Tài liệu Global Perspectives on Bronchoscopy Edited by Sai Praveen Haranath and Samiya Razvi ppt

GLOBAL PERSPECTIVES

ON BRONCHOSCOPY

Edited by Sai Praveen Haranath

and Samiya Razvi

Global Perspectives on Bronchoscopy

Edited by Sai Praveen Haranath and Samiya Razvi

Published by InTech

Janeza Trdine 9, 51000 Rijeka, Croatia

Copyright © 2012 InTech

All chapters are Open Access distributed under the Creative Commons Attribution 3.0

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As for readers, this license allows users to download, copy and build upon published

chapters even for commercial purposes, as long as the author and publisher are properly

credited, which ensures maximum dissemination and a wider impact of our publications.

Notice

Statements and opinions expressed in the chapters are these of the individual contributors

and not necessarily those of the editors or publisher. No responsibility is accepted for the

accuracy of information contained in the published chapters. The publisher assumes no

responsibility for any damage or injury to persons or property arising out of the use of any

materials, instructions, methods or ideas contained in the book.

Publishing Process Manager Jana Sertic

Technical Editor Teodora Smiljanic

Cover Designer InTech Design Team

First published May, 2012

Printed in Croatia

A free online edition of this book is available at www.intechopen.com

Additional hard copies can be obtained from [email protected]

Global Perspectives on Bronchoscopy, Edited by Sai Praveen Haranath and Samiya Razvi

p. cm.

ISBN 978-953-51-0642-5

Contents

Preface IX

Section 1 Basics of Bronchoscopy 1

Chapter 1 Role of Flexible-Bronchoscopy in

Pulmonary and Critical Care Practice 3

Gilda Diaz-Fuentes and Sindhaghatta K. Venkatram

Chapter 2 Monitoring, Sedation, and Anesthesia

for Flexible Fiberoptic Bronchoscopy 35

Michael J. Morris, Herbert P. Kwon

and Thomas B. Zanders

Section 2 Bronchoscopic Investigations 55

Chapter 3 Role of Broncoalveolar Lavage in Diagnosis 57

Mohammad Shameem

Chapter 4 Lung Cancer – CT Vs Bronchoscopy 71

António Saraiva and Christopher Oliveira

Section 3 Bronchoscopy in Special Situations 89

Chapter 5 Bronchoscopy in

Mechanically Ventilated Patients 91

Angel Estella

Chapter 6 Bronchoscopy in Bronchiectasis and Cystic Fibrosis 107

Aditya Kasarabada, Mark E. Lund and Jeffrey B. Hoag

Section 4 Evolving Therapeutic Uses of Bronchoscopy 125

Chapter 7 Endotracheal Intubation with

Flexible Fiberoptic Bronchoscope

(FFB) in Cases of Difficult Airway 127

Francisco Navarro, Raúl Cicero and Andrea Colli

VI Contents

Chapter 8 Bronchoscopic Balloon Dilation (BBD)

for Benign Tracheobronchial Stenosis 135

Masayuki Tanahashi, Hiroshi Niwa,

Haruhiro Yukiue, Eriko Suzuki, Hiroshi Haneda,

Naoko Yoshii and Hisanori Kani

Chapter 9 Endoscopic Percutaneous Tracheotomy in Prolonged

Intubation of Mechanical Ventilated Patients

Admitted in Cardio-Thoracic Intensive Care Unit 151

Rosa Mastropierro, Michela Bettinzoli and Aldo Manzato

Section 5 Pediatric Bronchoscopy 175

Chapter 10 Pediatric Bronchoscopy 177

Selma Maria de Azevedo Sias,

Ana Cristina Barbosa Domingues

and Rosana V. Mannarino

Chapter 11 Manual Jet Ventilation Using

Manujet III for Bronchoscopic

Airway Foreign Body Removal in Children 201

Shaoqing Li, Yuqi Liu and Fang Tan

Chapter 12 Utility of Pediatric Flexible Bronchoscopy

in the Diagnosis and Treatment of

Congenital Airway Malformations in Children 219

Yong Yin, Shuhua Yuan, Wenwei Zhong and Yu Ding

Preface

Bronchoscopy has become an essential part of modern medicine. Recent advances in

technology have allowed integration of ultrasound with this tool. The use of lasers

along with bronchoscopes has increased the therapeutic utility of this device. Globally

an increasing number of pulmonary specialists, anaesthesiologists and thoracic

surgeons are using the bronchoscope to expedite diagnosis and treatment. The current

volume on bronchoscopy adds to the vast body of knowledge on this topic. The

contributions from around the world cover the breadth of this field and include

cutting edge uses as well as a section on pediatric bronchoscopy.

