{"title":"Evaluating the Usefulness of the Insertion Tube Rotation Function of Bronchoscope in Cadaver Models.","authors":"Naofumi Shinagawa, Yuta Takashima, Masahiro Kashima, Daisuke Morinaga, Shotaro Ito, Kosuke Tsuji, Mineyoshi Sato, Hirofumi Takahashi, Tetsuaki Shoji, Megumi Furuta, Toshiaki Shichinohe, Satoshi Konno","doi":"10.1097/LBR.0000000000001005","DOIUrl":"10.1097/LBR.0000000000001005","url":null,"abstract":"<p><strong>Background: </strong>The Olympus bronchoscope is equipped with an insertion tube rotation function; however, data on its usefulness are currently limited. Here, we evaluated the amount of body and wrist movement required by bronchoscopists, the operability of the bronchoscope, and its ease of use with and without the insertion tube rotation function.</p><p><strong>Methods: </strong>This study was performed on 10 bronchoscopists using 2 cadaveric bodies. The primary endpoint was the amount of movement exerted by the bronchoscopist, which was evaluated using motion capture. We also assessed the deepest bronchial generations that could be reached by the bronchoscope and the time required for insertion. Immediately after the procedures, the bronchoscopists completed a questionnaire to evaluate their perceived difficulty level.</p><p><strong>Results: </strong>The bronchoscopists achieved a 33.5% reduction in wrist rotation (67.8 vs. 110.2 degrees, P<0.05) and a 23.9% reduction in body rotation (17.2 vs. 24.4 degrees, P<0.05) using the insertion tube rotation function for all segmental bronchi. During forceps insertion to simulated lesions, the bronchoscopists' body movement was reduced by 65.1% (11.6 vs. 33.9 degrees, P<0.05), and wrist rotation by 47.6% (63.5 vs. 122.7 degrees, P<0.05). Furthermore, bronchoscopists experienced significantly reduced difficulty inserting biopsy forceps toward simulated target lesions (3.9 vs. 3.2 points, P<0.05) and required less assistance (4.0 vs. 2.0 points, P<0.05) when using the insertion tube rotation function.</p><p><strong>Conclusion: </strong>The insertion tube rotation function of the bronchoscope facilitated its insertion and improved operability.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Enambir Josan, Nicholas Pastis, Jing Peng, Jianing Ma, Kamran Mahmood, Mauricio Danckers, Christian Ghattas, Alberto Revelo, Jasleen Pannu
{"title":"A Survey of Program Directors on Procedural Competence and Volume in the US Pulmonary and Critical Care Fellowships.","authors":"Enambir Josan, Nicholas Pastis, Jing Peng, Jianing Ma, Kamran Mahmood, Mauricio Danckers, Christian Ghattas, Alberto Revelo, Jasleen Pannu","doi":"10.1097/LBR.0000000000001004","DOIUrl":"10.1097/LBR.0000000000001004","url":null,"abstract":"<p><strong>Background: </strong>In the United States, Pulmonary and Critical Care Medicine (PCCM) fellowship training traditionally requires performing a minimum number of bronchoscopy and pleural procedures to be deemed competent. However, expert panel recommendations favor assessments based on skill and knowledge. PCCM trainees have a variable exposure to the advanced procedures in the presence of interventional pulmonary (IP) fellowships, so we surveyed the PCCM program directors (PD) across the United States to assess the procedural volume and competency of their fellows.</p><p><strong>Methods: </strong>Survey invitations were emailed between April 2022 and May 2022, and responses were collected from PCCM fellowship programs. The PD assessed the competency and volume of procedures performed by PCCM fellows at the end of training. The primary objective was to determine the effect of IP fellowship or IP faculty on fellows' procedural competency. The secondary objective was to assess the same impact on procedural volume.</p><p><strong>Results: </strong>The survey response rate was 41.9% (n=109/260) with an average of 4.23 fellows/program (95% CI: 3.9-4.6). 74.5% (73/98) programs reported having access to IP faculty, while 26.5% (26/98) had an AABIP-accredited IP fellowship. No significant difference was noted for procedural competency or volume in programs with or without an IP fellowship or IP faculty during training. Most programs reported that PCCM fellows do not perform advanced bronchoscopy procedures.</p><p><strong>Conclusion: </strong>An IP fellowship or IP faculty at a PCCM training institution did not appear to influence the PD-assessed volume or competency of common bronchoscopy and pleural procedures performed by fellows.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wilson S Tsai, Erin Haywood, Xinhua Li, Jeremy Rosenbaum, Brenna Lindsey
