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PubMed1992

Fibreoptic bronchoscopy in the critically ill: a prospective study of its diagnostic and therapeutic value.

AIM: A prospective study was undertaken to assess the diagnostic value and therapeutic usefulness of fibreoptic bronchoscopy in the critically ill. METHOD: Fifty-six bronchoscopies were performed in fifty patients. Biochemical, radiological, microbiological and clinical assessments were made before and after each procedure. RESULTS: Eighteen fibreoptic bronchoscopies were performed for therapeutic indications (32.1%) of which ten (55.6%) yielded a useful outcome. Thirty-eight bronchoscopies were for diagnostic purposes (67.8%) of which 22 (57.9%) were clinically useful. Broncho-alveolar lavage was performed in twenty-eight cases (50%) and it led to a clinically useful diagnosis in 17 (60.7%). There was no major complication. A subgroup of patients was defined (persistent left lower lobe collapse or consolidation following thoracic or abdominal surgery) in whom fibreoptic bronchoscopy usually did not yield a useful outcome. CONCLUSION: The use of fibreoptic bronchoscopy in the Intensive Care Unit, in combination with the technique of broncho-alveolar lavage, results in a clinically useful outcome in the majority of cases. Fibreoptic bronchoscopy is an effective and safe diagnostic and therapeutic tool in critically ill patients.

Adolescent↗

PubMed2003

Rigid bronchoscopy induces bacterial translocation: an experimental study in rats.

Bronchoscopy has the potential to propagate infections. Bacterial translocation was hypothesised to be the cause of infections observed following bronchoscopy and this study was designed to assess the risk of bacterial translocation following rigid bronchoscopy in rats. A total of 30 rats were evaluated. The study group (n=15) underwent rigid bronchoscopy. Arterial blood gas analysis was performed in all rats. Blood and tissue cultures from the ileum, caecum, mesenteric lymph nodes, liver, spleen, mediastinal lymph nodes and lung were obtained 24 h following bronchoscopy. Bacterial translocation to the mesenteric lymph nodes was found in seven of 15 rats (46.7%) that underwent bronchoscopy, compared with none of the controls. Of the seven positives, three rats (42.8%) also demonstrated other organ involvement, such as the liver and spleen. Escherichia coli, Salmonella typhymirium, S. enteritidis and Pseudomonas spp. were found as translocating bacteria. In the study group, pH and arterial oxygen tension were significantly lower and arterial carbon dioxide tension was higher, compared with controls. This study shows that rigid bronchoscopy may induce bacterial translocation in rats. Further investigations aimed at understanding the clinical consequences of this phenomenon are warranted.

Animals↗

PubMed1996

Cost-effectiveness of collecting routine cytologic specimens during fiberoptic bronchoscopy for endoscopically visible lung tumor.

STUDY OBJECTIVE: Fiberoptic bronchoscopy is the most common modality used to diagnose endobronchial carcinoma. Collection of brushing and washing specimens for cytology is common during bronchoscopy for endobronchial abnormality, but it is unknown if collection of these specimens is cost-effective. DESIGN: Retrospective review of a computerized database with cost-effectiveness analysis. SETTING: Tertiary care medical center. PATIENTS: Two hundred one patients undergoing bronchoscopy for endobronchial lung tumor. INTERVENTION: All patients in the study underwent fiberoptic bronchoscopy that included forceps biopsies, washings, and brushings. In addition to analyzing the sensitivity of forceps-biopsy, washings, and brushings at diagnosing malignancy, we analyzed the cost-effectiveness of three potential specimen collection strategies. These strategies were (1) collection of both washings and brushings in addition to forceps biopsy specimen, (2) collection of either washings or brushings in addition to forceps biopsy specimen, and (3) collection of forceps biopsy specimen only. MEASUREMENTS AND RESULTS: The sensitivity of bronchoscopy, including biopsy, washing, and brushing is 85.3% (95% confidence interval [CI], 80.1 to 90.5%). The sensitivity of forceps biopsy is 80.8% (95% CI, 75.0 to 86.6%). The addition of washings and brushings increases the sensitivity of bronchoscopy from 80.8 to 85.3% (McNemar's p = 0.01). Cost-effectiveness analysis reveals that forceps biopsy plus washing or brushing has a marginal cost-effectiveness ratio of $308 per reduced-quality day avoided compared with forceps alone. Adding an additional cytology specimen has a marginal cost-effectiveness ratio of $5,500 per reduced-quality day avoided. CONCLUSIONS: There is a modest but definite increase in the sensitivity of bronchoscopy in diagnosing endobronchial cancer with the addition of washings and brushings for cytology. Cost-effectiveness analysis reveals that collection of either washings or brushings is probably the best strategy.

