Les bonnes pratiques de la bronchoscopie souple diagnostique, en 2007

doi:10.1016/S0761-8425(07)78513-3

Revue des Maladies Respiratoires

Volume 24, Issue 10, December 2007, Pages 1363-1392

https://doi.org/10.1016/S0761-8425(07)78513-3 Get rights and content

Résumé

Les bonnes pratiques de la bronchoscopie souple diagnostique décrivent les éléments importants à connaître et prendre en compte lors de la réalisation d’une bronchoscopie souple diagnostique, programmée, chez l’adulte. Il s’agit d’une mise au point pratique.

Les conditions de sécurité, les complications, l’anesthésie, les risques infectieux, le nettoyage désinfection sont développés à partir d’une revue de la littérature. La pratique de la bronchoscopie en soins intensifs qui nécessite peut être plus d’attention du fait des terrains plus fragiles fait l’objet d’une discussion étendue.

Les performances des différentes techniques de prélèvement complètent ce travail.

Les indications, la bronchoscopie interventionnelle, la bronchoscopie en pédiatrie ne sont pas développées.

Summary

These guidelines on flexible bronchoscopy depict important clues to be known and taken into account while practicing flexible bronchoscopy, in adult, except in emergency situations. This is a practical clarification.

Safety conditions, complications, anesthesia, infectious risks, cleaning and disinfection are detailed from a review of the literature. Intensive care practice of bronchoscopy requires more attention due to higher risks patients and is discussed extensively. Standards and performances of the various sampling techniques complete this work. Indications for bronchoscopy, therapeutic and paediatric bronchoscopy are not covered in these guidelines.

Références (229)

R.B. Dreisin et al.
Flexible fiberoptic bronchoscopy in the teaching hospital. Yield and complications
Chest
(1978)
W. Pereira et al.
A prospective cooperative study of complications following flexible fiberoptic bronchoscopy
Chest
(1978)
C.A. Pue et al.
Complications of fiberoptic bronchoscopy at a university hospital
Chest
(1995)
G.I. Lukomsky et al.
Complications of bronchoscopy: comparison of rigid bronchoscopy under general anesthesia and flexible fiberoptic bronchoscopy under topical anesthesia
Chest
(1981)
D.C. Zavala
Complications following fiberoptic bronchoscopy. The “good news” and the “bad news”
Chest
(1978)
D.C. Zavala
Pulmonary hemorrhage in fiberoptic transbronchial biopsy
Chest
(1976)
M.J. Smith et al.
Is fibreoptic bronchoscopy in patients with lung cancer and hepatic metastases potentially dangerous?
Br J Dis Chest
(1985)
N. Milman et al.
Serum concentrations of lignocaine and its metabolite monoethylglycinexylidide during fibre-optic bronchoscopy in local anaesthesia
Respir Med
(1998)
Y. Matsushima et al.
Alterations in pulmonary mechanics and gas exchange during routine fiberoptic bronchoscopy
Chest
(1984)
M.S. Kristensen et al.
Pulse oximetry at fibre-optic bronchoscopy in local anaesthesia: indication for postbronchoscopy oxygen supplementation?
Respir Med
(1998)

E.N. Evans et al.

Changes in oxygen saturation and transcutaneous carbon dioxide and oxygen levels in patients undergoing fibreoptic bronchoscopy

Respir Med

(1998)

M. Antonelli et al.

Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients

Chest

(1996)

P.M. Suratt et al.

Deaths and complications associated with fiberoptic bronchoscopy

Chest

(1976)

J.C. Luck et al.

Arrhythmias from fiberoptic bronchoscopy

Chest

(1978)

D.L. Shrader et al.

The effect of fiberoptic bronchoscopy on cardiac rhythm

Chest

(1978)

I. Matot et al.

Myocardial ischemia in sedated patients undergoing fiberoptic bronchoscopy

Chest

(1997)

E.M. Cordasco et al.

Bronchoscopically induced bleeding. A summary of nine years’ Cleveland clinic experience and review of the literature

Chest

(1991)

D.M. Mitchell et al.

Transbronchial lung biopsy with the fibreoptic bronchoscope: analysis of results in 433 patients

Br J Dis Chest

(1981)

T.A. Papin et al.

Transbronchial biopsy in the thrombocytopenic patient

Chest

(1985)

D.A. Brickey et al.

Transbronchial biopsy in the presence of profound elevation of the international normalized ratio

Chest

(1999)

F.J. Herth et al.

