Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 23
Filter
1.
BMC Anesthesiol ; 22(1): 90, 2022 04 02.
Article in English | MEDLINE | ID: covidwho-1833280

ABSTRACT

BACKGROUND: Apart from conventional reusable bronchoscopes, single-use bronchoscopes (SUB) were recently introduced. Data suggest that SUB might prevent from the risk of cross contamination (i.e. multiresistant pathogens, SARS CoV-2) and save costs. We aimed to investigate visualization, ventilation, handling characteristics, changes in patients' gas exchange, and costs associated with both types of bronchoscopes during percutaneous dilatational tracheostomy (PDT). METHODS: In this prospective, randomized, noninferiority study, 46 patients undergoing PDT were randomized 1:1 to PDT with SUB (Ambu aScope) or reusable bronchoscopes (CONV, Olympus BF-P60). Visualization of tracheal structures rated on 4-point Likert scales was the primary end-point. Furthermore, quality of ventilation, device handling characteristics, changes in the patients' gas exchange, pH values, and costs were assessed. RESULTS: Noninferiority for visualization (the primary endpoint) was demonstrated for the SUB group. Mean visualization scores (lower values better) were 4.1 (95% confidence intervals: 3.9;4.3) for SUB vs. 4.1 (4.0;4.2) for CONV. Noninferiority of ventilation (estimated by minute volume and SpO2) during the procedure could be shown as well. Mean score was 2.6 (2.0;3.1) for SUB vs. 2.4 (2.1;2.7) for CONV (lower values better). No significant differences regarding handling (SUB: 1.2 (1.0;1.4), CONV: 1.3 (1.1;1.6)), blood gas analyses and respiratory variables were found. Cost analysis in our institution revealed 93 € per conventional bronchoscopy versus 232.50 € with SUB, not considering an estimate for possible infection due to cross-contamination with the reusable device. CONCLUSION: In our study, visualization and overall performance of the SUB during PDT were noninferior to reusable bronchoscopes. Therefore, PDT with SUB is feasible and should be considered if favored by individual institution's cost analysis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03952247 . Submitted for registration on 28/04/2019 and first posted on 16/05/2019.


Subject(s)
Bronchoscopes , COVID-19 , Dilatation , Humans , Prospective Studies , Tracheostomy/methods
2.
Monaldi Arch Chest Dis ; 92(3)2021 Dec 16.
Article in English | MEDLINE | ID: covidwho-1593755

ABSTRACT

Pulmonary hamartomas represent the most frequent family of benign lung tumors that typically involve the lung parenchyma and only rarely grow as endobronchial tumors. The elective treatment of endobronchial hamartoma is the bronchoscopic resection, and in those cases in which tumor extension and localization makes it not possible, surgical treatment must be evaluated. Patients with symptomatic COVID-19, hospitalized, frequently undergo a chest CT scan and in some cases, occasional findings may emerge, requiring diagnostic investigations such as bronchoscopy and interventional pulmonology procedures. Therefore, in such a delicate pathological condition, such as COVID-19, the need to perform bronchoscopy and interventional pulmonology procedures, minimizing the risk of viral transmission and ensuring necessary assistance, represents a great challenge for pulmonologists. In this article authors describe, for the first time in literature, a rare case of endobronchial hamartoma, radically resected using a single use bronchoscope, in a young female patient hospitalized for symptomatic COVID-19.


Subject(s)
Bronchial Diseases , COVID-19 , Hamartoma , Lung Neoplasms , Bronchial Diseases/pathology , Bronchoscopes , Bronchoscopy/methods , Female , Hamartoma/diagnosis , Hamartoma/pathology , Hamartoma/surgery , Humans
5.
Respir Res ; 21(1): 320, 2020 Dec 02.
Article in English | MEDLINE | ID: covidwho-1388763