Bronchoscopy↗

PubMed2003

Diagnostic accuracy and safety of flexible bronchoscopy with multiplanar reconstruction images and ultrafast Papanicolaou stain: evaluating solitary pulmonary nodules.

STUDY OBJECTIVES: To assess the diagnostic accuracy and safety of flexible bronchoscopy with multiplanar reconstruction (MPR) images and ultrafast Papanicolaou (UFP) stain in evaluating solitary pulmonary nodules (SPNs). DESIGN: Prospective study of bronchoscopies performed between June 2000 and June 2002. PATIENTS: One hundred consecutive patients with SPNs underwent bronchoscopy with MPR and UFP (MPR and UFP group). The data on historical control were collected in a retrospective fashion, between July 1997 and June 2000. METHOD: All information obtained from MPR regarding the leading bronchus of the SPNs was used to guide biopsy. Samples obtained by curette biopsies were stained with UFP and evaluated by a cytopathologist during the bronchoscopy procedure. RESULTS: There were 88 malignant and 12 benign lesions in the MPR and UFP group, and 97 malignant and 3 benign lesions in the historical control group. The total diagnostic accuracy of bronchoscopy in the MPR and UFP group (91%) was significantly higher compared with the historical control group (58%) [p < 0.05]. Although the yield of bronchoscopy was significantly related to the lesion size in the historical control group (p < 0.05), there was no significant association between the diagnostic yield and lesion size in the MPR and UFP group. The diagnostic yield for SPNs < 4.0 cm in the MPR and UFP group was significantly higher compared with the historical control group (p < 0.05). In addition, the diagnostic yield in both upper lobes in the MPR and UFP group was significantly higher compared with the historical control group (p < 0.05). On the contrary, the complication rate was significantly lower in the MPR and UFP group (2%) compared with the historical control group (13%) [p < 0.05]. CONCLUSION: Combined use of the MPR image and UFP during flexible bronchoscopy improved diagnostic accuracy and safety in evaluating SPNs using a double-hinged curette.

Adult↗

PubMed2004

Grading airway stenosis down to the segmental level using virtual bronchoscopy.

OBJECTIVE: To assess the sensitivity of noninvasive virtual bronchoscopy based on multirow detector CT scanning in detecting and grading central and segmental airway stenosis using flexible bronchoscopic findings as the reference standard. MATERIALS AND METHODS: In a blinded controlled trial, multirow detector CT virtual bronchoscopy and flexible bronchoscopy were used to search for and grade airway stenosis in 20 patients. CT scan data were obtained with a multirow detector CT scanner using 4 x 1 mm collimation. Flexible bronchoscopy findings were graded by a pulmonologist and served as the reference standard for 176 central airway regions (ie, trachea, main bronchi, and lobar bronchi) and 302 segmental airway regions. The extent of airway narrowing was categorized as grade 0 (no narrowing), grade 1 (< 50%), or grade 2 (> or =50%). RESULTS: Flexible bronchoscopy revealed 30 stenoses in the central airways and 10 in the segmental airways. Virtual bronchoscopy detected 32 stenoses in the central airways (sensitivity, 90.0%; specificity, 96.6%; accuracy, 95.5%) and 22 in the segmental airways (sensitivity, 90.0%; specificity, 95.6%; accuracy, 95.5%). The number of false-positive findings was higher in the segmental airways (13 false-positive findings) than in the central airways (5 false-positive findings), which caused a lower positive predictive value for the segmental airways (40.9%) than for the central airways (84.4%). Flexible and virtual bronchoscopic gradings correlated better for central airway stenosis (r = 0.87) than for segmental airway stenosis (r = 0.61). CONCLUSION: Although a high sensitivity was found for the detection of both central and segmental airway stenosis, the number of false-positive findings was higher for segmental airways. However, noninvasive multirow detector CT virtual bronchoscopy enables high-resolution endoluminal imaging of the airways down to the segmental bronchi.

