PubMed · 13837945
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D E THOMAS. 1960. Bronchoscopy made easy.. https://doi.org/10.1164/arrd.1960.82.1.117
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OBJECTIVE: To demonstrate the diagnostic yield, therapeutic role and safety of flexible bronchoscopy via an intensivist-led service in critically ill children. DESIGN: Retrospective chart review. SETTING: Regional paediatric intensive care unit. MEASUREMENTS AND RESULTS: One hundred forty-eight flexible bronchoscopies were performed by two intensivists on 134 patients (median age 16.5 months) over a 2.5-year period. Eighty-eight percent of patients required mechanical ventilation, and 22% were receiving inotropes. Case mix included general (n = 77), cardiac surgery (n = 18), cardiology (n = 13), ear-nose-and-throat surgery (n = 17), oncology (n = 8) and renal (n = 1). The indication for bronchoscopy was defined a priori according to one of four categories: suspected upper airway disease (n = 32); lower airway disease (n = 70); investigation of pulmonary disease (n = 25); and extubation failure (n = 21). Bronchoscopy was generally performed soon after PICU admission, at a median time of 1.5 days for the former three categories, and 4 days for extubation failure group. A positive yield from bronchoscopy (diagnosis that explained the clinical condition or influenced patient management) was present in 113 of 148 (76%) procedures, varying within groups from 44% (pulmonary disease) to 90% (extubation failure). Ten percent of patients developed a fall in oxygen saturations > 20% during the procedure and 17% required a bolus of at least 10 ml/kg of 0.9% saline for hypotension. CONCLUSIONS: Critically ill patients with respiratory problems may benefit from a PICU-led bronchoscopy service as the yield for positive bronchoscopic finding is high, particularly for upper airway problems or extubation failure.
The aim of this study was to demonstrate the possibilities, advantages and limitations of virtual bronchoscopy using data sets from positron emission tomography (PET) and computed tomography (CT). Twelve consecutive patients with lung cancer underwent PET/CT. PET was performed with F-18-labelled 2-[fluorine-18]-fluoro-2-deoxy-D: -glucose ((18)F-FDG). The tracheobronchial system was segmented with a volume-growing algorithm, using the CT data sets, and visualized with a shaded-surface rendering method. The primary tumours and the lymph node metastases were segmented for virtual CT-bronchoscopy using the CT data set and for virtual PET/CT-bronchoscopy using the PET/CT data set. Virtual CT-bronchoscopy using the low-dose or diagnostic CT facilitates the detection of anatomical/morphological structure changes of the tracheobronchial system. Virtual PET/CT-bronchoscopy was superior to virtual CT-bronchoscopy in the detection of lymph node metastases (P=0.001), because it uses the CT information and the molecular/metabolic information from PET. Virtual PET/CT-bronchoscopy with a transparent colour-coded shaded-surface rendering model is expected to improve the diagnostic accuracy of identification and characterization of malignancies, assessment of tumour staging, differentiation of viable tumour tissue from atelectases and scars, verification of infections, evaluation of therapeutic response and detection of an early stage of recurrence that is not detectable or is misjudged in comparison with virtual CT-bronchoscopy.
Screening studies involving chest x-rays with and without additional sputum cytology, have failed to bring about any reduction in mortality from lung cancer. With regard to all other potential screening methods, no studies investigating tumor-specific mortality are available. Against such a background, none of the relevant societies recommend systematic screening. Sputum cytology is sensitive only for central lesions. Autofluorescence bronchoscopy is limited to the detection of early malignant and premalignant lesions in the central airways. While CT screening detects numerous round foci, only a few of these prove to be carcinomas. In contrast to these findings, we have the positive results of non-controlled screening studies employing low-dose CT, which, however, has not been widely accepted.