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Bronchoscopy the Florida Gold Coast Travel Guide

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Bronchoscopy the Florida Gold Coast Travel Guide Powered By Docstoc
					   BRONCHOSCOPY

          Cori Daines, MD
Pediatric Pulmonology, Allergy and
            Immunology
       University of Arizona
          BACKGROUND
• Allows direct visualization of the airways
• Rigid and flexible instruments
• Clinical tool
  – Airway anatomy
  – Airway sampling
  – Therapeutic
• Research tool
               ORIGINS
• Until the 1980’s, only rigid instruments
  were widely used
• Multiple generations of adult and pediatric
  flexible bronchoscopes now
• Widely used in adult and pediatric
  pulmonary medicine now
   RIGID BRONCHOSCOPY
• Generally performed by ENT’s and
  surgeons
• Procedure oriented
  –   Foreign body removal
  –   Biopsies
  –   Granuloma/polyp removal
  –   Laser
  –   Stent placement
• Visualization for future surgery
          INSTRUMENTS
• Rigid bronchoscopes
  – Hollow metal tube
  – Glass rod telescope
• Ultimate optics
FLEXIBLE BRONCHOCSOPY
• Examination of the entire respiratory
  anatomy, nose to bronchi
• Minor impact on anatomy
• Able to pass through an endotracheal tube
  or tracheostomy tube
             INSTRUMENTS
• Flexible instruments
  – Fiberoptic bronchoscopes
     •   2.2mm ultrathin
     •   2.8mm/1.2mm suction channel
     •   3.4mm/1.2mm suction channel
     •   4.4mm/2.0mm suction channel
     •   4.9mm/2.2mm suction channel
     •   5.9mm/3.0mm suction channel
             INSTRUMENTS
• Flexible instruments
  – Video bronchoscopes
     •   2.8mm/1.2mm suction channel (hybrid video scope)
     •   3.8mm/1.2mm suction channel
     •   4.0mm/2.0mm suction channel (hybrid video scope)
     •   4.9mm/2.0mm suction channel
     •   6.0mm/3.0mm suction channel
     •   6.3mm/3.2mm suction channel
Fiberoptic bronchoscope
2.8mm diameter
Pediatric videoscope
3.8mm diameter
            INDICATIONS
• When flexible bronchoscopy is the best,
  easiest, safest, most efficient way to obtain
  the information
AIRWAY ANATOMY
TECHNIQUE
             TECHNIQUE
• Anesthesia
  – Best accomplished in the operating room
  – May be performed bedside in an ICU setting
  – Continuous monitoring
  – Light anesthesia--allows continued spontaneous
    breathing
  – May be done with conscious sedation in older
    individuals
               TECHNIQUE
• Insertion
  –   Nasal
  –   Endotracheal tube
  –   Tracheostomy tube
  –   Appropriate topical anesthesia and lubrication
              TECHNIQUE
• Anatomical survey
  –   Nasal passages
  –   Pharynx
  –   Larynx
  –   Trachea
  –   Bronchi
• Examine all before any other procedures
               TECHNIQUE
• Additional procedures
  –   Bronchoalveolar lavage
  –   Brushings
  –   Bronchial biopsy
  –   Transbronchial biopsy
  –   Laser
  –   Others: cryotherapy, stent placement, foreign
      body removal, needle biopsy
    BRONCHOALVEOLAR
         LAVAGE
• Small aliquots of sterile normal saline
  instilled into the airway
• Removed by suctioning
• Samples distal bronchial and alveolar
  surfaces
• Wedge position to prevent loss of fluid
                    TESTS
• Microbiology
  – Bacterial, viral, fungal, AFB, special techniques
• Pathology
  – Cell count, differential, special stains
MICROBIOLOGIC STUDIES
• Stains
  – Gram stain
  – Acid fast stain (Ziehl-Neelsen)
• Antibody tests
  – Rapid tests, DFA tests
• In-situ
• PCR
          SPECIAL STAINS
• Lipid
  – Oil Red O
  – Sudan
• Hemosiderin
  – Prussian Blue
• Alveolar proteinosis
  – PAS
  – Electron microscopy
          SPECIAL STAINS
• Fungi
  – Silver (Gomori’s methenamine silver stain)
• Pneumocystis carinii
  – Silver stain
  – Papanicolaou
BRONCHOALVEOLAR
     LAVAGE
     SPECIFIC INDICATIONS
•   Atelectasis
•   Recurrent pneumonia
•   Chronic cough
•   Persistent/unexplained wheeze
•   Hemoptysis
•   Suspected airway compression/obstruction
•   Stridor
•   Upper airway obstruction
•   Suspected aspiration
•   Evaluation of tracheostomies
    BRONCHOSCOPY TEAM
•   Pulmonologists
•   Respiratory therapists
•   Anesthesia
•   Nurses
•   Laboratory
    – Microbiology
    – Pathology

				
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posted:8/12/2011
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