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2 most common complications after bronchoscopy: Complications of bronchoscopy: A concise synopsis

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Complications of bronchoscopy: A concise synopsis

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Severe Complications of Bronchoscopy | Respiration

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Case Reports|
August 21 2008

Faguang Jin;

Deguang Mu;

Dongling Chu;

Enqing Fu;

Yonghong Xie;

Tonggang Liu

Respiration (2008) 76 (4): 429–433.

https://doi.org/10.1159/000151656

Article history

Received:

October 22 2007

Accepted:

June 02 2008

Published Online:

August 21 2008

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Faguang Jin, Deguang Mu, Dongling Chu, Enqing Fu, Yonghong Xie, Tonggang Liu; Severe Complications of Bronchoscopy. Respiration 1 November 2008; 76 (4): 429–433. https://doi.org/10.1159/000151656

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Background: Interventional bronchoscopy is widely used for the diagnosis and therapy of many lung and airway diseases. Concern has been raised about its complications. Objective: To review the severe complications associated with bronchoscopy. Methods: A retrospective review of clinical records of 23,862 patients who underwent bronchoscopic examination or therapy from December 1983 to December 2004 in our department. Severe complications associated with bronchoscopic examination or therapy were analyzed. Results: During the study period, among 23,862 cases, 152 cases experienced severe complications; 3 cases died; the rate of severe complications was 0.637%; mortality rate was 0.013%. The complications included laryngeal, tracheal and bronchial spasm in 68 cases, hematorrhea in 37 cases, arrhythmia in 19 cases, airway obstruction in 8 cases, esophagotracheal fistula in 5 cases, pneumothorax in 4 cases, tracheal perforation in 3 cases, death in 3 cases. Conclusions: Bronchoscopy is a safe procedure. The increased rate of severe complications and death associated with bronchoscopy may be ascribed to the increasingly wide use of bronchoscopy.

Keywords:

Bronchoscopy,
Complications

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Bronchoscopy of the lungs: what it is and how it is done for adults, preparation for fiber bronchoscopy (FBS)

Bronchoscopy is a medical diagnostic procedure that involves examining and performing certain manipulations in the upper respiratory tract. For these purposes, a special optical device is used – a bronchoscope, which has the form of a flexible tube with a diameter of 3-6 mm, equipped with a special “cold lamp”, a video camera and a channel for bringing manipulation instruments.

Types of bronchoscopy

Depending on the purpose of the bronchoscopy, bronchoscopy can be diagnostic and therapeutic:

  • Diagnostic bronchoscopy involves examining the airways and taking material for further examination by tissue biopsy and / or sampling of lavage water from the alveoli and bronchi. It is prescribed for the diagnosis of malformations of the respiratory system, inflammatory and infectious diseases, the detection of neoplasms of the bronchi and lungs, and the identification of the causes of hemoptysis.
  • Therapeutic bronchoscopy, in addition to examining the respiratory tract, involves therapeutic manipulations, for example, removing foreign bodies, stopping bleeding, removing sputum, neoplasms and various kinds of obstructions. In addition, with its help, targeted administration of drugs into the bronchial tree and sanitation of the respiratory tract (removal of viscous sputum, pus, etc.) is possible. [1-3]

Indications for bronchoscopy

Diagnostic bronchoscopy is prescribed in the following cases:

  • Frequent persistent bronchitis and pneumonia, difficult to treat.
  • Hemoptysis and bleeding.
  • Suspicion of malignant tumors of the bronchi and lungs.
  • Shortness of breath of unknown etiology. [4]
  • Diagnostics of tuberculosis, sarcoidosis, cystic fibrosis, etc.
  • Purulent processes – abscess, gangrene of the lungs.
  • The presence of foreign bodies in the lumen of the respiratory tract or suspicion of their presence according to radiography.
  • Presence of radiologically detectable neoplasms with endo- or peribrochial/tracheal growth.
  • Assess the degree of airway injury in patients with airway burns or chest trauma. [1,2]

When therapeutic bronchoscopy is performed:

  • The need to remove viscous secretions or sputum from the tracheobronchial tree.
  • The need for endobronchial administration of medicinal drugs.
  • Stop bleeding.
  • Removal of small benign endobronchial or endotracheal neoplasms.
  • Removal of foreign objects.
  • Installation of a stent to ensure the patency of the airways with their strictures or tumor stenoses.
  • Treatment of fistulas.

