ObjectiveTo evaluate the efficacy and safety of selective large volume broncholavage by bronchonscopy in treatment of patients with acute exacerbation of bronchiectasis. MethodsA single-center randomized control,non-blind clinical trial was conducted.A total of 65 patients were randomly divided into Group A(large volume broncholavage group,n=21),Group B (mini- large volume broncholavage group,n=22) and Group C (control group,n=22).All patients received routine therapy of acute exacerbation of bronchiectasis while additional broncholavage was administered in the treatment groups for only once.Warm normal saline solution was instilled for Group A at volume of 500 to 2 000 mL and for Group B at volume of 100 to 200 mL.The baseline characteristics,Simplified Clinical Pulmonary Infection Score(CPIS) and C-reactive protein (CRP) were recorded at the first and on 7th day.The duration of antibiotic use,the length of hospital stay and total effective rate were compared among three groups. ResultsThe lavage volume was (1 250.0±403.3)mL for Group A and (141.0±41.2)mL for Group B.The length of hospital stay and duration of antibiotic use were (8.4±1.0)d and (7.9±1.1)d respectively,shorter than those in Group B[(13.5±1.6)d,(11.6±2.4)d] and Group C[(15.3±3.2)d,(13.3±2.6)d] with significant difference between three groups(all P<0.05).The total effective rates was 95.23% in Group A,higher than those in Group B (81.82%) and Group C (68.19%)(all P<0.05).The CPIS on the 7th day of Group A was 1.9±1.4,lower than that in Group B (2.7±0.8) and Group C (3.7±0.9)(P<0.05).The CRP of Group A decreased more quickly than Group B and Group C.The adverse events occurred in Group A and Group B including transient hypoxemia (23.81%,9.09%, respectively),tarchycardia(100%,68.18%, respectively),airway mucosal injury(38.09%,13.64%, respectively) and elevated blood pressure (19.05%,13.64%, respectively). ConclusionSelective large volume broncholavage through bronchonscopy is an effective and safe treatment for patients with acute exacerbation or bronchiectasis.
Malignant airway stenosis generally refers to airway lumen stenosis caused by various primary and metastatic malignant tumors and restricted airflow, which can be manifested as dyspnea to varying degrees or even asphyxia and death. It seriously affects the quality of life of patients with airway stenosis. With the continuous development of bronchoscope interventional techniques, various interventional therapies such as ablation, dilation and stent implantation can be used to reventilate the airway. Among them, ablation treatment is the most commonly used method. The methods of ablation treatment include cold, heat, photodynamic, local chemoradiotherapy, etc. This article will review the new applications of various methods used in the ablation treatment of malignant airway stenosis progress.
ObjectivePulmonary infection is commonly seen in patients with rheumatic autoimmune disease (RAD).Sometimes bronchoscopy is used to obtain microorganisms.In order to improve diagnostic yield, the factors affecting diagnostic yield of bronchoscopy in obtaining microorganisms in RAD patients with pulmonary abnormality were analyzed retrospectively. MethodsA retrospective study was performed in RAD patients with lung infiltrates who received bronchoscopy for obtaining microorganisms at the Department of Rheumatology,Peking Union Medical College Hospital from January 2009 to June 2013.Patients characteristics,clinical symptoms,medication history,laboratory parameters,radiographic findings and locations where microorganisms were obtained were recorded. Results87 patients received 91 bronchoscopic exams,including 72 bronchoalveolar lavages,21 bronchial aspirates,and 72 bronchial brushes.The total diagnostic yield was 52.7%.The diagnostic yield was 71.4% with bronchoalveolar lavage,38.9% with bronchial aspirate,and 18.1% with bronchial brush.Diagnostic yield was significantly higher in the patients with clinical symptoms of fever,cough or expectoration compared with the patients without either symptoms (60.0%% vs.34.6%,P=0.028).The patients with CT finding of nodular,massive or consolidation had a higher diagnostic yield compared with those with CT findings of reticular,linear or ground glass opacity (61.8% vs.26.1%,P=0.003).Diagnostic yield was not affected by location of bronchoalveolar lavage (P=0.691). ConclusionRAD patients with fever,cough or sputum,and CT findings of nodular,massive or consolidation would get a higher diagnostic yield by bronchoscopy.
