as informative/uninformative by our method versus 99.2%/47.6% by ResNet. In addition, ≥97% of lesion frames were correctly identified, with false positive and false negative rates ≤3%.Clinical relevance-The method makes AFB-based bronchial lesion analysis more efficient, thereby helping to advance the goal of better early lung cancer detection.


Assuntos
Broncoscopia , Neoplasias Pulmonares , Lesões Pré-Cancerosas , Brônquios , Fluorescência , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Lesões Pré-Cancerosas/diagnóstico por imagem
6.
Medicine (Baltimore) ; 99(43): e22942, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120855

RESUMO

RATIONALE: Tracheobronchial amyloidosis (TBA) associated with Sjögren syndrome is very rare. Here, we describe a case with this phenomenon, in order to better understand the condition. PATIENT CONCERNS: A 52-year-old woman presented after 6 months of coughing, sputum, and dyspnea. Chest computed tomography revealed thickened bronchial walls, which were irregular on the left side the trachea. She had a history of dry eye and dry mouth of at least 3 years' duration. DIAGNOSES: Sjögren syndrome was diagnosed based on her symptoms, ophthalmological and parotid examination, and immunological and autoantibody tests. The diagnosis of TBA was confirmed by Congo red staining of a tracheal biopsy. INTERVENTIONS: The patient was given glucocorticoids without any other immunosuppressants. OUTCOMES: The symptoms improved after 6 months. LESSONS: TBA associated with Sjögren syndrome is a rare condition. TBA is characterized by amyloid deposition to the trachea in the absence of systemic amyloidosis. Diagnosis requires tissue biopsy with demonstration of amyloid deposition.


Assuntos
Amiloidose/etiologia , Broncopatias/patologia , Síndrome de Sjogren/complicações , Doenças da Traqueia/patologia , Amiloidose/diagnóstico , Biópsia , Broncoscopia/métodos , Tosse/diagnóstico , Tosse/etiologia , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Pessoa de Meia-Idade , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/tratamento farmacológico , Escarro , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
7.
Anaesth Intensive Care ; 48(5): 354-357, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33016096

RESUMO

The insertion depth of the left-sided double-lumen tube needs careful positioning and bronchoscopic confirmation. Several formulae based on body height have been used for estimating the optimal insertion depth of a left-sided double-lumen tube. We conducted this prospective study to test the hypothesis that our earlier developed height-based formula (0.25 × body height0.916) could predict the accurate insertion depth of a left-sided double-lumen tube. After obtaining ethical approval, 66 patients who underwent thoracic surgery were included. A left-sided double-lumen tube was advanced blindly to the predicted depth of insertion calculated using our formula. The optimal position of the left-sided double-lumen tube was confirmed using a fibreoptic bronchoscope. The primary outcome was the percentage of tubes placed in the optimal position without the need for further adjustments. The secondary outcomes included the need for bronchoscopic adjustments and the final correct insertion depth of the left-sided double-lumen tube. The formula resulted in an optimum position of the left-sided double-lumen tube without further adjustments in 45 patients (70%) (95% confidence interval 58%-80%). The left-sided double-lumen tube was withdrawn or advanced in 18.2% and 12.1%, respectively, to achieve the optimal insertion depth. We found that our formula provided satisfactory positioning in about 70% of patients and that in the remaining patients, the adjustments required to achieve satisfactory positioning under fibreoptic bronchoscope guidance were minimal. Nevertheless, as it is not possible to predict which patients will have a satisfactory tube position, bronchoscopic confirmation for the final positioning is still required.


Assuntos
Intubação Intratraqueal , Procedimentos Cirúrgicos Torácicos , Estatura , Broncoscopia , Humanos , Estudos Prospectivos
8.
J Breath Res ; 14(4): 046013, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33021204

