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 , SpainABSTRACT
OBJECTIVE: New endoscopic techniques have been developed as an alternative to surgical treatment of bronchopleural fistula. The objective of this study was to analyze our experience with endoscopic treatment of such fistulas. MATERIAL AND METHODS: We conducted a retrospective study of patients with bronchopleural fistula diagnosed by fiberoptic bronchoscopy. Patient characteristics, underlying disease, fistula size, and outcome of endoscopic treatment were analyzed. The endoscopic technique consisted of injection of fibrin sealants (Histoacryl and/or Tissucol) through the catheter of the fiberoptic bronchoscope. RESULTS: Between 1997 and 2004, 18 patients were diagnosed with bronchopleural fistula by fiberoptic bronchoscopy. All were men with a mean (SD) age of 62 (12) years. Bronchopleural fistula was diagnosed after neoplastic surgery in 16 patients, in the bronchial suture after lung transplantation in 1 patient, and concurrently with pleural effusion due to hydatidosis in the remaining patient. The size of the fistula ranged from 1 mm to 10 mm (mean 3.6 [2.7] mm). Fibrin sealants were applied in 14 patients, 2 underwent direct surgery after diagnosis, and the bronchopleural fistula closed spontaneously in the remaining 2. The fibrin sealant used was Histoacryl in 12 patients and Tissucol in 2. Pleural drainage was employed simultaneously and antibiotic therapy was administered at the discretion of the surgeon. The 4 patients whose bronchopleural fistula was associated with empyema also underwent pleural lavage. In 12 patients the fistulas closed as a result of the endoscopic technique (85.7%), and no complications were observed. For 85.7%, fewer than 3 applications of fibrin sealant were necessary. CONCLUSIONS: The success rate of closure of bronchopleural fistula with fibrin sealants injected under guidance with fiberoptic bronchoscopy is high and there are no complications. This technique can render surgery unnecessary.
Subject(s)
Bronchial Fistula/therapy , Bronchoscopy , Enbucrilate , Pleural Diseases/therapy , Respiratory Tract Fistula/therapy , Tissue Adhesives , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Objetivo: Se han desarrollado nuevas técnicas endoscópicas como alternativa al tratamiento quirúrgico de las fístulas bronquiales (FB). El objetivo de nuestro trabajo ha sido analizar nuestra experiencia en el tratamiento endoscópico de las FB. Material y métodos: Hemos realizado un estudio retrospectivo de los pacientes con FB diagnosticados por fibrobroncoscopia analizando sus características, enfermedad causal de la fístula, tamaño y resultados del tratamiento endoscópico. La técnica endoscópica consistió en la instilación mediante catéter a través del fibrobroncoscopio de sustancias sellantes (SS) (Histoacryl® y/o Tissucol®). Resultados: Entre 1997 y 2004 diagnosticamos 18 FB a través de fibrobroncoscopia, todas ellas en varones con una edad media (± desviación estándar) de 62 ± 12 años. En 16 pacientes la FB se produjo tras cirugía de neoplasia, en uno apareció en la sutura bronquial de un trasplante pulmonar y en otro fue simultánea a un derrame pleural por hidatidosis. El tamaño osciló entre 1 y 10 mm (media de 3,6 ± 2,7 mm). Aplicamos SS en 14 pacientes, en 2 se realizó cirugía directamente tras el diagnóstico y en otros 2 la FB cerró espontáneamente. Las SS utilizadas fueron Histoacryl® en 12 pacientes y Tissucol® en otros 2. Simultáneamente se empleó drenaje pleural y antibioterapia sistémica según criterio del cirujano. En los 4 casos donde la FB estaba asociada a empiema se aplicaron además lavados pleurales. La técnica endoscópica cerró la FB en 12 pacientes (85,7%) sin complicaciones asociadas. En el 85,7% fueron necesarias menos de 3 aplicaciones de SS. Conclusiones: La utilización de SS, mediante técnicas de fibrobroncoscopia, permite el cierre de las FB con un alto porcentaje de éxito, un número reducido de aplicaciones y nula morbilidad, evitando la cirugía de la fístula
Objective: New endoscopic techniques have been developed as an alternative to surgical treatment of bronchopleural fistula. The objective of this study was to analyze our experience with endoscopic treatment of such fistulas. Material and methods: We conducted a retrospective study of patients with bronchopleural fistula diagnosed by fiberoptic bronchoscopy. Patient characteristics, underlying disease, fistula size, and outcome of endoscopic treatment were analyzed. The endoscopic technique consisted of injection of fibrin sealants (Histoacryl® and/or Tissucol®) through the catheter of the fiberoptic bronchoscope. Results: Between 1997 and 2004, 18 patients were diagnosed with bronchopleural fistula by fiberoptic bronchoscopy. All were men with a mean (SD) age of 62 (12) years. Bronchopleural fistula was diagnosed after neoplastic surgery in 16 patients, in the bronchial suture after lung transplantation in 1 patient, and concurrently with pleural effusion due to hydatidosis in the remaining patient. The size of the fistula ranged from 1 mm to 10 mm (mean 3.6 [2.7] mm). Fibrin sealants were applied in 14 patients, 2 underwent direct surgery after diagnosis, and the bronchopleural fistula closed spontaneously in the remaining 2. The fibrin sealant used was Histoacryl® in 12 patients and Tissucol® in 2. Pleural drainage was employed simultaneously and antibiotic therapy was administered at the discretion of the surgeon. The 4 patients whose bronchopleural fistula was associated with empyema also underwent pleural lavage. In 12 patients the fistulas closed as a result of the endoscopic technique (85.7%), and no complications were observed. For 85.7%, fewer than 3 applications of fibrin sealant were necessary. Conclusions: The success rate of closure of bronchopleural fistula with fibrin sealants injected under guidance with fiberoptic bronchoscopy is high and there are no complications. This technique can render surgery unnecessary
