Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the saf...Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the safety and feasibility of holmium laser combined with cryotherapy delivered via flexible bronchoscopy for the treatment of post-intubation SGS in children.Methods:This study involved all patients with post-intubation SGS seen at the Interventional Pulmonology Department of Beijing Children's Hospital between July 2014 and December 2016.Holmium laser treatment and cryotherapy was then performed under flexible bronchoscopy,whose parents refused to accept the alternative standard treatment of tracheotomy and balloon dilation under direct laryngoscopy.results:Sixteen patients with post-intubation SGS were included in this study.Ages ranged from 2 months to 12.25 years old.According to the Cotton-Myer grading system,three cases were Grade II,12 cases were Grade III,and one case was Grade IV.According to the McCaffrey system,eight cases were Stage 1,two cases were Stage 2,and six cases were Stage 3.The average number of procedures was 4.88.Fifteen of the 16 patients achieved clinical cure.One patient achieved clinical improvement.The average treatment course duration was 55.31 days.No severe complications were seen.Post-treatment clinical symptoms,endoscopic findings and quality of life showed marked improvement.Interpretation:Our study supports the conclusion that holmium laser treatment combined with cryotherapy via flexible bronchoscopy appears to be a safe and feasible treatment for post-intubation SGS in children.展开更多
Background:Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy;however,the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion.This study ai...Background:Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy;however,the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion.This study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis,improve the first-pass success rate and patients’tolerance,and reduce postoperative bleeding.Methods:This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October 2020.Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups:control group,simple cotton bud detection group(CD group),and adrenaline+lidocaine detection group(AD group).The primary outcome was the time to pass the glottis.Secondary outcomes included the first-pass success rate,the patients’tolerance scores,and post-operative bleeding.One-way analysis of variance,Kruskal-WallisH test,Chi-squared test,Fisher’s exact test,and Bonferroni’s multiple comparison tests were used in this study.Results:In total,189 men and 111 women were enrolled in this study,with a mean age of 55.72±12.86 years.The insertion time was significantly shorter in the AD group than in the control group(18.00 s[12.00–26.50 s]vs.24.00 s[14.50–45.50 s],P=0.005).Both the AD(99%vs.83%,χ2=15.62,P<0.001)and CD groups(94%vs.83%,χ2=5.94,P=0.015)had a significantly higher first-pass success rate than the control group.Compared with the control group,post-operative bleeding(1%vs.13%,χ2=11.06,P<0.001)was significantly lower in the AD group.However,no significant difference was found in the patients’tolerance scores.Conclusions:Pre-operative nasal cavity probe tests especially with adrenaline and lidocaine during flexible bronchoscopy can significantly reduce the time to pass the glottis,improve the first-pass success rate,and reduce post-operative nasal bleeding.Pre-operative nasal probe tests are recommended as a time-saving procedure for patients undergoing flexible bronchoscopy.Trial registration:Chinese Clinical Trial Registry(ChiCTR),ChiCTR2000032668;http://www.chictr.org.cn/showprojen.aspx?proj=53321.展开更多
Flexible bronchoscopy(FB)has become a standard of care for the triad of inspection,sampling,and treatment in critical care patients.It is an invaluable tool for diagnostic and therapeutic purposes in critically ill pa...Flexible bronchoscopy(FB)has become a standard of care for the triad of inspection,sampling,and treatment in critical care patients.It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit(ICU).Less is known about its role outside the ICU,particularly in the intermediate care unit(IMCU),a specialized environment,where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided.In the IMCU,the leading indications for a diagnostic work-up are:To visualize airway system/obstructions,perform investigations to detect respiratory infections,and identify potential sources of hemoptysis.The main procedures for therapeutic purposes are secretion aspiration,mucus plug removal to solve atelectasis(total or lobar),and blood aspiration during hemoptysis.The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients.Serious adverse events related to FB are relatively uncommon,but they may be due to lack of expertise or appropriate precautions.Finally,nowadays,during dramatic recent coronavirus disease 2019(COVID-19)pandemic,the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined.Hence,we provide a concise review on the role of FB in an IMCU setting,focusing on its indications,technical aspects and complications.展开更多