Aged↗

PubMed1981

Modification of the effect of fiberoptic bronchoscopy on pulmonary mechanics.

Thirty-three patients who were to undergo diagnostic fiberoptic bronchoscopy were studied. Pulmonary function tests were performed before the procedure, after topical lidocaine anesthesia, and immediately and four hours after bronchoscopy. Nine patients received aerosolized isoproterenol (Isuprel) before the topical anesthesia, and nine received aerosolized atropine. Pulmonary function tests were also performed after this intervention. In those patients receiving no premedication, all the indices of expiratory flow were reduced significantly immediately after bronchoscopy, and after the topical anesthesia, the FEV1 and FVC were significantly reduced. In the atropine groups, the FVC and FEV1 increased significantly after atropine, and increased still further following topical lidocaine anesthesia. By four hours after bronchoscopy, however, the midmaximal expiratory flow ws significantly reduced. In the isoproterenol group, only the FEV1 was significantly improved by the drug, and this improvement persisted even after the lidocaine. It decreased transiently immediately after bronchoscopy, but by four hours, was significantly above baseline again. The FVC diminished significantly immediately after bronchoscopy. It is concluded that fiberoptic bronchoscopy deleteriously affects pulmonary function and that inhaled isoproterenol or atropine largely protects against these deleterious effects.

Adult↗

PubMed1988

Utility of fiberoptic bronchoscopy in patients with hemoptysis and a nonlocalizing chest roentgenogram.

The need for fiberoptic bronchoscopy in the patient with hemoptysis and a normal or nonlocalizing chest roentgenogram remains a subject of debate. Currently, diagnostic fiberoptic bronchoscopy is recommended as the investigative procedure of choice. To develop predictors that identify the patient in whom fiberoptic bronchoscopy is most likely to be diagnostic, we reviewed our community's experience with this population over a five-year period. We identified 196 patients with hemoptysis and a normal or nonlocalizing chest roentgenogram who underwent fiberoptic bronchoscopy. Three quarters were active or previous smokers. We examined the relationship of advancing age, sex, smoking, nonspecific roentgenographic findings and the amount, duration, and previous bouts of hemoptysis to the incidence of a diagnostic fiberoptic bronchoscopy. Twelve patients (6 percent) had bronchogenic carcinoma and 33 (17 percent) another specific cause for the hemoptysis identified by fiberoptic bronchoscopy. By univariate and discriminant analyses, we found that the three factors of age of 50 years or more, male sex, and smoking of 40 pack-years or more best predicted a diagnosis of malignancy. Bleeding in excess of 30 ml daily was associated with an increase in overall diagnostic yield. The presence of two of the three factors associated with malignancy or bleeding in excess of 30 ml daily (or both) identified 100 percent of the patients with bronchogenic carcinoma and 82 percent of all of the diagnostic fiberoptic bronchoscopic procedures. use of these criteria in selecting the patient for fiberoptic bronchoscopy could have reduced our use of the bronchoscope by 28 percent, with the remaining patients safely observed.

Adolescent↗

PubMed2004

Low-dose MDCT and virtual bronchoscopy in pediatric patients with foreign body aspiration.