ABSTRACT

BACKGROUND: The disposable bronchoscope is an excellent alternative to face the problem of SARS-CoV-2 and other cross infections, but the bronchoscopist's perception of its quality has not been evaluated. METHODS: To evaluate the quality of the Ambu-aScope4 disposable bronchoscope, we carried out a cross-sectional study in 21 Spanish pulmonology services. We use a standardized questionnaire completed by the bronchoscopists at the end of each bronchoscopy. The variables were described with absolute and relative frequencies, measures of central tendency and dispersion depending on their nature. The existence of learning curves was evaluated by CUSUM analysis. RESULTS: The most frequent indications in 300 included bronchoscopies was bronchial aspiration in 69.3% and the median duration of these was 9.1 min. The route of entry was nasal in 47.2% and oral in 34.1%. The average score for ease of use, image, and aspiration quality was 80/100. All the planned techniques were performed in 94.9% and the bronchoscopist was satisfied in 96.6% of the bronchoscopies. They highlighted the portability and immediacy of the aScope4TM to start the procedure in 99.3%, the possibility of taking and storing images in 99.3%. The CUSUM analysis showed average scores > 70/100 from the first procedure and from the 9th procedure more than 80% of the scores exceeded the 80/100 score. CONCLUSIONS: The aScope4™ scored well for ease of use, imaging, and aspiration. We found a learning curve with excellent scores from the 9th procedure. Bronchoscopists highlighted its portability, immediacy of use and the possibility of taking and storing images.


Subject(s)
Attitude of Health Personnel , Bronchoscopes , Bronchoscopy/instrumentation , Disposable Equipment , Health Knowledge, Attitudes, Practice , Pulmonologists , Clinical Competence , Cross-Sectional Studies , Equipment Design , Health Care Surveys , Humans , Learning Curve , Prospective Studies , Spain
7.
Expert Rev Med Devices ; 18(5): 439-443, 2021 May.
Article in English | MEDLINE | ID: covidwho-1199410

ABSTRACT

Introduction: The reduction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission has been achieved through numerous public health initiatives worldwide. In the hospital environment, certain high-risk procedures have the potential to cause transmission of the virus to health-care workers and nosocomial transmission to patients through different mechanisms including the generation of aerosols and fomite formation via contamination of medical devices.Areas covered: Aerosol-generating procedures such as bronchoscopy are considered high risk for SARS-CoV-2 transmission. As a result, single-use devices should be used where possible and changing to single-use flexible bronchoscopes has been advised by respiratory societies internationally. In this paper, we outline the rationale for this advice and have analyzed the evidence relating to the reduction in SARS-CoV-2 transmission arising from a switch to these single-use devices and the potential impact that this switch may have on the quality of pulmonology services.Expert opinion: In this paper, we outline the rationale for this advice and have analyzed the evidence relating to the reduction in SARS-CoV-2 transmission arising from a switch to these single-use devices and the potential impact that this switch may have on the quality of pulmonology services.


Subject(s)
Bronchoscopes , COVID-19/prevention & control , Cross Infection/prevention & control , Cross Infection/virology , Bronchoscopy , COVID-19/virology , Humans , Risk Factors , SARS-CoV-2/physiology
8.
Adv Respir Med ; 89(4): 448-450, 2021.
Article in English | MEDLINE | ID: covidwho-1196089

ABSTRACT

Bronchoscopy is an aerosol-generating procedure and involves a high risk of transmission of SARS-CoV-2 to health care workers. There are very few indications for performing bronchoscopy in a patient with confirmed COVID-19. These include atelectasis, foreign body aspiration, and suspected superinfection in immunocompromised patients. Proper use of standard personal protective equipment is mandatory to reduce the risk of transmission to health care workers. In this article, we describe a case of acute lung collapse in a 16-year-old boy with cerebral palsy who was infected with COVID-19. This patient responded to therapeutic bronchoscopy and had complete resolution of lung collapse within 24 hours of the procedure.


