Rendimiento diagnóstico del aspirado bronquial en pacientes con tuberculosis pulmonar con baciloscopía de esputo negativo en el Hospital Militar Central. 2011-2012 / Diagnostic yield of bronchial aspirate in patients with pulmonary tuberculosis with negative sputum smear at the Central Military Hospital. 2011-2012

Estudio realizado en el Hospital Militar Central de tipo descriptivo, retrospectivo, transversal en pacientes mayores de 15 años sintomáticos respiratorios, con patrón radiológico anormal y con baciloscopía directa en esputo y/o esputo inducido negativos en, por lo menos, 2 oportunidades y a quienes para descartar tuberculosis (TBC) pulmonar se les realizó broncofibroscopía; durante el periodo 2011-2012. El objetivo fue el de determinar la utilidad del aspirado bronquial obtenido por broncofibroscopía en el diagnóstico de TBC pulmonar. Se real izaron 146 broncofibroscopías a igual número de pacientes. El diagnóstico de tuberculosis pulmonar se realizó en 129 pacientes, evaluándose los resultados del examen directo de cada una de las muestras así obtenidas y del cultivo del aspirado bronquial. Encontramos que la sensibilidad (Se) y Especificidad (Es) para el examen directo del aspirado bronquial fue de 30.00 por ciento y 96.20 por ciento con un valor predictivo positivo (VPP) de 83.33 por ciento y un valor predictivo negativo (VPN) de 68.47 por ciento. Para el cultivo del lavado bronquial, se encontró una Sensibilidad (Se) del 38.75 por ciento y Especificidad del 100 por ciento, con un VPP del 100 por ciento y VPN del 17.71 por ciento. Cuando consideramos juntos el examen directo del aspirado bronquial y cultivo del aspirado bronquial encontramos una Sensibilidad y Especificidad de 46.31 por ciento y 100 por ciento. Concluyéndose que el examen directo del aspirado bronquial obtenidas por broncofibroscopía más el cultivo del aspirado bronquial incrementa la sensibilidad para el diagnóstico de tuberculosis en más de un 40 por ciento. Por lo que es un procedimiento sencillo, válido y de gran utilidad para el diagnóstico de Tuberculosis.

Study conducted at the "Hospital Militar Central" descriptive, retrospective, cross in patients older than 15 years with respiratory symptoms, abnormal radiographic pattern direct sputum smear and/or induced sputum negative in at least 2 opportunities and those for rule out tuberculosis (TB) underwent pulmonary bronchoscopy, during the period 2011-2012. The objective was to determine the usefulness of bronchial aspirate obtained by bronchoscopy in the diagnosis of pulmonary TB. Were performed 146 bronchoscopies an equal number of patients were performed. Diagnosis of pulmonary tuberculosis was conducted in 129 patients, and the results assessed direct each of the samples thus obtained and bronchial aspirate cultivation examination. We found that the sensitivity (Se) and specificity (Sp) for direct examination of bronchial aspirate was 30.00 per cent and 96.20 per cent with a positive predictive value (PPV) of 83.33 per cent and a negative predictive value (NPV) of 68.47 per cent. For the culture of bronchial washing sensitivity (Se) of 38.75 per cent and specificity of 100 per cent was found, with a PPV of 100 per cent and NPV of 17.71 per cent. When we consider together the direct examination of bronchial aspirate and culture of bronchial aspirate found a sensitivity and specificity of 46.31 per cent and 100 per cent. Concluding that the direct examination of bronchial aspirate obtained by bronchoscopy growing more bronchial aspirates increases the sensitivity for the diagnosis of tuberculosis in more than 40 per cent. So it is a simple, valid and useful for the diagnosis of Tuberculosis procedure.

Broncofibroscopia para el manejo de las secreciones respiratorias en pacientes ventilados / Bronchoscopy for the management of respiratory secretions in ventilated patients

La ventilación mecánica artificial es un soporte para el paciente crítico en la unidad de cuidados intensivos. Uno de los mayores problemas en pacientes con insuficiencia respiratoria aguda bajo sopote ventilatorio es la presencia de secreciones respiratorias. Ellas provocan obstrucción de la vía aérea artificial, la tráquea y los bronquios, alterando el flujo de gas hacia y desde los alvéolos, además se convierten en un factor predisponente en la génesis de las atelectasias y la neumonía asociada a la ventilación mecánica artificial. Las terapias convencionales como hidratación, antibióticos, esteroides, agentes mucolíticos, fisioterapia respiratorias, broncodilatadores y aspiraciones endotraqueales a ciegas no son totalmente efectivas. Se realizó un estudio experimental controlado donde quedaron demostradas las ventajas del proceder al encontrarse menos secreciones respiratorias moderadas y abundantes después del cuarto día de ventilación

Artificial mechanical ventilation is a support for the critically ill patient in intensive care unit. One of the biggest problems in patients with acute respiratory failure in ventilatory support is the presence of respiratory secretions. They cause obstruction of the artificial airway, trachea and bronchus, altering the gas flow to and from the alveoli also they become a predisposing factor in the genesis of atelectasis and pneumonia associated to artificial mechanical ventilation. Conventional therapies such as hydration, antibiotics, steroids, mucolytic agents, respiratory physiotherapy, bronchodilators, and blind endotracheal aspirations are not entirely effective.A controlled experimental study was carried out where they were demonstrated the benefits of the procedure to be less moderate and abundant respiratory secretions after the fourth day of ventilation