RESUMO

Volatile organic compound (VOC) breath testing of lung and head and neck squamous cell carcinoma (SCC) has been widely studied, however little is known regarding VOC profiles of in-situ SCC. A prospective study of VOC in patients with histologically proven SCC, either in-situ or advanced, and controls. Breath samples were analysed using the E-nose Cyranose ®320 and by gas chromatography/mass spectroscopy. Predictive models were developed using bootstrap forest using all 32 sensors. Data from 55 participants was analysed: 42 SCC cases comprising 20 bronchial (10 in-situ, 10 advanced) and 22 laryngeal (12 in-situ, 10 advanced), and 13 controls. There were 32 (76%) male SCC cases with mean age 63.6 (SD = 9.5) compared with 11 (85%) male controls with mean age 61.9 (SD = 10.1). Predictive models for in situ cases had good sensitivity and specificity compared to controls (overall, 95% and 69%; laryngeal, 100% and 85%; bronchial, 77% and 80%). When distinguishing in-situ and advanced tumours, sensitivity and specificity 82% and 75% respectively. For different tumour types (bronchial versus advanced laryngeal) sensitivity and specificity were 100% and 80% respectively. VOCs isolated from in-situ cancers included some previously demonstrated in advanced cancers and some novel VOCs. In-situ bronchial and laryngeal cancer can be detected by VOC analysis. Distinction from normal controls and between the two tumour types could allow screening in high risk groups for these curable lesions.


Assuntos
Testes Respiratórios/métodos , Neoplasias Brônquicas/diagnóstico , Carcinoma in Situ/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Neoplasias Laríngeas/diagnóstico , Compostos Orgânicos Voláteis/análise , Brônquios/patologia , Broncoscopia , Estudos de Casos e Controles , Feminino , Fluorescência , Cromatografia Gasosa-Espectrometria de Massas , Humanos , Laringe/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
9.
J Breath Res ; 14(4): 046012, 2020 10 06.
Artigo em Inglês | MEDLINE | ID: mdl-33021213

RESUMO

Breath analysis holds promise for non-invasive in vivo monitoring of disease related processes. However, physiological parameters may considerably affect profiles of exhaled volatile organic substances (VOCs). Volatile substances can be released via alveoli, bronchial mucosa or from the upper airways. The aim of this study was the systematic investigation of the influence of different sampling sites in the respiratory tract on VOC concentration profiles by means of a novel experimental setup. After ethical approval, breath samples were collected from 25 patients undergoing bronchoscopy for endobronchial ultrasound or bronchoscopic lung volume reduction from different sites in the airways. All patients had total intravenous anaesthesia under pressure-controlled ventilation. If necessary, respiratory parameters were adjusted to keep PETCO2 = 35-45 mm Hg. 30 ml gas were withdrawn at six sampling sites by means of gastight glass syringes: S1 = Room air, S2 = Inspiration, S3 = Endotracheal tube, S4 = Trachea, S5 = Right B6 segment, S6 = Left B6 segment (S4-S6 through the bronchoscope channel). 10 ml were used for VOC analysis, 20 ml for PCO2 determination. Samples were preconcentrated by solid-phase micro-extraction (SPME) and analysed by gas chromatography-mass spectrometry (GC-MS). PCO2 was determined in a conventional blood gas analyser. Statistically significant differences in substance concentrations for acetone, isoprene, 2-methyl-pentane and n-hexane could be observed between different sampling sites. Increasing substance concentrations were determined for acetone (15.3%), 2-methyl-pentane (11.4%) and n-hexane (19.3%) when passing from distal to proximal sampling sites. In contrast, isoprene concentrations decreased by 9.9% from proximal to more distal sampling sites. Blank bronchoscope measurements did not show any contaminations. Increased substance concentrations in the proximal respiratory tract may be explained through substance excretion from bronchial mucosa while decreased concentrations could result from absorption or reaction processes. Spatial mapping of VOC profiles can provide novel insights into substance specific exhalation kinetics and mechanisms.


Assuntos
Testes Respiratórios/métodos , Broncoscopia , Expiração , Manejo de Espécimes , Compostos Orgânicos Voláteis/análise , Dióxido de Carbono/química , Feminino , Humanos , Limite de Detecção , Pulmão/química , Masculino , Pessoa de Meia-Idade , Pressão Parcial
10.
Medicine (Baltimore) ; 99(42): e22449, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080680