Introduction: The COVID-19 pandemic has resulted in a reconsideration of our traditional teaching modalities and develop newer, dynamic methods. Both high and low fidelity bronchoscopy simulators are costly. The objec...Introduction: The COVID-19 pandemic has resulted in a reconsideration of our traditional teaching modalities and develop newer, dynamic methods. Both high and low fidelity bronchoscopy simulators are costly. The objective was to assess whether a combination of a low-cost bio-simulator made of recyclable materials (ALFIE<sup>TM</sup> Airway Low Fidelity including EBUS (endobronchial ultrasound)) and single use flexible bronchoscopy (SUFB) has the capability of differentiating novices from experts and the ability to train novices in bronchoscopy. Materials and Methods: Trainees were evaluated individually before and after training using a modified validated Bronchoscopy Skills and Tasks Assessment Tool (B-STAT) and SUFB. Results: 18 trainees were included (14 residents and 4 fellows). Pre-training assessment of scope handling differentiated novices from experienced bronchoscopists (p = 0.0025, 95% confidence intervals (CI) 3.12 - 12.17). Training of novices was associated with an improvement in scope handling and sampling (p = 0.0001, 95% CI 4.73 - 10.27). Conclusion: ALFIE<sup>TM</sup> and SUFB have the potential to create a low-cost platform to teach bronchoscopy remotely.展开更多
BACKGROUND Foreign body aspiration mainly occurs in children,which can cause a severe concurrent syndrome and even death without timely treatment.As a rare foreign body,aspiration of lime is seldom reported,and most c...BACKGROUND Foreign body aspiration mainly occurs in children,which can cause a severe concurrent syndrome and even death without timely treatment.As a rare foreign body,aspiration of lime is seldom reported,and most cases involve a small amount of hydrated lime.Although the symptoms are usually severe,the prognosis is good after suitable treatment.Experience of treatment for lime aspiration is lacking,and this report provides novel evidence for treatment of mass burnt lime aspiration using bronchoscopy.CASE SUMMARY We report an adult with a large amount of burnt lime aspiration.Because of delay in clearance of the inhaled lime in the trachea and bronchus at the local hospital,he suffered several severe complications,including complete occlusion of the right primary bronchus,aeropleura,aerodermectasia,pneumomediastinum,secondary infection and hypoxemia at 4 d after injury.After transferring to our department,bronchoscopy was immediately carried out to clear the lime in the major airway,using foreign body forceps,biopsy forceps,puncture needle,and hairbrush.The patient’s condition recovered rapidly and at 3-months’follow-up,he demonstrated good recovery of the bronchus and lung parenchyma.CONCLUSION After mass lime aspiration,flexible fiberoptic bronchoscopy is suggested as early as possible,using clamping,flushing or cryotherapy.展开更多
基金Special Fund of the Pediatric Medical Coordinated Development Center of Beijing Municipal Administration,No.XTZD20180105.
文摘Importance:Post-intubation subglottic stenosis(SGS)in children can be life threatening.Definitive treatment varies and lacks a universally accepted approach.Objective:We performed a prospective study to assess the safety and feasibility of holmium laser combined with cryotherapy delivered via flexible bronchoscopy for the treatment of post-intubation SGS in children.Methods:This study involved all patients with post-intubation SGS seen at the Interventional Pulmonology Department of Beijing Children's Hospital between July 2014 and December 2016.Holmium laser treatment and cryotherapy was then performed under flexible bronchoscopy,whose parents refused to accept the alternative standard treatment of tracheotomy and balloon dilation under direct laryngoscopy.results:Sixteen patients with post-intubation SGS were included in this study.Ages ranged from 2 months to 12.25 years old.According to the Cotton-Myer grading system,three cases were Grade II,12 cases were Grade III,and one case was Grade IV.According to the McCaffrey system,eight cases were Stage 1,two cases were Stage 2,and six cases were Stage 3.The average number of procedures was 4.88.Fifteen of the 16 patients achieved clinical cure.One patient achieved clinical improvement.The average treatment course duration was 55.31 days.No severe complications were seen.Post-treatment clinical symptoms,endoscopic findings and quality of life showed marked improvement.Interpretation:Our study supports the conclusion that holmium laser treatment combined with cryotherapy via flexible bronchoscopy appears to be a safe and feasible treatment for post-intubation SGS in children.