{"title":"Radiation in the Bronchoscopy Suite: One Center's Experience With Navigational Bronchoscopy and a Review of the Literature.","authors":"Wilson S Tsai, Erin Haywood, Xinhua Li, Jeremy Rosenbaum, Brenna Lindsey","doi":"10.1097/LBR.0000000000001001","DOIUrl":"10.1097/LBR.0000000000001001","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to quantify radiation doses during navigational bronchoscopy procedures, comparing them with reported cohorts and evaluating the LungVision (Body Vision Medical Inc.) system's efficacy in dose reduction.</p><p><strong>Methods: </strong>This retrospective observational study included 52 consecutive navigational bronchoscopy cases, categorized into 4 imaging groups based on the C-arm: Cios Spin (Siemens Healthineers), or OEC 9900 (GE HealthCare); and the 3D tomographic imaging algorithm: Cios Spin's onboard imaging, or LungVision's AI-driven imaging. Patient and lesion data, outcomes, and radiation indices were collected. Existing literature on 3D image guidance for bronchoscopic lung nodules was reviewed to compare reported radiation doses.</p><p><strong>Results: </strong>Combining LungVision with Cios Spin significantly reduced radiation dose in all cases compared with using Cios Spin alone: Cumulative air kerma (Ka,r) reduced from 238.7 to 119.1 mGy (P=0.03), and air kerma-area product (KAP) decreased from 28.19 to 15.09 Gy·cm2 (P=0.03). For biopsy cases, LungVision led to notable dose reductions: Ka,r of 279 to 129.1 mGy, and KAP of 30.70 to 16.27 Gy·cm2. LungVision notably reduced radiation indices in 7 paired spins, isolating the 3D imaging algorithm as the sole variable with the same Cios Spin C-arm. A literature review provides additional context on radiation for bronchoscopic biopsies.</p><p><strong>Conclusion: </strong>Following the \"as low as reasonably achievable\" (ALARA) principle minimizes ionizing radiation exposure, benefiting patients and operators. Physicians should compare baseline radiation levels with the literature and adopt dose-reduction techniques. LungVision's lower dose indices render it effective for real-time 3D imaging during navigational bronchoscopy while reducing radiation dose.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel Vis, Elaine Dumoulin, Erik Vakil, Paul MacEachern, Laila Samy, Chris Hergott, Alain Tremblay
{"title":"Use of Narrow Band Imaging to Guide Endobronchial Biopsy for Suspected Sarcoidosis.","authors":"Daniel Vis, Elaine Dumoulin, Erik Vakil, Paul MacEachern, Laila Samy, Chris Hergott, Alain Tremblay","doi":"10.1097/LBR.0000000000001000","DOIUrl":"10.1097/LBR.0000000000001000","url":null,"abstract":"<p><strong>Background: </strong>Diagnosis of sarcoidosis often involves endobronchial biopsy (EBB), but studies have shown varying yields for EBB in suspected sarcoidosis, partly due to differences in identifying abnormal mucosa under white light (WL). Narrow band imaging (NBI) may assist in the visualization of abnormal mucosa, but its role in sarcoidosis remains to be characterized.</p><p><strong>Methods: </strong>Individuals referred for suspected sarcoidosis were considered for enrollment. Bronchoscopy with both WL and NBI was conducted, followed by EBB. The main objectives were to characterize NBI abnormalities in this patient population and determine the incremental yield of NBI-directed EBB.</p><p><strong>Results: </strong>In our cohort of 100 suspected sarcoidosis patients (66% male, median age 42), 88 were diagnosed with sarcoidosis, through cytopathology (n=78) or clinical evaluation (n=10). NBI high-grade lesions were more common than WL high-grade lesions (58% vs. 27%, difference 31%, 95% CI 18.3-42.5% P<0.001). High-grade WL EBB were more likely to be positive than low-grade WL biopsies [20/31 (65%) vs. 20/91 (22%), odds ratio (OR) 6.5, 95% CI 2.7-15.6, P<0.01]). Conversely, high-grade NBI lesions were no more likely to be positive than low-grade NBI lesions [23/63 (37%) vs. 17/59, (29%), OR 1.42, 95% CI 0.66-3.0, P=0.366]. EBB positivity and false-negative EBUS-TBNA were more common in patients with Scadding stage 2 or greater, suggesting that the chest radiography stage may help select patients more likely to benefit from adjunctive EBB.</p><p><strong>Conclusion: </strong>NBI abnormalities are common in patients with sarcoidosis, but unlike WL abnormalities, do not predict the finding of granulomatous inflammation on EBB. The chest radiography stage may be useful to identify patients more likely to benefit from EBB in addition to EBUS-TBNA.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 2","pages":""},"PeriodicalIF":3.3,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gerard N Olive, Steven C Leong, Henry M Marshall, Ian A Yang, Rayleen V Bowman, Kwun M Fong
