- •Foreword
- •Preface
- •Contents
- •About the Editors
- •Contributors
- •1: Tracheobronchial Anatomy
- •Trachea
- •Introduction
- •External Morphology
- •Internal Morphology
- •Mucous Layer
- •Blood Supply
- •Anatomo-Clinical Relationships
- •Bronchi
- •Main Bronchi
- •Bronchial Division
- •Left Main Bronchus (LMB)
- •Right Main Bronchus (RMB)
- •Blood Supply
- •References
- •2: Flexible Bronchoscopy
- •Introduction
- •History
- •Description
- •Indications and Contraindications
- •Absolute Contraindications
- •Procedure Preparation
- •Technique of FB Procedure
- •Complications of FB Procedure
- •Basic Diagnostic Procedures
- •Bronchoalveolar Lavage (BAL)
- •Transbronchial Lung Biopsy (TBLB)
- •Transbronchial Needle Aspiration (TBNA)
- •Bronchial Brushings
- •Advanced Diagnostic Bronchoscopy
- •EBUS-TBNA
- •Ultrathin Bronchoscopy
- •Transbronchial Lung Cryobiobsy (TBLC)
- •Therapeutic Procedures Via FB
- •LASER Bronchoscopy
- •Electrocautery
- •Argon Plasma Coagulation (APC)
- •Cryotherapy
- •Photodynamic Therapy
- •Airway Stent Placement
- •Endobronchial Valve Placement
- •Conclusion
- •References
- •History and Historical Perspective
- •Indications and Contraindications
- •Procedure Description
- •Procedure Planning
- •Target Approximation
- •Sampling
- •Complications
- •Future Directions
- •Summary and Recommendations
- •References
- •4: Rigid Broncoscopy
- •Innovations
- •Ancillary Equipment
- •Rigid Bronchoscopy Applications
- •Laser Bronchoscopy
- •Tracheobronchial Prosthesis
- •Transbronchial Needle Aspiration (TBNA)
- •Rigid Bronchoscope in Other Treatments for Bronchial Obstruction
- •Mechanical Debridement
- •Pediatric Rigid Bronchoscopy
- •Tracheobronchial Dilatation
- •Foreign Bodies Removal
- •Other Indications
- •Complications
- •The Procedure
- •Some Conclusions
- •References
- •History and Historical Perspective
- •Indications and Contraindications
- •Preprocedural Evaluation and Preparation
- •Physical Examination
- •Procedure-Related Indications
- •Application of the Technique
- •Topical Anesthesia
- •Anesthesia of the Nasal Mucosa and Nasopharynx
- •Anesthesia of the Mouth and Oropharynx
- •Superior Laryngeal Nerve Block
- •Recurrent Laryngeal Nerve Block (RLN)
- •Conscious Sedation
- •Monitored Anesthesia Care (MAC)
- •General Anesthesia
- •Monitoring the Depth of Anesthesia
- •Interventional Bronchoscopy Suites
- •Airway Devices
- •Laryngeal Mask Airway (LMA)
- •Endotracheal Tube (ETT)
- •Rigid Bronchoscope
- •Modes of Ventilation
- •Spontaneous Ventilation
- •Assisted Ventilation
- •Noninvasive Positive Pressure Ventilation (NIV)
- •Positive Pressure Controlled Mechanical Ventilation
- •Jet Ventilation
- •Electronic Mechanical Jet Ventilation
- •Postprocedure Care
- •Special Consideration
- •Anesthesia for Peripheral Diagnostic and Therapeutic Bronchoscopy
- •Anesthesia for Interventional Bronchoscopic Procedures During the COVID-19 Pandemic
- •Summary and Recommendations
- •Conclusion
- •References
- •Background
- •Curricular Structure and Delivery
- •What Is a Bronchoscopy Curriculum?
