Objective To investigate the diagnostic value and complications of fibrobronchoscopy and bronchoalveolar lavage in immunocompromised patients with pulmonary infiltrates. Methods Fiberoptic bronchoscopy was performed in 31 immunocompromised patients. The clinical data and results of bronchoalveolar lavage were collected. In addition to conventional microbiological methods, molecular detection for cytomegalovirus( CMV) and respiratory viruses were performed. Results In all cases BAL was performed. The overall diagnostic yield of fibrobronchoscopy was 65% . The diagnosis was more likely to be established by fibrobronchoscopy when the lung infiltrate was due to an infectious agent( 86%) than to a noninfectious process( 25% ) . By molecular detection, CMV was identified in 4 cases, and other respiratory viruses were identified in 3 cases. Fever ( 23% ) was the most common complication. Conclusions Fibrobronchoscopy and BAL are effective and safe for the diagnosis of pulmonary infiltrates in immunocompromised patients. The molecular technique may help to enhance the diagnostic yield of BAL.
Objective To study the application of virtual reality bronchoscopy stimulation in novice trainees. Methods Four novice bronchoscopists entered the training programby using a VR bronchoscopy in the clinical skill center. After the program, the dexterity, speed, and accuracy of all the four doctors were tested using the virtual simulation models. Results were compared to four skilled physicians as control group who had performed at least 50 bronchoscopies. Before-training and after-training test scores were compared using paired t tests. For comparisons between after-training novice and skilled physician scores, unpaired twosample t tests were used. Results All of the four trainees finished the training program. The novices significantly improved their dexterity, speed and accuracy. The percentage of observed segments increased from ( 74. 0 ±5. 1) % to ( 89. 3 ±4. 0) % . The number of contacts with the bronchial wall decreased from 87. 5 ±13. 2 to 30. 5 ±9. 3, and total time spent shortened from ( 700. 8 ±56. 6) s to ( 607. 0 ±17. 8) s. There were no statistically significant differences between novice accuracy ( the percentage of observed segments) after training and skilled physician accuracy [ ( 89. 3 ±4. 0) % vs ( 91. 3 ±3. 0) % , P = 0. 456] . Conclusion Practice using a virtual bronchoscopy simulator help novice trainees to attain a level of skill at performing diagnostic bronchoscopy, and it might play an important role in the training of chest physicians.
Objective To investigate the manifestations, diagnosis and treatment of tracheobronchopathia osteochondroplastica ( TO) . Methods Two cases of TO were described and 76 cases in the medical literature after 2000 were reviewed. Results TO usually manifests in adults, and affects both genders. The clinical presentation of TO is nonspecific. Bronchoscopy remains the gold standard for diagnosing this condition. Hard sessile nodules arising from the anterior and lateral walls of the airway,typically sparing the posterior membrane, are classic appearance that can be easily recognized. The CT scan is more sensitive and specific, which plays an important role in the diagnosis of TO. Bronchial biopsies disclose the abnormal presence of cartilage and bone tissue in the bronchial submucosa. To date there is nospecific treatment for the disease. Only a minority of cases develop into significant upper airway obstruction and require invasive procedures to remove or bypass the obstacle on affected airways. Conclusions TO is a stable or slowly progressive benign disease. Chest computed tomography and fiberoptic bronchoscopy are thebest diagnostic procedures to identify TO.
ObjectiveTo evaluate the clinical effects of nebulized lidocaine anesthesia and anesthesia with lidocaine and midazolam in patients with preoperative bronchoscopy. MethodsTotally, 136 inpatients between May 2002 and June 2013 with preoperative bronchoscopy were included in the study. The patients were randomly assigned to experimental group and control group with 68 patients in each. For patients in the experimental group, 8 mL of 2% lidocaine was administered through inhalation anesthesia, followed by 2-3 mg bolus of midazolam, and subsequently 0.5 mg of midazolam was administered every 2 minutes depending on patients' awareness. Patients in the control group accepted lidocaine alone for anesthesia. The clinical efficacy and adverse effects of both the two ways of anesthesia were observed. ResultsThe time of sustained and effective anesthesia was (24.5±2.8) minutes in the experimental group, as compared with (16.8±2.1) minutes in the control group (P<0.01). The average amount of consumption of lidocaine was (12.4±1.3) mL in the experimental group, as compared with (16.8±1.5) mL in the control group (P<0.01). The heart rate at 5 min after operation was (81.5±19.5) beats/min in the experimental group, as compared with (94.6±34.6) beats/min in the control group (P<0.01). The mean pulse oxygen saturation at 5 min after operation was (93.5±3.6)% in the experimental group, as compared with (88.2±13.3)% in the control group (P<0.01). ConclusionCombined application of lidocaine and midazolam before bronchoscopy is simple and feasible for anesthesia, which has higher success rate, lesser side effects and other reactions such as body movement and coughing.