RESUMO

INTRODUCTION: Expiratory central airway collapse is defined by excessive inward bulging of either tracheobronchial posterior membrane or cartilage. The former is called excessive dynamic airway collapse (EDAC), and the latter, depending on the site of collapse, tracheomalacia, bronchomalacia or tracheobronchomalacia. Due to their non-specific symptoms and lack of awareness amongst clinicians they tend to be mislabeled as common obstructive lung disorders, or complicate their course undetected. Particular controversies refer to EDAC sometimes considered just as a symptom of obstructive lung disease and not a separate entity. Nonetheless, a growing body of evidence indicates that EDAC might be present in patients without apparent obstructive lung disease or it might be an independent risk factor in chronic obstructive pulmonary disease or asthma patients. PATIENT CONCERNS: Patient #1 was admitted because of idiopathic chronic cough whereas patient #2 was admitted for differential diagnosis of dyspnea of uncertain etiology. In both patients symptoms were unresponsive to bronchodilators and inhaled corticosteroids. FINDINGS AND DIAGNOSIS: In both patients an excess collapse of tracheobronchial posterior membrane was detected during bronchoscopy; in patient #1, of right main bronchus and right upper lobe bronchus and in patient #2 of right upper lobe bronchus and both main bronchi. Excess central airway collapse in patient #2 was also visualized on expiratory chest CT. In patient #1 spirometry did not reveal obturation, whereas in patient #2 only mild, irreversible, obstruction was revealed, disproportionate to patients significant breathlessness. INTERVENTIONS: Both patients were treated with N-acetylcysteine and adjustable positive expiratory pressure valves. OUTCOMES: Due to aforementioned treatment chronic cough in patient #1 subsided almost completely whereas patient's #2 dyspnea improved significantly. CONCLUSIONS: In presented cases EDAC was an unexpected finding, even though, it firmly corresponded with reported symptoms. Treatment modification led to improvement of patients quality of life.


Assuntos
Traqueobroncomalácia/diagnóstico , Traqueobroncomalácia/terapia , Acetilcisteína/uso terapêutico , Adulto , Idoso , Broncoscopia , Diagnóstico Diferencial , Feminino , Humanos , Respiração com Pressão Positiva/instrumentação , Espirometria , Tomografia Computadorizada por Raios X
11.
Rev Fac Cien Med Univ Nac Cordoba ; 77(3): 187-190, 2020 08 21.
Artigo em Espanhol | MEDLINE | ID: mdl-32991106

RESUMO

Objetivo: Medición de la eficacia y relevamiento de las complicaciones asociadas a la a realización de traqueostomía percutánea (TP) guiada por videobroncoscopia en un hospital universitario de alta complejidad. Materiales y métodos: Estudio observacional retrospectivo realizado entre mayo de 2017 y agosto de 2019. El criterio para la indicación de TP fue desvinculación prolongada de la ventilación mecánica en todos los casos. Incluyó pacientes mayores de 18 años en que se realizó TP electiva guiada por videobroncoscopia. Se registraron variables demográficas, APACHE II y días de ventilación mecánica previos a la TP. La eficacia del procedimiento fue evaluada en base a la tasa de éxito en la ejecución, la necesidad de conversión a técnica abierta. Asimismo, se registraron las complicaciones observadas. Resultados: Se evaluaron 235 procedimientos (149 hombres y 86 mujeres) en pacientes con edad media de 61 años ± 19, un score APACHE II 18 ± 8. La TP pudo ser ejecutada en forma rápida y satisfactoria en todos los pacientes sin requerimiento de conversión a técnica abierta. Se presentaron complicaciones tempranas en el 3,8% (9) de los casos. El sangrado menor fue la complicación más frecuentemente observada en 5 casos (2,1%), hipotensión en 3 casos (1,3%) e hipoxemia transitoria en un caso (0,4%). Asimismo el 2,1% (5) de los casos registró complicaciones tardías. Conclusión: La realización de TP mediante la técnica de dilatador único guiada por videobroncoscopia se describe como un procedimiento efectivo y seguro, que puede realizarse en unidades de cuidados intensivos con baja tasa de complicaciones. Objective: Measurement of the efficacy and complications associated with performing percutaneous tracheostomy (PT) guided by video bronchoscopy. Materials and methods: Retrospective observational study conducted between May 2017 and August 2019. Adult patients who underwent elective PT guided by video bronchoscopy were included. The criteria for the indication of PT was prolonged weaning from mechanical ventilation in all cases. Demographic variables, APACHE II score and days of mechanical ventilation prior to PT were recorded. The efficacy of the procedure was evaluated based on the success rate in the execution, the need for conversion to open technique. Also complications observed were recorded. Results: 235 procedures (149 men and 86 women) were evaluated in patients with an average age of 61 years ± 19 and APACHE II score 18 ± 8. The PT was performed quickly and satisfactorily in all patients without conversion to open technique in any case. Complications occurred in 3.8% (9) of the cases. Minor bleeding was the most frequently observed complication in 5 cases (2.1%), hypotension in 3 cases (1.3%), and transient hypoxemia in one patient (0.4%). Also, 2,1% (5) of the cases presented late complications. Conclusion: Performing PT guided by video bronchoscopy is described as an effective and safe procedure that can be done in intensive care units with a low rate of complications.