- •Tradition, Teaching Styles, and Beliefs
- •Using Assessment Tools to Guide the Educational Process
- •The Ethics of Teaching
- •When Learners Teach: The Journey from Novice to Mastery and Back Again
- •The Future Is Now
- •References
- •Interventional Procedure
- •Assessment of Flow–Volume Curve
- •Dyspnea
- •Analysis of Pressure–Pressure Curve
- •Conclusions
- •References
- •Introduction
- •Adaptations of the IP Department
- •Environmental Control
- •Personal Protective Equipment
- •Procedure Performance
- •Bronchoscopy in Intubated Patients
- •Other Procedures in IP Unit
- •References
- •Introduction
- •Safety
- •Patient Safety
- •Provider Safety
- •Patient Selection and Screening
- •Lung Cancer Diagnosis and Staging
- •Inpatients
- •COVID-19 Clearance
- •COVID Clearance: A Role for Bronchoscopy
- •Long COVID: A Role for Bronchoscopy
- •Preparing for the Next Pandemic
- •References
- •Historical Perspective
- •Indications and Contraindications
- •Evidence-Based Review
- •Summary and Recommendations
- •References
- •Introduction
- •Clinical Presentation
- •Diagnosis
- •Treatment
- •History and Historical Perspectives
- •Indications and Contraindications
- •Benign and Malignant Tumors
- •Tumors with Uncertain Prognosis
- •Application of the Technique
- •Evidence Based Review
- •Summary and Recommendations
- •References
- •12: Cryotherapy and Cryospray
- •Introduction
- •Historical Perspective
- •Equipment
- •Cryoadhesion
- •Indications
- •Cryorecanalization
- •Cryoadhesion and Foreign Body Removal
- •Cryoadhesion and Mucus Plugs/Blood Clot Retrieval
- •Endobronchial Cryobiopsy
- •Transbronchial Cryobiopsy for Lung Cancer
- •Safety Concerns and Contraindications
- •Cryoablation
- •Indications
- •Evidence
- •Safety Concerns and Contraindications
- •Cryospray
- •Indications
- •Evidence
- •Safety Concerns and Contraindications
- •Advantages of Cryotherapy
- •Limitations
- •Future Research Directions
- •References
- •13: Brachytherapy
- •History and Historical Perspective
- •Indications and Contraindications
- •Application of the Technique
- •Evidence-Based Review
- •Adjuvant Treatment
- •Palliative Treatment
- •Complications
- •Summary and Recommendations
- •References
- •14: Photodynamic Therapy
- •Introduction
- •Photosensitizers
- •First-Generation Photosensitizers
- •M-Tetrahidroxofenil Cloro (mTHPC) (Foscan®)
- •PDT Reaction
- •Tumor Damage Process
- •Procedure
- •Indications
- •Curative PDT Indications
- •Palliative PDT Indications
- •Contraindications
- •Rationale for Use in Early-Stage Lung Cancer
- •Rationale
- •PDT in Combination with Other Techniques for Advanced-Stage Non-small Cell Lung Cancer
- •Commentary
- •Complementary Endoscopic Methods for PDT Applications
- •New Perspectives
- •Other PDT Applications
- •Conclusions
- •References
- •15: Benign Airways Stenosis
- •Etiology
- •Congenital Tracheal Stenosis
- •Iatrogenic
- •Infectious
- •Idiopathic Tracheal Stenosis
- •Distal Bronchial Stenosis
- •Diagnosis Methods
- •Patient History
- •Imaging Techniques
- •Bronchoscopy
- •Pulmonary Function Test
- •Treatment
- •Endoscopic Treatment
- •Dilatation
- •Laser Therapy
- •Stents
- •How to Proceed
- •Stent Placement
- •Placing a Montgomery T Tube
- •The Rule of Twos for Benign Tracheal Stenosis (Fig. 15.23)
- •Surgery
- •Summary and Recommendations
