Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

Mohan, Anant; Madan, Karan; Hadda, Vijay; Tiwari, Pawan; Mittal, Saurabh; Guleria, Randeep; Khilnani, GC; Luhadia, SK; Solanki, RK; Kb, Gupta; Swarnakar, Rajesh; Gaur, SN; Singhal, Pratibha; Ayub, Irfan Ismail; Bansal, Shweta; Bista, Prashu Ram; Biswal, Shiba Kalyan; Dhungana, Ashesh; Doddamani, Sachin; Dubey, Dilip; Garg, Avneet; Hussain, Tajamul; Iyer, Hariharan; Venkatnarayan, Kavitha; Kalai, Umasankar; Kumar, Rohit; Mehta, Swapnil; Nongpiur, Vijay Noel; Loganathan, N; Pb, Sryma; Pangeni, Raju; Shrestha, Prajowl; Singh, Jyoti; Suri, Tejas M; Agarwal, Sandip; Agarwal, Ritesh; Aggarwal, Ashutosh N.; Agrawal, Gopal; Arora, Suninder; Thangakunam, Balamugesh; Behera, Digambar; Jayachandra,; Chaudhry, Dhruva; Chawla, Rajesh; Chawla, Rakesh K.; Chhajed, Prashant N.; Christopher, Devasahayam Jesudas; Mk, Daga; Das, Rekha; D’Souza, George; Dhar, Raja; Dhooria, Sahajal; Ghoshal, Aloke Gopal; Goel, Manoj K.; Gopal, Bharat; Goyal, Rajiv; Gupta, Neeraj; Nk, Jain; Jain, Neetu; Jindal, Aditya; Sk, Jindal; Kant, Surya; Katiyar, Sandeep; Koul, Parvaiz A; Kumar, Jaya; Kumar, Raj; Lall, Ajay C.; Mehta, Ravindra; Nath, Alok; Pattabhiraman, V.; Patel, Dharmesh; Prasad, Rajendra; Samaria, Jai Kumar; Sehgal, Inderpaul Singh; Shah, Sapan; Sindhwani, Girish; Singh, Sheetu; Singh, Virendra; Singla, Rupak; Jc, Suri; Talwar, Deepak; Jayalakshmi, T; V., Rajagopal T.

doi:10.4103/lungindia.lungindia_108_19

Cited by 67 publications

(68 citation statements)

References 411 publications

(505 reference statements)

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“…In this evaluation, Bronchosampler provided an excellent % sample yield from the miniBAL. The reported acceptable volume of retrieved fluid varies between 10 and 50% for diagnosis of infection or cellular analysis [9-11]. The actual yield is influenced by many factors, including the variations in the protocols for BAL/BW, the experience of the bronchoscopist, endobronchial aspects, and the efficiency of the sample collection.…”

Section: Discussionmentioning

confidence: 99%

Safe and Efficient Practice of Bronchoscopic Sampling from Mechanically Ventilated Patients: A Structured Evaluation of the Ambu Bronchosampler-Ascope 4 Integrated System

Singh

Shah

2021

Respiration

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Background: Bronchoscopic sampling of bronchoalveolar fluid (BAL) should be safe and effective. Current sampling practice risks loss of sample to the attached negative flow, aerosolisation, or spillage, due to repeated circuit breaks, when replacing sample containers. Such concerns were highlighted during the recent coronavirus pandemic. Objectives: Evaluation of an alternative integrated sampling solution, with the Ambu Bronchosampler with aScope 4, by an experienced bronchoscopist in ICU. Methods: An observational study of 20 sequential bronchoscopic diagnostic sampling procedures was performed on mechanically ventilated patients with suspected ventilator-associated pneumonia. Mixed methods assessment was done. The predefined outcome measures were (1) ease of set up, (2) ease of specimen collection, (3) ease of protecting specimen from loss or spillage, and (4) overall workflow. The duration of the procedure and the % volume of sample retrieved were recorded. Results: The mean (±standard deviation [SD]) time for collecting 1 sample was 2.5 ± 0.8 min. The mean (±SD) specimen yield for instilled miniBAL was 54.2 ± 17.9%. Compared with standard sampling, the set-up was much easier in 18 (90%), or easier in 2 (10%) of procedures, reducing the connection steps. It was much more intuitive to use in 14 (70%), more intuitive in 4 (20%), and no more intuitive to use in 2 (10%). The overall set-up and workflow was much easier in 69% of the 13 intraprocedural connections and easier or as easy in the remaining 31% procedures. All procedures where pre connection was established were much easier (7, 100%). The Ambu Bronchosampler remained upright in all procedures with no loss or spillage of sample. Obtaining a sample was much easier in 60%, easier in 10%, no different in 20%, and worse in 10%. The ability to protect a sample from start to finish compared to standard procedures was much easier in 80%, easier in 15%, and no different in 5% of procedures. Overall workflow was much easier in 14 (70%), easier in 4 (20%), and no different in 2 (10%) of procedures. Conclusions: The Ambu Bronchosampler unit was a reliable, effective, and possibly safer technique for diagnostic sampling in ICU. It may improve safety standards during the coronavirus pandemic. A randomized control trial against the standard sampling technique is warranted.

