Evaluation of intubation and intensive care use of the new Ambu (R) aScope (TM) 4 broncho and Ambu (R) aView (TM) compared to a customary flexible endoscope a multicentre prospective, non-interventional study

Background: Flexible endoscopes have been well established for diagnostic and therapeutic interventions in critically ill patients. The purpose of this study was to compare the utility between the novel aScope 4 Broncho and the standard bronchoscope in a non-interventional study. Methods: In a prospective multicentre study, we evaluated the aScope 4 Broncho for different clinical indications involving an endoscopy procedure. We compared the acceptability of and preference for the novel Ambu (R) aScope (TM) 4 Broncho (Ambu (R) A/S, Ballerup, Denmark) with that of the customary flexible endoscope (reusable or single-use) normally used at each of the study centres. Results: A total of 176 aScope 4 Broncho-aided interventions were evaluated, and the primary finding of the study was that the aScope 4 Broncho was preferred over customary devices for both diagnostic/therapeutic bronchoscopy (58% preference, P < 0.001), awake intubation with a flexible endoscope (65% preference, P = 0.0026), and pooled data (59%, P < 0.001). Conclusion: Possible reasons for the higher acceptability of and preference for the aScope 4 Broncho are the manoeuvrability of the scope and the optimised visualisation during tracheal intubation or of the bronchial system. Because of these benefits, any encountered risks may be reduced in patients undergoing bronchoscopic procedures, including in critically ill and presurgical/medical patients. (C) 2020 Elsevier Ltd. All rights reserved

When Pulmonologists Are Novice to Navigational Bronchoscopy, What Predicts Diagnostic Yield?

Predicting factors of diagnostic yield in electromagnetic navigation bronchoscopy (ENB) have been explored in a number of previous studies based on data from experienced operators. However, little is known about predicting factors when the procedure is carried out by operators in the beginning of their learning curve. We here aim to identify the role of operators&rsquo; experience as well as lesion&ndash; and procedure characteristics on diagnostic yield of ENB procedures in the hands of novice ENB operators. Four operators from three centers without prior ENB experience were enrolled. The outcome of consecutive ENB procedures was assessed and classified as either diagnostic or non-diagnostic and predicting factors of diagnostic yield were assessed. A total of 215 procedures were assessed. A total of 122 (57%) of the ENB procedures resulted in diagnostic biopsies. Diagnostic ENB procedures were associated with a minor yet significant difference in tumor size compared to non-diagnostic/inconclusive ENB procedures (28 mm vs. 24 mm; p = 0.03). Diagnostic ENB procedures were associated with visible lesions at either fluoroscopy (p = 0.003) or radial endobronchial ultrasound (rEBUS), (p = 0.001). In the logistic regression model, lesion visibility on fluoroscopy, but none of operator experience, the presence of a bronchus sign, lesion size, or location nor visibility on rEBUS significantly impacted the diagnostic yield. In novice ENB operators, lesion visibility on fluoroscopy was the only factor found to increase the chance of obtaining a diagnostic sample