Aspirin does not increase bleeding complications after transbronchial biopsy

Chest

(2002)

A. Ernst et al.

Effect of routine clopidogrel use on bleeding complications after transbronchial biopsy in humans

Chest

(2006)

S.H. Wilson et al.

Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting

J Am Coll Cardiol

(2003)

J.P. Collet et al.

Myocardial infarction after aspirin cessation in stable coronary artery disease patients

Int J Cardiol

(2000)

J.L. Orford et al.

Frequency and correlates of coronary stent thrombosis in the modern era: analysis of a single center registry

J Am Coll Cardiol

(2002)

C. Decoene et al.

Thrombose tardive d’une endoprothèse coronaire pharmaco-active après arrêt des agents antiplaquettaires

Ann Fr Anesth Reanim

(2005)

V. Trosini-Desert et al.

Bronchoscopie souple et antiagrégants plaquettaires : analyse du rapport bénéfices-risques

Rev Mal Respir

(2007)

L.R. Joyner et al.

Transbronchial forceps lung biopsy through the fiberoptic bronchoscope. tdiagnosis of diffuse pulmonary disease

Chest

(1975)

H.S. Puar et al.

Bronchial and transbronchial lung biopsy without fluoroscopy in sarcoidosis

Chest

(1985)

M. Ahmad et al.

The safety of outpatient transbronchial biopsy

Chest

(1986)

G. Izbicki et al.

Is routine chest radiography after transbronchial biopsy necessary? A prospective study of 350 cases

Chest

(2006)

M.C. Witte et al.

Incidence of fever and bacteremia following transbronchial needle aspiration

Chest

(1986)

R.A. Dweik et al.

Analysis of the safety of bronchoscopy after recent acute myocardial infarction

Chest

(1996)

D.P. Dunagan et al.

Fiberoptic bronchoscopy in coronary care unit patients: indications, safety, and clinical implications

Chest

(1998)

T. Bein et al.

Fiberoptic bronchoscopy after recent acute myocardial infarction: stress for the heart?

Chest

(1997)

P.A. Kvale

Is it really safe to perform bronchoscopy after a recent acute myocardial infarct?

Chest

(1996)

J.A. Rankin et al.

Bronchoalveolar lavage. Its safety in subjects with mild asthma

Chest

(1984)

L. Tapanainen et al.

Investigative bronchoscopy and endobronchial biopsy is well tolerated in hyperreactive asthma patients

Respir Med

(2002)

K. Hattotuwa et al.

Safety of bronchoscopy, biopsy, and BAL in research patients with COPD

Chest

(2002)

A.J. Knox et al.

Fibreoptic bronchoscopy in the elderly: 4 years’ experience

Br J Dis Chest

(1988)

B. Hehn et al.

Flexible bronchoscopy in the elderly

Clin Chest Med

(2001)

J.R. Peerless et al.

The effect of fiberoptic bronchoscopy on cerebral hemodynamics in patients with severe head injury

Chest

(1995)

M.K. Bajwa et al.

Fiberoptic bronchoscopy in the presence of space-occupying intracranial lesions

Chest

(1993)

D. Honeybourne

British Thoracic Society guidelines on diagnostic flexible bronchoscopy

Thorax

(2001)

W.F. Credle et al.

Complications of fiberoptic bronchoscopy

Am Rev Respir Dis

(1974)

F.G. Simpson et al.

Postal survey of bronchoscopic practice by physicians in the United Kingdom

Thorax

(1986)

C.M. Smyth et al.

Survey of flexible fibreoptic bronchoscopy in the United Kingdom

Eur Respir J

(2002)

R.R. Hanson et al.

Transbronchial biopsy via flexible fiberoptic bronchoscope ; results in 164 patients

Am Rev Respir Dis

(1976)

A.D. Sutherland et al.

Patient comfort and plasma lignocaine concentrations during fibreoptic bronchoscopy

Anaesth Intensive Care

(1985)

S. Loukides et al.

Serum concentrations of lignocaine before, during and after fiberoptic bronchoscopy

Respiration

(2000)

Cited by (28)

