Flexible Fiberoptic Bronchoscopy in the Teaching Hospital

Dreisin, Robert B.; Albert, Richard K.; Talley, Paul A.; Kryger, Meir H.; Scoggin, Charles H.; Zwillich, Clifford W.

doi:10.1378/chest.74.2.144

Cited by 94 publications

(46 citation statements)

References 10 publications

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“…Our study shows a diagnostic yield of over 80% in the group evaluated with electrocoagulation-enabled biopsy. These figures are comparable to results from earlier studies using standard biopsy techniques [5,18,19], and suggest that the new approach does not have any significant negative impact on the histopathological diagnosis. The mean number of biopsy samples obtained in this study was 2.92 ±1.46, and it is possible that additional samples could have improved the diagnostic yield further [6].…”

Section: Discussionsupporting

confidence: 86%

A Randomized Controlled Trial of Electrocoagulation-Enabled Biopsy versus Conventional Biopsy in the Diagnosis of Endobronchial Lesions

Khan

Aggarwal²,

Agarwal³

et al. 2010

Respiration

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Background: Although electrocoagulation at time of endobronchial biopsy can potentially reduce procedure-related bleeding during fiberoptic bronchoscopy (FOB), it can also impair quality of tissue specimen; credible data for either are lacking. Objective: To evaluate the impact of hot biopsy on the quality of tissue samples and to quantify the amount of procedure-related bleeding during endobronchial biopsy. Methods: In this single-center, prospective, single-blind, randomized controlled study we included adult patients referred for FOB and having endobronchial lesions. Patients were randomized to bronchial biopsy using an electrocoagulation-enabled biopsy forceps, with (EC+ group) or without (EC– group) application of electrocoagulation current (40 W for 10 s in a monopolar mode). Procedure-related bleeding was semi-quantified by observer description, as well as through a visual analogue scale. Overall quality of biopsy specimen and tissue damage were assessed and graded by a pulmonary pathologist blinded to FOB details. Result: 160 patients were randomized to endobronchial biopsy with (n = 81) or without (n = 79) the application of electrocoagulation. There were no severe bleeding episodes in either group, and severity of bleeding in the EC+ and EC– groups was similar (median visual analogue scale scores of 14 and 16, respectively). Histopathological diagnosis was similar in the EC+ and EC– groups (77.8% and 82.3%, respectively). There was no significant difference in tissue quality between the two groups. Conclusion: Use of electrocoagulation-enabled endobronchial biopsy does not alter specimen quality and does not result in any significant reduction in procedure-related bleeding.

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Section: Discussionsupporting

confidence: 86%

A Randomized Controlled Trial of Electrocoagulation-Enabled Biopsy versus Conventional Biopsy in the Diagnosis of Endobronchial Lesions

Khan

Aggarwal²,

Agarwal³

et al. 2010

Respiration

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“…Importantly, events with a major clinical impact - including escalations in the level of care, respiratory failure, and failure to achieve the goals of bronchoscopy - were uncommon and similar to those reported in the literature (0.3-6%) [6,24,25,26,27,28,29]. We believe that the high frequency of minor complications in our patients reflects the prospective nature of our recording and rigorous inclusion of even minor events as complications.…”

Section: Discussionmentioning

confidence: 71%

Sedation for Bronchoscopy and Complications in Obese Patients

Khan¹,

Chatterjee

Bellinger

et al. 2016

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Background: Bronchoscopy is a safe and minimally invasive diagnostic tool, but no studies have reported prospectively on sedation and outcomes in patients with objectively defined obesity. Objectives: The purpose of the study is to determine if obese patients require more sedation or had more procedural complications during bronchoscopy under moderate sedation than non-obese patients. Methods: We evaluated complications and sedation requirements in non-obese versus obese patients, defined by multiple criteria including body mass index (BMI), neck circumference, abdominal height, and Mallampati scores. Results: Data were collected prospectively in 258 patients undergoing bronchoscopy under moderate sedation. By varying criteria, there were the following proportions of obese patients: 30% by BMI >30, 39% by neck circumference >40 cm, and 35% by abdominal height >22 cm in males and >20 cm in females. Sedative and analgesic dosing was not clinically significantly higher in obese patients than in non-obese patients. There was no difference in complications or procedural success based on obesity criteria. Hemoglobin oxygen desaturations occurred more often during bronchoscopy in patients with increasing Mallampati scores (p = 0.04), but this had no effect on bronchoscopy time or successful completion of the procedure. A subset of patients with previous polysomnogram-proven obstructive sleep apnea were more likely to have earlier termination of their procedure (15.8%) than patients with no diagnosed sleep apnea (2.3%; p = 0.002). Conclusion: In this prospective assessment of patients with obesity, we found neither clinically significant differences in sedation needs nor increases in complications in obese versus non-obese patients using a variety of indices of obesity.

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“…In 1978, Dreisin et al [21] reported an 11% total complication rate, with 5% major complications in 205 prospectively studied flexible bronchoscopies. Sedation data was not rigorously reported in this study.…”

Section: Discussionmentioning

confidence: 99%

Nurse-Administered Propofol Sedation: Feasibility and Safety in Bronchoscopy

et al. 2009

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tion was 25 min (range 3-123). The average propofol dose was 3.13 mg/kg (range 0.12-20 mg/kg). Adverse events attributable to sedation were noted in 33 (6.6%) procedures. Of the 14 (2.8%) major adverse events (death, need for intubation, ICU stay, or hospitalization), only 6 (1.2%) were potentially attributable to the sedation regimen. There were 2 deaths, neither of which was related to sedation. Conclusions: Nurse-administered propofol sedation is a feasible and safe sedation method for bronchoscopic procedures.

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Flexible Fiberoptic Bronchoscopy in the Teaching Hospital

Cited by 94 publications

References 10 publications

A Randomized Controlled Trial of Electrocoagulation-Enabled Biopsy versus Conventional Biopsy in the Diagnosis of Endobronchial Lesions

A Randomized Controlled Trial of Electrocoagulation-Enabled Biopsy versus Conventional Biopsy in the Diagnosis of Endobronchial Lesions

Sedation for Bronchoscopy and Complications in Obese Patients

Nurse-Administered Propofol Sedation: Feasibility and Safety in Bronchoscopy

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