ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Pediatric flexible bronchoscopy (FFB) and bronchoalveolar lavage (BAL) have been proven safe and effective in many clinical settings. However, insufficient attention has been paid to the description of a safe bronchoscopic technique in critically ill infants and children. Previously described techniques of FFB and BAL have been associated with bradycardia and/or oxyhemoglobin desaturation in mechanically ventilated pediatric patients. We retrospectively evaluated the safety of using manual ambu-bag ventilation with 100% oxygen to perform 13 FFB and BAL procedures in 11 critically ill pediatric patients. The setting was an urban pediatric intensive care unit. There were no major complications, such as bleeding, abscess, or pneumothorax, and no episodes of acute acidosis, oxyhemoglobin desaturation, or bradycardia associated with the procedures. Systolic blood pressure was elevated by 10 mm Hg after 5 of 13 procedures. Compared to previously described techniques, manual ambu-bag ventilation with 100% oxygen provides superior cardiopulmonary stability during FFB and BAL in mechanically ventilated pediatric patients. Although the significance of systolic blood pressure elevation after FFB and BAL is unknown, our study supports the conclusion that FFB and BAL can be performed safely in critically ill infants and children.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

To determine the role of emergent flexible bronchoscopy (EFB) in the evaluation of acute chest trauma, we retrospectively reviewed the bronchoscopic reports of 30 consecutive patients. 26 male and 4 female, over a 3-year period. Twenty-two patients presented following blunt chest trauma and eight following penetrating injury. They all received EFB within the first 24 h of the trauma, 24 of them within 12 h of arrival. Eighteen patients (60%) had positive bronchoscopic findings: bleeding from a peripheral airway (four patients), mucus plugs or thick secretion (four), tracheal lacerations (three), bronchial transections (two), supraglottic tear (one), severe vocal cord synechiae (one), subglottic swelling (one), blood clot in the bronchus (one), and distortion of the bronchial mucosa (one). The physical and roentgen-ologic findings that indicated a high probability of positive bronchoscopic findings included open wound over chest, subcutaneous emphysema, decreased breathing sound, bilateral pneumothoraces, pneumomediastinum, and signs of tracheobronchial separation. Ten patients (33%) benefited from EFB by a contribution in early management based on the bronchoscopic findings, which consisted of emergency operation or relieving respiratory distress by suction of endobronchial blood clot or secretion. The cases that most benefited from bronchoscopy were the ones that underwent EFB within 12 h after arrival. There was no bronchoscopy-related morbidity or mortality. We conclude that while EFB is valuable in selected patients with acute blunt and penetrating chest trauma, no combination of physical findings and roentgenologic findings is able to satisfactorily predict which patients will benefit.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A growing number of immunocompromised patients are undergoing both diagnostic and therapeutic flexible bronchoscopy (FFB). Despite written policies and recommendations for high-level disinfection and sterilization, a number of infections transmitted by contaminated FFB have been reported. The purpose of this study was to analyze prospectively our department's cleaning and sterilization protocols. The sterilization procedure utilizes a liquid chemical sterilization process using peracetic acid as the active biocidal agent. We prospectively studied 20 consecutive patients suspected to have a lower respiratory tract infection who underwent a FFB procedure with bronchoalveolar lavage (BAL) and protected specimen brush (PSB) specimen collections. Sterile normal saline (NS) was aseptically suctioned and collected through the bronchoscope's suction channel after the procedure (preprocessing fluid). The scope was then cleaned and processed in a liquid chemical sterilization system. After processing, sterile NS was suctioned and collected (postprocessing fluid) in a similar fashion. Cultures of the BAL and PSB, preprocessing, and postprocessing fluids were compared. In addition to the 20 patients studied, deliberate inoculations of the FFB withMycobacterium aviumcomplex (MAC) organisms were done. Cultures of the inoculated, preprocessing, and postprocessing fluids were compared. BAL cultures and PSB cultures revealed growth in 14 and in 15 of 20 patients, respectively.Pneumocystis cariniiwas noted in three patients. Viral cultures were positive for cytomegalovirus in three patients and positive for herpes simplex virus in one patient. All postprocessing fluid cultures were negative except in two patients. In these two, the postprocessing fluid was positive for the presence of coagulase-negative staphylococci and diphtheroids. The rare number of these organisms isolated was felt most likely to represent contaminated collection or processing procedures in the laboratory. The postprocessing fluids of the inoculated bronchoscopes revealed no growth for MAC organisms. Our results indicate that our department's cleaning and sterilization protocol was effective in eradicating bacterial, mycobacterial, and viral organisms. The liquid chemical sterilization system utilizing peracetic acid as the active biocidal agent provided an effective and safe sterilization process with a relatively quick turnover time.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Ten nonintubated patients with respiratory failure underwent 40 flexible bronchoscopies during iron lung mechanical ventilation in a pulmonary division. Six patients had chronic obstructive pulmonary disease, two had lung fibrosis, and two suffered from kyphoscoliosis/postpolio syndrome. Flexible bronchoscopy during iron lung ventilation was performed to remove tracheobronchial secretions, to look for other conditions leading to upper airway obstruction such as tracheomalacia, and to obtain protected brush samples for bacterial and fungal cultures. Fifty percent of the patients had bacteriologically positive samples. Following the period of negative pressure ventilation (2 h/4 t.i.d. for 3–6 days), the Pao2(mean ± SD) increased from 34 ± 11 to 60 ± 10 mm Hg (p < 0.001), the Paco2decreased from 96 ± 30 to 56 ± 8 mm Hg (p < 0.001), and the clinical conditions of the patients improved. After flexible bronchoscopic drainage of the large airways, the clinical conditions and Pao2further improved in 80% of the patients. Flexible bronchoscopy was crucial in the early diagnosis of upper airway obstruction or compression (eight patients, 80%), leading to the simultaneous application of nasal continuous positive airway pressure during iron lung treatment. We conclude that flexible bronchoscopy is safe and very useful in the management of iron lung-ventilated patients.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

