Comparing fiberoptic bronchoscopy and a tracheal tube-mounted camera-guided percutaneous dilatational tracheostomy: authors' reply

Grensemann, Jörn; Eichler, Lars; Kähler, Sophie; Jarczak, Dominik; Simon, Marcel; Pinnschmidt, Hans O.; Kluge, Stefan

doi:10.1186/s13054-018-2004-2

Cited by 1 publication

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“…It has been recommended to maintain a difference of inner tube diameter and bronchoscope outer diameter of at least 2 mm to maintain a sufficient ventilation and to prevent an auto-positive end-expiratory pressure [ 20 ]. Considering the diameter, it may be argued that an even smaller bronchoscope could lead to an improved ventilation with less pronounced hypercarbia, however, the cross sectional area of the suctioning channel decreases as well, possibly preventing the aspiration of mucus or blood from the bronchial tree during the intervention [ 21 ]. Therefore, a compromise in necessary to balance ventilation and suctioning.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous dilatational tracheostomy with single use bronchoscopes versus reusable bronchoscopes – a prospective randomized trial (TraSUB)

et al. 2022

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Background Apart from conventional reusable bronchoscopes, single-use bronchoscopes (SUB) were recently introduced. Data suggest that SUB might prevent from the risk of cross contamination (i.e. multiresistant pathogens, SARS CoV-2) and save costs. We aimed to investigate visualization, ventilation, handling characteristics, changes in patients’ gas exchange, and costs associated with both types of bronchoscopes during percutaneous dilatational tracheostomy (PDT). Methods In this prospective, randomized, noninferiority study, 46 patients undergoing PDT were randomized 1:1 to PDT with SUB (Ambu aScope) or reusable bronchoscopes (CONV, Olympus BF-P60). Visualization of tracheal structures rated on 4-point Likert scales was the primary end-point. Furthermore, quality of ventilation, device handling characteristics, changes in the patients’ gas exchange, pH values, and costs were assessed. Results Noninferiority for visualization (the primary endpoint) was demonstrated for the SUB group. Mean visualization scores (lower values better) were 4.1 (95% confidence intervals: 3.9;4.3) for SUB vs. 4.1 (4.0;4.2) for CONV. Noninferiority of ventilation (estimated by minute volume and SpO2) during the procedure could be shown as well. Mean score was 2.6 (2.0;3.1) for SUB vs. 2.4 (2.1;2.7) for CONV (lower values better). No significant differences regarding handling (SUB: 1.2 (1.0;1.4), CONV: 1.3 (1.1;1.6)), blood gas analyses and respiratory variables were found. Cost analysis in our institution revealed 93 € per conventional bronchoscopy versus 232.50 € with SUB, not considering an estimate for possible infection due to cross-contamination with the reusable device. Conclusion In our study, visualization and overall performance of the SUB during PDT were noninferior to reusable bronchoscopes. Therefore, PDT with SUB is feasible and should be considered if favored by individual institution’s cost analysis. Trial registration. ClinicalTrials.gov, NCT03952247. Submitted for registration on 28/04/2019 and first posted on 16/05/2019.

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Section: Discussionmentioning

confidence: 99%