- •References
- •16: Endobronchial Prostheses
- •Introduction
- •Indications
- •Extrinsic Compression
- •Intraluminal Obstruction
- •Stump Fistulas
- •Esophago-respiratory Fistulas (ERF)
- •Expiratory Central Airway Collapse
- •Physiologic Rationale for Airway Stent Insertion
- •Stent Selection Criteria
- •Stent-Related Complications
- •Granulation Tissue
- •Stent Fracture
- •Migration
- •Contraindications
- •Follow-Up and Patient Education
- •References
- •Introduction
- •Overdiagnosis
- •False Positives
- •Radiation
- •Risk of Complications
- •Lung Cancer Screening Around the World
- •Incidental Lung Nodules
- •Management of Lung Nodules
- •References
- •Introduction
- •Minimally Invasive Procedures
- •Mediastinoscopy
- •CT-Guided Transthoracic Biopsy
- •Fluoroscopy-Guided Transthoracic Biopsies
- •US-Guided Transthoracic Biopsy
- •Thoracentesis and Pleural Biopsy
- •Thoracentesis
- •Pleural Biopsy
- •Surgical or Medical Thoracoscopy
- •Image-Guided Pleural Biopsy
- •Closed Pleural Biopsy
- •Image-Guided Biopsies for Extrathoracic Metastases
- •Tissue Acquisition, Handling and Processing
- •Implications of Tissue Acquisition
- •Guideline Recommendations for Tissue Acquisition in Mediastinal Staging
- •Methods to Overcome Challenges in Tissue Acquisition and Genotyping
- •Rapid on-Site Evaluation (ROSE)
- •Sensitive Genotyping Assays
- •Liquid Biopsy
- •Summary, Recommendations and Highlights
- •References
- •History
- •Data Source and Methodology
- •Tumor Size
- •Involvement of the Main Bronchus
- •Atelectasis/Pneumonitis
- •Nodal Staging
- •Proposal for the Revision of Stage Groupings
- •Small Cell Lung Cancer (SCLC)
- •Discussion
- •Methodology
- •T Descriptors
- •N Descriptors
- •M Descriptors
- •Summary
- •References
- •Introduction
- •Historical Perspective
- •Fluoroscopy
- •Radial EBUS Mini Probe (rEBUS)
- •Ultrasound Bronchoscope (EBUS)
- •Virtual Bronchoscopy
- •Trans-Parenchymal Access
- •Cone Beam CT (CBCT)
- •Lung Vision
- •Sampling Instruments
- •Conclusions
- •References
- •History and Historical Perspective
- •Narrow Band Imaging (NBI)
- •Dual Red Imaging (DRI)
- •Endobronchial Ultrasound (EBUS)
- •Optical Coherence Tomography (OCT)
- •Indications and Contraindications
- •Confocal Laser Endomicroscopy and Endocytoscopy
- •Raman Spectrophotometry
- •Application of the Technique
- •Supplemental Technology for Diagnostic Bronchoscopy
- •Evidence-Based Review
- •Summary and Recommendations, Highlight of the Developments During the Last Three Years (2013 on)
- •References
- •Introduction
- •History and Historical Perspective
- •Endoscopic AF-OCT System
- •Preclinical Studies
- •Clinical Studies
- •Lung Cancer
- •Asthma
- •Airway and Lumen Calibration
- •Obstructive Sleep Apnea
- •Future Applications
- •Summary
- •References
- •23: Endobronchial Ultrasound
- •History and Historical Perspective
- •Equipment
- •Technique
- •Indication, Application, and Evidence
- •Convex Probe Ultrasound
- •Equipment
- •Technique
- •Indication, Application, and Evidence
- •CP-EBUS for Malignant Mediastinal or Hilar Adenopathy
- •CP-EBUS for the Staging of Non-small Cell Lung Cancer
- •CP-EBUS for Restaging NSCLC After Neoadjuvant Chemotherapy
- •Complications
- •Summary
- •References
- •Introduction
- •What Is Electromagnetic Navigation?
