Iatrogenic injuries to the trachea and main bronchi

INTRODUCTION: Iatrogenic tracheobronchial injuries are rare. AIM: To analyse the mechanism of injury, symptoms and treatment of these patients. MATERIAL AND METHODS: Retrospective analysis of hospital records of all patients treated for main airway injuries between 1990 and 2012 was performed. RESULTS: There were 24 patients, including 21 women and 3 men. Mean time between injury and initiation of treatment was 12 hours (range: 2-48). In 16 patients the injury occurred during tracheal intubation, in 1 during rigid bronchoscopy, in 1 during rigid oesophagoscopy, in 1 during mediastinoscopy and in 5 during open surgery. Mean length of airway tear was 3.8 cm (range: 1.5-8). In 1 patient there was an injury to the cervical trachea and in the remaining 23 in the thoracic part of the airway. The treatment included repair of the membranous part of the trachea performed via right thoracotomy in 10 patients (in 1 patient additionally coverage with a pedicled intercostal muscle flap was used), a self-expanding metallic stent in 1 patient, suture of the right main bronchus and the oesophagus in 1, left upper sleeve lobectomy in 1, right upper lobectomy in 1, implantation of a silicone Y stent in 3, mini-tracheostomy in 1, and conservative treatment in 5 patients. CONCLUSIONS: Intubation is the most frequent cause of iatrogenic main airway injuries. Patients with these life-threatening complications require an individualised approach and treatment in a reference centre

Tension pneumothorax as a severe complication of endobronchial ultrasound-guided transbronchial fine needle aspiration of mediastinal lymph nodes

This article presents a case report of a patient suffering from bullous emphysema and chronic obstructive pulmonary disease, who was diagnosed with tension pneumothorax after undergoing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Tension pneumothorax is a severe but rare complication of EBUS-TBNA. It can result from lung injury caused by the biopsy needle or, in patients suffering from bullous emphysema, from spontaneous rupture of an emphysematous bulla resulting from increased pressure in the chest cavity during cough caused by bronchofiberoscope insertion. The authors emphasize that patients should be carefully monitored after the biopsy, and, in the case of complications, provided with treatment immediately in proper hospital conditions. Patients burdened with a high risk of complications should be identified before the procedure and monitored with extreme care after its completion

Endosonography-guided fine needle aspiration in the diagnosis of sarcoidosis : a randomized study

There are no widely accepted standards for the diagnosis of sarcoidosis. The aim of this study was to assess the relative diagnostic yield of endobronchial ultrasound fine-needle aspiration (EBUS‑FNA) and endoscopic ultrasound fine-needle aspiration (EUS‑FNA), and to compare them with standard diagnostic techniques such as endobronchial biopsy (EBB), transbronchial lung biopsy (TBLB), transbronchial needle aspiration (TBNA), and mediastinoscopy. This was a prospective randomized study including consecutive patients with clinical diagnosis of stage I or II sarcoidosis. EBB, TBLB, and TBNA were performed at baseline in all patients. Subsequently, patients were randomized to group A (EBUS‑FNA) or group B (EUS‑FNA). Next, a crossover control test was performed: all patients with negative results in group A underwent EUS‑FNA and all patients with negative results in group B underwent EBUS‑FNA. If sarcoidosis was not confirmed, mediastinoscopy was performed. We enrolled 106 patients, of whom 100 were available for the final analysis. The overall sensitivity and accuracy of standard endoscopic methods were 64% each. When analyzing each of the standard endoscopic methods separately, the diagnosis was confirmed with EBB in 12 patients (12%), with TBLB in 42 patients (42%), and with TBNA in 44 patients (44%). The sensitivity and accuracy of each endosonographic technique were significantly higher than those of EBB+TBLB+TBNA (P = 0.0112 vs P = 0.0134). The sensitivity and accuracy of EBUS‑FNA and EUS‑FNA are significantly higher than those of standard endoscopic methods. Moreover, the sensitivity and accuracy of EUS‑FNA tend to be higher than those of EBUS‑FNA

Initial Polish experience of Flexible 19 gauge Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration

  INTRODUCTION: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopist’s feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). MATERIAL AND METHODS: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. RESULTS: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 ± 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. CONCLUSIONS: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable.