OBJECTIVE: The purpose of this study was to investigate the potential use of low-tube-current MDCT virtual bronchoscopy for the evaluation of children with suspected foreign body aspiration. SUBJECTS AND METHODS: Low-tube-current MDCT was performed in 23 patients (10 girls, 13 boys) with a mean age of 3.3 years (9 months-13 years) with suspicion of foreign body aspiration. Chest radiographs were obtained before CT was performed. MDCT was performed using 25- to 50-mA tube currents. MDCT virtual bronchoscopy images were obtained. Neither sedation nor IV contrast medium was used during CT scanning. All patients underwent endoscopic evaluation within 24 hr after MDCT was performed. MDCT virtual bronchoscopy findings were retrospectively compared with the results of rigid bronchoscopy. RESULTS: The mean tube current was 35 mA (range, 25-50 mA). Imaging quality was excellent in nine studies (39%), good in 12 studies (52%), and poor in two studies (9%). Motion artifacts were present on several slices in five examinations. In 15 patients, all foreign bodies detected by conventional bronchoscopy were also revealed on MDCT virtual bronchoscopy. The foreign body was in the right main bronchus in six patients, in the bronchus intermedius in one patient, and in the left main bronchus in eight patients. No discordance was found between the two techniques. MDCT revealed hyperaeration of the ipsilateral lung in five patients, atelectasis in five patients, infiltration in three patients, and infiltration and bronchiectasis in two patients; it showed infiltration in four patients and atelectasis in one of eight patients without a foreign body detected. There were no abnormal findings in three patients. CONCLUSION: Evaluation of foreign body aspiration of the airway in children can be accomplished by using a low-tube-current MDCT protocol. It may be useful both in showing the exact location of a foreign body before bronchoscopy and in ruling out a foreign body in patients with a low level of suspicion and normal or nonspecific findings on chest radiography.

Artifacts↗

PubMedDate not supplied

Complications of bronchoscopy for foreign body removal: experience in 1,035 cases.

BACKGROUND: Tracheobronchial foreign body aspirations, which threaten lives in childhood, also carry potential risks during and after bronchoscopy. The aim of this study is to review complications and precautions that need to be taken against possible risks. METHODS: From 1987 to 2005, bronchoscopy was done in 1,035 children in our department on suspicion of foreign body aspiration. The average age of these patients, mostly male (55%), was 4.1 years. Medical history, physical examination, radiological methods and bronchoscopy were used in the diagnosis. Bronchoscopy was applied under general anaesthesia, and the respiratory and cardiac systems were closely observed for 4 hours after the process. RESULTS: Nine hundred eleven of 1,035 patients (88%) had a foreign body in the tracheobronchial system. In 42 of the patients, infection required aggressive medication; in 30, hypoxia and bradycardia occurred as a result of obstruction during bronchoscopy; in 37, laryngeal edema, laryngeal spasm and/or bronchospasm required ventilation support; in 6 patients, tracheobronchial system bleeding occurred; in 2 patients pneumothorax occurred, in 1 patient pneumomediastinum was observed and 6 patients needed thoracotomies because of foreign body aspiration. In this series there were 8 deaths. CONCLUSION: Bronchoscopy, performed for tracheobronchial foreign body aspiration, carries a potential life-threatening risk during and after the process. The clinician needs to be aware of these risks, take proper precautions, and perform bronchoscopy by taking the medical condition of the patient and characteristics of the inspired foreign body into consideration.

Adolescent↗

PubMed1992

A potential new technique for awake fibreoptic bronchoscopy--use of the laryngeal mask airway.

OBJECTIVE: To assess the potential use of the laryngeal mask airway (LMA) for awake diagnostic fibreoptic bronchoscopy. DESIGN: A prospective study of 50 patients presenting for awake diagnostic bronchoscopy. All patients were premedicated with pethidine and atropine. The LMA was inserted under topical anaesthesia with sedation and the quality of the subsequent laryngoscopy and bronchoscopy was assessed for both patient and bronchoscopist. SETTING AND PATIENTS: All patients over the age of 18 years who presented to Cairns Base Hospital for diagnostic bronchoscopy were asked to participate in the study. MAIN OUTCOME MEASURES: The main factors determining the suitability of the technique were insertion rate, ease of the laryngoscopy and bronchoscopy, oxygen saturation and patient acceptance. RESULTS: The LMA was inserted successfully in all patients and the bronchoscopy subsequently performed. The first time insertion rate was 72%. The mean oxygen saturation during the procedure was 98% and patients tolerated the technique. CONCLUSIONS: The potential advantages of the LMA are that it is simple to insert, avoids nasal trauma and facilitates direct laryngoscopy. It allows respiration to be monitored and oxygen to be administered. The technique may have a role to play in patients whose respiratory function is in a critical condition, but confirmation of this awaits comparative trials. A period of training is recommended in anaesthetised patients before the LMA is used for awake diagnostic bronchoscopy.

Anesthesia, Local↗

PubMed2000

[Endoscopic approach to pulmonary diseases: Bronchoscopy for critical respiratory care in neonates, infants, and children].

