Complications of rigid bronchoscopy

Chaddha, Udit; Murgu, Septimiu

doi:10.1111/resp.13917

Cited by 9 publications

(8 citation statements)

References 19 publications

(82 reference statements)

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“…The silicone stent is more preferred than the fully covered SEMS in patients with benign airway disease after thoroughly exploring all the other treatment strategies in the advisory by the U.S. Food and Drug Administration ( 18 ). The primary technical disadvantage of silicone stent is the difficulty of inserting the rigid bronchoscopy into the distal end of the twisted and stenotic tracheobronchial tree in this case of complex PTTS ( 5 , 19 ). In addition, this procedure could increase the risk of TEF perforation.…”

Section: Discussionmentioning

confidence: 98%

Management of stent-related tracheoesophageal fistula in complex post-tuberculosis tracheobronchial stenosis: A case report

Bai

Yin²,

Chi³

et al. 2022

Front. Med.

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BackgroundThe covered self-expandable metallic stents (SEMS) have been used to manage benign tracheobronchial stenosis, especially the complex post-tuberculosis (TB) tracheobronchial stenosis (PTTS) with cartilage destruction or malacia. This procedure could lead to stent-related tracheoesophageal fistula (TEF).Case presentationA 21-year-old woman, who had one covered Y-shaped SEMS inserted to manage complex PTTS 2 years ago, presented with dyspnea and frequent coughing on drinking water. The bronchoscopy confirmed extensive granulation tissue hyperplasia and a TEF on the upper edge of the covered SEMS. The covered SEMS was removed in three steps, and another fully covered Y-shape SEMS (Microtech Co., Ltd., Nanjing, China) was inserted to restore patency in the tracheobronchial tree and occlude the TEF orifice. Recombinant bovine basic fibroblast growth factor (rbFGF) (6,000 IU/time) was sprayed into and around the fistula through the V-System single-use cannula via the flexible bronchoscope every other week. The patient showed sustained clinical and radiographic improvement, and the TEF healed.ConclusionWe presented a three-step bronchoscopic approach to managing a stent-related TEF in a patient with complex PTTS. Subsequently, regular bronchoscopic debridement of granulation tissue developing on the upper edge of SEMS is necessary to maintain the stent patency and reduce the risk of recurrent stent-related TEF. A fully covered SEMS associated with the local administration of rbFGF seems to offer an alternative simplified one-stage procedure for the temporary management of TEF combined with complex PTTS in non-surgical candidates.

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Section: Discussionmentioning

confidence: 98%

Management of stent-related tracheoesophageal fistula in complex post-tuberculosis tracheobronchial stenosis: A case report

Bai

Yin²,

Chi³

et al. 2022

Front. Med.

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“…In the AQuIRE registry by Eapen et al, hypoxemia occurred in up to 25% of RB cases, with an increased risk of procedures requiring FiO 2 < 0.4 to enable thermal ablative procedures [ 22 ]. In the patient cohort of Murgu et al, 67.1% of the patients experienced intraoperative hypoxemia and 3.8% major bleeding during RB [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

“…Bronchoscopy-associated risks were analyzed based on perioperative adverse events. Averse events included hypoxemia, bleeding, fistula formation, bronchospasm, and hemodynamic instability [ 22 ]. Hypoxemia was defined as an SpO 2 below 90% for at least 1 min [ 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

One-Lung Ventilation during Rigid Bronchoscopy Using a Single-Lumen Endotracheal Tube: A Descriptive, Retrospective Single-Center Study

Steinack¹,

Balmer²,

Ulrich³

et al. 2023

JCM

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Using one-lung ventilation (OLV) through a single-lumen endotracheal tube (SLT) in the untreated lung during rigid bronchoscopy (RB) and jet ventilation, high oxygenation can be guaranteed, whilst procedures requiring thermal energy in the other lung are still able to be used. This pilot study aimed to examine the bronchoscopy-associated risks and feasibility of OLV using an SLT during RB in patients with malignant airway stenosis. All consecutive adult patients with endobronchial malignant lesions receiving OLV during RB from 1 January 2017 to 12 May 2021 were included. We assessed perioperative complications in 25 RBs requiring OLV. Bleeding grades 1, 2, and 3 complicated the procedure in two (8%), five (20%), and five (20%) patients, respectively. The median saturation of peripheral oxygen remained at 94% (p = 0.09), whilst the median oxygen supply did not increase significantly from 0 L/min to 2 L/min (p = 0.10) within three days after the bronchoscopy. The 30-day survival rate of the patients was 79.1% (95% CI 58.4–91.1%), all of whom reported an improvement in subjective well-being after the bronchoscopy. OLV using an SLT during RB could be a new treatment approach for endobronchial ablative procedures without increasing bronchoscopy-associated risks, allowing concurrent high-energy treatments.

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“…Therapeutic rigid bronchoscopy (RB) has been an effective tool for restoring airway lumen patency over the past century (15). However, RB-related complications are serious and involve various aspects from rigid bronchoscopic intubation, type of anesthesia implemented, therapeutic intervention performed to characteristics of patients and lesions (16). Therapeutic fiberoptic bronchoscope is another widely used effective technique to offer prompt palliation for patients with endotracheal tumor.…”

Section: Discussionmentioning

confidence: 99%

Alfentanil and propofol induced anesthesia for patients with huge endotracheal tumor undergoing fiberoptic bronchoscopic interventional therapy: case report

Zhu¹,

Sun²,

Wang³

et al. 2022

Transl Cancer Res TCR

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Background: There is a high risk of hypoxia or apnea for patients with huge tracheal tumor during general anesthesia. Here we reported two cases of extremely huge endotracheal tumors undergoing fiberoptic bronchoscopic interventional therapy under general anesthesia. We hope the experience will be of reference value for formulating reasonable anesthesia scheme for such critically ill patients.Case Description: The two patients were accompanied with severe respiratory distress. And fiberoptic bronchoscopy revealed that the trachea cavity was blocked nearly completely by extremely huge tracheal tumor. Tracheal tumors were scheduled to be removed with fiberoptic bronchoscopic interventional therapy.General anesthesia was inducted with alfentanil and propofol. Then a laryngeal mask was inserted and spontaneous breath was preserved. During the operation, complete airway obstruction occurred, but it was effectively handled by using the fiberoptic bronchoscope to push the tumor and reopen the gap between the mass and the tracheal wall. After the therapy, the patients' symptom of respiratory distress was relieved significantly.Conclusions: For patients with huge tracheal tumor that to be handled with fiberoptic bronchoscopic interventional therapy, general anesthesia with spontaneous breath induced by alfentanil and propofol is preferable. The most important, when complete airway blockade occurs during the process, pushing the tumor and reopening the respiratory tract with fiberoptic bronchoscope is a fairly effective solution to enable patients to be reoxygenated.

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Complications of rigid bronchoscopy

Abstract: See related https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13873

Cited by 9 publications

References 19 publications

Management of stent-related tracheoesophageal fistula in complex post-tuberculosis tracheobronchial stenosis: A case report

Management of stent-related tracheoesophageal fistula in complex post-tuberculosis tracheobronchial stenosis: A case report

One-Lung Ventilation during Rigid Bronchoscopy Using a Single-Lumen Endotracheal Tube: A Descriptive, Retrospective Single-Center Study

Alfentanil and propofol induced anesthesia for patients with huge endotracheal tumor undergoing fiberoptic bronchoscopic interventional therapy: case report

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