ABSTRACT
BACKGROUND: Early detection of bacterial pathogens in the lower airway is an important part of managing CF. This study aimed to assess the diagnostic accuracy of oropharyngeal suction (OPS) samples in obtaining airway bacterial cultures in young children with cystic fibrosis (CF), and the level of child distress caused by obtaining OPS samples. METHODS: Young children with CF undergoing broncho-alveolar lavage (BAL) as part of concurrent research or routine annual surveillance were studied. OPS was performed by stimulating a cough and suctioning the back of the oropharynx in the awake child to replicate clinical practice. BAL of the right upper, middle and lingula lobes was then performed. Samples were sent for standard bacterial culture. The child's distress during OPS was rated using the Groningen Distress Scale (1=calm, 2=timid/nervous, 3=serious distress but still under control, 4=serious distress with loss of control, 5=panic). RESULTS: There were 65 paired samples obtained from 39 children (21 boys, mean age on day of first sampling was 34.1months, SD 19.1months). For Pseudomonas aeruginosa, specificity, sensitivity, NPV and PPV with 95% CI were 98% (87-99), 75% (20-96), 98% (91-98) and 60% (15-93%) respectively. In all age groups combined, median level of distress was 3 (IQR 2-4), with distress highest in 2 and 3year olds, with a median of 4 (IQR 3-4). CONCLUSION: OPS has diagnostic utility in determining the absence of organisms in the lower airway, with specificity for P.aeruginosa detection of 98%. However, a positive OPS result is not necessarily a good indicator of lower airway infection. Distress levels were high during OPS, mostly in 2 and 3year olds.
Subject(s)
Bronchoalveolar Lavage , Cystic Fibrosis , Oropharynx/microbiology , Pseudomonas Infections/diagnosis , Pseudomonas aeruginosa/isolation & purification , Respiratory Tract Infections , Specimen Handling , Suction , Australia , Bronchoalveolar Lavage/adverse effects , Bronchoalveolar Lavage/methods , Bronchoalveolar Lavage/psychology , Child, Preschool , Cystic Fibrosis/diagnosis , Cystic Fibrosis/microbiology , Dimensional Measurement Accuracy , Early Diagnosis , Female , Humans , Infant , Male , Psychomotor Agitation/diagnosis , Psychomotor Agitation/etiology , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/microbiology , Specimen Handling/adverse effects , Specimen Handling/methods , Specimen Handling/psychology , Sputum/microbiology , Suction/adverse effects , Suction/methods , Suction/psychologyABSTRACT
Although a rare condition, pulmonary alveolar proteinosis (PAP) can be a very devastating diagnosis with life-altering consequences. This case study follows the path of a young woman who is currently undergoing whole lung lavage as treatment for pulmonary alveolar proteinosis. The entire concept of flooding a lung with large quantities of saline as a treatment for lung disease is contrary to normal respiratory care. Caring for the patient with PAP provides many challenges for the perianesthesia nurse. Management of the postanesthesia airway, oxygen administration and maintenance of oxygen saturation, and pain relief skills are all of high importance to the patient with PAP. These skills plus the emotional support provided by the experienced perianesthesia nurse can ensure a safe recovery from this unusual procedure.
Subject(s)
Bronchoalveolar Lavage/nursing , Postanesthesia Nursing/organization & administration , Pulmonary Alveolar Proteinosis/therapy , Adult , Anesthesia Recovery Period , Bronchoalveolar Lavage/adverse effects , Bronchoalveolar Lavage/methods , Bronchoalveolar Lavage/psychology , Dyspnea/etiology , Female , Humans , Hyperbaric Oxygenation , Nurse's Role , Nursing Assessment/methods , Oxygen Inhalation Therapy , Pain, Postoperative/etiology , Pain, Postoperative/nursing , Patient Care Planning , Patient Care Team/organization & administration , Patient Selection , Physical Examination/nursing , Pulmonary Alveolar Proteinosis/complications , Pulmonary Alveolar Proteinosis/diagnosis , Pulmonary Alveolar Proteinosis/psychology , Social SupportABSTRACT
OBJECTIVE: This study investigated the potential for predicting which patients would have a negative emotional reaction to bronchoscopy. METHODOLOGY: A questionnaire was distributed to 120 patients who had undergone diagnostic fibreoptic bronchoscopy. A visual analog scale to evaluate the patient's discomfort was adopted. Multiple linear regression analysis was used to determine factors significantly influencing discomfort. The regression model included the following variables: age, gender, symptoms, smoking habits, proximal bronchial brushing, distal bronchial brushing, bronchial washing, proximal transbronchial biopsy, transbronchial lung biopsy, examination time, the bronchoscopist's experience, and the patient's anxiety level. RESULTS: The bronchoscopist's experience (P = 0.001) and the patient's anxiety level (P < 0.001) were variables that significantly influenced discomfort. These results suggest that discomfort decreased with the bronchoscopist's experience and increased with the patient's anxiety regarding bronchoscopy. CONCLUSIONS: The results suggest that subjective discomfort can be predicted both by the bronchoscopist's experience and by a questionnaire about the patient's anxiety level before bronchoscopy. Therefore, it is recommended that the patient's anxiety level be determined through the use of a questionnaire before bronchoscopy, and that more experienced bronchoscopists should take charge if the patient is judged as being excessively anxious. If experienced bronchoscopists are unavailable, the more anxious patient should receive more sedatives.
Subject(s)
Bronchoscopy , Pain/etiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Anxiety/psychology , Attitude to Health , Biopsy/psychology , Bronchoalveolar Lavage/psychology , Bronchoscopy/methods , Bronchoscopy/psychology , Cytodiagnosis/psychology , Female , Fiber Optic Technology , Forecasting , Humans , Male , Middle Aged , Pain/psychology , Pain Measurement , Sex Factors , Time FactorsABSTRACT
STUDY OBJECTIVES: Asymptomatic HIV-infected individuals are increasingly recruited for studies involving invasive procedures such as bronchoscopy. We sought to determine the response to and outcome of a request for a research bronchoscopy in HIV-positive individuals with no respiratory disease, and whether this would adversely affect future decisions to have a medically indicated bronchoscopy. DESIGN AND SETTING: Prospective, semistructured, questionnaire-based study in a London teaching hospital HIV outpatient clinic. PARTICIPANTS: One hundred and seven consecutive HIV-infected eligible individuals. Thirty-one healthy volunteers served as a control group for the subjective response to bronchoscopy. MAIN OUTCOME MEASURES: Subjects' attitudes and responses to requests for bronchoscopy and subsequent behavior when they required medically indicated bronchoscopy. RESULTS: Seventy-five patients (70%) agreed to the procedure in principle, predominantly for altruistic reasons. Thirty-nine subjects underwent bronchoscopy. Five percent found it worse than expected; and 79% agreed to another research bronchoscopy (performed in 11 subjects approximately 2 years later). All patients said they would undergo bronchoscopy again for diagnostic purposes (required in seven during the study). When compared to a healthy volunteer population within the same study, postbronchoscopy symptoms were similar in frequency although somewhat different in nature. Subjects felt that a clear explanation of what was involved enhanced their participation in this research. CONCLUSIONS: Invasive research procedures such as bronchoscopy can be performed and are repeatable in a healthy HIV-infected population. Performance of procedures for research purposes does not appear to adversely affect future health-care decisions.