Contraindications for bronchoscopy

Mainly, contraindications for bronchoscopy are related to the general serious condition of the patient. As a rule, in these cases, the procedure is postponed. Absolute contraindications for bronchoscopy are:

  • Severe arrhythmia that cannot be corrected.
  • Failure to provide adequate oxygenation during bronchoscopy.
  • The presence of acute respiratory failure with hypercapnia, except when the patient is on mechanical ventilation (ALV) and breathing through an endotracheal tube.
  • Bronchoscopy should be used with extreme caution in patients with vena cava syndrome, pulmonary hypertension, severe coagulopathy, and uremia. These patients have an increased risk of severe bleeding and pneumothorax (collapse of the lung), but with proper technique, bronchoscopy is a safe procedure. [1,2]

Possible complications of bronchoscopy

Serious complications after bronchoscopy are rare. The risk of their development is higher in the elderly and those with severe comorbidities.

For a few days after bronchoscopy, there may be soreness in the throat during swallowing. This symptom is not dangerous and will soon pass. Gargling, special lozenges help to reduce discomfort. If, after bronchoscopy, one of the symptoms listed below appears, you should immediately consult a doctor:

  • Increase in body temperature to 38° C or more.
  • Coughing up blood.
  • Chest pain.
  • Great hoarseness of voice.
  • Labored breathing.
  • Pain and redness at the injection site.

How a bronchoscopy works

Before the procedure, the patient must not eat or drink for at least 6 hours. Also, before bronchoscopy, premedication is performed – sedatives, local anesthetics and, if necessary, anesthesia are administered. The task of this stage is to minimize the patient’s discomfort during the study, to reduce the cough reflex and the secretory function of the bronchi. [5]

Before starting bronchoscopy, the vocal cords and pharyngeal surface are irrigated with an aerosol or inhaled anesthetic, such as lidocaine. The bronchoscope is lubricated with a lubricant and inserted through the nostrils, through the mouth, or through a tracheostomy. Sequentially moving along the respiratory tract, the doctor examines the nasopharynx and larynx. During inspiration, the bronchoscope is passed through the vocal cords and then the subglottis of the larynx, trachea and the surface of the bronchi are examined. While advancing the bronchoscope, the patient may feel a pronounced urge to cough, but with adequate anesthesia, the cough reflex disappears. A number of patients are afraid of suffocating during the procedure, but it is important to reassure and warn the patient in advance that the diameter of the bronchoscope is much smaller than the diameter of the bronchi, so there is no risk of asphyxia. In addition, during the bronchoscopy procedure, monitoring of oxygenation (blood oxygen saturation), control of blood pressure, pulse and cardiac activity is carried out.

During bronchoscopy, the doctor pays attention to the condition of the mucous membrane of the respiratory tract, its color, the nature of the folds, the severity of the vascular pattern. Normally, it should have a pale pink color, a slightly yellowish color is allowed. Its surface is matte with moderately pronounced folds. In the large bronchi and trachea, the pattern of blood vessels and the contours of the cartilage rings are well distinguished. When breathing, the walls of the bronchi and trachea must be mobile. [6]

During inflammatory processes, hyperemic edematous mucosa will be noticeable during bronchoscopy. The folds will be erased, and mucus or a purulent secret is found in the lumen of the bronchi. In atrophic processes, on the contrary, folding increases, the mucosa becomes thinner, blood vessels shine through it. The lumen of the bronchi is dilated or gaping.

Also, during bronchoscopy, foreign bodies and endobronchial neoplasms are visualized (they grow inside the bronchial lumen). Peribronchial neoplasms can be detected by indirect signs:

  • Bronchial lumen deformation.
  • Changes in the mobility of the bronchus wall during respiratory movements.
  • Local change in folding.
  • Local change in the vascular pattern.

In addition, bronchoscopy involves additional diagnostic and therapeutic procedures:

  • Brush biopsy – a special brush is inserted through the manipulation channel of the bronchoscope, with which cells are scraped off the surface of suspicious areas.
  • Transbronchial biopsy – performed using forceps, which lead to a suspicious area in the lung parenchyma. To increase the diagnostic value and reduce the risk of complications, it is recommended to perform bronchoscopy with such a biopsy under X-ray control.
  • Endoscopic ultrasonography – ultrasound examination through the wall of the bronchus using a miniature probe located at the end of the bronchoscope. This procedure helps evaluate neoplasms of the tracheobronchial tree and mediastinum. Under the control of endo-ultrasound, a fine-needle biopsy can be performed – insert a needle into the tumor through the wall of the bronchus and obtain material for research.
  • Washing the lumen of the bronchi. Using a special channel through a bronchoscope, a sterile saline solution is injected into the lumen of the bronchi, which is then aspirated.
  • Bronchoalveolar lavage. 50-200 ml of sterile saline is injected into the terminal bronchioles. After it fills the distal section of the bronchial tree, the liquid is aspirated and sent to the laboratory for testing for the presence of pathogenic microflora, cells and proteins that can occur in the pathology of the alveolar tissue.
  • Removal of foreign bodies and small neoplasms (polyps). This manipulation is carried out with the help of special forceps or a loop. The wound surface is coagulated.
  • Stop bleeding. Recently, the leading method of stopping bleeding is valvular bronchoblocking. Bronchoscopy with occlusion of the bronchus with a tight gauze swab, hemostatic or foam rubber sponge, Fogarty balloon, as well as electrocoagulation or application with polymers is also used. [7]

After all manipulations are completed, the bronchoscope is removed, and the patient is under the supervision of the medical staff for some time. If necessary, additional oxygenation is carried out using oxygen therapy. After restoration of the pharyngeal reflex, normalization of saturation without oxygen support, the patient can leave the clinic. Bronchoscopy can be performed on an outpatient basis – this does not require hospitalization in a hospital.

Advantages and disadvantages of bronchoscopy

Bronchoscopy is an important diagnostic and therapeutic procedure that provides information that is critical to diagnosis and treatment. There are no analogues to her today. However, bronchoscopy is associated with certain risks, which we discussed above. According to statistics, very rarely (1/10,000 studies) severe complications leading to death can occur (usually in severe patients). [2]

A clear selection of patients, taking into account indications and contraindications for bronchoscopy, as well as strict adherence to the technique of the procedure, helps to minimize such risks. The risks are also reduced when the study is carried out by an experienced doctor. In our clinic, bronchoscopy is performed by Mikhail Sergeevich Burdyukov, doctor of medical sciences, medical expert.

Appointment for a consultation around the clock

+7 (495) 668-82-28

References:

  1. Ovchinnikov A.A. Diagnostic and therapeutic possibilities of modern bronchoscopy. Regular issues of “RMJ” No. 12 dated April 28, 2000, p. 515.
  2. Naser Mahmoud; Rishik Vashisht; Devang Sanghavi; Satish Kalanjeri. Bronchoscopy. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.
  3. Poddubny B. K., Davydov M. P., Ungiadze G. V., Kuvshinov Yu. P., Belousova N. V., Kontsevaya A. Yu., Kireev M. Yu. Bronchoscopy in the palliative treatment of patients with lung cancer / / Vestn. RONTS im. N. N. Blokhin RAMS. 2003. No. 1.
  4. Tatyana Borisovna Kuchmaeva, Vladimir Viktorovich Shcheglov The role of bronchoscopy in the differential diagnosis of broncho-obstructive syndrome // Medical Bulletin of the North Caucasus. 2014. No. 4 (36).
  5. Steiner M. Safety of flexible bronchoscopy: premedication preparation // Vrach. 2016. No. 11.
  6. Tyler J. Paradis, Jennifer Dixon, and Brandon H. Tieu. The role of bronchoscopy in the diagnosis of airway disease. J Thorac Dis. Dec 2016; 8(12): 3826–3837. doi: 10.21037/jtd.2016.12.68.
  7. Aleksey Adrianovich Ovchinnikov Operative bronchoscopy // Practical Pulmonology. 2006. No. 1.

Valve bronchoblocking – Khanty-Mansiysk Clinical Tuberculosis Dispensary

Application valve bronchoblocking in complicated pulmonary tuberculosis

Based on many summer scientific research carried out in Barnaul and clinical trials conducted in various clinics in Moscow, St. Petersburg , Novosibirsk, Tomsk, Tyumen, Kemerovo and other cities of Russia, a method was developed for the treatment of pulmonary tuberculosis and its complications by using an endobronchial valve. New in the proposed method of treating tuberculosis is the creation of therapeutic hypoventilation and atelectasis in the affected area of ​​the lung while maintaining the drainage function of the blocked bronchus and destruction cavity.
The use of valvular bronchial blockage in complicated pulmonary tuberculosis (a manual for physicians). – Barnaul, 2008 A. V. Levin, E. A. Tseymakh, P. E. Zimonin

Device for valvular bronchoblocking

A method for treating lung diseases and their complications by using an endobronchial check valve has been developed and has been successfully used since 2000 ( Fig. 1).

