What are the most common complications of bronchoscopy. How can healthcare professionals minimize risks associated with the procedure. What factors contribute to increased complication rates in bronchoscopy. How does patient selection impact the safety of bronchoscopic procedures. What role does proper equipment maintenance play in preventing complications.

Understanding Bronchoscopy: Purpose and Procedure

Bronchoscopy is a crucial diagnostic and therapeutic tool in pulmonary medicine. This minimally invasive procedure allows physicians to visualize the airways, collect samples, and perform interventions. Despite its widespread use and relative safety, it’s essential to understand the potential complications that may arise.

Types of Bronchoscopy

• Flexible bronchoscopy
• Rigid bronchoscopy
• Endobronchial ultrasound (EBUS)

Each type of bronchoscopy has its specific indications and potential risks. Flexible bronchoscopy is the most commonly performed due to its versatility and patient comfort. Rigid bronchoscopy, while less frequent, remains valuable for certain therapeutic interventions and management of massive hemoptysis.

Common Complications of Bronchoscopy

While bronchoscopy is generally safe, it’s not without risks. Understanding these potential complications is crucial for both healthcare providers and patients.

Bleeding

Bleeding is one of the most frequent complications encountered during bronchoscopy. It can range from minor mucosal bleeding to severe hemorrhage, especially in patients with underlying coagulation disorders or those undergoing transbronchial biopsies.

Respiratory Complications

Respiratory issues are another common concern. These may include:

• Hypoxemia
• Pneumothorax
• Laryngospasm
• Bronchospasm

Patients with pre-existing lung disease or those undergoing more invasive procedures are at higher risk for these complications.

Cardiovascular Complications in Bronchoscopy

Cardiovascular events, while less common, can be serious and potentially life-threatening. These may include:

• Arrhythmias
• Hypotension
• Myocardial ischemia

Patients with underlying cardiac conditions or those undergoing bronchoscopy under conscious sedation require careful monitoring to mitigate these risks.

Infection Risks Associated with Bronchoscopy

Infection is a rare but significant complication of bronchoscopy. It can occur due to:

• Inadequate sterilization of equipment
• Cross-contamination between patients
• Introduction of oral flora into the lower airways

Proper cleaning and disinfection protocols are essential to minimize this risk. Healthcare facilities must adhere to strict guidelines for bronchoscope reprocessing to prevent transmission of infectious agents.

Sedation-Related Complications in Bronchoscopy

Many bronchoscopic procedures are performed under conscious sedation to improve patient comfort and cooperation. However, sedation carries its own set of risks, including:

• Respiratory depression
• Paradoxical reactions
• Prolonged recovery time

Careful titration of sedative medications and continuous monitoring of vital signs are crucial to ensure patient safety during and after the procedure.

Special Considerations for Bronchoscopy in Critical Care Settings

Bronchoscopy in critically ill patients presents unique challenges and increased risks. Factors to consider include:

• Mechanical ventilation
• Hemodynamic instability
• Coagulation disorders
• Immunosuppression

In these cases, the potential benefits of the procedure must be carefully weighed against the increased risk of complications. Close collaboration between pulmonologists, intensivists, and anesthesiologists is essential for optimal patient outcomes.

Preventing and Managing Bronchoscopy Complications

While complications cannot be entirely eliminated, several strategies can significantly reduce their occurrence and severity:

Pre-Procedure Assessment

Thorough evaluation of the patient’s medical history, current condition, and potential risk factors is crucial. This includes:

• Review of medications, especially anticoagulants
• Assessment of respiratory and cardiac function
• Evaluation of coagulation status

Patient Selection and Preparation

Careful patient selection is key to minimizing complications. Some considerations include:

• Optimizing respiratory status prior to the procedure
• Correcting coagulation abnormalities when possible
• Providing appropriate pre-procedure fasting instructions

Procedural Techniques

Employing proper techniques during bronchoscopy can significantly reduce the risk of complications:

• Minimal and gentle manipulation of the bronchoscope
• Careful selection of biopsy sites
• Use of fluoroscopic guidance when appropriate
• Adequate suction to maintain airway patency

Post-Procedure Monitoring

Vigilant post-procedure monitoring is essential for early detection and management of complications:

• Continuous pulse oximetry
• Regular assessment of respiratory status
• Monitoring for bleeding or pneumothorax
• Gradual return to normal activities

Emerging Technologies and Their Impact on Bronchoscopy Safety

Advancements in bronchoscopy technology have the potential to further improve safety and reduce complications:

Robotic Bronchoscopy

Robotic systems offer enhanced precision and stability, potentially reducing trauma to the airways and improving diagnostic yield. This technology may be particularly beneficial for peripheral lung lesions that are challenging to access with conventional bronchoscopes.

