Surfactant therapy using a bronchofiberscope in respiratory distress syndrome.

BACKGROUND: Avoiding endotracheal intubation and using nasal continuous positive airway pressure as the initial treatment is recommended in infants with respiratory distress syndrome (RDS), and modes of lesser invasive surfactant administration have recently been reported. We report a pilot study assessing the feasibility of surfactant therapy using a bronchofiberscope (STUB) in RDS. METHODS: Surfactant was administered to 31 preterm infants (gestational age range of 28 weeks 0 days to 36 weeks 6 days) diagnosed with RDS, through the working channel of the bronchofiberscope or endotracheal tubes. Patient characteristics, outcomes, adverse events, and comorbidities were assessed in the two groups. RESULTS: Twelve infants received STUB. Two of the 12 infants (17%) needed subsequent intubation and additional surfactant administration. Nineteen infants received surfactant through endotracheal tubes. Four of the 19 infants (21%) required additional surfactants. There was no significant difference in the number of infants that needed additional surfactant (p = 1.00). Gestational age, birthweight, length of hospitalization, adverse events, such as desaturations and bradycardias, and comorbidities were similar between the two groups. Days of invasive ventilation were significantly shorter in the STUB group (p = 0.0002). CONCLUSION: STUB was feasible in this small cohort and reduced the need for intubation to 17%, leading to fewer days of invasive ventilation, without increasing comorbidities and adverse events. To the best of our knowledge, this is the first study to administer surfactants using bronchofiberscopes.

Pathogenic bacteria recovered from bronchial secretions by bronchofiberscope and their antibiotic resistance profile in bronchiectasis patients complicated with infection / 中国感染与化疗杂志

Objective To analyze the antibiotic resistance of pathogenic bacteria recovered from bronchial secretions by bronchofiberscope in bronchiectasis patients complicated with infection for improving antibacterial therapy. Methods A total of 97 bronchiectasis patients complicated with infection treated in Liyuan Hospital during the period from June 2013 to December 2015 were included in this analysis. The pathogens were recovered from bronchial secretions by bronchofiberscope and subjected to antimicrobial susceptibility testing by Kirby-Bauer disc method. The data were analyzed with WHONET 5.5 software. Results Pathogenic organisms were isolated from 53 (54.6%) of the 97 patients, including 49 (92.4%) strains of gram negative bacilli, mainly Pseudomonas aeruginosa, followed by Acinetobacter baumannii, Klebsiella pneumoniae, 3 (5.7%) strains of?gram?positive?cocci,?specifically?2?strains?of?S. aureus and 1 strain of S. pneumoniae, and 1 (1.9%) strain of Candida albicans. Antimicrobial susceptibility testing showed that most P. aeruginosa isolates (>71.8%) were susceptible to tobramycin, amikacin,cefepime, and aztreonam, but 100% resistant to levofloxacin. More A. baumannii isolates were susceptible to tobramycin and amikacin (both 85.7%), followed by imipenem (>42.9%). More than half (>50%) of the K. pneumoniae isolates were resistant to cefotaxime, gentamycin, ciprofloxacin, and levofloxacin.Conclusions Gram negative bacilli are dominant in the pathogenic organisms recovered from bronchial secretions in bronchiectasis patients complicated with infection. Most of the pathogens are relatively susceptible to tobramycin and amikacin, but resistant to ciprofloxacin?and?levofloxacin.

Comparison of the clinical performances of Air-Qsp and i-Gel for airway management under general anesthesia with a muscle relaxant.

STUDY OBJECTIVES: Recently, i-Gel intubating laryngeal airway (ILA) has been frequently used because of the ease for airway insertion by residents and young anesthesiologists. However, it sometimes fails to fit or ventilate sufficiently in Japanese patients. Use of Air-Qsp, which is a new non-inflatable cuffed ILA, in a clinical setting has become possible. The purpose of this study was to compare the clinical performance of Air-Qsp with that of i-Gel for airway management in Japanese adult patients. DESIGN: A randomized, single-blinded, prospective study was conducted after approval from the institutional review board. SETTING: Operating rooms at hospitals. PATIENTS: Thirty-seven adult patients aged 20 to 69 years, with ASA physical status I or II, and scheduled for elective surgery under general anesthesia in the supine position. INTERVENTIONS: Patients were randomly assigned to insertion with Air-Qsp (Group A: n=20) or i-Gel (Group I: n=17). MEASUREMENTS: The number of insertions, duration of insertion, changes in systolic blood pressure and heart rate during insertion, delivered tidal volume for setting volume control ventilation, distribution of the tips of the bronchofiberscopes (BFs) on a clock face, and the number of postoperative complications was evaluated. MAIN RESULTS: Two patients in Group A and one patient in Group I were excluded because insertion of the device failed. There were no significant differences in measured parameters between the 2 groups. The distribution of the tips of the bronchofiberscopes tended to be around the center of the glottis in Group A, whereas they were more toward the 6-o'clock position in Group I. CONCLUSIONS: Air-Qsp is as useful as i-Gel in Japanese patients and the distributions of the tips of BFs through ILAs are different for Air-Qsp and i-Gel.