- •SuperDimension Navigation System (EMN-SD)
- •Computerized Tomography
- •Computer Interphase
- •The Edge Catheter: Extended Working Channel (EWC)
- •Procedural Steps
- •Planning
- •Detecting Anatomical Landmarks
- •Pathway Planning
- •Saving the Plan and Exiting
- •Registration
- •Real-Time Navigation
- •SPiN System Veran Medical Technologies (EMN-VM)
- •Procedure
- •Planning
- •Navigation
- •Biopsy
- •Complications
- •Limitations
- •Summary
- •References
- •Introduction
- •Image Acquisition
- •Hardware
- •Practical Considerations
- •Radiation Dose
- •Mobile CT Studies
- •Future Directions
- •Conclusion
- •References
- •26: Robotic Assisted Bronchoscopy
- •Historical Perspective
- •Evidence-Based Review
- •Diagnostic Yield
- •Monarch RAB
- •Ion Endoluminal Robotic System
- •Summary
- •References
- •History and Historical Perspective
- •Indications and Contraindications
- •General
- •Application of the Technique
- •Preoperative Care
- •Patient’s Position and Operative Field
- •Incision and Initial Dissection
- •Palpation
- •Biopsy
- •Control of Haemostasis and Closure
- •Postoperative Care
- •Complications
- •Technical Variants
- •Extended Cervical Mediastinoscopy
- •Mediastinoscopic Biopsy of Scalene Lymph Nodes
- •Inferior Mediastinoscopy
- •Mediastino-Thoracoscopy
- •Video-Assisted Mediastinoscopic Lymphadenectomy
- •Transcervical Extended Mediastinal Lymphadenectomy
- •Evidence-Based Review
- •Summary and Recommendations
- •References
- •Introduction
- •Case 1
- •Adrenal and Hepatic Metastases
- •Brain
- •Bone
- •Case 1 Continued
- •Biomarkers
- •Case 1 Concluded
- •Case 2
- •Chest X-Ray
- •Computerized Tomography
- •Positive Emission Tomography
- •Magnetic Resonance Imaging
- •Endobronchial Ultrasound with Transbronchial Needle Aspiration
- •Transthoracic Needle Aspiration
- •Transbronchial Needle Aspiration
- •Endoscopic Ultrasound with Needle Aspiration
- •Combined EUS-FNA and EBUS-TBNA
- •Case 2 Concluded
- •Case 3
- •Standard Cervical Mediastinoscopy
- •Extended Cervical Mediastinoscopy
- •Anterior Mediastinoscopy
- •Video-Assisted Thoracic Surgery
- •Case 3 Concluded
- •Case 4
- •Summary
- •References
- •29: Pleural Anatomy
- •Pleural Embryonic Development
- •Pleural Histology
- •Cytological Characteristics
- •Mesothelial Cells Functions
- •Pleural Space Defense Mechanism
- •Pleura Macroscopic Anatomy
- •Visceral Pleura (Pleura Visceralis or Pulmonalis)
- •Parietal Pleura (Pleura Parietalis)
- •Costal Parietal Pleura (Costalis)
- •Pleural Cavity (Cavitas Thoracis)
- •Pleural Apex or Superior Pleural Sinus [12–15]
- •Anterior Costal-Phrenic Sinus or Cardio-Phrenic Sinus
- •Posterior Costal-Phrenic Sinus
- •Cost-Diaphragmatic Sinus or Lateral Cost-Phrenic Sinus
- •Fissures18
- •Pleural Vascularization
- •Parietal Pleura Lymphatic Drainage
- •Visceral Pleura Lymphatic Drainage
- •Pleural Innervation
- •References
- •30: Chest Ultrasound
- •Introduction
- •The Technique
- •The Normal Thorax
- •Chest Wall Pathology
- •Pleural Pathology
- •Pleural Thickening
- •Pneumothorax
- •Pulmonary Pathology
- •Extrathoracic Lymph Nodes
- •COVID and Chest Ultrasound
- •Conclusions
- •References
- •Introduction
- •History of Chest Tubes
- •Overview of Chest Tubes
- •Contraindications for Chest Tube Placement
- •Chest Tube Procedural Technique
- •Special Considerations
- •Pneumothorax
- •Empyema
- •Hemothorax
- •Chest Tube Size Considerations
- •Pleural Drainage Systems
- •History of and Introduction to Indwelling Pleural Catheters
- •Indications and Contraindications for IPC Placement
- •Special Considerations
- •Non-expandable Lung
- •Chylothorax