Navigation Bronchoscopy

Electromagnetic navigation and virtual bronchoscopy techniques provide real-time guidance, allowing for more accurate targeting of lesions and reduced risk of complications such as pneumothorax.

Cryobiopsy

Cryobiopsy techniques offer larger tissue samples with potentially lower bleeding risk compared to conventional forceps biopsies. This may be particularly useful in the diagnosis of interstitial lung diseases.

As these technologies continue to evolve, it’s crucial for bronchoscopists to stay updated on their proper use and potential benefits in reducing procedure-related complications.

Training and Competency in Bronchoscopy

Adequate training and ongoing skill maintenance are fundamental to ensuring the safety of bronchoscopic procedures. Key aspects include:

Initial Training

• Comprehensive understanding of airway anatomy
• Mastery of bronchoscope handling techniques
• Familiarity with various biopsy and sampling methods
• Recognition and management of potential complications

Ongoing Education

Continuing education is essential for bronchoscopists to stay current with:

• Advances in bronchoscopic techniques
• New equipment and technologies
• Updated guidelines and best practices
• Quality improvement initiatives

Simulation Training

Simulation-based training offers a safe environment for practitioners to refine their skills and practice managing complications without risk to patients. This can include:

• Virtual reality simulators
• High-fidelity mannequins
• Cadaveric models

Regular participation in simulation exercises can help maintain and improve bronchoscopy skills, particularly for less common procedures or complications.

Quality Assurance in Bronchoscopy

Implementing robust quality assurance programs is crucial for maintaining high standards of safety in bronchoscopy. Key elements include:

Performance Metrics

Tracking and analyzing performance metrics can help identify areas for improvement:

• Diagnostic yield rates
• Complication rates
• Patient satisfaction scores
• Procedure times

Regular Audits

Conducting regular audits of bronchoscopy practices can help ensure adherence to guidelines and identify potential safety issues:

• Equipment maintenance logs
• Infection control practices
• Sedation protocols
• Documentation completeness

Incident Reporting and Analysis

Establishing a culture of open reporting and thorough analysis of adverse events is essential for continuous improvement:

• Non-punitive reporting systems
• Root cause analysis of complications
• Implementation of preventive measures
• Sharing of lessons learned

By focusing on these quality assurance measures, healthcare facilities can work towards minimizing complications and optimizing patient outcomes in bronchoscopy.

Patient Education and Informed Consent

Proper patient education and obtaining informed consent are crucial components of safe bronchoscopy practice:

Pre-Procedure Information

Patients should receive comprehensive information about:

• The purpose and benefits of the procedure
• Potential risks and complications
• Alternative diagnostic or therapeutic options
• What to expect before, during, and after the bronchoscopy

Addressing Patient Concerns

Healthcare providers should take time to address any questions or concerns patients may have, such as:

• Pain or discomfort during the procedure
• Recovery time and post-procedure restrictions
• Impact on concurrent medical conditions
• Follow-up care and result reporting

Documenting Informed Consent

The informed consent process should be thoroughly documented, including:

• Discussion of risks and benefits
• Patient’s understanding of the procedure
• Any specific concerns or preferences expressed by the patient
• Signatures of the patient (or legal representative) and healthcare provider

By ensuring patients are well-informed and actively involved in the decision-making process, healthcare providers can enhance patient satisfaction and potentially reduce anxiety-related complications during bronchoscopy.

