Interventional Chest/Diagnostic Procedures (IC/DP) NetWork
General Bronchoscopy
(Safety, Complications, General Guidelines,
Bronchoalveolar Lavage, and Basic Diagnostic Bronchoscopy)
Fagon JY. Diagnosis and treatment of ventilator-associated pneumonia: fiberoptic bronchoscopy with bronchoalveolar lavage is essential. Semin Respir Crit Care Med 2006; 27:34-44 PubMed Abstract
A review of the diagnosis of ventilator-associated pneumonia with BAL.
Mehta AC, Prakash UB, Garland R, et al. American College of Chest Physicians and American Association for Bronchoscopy consensus statement: prevention of bronchoscopy-associated infection. Chest 2005; 128:1742-1755
A review of prevention of bronchoscopy-related infections.
Meyer KC. The role of bronchoalveolar lavage in interstitial lung disease. Clin Chest Med 2004; 25:637-649 PubMed Abstract
A review of the use of BAL in the diagnosis of the interstitial lung diseases.
Chhajed PN, Glanville AR. Management of hypoxemia during flexible bronchoscopy. Clin Chest Med 2003; 24:511-516 PubMed Abstract
A review of the management of hypoxemia during flexible bronchoscopy.
Pisani RJ. Clinical utility of bronchoalveolar lavage in immunocompromised hosts. Mayo Clin Proc 1992; 67:221-227 PubMed Abstract
A review of the utility and role of bronchoalveolar lavage in establishing a diagnosis in the immunocompromised host.
Ouellette DR. The safety of bronchoscopy in a pulmonary fellowship program. Chest 2006; 130:1185-1190
A retrospective review of preexisting quality improvement data from a single center comprising 51 pulmonary and critical care fellows, 20 staff supervising physicians, and a total of 3,538 training bronchoscopies. The cumulative complication rate for the first trimester of the first year of fellowship was 3.1%, whereas the cumulative complication rate in the second and third trimester of the first year of fellowship was 1.57%.
Gorman SR, Beamis JF. Complications of flexible bronchoscopy. Clin Pulm Med 2005; 12:177-183 Abstract
A review of the most common and uncommon complications with recommendations for prevention and treatment.
Gundy KV, Boylen CT. Fiberoptic bronchoscopy: indications, complications, contraindications. Postgrad Med 1988; 83:289-294 PubMed Abstract
A review of general indications for bronchoscopy, as well as a review of the literature on diagnostic yield with the use of bronchoscopy for specific individual infectious and noninfectious disease states.
Wahidi MM, Rocha AT, Hollingsworth JW, et al. Contraindications and safety of transbronchial lung biopsy via flexible bronchoscopy: a survey of pulmonologists and review of the literature. Respiration 2005; 72:285-295 PubMed Abstract
Describes the varied practices among pulmonologists, with specific attention to the practice of holding anticoagulation medications prior to bronchoscopy.
Colt HG, Matsuo T. Hospital charges attributable to bronchoscopy-related complications in outpatients. Respiration 2001; 68:67-72 PubMed Abstract
Reviews the incidence of cost secondary to the treatment of bronchoscopic complications. Hospital charges that are directly attributable to outpatient flexible bronchoscopy-related complications are minimal, but escalate considerably if hospitalization becomes necessary.
de Blic J, Marchac V, Scheinmann P. Complications of flexible bronchoscopy in children: prospective study of 1,328 procedures. Eur Respir J 2002; 20:271-1276 PubMed Abstract
Flexible bronchoscopy is a safe procedure with <2% major complications. Careful analysis of indications and clinical status for each patient, as well as proper anesthesia and monitoring during the examination, ensure better outcomes.
Cavaliere S, Foccoli P, Farina PL. Nd:YAG laser bronchoscopy: a 5-year experience with 1,396 applications in 1,000 patients. Chest 1988; 94:15-21
A review of a large number of patients with central airway obstruction treated with rigid bronchoscopy and laser, as well as a description of outcomes and safety in this procedural technique.
Caputi M, Bellissimo U, Di Matteo L, et al. Complications during bronchofiberscopy and rigid bronchoscopy. Panminerva Med 1986; 28:271-277
PubMed Abstract
A 40-year experiential review of complications seen with flexible and rigid bronchoscopy.