- •Pleurodesis
- •Follow-Up and IPC Removal
- •IPC-Related Complications and Management
- •Competency and Training
- •Summary
- •References
- •32: Empyema Thoracis
- •Historical Perspectives
- •Incidence
- •Epidemiology
- •Pathogenesis
- •Clinical Presentation
- •Radiologic Evaluation
- •Biochemical Analysis
- •Microbiology
- •Non-operative Management
- •Prognostication
- •Surgical Management
- •Survivorship
- •Summary and Recommendations
- •References
- •Evaluation
- •Initial Intervention
- •Pleural Interventions for Recurrent Symptomatic MPE
- •Especial Circumstances
- •References
- •34: Medical Thoracoscopy
- •Introduction
- •Diagnostic Indications for Medical Thoracoscopy
- •Lung Cancer
- •Mesothelioma
- •Other Tumors
- •Tuberculosis
- •Therapeutic Indications
- •Pleurodesis of Pneumothorax
- •Thoracoscopic Drainage
- •Drug Delivery
- •Procedural Safety and Contraindications
- •Equipment
- •Procedure
- •Pre-procedural Preparations and Considerations
- •Procedural Technique [32]
- •Medical Thoracoscopy Versus VATS
- •Conclusion
- •References
- •Historical Perspective
- •Indications and Contraindications
- •Evidence-Based Review
- •Endobronchial Valves
- •Airway Bypass Tracts
- •Coils
- •Other Methods of ELVR
- •Summary and Recommendations
- •References
- •36: Bronchial Thermoplasty
- •Introduction
- •Mechanism of Action
- •Trials
- •Long Term: Ten-Year Study
- •Patient Selection
- •Bronchial Thermoplasty Procedure
- •Equipment
- •Pre-procedure
- •Bronchoscopy
- •Post-procedure
- •Conclusion
- •References
- •Introduction
- •Bronchoalveolar Lavage (BAL)
- •Technical Aspects of BAL Procedure
- •ILD Cell Patterns and Diagnosis from BAL
- •Technical Advises for Conventional TLB and TLB-C in ILD
- •Future Directions
- •References
- •Introduction
- •The Pediatric Airway
- •Advanced Diagnostic Procedures
- •Endobronchial Ultrasound
- •Virtual Navigational Bronchoscopy
- •Cryobiopsy
- •Therapeutic Procedures
- •Dilation Procedures
- •Thermal Techniques
- •Mechanical Debridement
- •Endobronchial Airway Stents
- •Metallic Stents
- •Silastic Stents
- •Novel Stents
- •Endobronchial Valves
- •Bronchial Thermoplasty
- •Discussion
- •References
- •Introduction
- •Etiology
- •Congenital ADF
- •Malignant ADF
- •Cancer Treatment-Related ADF
- •Benign ADF
- •Iatrogenic ADF
- •Diagnosis
- •Treatment Options
- •Endoscopic Techniques
- •Stents
- •Clinical Results
- •Stent Complications
- •Other Available Stents
- •Other Endoscopic Methods
- •References
- •Introduction
- •Anatomy and Physiology of Swallowing
- •Functional Physiology of Swallowing
- •Epidemiology and Risk Factors
- •Types of Foreign Bodies
- •Organic
- •Inorganic
- •Mineral
- •Miscellaneous
- •Clinical Presentation
- •Acute FB
- •Retained FB
- •Radiologic Findings
- •Bronchoscopy
- •Airway Management
- •Rigid Vs. Flexible Bronchoscopy
- •Retrieval Procedure
- •Instruments
- •Grasping Forceps
- •Baskets
- •Balloons
- •Suction Instruments
- •Ablative Therapies
- •Cryotherapy
- •Laser Therapy
- •Electrocautery and APC
- •Surgical Management
- •Complications
- •Bleeding and Hemoptysis
- •Distal Airway Impaction
- •Iron Pill Aspiration
- •Follow-Up and Sequelae
- •Conclusion
- •References
- •Vascular Origin of Hemoptysis
- •History and Historical Perspective
- •Diagnostic Bronchoscopy
- •Therapeutic Bronchoscopy
- •General Measures
- •Therapeutic Bronchoscopy
- •Evidence-Based Review
- •Summary
- •Recommendations
- •References
- •History
- •“The Glottiscope” (1807)
- •“The Esophagoscope” (1895)
- •The Rigid Bronchoscope (1897–)
- •The Flexible Bronchoscope (1968–)
- •Transbronchial Lung Biopsy (1972) (Fig. 42.7)