Of the 605 pediatric patients admitted to our intensive care unit during the past 6 years, 90 underwent 380 bronchoscopies for diagnostic and therapeutic purposes. The indications for bronchoscopy were atelectasis/retention of airway secretion (n = 52), pneumonia (n = 31), airway bleeding (n = 14), pulmonary edema (n = 11), tracheobronchomalacia/airway stenosis (n = 11), and airway foreign body/aspiration (n = 7). Visualization of the airway was helpful for the diagnosis of respiratory problems; in 9 infants, bronchoscopy revealed tracheobronchial stenosis which other diagnostic modalities failed to detect. In 25 of the 31 patients with pneumonia, specimens taken by bronchoscopy were positive for specific pathogens. Bronchoscopy also proved to have significant therapeutic value, especially for airway cleaning; bronchial suctioning resulted in immediate reexpansion of the collapsed lung in 25 of 34 cases of physiotherapy-resistant atelectasis. A rigid bronchoscope was used to remove airway foreign body in 2 cases. Prototype channeled-ultrathin fiberscopes were utilized in 99 of 380 bronchoscopies. No complications were noted except for severe hypoxia and bradycardia in one infant. We conclude that bronchoscopy is a safe and useful modality for the critical respiratory care of infants and children.

Adolescent↗

PubMed1999

Fibreoptic bronchoscopy in the diagnosis of lung cancer.

A total of 562 patients with lung cancer was evaluated by fibreoptic bronchoscopy (FOB) by three bronchoscopic diagnostic procedures: biopsy, bronchial brushing and bronchial washing. Endoscopically visible tumours (EV) were detected in 264, while 257 had endoscopically nonvisible tumours > or = 2 cm in diameter and FOB was done without fluoroscopy because of limited availability (ENV). Forty-one had small (< 2 cm), endoscopically nonvisible tumours with FOB performed under uniplanar fluoroscopy (ENV + F). The overall diagnostic yield rates of FOB were 98.1%, 61.5% and 58.5% for the EV, ENV and ENV + F cases, respectively. Reviewing the differential yield rates of the three diagnostic techniques and comparing them with the results of previous studies led to the following conclusions. (1) Combinations of biopsy with brushing and biopsy with washing can diagnose more than 95% of all fibreoptic bronchoscopy positive cases with endoscopically visible tumours. Performing either of these combinations may be more cost-effective than doing all three techniques routinely. (2) For cases with endoscopically nonvisible tumours, performance of all three diagnostic techniques is recommended, especially when fibreoptic bronchoscopy is performed without fluoroscopic guidance, as washing and brushing seem to compensate for a lower yield of the biopsy. (3) For tumours < 2 cm in diameter, knowledge on the diagnostic efficacy of fibreoptic bronchoscopy was limited owing to the small size of previous studies. The yield of 58.5% for fibreoptic bronchoscopy in these patients with performance of all three diagnostic procedures was comparatively high. It could be further increased to 75.6% if supplemented by percutaneous needle biopsy when fibreoptic bronchoscopy turned out to be nondiagnostic. If available, the use of transbronchial needle aspiration may also increase the overall diagnostic yield of fibreoptic bronchoscopy in these cases.

Biopsy↗

PubMed2006

[The role of fiberoptic bronchoscopy in the diagnostic algorithm of solitary pulmonary nodule].

The role of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodule is controversial. The aim of the study was to evaluate the results of routine bronchoscopy performed in patients with peripheral lung nodule of 5-40 mm in diameter. From 60 patients with peripheral lung nodule, who underwent routine diagnostic fiberoptic bronchoscopy between 2003 - 2005, we selected 36 patients in whom the final discrimination between malignant and benign tumor was achieved based on either pathological examination or radiological criteria (lack of growth within 2 years of radiological follow up). There were 22 (61%) patients with malignant tumor and 14 (39%) with benign nodule. All malignant tumors were lung carcinomas. In 10 of these patients we found macroscopic abnormalities during bronchoscopy and in 9 of them pathologic examination of specimens collected during the procedure could confirm malignant tissue. In two patients with benign lung nodule a second lung lesion (in different lung lobe) which proved to be lung cancer was identified during fiberoptic bronchoscopy. Sensitivity, specificity and diagnostic accuracy of fiberoptic bronchoscopy in the diagnosis of peripheral lung nodules were 41%, 100%, and 64% respectively. Abandoning fiberoptic bronchoscopy in the diagnostic algorithm in patients with peripheral lung nodules seems unjustified, although its limitations should be taken into account.