{"title":"Transbronchial Needle Aspiration via Ultrathin Bronchoscope Improves Diagnostic Yield for Peripheral Lung Lesions: Randomized Sequencing Trial.","authors":"Gerard N Olive, Steven C Leong, Henry M Marshall, Ian A Yang, Rayleen V Bowman, Kwun M Fong","doi":"10.1097/LBR.0000000000000996","DOIUrl":"10.1097/LBR.0000000000000996","url":null,"abstract":"<p><strong>Background: </strong>Peripheral pulmonary lesions (PPLs) are frequently identified and require diagnostic sampling. Diagnostic yield of radial endobronchial ultrasound (rEBUS) guided bronchoscopic biopsies is suboptimal, despite ultrasound confirmation of navigation success. Pairing ultrathin bronchoscopy and peripheral transbronchial needle aspiration (pTBNA) may improve yield.</p><p><strong>Methods: </strong>We prospectively recruited consecutive patients undergoing Olympus MP190F ultrathin bronchoscopy with rEBUS-guided sampling of PPLs. Cases were randomized to pTBNA (Olympus Periview FLEX) either before or after the usual transbronchial forceps biopsy (TBLBx) and brush. Diagnostic yield from cytology or histopathology, clinical outcomes to a minimum 24 months follow-up and complications were recorded.</p><p><strong>Results: </strong>One hundred one sampled lesions were included (pTBNA first 61, pTBNA last 40). Overall diagnostic yield was 66.3%, with no significant difference between groups (64% vs. 70% P=0.528) or prespecified subgroups according to sampling order. Seventy lesions had an end diagnosis of malignancy, of which 50 were correctly diagnosed (71.4%). TBLBx (49/96, 49%) and pTBNA (48/101, 47.5%) had the highest individual positive yield. For 12 (11.9%) participants, pTBNA was the only positive sample. Lesions <20 mm and those with eccentric rEBUS image seemed to benefit most from this approach. Rapid on-site cytologic examination (ROSE) was associated with both positive procedural diagnosis (P=0.019) and pTBNA-positive samples (P=0.004). Pneumothorax occurred in 4% and moderate bleeding in 5%. Thirteen percent had an unplanned admission within 1 month of bronchoscopy.</p><p><strong>Conclusion: </strong>Adding pTBNA to conventional sampling through an ultrathin bronchoscope guided by rEBUS, improved diagnostic yield (11.9% additional diagnoses). The sampling sequence did not affect the yield of pTBNA.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eveline C F Gerretsen, Marleen Groenier, Jouke T Annema, Erik H F M van der Heijden, Walther N K A van Mook, Arnoud F Aldenkamp, Emanuel Citgez, Laurence M M J Crombag, Wanda Hagmolen Of Ten Have, Birgitta I Hiddinga, Bart P C Hoppe, Maarten K Ninaber, Marianne A van de Pol, Bas Robberts, Marijke Rutten, Roy Sprooten, Michiel Wagenaar, Frank W J M Smeenk
{"title":"Basic Bronchoscopy Competence Achieved by a Nationwide One-day Simulation-based Training.","authors":"Eveline C F Gerretsen, Marleen Groenier, Jouke T Annema, Erik H F M van der Heijden, Walther N K A van Mook, Arnoud F Aldenkamp, Emanuel Citgez, Laurence M M J Crombag, Wanda Hagmolen Of Ten Have, Birgitta I Hiddinga, Bart P C Hoppe, Maarten K Ninaber, Marianne A van de Pol, Bas Robberts, Marijke Rutten, Roy Sprooten, Michiel Wagenaar, Frank W J M Smeenk","doi":"10.1097/LBR.0000000000000995","DOIUrl":"10.1097/LBR.0000000000000995","url":null,"abstract":"<p><strong>Background: </strong>In 2020, a mandatory, nationwide 1-day bronchoscopy simulation-based training (SBT) course was implemented for novice pulmonology residents in the Netherlands. This pretest-posttest study was the first to evaluate the effectiveness of such a nationwide course in improving residents' simulated basic bronchoscopy skills.</p><p><strong>Methods: </strong>After passing a theoretical test, residents followed a 1-day SBT course, available in 7 centers, where they practiced their bronchoscopy skills step-by-step on a virtual reality simulator under pulmonologist supervision. Residents practiced scope handling efficiency (task 1) and navigational skills combined with lung anatomy knowledge (task 2). Task 1 outcome measures were navigational skill simulator metrics: percentage of time at mid-lumen, percentage of time with scope-wall contact, procedure time (PT), number of wall contacts and number of wall contacts per minute of PT. Task 2 outcome measures were PT, observational assessment scores of a validated tool with a 5-point scale (1 representing the worst and 5 the best competence) and blinded dexterity assessments.