- •Laser Therapy (1981–)
- •Endobronchial Stents (1990–)
- •Electromagnetic Navigation (2003–)
- •Bronchial Thermoplasty (2006–)
- •Endobronchial Microwave Therapy (2004–)
- •American Association for Bronchology and Interventional Pulmonology (AABIP) and Journal of Bronchology and Interventional Pulmonology (JOBIP) (1992–)
- •References
- •Index
8 Interventional Procedures During the COVID-19 Pandemics: Adaptations in the Interventional… |
123 |
|
|
Procedure Performance
All societies recommend postponing elective procedures in suspected or known COVID-19 patients. Bronchoscopy is considered to be a relatively contraindicated procedure in these situations as its bene t in face of infectious risk of operators is not clear [7].
Although rescheduling certain procedures is obvious, in other cases the decision is not straightforward and risks/bene ts must be weighted [6, 9].
Nonelective bronchoscopic procedures are mainly performed for microbiological evaluation in suspected superinfection and obstructive atelectasis [3]. Elective procedures mostly represent diagnostic (oncologic and microbiologic purposes) and therapeutic reasons [18].
Bronchoscopy inNonintubated Patients
In an ideal scenario, it is safer to perform all the procedures in intubated patients and with general anesthesia to minimize droplet emission. In the real world, this situation may not be possible and the procedure must be done in spontaneous ventilation and in a nonintubated patient. Considering this last situation, some recommendations are listed below:
•\ To reduce direct exposure, the operator should stand behind the patient.
•\ Oxygen supplementation should be done without humidi cation.
•\ Nebulized medications should be avoided before or after the procedure.
•\ Some guidelines suggest not to use lidocaine for pharyngeal anesthesia, while others suggest cough-suppressive drugs to reduce aerosolization [7].
•\ Appropriate sedation should be performed.
•\ A transnasal approach is preferred when possible, and a facial mask should be placed over the patients’ mouth (Fig. 8.2a). An oral aspiration cannula should be available. The use of nonvented oronasal masks with a dedicated
bronchoscopic entrance is also a possible option.
•\ In hypoxemic patients, bronchoscopy may be performed under noninvasive ventilation (NIV) (Fig. 8.2b).
•\ Other barrier systems have been used as alternatives to masks, with the aim of minimizing the dispersion of droplets, like the existence of a protective box placed over the patient’s head, but they need further investigations to prove their ef cacy (Fig. 8.2c).
•\ Bronchoscopy under high-fow oxygen is not recommended.
Bronchoscopy in Intubated Patients
About 5% of COVID-19 patients can develop respiratory failure and need mechanical ventilation [1]. In critically ill patients under invasive ventilation, ventilator-associated pneumonia occurs in up to 30%, and lobar collapse causing atelectasis is frequent and multifactorial. The combination of predisposing factors related to the underlying pathology, sedation, position, inadequate secretion aspiration and the high fraction of inspired oxygen will contribute to pulmonary atelectasis [19].
Performing a bronchoscopy in an intubated patient has some advantages: offers a secure airway, it is easier to oxygenate and reduces muscular workout and fatigue [20]. Several considerations may be considered:
•\ It is always preferred to perform the procedure under general anesthesia. In speci c and more complex cases, if there is no contraindication, consider muscle relaxation with a neuromuscular blocker.