Subject(s)
Bronchoscopy/methods , COVID-19/therapy , Pulmonary Atelectasis/therapy , Acute Disease , Adolescent , Bronchoscopes , COVID-19/complications , Humans , Male , Pulmonary Atelectasis/etiology , Treatment Outcome
9.
Expert Rev Respir Med ; 15(6): 773-779, 2021 06.
Article in English | MEDLINE | ID: covidwho-1165209

ABSTRACT

Introduction: Bronchoscopy and related procedures have unambiguously been affected during the Corona Virus Disease 2019 (COVID-19) pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus-2 (SARS COV-2). Ordinary bronchoscopy practices and lung cancer services might have changed over this pandemic and for the years to come.Areas covered: This manuscript summarizes the utility of bronchoscopy in COVID-19 patients, and the impact of the pandemic in lung cancer diagnostic services, in view of possible viral spread during these We conducted a literature review of articles published in PubMed/Medline from inception to November 5th, 2020 using relevant terms.Expert opinion: Without doubt this pandemic has changed the way bronchoscopy and related procedures are being performed. Mandatory universal personal protective equipment, pre-bronchoscopy PCR tests, dedicated protective barriers and disposable bronchoscopes might be the safest and simpler way to perform even the most complicated procedures.


Subject(s)
Bronchoscopy , COVID-19/epidemiology , COVID-19/therapy , Cross Infection/prevention & control , Practice Patterns, Physicians' , Bronchoscopes/microbiology , Bronchoscopes/standards , Bronchoscopes/virology , Bronchoscopy/instrumentation , Bronchoscopy/methods , Bronchoscopy/standards , COVID-19/prevention & control , COVID-19/transmission , Equipment Contamination/prevention & control , History, 21st Century , Humans , Lung Neoplasms/diagnosis , Medical Oncology/instrumentation , Medical Oncology/methods , Medical Oncology/standards , Pandemics , Personal Protective Equipment/virology , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/trends , SARS-CoV-2/physiology
10.
Monaldi Arch Chest Dis ; 91(2)2021 Mar 02.
Article in English | MEDLINE | ID: covidwho-1119589

ABSTRACT

Severe Acute Respiratory Syndrome due to Coronavirus-19 (SARS-CoV-2) is caused by combined alveolar-capillary lung damage, with bilateral pneumonia and thrombosis, which often causes respiratory failure. Proper COVID-19 management requires high skills in airway control and the need to perform aerosol-generating procedures such as bronchoscopy, which can increase the possibility of virus spreading among healthcare professionals. In an epidemiologically delicate moment, the multidisciplinary decision on "WHEN, HOW and WHY" to perform bronchoscopies minimizing the risk of COVID-19 transmission, represented a great challenge for all specialists engaged in bronchoscopic procedures. In this work authors want to share all technical aspects of 87 videobronchoscopies performed in confirmed or suspected COVID-19 patients, from 3rd to 6th January 2020, describing the reason, the organizational and operational model and patients characteristics. Was also evaluated the impact of high-risk procedures such as bronchoscopy on the personnel involved. The disclosure of all technical details, represents, in the opinion of the authors, an important contribution, capable of providing support to all physicians engaged in bronchoscopy procedures in confirmed or suspected COVID-19 patients.


Subject(s)
Airway Management , Bronchoscopy , COVID-19/prevention & control , Infection Control/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Bronchoscopes , COVID-19/diagnosis , COVID-19/transmission , Humans , Patient Selection , Personal Protective Equipment
12.
Respiration ; 100(1): 27-33, 2021.
Article in English | MEDLINE | ID: covidwho-1064198