Assuntos
Broncoscopia , Traqueostomia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
12.
Pulmonology ; 26(6): 386-397, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32868252

RESUMO

Coronavirus disease 2019 (COVID-19) is an emerging infectious disease caused by a novel SARS-CoV-2 pathogen. Its capacity for human-to-human transmission through respiratory droplets, coupled with a high-level of population mobility, has resulted in a rapid dissemination worldwide. Healthcare workers have been particularly exposed to the risk of infection and represent a significant proportion of COVID-19 cases in the worst affected regions of Europe. Like other open airway procedures or aerosol-generating procedures, bronchoscopy poses a significant risk of spreading contaminated droplets, and medical workers must adapt the procedures to ensure safety of both patients and staff. Several recommendation documents were published at the beginning of the pandemic, but as the situation evolves, our thoughts should not only focus on the present, but should also reflect on how we are going to deal with the presence of the virus in the community until there is a vaccine or specific treatment available. It is in this sense that this document aims to guide interventional pulmonology throughout this period, providing a set of recommendations on how to perform bronchoscopy or pleural procedures safely and efficiently.


Assuntos
Betacoronavirus , Broncoscopia/métodos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Pneumologia/métodos , Aerossóis , Consenso , Surtos de Doenças , Humanos , Portugal , Sociedades
13.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(9): 784-790, 2020 Sep 12.
Artigo em Chinês | MEDLINE | ID: mdl-32894913

RESUMO

Objectives: To evaluate the efficacy of interventional bronchoscopy for the treatment of scarring airway stenosis and to analyze the influencing factors related to the success rate. Methods: Between January 2013 to December 2016, 301 patients with scarring airway stenosis treated by interventional bronchoscopy in 18 tertiary hospitals were reviewed retrospectively. The methods of interventional bronchoscopy included electric knife cutting, laser cauterization, balloon dilation, cryotherapy, local drug usage and/or stenting. Airway stenosis characteristics and patients' performance status at baseline and after interventional bronchoscopy were recorded. The interval days between the first two interventional bronchoscopy treatment (maintained patency time) and the final treatment efficacy were recorded. Results: The clinical stability rate of interventional bronchoscopy for the treatment of scarring tracheal stenosis was 67.8% (204/301) . Stenosis sites (OR 1.548; 95% CI: 1.038-2.307, P=0.032) , dyspnea index (OR 2.140; 95% CI: 1.604-2.855, P<0.001) , and interventional method (OR 0.458; 95% CI: 0.267-0.787, P=0.005) were independent predictors associated with the efficacy of interventional bronchoscopy treatment. Stenosis sites (OR 1.508; 95% CI: 1.273-1.787, P<0.001) , stenosis grade (OR 1.581; 95% CI: 1.029-2.067, P=0.001) , anesthesia method (OR 1.581; 95% CI: 1.029-2.067, P<0.001) , and local drug usage (OR 1.304; 95% CI: 1.135-1.497, P<0.001) were independent predictors associated with the maintained patency time after first interventional bronchoscopy treatment. Conclusion: Interventional bronchoscopy is a useful treatment method for scarring airway stenosis. Enough attention should be paid to influencing factors in order to improve treatment efficacy during the treatment process.


Assuntos
Obstrução das Vias Respiratórias , Broncoscopia , China , Cicatriz , Constrição Patológica , Humanos , Estudos Retrospectivos , Resultado do Tratamento
14.
Kyobu Geka ; 73(9): 704-707, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-32879277

RESUMO

Massive pulmonary hemorrhage, although rare, is a potentially life-threatening complications during heart surgery. We herein present 1 such case successfully treated by selective bronchial occlusion using an Endobronchial Watanabe Spigot (EWS). The 82-year-old female underwent mitral valve replacement, tricuspid annuloplasty, and maze procedure. An hour and a half after cessation of cardiopulmonary bypass, the patient suffered a massive pulmonary hemorrhage. A subsequent bronchoscopy identified the hemorrhage site at the right middle lobe bronchus (B5b), and an EWS was then selectively deployed into this bronchus to block the hemorrhage. The following day, bronchial arterial embolization was performed, enabling the removal of the spigot on the next day. The patient's respiratory condition gradually improved, allowing for extubation on the 21st postoperative day. By preventing bleeding into neighboring bronchi, which, in turn, avoids the risk of exacerbating hypoxia, bronchial occlusion with EWSs is highly effective in managing massive pulmonary hemorrhage during heart surgery.