The role of HFNC oxygen in pre-oxygenation prior to intubation and the practice of invasive procedures
2023, Revue des Maladies Respiratoires
Les dernières années ont amené la communauté médicale à largement utiliser l’Oxygénothérapie à Haut Débit (OHD). Son utilisation a été étendue à la pratique de procédures invasives dont la pré-oxygénation avant intubation orotrachéale, geste pourvoyeur de complications. La pré-oxygénation vise au maintien d’une saturation en oxygène la plus élevée possible et ce, pour des durées prolongées. L’OHD semble aussi efficace que l’oxygène standard sur l’hématose, chez le patient peu hypoxémique, avec, cependant, une tendance à la diminution des évènements indésirables liés à l’intubation. Il perdure que la Ventilation Non Invasive (VNI), quant à elle, reste probablement plus efficace que l’OHD, afin de prévenir la survenue d’évènements respiratoires, durant la pré-oxygénation des patients plus sévèrement hypoxémiques. Étudiée également dans le cadre de procédures à risque telles que l’endoscopie bronchique, l’OHD permet une meilleure saturation en oxygène que les méthodes standards, chez le patient peu ou pas hypoxémique. La VNI garde probablement sa place chez le patient plus instable, diminuant les épisodes de désaturation. L’OHD peut donc raisonnablement être une alternative à la VNI en cas de mauvaise tolérance. Celle-ci pourrait également permettre l’oxygénation en continu de patient nécessitant la réalisation de gestes comme l’endoscopie digestive ou l’échographie trans-œsophagienne.
Over recent years, High Flow Nasal Cannula (HFNC) oxygen therapy has been more and more extensively applied in numerous medical settings, and it is now carried out in invasive procedures such as pre-oxygenation before orotracheal intubation, often leading to complications. More generally, pre-oxygenation is aimed at maintaining the highest possible oxygen saturation for extended periods of time. With this in mind, HFNC seems as effective as standard oxygen delivery with regard to hematosis in patients with mild or moderate hypoxemia, and it presents the advantage of reducing the adverse events associated with intubation. That said, during pre-oxygenation of patients with severe hypoxemia, non-invasive ventilation (NIV) is probably more effective than HFNC, especially in the prevention of respiratory events. However, in patients with little or no hypoxemia undergoing risky procedures such as bronchial endoscopy, HFNC allows better oxygen saturation than standard methods. To summarize, even though NIV remains useful in unstable patients, especially in decreasing desaturation episodes, HFNC could represent a reasonable alternative in case of poor tolerance, allowing continuous oxygenation of patients requiring digestive endoscopy or trans-esophageal ultrasound.
Tolerance's improvement of flexible bronchoscopy by Ericksonian hypnosis: The BREATH study
2022, Respiratory Medicine and Research
Citation Excerpt :
Flexible bronchoscopy is a common and essential procedure in pneumology. According to the experts of the Groupe d’endoscopie de langue française (GELF), an official working group of the Société de pneumologie de langue française (SPLF), 350,000 flexible bronchoscopy procedures were performed annually in France in 2009, most of them under outpatient local anaesthesia [1]. The use of general anaesthesia is rare and performed at the patient or pulmonologist request when the examination could not be performed under good conditions.
The aim of this study was to determine whether the use of Ericksonian hypnosis may allow an improvement of the tolerance of flexible bronchoscopy.
A comparative, two parallel-group, prospective, randomized monocentric clinical trial was conducted. After randomization, patients were divided into two groups: a standard group, in which bronchoscopy was performed according to the official French good practice guidelines and a study group, in which bronchoscopy was performed under hypnosis.
Sixty-seven patients were included, 7 patients were excluded and 60 patients were randomized. No significant differences in age, gender, examination indication and duration were observed between both groups. Two patients of the standard group removed the endoscope by themselves, resulting in a premature termination of bronchoscopy and they were excluded from the statistical analysis. In the standard group, the levels of anxiety, cough, dyspnoea and pain increased during the examination and the addition of local anaesthesia was more often required. In the hypnosis group, levels of anxiety, cough, dyspnoea decreased, whereas only the level of pain increased. There was a statistic significative difference in favour of hypnosis for all the other variables. Moreover, the behaviour score was higher in the standard group: 19.5 ± 14.5 versus 7.3 ± 4.7 (P < 0.001), indicating a better tolerance in the hypnosis group. In the standard group, 14 patients refused a new examination under the same conditions versus 7 in the hypnosis group, and 12 patients asked for general anaesthesia in case of a new examination versus 7 in the hypnosis group.
This randomised control trial is the first to test the faisability and the potential usefulness of Ericksonian hypnosis during flexible bronchoscopy. Our results indicates an improvement of tolerance and a positive effect on all studied parameters except pain. This method could be widely offered to all patients undergoing flexible bronchoscopy.
Pre- and post-COVID practice of interventional pulmonology in adults in Portugal
2022, Pulmonology
Citation Excerpt :
Bronchology and Interventional Pulmonology (IP) has evolved significantly in the last 20 years, with the development of technologies and practices. Despite the existence of several guidelines from international associations and institutions, most are recommendations set by experts in this field and more focused on safety and functional aspects than in robust scientific evidence, so procedures are usually not standardised.1–7 Considering the existing variance of methods and the little knowledge about bronchoscopy practices, several countries undertook national surveys to characterize the availability of resources, the clinical application of techniques, and its specificities.8–15
There is a lack of information regarding bronchoscopy practice in adults in Portugal. Our objective was to obtain an overview of the characteristics, resources, techniques and behaviors in national interventional pulmonology (IP) units, before and after SARS-CoV-2 outbreak.
An online survey was developed by an expert panel with a total of 46 questions comprising the specifications of each unit, namely physical space, equipment, staff, procedure planning, monitoring, technical differentiation, and numbers pre- and post-COVID-19. Forty-one interventional pulmonology centers were invited to participate between April and May 2021.
37 units (90.2%) responded to the survey. The majority (64.9%) have a fully dedicated space with a weekly presence of ≥3 chest physicians (82.1%) and support of an anesthesiologist on specific days (48.6%). There is marked heterogeneity in the IP unit's equipment, and 56.8% acquired disposable bronchoscopes after COVID-19 pandemics. Pre-bronchoscopy hemogram, platelet count and coagulation tests are regularly asked by more than 90% of the units, even when deep sedation or biopsies are not planned. In 97.3% of cases, topical anesthesia and midazolam are utilized. Propofol (21.6%) and fentanyl (29.7%) are occasionally employed in some institutions. Most units use ancillary sampling techniques to diagnose central or peripheral lesions, with radial EBUS being used for guidance of distal procedures in 37.8% of centers, linear EBUS and EUS-B-FNA for mediastinal diagnosis and/or staging in 45.9% and 27.0% of units, respectively. Cryobiopsies are used by 21.6% of respondents to diagnose diffuse lung diseases. Rigid bronchoscopy is performed in 37.8% of centers. There was a decrease in the number of flexible (p < 0.001) and rigid (p = 0.005) bronchoscopies and an upscale of personal protective equipment (PPE) during the COVID-19 outbreak.
IP units have variable bronchoscopic practices, but during the COVID-19 pandemic, they complied with most international recommendations, as elective procedures were postponed and PPE levels increased.
Cas clinique n° 4 : Apport des nouvelles techniques bronchocopiques dans la prise en charge du cancer pulmonaire
2021, Revue des Maladies Respiratoires Actualites
How to manage anticoagulant treatment in case of invasive procedures (surgery, endoscopy…)
2021, Revue des Maladies Respiratoires
The GELF is over, long live the GETIF!!
2021, Revue des Maladies Respiratoires