ObjectiveTo observe the relationship between ventilator-associated pneumonia (VAP) and changes in bronchial mucosa and sputum in critically ill patients. A prediction model for SEH score was developed according to the abnormal degrees of airway sputum , mucosal edema and mucosal hyperemia , as well as to analyze the diagnostic value of the SEH scores for VAP during bronchoscopy. MethodsA collection of general data and initial bronchoscopy results was conducted for patients admitted to the department of intensive care unit at West China Hospital from March 1, 2024, to July 1, 2024. Patients were divided into infection group (n=138) and non-infection group (n=227) according to diagnostic criteria for VAP based on the date of their first bronchoscopy. T-tests were used to compare baseline data between groups, while analysis of variance was employed to assess differences in airway mucosal and sputum lesions. A binary logistic regression model was constructed using the SEH scores for predicting VAP risk, with receiver operating characteristic curve area under the curve (AUC) utilized to evaluate model accuracy. ResultsA total of 365 patients were included in this study, among which 138 cases (37.8%) were diagnosed with VAP. The AUC for using SEH scores in diagnosing VAP was found to be 0.81 [95% confidence interval (CI) 0.76-0.85], with an optimal cutoff value set at 6.5. The sensitivity and specificity of SEH scores for diagnosing VAP were determined as 79.7% (95% CI: 72.2%-85.6%) and 73.1% (95% CI:67.0%-78.5%). Patients with SEH scores over 6.5 exhibited a significantly higher rate of VAP infection (64.3% vs.14.4%, P<0.0001), elevated white blood cell count levels (WBC) [(13.3±7.5 vs.1.8±6.2), P=0.04], as well as increased hospital mortality rates (39.8 % vs.24.2 %, P=0.002). ConclusionsThe SEH scores has a certain efficacy in the diagnosis of VAP in patients with mechanical ventilation. Compared with the traditional VAP diagnostic criteria, SEH scores is easier to obtain in clinical practice, and has certain clinical application value.
Lung cancer management is complex and requires a multi-disciplinary approach to provide comprehensive care. Interventional pulmonology (IP) is an evolving field that utilizes minimally invasive modalities for the initial diagnosis and staging of suspected lung cancers. Endobronchial ultrasound guided sampling of mediastinal lymph nodes for staging and detection of driver mutations is instrumental for prognosis and treatment of early and later stage lung cancers. Advances in navigational bronchoscopy allow for histological sampling of suspicious peripheral lesions with minimal complication rates, as well as assisting with fiducial marker placements for stereotactic radiation therapy. Furthermore, IP can also offer palliation for inoperable cancers and those with late stage diseases. As the trend towards early lung cancer detection with low dose computed tomography is developing, it is paramount for the pulmonary physician with expertise in lung nodule management, minimally invasive sampling and staging to integrate into the paradigm of multi-specialty care.
ObjectiveTo investigate the clinical features and relationship of anthracosis and bronchial anthracofibrosis (BAF).MethodsA retrospective study among 591 patients who did bronchoscopy in this hospital from January 2016 to December 2018 was performed. Of them, 71 patients had anthracosis, including 39 BAF. Their clinical data, bronchoscopic results, CT scan and pulmonary function tests were analyzed and compared.ResultsThe prevalence of anthracosis was 12.0% (71/591), while 54.9% (39/71) of anthrocosis were BAF. BAF patients shared features of old age (77.0±10.4), female domination (59.0%), low smoking ratio (25.6%) and high prevalence of tuberculosis (41.0%). Upper lobe bronchi and right lobe bronchus were the predominant sites of involvement. Right lobe bronchus was the most common site of stenosis or occlusion in BAF. According to CT scan, 69.0% of all anthrocasis cases had enlarged or calcificated lymph node in mediastinal or hilar positions. Paratracheal, parahilar, subcarinal lymph nodes were most frequently involved. Compared BAF with non-BAF patients, BAF patients had significantly more cough and expectoration. There was no statistical differences in age, sex, smoking history, infection with tuberculosis, the distribution of anthracosis and abnormal lymph nodes. Though only 26 of 71 patients performed respiratory function tests, there were significantly more cases of obstructive ventilation function disturbance in BAF than in non-BAF patients.ConclusionsAnthracosis occurs at regular locations in lung, usually accompanied with abnormal mediastinal/hilar lymph nodes and associated with tuberculosis. BAF might be a more severe type of anthracosis.