Adolescent↗

PubMed1990

A pseudoepidemic of Sporothrix cyanescens pneumonia occurring during renovation of a bronchoscopy suite.

Sporothrix cyanescens, an uncommonly isolated mold, was cultured from biopsy tissue, bronchial washings and sputum obtained at bronchoscopy from four patients during a one-month period. These patients had undergone fiberoptic bronchoscopy to aid in the diagnosis of pneumonic infiltrates. During this period of time the bronchoscopy suite was being extensively renovated. Cultures of bronchoscopes, biopsy forceps and effluents from the bronchoscopy injection ports were negative for fungi, as were all environmental samples taken from the bronchoscopy suite. Known pulmonary pathogens were eventually isolated from two of the patients and the pneumonias resolved in all four patients. It is believed that bronchoscopy material was contaminated by dust created during modernization of the bronchoscopy suite and that the four isolates represent a unique pseudoepidemic of S. cyanescens pneumonia.

Aged↗

PubMed1994

Anticholinergic premedication for fibreoptic bronchoscopy.

Atropine is routinely used as part of the premedication regimen for fibreoptic bronchoscopy. This study was performed, firstly, to evaluate the effect of anticholinergic agents on the ease of bronchoscopy, haemodynamic parameters and patient comfort during the procedure; and secondly, to compare atropine with glycopyrrolate, a newer acetylcholine antagonist which is claimed to cause less tachycardia and sedation, whilst suppressing salivation more effectively. One hundred and ninety consecutive patients were randomly allocated to three treatment groups: diazepam 5 mg; diazepam 5 mg + atropine 600 micrograms; and diazepam 5 mg + glycopyrrolate 300 micrograms. Diazepam was given orally one hour before bronchoscopy, and glycopyrrolate/atropine intramuscularly 30 min before bronchoscopy. All patients received thalamonal intravenously, lignocaine gel into one nostril, and lignocaine by transtracheal injection just prior to the procedure. The incidence of bronchoscopy related haemodynamic problems was similar in all three groups. Troublesome coughing, as observed by the operator, was less frequent with glycopyrrolate (control 51%, atropine 42%, glycopyrrolate 30%), as was patient movement (40%, 32%, 19%, respectively). Uncomfortable dryness of the mouth was most common with glycopyrrolate (37%, 32%, 66%, respectively), but overall assessment of discomfort, and the number of patients who would agree to a repeat bronchoscopy (73%, 76%, 70%, respectively) were very similar in all three groups. In conclusion, the differences between the three groups were slight. Glycopyrrolate made the bronchoscopy slightly easier for the operator because of significantly improved cough and movement suppression, though atropine was marginally preferable in terms of patient comfort.

Administration, Oral↗

PubMed1998

Neonatal/infant rigid bronchoscopy.

OBJECTIVE: The neonatal intensive care unit (NICU) of the Montreal Children's Hospital (MCH) has averaged 358 admissions/ year over the past 10 years. Over the same period, 1.8% of these admissions have required rigid bronchoscopy in either the neonatal or infant time period: 175 rigid bronchoscopies were performed on 76 patients since 1977. METHOD: We retrospectively reviewed the findings at first bronchoscopy. Our cases were analyzed regarding indication for bronchoscopy, primary airway pathology, concomitant secondary airway pathology, management, outcome, and overall prognosis. RESULTS: Normal bronchoscopic findings were seen in 25% of cases. The remaining 75% revealed pathology in sites ranging from the oropharynx to the bronchus. The majority were subglottic (15), esophageal atresia/tracheoesophageal fistula (14), and glottic (11). There was concurrent airway pathology in 41% of the cases, ranging from 0% in the bronchial group to 75% in the oral/pharyngeal group. Thirty three percent of patients with a secondary airway pathology identified required further airway intervention, either therapeutic bronchoscopy at the same time or later airway surgery. There were no major complications from rigid bronchoscopy in our series. The mortality due to airway pathology was highest in the supraglottic/ glottic group (36%). CONCLUSION: Rigid bronchoscopy performed in the neonatal/infant period is safe. The primary and concomitant secondary diagnosis are high (75% and 41%, respectively), while both may require further airway intervention. Finally, it directs early management of these cases for better prognosis.