ABSTRACT

BACKGROUND: Bronchoscopic sampling of bronchoalveolar fluid (BAL) should be safe and effective. Current sampling practice risks loss of sample to the attached negative flow, aerosolisation, or spillage, due to repeated circuit breaks, when replacing sample containers. Such concerns were highlighted during the recent coronavirus pandemic. OBJECTIVES: Evaluation of an alternative integrated sampling solution, with the Ambu Bronchosampler with aScope 4, by an experienced bronchoscopist in ICU. METHODS: An observational study of 20 sequential bronchoscopic diagnostic sampling procedures was performed on mechanically ventilated patients with suspected ventilator-associated pneumonia. Mixed methods assessment was done. The predefined outcome measures were (1) ease of set up, (2) ease of specimen collection, (3) ease of protecting specimen from loss or spillage, and (4) overall workflow. The duration of the procedure and the % volume of sample retrieved were recorded. RESULTS: The mean (±standard deviation [SD]) time for collecting 1 sample was 2.5 ± 0.8 min. The mean (±SD) specimen yield for instilled miniBAL was 54.2 ± 17.9%. Compared with standard sampling, the set-up was much easier in 18 (90%), or easier in 2 (10%) of procedures, reducing the connection steps. It was much more intuitive to use in 14 (70%), more intuitive in 4 (20%), and no more intuitive to use in 2 (10%). The overall set-up and workflow was much easier in 69% of the 13 intraprocedural connections and easier or as easy in the remaining 31% procedures. All procedures where pre connection was established were much easier (7, 100%). The Ambu Bronchosampler remained upright in all procedures with no loss or spillage of sample. Obtaining a sample was much easier in 60%, easier in 10%, no different in 20%, and worse in 10%. The ability to protect a sample from start to finish compared to standard procedures was much easier in 80%, easier in 15%, and no different in 5% of procedures. Overall workflow was much easier in 14 (70%), easier in 4 (20%), and no different in 2 (10%) of procedures. CONCLUSIONS: The Ambu Bronchosampler unit was a reliable, effective, and possibly safer technique for diagnostic sampling in ICU. It may improve safety standards during the coronavirus pandemic. A randomized control trial against the standard sampling technique is warranted.


Subject(s)
Bronchoscopes , Bronchoscopy/methods , Disposable Equipment , Respiration, Artificial , Specimen Handling/methods , Bronchoalveolar Lavage/instrumentation , Bronchoalveolar Lavage/methods , Bronchoalveolar Lavage Fluid , Bronchoscopy/instrumentation , COVID-19/prevention & control , COVID-19/transmission , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Exposure/prevention & control , Patient Isolators , Personal Protective Equipment , Pneumonia, Ventilator-Associated/diagnosis , Risk Assessment , SARS-CoV-2
13.
Expert Rev Respir Med ; 15(4): 453-475, 2021 04.
Article in English | MEDLINE | ID: covidwho-1054202

ABSTRACT

Introduction: During the last 40 years equipment has been improved with smaller instruments and sufficient size working channels. This has ensured that bronchoscopy offers therapeutic and interventional options.Areas covered: We provide a review of recent advances and clinical challenges in pediatric bronchoscopy. This includes single-use bronchoscopes, endobronchial ultrasound, and cryoprobe. Bronchoscopy in persistent preschool wheezing and asthma is included. The indications for interventional bronchoscopy have amplified and included balloon dilatation, endoscopic intubation, the use of airway stents, whole lung lavage, closing of fistulas and air leak, as well as an update on removal of foreign bodies. Others include the use of laser and microdebrider in airway surgery. Experience with bronchoscope during the COVID-19 pandemic has been included in this review. PubMed was searched for articles on pediatric bronchoscopy, including rigid bronchoscopy as well as interventional bronchoscopy with a focus on reviewing literature in the past 5 years.Expert opinion: As the proficiency of pediatric interventional pulmonologists continues to grow more interventions are being performed. There is a scarcity of published evidence in this field. Courses for pediatric interventional bronchoscopy need to be developed. The COVID-19 experience resulted in safer bronchoscopy practice for all involved.


