Bronchoscopy

The rigid bronchoscopy is only used today when a further opening and larger working channels for better insight and instrumentation are needed.

Under bronchoscopy means the endoscopic examination of the airways. The rigid bronchoscopy is now in almost all diagnostic and been replaced by flexible fiberoptic bronchoscopy most therapeutic indications. The rigid bronchoscopy is only used today when a further opening and larger working channels for better insight and instrumentation are needed. Investigation strong pulmonary hemorrhage (in the can better identify the rigid bronchoscope the source of bleeding and better suck the blood with its larger intake port and prevent suffocation) detecting and removing aspirated foreign bodies in young children recognition of obstructive endobronchial Läsionenfür possible Laserdebulking or stent placement. Flexible bronchoscopes are almost all compatible with a color video recorder, which simplifies the visualization and documentation of findings. Diagnostic flexible bronchoscopy enable direct visualization of the airways up to and including the subsegmental bronchi sampling of respiratory secretions and cells on BAL, brush biopsies and flushing of the peripheral airways and alveoli biopsy endobronchial, parenchymal and mediastinal structures Therapeutic applications include the extraction of recovered secretions, endobronchial stent placement, removal of foreign bodies and balloon dilatation of stenoses of the respiratory tract. Bronchoscopy ANTONIA REEVE / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl: ‘/-/media/manual/professional/images/m4400159-bronchoscopy-science-photo-library-high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/-/media/manual/professional/images/m4400159-bronchoscopy-science-photo-library-high_de.jpg?la=de&thn=0’, title: ‘bronchoscopy’ description: ” credits’ ANTONIA REEVE / SCIENCE PHOTO LIBRARY ‘, hideCredits: false, hideTitle: false, hideFigure: false, hideDescription: true}; var panel = $ (MManual.utils.getCurrentScript ()) Closest ( ‘image-element-panel.’). ko.applyBindings (model, panel.get (0)); Indications for flexible bronchoscopy procedure indication diagnosis Abnormal chest radiograph: To diagnose the etiology of pneumonia * in an immunocompromised patients; in an immunocompetent patients with recurrent or persistent disease or a patient with a paratracheal / mediastinal / hilar lesion, parenchymal mass or nodes, particularly in a proximal section of the lung atelectasis (persistent) Cough (persistent, inexplicable) * diffuser lung process (transbronchial lung biopsy ) investigation of rejection in recipients of lung transplants examination of the respiratory tract in patients with burns examination of bronchial disorders in a patient with chest trauma hemoptysis lung abscess in an edentulous patient (suspected endobronchial lesion) lung cancer staging positive sputum cytology in a patient with a normal chest x-ray * Assumed tracheoesophageal fistula Unexplained hoarseness or vocal cord paralysis wheezing (located / fixed) Therapeutic aspiration of retained secretions *, † bronchopulmonary lavage (pulmonary alveolar proteinosis) laser resection of the tumor ‡ treatment bronchopleural fistulas Photodynamic Therapy ‡ insertion of airway stents ‡ Place a tube in a difficult situation (neck injuries, anno male anatomy) removing a foreign body ‡ * Flexible bronchoscopy is indicated only after failure of less invasive examinations and treatments. † Flexible bronchoscopy is not a substitute for a physical therapy of the thorax, and Bronchodilatorenvernebelung nasotracheales suction. You should be left to hypoxia (for a ventilated patients) and / or lobarer atelectasis due to “impacted secretions refractory” compared with conventional therapy. ‡ The rigid bronchoscopy provides more control in instrumental interventions than the flexible bronchoscopy and can be helpful. Contraindications Absolute contraindications include Non-catchable life-threatening arrhythmias Missing possibility Acute to provide the patient during the procedure with sufficient oxygen respiratory failure with hypercapnia (unless the patient is intubated and ventilated) Severe tracheal obstruction Relative contraindications: Uncooperative patients More recently, myocardial infarction Incorrigible coagulopathy due to the increased bleeding risk transbronchial biopsies in patients with uremia, obstruction of the upper vena cava