基金National Natural Science Foundation of China(NSFC No.81770072)The"1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(No.ZYJC18021)Chengdu Science and Technology Bureau(No.2018-CY02-00064-GX)。
文摘Background:Nasal insertion is the preferred method for non-intubated patients in flexible bronchoscopy;however,the relatively narrow nasal cavity results in difficulties related to bronchoscope insertion.This study aimed to investigate whether pre-operative nasal probe tests could reduce the time to pass the glottis,improve the first-pass success rate and patients’tolerance,and reduce postoperative bleeding.Methods:This three-arm prospective randomized controlled trial was conducted in a tertiary hospital between May and October 2020.Three hundred patients requiring diagnosis and treatment using flexible bronchoscopy were randomly allocated to three groups:control group,simple cotton bud detection group(CD group),and adrenaline+lidocaine detection group(AD group).The primary outcome was the time to pass the glottis.Secondary outcomes included the first-pass success rate,the patients’tolerance scores,and post-operative bleeding.One-way analysis of variance,Kruskal-WallisH test,Chi-squared test,Fisher’s exact test,and Bonferroni’s multiple comparison tests were used in this study.Results:In total,189 men and 111 women were enrolled in this study,with a mean age of 55.72±12.86 years.The insertion time was significantly shorter in the AD group than in the control group(18.00 s[12.00–26.50 s]vs.24.00 s[14.50–45.50 s],P=0.005).Both the AD(99%vs.83%,χ2=15.62,P<0.001)and CD groups(94%vs.83%,χ2=5.94,P=0.015)had a significantly higher first-pass success rate than the control group.Compared with the control group,post-operative bleeding(1%vs.13%,χ2=11.06,P<0.001)was significantly lower in the AD group.However,no significant difference was found in the patients’tolerance scores.Conclusions:Pre-operative nasal cavity probe tests especially with adrenaline and lidocaine during flexible bronchoscopy can significantly reduce the time to pass the glottis,improve the first-pass success rate,and reduce post-operative nasal bleeding.Pre-operative nasal probe tests are recommended as a time-saving procedure for patients undergoing flexible bronchoscopy.Trial registration:Chinese Clinical Trial Registry(ChiCTR),ChiCTR2000032668;http://www.chictr.org.cn/showprojen.aspx?proj=53321.
文摘Flexible bronchoscopy(FB)has become a standard of care for the triad of inspection,sampling,and treatment in critical care patients.It is an invaluable tool for diagnostic and therapeutic purposes in critically ill patients in intensive care unit(ICU).Less is known about its role outside the ICU,particularly in the intermediate care unit(IMCU),a specialized environment,where an intermediate grade of intensive care and monitoring between standard care unit and ICU is provided.In the IMCU,the leading indications for a diagnostic work-up are:To visualize airway system/obstructions,perform investigations to detect respiratory infections,and identify potential sources of hemoptysis.The main procedures for therapeutic purposes are secretion aspiration,mucus plug removal to solve atelectasis(total or lobar),and blood aspiration during hemoptysis.The decision to perform FB might depend on the balance between potential benefits and risks due to frailty of critically ill patients.Serious adverse events related to FB are relatively uncommon,but they may be due to lack of expertise or appropriate precautions.Finally,nowadays,during dramatic recent coronavirus disease 2019(COVID-19)pandemic,the exact role of FB in COVID-19 patients admitted to IMCU has yet to be clearly defined.Hence,we provide a concise review on the role of FB in an IMCU setting,focusing on its indications,technical aspects and complications.
文摘Introduction: The COVID-19 pandemic has resulted in a reconsideration of our traditional teaching modalities and develop newer, dynamic methods. Both high and low fidelity bronchoscopy simulators are costly. The objective was to assess whether a combination of a low-cost bio-simulator made of recyclable materials (ALFIE<sup>TM</sup> Airway Low Fidelity including EBUS (endobronchial ultrasound)) and single use flexible bronchoscopy (SUFB) has the capability of differentiating novices from experts and the ability to train novices in bronchoscopy. Materials and Methods: Trainees were evaluated individually before and after training using a modified validated Bronchoscopy Skills and Tasks Assessment Tool (B-STAT) and SUFB. Results: 18 trainees were included (14 residents and 4 fellows). Pre-training assessment of scope handling differentiated novices from experienced bronchoscopists (p = 0.0025, 95% confidence intervals (CI) 3.12 - 12.17). Training of novices was associated with an improvement in scope handling and sampling (p = 0.0001, 95% CI 4.73 - 10.27). Conclusion: ALFIE<sup>TM</sup> and SUFB have the potential to create a low-cost platform to teach bronchoscopy remotely.
文摘BACKGROUND Foreign body aspiration mainly occurs in children,which can cause a severe concurrent syndrome and even death without timely treatment.As a rare foreign body,aspiration of lime is seldom reported,and most cases involve a small amount of hydrated lime.Although the symptoms are usually severe,the prognosis is good after suitable treatment.Experience of treatment for lime aspiration is lacking,and this report provides novel evidence for treatment of mass burnt lime aspiration using bronchoscopy.CASE SUMMARY We report an adult with a large amount of burnt lime aspiration.Because of delay in clearance of the inhaled lime in the trachea and bronchus at the local hospital,he suffered several severe complications,including complete occlusion of the right primary bronchus,aeropleura,aerodermectasia,pneumomediastinum,secondary infection and hypoxemia at 4 d after injury.After transferring to our department,bronchoscopy was immediately carried out to clear the lime in the major airway,using foreign body forceps,biopsy forceps,puncture needle,and hairbrush.The patient’s condition recovered rapidly and at 3-months’follow-up,he demonstrated good recovery of the bronchus and lung parenchyma.CONCLUSION After mass lime aspiration,flexible fiberoptic bronchoscopy is suggested as early as possible,using clamping,flushing or cryotherapy.