Broncofibroscopia para el manejo de la atelectasia y los estudios microbiológicos en pacientes ventilados / Bronchoscopy for the atelectasis management and microbiological studies in ventilated patients

La atelectasia es una complicación frecuente en pacientes bajo ventilación mecánica artificial que aumenta la estadía, los costos y la mortalidad de los pacientes en la unidad de cuidados intensivos, representa un problema sin resolver para el paciente ventilado, tiene efecto deletéreo sobre algunos parámetros ventilatorios como la diferencia álveolo-arterial de oxígeno, la relación entre presión de oxígeno y fracción inspirada de oxígeno y la compliancia pulmonar, la broncofibroscopia es efectiva para prevenirla, diagnosticarla y tratarla en este grupo de enfermos. Obtener muestras de secreciones respiratorias para estudios microbiológicos en pacientes ventilados ha sido un tema muy debatido en la literatura médica, disminuir la frecuencia de neumonía asociada a la ventilación mecánica y aislar el germen responsable es muy útil para la elección del antimicrobiano, la broncofibroscopia demuestra ser superior a otras técnicas incluida la aspiración con sondas a ciegas en los pacientes ventilados

Atelectasis is a frequent complication in patients on artificial ventilation which increases the stay, cost and mortality of patients in the intensive care unit is an unsolved problem for the ventilated patient, has deleterious effect on some ventilatory parameters as alveolar-arterial oxygen difference, the relationship between oxygen pressure and fraction of inspired oxygen and lung compliance, bronchoscopy is effective to prevent, diagnose it and treat it in this group of patients. Get samples of respiratory secretions for microbiologic studies in ventilated patients has been a very debated topic in the literature, reducing pneumonia frequency associated with mechanical ventilation and isolate the responsible germ is very useful for the choice of antimicrobial, the bronchoscopy shows be superior to other techniques including aspiration probe blindly in ventilated patients

Correlação entre a radiologia tóracica e a broncofibroscopia em pacientes com suspeita de Câncer de pulmão. Análise de 67 exames. / Correlation between the thoracic radiolofy and fiberoptic bronchoscopy in patients with suspected lung cancer. Analysis of 67 procedures.

Introdução: a broncofibroscopia (BFC), a tomografia computadorizada (TC) e a teleradiografia de tórax (Rx) são métodos complementares de investigação no câncer de pulmão (CP). A identificação de anormalidades radiológicas como atelectasia ou massa pulmonar precedendo a realização da BFC parecem aumentar a curácica diagnóstica da BCF. O objetivo deste estudo foi avaliar a correlação entre radiologia torácica e o rendimento diagnóstico da BFC no CP em um Hospital Universitário no Rio de Janeiro. Métodos: Foram avaliados retrospectivamente os prontuários de pacientes cuja indicação do exame havia sido suspeita de câncer de pulmão, submetidos à BFC no período entre 1º Janeiro de 2001 e 31 de Março de 2002. Os autores descrevem as anormalidades radiológicas mais comumente associadas ao diagnóstico de CP. Resultados: 67 pacientes (48 homens) foram estudados, com uma média de idade de 64 anos (44 a 87 anos). A BFC Teve o seu maior rendimento diagnóstico entre os pacientes com massa pulmonar ao Rx (58%, 38/67) e com lesão visível à endoscopia (84%, 56/57). A correlação entre radiologia e diagnóstico broncoscópico de CP foi de 90% (60/67). Conclusão: BFC e a radiologia são métodos complementares usados na investigação de pacientes de CP. O Rx e a TC de tórax são úteis na suspeita de câncer de pulmão, com excelentes correlação entre a suspeita de doenças na radiologia e a visualização direta na BFC.

Introduction: fiberoptic bronchoscopy (FB), thoracic computed tomography (CT) and chest radiograph are complementary methods of investigating patients with lung cancer (LC). Chest radiographic abnormalities such as pulmonary mass or atelectasis prior to FB have been shown diagnostic value in a attempt to increase the diagnostic yield of the FB. The aim of this study was to evaluate the correlation between thoracic radiology and bronchoscopic for the LC diagnosis in a Universitary Hospital in Rio de Janeiro. Methods: medical charts of patients who underwent FB from January 1, 2001 to March, 31, 2002 because lung cancer suspected were evaluted. The authors describe the most frequent radiographics abnormalities related to the LC diagnosis suspected. Results: 67 patients (48 men) were studied with a mean age of 64 years (range 44-87). FB had higher diagnostic yield among patients with pulmonary mass on the chest radiograph (58%, 38/65) and visible lesion on endoscopy (84%, 56/67). The correlation between radiology and bronchoscopic diagnosis of LC was 90% (60/67). Conclusion: FB and radiology are complementary methods used in the investigation of patients with suspicion of LC. Chest radiographs and CT had been shown to be of value prior to FB in the investigation of malignancy, with excellent correlation between the detection of diase on radiology and direct visualisation at FB.