Perrin G, Colt HG, Martin C, et al. Safety of interventional rigid bronchoscopy using intravenous anesthesia and spontaneous assisted ventilation: a prospective study. Chest 1992; 102:1526-1530
Total intravenous anesthesia and spontaneous assisted ventilation is well-tolerated in patients undergoing rigid bronchoscopy.
Infections and Infection Prevention in Bronchoscopy
Mehta AC, Prakash U, Garland R, et al. American College of Chest Physicians and the American Association of Bronchology Consensus Statement: prevention of flexible bronchoscopy-associated infection. Chest 2005; 128:1742-1755
A consensus guideline on strategies for reducing procedural-related infections from bronchoscopy.
Cetre JC, Nicolle MC, Salord H, et al. Outbreaks of contaminated broncho-alveolar lavage related to intrinsically defective bronchoscopes. J Hosp Infect 2005; 51:39-45 PubMed Abstract
Description of a 2001 outbreak of Enterobacteraceae in BAL fluid in a 700-bed institution, as well as the process troubleshooting of such an occurrence.
Ramsey A, Oemig T, Davis JP, et al. An outbreak of bronchoscopy-related Mycobacterium tuberculosis infections due to lack of bronchoscope leak testing. Chest 2002; 121:976-981
M tuberculosis contamination of the bronchoscope occurred during an index patient’s procedure. Standard reprocessing recommendations, including the leak test, should be strictly followed to reduce cross contamination.
Centers for Disease Control. Bronchoscopy-related infections and pseudoinfections—New York, 1996 and 1998. MMWR 1999; 48:557-560 PubMed Abstract
A review of cluster cases involving Mycobacteriium tuberculosis, M intracellulare, and imipenem-resistant Pseudomonas aeruginosa in bronchoscopy.
Safety of Bronchoscopy in Specific Patient Populations
Dweik RA, Mehta AC, Meeker DP, et al. Analysis of the safety of bronchoscopy after recent acute myocardial infarction. Chest 1996; 110:825-828
A retrospective chart review of 20 patients from 1986 to 1994 who underwent bronchoscopy while hospitalized for acute myocardial infarction. The authors concluded that flexible bronchoscopy is safe in the immediate post-acute myocardial infarction period, as long as the patient does not have active ischemia at the actual time of the procedure.
Dunagan DP, Burke HL, Aquino SL, et al. Fiberoptic bronchoscopy in coronary care unit patients: indications, safety, and clinical implications. Chest 1998; 114:1660-1667
Bronchoscopy may be diagnostically safe and useful in evaluating pulmonary abnormalities in select patients with acute cardiac disease; however, its role must be further studied. In this report, a positive bronchoscopic culture was associated with a higher mortality in the 40 patients studied.
D’Aloi A, Faggiano P, Fiorina C, et al. Cardiac arrest due to ventricular fibrillation as a complication occurring during rigid bronchoscopic laser therapy. Monaldi Arch Chest Dis 2003; 59:88-90 PubMed Abstract
A case description of a 31-year-old female with cicatricial stenosis of the left main stem bronchus from prior M tuberculosis who developed an episode of prolonged cardiac arrest due to ventricular fibrillation.
Matot I, Drenger B, Glantz L, et al. Coronary spasm during outpatient fiberoptic laser bronchoscopy. Chest 1999; 115:1744-1746
A case report of a 63-year-old female with metastatic breast carcinoma undergoing laser resection of an endobronchial mass. There was no evidence of significant hypoxemia during the procedure. Coronary vasospasm was observed upon coronary angiography.
Peikert T, Rana S, Edell ES. Safety, diagnostic yield, and therapeutic implications of flexible bronchoscopy in patients with febrile neutropenia and pulmonary infiltrates. Mayo Clin Proc 2005; 80:1414-1420 PubMed Abstract
A favorable safety record, good diagnostic yield, and therapeutic implications support the routine use of BAL for the neutropenic patient with pulmonary infiltrates. This is a retrospective review of 35 patients in this patient demographic. The results from BAL and/or transbronchial biopsy resulted in a management change in 51% of these patients.