</p><p><strong>Results: </strong>The study included 100 residents. All outcome measures of task 1 improved significantly (P<0.001), except for the number of wall contacts per minute of PT (4.3 [IQR 3.0 to 6.2] pre vs. 3.5 [IQR 2.6 to 5.3] post, P=0.07). For task 2, PT was reduced by 54% (10.3±2.7 minutes pre vs. 4.7±0.9 minutes post, P<0.001) with an improvement in overall-competence scores (2.0 [IQR 1.0 to 2.0] pre vs. 4.0 [IQR 4.0 to 5.0] post, P<0.001) and all dexterity parameters (P<0.001).</p><p><strong>Conclusion: </strong>Nationwide implementation of a SBT course led to rapid improvement of residents' basic bronchoscopy skills while halving PT.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ilana Roberts Krumm, Katherine Malcolm, Maya Vella, Aris Oates, Steve Hays, Jasleen Kukreja, Yaron B Gesthalter
{"title":"Characterizing Risk Factors Associated With Recurrent Pleural Effusions in the Lung Transplant Recipients.","authors":"Ilana Roberts Krumm, Katherine Malcolm, Maya Vella, Aris Oates, Steve Hays, Jasleen Kukreja, Yaron B Gesthalter","doi":"10.1097/LBR.0000000000000992","DOIUrl":"10.1097/LBR.0000000000000992","url":null,"abstract":"<p><strong>Background: </strong>Pleural effusions remain a common postoperative complication following lung transplantation, occurring in 10% to 26% of cases. We aimed to explore potential clinical or radiographic features associated with clinically significant post-lung transplant pleural effusions requiring repeat interventions for their management.</p><p><strong>Methods: </strong>Lung transplantation recipients who underwent thoracentesis at our institution between June 2012 and October 2022 were reviewed. In total, 77 patients were included. Data were collected via the electronic health record and adjudicated through direct chart review. Patients were stratified by the need for a single thoracentesis (control group) or additional interventions, including serial thoracentesis, pigtail placement, and surgery (composite group). The computed tomography (CT) of the chest before the first thoracentesis was reviewed by a thoracic radiologist who was blinded to patient outcome.</p><p><strong>Results: </strong>Single thoracentesis was used to manage 25 (32.5%) patients, 4 (5.2%) required multiple thoracenteses, 42 (54.5%) required a pigtail catheter, and 6 (7.8%) required decortication for definitive management. In the composite group compared with the control group, who were managed by a single thoracentesis, there was an increased incidence of loculations (36.8% vs. 8%, P=0.01), rounded atelectasis (22.8% vs. 4%, P=0.05), and larger effusion size (P=0.01). The composite group had higher pleural fluid eosinophils (0.33% vs. 0% in control, P = <0.01) and monocytes (14.8% vs. 7.3%, P=0.04) levels.</p><p><strong>Conclusion: </strong>Baseline imaging, such as larger effusion size, loculations and rounded atelectasis, and pleural fluid cell profile with increased eosinophils and monocytes, can potentially identify clinically significant and refractory pleural effusions.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142728901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chan Yeu Pu, Camilo A Avendano, Makayla Durant, Sidharta P Gangadharan, Jason Beattie, Mihir Parikh, Kai E Swenson, Chenchen Zhang, Adnan Majid
{"title":"Tunneled Pleural Catheters: An Effective Nonsurgical Alternative for Nonexpandable Lung in Chronic Pleural Infection.","authors":"Chan Yeu Pu, Camilo A Avendano, Makayla Durant, Sidharta P Gangadharan, Jason Beattie, Mihir Parikh, Kai E Swenson, Chenchen Zhang, Adnan Majid","doi":"10.1097/LBR.0000000000000994","DOIUrl":"10.1097/LBR.0000000000000994","url":null,"abstract":"<p><strong>Background: </strong>Open window thoracostomy (OTW) is the standard of care for debilitated patients with chronic pleural infection and nonexpandable lungs (NEL) who are not candidates for major surgical intervention. Tunneled pleural catheters (TPC) offer tremendous treatment potential in this setting based on their efficacy in malignant pleural effusion and NEL. We aim to assess the efficacy, safety, and health care utilization of TPC in this setting.