•\ A cuffed endotracheal tube is preferred over the supraglottic devices; cuff pressure should be maintained between 25 and 30 cm H2O [21].
•\ The use of an adapter (e.g., swivel) may facilitate the entry of the bronchoscope, avoiding disconnection of the ventilator circuit and minimizing air leaks.
•\ Pressure-limited volumetric ventilatory modes with FIO2 100%, attempting to main-
124 |
F. Guedes and A. Bugalho |
|
|
a
b |
c |
Fig. 8.2 (a) Facial mask placed over the patients’ mouth. (b) Noninvasive ventilation mask. (c) Protective box
tain constant PEEP during the procedure are desirable. Variations in ventilatory parameters can be performed dynamically after adequate patient-related risk assessment.
•\ To avoid aerosol dispersion, a simple maneuver consists of clamping the ventilation circuit just before introduction of bronchoscope, repeating the same step just before withdrawal.
•\ When performing a bronchoalveolar lavage, the volume used should be reduced to a minimum, and it is worth mentioning that 2–3 mL
of recovery lavage is able to provide a SARS- CoV-2 diagnosis.
•\ Bronchoscope removal and reinsertion during the procedure should be avoided or reduced.
Other Procedures in IP Unit
In patients with suspected or con rmed COVID-19, rigid bronchoscopy should be avoided, but there are scenarios where fexible
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/
8 Interventional Procedures During the COVID-19 Pandemics: Adaptations in the Interventional… |
125 |
|
|
bronchoscopy would be considered dif cult or even impossible, such as some foreign body aspiration, massive hemoptysis, severe central airway obstruction, or migrated airway stents. In those cases, the procedure should always be performed in a negative pressure room, with controlled ventilation (if possible utilizing closed ventilation systems instead of jet ventilation) and using rubber caps on the ports of rigid scope to avoid air leaks.
Pleural procedures are not listed as aerosol generating procedure in the CDC recommendations, and they do not appear to be a prominent feature of COVID-19 [22, 23].
Thoracoscopy is not recommended as a principle and the risk bene t must be assessed. When required, the use of one-way valve trocars should be preferred.
Summary andRecommendations
The World Health Organization recommends the preparation of a checklist to be completed during the procedure to minimize the risk of infection by the participating staff. This vision must include the pre-procedure planning, the execution, and the post-procedure phase. It is mandatory that proper training be provided to all health care staff involved in IP.
The pre-procedure includes:
•\ Adaptation the IP (proper rooms and circuits); •\ Revise prioritization of all the procedures;
•\ Perform pre-screening checklist (symptoms, contact history, and occupational exposure);
•\ RT-PCR nasopharyngeal swab for SARS- CoV-2 test 24–48 h preceding the exam; and
•\ Proceed according to priority and test results.
In the procedure execution phase:
•\ Gown adequate PPE and perform procedure at adequate endoscopy suite;
•\ Prepare in advance all equipment needed and plan the procedure;
•\ Minimize direct exposure:
––Stand behind the patient;
––Use appropriate sedation;
––Place surgical mask over patients’ mouth;
––Avoid nebulized drugs;
––In ventilated patients, prefer endotracheal tubes and clamp ventilation circuit when introducing and removing bronchoscope;
––Use disposable bronchoscopes in con-rmed or highly suspicious COVID-19 patients; and
––Minimize procedure duration.
•\ Reduce team to minimal necessary; and
•\ Medical doctors in training can be present during exam if they have previous adequate formation.
In the post-procedure timing:
•\ Collect samples in closed circuits, according to local infectious control guidelines;
•\ Reprocessing of bronchoscopes must be considered an aerosol-generating procedure;
•\ Disinfect foor and surfaces after each procedure;
•\ Allow adequate time (30 min) between procedures; and
•\ Perform sequential remove of PPE in a designated area.
Acknowledgements The authors acknowledge H.N. Bastos and M. de Santis for the photos and H.N. Bastos, J.P. Boléo-Tomé, L.V. Rodrigues, S. Campaínha, and M. de Santis for the discussion of some topics.
References
1.\ Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–42.