ObjectivePulmonary infection is commonly seen in patients with rheumatic autoimmune disease (RAD).Sometimes bronchoscopy is used to obtain microorganisms.In order to improve diagnostic yield, the factors affecting diagnostic yield of bronchoscopy in obtaining microorganisms in RAD patients with pulmonary abnormality were analyzed retrospectively. MethodsA retrospective study was performed in RAD patients with lung infiltrates who received bronchoscopy for obtaining microorganisms at the Department of Rheumatology,Peking Union Medical College Hospital from January 2009 to June 2013.Patients characteristics,clinical symptoms,medication history,laboratory parameters,radiographic findings and locations where microorganisms were obtained were recorded. Results87 patients received 91 bronchoscopic exams,including 72 bronchoalveolar lavages,21 bronchial aspirates,and 72 bronchial brushes.The total diagnostic yield was 52.7%.The diagnostic yield was 71.4% with bronchoalveolar lavage,38.9% with bronchial aspirate,and 18.1% with bronchial brush.Diagnostic yield was significantly higher in the patients with clinical symptoms of fever,cough or expectoration compared with the patients without either symptoms (60.0%% vs.34.6%,P=0.028).The patients with CT finding of nodular,massive or consolidation had a higher diagnostic yield compared with those with CT findings of reticular,linear or ground glass opacity (61.8% vs.26.1%,P=0.003).Diagnostic yield was not affected by location of bronchoalveolar lavage (P=0.691). ConclusionRAD patients with fever,cough or sputum,and CT findings of nodular,massive or consolidation would get a higher diagnostic yield by bronchoscopy.
ObjectiveTo evaluate the efficacy and safety of selective large volume broncholavage by bronchonscopy in treatment of patients with acute exacerbation of bronchiectasis. MethodsA single-center randomized control,non-blind clinical trial was conducted.A total of 65 patients were randomly divided into Group A(large volume broncholavage group,n=21),Group B (mini- large volume broncholavage group,n=22) and Group C (control group,n=22).All patients received routine therapy of acute exacerbation of bronchiectasis while additional broncholavage was administered in the treatment groups for only once.Warm normal saline solution was instilled for Group A at volume of 500 to 2 000 mL and for Group B at volume of 100 to 200 mL.The baseline characteristics,Simplified Clinical Pulmonary Infection Score(CPIS) and C-reactive protein (CRP) were recorded at the first and on 7th day.The duration of antibiotic use,the length of hospital stay and total effective rate were compared among three groups. ResultsThe lavage volume was (1 250.0±403.3)mL for Group A and (141.0±41.2)mL for Group B.The length of hospital stay and duration of antibiotic use were (8.4±1.0)d and (7.9±1.1)d respectively,shorter than those in Group B[(13.5±1.6)d,(11.6±2.4)d] and Group C[(15.3±3.2)d,(13.3±2.6)d] with significant difference between three groups(all P<0.05).The total effective rates was 95.23% in Group A,higher than those in Group B (81.82%) and Group C (68.19%)(all P<0.05).The CPIS on the 7th day of Group A was 1.9±1.4,lower than that in Group B (2.7±0.8) and Group C (3.7±0.9)(P<0.05).The CRP of Group A decreased more quickly than Group B and Group C.The adverse events occurred in Group A and Group B including transient hypoxemia (23.81%,9.09%, respectively),tarchycardia(100%,68.18%, respectively),airway mucosal injury(38.09%,13.64%, respectively) and elevated blood pressure (19.05%,13.64%, respectively). ConclusionSelective large volume broncholavage through bronchonscopy is an effective and safe treatment for patients with acute exacerbation or bronchiectasis.