Antonelli M, Conti G, Riccioni L, et al. Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients. Chest 1996; 110:724-728
Eight patients enrolled in this study with the aim to assess feasibility and safety of noninvasive positive-pressure ventilation via a face mask to aid in bronchoscopy with BAL in immunosuppressed patients with significant gas exchange abnormalities. NPPV was found to significantly improve gas exchange and bronchoscopy could be carried out. A causative pathogen was identified by BAL in all patients and resulted in specific treatment. Use of NPPV can be considered during bronchoscopy of immunocompromised patients with hypoxemia.
Hattotuwa K, Gamble E, O’Shaughnessy T, et al. Safety of bronchoscopy, biopsy, and BAL in research patients with COPD. Chest 2002; 122:1909-1912
Fifty-seven patients were studied with mild, moderate, and severe COPD. There was a reported incidence of 2% adverse events requiring hospital treatment; the patients with moderate and severe disease were at higher risk. Severe bronchospasm and pneumothorax were some of the adverse events reported. There were no deaths. Minor hemoptysis at 3.1% requiring no intervention was reported. Overall bronchoscopy with biopsy and BAL was concluded to be safe for all degrees of COPD, as long as safety guidelines were followed during the procedure.
Chetta A, Foresi A, Bertorelli G, et al. Lung function and bronchial responsiveness after bronchioalveolar lavage and bronchial biopsy performed without premedication in stable asthmatic subjects. Chest 1992; 101:1563-1568
Thirteen mild and stable asthmatic patients were studied with assessments of PEFR before, and immediately after, bronchoscopic BAL and bronchial biopsy. The authors concluded that these procedures could be performed safely following administration of only local anesthesia.
Djukanovic R, Wilson JW, Lai CK, et al. The safety aspects of fiberoptic bronchoscopy, bronchoalveolar lavage, and endobronchial biopsy in asthma. Am Rev Respir Dis 1991; 143:772-777 PubMed Abstract
Physiologic effects of bronchoscopy with BAL and endobronchial biopsy performed under local anesthetic were studied in 20 subjects with asthma and 8 healthy nonatopic control subjects. The degree of measurable bronchospasm in a preprocedure methacholine challenge appeared to predict patients who have responsive airways. It was concluded that the asthmatic patients had a larger degree of desaturation during biopsy, and that, while bronchoscopy seemed to be safely performed in these patients, those with a larger degree of bronchial hyperresponsiveness as measured by PC20 were at higher risk of complications.
Humbert M, Robinson DS, Assoufi B, et al. Safety of fiberoptic bronchoscopy in asthmatic and control subjects and effect on asthma control over two weeks. Thorax 1996; 51:664-669
PunMed Abstract
A study population of both asthmatic and control subjects was assessed with PEFR before, immediately after, and 2 weeks after bronchoscopy. After bronchial biopsies, there was no difference between the median maximal fall in PEFR or arterial oxygen saturation between asthmatic patients and the control group. The authors found bronchoscopy to be well tolerated in asthmatic subjects. They suggest that the fall in PEFR in asthmatics and control subjects is secondary to sedation rather than bronchospasm.
Bahhady I, Ernst A. Risks of and recommendations for flexible bronchoscopy in pregnancy: a review. Chest 2004; 126:1974-1981
A review of potential risks specific to the pregnant patient.
Weiss SM, Hert RC, Gianola FJ, et al. Complications of fiberoptic bronchoscopy in thrombocytopenic patients. Chest 1993; 104:1025-1028
A prospective study of 47 bone marrow transplant patients undergoing BAL with varying levels of thrombocytopenia. BAL was diagnostic in 47 % of patients. There was an incidence of complications of 12% in the patients with thrombocytopenia—four patients were reported specifically to have hemoptysis and/or epistaxis, and all complications but one were minor and self-limiting.
Hertz MI, Woodward ME, Gross CR, et al. Safety of bronchoalveolar lavage in the critically ill, mechanically ventilated patient. Crit Care Med 1991; 19:1526-1532
PubMed Abstract
A retrospective case series of 99 critically ill patients who underwent bronchoscopy with BAL. No procedure required termination due to complications. BAL was well tolerated when risk factors such as hypoxemia or coagulopathy were addressed and treated before the procedure. The researchers noted that the degree of transient hypoxemia could not be predicted prior to the procedure.
Miscellaneous
Shetty PG, Fatterpekar GM, Manohar S, et al. Fatal cerebral air embolism as a complication of transbronchoscopic lung biopsy: a case report. Australas Radiol 2001; 45:215-217 PubMed Abstract
A single case report of a rare complication seen in bronchoscopy.