Study on Anesthesia Method Improvement for Branchofiberoscope / 中国药房

OBJECTIVE:To compare anesthesia effects of 3 anesthesia methods,to investigate anesthesia improvement method for bronch fiber oscope. METHODS:315 patients undergoing bronch fiber oscope were randomly divided into group A(106 cas-es),group B(104 cases)and group C(105 cases). Group A was treated with traditional bronch fiber oscope lidocaine atomization local anesthesia,group B was treated with modified bronch fiber oscope pethidine combined with lidocaine atomization local anes-thesia and group C was treated with three-limb tube connected with laryngeal mask and target-controlled propofol and remifentanil general anesthesia. SaO2,SBP,DBP,heart rate,breathing rate,excellent anesthesia rate,compliance rate,the rate of bodymove-ment and choking,pain recalling rate were compared among 3 groups before and during examination,and ADR was observed. RE-SULTS:Compared with before examination,SaO2 of group A was decreased significantly during examination,with statistical sig-nificance(P<0.05);that of group B and C had no obvious change before and during examination. Blood pressure,heart rate and breathing rate of 3 groups had no obvious change before and during examination. The excellent anesthesia rate and compliance rate of group A were significantly lower than those of group B and C,but the rate of bodymovement cough and pain recalling rate were significantly higher than group B and C,with statistical significantly(P<0.05). The excellent anesthesia rate and compliance rate of group B were significantly lower than those of group C,but the rate of bodymovement cough and pain recalling rate were signifi-cantly higher than group C,with statistical significance (P<0.05). No ADR was found in 3 groups. CONCLUSIONS:Modified bronchoscope atomization local anesthesia and modified painless bronchoscope are better than traditional bronch fiber oscope atomi-zation local anesthesia in anesthesia effect,safety,degree of comfort and acceptability. Modified bronchoscope atomization local an-esthesia was best but most expensive,so these methods can be chosen according to patient’s condition.

Effect of dexmedtomidine combined with low-dose ketamine on patients during sedative amnesia fiberoptic nasotracheal intubation / 临床麻醉学杂志

Objective To investigate the influence of low-dose ketamine and dexmedetomidine on cardiovascular response during. sedative amnesia fiberoptic nasotracheal intubation. Methods Ninety ASA Ⅰ or Ⅱ patients scheduled to recerve general anesthesia were evenly random-ized to dexmedetomidine and ketamine (group DK),dexmedetomidine and propofol (group DP)and dexmedetomidine and remifentanil (group DR).Ten minutes before intubation,the patients in group DK received intravenously dexmedetomidine 1.0 μg/kg plus ketamine 0.5 mg·kg-1 ·h-1 ;those in group DP received intravenously dexmedetomidine 1.0 μg/kg plus propofol 2.0 mg · kg-1 · h-1 ;those in group DR received intravenously dexmedetomidine 1.0 μg/kg plus remifentanil 5.0μg·kg-1 ·h-1 .Nasotracheal intubation was performed with fiberoptic bronchoscopy after dexemeto-midine injection and complete topical anesthesia.HR,MAP,SpO 2 and Ramsay sedation score were re-corded before anesthesia (T0 ,baseline),before intubation (T1 ),immediately intubated (T2 )and five minutes after intubation (T3 ).Side effects such as restlessness,bucking,respiratory depression and cardiovascular event during intubation and awareness of intubation were also recorded.Results All pa-tients in three groups were performed successfully.HR and MAP were significantly decreased in groups DP and DR at T1 (P <0.05),SpO 2 was significantly decreased in group DP at T1 (P <0.05);MAP in group DR were higher than those in group DP,HR in groups DP and DR were significantly increased than those in group DK at T3 (P < 0.05 );Ramsay score were significantly decreased in groups DP and DR at T2 ,significantly lower in group DR at T3 than those in groups DK and DP (P<0.05).The incidences of bradycardia and respriatory depression were significantly higher in group DP than those in group DK,and bucking,restlessness,tachycardia incidence rate in group DR were significantly higher than those in groups DK and DP (P <0.05).Conclusion Dexmedetomidine com-bined with low dose ketamine together with topical anesthesia is an ideal method for sedative amnesia fiberoptic nasotracheal intubation with slighter cardiovascular response and less side effects.