In this prospective observational study, we monitored blood pressure, heart rate, and oxygen saturation prior to, during, and after 46 consecutive flexible bronchoscopies (FFB) to ascertain the effect of bronchoscopy and its component procedures on blood pressure in patients with and without known hypertension. We performed 43 bronchial washings, 28 bronchoscopic biopsies, and 22 brushings. Blood pressure, pulse, and oxygen saturation were recorded before and after each component of the total procedure. Hypotension (blood pressure,p< 0.045). Nineteen patients had a history of hypertension and 13 of these were currently taking medications to control their blood pressure. The MAP was 108 before and after bronchoscopy in this group. The MAP increased 10 to 15 mm Hg with each component of the bronchoscopy procedure. However, the blood pressure response (MAP, 124), compared to the prebronchoscopy measurement, was statistically significant only with bronchial washing (P< 0.02). Eight of the 13 patients who were taking antihypertensive medication, and were nil per os (npo) for the procedure, had sustained hypertension during the procedure (systolic >150 and diastolic >105). The conclusion from this study of patients undergoing bronchoscopy without intravenous sedation is that significant hypertensive changes occur with the procedure. As a result of this study, we changed our npo order for bronchoscopy to npo except for prescribed oral medications.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

After the initial use of expandible metallic stents (Gianturco type) in vascular and biliary pathology, they have been used in airway narrowing due to tumoral compression, postsurgical stenosis, posttransplantation lesion, posttraumatic lesion, and tracheobronchol malacia. Reported complications in the above-mentioned conditions are granuloma formation, stent migration, localized inflammation, fatal massive hemoptysis, wall perforation, obstruction, and respiratory distress. An expandible metallic stent was used successfully in tuberculous bronchial stenosis that did not respond to medical therapy. But there was no long-term follow-up report after stent insertion. To our knowledge, obstruction after self-expanding metallic stent insertion in tuberculous bronchial stenosis is previously unreported in the English-language literature. We report a case of obstruction after successful Gianturco metallic stent insertion due to tuberculous bronchial stenosis.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

A new covered Wallstent was used in a 47-year-old patient with complete obstruction of the right endobronchial tree due to advanced squamous cell carcinoma of the right upper lobe. Life-threatening dyspnea had developed because of a subtotal conical stricture 1.5 cm in length involving the distal trachea and proximal left main bronchus. A silicone stent was inserted but had to be removed because of insufficient anchorage. A Gianturco metal stent was inserted instead, with good relief of dyspnea, but 3 weeks later recurrent tumor growth through the stent led to vital dyspnea again. A Wallstent with a flexible polyurethane covering was inserted, with immediate symptom relief. Bronchoscopy 1 month later showed perfect position and patency of the stent. The patient died of cachexia and bronchopneumonia 6 weeks after stent insertion. This new Wallstent worked well in a short stricture with a significant diameter gradient, the covering preventing recurrent obstructive tumor growth. Long-term compatibility will have to be tested.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID

摘要:

Pure tracheal lipomas are rare. We recently observed one case of tracheal lipoma causing upper airway obstruction. The benign tumor was endoscopically resected with a neodymium: YAG laser operating through a flexible bronchoscope. The patient is well and recurrence-free after 4 years.

ISSN:1070-8030    

出版商:OVID    

年代:1995

数据来源: OVID