Harar RP, Pratap R, Chadha N, et al. Bilateral tension pneumothorax following rigid bronchoscopy. J Laryngol Otol 2005; 119:400-402 PubMed Abstract
A case report of the complication of tension pneumothorax during airway manipulation.
Overview of Interventional Pulmonology
Wahidi MM, Herth FJ, Ernst A. State of the art: interventional pulmonology. Chest 2007; 131:261-274
A review of various interventional pulmonology techniques.
Colt HG, Harrell JH. Therapeutic rigid bronchoscopy allows level of care changes in patients with acute respiratory failure from central airway obstruction. Chest 1997; 112:202-206
A retrospective review of 32 patients with acute respiratory distress. Nineteen required mechanical ventilation with central airway obstruction, 18 had benign pathologic findings, and 14 had malignant pathologic findings. Following the interventional procedure, 52.6% was successfully extubated and the acute level of care was altered successfully.
Becker HD, March BR. History of rigid bronchoscope. Progr Respir Res 2000; 30:2-15
A broad, historic review of the beginnings of the role of rigid bronchoscopy.
Lamb CR, Beamis JF. Rigid bronchoscopy: an interventional tool with a history and a future. In: Beamis JF, Mathur P, Mehta AC, eds. Interventional Pulmonary Medicine. New York, NY: Marcel Dekker, 2004; 13-31
A practical review of the basic technique and application of rigid bronchoscopy with a guide of recommended elements to incorporate in an interventional practice. A section is included about ventilator strategy during rigid bronchoscopy.
Helmers RA, Sanderson DR. Rigid bronchoscopy: the forgotten art. Clin Chest Med 1995; 16:393-399 PubMed Abstract
A general review of indications, contraindications, and applications of rigid bronchoscopy.
Tracheobronchial Stents
Saad CP, Murthy S, Krizmanich G, et al. Self-expandable metallic airway stents and flexible bronchoscopy long-term outcomes analysis. Chest 2003; 124:1993-1999
A retrospective review of benign and malignant airway diseases with observation of outcomes in metallic airway stents.
Wood DE. Airway stenting. Chest Surg Clin N Am 2001; 11:841-860 PubMed Abstract
A review of indications, contraindications, and stent selection that is disease-specific.
Vonk-Noordegraff A, Postmus PE, Sutejda TG. Tracheobronchial stenting in the terminal care of cancer patients with central airway obstruction. Chest 2001; 120:1811-1814
A retrospective analysis of symptomatic patients with central airway obstruction, conducted to evaluate the palliative benefit of stent insertion.
Electrocautery and Argon Plasma Coagulation and Cryotherapy
Sheski FD, Mathur PN. Cryotherapy, electrocautery and brachytherapy. Clin Chest Med 1999; 20:123-138 PubMed Abstract
A review and practical application of three modalities of airway therapies.
Boxem T, Muller M, Venmans B, et al. Nd-YAG laser vs bronchoscopic electrocautery for palliation of symptomatic airway obstruction: a cost-effectiveness study. Chest 1999; 116:1108-1112
A comparative study of the cost of laser vs electrocautery in the treatment of airway obstruction, with the results favoring electrocautery as an effective and less expensive modality.
Keller CA, Hinerman R, Singh A, et al. The use of endoscopic argon plasma coagulation in airway complications after solid organ transplantation. Chest 2001; 119:1968-1975
A brief report on the use of APC in patients presenting with benign airway diseases.
Morice RC, Ece T, Ece F, et al. Endobronchial argon plasma coagulation for treatment of hemoptysis and neoplastic airway obstruction. Chest 2001; 119:781-787
One of the largest reported experiences with argon plasma coagulation in the treatment of airway obstruction (60 patients).
Thoracic Ultrasound
Jones WJ, Moyers JP, Rogers JT, et al. Ultrasound-guided thoracentesis: is it a safer method? Chest 2003; 123:418-423
A prospective study assessing the incidence of complications from thoracentesis performed under ultrasound guidance by interventional radiologists.
Beckh S, Bolcskei PL, Lessnau KD. Real-time chest ultrasonography: a comprehensive review for the pulmonologist. Chest 2002; 122:1759-1773
A review of real-time ultrasonography of the chest with practical application for the pulmonologist.