or pulmonary hypertension should be taken with caution. However, the inspection of the airways is low risk in these patients. Procedure bronchoscopy should only pulmonologist or other appropriately trained personnel (doctors of other disciplines, n. D. Talk .: possibly respiratory therapists for secretion removal) under the supervision of the patient, usually a suitably equipped in special examination rooms, operating theaters or on ITS (in ventilated patients) be performed. Patients should be at least 6 hours before the examination not eaten and i.v. Have access. Intermittent blood pressure measurement, continuous pulse oximetry monitoring and a monitor should be made. Additional administration of oxygen should be. Widely used is a premedication with atropine 0.01 mg / kg i.m. or iv to reduce mucus production and vagal tone. In recent studies, this approach has been questioned. Most patients receive prior to the procedure, anesthesia with short-acting benzodiazepines and / or opioids, to reduce anxiety, discomfort and cough. In some hospitals, general anesthesia (z. B. deep sedation with propofol and airway control over endotracheal intubation or use of a larynx mask) is applied prior to bronchoscopy general. First, throat and vocal cords are sprayed with nebulized lidocaine or (1 or 2% strength up to 250-300 mg for a patient weighing 70 kg). The bronchoscope is smeared and either through the nostril, the mouth, which is held open by a teething ring or block or by an artificial respiration flow such. B. introduced an endotracheal tube. After inspection of the nasopharynx and larynx, doctors push against the endoscope during inspiration through the glottis into the trachea and then further distally into the Bronchialraum. Depending on the indication, additional measures may possibly under fluoroscopy, are performed. Bronchial lavage: saline is injected through the bronchoscope, and then aspirated from the respiratory tract. Brush biopsy: A small brush is inserted through the bronchoscope, can be removed with the suspect for obtaining cells Mukosabezirke under vision. Bronchoalveolar lavage: 50-200 ml of sterile saline solution to be injected into the distal bronchial tree and then suction filtered to obtain cells, proteins and micro-organisms from the alveoli. By lavage caused local edema can lead to a temporary hypoxemia. Transbronchial biopsy: A small pliers is advanced through the bronchoscope and the respiratory tract, and so one or more samples taken from the lung parenchyma. Trans Bronchial biopsies can be performed without fluoroscopy. However, studies show under fluoroscopic a higher diagnostic accuracy and lower Pneumothoraxinzidenz. Transbronchial needle aspiration: A retractable needle is inserted through the bronchoscope and can be used to scan an enlarged lymph nodes or masses. Endobronchial ultrasound (EBUS) can be used to guide the needle biopsy. The patients usually get an extra dose of oxygen and monitored for 2-4 hours after treatment. The two main signs of full recovery are reinstated translated gag reflex and adequate oxygen saturation without additional administration of oxygen. P. a. Chest x-ray absorption for Pneumothoraxausschluss by transbronchial biopsy is a clinical standard. Complications Severe complications are rare; in 10-15% of patients lighter bleeding from biopsy sites and fever occur. Premedication can lead to oversedation with reduced respiratory drive, drop in blood pressure and cardiac arrhythmias. Rarely topically applied local anesthetics cause laryngospasm, bronchospasm, seizures, methemoglobinemia with refractory cyanosis or arrhythmias and even cardiac arrest. Bronchoscopy itself can cause Small laryngeal edema or injury with hoarseness hypoxemia in patients with compromised gas exchange arrhythmias (most frequently premature atrial contractions, premature ventricular contractions or bradycardia) passing the infection of suboptimal sterilized devices (very rare), the mortality rate is 1-4 / 10,000 patients. The highest risk in elderly patients and patients with existing severe comorbidities (severe COPD, coronary heart disease, pneumonia with hypoxemia, advanced tumor diseases, psychiatric disorders). Transbronchial biopsy can pneumothorax (2-5%) (0.1%) cause significant bleeding (1-1.5%), or death, but by carrying out the procedure, a thoracotomy is often avoided.

Health Life Media Team

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