Assuntos
Broncopatias , Procedimentos Cirúrgicos Cardíacos , Idoso de 80 Anos ou mais , Brônquios , Broncoscopia , Feminino , Hemorragia , Humanos , Recém-Nascido
15.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 1013-1015, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32912420

RESUMO

OBJECTIVE: To explore the clinical effect of ultrasound evaluation of fiberoptic bronchoscope (FB) guided tracheotomy, which can provide help for difficult tracheotomy and new operators. METHODS: The operating protocol was standardized for ultrasound evaluation of FB guided tracheotomy. Ten patients with difficult tracheotomy admitted to the department of critical care medicine of Donge Hospital from October 2019 to January 2020 were enrolled. According to this protocol, FB guided tracheotomy was performed under the ultrasound evaluation, and the amount of blood loss, operation time and related complications during procedures were collected. RESULTS: The preparation of supplies, personnel, patients and the operation, the process of FB guided tracheotomy under the ultrasound evaluation were standardized. When tracheotomy was preformed for patients with difficult tracheotomy, it was necessary to use ultrasound first to evaluate the neck condition and vascular disorientation of patients, and the tracheotomy plan (tracheotomy site, incision size, and incision depth) was designed, and then the tracheotomy process was monitored under the guidance of FB. Among the 10 patients with difficult tracheotomy, 6 were male and 4 were female; body mass index was (32.2±1.4) kg/m2. Tracheotomy was successfully completed within 10 minutes in all the 10 patients, with less than 5 mL blood loss, and no complications occurred. CONCLUSIONS: Ultrasound evaluation of FB guided tracheotomy can improve the clinical operations and ensure patient safety.


Assuntos
Broncoscópios , Traqueotomia , Broncoscopia , Feminino , Humanos , Masculino , Traqueostomia , Ultrassonografia
16.
J Otolaryngol Head Neck Surg ; 49(1): 66, 2020 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928308

RESUMO

We present the case of an eight year old boy who presented with foreign body aspiration during the COVID-19 pandemic. The patient was taken the operating room for rigid bronchoscopy and foreign body removal. The details of the operation, steps taken for protection of health care workers, and lessons learned are discussed. Bronchoscopy was performed using N95 respirators and Stryker Flyte Hood garments, combined with a streamlined instrument set-up. Simulation in advance of these cases improves communication and operative planning. Surgeons should have equipment to retrieve foreign bodies from the oropharynx available. Techniques that reduce surgical time and thus exposure risk should be considered.


Assuntos
Betacoronavirus , Brônquios , Broncoscopia/métodos , Infecções por Coronavirus/complicações , Corpos Estranhos/cirurgia , Pandemias , Pneumonia Viral/complicações , Broncoscópios , Criança , Infecções por Coronavirus/epidemiologia , Desenho de Equipamento , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico , Humanos , Masculino , Pneumonia Viral/epidemiologia , Radiografia
17.
Adv Ther ; 37(11): 4538-4548, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32944885

RESUMO

The coronavirus disease (COVID-19) pandemic has highlighted the importance of reducing occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The reprocessing procedure for reusable flexible bronchoscopes (RFBs) involves multiple episodes of handling of equipment that has been used during an aerosol-generating procedure and thus is a potential source of transmission. Single-use flexible bronchoscopes (SUFBs) eliminate this source. Additionally, RFBs pose a risk of nosocomial infection transmission between patients with the identification of human proteins, deoxyribonucleic acid (DNA) and pathogenic organisms on fully reprocessed bronchoscopes despite full adherence to the guidelines. Bronchoscopy units have been hugely impacted by the pandemic with restructuring of pre- and post-operative areas, altered patient protocols and the reassessment of air exchange and cleaning procedures. SUFBs can be incorporated into these protocols as a means of improving occupational safety. Most studies on the efficacy of SUFBs have occurred in an anaesthetic setting so it remains to be seen whether they will perform to an acceptable standard in complex respiratory procedures such as transbronchial biopsies and cryotherapy. Here, we outline their potential uses in a respiratory setting, both during and after the current pandemic.