This was a tough job for me as an editor of the book, since the authors wrote vast

and extensive chapters . It was a great experience. I would request readers to review

the book and suggest areas for modification or further topic additions for future

versions. Every care has been taken to ensure the accuracy of information and

authors are aware of the strict rules against plagiarism. The book is divided in

various sections in order to make it easier for the beginner, as well as the advanced

reader to have a rapid overview of this topic. The section on pediatric bronchoscopy

highlights issues specific to children that are recognizably different from adults,

including airway anatomy, anesthesia considerations and the emerging field of

diagnostic and therapeutic procedures in this age group. A major indication for

bronchoscopy in infants and young children continues to be evaluation for

congenital airway malformations, and both common and uncommon disorders

are reviewed with illustrations in this text.

As a pulmonary and critical care physician it has been fulfilling to see the chapters

on special areas like bronchoscopy in bronchiectasis as well as in the intensive care

unit. Practical uses like managing and monitoring the airway during percutaneous

tracheostomy performance has an entire chapter devoted to this evolving topic . In

summary, this book is a great testament to the power of collaboration and is a

superb resource for doctors in training, ancillary team members as well as practicing

healthcare providers who have to perform or arrange bronchoscopy or the similar

procedures. I would like to sincerely thank my associate editor Dr Samiya Razvi for

ensuring the pediatric section to integrate well into this comprehensive book. I am

grateful to InTech as well as Jana Sertic, my coordinator, for her patient yet firm

requests for expediting this book. I hope the readers will find this book enjoyable for

X Preface

reading and that they will recignize a contemporary source of knowledge in our

book.

Dr. Sai Praveen Haranath

Consultant Pulmonologist and Critical Care Medicine Specialist,

Axon Anesthesia Associates, Hyderabad,

Apollo Hospitals, Jubilee Hills, Hyderabad,

India

Dr. Samiya Razvi

Consultant Pediatric Pulmonologist,

Apollo Hospitals, Jubilee Hills, Hyderabad,

India

Section 1

Basics of Bronchoscopy

1

Role of Flexible-Bronchoscopy in

Pulmonary and Critical Care Practice

Gilda Diaz-Fuentes and Sindhaghatta K. Venkatram

Division of Pulmonary and Critical Care Medicine,

Bronx Lebanon Hospital Center, Bronx, New York

USA

1. Introduction

The introduction of the flexible bronchoscope by Dr. Ikeda in 1968 revolutionized

bronchoscopy around the world. Initially, bronchoscopy was performed by surgical

specialists with a rigid scope only in highly specialized centers, and the main indication was

for therapeutic purposes. In the 1970s, flexible fiberoptic bronchoscopy (FFB) was learned by

pulmonologists and surgical specialists and proved itself as a safe and useful technique for

diagnostic and therapeutic purposes. The results have been a rapid proliferation of FFB

inside and outside of the academic institutions.

In the armamentarium of the pulmonary physician, FFB assumes a central position that is

somewhere between the noninvasive diagnostic maneuvers such as physical examination,

laboratory study, pulmonary function testing and radiologic diagnostics on one side and

invasive surgical procedures such as mediastinoscopy and diagnostic thoracotomy on the

other side.

A recent trend has been the emergence of “interventional bronchoscopy” and the

“interventional bronchoscopist”. These phrases denote a two-tier system in which one group

of bronchoscopists perform “routine bronchoscopy” and the other performs special

bronchoscopic procedures. Disease processes encompassed within this discipline include

complex airway management problems, benign and malignant central airway obstruction,

pleural diseases, and pulmonary vascular procedures. Diagnostic and therapeutic procedures

pertaining to these areas include, but are not limited to, rigid bronchoscopy, transbronchial

needle aspiration (TBNA), auto fluorescence bronchoscopy, endobronchial ultrasound (EBUS),

transthoracic needle aspiration (TTNA) and biopsy, laser bronchoscopy, endobronchial

electrosurgery, argon-plasma coagulation, cryotherapy, airway stent insertion, balloon

bronchoplasty and dilatation techniques, endobronchial radiation, photodynamic therapy,

percutaneous dilatational tracheotomy, transtracheal oxygen catheter insertion, medical

thoracoscopy, and imaging-guided thoracic interventions. (Anders et al. 1988)

Considering the prominence of FFB in the procedural armamentarium of pulmonary

physicians (among other specialties) and the new developments of interventional

bronchoscopy, it is important for the non-interventional pulmonologist and physician in

pulmonary training to have a clear understanding of the role of FFB.