The influence of lung volume reduction with intrabronchial valves on the quality of life of patients with heterogeneous emphysema — a prospective study

Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used — bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Material and methods: From 2011 to 2013 a single center prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ± 10 years old), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (–12.8; p < 0.001) and in domains and differences were for: “symptoms” (–8.5; p < 0.001), “activity” (–13.9; p < 0.001) and “influence on life”(–13.5; p < 0.002). Conclusions: The presented study revealed the significant improvement of the quality of life measured by SGRQ after the IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment.Introduction: A heterogeneous emphysema is one of the most severe forms of chronic obstructive pulmonary disease (COPD). In some cases, besides the standard pharmacotherapy, a new treatment option of emphysema can be used — bronchoscopic lung volume reduction (BLVR) with the use of intrabronchial valves. Objectives: To examine the health-related quality of life (HRQoL) of patients with severe emphysema after intrabronchial valve (IBV) implantation for the treatment of one lung. Material and methods: From 2011 to 2013 a single centre prospective observational study was performed. The study assessed the effect of the therapeutic BLVR intervention, measured by St. George Respiratory Questionnaire (SGRQ). A statistical analysis by use of Wilcoxon test for dependent variables was performed. Results: Twenty patients were enrolled to the study (mean age 63 ± 10 years), all ex-smokers with tobacco exposure 38 ± 11.3 packyears. After 3 months of IBV treatment the average SGRQ score improved significantly in total (–12.8; p < 0.001) and in domains and the differences were for: “symptoms” (–8.5; p < 0.001), “activity” (–13.9; p < 0.001) and “influence on life”(–13.5; p < 0.002). Conclusions: The presented study revealed a significant improvement of the quality in the life measured by SGRQ after IBV treatment for heterogeneous emphysema. For the first time our study showed the significant improvement of all three domains of SGRQ after IBV treatment

Initial Polish experience of flexible 19 gauge endobronchial ultrasound-guided transbronchial needle aspiration

Introduction: EBUS is a well established minimally invasive diagnostic tool for mediastinal and hilar lymphadenopathy. The novel ViziShot Flex 19G needle (Olympus Respiratory America, Redmond, WA, USA) was introduced in 2015 in order to improve loaded scope flexion and to obtain larger tissue samples for analysis. The aims of this study were to assess diagnostic yield of Flex 19G needles and to present endoscopist’s feedback about the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Material and methods: The Flex 19G needles were used in patients with hilar and/or mediastinal adenopathy in two Polish pulmonology centers. Cytology smears and cell blocks (CB) were prepared. The prospective analysis was performed due to collected data. Results: Twenty two selected patients with confirmed adenopathy on chest-CT (mean age 58 ± 12) underwent EBUS-TBNA with use of Flex 19G needles. All procedures occurred to be diagnostic for smears (yield 100%). The malignancy was found in 15 cases (68.2%), and benign adenopathy in 7 (31.8%). In 12 of 14 cases of lung cancer (yield 85.7%) CB were diagnostic for immunohistochemical and molecular staining. After puncturing nodes, especially in hilar position not extensive bleeding was observed. Comparing to standard 21/22G EBUS-TBNA endoscopists underlined better flexion of loaded scope and sample adequacy and found non-significant differences in another biopsy details. Conclusions: The first Polish experience with use of Flex 19G EBUS-TBNA needle occurs to be similar in performance with standard technique with use of 22/21G needles and presents high diagnostic yield for lung cancer diagnostics, especially when preparing CB. A safety profile of the biopsy is acceptable

Wstępne polskie doświadczenia z użyciem igły Flex 19G do przezoskrzelowej biopsji pod kontrolą ultrasonografii wewnątrzoskrzelowej

