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2004, Number 1

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Rev Inst Nal Enf Resp Mex 2004; 17 (1)

Fiberoptic bronchoscopy in critical care medicine

Aguilar RMP, García OJG, Pérez RA, Navarro RF, Cicero SR

Language: Spanish
References: 31
Page: 7-14
PDF size: 92.97 Kb.


ABSTRACT

Objective: To identify the indications of fiberoptic bronchoscopy (FOB) in patients hospitalized in Intensive Care Units (ICU). Material and methods: Observational clinic study retrospective and prospective of patients hospitalized in ICU with FOB, from October 2001-September 2003. In all cases it was recorded diagnostic indication for FOB, findings, complications and ICU where it comes from. Test of proportions with confidence limits for binomial distribution (Bernoulli) was applied. Results: Of 867 FOB, 88 were performed in ICU (10.14%), 51 males, 37 females, mean age 52.35; SD 17.27; range 15-86 years old. Fifty patients came from different services IC units, central, infectology, oncology, cardiology and neurology, 38 were from Respiratory Intensive Care Unit (RICU). In 50 cases the indication was pneumonia, 16 communitary, 12 by aspiration, 12 ventilator associated and 10 nosocomial. 15 correspond to RICU and 35 from non-pneumologic ICU. There were no significative differences. Diagnosis of the others 38 patients were 18 atelectasis, 6 malignancies, 5 hemoptysis, 3 evaluation of tracheostomy, 2 tracheoesophageal fistula, 2 tracheal stenosis, 1 lung abscess an 1 burn of airway. 65 FOB were for diagnosis, 11 therapeutics and 12 by both. Only 2 patients presented complications. No casualties were recorded. Conclusion: FOB is a safe method for diagnostic and therapeutic indications in patients in critical conditions under intensive care and make easier the decisions for clinical management, with low morbidity.


REFERENCES

  1. Raoof S, Mehrischi S, Prakash UB. Role of Bronchoscopy in Modern Medical Intensive Care Unit. Clin Chest Med 2001;22:241-261.

  2. Dellinger RP, Bandi V. Fiberoptic Bronchoscopy in the Intensive Care Unit. Crit Care Clin 1992;8:755-772.

  3. Liebler JM, Markin CJ. Fiberoptic Bronchoscopy for Diagnosis and Treatment. Crit Care Clin 2000;16:83-100.

  4. Padua A, Castorena G, Ramírez AJ, Cicero R. La fibrobroncoscopia en el enfermo con patología broncopulmonar aguda. Gac Med Mex 1980;116:23-29.

  5. Kreider ME, Lipson DA. Bronchoscopy for Atelectasis in the ICU. Chest 2003;124:344-350.

  6. Tsao TC, Tsai YH, Lan RS, Shieh WB, Lee CH. Treatment for Collapsed Lung in Critically ill Patients. Selective Intrabronchial Air Insufflation Using the Fiberoptic Bronchoscope. Chest 1990;97:435-438.

  7. Olopade CO, Prakash UB. Bronchoscopy in the Critical Care Unit. Mayo Clin Proc 1989;64:1255-1263.

  8. Allen R, Dunn W, Limper A. Diagnosing Ventilator Associated Pneumonia: The Role of Bronchoscopy. Mayo Clin Proc 1994;69:962-968.

  9. Langer M, Moscón P, Cigada M, Mandalli M. Long-term Respiratory Support and Risk of Pneumonia in Critically ill Patients. Am Rev Respir Dis 1989;140:302-305.

  10. Heyland DK, Cook DJ, Marshall J, Heule M, Guslits B, Lang J, et al. The Clinical Utility of Invasive Diagnostic Techniques in the Setting of Ventilator-associated Pneumonia. Chest 1999;115:1076-1084.

  11. Rello J, Ausina V, Ricart M, Castella J, Prats G. Impact of Previous Antimicrobial Therapy on the Etiology and Outcome of Ventilator-associated Pneumonia. Chest 1993;104:1230-1235.

  12. Andrews CP, Coalson JJ, Smith JD, Johanson WG Jr. Diagnosis of Nosocomial Bacterial Pneumonia in Acute, Diffuse Lung Injury. Chest 1981;80:254-258.