COMPARATIVE STUDY ON ORTHO-PHTHALALDEHYDE AND GLUTARALDEHYDE FOR DISINFECTION BRONCHOSCOPY / 现代医院

Objective Comparative study of the disinfection expense , turnover rate and the effect on health of ortho-phthalaldehyde and glutaraldehyde used for disinfection of bronchofiberscope , to provide the basis of the promoted application of domestic ortho -phthalaldehyde .Methods Based in turnover time of each bronchofiber-scope, the maxminal disinfection expense in month , the maxminal number of bronchofiberscope in month and the maxminal net value were compared with medical revenue in month .Two different disinfections are calculated .Ques-tionnaires about the effects were sent to twenty workers from the supply room involved in using two different disinfec -tion liquid, and the results were analyzed .Results The disinfection expenses of ortho -phthalaldehyde were higher than that of glutaraldehyde , but bronchofiberscope turnover rate increased by 50%, while medical net revenue in-creased by 40%.According to the questionnaires , the respiratory and conjunctival irritation of the workers were mi-nor, and the symptom of any skin irritation did not appear .Conclusion Although the expense increased , ortho-phthalaldehyde obviously improved the bronchofiberscope turnover rate and medical net revenue ,reduced the staff oc-cupational exposure and equipment residual effects on patients .Thus, ortho-phthalaldehyde is an efficient disinfect-ant that is worthy of being promoted in clinical practice .

Clinical features of airway malacia in children: a retrospective analysis of 459 patients.

AIM: To investigate the clinical features of airway malacia in children. MATERIAL AND METHODS: A comprehensive analysis was done on information of 459 young patients with airway malacia. RESULTS: Number of children with tracheomalacia, tracheobronchomalacia, and bronchomalacia was 7 (1.5%), 17 (3.7%), and 435 (94.8%), respectively. Incidence of bronchomalacia in left lung was 11.0% (n=48), while that of right lung was 53.3% (n=232). Meanwhile, bronchomalacia of both lungs were noticed in 155 children (35.6%). With regards to the extent of malacia, number of children with slight, moderate and severe malacia was 226, 195, and 38, respectively. All the children enrolled in this study were diagnosed with pulmonary infection, among which 376 were diagnosed with ordinary pneumonia, 83 were diagnosed with severe pneumonia. 227 children showed a disease course of less than 1 month, while 201 children reported a disease course of 1~3 months, and 31 children reported a disease course of more than 3 months. Statistical difference was noticed in the disease condition of respiratory tract infection of patients with various malacia extent (P < 0.05). Re-check of fiberoptic bronchoscopy was performed in 19 patients, among which 14 patients (73.7%) showed improvement compared with the previous conditions. CONCLUSION: Airway malacia has been frequently noticed in male children aged ≤ 2 years old. Patients with severe airway malacia were apt to develop severe pneumonia compared with those with slight or moderate malacia. Improvements or even elimination of malacia were noticed with the aging of the children and the anti-infection therapy.

Treatment of multi-drug resistance pulmonary tuberculosis by regional perfusion via bronchofiberscope / 中国医师进修杂志

Objective To evaluate the clinical value bronchofiberscope and perfusion in the treatment of multi- drug resistant pulmonary tuberculosis (MDR-TB).Methods Forty-two cases were treated by injecting amikacin (0.4 g), ofloxacin (0.4 g), after cleaning up exudation through bronchofiberscope and catheter intervention combined with chemotherapy therapy, while 37 controls were treated by chemotherapy only.Results By the end of 9 months, the sputum tubercle bacillus conversion rate, radiographical improvement rate were 92.9% and 90.5% respectively in the treated groups,while all these indications were higher than those of control group 62.2% and 59.5% (P

Bronchofiberscope and Catheter Intervention in Treatment of Multi-drug Resistant Pulmonary Tuberculosis(35 cases Report) / 中国医师杂志

Objective To evaluate the clinical value of bronchofiberscope and catheter intervention in treatment of multi-drug resistant pulmonary tuberculosis.Methods Thirty-five patients with multi-drug resistant pulmonary tuberculosis were treated by injecting drug gel,it was composed by rimifon and rifampin and aldinamide and capreomycin through bronchofiberscope and catheter in addition to chemotherapy,while thirty-five controls were treated by chemotherapy only.Results At the end of the treatment,the sputum bacterial conversion to negative rate was 88 5%,radiographic improvement rate was 82 9% and cavity closing rate was 31 4% in the treatment group,all of which were higher than in the controls(51 4%,45 7% and 11 4% respectively)(P

Comparative Analysis between CT Appearances,Bronchofiberscopic Results and Pathological Examinations in Bronchogenic Stenosis / 实用放射学杂志

Objective To evaluate CT and bronchofiberscopic value in diagnosing bronchogenic stenosis.Methods The CT and bronchofiberscopic appearances of bronchogenic stenosis in 45 cases were analysed comparatively with the results of the pathological examinations.Results Among the 45 cases, there were central pulmonary carcinoma in 25 patients, endobronchial tuberculosis in 10 patients, bronchogenic pneumonia in 9 patients and radiation pneumonia in 1 patient all confirmed pathologically. Conclusion CT and bronchofiberscope are of respectively advantages in diagnosing bronchogenic stenosis,combining both of them,the diagnosis and differential diagnosis of bronchogenic stenosis can be improved.