Assuntos
Broncoscópios/tendências , Broncoscopia/tendências , Infecções por Coronavirus/diagnóstico , Contaminação de Equipamentos/prevenção & controle , Pneumonia Viral/diagnóstico , Betacoronavirus , Equipamentos Descartáveis , Humanos , Técnicas Microbiológicas/tendências , Pandemias
18.
PLoS One ; 15(9): e0239114, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32956379

RESUMO

BACKGROUND: In recent years, transbronchial cryobiopsy (TBCB) has come to be increasingly used in interventional pulmonology units as it obtains larger and better-quality samples than conventional transbronchial lung biopsy (TBLB) with forceps. No multicenter studies have been performed, however, that analyse and compare TBCB and TBLB safety and yield according to the interstitial lung disease (ILD) classification. OBJECTIVES: We compared the diagnostic yield and safety of TBCB with cryoprobe sampling versus conventional TBLB forceps sampling in the same patient. METHOD: Prospective multicenter clinical study of patients with ILD indicated for lung biopsy. Airway management with orotracheal tube, laryngeal mask and rigid bronchoscope was according to the protocol of each centre. All procedures were performed using fluoroscopy and an occlusion balloon. TBLB was followed by TBCB. Complications were recorded after both TBLB and TBCB. RESULTS: Included were 124 patients from 10 hospitals. Airway management was orotracheal intubation in 74% of cases. Diagnostic yield according to multidisciplinary committee results for TBCB was 47.6% and for TBLB was 19.4% (p<0.0001). Diagnostic yield was higher for TBCB compared to TBLB for two groups: idiopathic interstitial pneumonias (IIPs) and ILD of known cause or association (OR 2.5; 95% CI: 1.4-4.2 and OR 5.8; 95% CI: 2.3-14.3, respectively). Grade 3 (moderate) bleeding after TBCB occurred in 6.5% of patients compared to 0.8% after conventional TBLB. CONCLUSIONS: Diagnostic yield for TBCB was higher than for TBLB, especially for two disease groups: IIPs and ILD of known cause or association. The increased risk of bleeding associated with TBCB confirms the need for safe airway management and prophylactic occlusion-balloon use. TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT02464592.


Assuntos
Broncoscopia/instrumentação , Criocirurgia/instrumentação , Fluoroscopia/instrumentação , Doenças Pulmonares Intersticiais/diagnóstico , Hemorragia Pós-Operatória/epidemiologia , Idoso , Biópsia/efeitos adversos , Biópsia/instrumentação , Biópsia/métodos , Broncoscopia/efeitos adversos , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Criocirurgia/efeitos adversos , Criocirurgia/métodos , Feminino , Fluoroscopia/efeitos adversos , Fluoroscopia/métodos , Humanos , Pulmão/patologia , Doenças Pulmonares Intersticiais/patologia , Masculino , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/etiologia , Estudos Prospectivos
19.
BMC Pulm Med ; 20(1): 243, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917185

RESUMO

BACKGROUND: Factors affecting the safety of bronchoscopy in patients with malignant hematologic disorders have not been well described. We evaluated the safety of bronchoscopy and describe factors affecting its complication rate in such patients. METHODS: Between January 2009 and December 2018, 316 bronchoscopies in 282 patients with malignant hematologic disorders and pulmonary infiltrates were performed at our institution. The bronchoscopic procedure used and its complications were evaluated. RESULTS: The most common underlying disease was acute myeloid leukemia (134/282 patients, 47.5%). Platelet transfusion was performed the day before or the day of bronchoscopy in 42.4%, supplemental oxygen was administered before the procedure in 23.1%, and midazolam was used in 74.4%. Thirty-five bronchoscopies (11.1%) were complicated by hemoptysis and 7 patients developed pneumothorax, 4 of whom required thoracic drainage. Two patients (0.6%) were intubated within 48 h of the procedure and prolonged oxygen desaturation (> 48 h) occurred in 3.8%. Multivariate analysis showed that only use of midazolam significantly reduced the risk of prolonged oxygen desaturation (hazard ratio 0.28, 95% confidence interval 0.09-0.85, p = 0.03). Transbronchial lung biopsy significantly increased the risk of hemoptysis (hazard ratio 10.40, 95% confidence interval 4.18-25.90, p = 0.00), while use of midazolam significantly reduced the risk (hazard ratio 0.31, 95% confidence interval 0.14-0.73, p = 0.01). CONCLUSIONS: Bronchoscopy is relatively safe in patients with malignant hematologic disorders. Caution and judicious use of sedatives may improve the patient's procedural tolerance and lower complications.


Assuntos
Broncoscopia/efeitos adversos , Neoplasias Hematológicas/complicações , Complicações Pós-Operatórias/etiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
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