Fig. 1. External view of endobronchial valves
Fundamentally new in the proposed method for the treatment of pulmonary tuberculosis, including drug-resistant forms, is the creation of therapeutic hypoventilation in the affected area of ​​the lung while maintaining the drainage function of the blocked bronchus and destruction cavity. The valve is made of a rubber compound (registration certificate No. ФС 01032006/5025-06 dated December 21, 2006), indifferent to the human body, and is a hollow cylinder (Fig. 2). On the one hand, the inner opening of the valve has an even round shape, on the other hand, it is made in the form of a collapsing petal valve, which is closed by excessive external pressure and the inherent elastic properties of the material from which it is made. Two-thirds of the outer surface of the valve is made up of thin lamellar radial petals to fix it in the bronchus. The valve is installed both with a rigid bronchoscope and with a bronchofiberscope. The size of the valve depends on the localization of the tuberculous process and the diameter of the draining bronchus where it is installed (lobar, segmental, subsegmental), and should exceed the diameter of the lumen of the bronchus by 1.2-1.5 times (Fig. 10). The valve allows air, sputum, bronchial contents to leave the lesion during exhalation and coughing. At the same time, the reverse flow of air into the affected areas of the lung does not occur, thereby achieving a gradual state of therapeutic hypoventilation and atelectasis of the lung tissue (Fig. 3).

Fig. 2. Scheme of the device of the endobronchial valve.
1. Hollow cylinder.
2. Valve bore.
3. Valve retention strap.
4. Radial petals for fixing the valve in the bronchus.
5. Drop-down petal valve

Expiratory

Inspiratory
3. The principle of operation of the endobronchial valve.

Valve bronchoplasty technique

Endobronchial valve placement is performed under general or local anesthesia. After examination and sanitation of the bronchial tree, the diameter of the bronchus orifice, where the valve will be installed, is estimated. The bronchoscope is removed and a valve of the required diameter is threaded onto its distal end, having previously lubricated the head of the bronchoscope with glycerin (Fig. 4).

Fig. 4. The endobronchial valve is mounted on the head of the bronchofibroscope.

The valve is installed in the blocked bronchus (Fig. 5, 6).

Fig. 5. Endobronchial valve is guided to the installation site.

Fig. 6. Fixation of the endobronchial valve in the blocked bronchus.

To control the effectiveness of valvular bronchoblocking, the patient undergoes a chest x-ray in direct and lateral projections on the next day, and in the future – according to indications.
Removal of the endobronchial valve is performed under local anesthesia or under anesthesia with standard endoscopic instruments (biopsy forceps or polypectomy loop).

Indications and contraindications for valvular bronchoblocking
The most frequent pathologies of the lungs, in the complex treatment of which it is advisable to use valvular bronchoblocking:
1. Pulmonary tuberculosis.
2. Pleural empyema and residual pleural cavities with bronchopleural fistulas.
3. Acute lung abscesses complicated by
– bleeding
– pyopneumothorax
4. Lung cancer complicated by bleeding.
5. Pulmonary emphysema.
6. Lung cysts.
7. Prolonged spontaneous pneumothorax.

Indications for the treatment of pulmonary tuberculosis
1. Infiltrative tuberculosis.
2. Fibrous-cavernous tuberculosis.
3. Drug resistance of Mycobacterium tuberculosis.
4. Acute progressive tuberculosis.
5. Relapses and exacerbations of the tuberculosis process.
6. Persistent bacterial excretion.
7. Poor tolerance to anti-tuberculosis drugs.
8. Old age.
9. Concomitant pathology (diabetes mellitus, peptic ulcer of the stomach and duodenum, diseases of the liver, kidneys, HIV infection).
10. Unruly patients.

Indications for the treatment of complicated pulmonary tuberculosis
1. Pulmonary bleeding.
2. Bronchopleural fistulas.
3. Spontaneous pneumothorax.

Relative contraindications for pulmonary tuberculosis
1. Purulent bronchitis.
2. Expiratory bronchial stenosis.

Valved bronchoplasty is an effective, minimally invasive, non-drug treatment for various forms of pulmonary tuberculosis, including drug-resistant forms and its most common complications, such as pulmonary hemorrhage and bronchopleural fistulas.