</p><p><strong>Methods: </strong>We retrospectively evaluated patients who underwent TPC procedures for the long-term management of chronic pleural infection and NEL who were not candidates for major surgical intervention. Clinically, complete treatment success was defined as fever abatement, normalization of white cell count, and stoppage of antimicrobial therapy without requiring surgical intervention. It is deemed a partial success if chronic antimicrobial suppression is still needed.</p><p><strong>Results: </strong>There were 20 patients who had TPC placed for chronic pleural infection with NEL. Clinical and partial treatment success was achieved in 9/17 and 8/17 patients, respectively, excluding 3 patients who were placed on comfort measures only. The median change in pleural volume was -218 mL. The median length of stay after TPC placement was 4.5 days. TPC was removed in 8 patients due to successful obliteration of pleural space in a median duration of 46.5 days. Four patients passed away with TPCs in place, 7 retained TPCs at the last health care system contact, and 1 patient had OTW due to TPC failure.</p><p><strong>Conclusion: </strong>This exploratory study suggests that TPC is an effective and safe intervention for the management of patients with chronic pleural infection and NEL lung who are not candidates for surgical intervention.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142962279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Murn, Alma V Burbano, Juan C Lara, Kai Swenson, Jason Beattie, Mihir Parikh, Adnan Majid
{"title":"Safety and Efficacy of Rigid Bronchoscopy-guided Percutaneous Dilational Tracheostomy: A Single-center Experience.","authors":"Michael Murn, Alma V Burbano, Juan C Lara, Kai Swenson, Jason Beattie, Mihir Parikh, Adnan Majid","doi":"10.1097/LBR.0000000000000990","DOIUrl":"10.1097/LBR.0000000000000990","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous dilational tracheostomy (PDT) is commonly performed by a broad spectrum of practitioners. Aside from relative contraindications such as morbid obesity, coagulopathy, and complex airway anatomy, it is preferred over surgical tracheostomy in the critically ill. Rigid bronchoscopy-guided (RBG) PDT provides a secure airway, allows for unobstructed ventilation, protects the posterior membrane from puncture, and increases suction capacity.</p><p><strong>Methods: </strong>This is a retrospective case series of patients who underwent RBG-PDT from 2008 to 2023 at Beth Israel Deaconess Medical Center. Electronic medical records were reviewed for preprocedural demographic data, procedural events, and postprocedural outcomes.</p><p><strong>Results: </strong>A total of 104 patients underwent RBG-PDT over a 15-year period. Median patient age was 61.95 (95% CI: 59.00-64.90), median BMI was 30.25 kg/m2 (IQR, 23.6 to 37.2) with 41.9% (32.5% to 51.3%) of patients included having a BMI over 30 kg/m2. PDT placement occurred in a mean of 13.7 days after intubation, with 70% due to prolonged mechanical ventilation resulting from ongoing respiratory failure. In all, 51.0% of patients had at least one increased bleeding risk factor, with an increased aPTT >36 seconds being the most common (36.5%). In all, 26.9% of patients underwent tracheostomy with ongoing therapeutic anticoagulation with heparin. In total, 60.6% of patients received concomitant percutaneous endoscopic gastrostomy (PEG) tube placement. No cases of pneumothorax or loss of the airway at the time of exchange of the endotracheal tube for rigid tracheoscopy were reported.</p><p><strong>Conclusion: </strong>RBG-PDT is a safe and effective procedure extending the patient population appropriate for PDT when performed by an experienced Interventional Pulmonology team.</p>","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"32 1","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alanna Barrios-Ruiz, Alejandra Yu Lee-Mateus, Ana Garza-Salas, Rodrigo Funes-Ferrada, Kelly S Robertson, Sebastian Fernandez-Bussy, David Abia-Trujillo
{"title":"Percutaneous Airway Silicone Stent External Fixation Outcomes and Techniques: Case Series With Literature Review.","authors":"Alanna Barrios-Ruiz, Alejandra Yu Lee-Mateus, Ana Garza-Salas, Rodrigo Funes-Ferrada, Kelly S Robertson, Sebastian Fernandez-Bussy, David Abia-Trujillo","doi":"10.1097/LBR.0000000000000983","DOIUrl":"10.1097/LBR.0000000000000983","url":null,"abstract":"","PeriodicalId":15268,"journal":{"name":"Journal of Bronchology & Interventional Pulmonology","volume":"31 4","pages":""},"PeriodicalIF":3.3,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}