ObjectiveTo explore sedation effect of dexmedetomidine alone and its effects on respiration and circulation of complications in transtracheal endoscopic interventional therapy. MethodsFrom April 2012 to May 2014, 60 adult patients who plan to undergo transtracheal endoscopic interventional therapy were recruited in the study. The patients were divided into a midazolam combined with fenanyl citrate intravenous injection group (MF group), and a dexmedetomidine target controlled infusion group (Y group) using the method of random number table, with 30 cases in each group. All patients were given 2% lidocaine 15 mL by ultrasonic atomizing inhalation for local surface anaesthesia preoperatively, and then the patients in MF group received midazolam and fentanyl citrate by slow intravenous injection, the patients in Y group received dexmedetomidine 0.5 g intravenous injection and persistant infusion of dexmedetomidinein dosage of 0.2 μg/h. The basic Ramsay sedation score (T0) was recorded, then the Ramsay sedation scoring was conducted when the bronchoscope entering into the pharyngeal cavity (T1), into the glottis (T2), and into the bronchial (T3), respectively. ResultsThere were no significant differences in restlessness, hypotension, hypertension, or tachycardia incidence rate between two groups (P>0.05). The differences in Ramsay score between two groups was not significant at T0 or T1 time point (P>0.05), but was significant at T2 and T3 time point (P<0.05). Compared with MF group, the incidence of respiratory depression and hypoxemia was significantly lower, and the recovery time was significantly shorter in Y group (P<0.05). All patients in Y group woke up immediately by simple call. While in MF group, 23 patients needed intravenous flumazenil to promote awakening. ConclusionDexmedetomidine alone can provide effective sedation in transtracheal endoscopic interventional therapy with good effect, high safety, and more convenient awakening.
ObjectiveTo analyze the clinic characteristics and the flexible bronchoscopic findings of 1 221 cases of endobronchial tuberculosis,and try to find out some useful clues for the diagnosis of endobronchial tuberculosis. MethodsThe clinic characteristics and the bronchoscopic findings of 1 221 cases of endobronchial tuberculosis were summarized and analyzed. ResultsIn the 1 221 cases of bronchial tuberculosis,there were 491 males and 730 females with mean age of 45.5±16.8 years(ranged between 6 and 84 years). The peak incidence of endobronchial tuberculosis in females was between 20 and 50 years old,and in males was between 45 and 70 years old. The lesions were more common in the right lung (757 cases,62.00%). The most susceptible segment involved was the right upper lobe(316 cases,25.88%). The cases of left main bronchus tuberculosis (270 cases,22.11%) were more than right main bronchus tuberculosis(247 cases,20.23%). The most common bronchoscopic appearances were oedematous-hyperaemic and necrosis. The typical changes include caseous necrosis(117 cases,14.50%),fibrostenotic(130 cases,10.65%),and granuloma(92 cases,7.53%),which often occurred in the left main bronchus. The most common endoscopic classification of endobronchial tuberculosis was type Ⅱ(531 cases,43.49%)and type Ⅲ(505 cases,41.36%). ConclusionsBronchial tuberculosis occures in females more of ten than males. Female patients were mainly under the age of 50 years,while male patients was mainly above the age of 45 years. The most susceptible segments are the right upper lobe and the left main bronchus. The most common endoscopic classification is necrotizing ulcerative and granulation proliferative.
Lung cancer management is complex and requires a multi-disciplinary approach to provide comprehensive care. Interventional pulmonology (IP) is an evolving field that utilizes minimally invasive modalities for the initial diagnosis and staging of suspected lung cancers. Endobronchial ultrasound guided sampling of mediastinal lymph nodes for staging and detection of driver mutations is instrumental for prognosis and treatment of early and later stage lung cancers. Advances in navigational bronchoscopy allow for histological sampling of suspicious peripheral lesions with minimal complication rates, as well as assisting with fiducial marker placements for stereotactic radiation therapy. Furthermore, IP can also offer palliation for inoperable cancers and those with late stage diseases. As the trend towards early lung cancer detection with low dose computed tomography is developing, it is paramount for the pulmonary physician with expertise in lung nodule management, minimally invasive sampling and staging to integrate into the paradigm of multi-specialty care.
ObjectiveTo highlight the characteristics of bronchial foreign body in Adults. MethodsThe clinical data of three patients with bronchial foreign body were analyzed and related literatures were reviewed. ResultsForeign bodies in three patients were all located in right bronchi. Their initial diagnoses were tumor, pneumonia and foreign body, respectively. They all didn't offer a definite history of foreign body aspiration. Foreign bodies in three patients were diagnosed and treated by bronchoscopy. Through reviewing 978 related literatures, we found 2920 cases of bronchial foreign body in adults. 75.00% of them didn't offer a history of foreign body aspiration. 80.13% of them were misdiagnosed as other diseases before bronchoscopy, such as pneumonia(31.23%), lung cancer(25.21%), tuberculosis(5.81%), bronchiectasis(6.58%) and asthma(12.47%). Some of them were misdiagnosed for over 30 years. ConclusionsBronchial foreign bodies in adults are easily misdiagnosed. Bronchoscopy plays an important role in diagnosis and treatment of bronchial foreign body.