Future Directions in Bronchoscopy Safety

As the field of interventional pulmonology continues to evolve, several areas show promise for further improving the safety profile of bronchoscopy:

Artificial Intelligence in Bronchoscopy

AI-assisted technologies have the potential to enhance various aspects of bronchoscopy:

• Real-time image analysis for lesion detection
• Automated navigation assistance
• Predictive algorithms for complication risk assessment
• Quality control in bronchoscope reprocessing

Personalized Risk Assessment

Developing more sophisticated risk stratification models could help tailor procedures to individual patients:

• Genetic markers for bleeding risk
• Biomarkers for predicting respiratory complications
• Integration of comorbidity data for personalized sedation protocols

Novel Bronchoscope Designs

Ongoing innovations in bronchoscope design aim to reduce complications and improve diagnostic yield:

• Ultra-thin scopes for improved peripheral access
• Disposable bronchoscopes to eliminate cross-contamination risk
• Integrated imaging technologies for real-time tissue analysis

As these advancements continue to be developed and refined, it’s crucial for the bronchoscopy community to rigorously evaluate their impact on patient safety and procedural outcomes through well-designed clinical studies.

Conclusion: Balancing Innovation and Safety in Bronchoscopy

Bronchoscopy remains an indispensable tool in pulmonary medicine, offering valuable diagnostic and therapeutic capabilities. While complications are relatively rare, understanding their nature, risk factors, and prevention strategies is essential for all practitioners involved in bronchoscopic procedures.

As we look to the future, the field of bronchoscopy is poised for exciting advancements that promise to enhance both efficacy and safety. However, it’s crucial to approach these innovations with a balanced perspective, ensuring that the fundamental principles of patient safety are never compromised in the pursuit of technological progress.

By maintaining a commitment to ongoing education, rigorous quality assurance, and patient-centered care, healthcare providers can continue to optimize the risk-benefit profile of bronchoscopy, ultimately improving outcomes for patients with respiratory disorders.

Complications of bronchoscopy: A concise synopsis

1. Ayers ML, Beamis JF., Jr Rigid bronchoscopy in the twenty-first century. Clin Chest Med. 2001;22:355–64. [PubMed] [Google Scholar]

2. Yarmus L, Feller-Kopman D. Bronchoscopes of the twenty-first century. Clin Chest Med. 2010;31:19–27. [PubMed] [Google Scholar]

3. Pue CA, Pacht ER. Complications of fiberoptic bronchoscopy at a university hospital. Chest. 1995;107:430–2. [PubMed] [Google Scholar]

4. Fazlalizadeh H, Adimi P, Kiani A, Malekmohammad M, Jabardarjani HR, Soltaninejad F, et al. Evaluation of bronchoscopy complications in a tertiary health care center. Tanaffos. 2014;13:48–50. [PMC free article] [PubMed] [Google Scholar]

5. Burgher LW. Complications and results of transbronchoscopic lung biopsy. Nebr Med J. 1979;64:247–8. [PubMed] [Google Scholar]

6. Dreisin RB, ALbert PK, Talley PA, Kryger MH, Scoggin CH, Zwillich CW. Flexible fiberoptic bronchoscopy in the teaching hospital. Yield and complications. Chest. 1978;74:144–9. [PubMed] [Google Scholar]

7. Pereira W, Jr, Kovnat DM, Snider GL. A prospective cooperative study of complications following flexible fiberoptic bronchoscopy. Chest. 1978;73:813–6. [PubMed] [Google Scholar]

8. Suratt PM, Smiddy JF, Gruber B. Deaths and complications associated with fiberoptic bronchoscopy. Chest. 1976;69:747–51. [PubMed] [Google Scholar]

9. Credle WF, Jr, Smiddy JF, Elliott RC. Complications of fiberoptic bronchoscopy. Am Rev Respir Dis. 1974;109:67–72. [PubMed] [Google Scholar]

10. Turner JS, WIlcox PA, Hayhurst MD, Potgieter PD. Fiberoptic bronchoscopy in the intensive care unit–a prospective study of 147 procedures in 107 patients. Crit Care Med. 1994;22:259–64. [PubMed] [Google Scholar]

11. Lindholm CE, Ollman B, Snyder JV, Millen EG, Grenvik A. Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients. Chest. 1978;74:362–8. [PubMed] [Google Scholar]

12. Matsushima Y, Jones RL, King EG, Moysa G, Alton JD. Alterations in pulmonary mechanics and gas exchange during routine fiberoptic bronchoscopy. Chest. 1984;86:184–8. [PubMed] [Google Scholar]