Pleural Catheters for Management of Pleural Effusions
Pien GW, Gant M, Washam C, et al. Implantable pleural catheter for “trapped lung” syndrome in patients with malignant pleural effusions. Chest 2001; 119:1641-1646
Indications for symptom relief in the patient with trapped lung and recurrent pleural effusions.
Ohm C, Park D, Vogen M, et al. Use of an indwelling pleural catheter compared with thoracoscopic talc pleurodesis in the management of malignant pleural effusions. Am Surg 2003; 69:198-202 PubMed Abstract
A prospective observational study comparing the two arms of treatment.
Pleural Disease
Lee P, Colt HG. Rigid and semirigid pleuroscopy: the future is bright. Respirology 2005; 10:418-425 PubMed Abstract
A review of pleuroscopy using rigid and semirigid instrument techniques.
Rodriguez-Panadero F, Janssen JP, Astoul P. Thoracoscopy: general overview and place in the diagnosis and management of pleural effusion. Eur Respir J 2006; 28:409-422 PubMed Abstract
A review of the use of thoracoscopy in the management of malignant pleural effusions.
Percutaneous Dilational Tracheostomy
Freeman BD, Isabella K, Lin N, et al. A meta-analysis of prospective trials comparing percutaneous and surgical tracheostomy in critically ill patients. Chest 2000; 118:1412-1418
A meta-analysis comparing surgical vs percutaneous approaches to tracheostomy.
Lung Cancer: Diagnosis and Staging
Hansra IK, Ernst A. Bronchoscopic-directed diagnosis of peripheral lung lesions suspicious for cancer. Thorac Surg Clin 2007; 17:159-165 PubMed Abstract
A review of currently available techniques and technologies for bronchoscopic diagnosis of peripheral lung lesions.
Yasufuku K, Fujisawa T. Staging and diagnosis of non-small cell lung cancer: invasive modalities. Respirology 2007; 12:173-183 PubMed Abstract
A review of invasive techniques, including bronchoscopic modalities such as endobronchial ultrasound for the staging of non-small cell lung cancer.
Herth FJ, Krasnik M, Vilmann P. EBUS-TBNA for the diagnosis and staging of lung cancer. Endoscopy 2006; 38 (suppl):S101-S105 PubMed Abstract
A review of the use of endobronchial ultrasound in the diagnosis and staging of lung cancer.
Herth FJ, Eberhardt R, Ernst A. The future of bronchoscopy in diagnosing, staging, and treatment of lung cancer. Respiration 2006; 73:399-409 PubMed Abstract
A review of new bronchoscopic technologies, such as endobronchial ultrasound, autofluorescence bronchoscopy, electromagnetic navigation, narrow band imaging, and confocal microscopy in the diagnosis and staging of lung cancer.
Gildea TR, Mazzone PJ, Karnak D, et al. Electromagnetic navigation diagnostic bronchoscopy: a prospective study. Am J Respir Crit Care Med 2006; 174:982-989 PubMed Abstract
A prospective study of peripheral lung lesions and mediastinal node sampling via electromagnetic navigation.
Holty JE, Kuschner WG, Gould MK. Accuracy of transbronchial needle aspiration for mediastinal staging of non-small cell lung cancer: a meta-analysis. Thorax 2005; 60:949-955 PubMed Abstract
A meta-analysis of the accuracy of TBNA for mediastinal staging of non-small cell lung cancer. Analysis includes studies using blind and image-guided TBNA sampling.
Thermoplasty
Cox G, Thomson NC, Rubin AS, et al. Asthma control during the year after bronchial thermoplasty. N Engl J Med 2007; 356:1327-1337 PubMed Abstract
A study of the effect of bronchial thermoplasty on the control of moderate to severe persistent asthma.
Endobronchial Lung Volume Reduction
Hopkinson NS. Bronchoscopic lung volume reduction: indications, effects, and prospects. Curr Opin Pulm Med 2007; 13:125-130 PubMed Abstract
A review of the current status of bronchoscopic lung volume reduction technologies.
Interventional Procedures in Miscellaneous Pulmonary Diseases
Lois M, Noppen M. Bronchopleural fistulas: an overview of the problem with special focus on endoscopic management. Chest 2005; 128:3955-3965
A review of bronchoscopic techniques for management of bronchopleural fistulas.
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