View all citing articles on Scopus

View full text

Bonnes pratiques cliniquesLes bonnes pratiques de la bronchoscopie souple diagnostique, en 2007Good practices of diagnostic flexible bronchoscopy

Résumé

Summary

Chest

Chest

Chest

Chest

Chest

Chest

Br J Dis Chest

Respir Med

Chest

Respir Med

Respir Med

Chest

Chest

Chest

Chest

Chest

Chest

Br J Dis Chest

Chest

Chest

Chest

Chest

J Am Coll Cardiol

Int J Cardiol

J Am Coll Cardiol

Ann Fr Anesth Reanim

Rev Mal Respir

Chest

Chest

Chest

Chest

Chest

Chest

Chest

Chest

Chest

Chest

Respir Med

Chest

Br J Dis Chest

Clin Chest Med

Chest

Chest

British Thoracic Society guidelines on diagnostic flexible bronchoscopy

Thorax

Complications of fiberoptic bronchoscopy

Am Rev Respir Dis

Postal survey of bronchoscopic practice by physicians in the United Kingdom

Thorax

Survey of flexible fibreoptic bronchoscopy in the United Kingdom

Eur Respir J

Transbronchial biopsy via flexible fiberoptic bronchoscope ; results in 164 patients

Am Rev Respir Dis

Patient comfort and plasma lignocaine concentrations during fibreoptic bronchoscopy

Anaesth Intensive Care

Serum concentrations of lignocaine before, during and after fiberoptic bronchoscopy

Respiration

Bonnes pratiques cliniques
Les bonnes pratiques de la bronchoscopie souple diagnostique, en 2007Good practices of diagnostic flexible bronchoscopy