13. Kreider ME, Lipson DA. Bronchoscopy for atelectasis in the ICU: A case report and review of the literature. Chest. 2003;124:344–50. [PubMed] [Google Scholar]

14. Kaparianos A, Argyropoulou E, Sampsonas F, Zania A, Efremidis G, Tsiamita M, et al. Indications, results and complications of flexible fiberoptic bronchoscopy: A 5-year experience in a referral population in Greece. Eur Rev Med Pharmacol Sci. 2008;12:355–63. [PubMed] [Google Scholar]

15. Kovaleva J, Peters FT, van der Mei HC, Degener JE. Transmission of infection by flexible gastrointestinal endoscopy and bronchoscopy. Clin Microbiol Rev. 2013;26:231–54. [PMC free article] [PubMed] [Google Scholar]

16. Simpson FG, Arnold AG, Purvis A, Belfield PW, Muers MF, Cooke NG. Postal survey of bronchoscopic practice by physicians in the United Kingdom. Thorax. 1986;41:311–7. [PMC free article] [PubMed] [Google Scholar]

17. Trouillet JL, Guiguet M, Gibert C, Fagon JY, Dreyfuss D, Blanchet F, et al. Fiberoptic bronchoscopy in ventilated patients. Evaluation of cardiopulmonary risk under midazolam sedation. Chest. 1990;97:927–33. [PubMed] [Google Scholar]

18. Matot I, Kramer MR, Glantz L, Drenger B, Cotev S. Myocardial ischemia in sedated patients undergoing fiberoptic bronchoscopy. Chest. 1997;112:1454–8. [PubMed] [Google Scholar]

19. Jin F, Mu D, Chu D, Fu E, Xie Y, Liu T. Severe complications of bronchoscopy. Respiration. 2008;76:429–33. [PubMed] [Google Scholar]

20. Stahl, DL, North CM, Lewis A, Kimberly WT, Hess DR. Case scenario: Power of positive end-expiratory pressure: Use of esophageal manometry to illustrate pulmonary physiology in an obese patient. Anesthesiology. 2014;121:1320–6. [PubMed] [Google Scholar]

21. Kerwin AJ, Croce MA, Timmons SD, Maxwell RA, Malhotra AK, Fabian TC. Effects of fiberoptic bronchoscopy on intracranial pressure in patients with brain injury: A prospective clinical study. J Trauma. 2000;48:878–82. [PubMed] [Google Scholar]

22. Wang KP, Mehta AC, Turner FJ, editors . 3rd Edition. Oxford: Wiley-Blackwell; 2012. Flexible Bronchoscopy. [Google Scholar]

23. Freeman BD, Morris PE. Tracheostomy practice in adults with acute respiratory failure. Crit Care Med. 2012;40:2890–6. [PubMed] [Google Scholar]

24. Hinerman R, Alvarez F, Keller CA. Outcome of bedside percutaneous tracheostomy with bronchoscopic guidance. Intensive Care Med. 2000;26:1850–6. [PubMed] [Google Scholar]

25. Fernandez L, Norwood S, Roettger R, Gass D, Wilkins H., 3rd Bedside percutaneous tracheostomy with bronchoscopic guidance in critically ill patients. Arch Surg. 1996;131:129–32. [PubMed] [Google Scholar]

26. Gobatto AL, Besen BA, Tierno PF, Mendes PV, Cadamuro F, Joelsons D, et al. Comparison between ultrasound- and bronchoscopy-guided percutaneous dilational tracheostomy in critically ill patients: A retrospective cohort study. J Crit Care. 2015;30:220.e13–7. [PubMed] [Google Scholar]

27. Kollofrath O. Removal of a bone stuck in the right bronchus using direct laryngoscopy. MMW. 1897;38:1038–9. [Google Scholar]

28. Panchabhai TS, Mehta AC. Historical perspectives of bronchoscopy. Connecting the dots. Ann Am Thorac Soc. 2015;12:631–41. [PubMed] [Google Scholar]

29. Drummond M, Magalhaes A, Hespanhol V, Marques A. Rigid bronchoscopy: Complications in a university hospital. J Bronchol. 2003;10:177–81. [Google Scholar]