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Section: Discussionmentioning

confidence: 99%

Safe and Efficient Practice of Bronchoscopic Sampling from Mechanically Ventilated Patients: A Structured Evaluation of the Ambu Bronchosampler-Ascope 4 Integrated System

Singh

Shah

2021

Respiration

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“…All bronchoscopic procedures were performed after an initial assessment of clinical features, radiology, indications and contraindications, and when less invasive procedures failed to yield a diagnosis. Bronchoscopy was performed after procedural consent, and standard protocols were followed at our center 5 . Briefly, we performed FB under local anaesthesia and sedation.…”

Section: Methodsmentioning

confidence: 99%

Role of flexible bronchoscopy in the diagnosis of invasive fungal infections

Muthu

Gandra

Dhooria

et al. 2021

Mycoses

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Background There are sparse data on the role of flexible bronchoscopy (FB) in diagnosing invasive mould infections (IMIs). Objective To investigate the safety and usefulness of FB in IMI. We evaluate the factors associated with a successful diagnosis of IMI using FB. Further, we compare subjects of invasive pulmonary aspergillosis (IPA) with pulmonary mucormycosis (PM). Methods We retrospectively reviewed the clinical features, imaging data, bronchoscopy, microbiology and pathology details of subjects who underwent FB for suspected IMI. We categorised FB as diagnostic if it contributed to the diagnosis of IMI. We performed a multivariate analysis to identify the factors associated with a diagnostic bronchoscopy. Results Of the 3521 FB performed over 18 months, 132 (3.7%) were done for suspected IMIs. We included 107 subjects for the final analysis. The risk factors for IMI included renal transplantation (29.0%), diabetes (27.1%), haematological malignancy (10.3%) and others. We found bronchoscopic abnormalities in 33 (30.8%) subjects, and these were more frequent in those with confirmed PM (67%) than IPA (27%). IMI was confirmed in 79 (14 proven, 48 probable and 17 possible) subjects. FB was diagnostic in 71%. We experienced major complications in three cases (2.7%), including one death. On multivariate analysis, the visualisation of endobronchial abnormalities during FB (OR [95%, CI], 8.5 [1.4–50.4]) was the only factor associated with a diagnostic FB after adjusting for age and various risk factors. Conclusions Flexible bronchoscopy is a useful and safe procedure in diagnosing IMIs. The presence of endobronchial abnormalities predicts a successful diagnostic yield on FB.

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“… 3 Contraindications to bronchoscopic cryotherapy will be the usual contraindications to bronchoscopy including hemodynamic instability, myocardial ischemia, life-threatening arrhythmias, and lack of informed consent. 4 …”

Section: Introductionmentioning

confidence: 99%

Bronchoscopic Cryotherapy for Acute Hypoxemic Respiratory Failure in Three Mechanically Ventilated Patients: A Case Series

Tale

Meitei

Prakash

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Endobronchial blood clots or mucus plugs can present with minimal symptoms or acute airway obstruction in the intensive care unit (ICU) patients. Acute airway obstruction can lead to rapid worsening of dyspnea owing to poor oxygenation due to collapse of the lung. Prompt recognition and treatment of this condition can translate into a successful outcome by decreasing morbidity and mortality and facilitating successful weaning of these patients. When conventional methods fail to relieve the obstruction, cryoextraction a novel technique, may prove to be a useful alternative for the removal of these clots and mucus plugs. Cryoextraction is best performed with rigid bronchoscopic intubation. However, in certain conditions, it may be used with a flexible fiberoptic bronchoscope (FOB) through an endotracheal tube, especially when bedside procedure is required in ICU patients. In this series, three cases are being discussed where bedside flexible bronchoscopy-guided cryoextraction was done leading to a successful resolution of acute hypoxemic respiratory failure. How to cite this article: Tale S, Meitei SP, Prakash V, Negi A, Mishra M, Sindhwani G. Bronchoscopic Cryotherapy for Acute Hypoxemic Respiratory Failure in Three Mechanically Ventilated Patients: A Case Series. Indian J Crit Care Med 2021;25(1):94–96.

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Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations

Cited by 67 publications

References 411 publications

Safe and Efficient Practice of Bronchoscopic Sampling from Mechanically Ventilated Patients: A Structured Evaluation of the Ambu Bronchosampler-Ascope 4 Integrated System

Safe and Efficient Practice of Bronchoscopic Sampling from Mechanically Ventilated Patients: A Structured Evaluation of the Ambu Bronchosampler-Ascope 4 Integrated System

Role of flexible bronchoscopy in the diagnosis of invasive fungal infections

Bronchoscopic Cryotherapy for Acute Hypoxemic Respiratory Failure in Three Mechanically Ventilated Patients: A Case Series

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