Safety and Clinical Utility of Flexible Bronchoscopic Cryoextraction in Patients With Non-neoplasm Tracheobronchial Obstruction

Sriratanaviriyakul, Narin; Lam, Francis; Morrissey, Brian M.; Stollenwerk, Nicholas; Schivo, Michael; Yoneda, Ken Y.

doi:10.1097/lbr.0000000000000203

Cited by 44 publications

(66 citation statements)

References 10 publications

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“…Although FFB is predominantly used for the diagnosis and treatment of respiratory diseases in critically ill patients, [1,2] the invasive nature of this technology can induce cough, dyspnea, airway reflex contraction, laryngospasm, and catecholamine release, with further detrimental effects on patient prognosis. [3] Consequently, the American College of Chest Physicians has highlighted the necessity of using sedation combined with topical anesthesia during FFB.…”

Section: Introductionmentioning

confidence: 99%

Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients

et al. 2017

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This study aimed to investigate the clinical effectiveness of dexmedetomidine and midazolam for sedation of intensive care unit (ICU) patients requiring flexible fiberoptic bronchoscopy (FFB).This retrospective cohort study included 148 patients from the third ICU ward of the Second Affiliated Hospital of Harbin Medical University (Harbin, China) who received simultaneous invasive mechanical ventilation and FFB between March 2012 and December 2014. Patients were divided into dexmedetomidine (n = 72) and midazolam (n = 76) groups according to sedative mode. The sedative effects, incidence of adverse events, and bronchoscopist satisfaction scores were compared between groups.During FFB, total sedation time and total time of FFB were significantly shorter in the midazolam group (P < .001, respectively), with a lower percentage of these patients requiring propofol for remedial sedation (P < .001). The incidence of FFB-related adverse events (including bronchospasm, cough, and decreased oxygen saturation) was significantly higher in dexmedetomidine group compared with midazolam group (P = .007, .014 and .008, respectively). However, the incidence of other adverse events was not significantly different between groups. In addition, bronchoscopist satisfaction scores were significantly higher in the midazolam compared with dexmedetomidine group (7.72 ± 1.65 vs 7.08 ± 1.77; P = .030).For sedation of ICU patients during FFB, combination of midazolam and dexmedetomidine demonstrated an enhanced sedative effect, lower incidence of adverse events, and higher bronchoscopist satisfaction score compared with dexmedetomidine alone, thus represents a suitable alternative sedative for FFB patients.

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Section: Introductionmentioning

confidence: 99%

Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients

et al. 2017

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“…Success with cryoextraction has been reported when treating various foreign bodies including blood clots, chewing gum, metal objects (despite their lack of water content), pills, and food particles (58)(59)(60)(61)(62)(63)(64)(65). Foreign bodies that contain sufficient water for freezing and adhering to the cryoprobe, and that are friable and difficult to remove en-bloc with standard forceps are ideal.…”

Section: Foreign Body Removal or Cryoextractionmentioning

confidence: 99%

Bronchoscopic Cryotherapy. Clinical Applications of the Cryoprobe, Cryospray, and Cryoadhesion

2016

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Cryotherapy is an evolving therapeutic and diagnostic tool used during bronchoscopy. Through rapid freeze-thaw cycles, cryotherapy causes cell death and tissue necrosis or tissue adherence that can be used via the flexible or rigid bronchoscope. This extreme cold can be used through the working channel of the bronchoscope via a specialized cryoprobe or directly with the use of spray cryotherapy. These properties allow for multiple bronchoscopic techniques, each with its own equipment and procedural, safety, and efficacy considerations. Bronchoscopic cryotherapy can be used in a variety of clinical scenarios, including the treatment of malignant and benign central airway obstruction and low-grade airway malignancy, foreign body removal or cryoextraction, endobronchial biopsy, and transbronchial biopsy. The bulk of the experience with bronchoscopic cryotherapy consists of uncontrolled case series of malignant central airway obstruction. There are also controlled data supporting the use of cryoadhesion for endobronchial biopsies, albeit with an increased risk of controllable bleeding. The use of cryoadhesion for transbronchial biopsies is an active area of investigation with limited controlled data. In addition, there are promising future directions using bronchoscopic cryotherapy, including chemosensitizing malignancy with cryotherapy and capitalizing on the synergy between cryotherapy and radiation.

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“…The authors’ conclusion that this technique is safe, easy, and effective is based on data demonstrating a 33% failure rate in a potentially life‐threatening situation! A recent retrospective study on bronchoscopic cryoextraction described a limited success rate for foreign body extraction in adults too . Other authors have cautioned that objects should be tested for cryoadherence before the technique is used in patients because cryoadhesive properties of most inorganic and several organic objects are unpredictable .…”

Section: To the Editormentioning

confidence: 99%

Caution to use bronchoscopic CO₂cryotherapy for foreign body removal in children

et al. 2016

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Safety and Clinical Utility of Flexible Bronchoscopic Cryoextraction in Patients With Non-neoplasm Tracheobronchial Obstruction

Abstract: We conclude that flexible bronchoscopic cryoprobe extraction of blood clots, mucous secretions, plastic bronchitis, and foreign bodies is a safe and effective option. It can be safely performed at the bedside and in many cases eliminates the need for rigid bronchoscopy.

Cited by 44 publications

References 10 publications

Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients

Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients

Bronchoscopic Cryotherapy. Clinical Applications of the Cryoprobe, Cryospray, and Cryoadhesion

Caution to use bronchoscopic CO₂cryotherapy for foreign body removal in children

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Safety and Clinical Utility of Flexible Bronchoscopic Cryoextraction in Patients With Non-neoplasm Tracheobronchial Obstruction

Abstract: We conclude that flexible bronchoscopic cryoprobe extraction of blood clots, mucous secretions, plastic bronchitis, and foreign bodies is a safe and effective option. It can be safely performed at the bedside and in many cases eliminates the need for rigid bronchoscopy.

Cited by 44 publications

References 10 publications

Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients

Effect of dexmedetomidine and midazolam for flexible fiberoptic bronchoscopy in intensive care unit patients

Bronchoscopic Cryotherapy. Clinical Applications of the Cryoprobe, Cryospray, and Cryoadhesion

Caution to use bronchoscopic CO2cryotherapy for foreign body removal in children

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Caution to use bronchoscopic CO₂cryotherapy for foreign body removal in children