WSTĘP: EBUS (endobronchial ultrasonography) jest małoinwazyjną metodą diagnostyczną o dobrze ugruntowanej pozycji w diagnostyce limfadenopatii śródpiersia i wnęk płucnych. ViziShotFlex 19G needle to nowa igła przeznaczona do zastosowania w tym badaniu wprowadzona na rynek przez firmę Olympus w 2015 roku. Jej konstrukcja ma zapewnić większą giętkość uzbrojonego endoskopu oraz uzyskanie większej ilości materiału tkankowego do analizy. Cele niniejszej pracy to ocena wydolności diagnostycznej procedury EBUS-TBNA (EBUS — transbronchial needle aspiration) z zastosowaniem igły Flex 19G oraz prezentacja opinii endoskopistów na temat badania z jej użyciem. MATERIAŁ I METODY: Igły Flex 19G zastosowano w diagnostyce pacjentów z adenopatią śródpiersia i/lub wnęk w dwóch ośrodkach pulmonologicznych w Polsce. Wykonywano zarówno rozmazy cytologiczne, jak i bloki komórkowe (CB — cell blocks). Dokonano prospektywnej analizy zebranych danych. WYNIKI: Dwudziestu dwóch wybranych pacjentów z adenopatią potwierdzoną w tomografii komputerowej (średnia wieku 58 ± 12 lat) podano badaniu EBUS-TBNA z użyciem igieł Flex 19G. Wszystkie wykonane rozmazy cytologiczne okazały się diagnostyczne (wydolność diagnostyczna 100%). Złośliwy charakter zmiany stwierdzono w 15 przypadkach (68,2%), natomiast łagodną adenopatię u 7 pacjentów (31,8%). W 12 z 14 przypadków raka płuca wykonane CB mogły być użyte do oznaczeń immunohistochemicznych i molekularnych. Po biopsji węzłów chłonnych, zwłaszcza wnękowych, nie obserwowano nasilonego krwawienia. W porównaniu ze standardową procedurą EBUS-TBNA z użyciem igły 21/22G endoskopiści podkreślali większą giętkość uzbrojonego endoskopu oraz jakość bioptatu, natomiast w pozostałych aspektach biopsji różnice były nieznaczące. WNIOSKI: Pierwsze polskie doświadczenia z użyciem igieł Flex 19G okazują się być podobne do standardowej techniki z użyciem igieł 21/22G oraz prezentują wysoką wydolność diagnostyczną w raku płuca, szczególnie z zastosowaniem CB. Profil bezpieczeństwa biopsji jest akceptowalny.WSTĘP: EBUS (endobronchial ultrasonography) jest małoinwazyjną metodą diagnostyczną o dobrze ugruntowanej pozycji w diagnostyce limfadenopatii śródpiersia i wnęk płucnych. ViziShotFlex 19G needle to nowa igła przeznaczona do zastosowania w tym badaniu wprowadzona na rynek przez firmę Olympus w 2015 roku. Jej konstrukcja ma zapewnić większą giętkość uzbrojonego endoskopu oraz uzyskanie większej ilości materiału tkankowego do analizy. Cele niniejszej pracy to ocena wydolności diagnostycznej procedury EBUS-TBNA (EBUS — transbronchial needle aspiration) z zastosowaniem igły Flex 19G oraz prezentacja opinii endoskopistów na temat badania z jej użyciem. MATERIAŁ I METODY: Igły Flex 19G zastosowano w diagnostyce pacjentów z adenopatią śródpiersia i/lub wnęk w dwóch ośrodkach pulmonologicznych w Polsce. Wykonywano zarówno rozmazy cytologiczne, jak i bloki komórkowe (CB — cell blocks). Dokonano prospektywnej analizy zebranych danych. WYNIKI: Dwudziestu dwóch wybranych pacjentów z adenopatią potwierdzoną w tomografii komputerowej (średnia wieku 58 ± 12 lat) podano badaniu EBUS-TBNA z użyciem igieł Flex 19G. Wszystkie wykonane rozmazy cytologiczne okazały się diagnostyczne (wydolność diagnostyczna 100%). Złośliwy charakter zmiany stwierdzono w 15 przypadkach (68,2%), natomiast łagodną adenopatię u 7 pacjentów (31,8%). W 12 z 14 przypadków raka płuca wykonane CB mogły być użyte do oznaczeń immunohistochemicznych i molekularnych. Po biopsji węzłów chłonnych, zwłaszcza wnękowych, nie obserwowano nasilonego krwawienia. W porównaniu ze standardową procedurą EBUS-TBNA z użyciem igły 21/22G endoskopiści podkreślali większą giętkość uzbrojonego endoskopu oraz jakość bioptatu, natomiast w pozostałych aspektach biopsji różnice były nieznaczące. WNIOSKI: Pierwsze polskie doświadczenia z użyciem igieł Flex 19G okazują się być podobne do standardowej techniki z użyciem igieł 21/22G oraz prezentują wysoką wydolność diagnostyczną w raku płuca, szczególnie z zastosowaniem CB. Profil bezpieczeństwa biopsji jest akceptowalny