  13. Chastre J, Trouillet JL, Dombret MC. Bronchoscopic Diagnosis of Bacterial Pneumonia: Protected Specimen Brush versus Bronchoalveolar Lavage. J Bronchology 1997;4:260-265.

  14. Lambotte O, Timsit JF, Garrouste-Orgeas M, Misset B, Benali A, Carlet J. The Significance of Distal Bronchial Samples with Commensals in Ventilator-associated Pneumonia: Colonizer or Pathogen? Chest 2002;122:1389-1399.

  15. Cicero R, Criales JL, Lorenze JM, Saldaña Y, Cardoso M, Casillas C, et al. Flexible Bronchoscopy and Helical Computed Tomography with Three Dimensional Reconstructions in Non-small cell Carcinoma of the Lung. Bronchology 1998;5:98-103.

  16. Cohn AI, Zornow MH. Awake Endotracheal Intubation in Patients with Cervical Spine Disease: A Comparison of the Bullard Laryngoscope and the Fiberoptic Bronchoscope. Anesth Analg 1995;81:1283-1286.

  17. Sheridan RL. Burns. Crit Care Med 2002;30:500S-514S.

  18. Silver MR, Balk RA. Bronchoscopic Procedures in the Intensive Care Unit. Crit Care Clin 1995;11:97-109.

  19. Dunagan DP, Burke HL, Aquino SL, Chin R Jr, Adair NE, Haponik EF. Fiberoptic Bronchoscopy in Coronary Care Unit Patients: Indications, Safety and Clinical Implications. Chest 1998;114:1660-1667.

  20. Turner JS, Wilcox PA, Hayhurst MD, Potgieter PD. Fiberoptic Bronchoscopy in the Intensive Care Unit. A Prospective Study of 147 Procedures in 107 Patients. Crit Care Med 1994;22:259-264.

  21. Jolliet P, Chevrolet JC. Bronchoscopy in the Intensive Care Unit. Intensive Care Med 1992;18:160-169.

  22. Utz JP, Prakash UBS. Indications or and Contraindications to Bronchoscopy. In: Prakash UBS, editor. Bronchoscopy. New York, NY: Raven Press, 1989:15-28.

  23. Dweik RA, Mhta AC, Meeker DP, Arroliga AC. Analysis of the Safety of Bronchoscopy after Recent Acute Myocardial Infarction. Chest 1996;110:825-828.

  24. Diette GB, Wiener CM, White P Jr. The Higher Risk of Bleeding in Lung Transplant Recipients from Bronchoscopy is Independent of Traditional Bleeding Risk. Chest 1999;115:397-402.

  25. Pereira JC, Pedreira WL Jr, Araujo EMPA, Soriano FG, Negri EM, Antonangelo L, et al. Impact of BAL in the Management of Pneumonia with Treatment Failure. Positive of BAL Culture Under Antibiotic Therapy. Chest 2000;118:1739-1746.

  26. Fagon J, Chastre J, Domart Y, Trovillet JL, Pierre J, Darne C, et al. Nosocomial Pneumonia in Patients Receiving Continuous Mechanical Ventilation. Am Rev Respir Dis 1989;139:877-884.

  27. Gruson D, Hilbert G, Valentino R, Vargas F, Chene G, Bebear C, et al. Utility of Fiberoptic in Bronchoscopy in Neutropenic Patients Admitted to the Intensive Care Unit with Pulmonary Infiltrates. Crit Care Med 2000;28:2224-2230.

  28. Ghamande S, Rafanan A, Dweik R, Arroliga AC, Mehta AC. Role of Transbronchial Needle Aspiration in Patients Receiving Mechanical Ventilation. Chest 2002;122:985-989.

  29. Krees JP, Christenson J, Pohlman AS, Linkin DR, Hall JB. Outcomes of Critically ill Cancer Patients in a University Hospital Setting. Am J Respir Care Med 1999;160:1957-1961.

  30. Meduri GU, Chastre J. The Standardization of Bronchoscopic Techniques for Ventilator-associated Pneumonia. Chest 1992;102:557S-564S.

  31. Laudgran R, Haggmark S, Reiz S. Hemodynamic Effects of Flexible Fiberoptic Bronchoscopy Performed Under Topical Anesthesia. Chest 1982;82:295-299.




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