30. Petrella F, Borri A, Casiraghi M, Cavaliere S, Donghi S, Galetta D, et al. Operative rigid bronchoscopy: Indications, basic techniques and results. Multimed Man Cardiothorac Surg 2014. 2014 [PubMed] [Google Scholar]

31. Dutau H, Vandemoortele T, Breen DP. Rigid bronchoscopy. Clin Chest Med. 2013;34:427–35. [PubMed] [Google Scholar]

32. Pathak V, Welsby I, Mahmood K, Wahidi M, MacIntyre N, Shofer S. Ventilation and anesthetic approaches for rigid bronchoscopy. Ann Am Thorac Soc. 2014;11:628–34. [PubMed] [Google Scholar]

33. Goudra BG, Singh PM, Borle A, Farid N, Harris K. Anesthesia for advanced bronchoscopic procedures: State-of-the-art review. Lung. 2015 [PubMed] [Google Scholar]

34. Dincq AS, Gourdin M, Collard E, Ocak S, D’Odemont JP, Dahlqvist C, et al. Anesthesia for adult rigid bronchoscopy. Acta Anaesthesiol Belg. 2014;65:95–103. [PubMed] [Google Scholar]

35. Nicastri DG, Weiser TS. Rigid bronchoscopy: Indications and techniques. Oper Tech Thorac Cardiovasc Surg. 2012;17:44–51. [Google Scholar]

36. Lukomsky GI, Ovchinnikov AA, Bilal A. Complications of bronchoscopy: Comparison of rigid bronchoscopy under general anesthesia and flexible fiberoptic bronchoscopy under topical anesthesia. Chest. 1981;79:316–21. [PubMed] [Google Scholar]

37. Hasdiraz L, Oguzkaya F, Bilgin M, Bicer C. Complications of bronchoscopy for foreign body removal: Experience in 1,035 cases. Ann Saudi Med. 2006;26:283–7. [PMC free article] [PubMed] [Google Scholar]

38. Facciolongo N, Patelli M, Gasparini S, Lazzari Agli L, Salio M, Somonassi C, et al. Incidence of complications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies. Monaldi Arch Chest Dis. 2009;71:8–14. [PubMed] [Google Scholar]

39. Grosu HB, Morice RC, Sarkiss M, Bashoura L, Eapen GA, Jimenez CA, et al. Safety of flexible bronchoscopy, rigid bronchoscopy, and endobronchial ultrasound-guided transbronchial needle aspiration in patients with malignant space-occupying brain lesions. Chest. 2015;147:1621–8. [PubMed] [Google Scholar]

40. Tomaske M, Gerber AC, Weiss M. Anesthesia and periinterventional morbidity of rigid bronchoscopy for tracheobronchial foreign body diagnosis and removal. Paediatr Anaesth. 2006;16:123–9. [PubMed] [Google Scholar]

41. Cordasco EM, Jr, Mehta AC, Ahmad M. Bronchoscopically induced bleeding. A summary of nine years’ Cleveland clinic experience and review of the literature. Chest. 1991;100:1141–7. [PubMed] [Google Scholar]

42. Kitamura S, Wagai F. Local administration of cold saline for the treatment of bleeding induced by transbronchial biopsy. J Jpn Soc Bronchol. 1984;6:309. [Google Scholar]

43. Kitamura S. Local administration of thrombin solution for the treatment of intrabronchial bleeding. Internal Med (Tokyo) 1984;53:747. [Google Scholar]

44. Solomonov A, Fruchter O, Suckerman T, Brenner B, Yigla M. Pulmonary hemorrhage: A novel mode of therapy. Respir Med. 2009;103:1196–200. [PubMed] [Google Scholar]

45. Zamani A. Bronchoscopic intratumoral injection of tranexamic acid to prevent excessive bleeding during multiple forceps biopsies of lesions with a high risk of bleeding: A prospective case series. BMC Cancer. 2014;14:143. [PMC free article] [PubMed] [Google Scholar]

46. Sanderson DR, Neel HB, 3rd, Fontana RS. Bronchoscopic cryotherapy. Ann Otol Rhinol Laryngol. 1981;90:354–8. [PubMed] [Google Scholar]

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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Citation

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.