ObjectiveTo evaluate the role of rapid on-site evaluation (ROSE) in the diagnosis of lung space-occupying lesions.MethodsFrom June 1, 2017 to December 30, 2017, transbronchial biopsies were performed in patients with lung space-occupying lesions on chest CT, and biopsies were taken for ROSE and subsequent routine pathological examination. ROSE interpretation was performed by a pulmonologist who had been trained in cytopathology for 3 months. The interpretation was correlated with the follow-up routine pathological examination. The contemporary cases with lung space-occupying lesions who underwent transbronchial biopsies without ROSE were retrospectively reviewed. The quality assessment of biopsy specimens recorded in pathological reports were compared between cases with and without ROSE.ResultsA total of 101 patients underwent transbronchial biopsies in parallel with ROSE. The interpretation results of the pulmonologist were compared with the follow-up routine pathology, which showed that the consistency rate of malignant lesions was 84.1% and the consistency rate of benign lesions was 93.8%. Consistency test showed good agreement between the ROSE conducted by the pulmonologist and the routine pathological examination by pathologists (κ=0.66, P<0.01). The quality assessment of biopsy specimens showed that there was no significant difference on rate of satisfied biopsy specimens between cases with and without ROSE (98.0%vs 94.5%, P=0.14).ConclusionsThe use of ROSE combining with bronchoscopy allows good preliminary assessment of lung space-occupying lesions. Pulmonologists trained in short-term formal cytopathology are fully capable of performing ROSE, thereby obviating the need for cytopathologists to participate in on-site evaluation.
ObjectiveTo highlight the characteristics of bronchial foreign body in Adults. MethodsThe clinical data of three patients with bronchial foreign body were analyzed and related literatures were reviewed. ResultsForeign bodies in three patients were all located in right bronchi. Their initial diagnoses were tumor, pneumonia and foreign body, respectively. They all didn't offer a definite history of foreign body aspiration. Foreign bodies in three patients were diagnosed and treated by bronchoscopy. Through reviewing 978 related literatures, we found 2920 cases of bronchial foreign body in adults. 75.00% of them didn't offer a history of foreign body aspiration. 80.13% of them were misdiagnosed as other diseases before bronchoscopy, such as pneumonia(31.23%), lung cancer(25.21%), tuberculosis(5.81%), bronchiectasis(6.58%) and asthma(12.47%). Some of them were misdiagnosed for over 30 years. ConclusionsBronchial foreign bodies in adults are easily misdiagnosed. Bronchoscopy plays an important role in diagnosis and treatment of bronchial foreign body.
Objective To study the application of virtual reality bronchoscopy stimulation in novice trainees. Methods Four novice bronchoscopists entered the training programby using a VR bronchoscopy in the clinical skill center. After the program, the dexterity, speed, and accuracy of all the four doctors were tested using the virtual simulation models. Results were compared to four skilled physicians as control group who had performed at least 50 bronchoscopies. Before-training and after-training test scores were compared using paired t tests. For comparisons between after-training novice and skilled physician scores, unpaired twosample t tests were used. Results All of the four trainees finished the training program. The novices significantly improved their dexterity, speed and accuracy. The percentage of observed segments increased from ( 74. 0 ±5. 1) % to ( 89. 3 ±4. 0) % . The number of contacts with the bronchial wall decreased from 87. 5 ±13. 2 to 30. 5 ±9. 3, and total time spent shortened from ( 700. 8 ±56. 6) s to ( 607. 0 ±17. 8) s. There were no statistically significant differences between novice accuracy ( the percentage of observed segments) after training and skilled physician accuracy [ ( 89. 3 ±4. 0) % vs ( 91. 3 ±3. 0) % , P = 0. 456] . Conclusion Practice using a virtual bronchoscopy simulator help novice trainees to attain a level of skill at performing diagnostic bronchoscopy, and it might play an important role in the training of chest physicians.
Objective To investigate the diagnostic value and complications of fibrobronchoscopy and bronchoalveolar lavage in immunocompromised patients with pulmonary infiltrates. Methods Fiberoptic bronchoscopy was performed in 31 immunocompromised patients. The clinical data and results of bronchoalveolar lavage were collected. In addition to conventional microbiological methods, molecular detection for cytomegalovirus( CMV) and respiratory viruses were performed. Results In all cases BAL was performed. The overall diagnostic yield of fibrobronchoscopy was 65% . The diagnosis was more likely to be established by fibrobronchoscopy when the lung infiltrate was due to an infectious agent( 86%) than to a noninfectious process( 25% ) . By molecular detection, CMV was identified in 4 cases, and other respiratory viruses were identified in 3 cases. Fever ( 23% ) was the most common complication. Conclusions Fibrobronchoscopy and BAL are effective and safe for the diagnosis of pulmonary infiltrates in immunocompromised patients. The molecular technique may help to enhance the diagnostic yield of BAL.