2.\ Wang W, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18):1843–4.
3.\ Arenas-De Larriva M, et al. The role of bronchoscopy in patients with SARS-CoV-2 pneumonia. ERJ Open Res. 2021;7(3).
4.\ Baldwin D, et al. Recommendations for day case bronchoscopy services during the COVID-19 pandemic. Eur Assoc Bronchol Interven Pulmonol; 2020.
126 |
F. Guedes and A. Bugalho |
|
|
5.\Cordovilla R, et al. “Recomendaciones de consenso SEPAR y AEER sobre el uso de la broncoscopia y la toma de muestras de la vía respiratoria en pacientes con sospecha o con infección con rmada por COVID19. Arch Bronconeumol. 2020;56:19–26.
6.\Guedes F, et al. Recommendations for interventional pulmonology during COVID-19 outbreak: a consensus statement from the Portuguese Pulmonology Society. Pulmonology. 2020;26(6):386–97.
7.\Lentz RJ, Colt H. Summarizing societal guidelines regarding bronchoscopy during the COVID-19 pandemic. Respirology. 2020;25(6):574.
8.\Pritchett MA, et al. Society for Advanced Bronchoscopy Consensus Statement and Guidelines for bronchoscopy and airway management amid the COVID-19 pandemic. J Thorac Dis. 2020;12(5):1781.
9.\Wahidi MM, et al. American Association for Bronchology and Interventional Pulmonology (AABIP) statement on the use of bronchoscopy and respiratory specimen collection in patients with suspected or con rmed COVID-19 infection. J Bronchol Interv Pulmonol. 2020;27(4):e52–4.
10.\Center for Disease Control and Prevention. Interim infection prevention and control recommendations for patients with suspected or con rmed coronavirus disease 2019 (COVID-19) in healthcare settings. Atlanta, GA: Center for Disease Control and Prevention; 2020.
11.\WHO. Strengthening the health systems response to COVID-19: technical guidance# 2: creating surge capacity for acute and intensive care, 6 April 2020. Geneva: World Health Organization. Regional Of ce for Europe; 2020.
12.\Adhikari U, et al. A case study evaluating the risk of infection from Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) in a hospital setting through bioaerosols. Risk Anal. 2019;39(12):2608–24.
13.\WHO. Coronavirus disease 2019 (COVID-19): situation report, 73. Geneva: WHO; 2020.
14.\Berríos-Torres SI, et al. Centers for disease control and prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91.
15.\Chen CC, Chi CY. Biosafety in the preparation and processing of cytology specimens with potential coronavirus (COVID-19) infection: perspectives from Taiwan. Cancer Cytopathol. 2020;128(5):309–16.
16.\Kalchiem-Dekel O, et al. Impact of COVID-19 on interventional pulmonology training. ATS Sch. 2021;2(2):236–48.
17.\Tran K, et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012;7(4):e35797.
18.\Du Rand I, et al. British Thoracic Society guideline for advanced diagnostic and therapeutic fexible bronchoscopy in adults. Thorax. 2011;66(Suppl 3):iii1–iii21.
19.\Hellyer TP, et al. Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2): a randomised controlled trial and process evaluation. Lancet Respir Med. 2020;8(2):182–91.
20.\Murgu SD, Pecson J, Colt HG. Bronchoscopy during noninvasive ventilation: indications and technique. Respir Care. 2010;55(5):595–600.
21.\Biselli P, et al. Reductions in dead space ventilation with nasal high fow depend on physiological dead space volume: metabolic hood measurements during sleep in patients with COPD and controls. Eur Respir J. 2018;51(5):1702251.
22.\Zhu J, et al. CT imaging features of 4121 patients with COVID-19: a meta-analysis. J Med Virol. 2020;92(7):891–902.
23.\Salehi S, et al. Coronavirus disease 2019 (COVID-19): a systematic review of imaging ndings in 919 patients. Am J Roentgenol. 2020;215(1):87–93.
Данная книга находится в списке для перевода на русский язык сайта https://meduniver.com/