Subject(s)
Bronchoscopes , Bronchoscopy/methods , Stents , Asthma , COVID-19/surgery , Child , Child, Preschool , Foreign Bodies/surgery , Humans , Intubation/methods
14.
Adv Ther ; 37(11): 4538-4548, 2020 11.
Article in English | MEDLINE | ID: covidwho-775209

ABSTRACT

The coronavirus disease (COVID-19) pandemic has highlighted the importance of reducing occupational exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The reprocessing procedure for reusable flexible bronchoscopes (RFBs) involves multiple episodes of handling of equipment that has been used during an aerosol-generating procedure and thus is a potential source of transmission. Single-use flexible bronchoscopes (SUFBs) eliminate this source. Additionally, RFBs pose a risk of nosocomial infection transmission between patients with the identification of human proteins, deoxyribonucleic acid (DNA) and pathogenic organisms on fully reprocessed bronchoscopes despite full adherence to the guidelines. Bronchoscopy units have been hugely impacted by the pandemic with restructuring of pre- and post-operative areas, altered patient protocols and the reassessment of air exchange and cleaning procedures. SUFBs can be incorporated into these protocols as a means of improving occupational safety. Most studies on the efficacy of SUFBs have occurred in an anaesthetic setting so it remains to be seen whether they will perform to an acceptable standard in complex respiratory procedures such as transbronchial biopsies and cryotherapy. Here, we outline their potential uses in a respiratory setting, both during and after the current pandemic.


Subject(s)
Bronchoscopes/trends , Bronchoscopy/trends , Coronavirus Infections/diagnosis , Equipment Contamination/prevention & control , Pneumonia, Viral/diagnosis , Betacoronavirus , COVID-19 , Disposable Equipment , Humans , Microbiological Techniques/trends , Pandemics , SARS-CoV-2
16.
J Otolaryngol Head Neck Surg ; 49(1): 66, 2020 Sep 14.
Article in English | MEDLINE | ID: covidwho-757114

ABSTRACT

We present the case of an eight year old boy who presented with foreign body aspiration during the COVID-19 pandemic. The patient was taken the operating room for rigid bronchoscopy and foreign body removal. The details of the operation, steps taken for protection of health care workers, and lessons learned are discussed. Bronchoscopy was performed using N95 respirators and Stryker Flyte Hood garments, combined with a streamlined instrument set-up. Simulation in advance of these cases improves communication and operative planning. Surgeons should have equipment to retrieve foreign bodies from the oropharynx available. Techniques that reduce surgical time and thus exposure risk should be considered.


Subject(s)
Betacoronavirus , Bronchi , Bronchoscopy/methods , Coronavirus Infections/complications , Foreign Bodies/surgery , Pandemics , Pneumonia, Viral/complications , Bronchoscopes , COVID-19 , Child , Coronavirus Infections/epidemiology , Equipment Design , Foreign Bodies/complications , Foreign Bodies/diagnosis , Humans , Male , Pneumonia, Viral/epidemiology , Radiography , SARS-CoV-2
18.
Zhonghua Jie He He Hu Xi Za Zhi ; 43(4): 332-334, 2020 Apr 12.
Article in Chinese | MEDLINE | ID: covidwho-591071

ABSTRACT

Endotracheal intubation is an independent risk factor for respiratory infectious diseases. We conducted a retrospective study in 12 cases with COVID-19 who underwent endotracheal intubation at ICU of the Guangzhou eighth hospital from January 20 to February 10, 2020. The intubation procedure, anesthetic regimen, and complication were collected and analyzed. The 9 healthcare workers who involved in intubation received virus nucleic acid test and 14 days temperature monitoring. All 12 patients were successfully intubated under the guidance of bronchoscope, without any complications. Midazolam, Propofol and Morphine or fentanyl were used for sedation and analgesia, avoiding patients cough and agitated during the procedure. The 9 healthcare workers were protected under the Personal Protective Equipment(PPE) with positive pressure protective hood. The detection of oropharyngeal swab virus nucleic acid were negative in all 9 healthcare workers, none of them had fever or any respiratory symptoms. The PPE with positive pressure protective hood should be needed to perform bronchoscope-guided endotracheal intubation in patients with COVID-19, it could strengthen to protect healthcare workers from virus exposure.


Subject(s)
Bronchoscopes , Coronavirus Infections/therapy , Intubation, Intratracheal , Personal Protective Equipment , Pneumonia, Viral/therapy , Betacoronavirus , COVID-19 , China , Coronavirus Infections/prevention & control , Humans , Infection Control , Intensive Care Units , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Retrospective Studies , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL