Effect of Bronchoscopy on Gas Exchange and Respiratory Mechanics in Critically Ill Patients With Atelectasis: An Observational Cohort Study

Smeijsters, Kim M. G.; Bijkerk, Ronald M; Daniëls, Hans; Ven, Peter M. van de; Girbes, Armand R. J.; Heunks, Leo; Spijkstra, Jan Jaap; Tuinman, Pieter R.

doi:10.3389/fmed.2018.00301

Cited by 6 publications

(7 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In line with these observations, in our study, more bronchoscopies at risk in ICUs were referred to trained pulmonologists, whereas most routine bronchoscopies with lower inherent risk might have been performed by intensivists outside the study population. The published small studies on bronchoscopies in ICUs state consistently higher complications rates comparable to our data, most commonly transient desaturation/hypoxaemia, bleeding, and arrhythmia [17, 18, 29, 39, 47-49]. Low complication rates were observed mainly in elective bronchoscopies from registries with a low proportion of invasive or complex procedures and patients without severe underlying diseases.…”

Section: Discussion/conclusionsupporting

confidence: 87%

“…There are few randomized controlled trials investigating bronchoscopy in acutely ill patients. Two randomized studies demonstrated no benefit of bronchoscopy for the treatment or prevention of lobar atelectasis in comparison with chest physiotherapy [33, 34], whereas other observational studies have found beneficial effects of bronchoscopy (i.e., resolution of atelectasis or improvement of oxygenation, ventilation, and respiratory mechanics) [29, 35]. Atelectasis may be caused by other mechanisms than secretions or airway occlusion by foreign bodies (e.g.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…Attributable mortality to flexible bronchoscopy was reported to be between 0.01 and 0.02% [13, 21-23, 26-28]. ICU patients have an intrinsic higher risk of bronchoscopy-associated complications [29-31].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy

et al. 2021

View full text Add to dashboard Cite

Background: Bronchoscopy is widely used and regarded as standard of care in most intensive care units (ICUs). Data concerning recommendations for on-call bronchoscopy are lacking. Objectives: Evaluation of recommendations, complications, and outcome of on-call bronchoscopies. Method: A retrospective single-centre analysis was conducted in a large university hospital. All on-call bronchoscopies performed outside normal working hours in the year before (period 1) and after (period 2) establishing a catalogue of recommendations for indications of on-call bronchoscopy on November 1, 2016, were included. Results: Overall, 924 bronchoscopies in 538 patients were analysed. A relative reduction of 83.6% from 794 bronchoscopies in 432 patients (1.84 per patient) during period 1 to 130 in 107 patients (1.21 per patient) during period 2 was observed. Most bronchoscopies (812/924, 87.9%) were performed in ICUs, and 416 patients (77.3%) were intubated. Bronchoscopies for excessive secretions decreased significantly during period 2. Fifty-three of 130 bronchoscopies (40.8%) fulfilled the specified recommendations during period 2, in comparison with 16.8% in period 1 (p < 0.001). Complications were recorded in 58 of 924 procedures (6.3%) and were more frequent in period 2, especially moderate bleeding. In-hospital mortality of patients undergoing on-call bronchoscopy did not differ between periods and was 28.7 and 30.2% in periods 1 and 2, respectively. Conclusion: The introduction of recommendations for on-call bronchoscopy led to a significant decline of on-call bronchoscopies without negatively affecting outcome. More evidence is needed in on-call bronchoscopy, especially for ICU patients with intrinsic higher complication rates.

show abstract

Section: Discussion/conclusionsupporting

confidence: 87%

Section: Discussion/conclusionmentioning

confidence: 99%

See 1 more Smart Citation

A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy

et al. 2021

View full text Add to dashboard Cite

show abstract

“…In view of the prediction, the nomogram could serve as a tool to select patients for evaluating the necessity of flexible bronchoscopy. In general, the presence of persistent atelectasis in chest imaging is a strong indicator for flexible bronchoscopy intervention 27,28 . Thus early bronchoscopic examination may be necessary for children with MPP presented with clinical sign of atelectasis, regardless of the presence of BMP.…”

Section: Discussionmentioning

confidence: 99%

Nomogram for Prediction of Bronchial Mucus Plugs in Children with Mycoplasma pneumoniae Pneumonia

Sheng

et al. 2020

Sci Rep

View full text Add to dashboard Cite

the presence of bronchial mucus plugs (BMp) in children with Mycoplasma pneumoniae pneumonia (MPP) results in delayed clinical and radiographic resolution and long-standing pulmonary sequelae. The predictive factors associated with BMP formation remains poorly defined. Nomograms to predict BMp presence in children with Mpp were proposed using a cohort of patients who underwent bronchoscopy intervention at Children's Hospital in Eastern China. Patients with MPP in an earlier period formed the training cohort (n = 872) for nomogram development, and those thereafter formed the validation cohort (n = 399) to confirmed model's performance. BMP in children with MPP were found in 196 (22.5%) and 91(22.8%) patients in the training and validation cohorts, respectively. the independent risk factors associated with BMp were age >5years (OR 2.06; 95% CI 1.43 to 2.98), higher IL-10 level (>10 ng/L, 2.19; 95% CI 1.46 to 3.28), higher IFN-γ level (>30 ng/L, 1.69; 95% CI 1.13 to 2.54), and presence of complication (3.43; 95% CI 1.45 to 8.09). Incorporating these 4 factors, the nomogram achieved good concordance indexes of 0.771(95% CI, 0.734-0.808) and 0.796 (95% CI, 0.744-0.848) in predicting BMP in the training and validation cohorts, respectively. The nomogram achieved an optimal prediction of BMP in children with MPP. Using this model, the risk of BMP formation would be determined, contributing to a rational therapeutic choice.

show abstract

“…In the intensive care unit, bronchoscopy is widely used to remove secretions and improve atelectasis. 8 – 11 Beyond that, bronchoalveolar lavage is performed under endotracheal intubation, and respiratory specimens are collected for microbial detection to guide anti-infection treatments. 12 – 17 During prehospital and intrahospital first aid, bronchoscopy can be used to intuitively observe the position of the trachea and aid in difficult endotracheal intubation or percutaneous tracheostomy, 18 – 20 as well as airway management after intubation.…”

Section: Discussionmentioning

confidence: 99%

Portable electronic bronchoscopy for clinical application: a multi-institutional randomized instrument validation study

Qiu

Feng

et al. 2022

J Int Med Res

View full text Add to dashboard Cite

Objective Electronic bronchoscopy is routinely used for the diagnosis and treatment of lung and bronchial disorders. However, the devices used are normally large and costly. Here, we evaluated the clinical effectiveness of a portable electronic bronchoscope produced by Zhejiang UE Medical Corp., the UE-EB. Methods We conducted a multi-institutional, randomized, single-blind, non-inferiority and parallel-group controlled clinical trial. Participants were randomly assigned 1:1 to the experimental group or control group. The primary indicator was the effectiveness of the device. Safety indicators were assessed from enrollment to 3 days after the operation. Results The UE-EB had good consistency between groups during the procedure, and the effective rate was 100.00% in both groups. The difference value (95% confidence interval) between the two groups was 0.00% (−5.45%, 5.45%), and the lower limit was greater than −10% (negative non-inferiority margin). There was also no difference between the two groups in terms safety indicators. Conclusions The portable electronic bronchoscope described in this study showed reliable effectiveness and safety. This device is worth promoting and applying in clinical practice. Research registry number: ZXLB20200295 (Zhejiang Medical Products Administration, China).

show abstract

Effect of Bronchoscopy on Gas Exchange and Respiratory Mechanics in Critically Ill Patients With Atelectasis: An Observational Cohort Study

Cited by 6 publications

References 20 publications

A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy

A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy

Nomogram for Prediction of Bronchial Mucus Plugs in Children with Mycoplasma pneumoniae Pneumonia

Portable electronic bronchoscopy for clinical application: a multi-institutional randomized instrument validation study

Contact Info

Product

Resources

About