Bronchoscopes↗

PubMed2004

Yield of surveillance bronchoscopy for acute rejection and lymphocytic bronchitis/bronchiolitis after lung transplantation.

BACKGROUND: Better understanding of the timing and pattern of surveillance bronchoscopy findings after lung transplantation could influence the timing and frequency of surveillance bronchoscopy. We present our surveillance bronchoscopy experience and test the hypothesis that patients not encountering early acute rejection or lymphocytic bronchitis/bronchiolitis are less likely to have subsequent occult occurrences in the 1st year after lung transplantation. METHODS: We conducted a retrospective study of 204 patients who underword transplantation between 1996 and 2000. Based on contemporary biopsy-specimen grading in the first 100 days, we formed 2 groups: No Early Rejection and Early Rejection. We compared subsequent yields of surveillance bronchoscopy and the incidence of acute rejection or of lymphocytic bronchitis/bronchiolitis. RESULTS: We reviewed 645 biopsies taken from 204 recipients during the first 100 days to classify patients into a No Early Rejection Group (n=67) or an Early Rejection Group (n=137). Yield of surveillance bronchoscopy for acute rejection or lymphocytic bronchitis/bronchiolitis was 31% with the greatest yield during the first 30 days (45%), and then decreasing to 26% (p <0.001). After Day 100, 71% of occult acute rejection episodes involved minimal (A1) lesions. Yield of surveillance bronchoscopy after Day 100 was 20% in the No Early Rejection Group and was 27% in the Early Rejection Group (p=0.22). Incidence of acute rejection or lymphocytic bronchitis/bronchiolitis after Day 100 was 41% in the No Early Rejection Group and was 50% in the Early Rejection Group (p=0.17). CONCLUSION: Surveillance bronchoscopy detects occult acute rejection or lymphocytic bronchitis/bronchiolitis in approximately one-third of biopsy specimens during the 1st year, with the majority of late abnormalities being minimal (A1) rejection. The absence of acute rejection or lymphocytic bronchitis/bronchiolitis during the first 100 days does not predict freedom from such events in the remainder of the 1st year.

Acute Disease↗

PubMed1985

[Fiberoptic bronchoscopy in intensive care medicine--functional efficacy and methodological side effects].

A prospective study was performed to determine the side effects of fiberoptic bronchoscopy on cardiopulmonary function, the influence of bronchial lavage on cardiopulmonary function, and the functional efficacy of fiberoptic bronchoscopy in obstructive atelectasis due to retained secretions. In 17 patients endotracheal intubation was immediately followed by a significant (P less than 0.01) rise in arterial, pulmonary artery and pulmonary capillary wedge pressure, heart rate, and cardiac output. There were no statistically significant differences in arterial blood gases and intrapulmonary right-to-left shunt. Two patients showed circulatory changes indicative of a heart insufficiency on the left side. A significant increase (P less than 0.001) in intrapulmonary right-to-left shunt from 12% to 17.5%, a significant decline in arterial oxygen tension of 15 mm Hg, and a significant increase of cardiac output from 6.4 to 7.71/min following saline solution lavage (20 ml in each bronchus) were observed in nine patients. The results indicate that bronchial lavage is the essential mechanism for the decline in arterial oxygen tension induced by fiberoptic bronchoscopy. In patients with unstable cardiopulmonary status, the cardiovascular response during bronchoscopy may be hazardous and the bronchoscopist should be aware of the pathophysiologic side effects involved. Fifteen therapeutic bronchoscopies were performed in five critically ill patients with obstructive atelectasis, due to retained secretions. Following the procedure, Qs/Qt declined from 23.9% to 15%, cardiac output from 9.3 to 7.31/min, and arterial Po2 increased from 58.9 to 70.9 mm Hg. The differences were statistically significant (P less than 0.0001). The therapeutic value of fiberoptic bronchoscopy in the treatment of obstructive atelectasis is demonstrated by the significant improvement in cardiopulmonary status.

Arrhythmias, Cardiac↗