Bronchoscopy: preparation, indications, howhappens, results, consequences after the procedure

Update: October 2018 Bronchoscopy is a procedure that allows
inspect the inside of the trachea and bronchi, take for histological
research area of ​​suspicious tissue, get a foreign body,
clear airway from viscous sputum. This is the most
Informative method of studying the tracheo-bronchial tree. is he
allows you to see minimal formations and tumors, but only in
trachea, large and medium bronchi. Bronchoscopy of the bronchi is also
the best way to clean (lavage) the airways in those
people who have a long time to be on the hardware
breathing.

About bronchoscopy – read more

Bronchoscopy is a manipulation that is performed
only in the hospital. Under local (treatment of mucous lidocaine)
or general anesthesia, the doctor introduces a special airway.
the apparatus is a bronchoscope, which is either flexible or
hard tube. At one end of the device illuminator, the other
ends with the optical system where the doctor is looking
directly with the eyes.

On the side of the bronchoscope there are holes where you can
connect:

  • syringe: for airway flushing or for aspiration
    sputum for analysis;
  • electric pump: it will “suck” sputum or blood –
    the contents of the trachea and bronchi;
  • special forceps or brushes for biopsy;
  • coagulator electrode – a device for cauterization bleeding
    vessels.

For these tools in the body of the device there is a special channel
through which they pass. In addition, the device can communicate with
video equipment to the doctor to assess the condition of the bronchi, not looking at
�”Tube” of the device, and looking at the monitor.

Usually a bronchoscope is inserted through the mouth. Some doctors use
for this, a laryngoscope is a device that will simultaneously illuminate
path for the bronchoscope and pressing out the root of the tongue and the epiglottis – the cartilage,
in which a flexible bronchoscope can rest.

Since doing bronchoscopy in many cases is
vital (for example, if there is damage or anomaly
development of the neck, and breathing is necessary through respiratory
apparatus), a bronchoscope can be inserted through the nose.

Also, if a patient breathes through a tracheostomy (a hole in the trachea,
through which is introduced a special cannula associated with respiratory
apparatus), the bronchoscope is inserted directly into the tracheostomy
hole. In this case, a separate anesthesia is not required.

What bronchoscopy shows:

  • trachea;
  • the main ones – right and left – bronchi;
  • lobar bronchi: three on the right, two on the left.

Smaller bronchi and bronchioles do not visualize the bronchoscope.
If a есть подозрение, что опухоль или воспаление располагается
it is there that computer or magnetic resonance is held
tomography.

We hope that it is available what it is – bronchoscopy
lungs, although it is more correct to call this manipulation
bronchoscopy (it means “visualization of the bronchi” in translation).

Indications for bronchoscopy

Bronchoscopy is necessary if:

  • there is shortness of breath in the absence of pathologies of the heart or bronchial
    asthma;
  • torments cough, and the X-ray shows nothing;
  • there is hemoptysis;
  • bronchitis and / or pneumonia often recur;
  • fetid sputum;
  • there is a feeling of incomplete inhalation or exhalation, with the disease
    heart and thoracic spine excluded;
  • there was a rapid weight loss in the absence of any
    diets;
  • there is cystic fibrosis;
  • x-ray of the lungs detected disseminated process –
    many areas of darkening that can be metastases, so
    and pulmonary tuberculosis;
  • according to computed tomography, it is impossible to distinguish the site
    suppuration from lung cancer with decay;
  • diagnosed with pulmonary tuberculosis;
  • need to establish the cause of severe pneumonia when the patient
    is on a breathing apparatus;
  • it is necessary to evaluate the dynamics of treatment after resection of the lung,
    bronchus;
  • repeated bronchoscopy is needed after using this
    the technique has removed the tumor;
  • if radiographs show expansion or contraction
    bronchi.

This is a bronchoscopy diagnostic and is used for
making a diagnosis.

There is also a medical procedure that is used when:

  • a foreign body got into the airways;
  • tracheal intubation impossible to transfer a patient
    to artificial ventilation: to perform operational
    interventions or in critical situations. This is a coma caused by
    various reasons; conditions when breathing is disabled (injury
    cervical spinal cord, botulism, myopathies);
  • need to clear the respiratory tract from sputum or blood. it
    it is extremely important in the treatment of pneumonia, especially against the background of cystic fibrosis,
    when sputum is very viscous;
  • pulmonary hemorrhage must be stopped;
  • one of the bronchi blocked the tumor, adhesions or sputum, in
    resulting in atelectasis (off from the respiration area
    lung);
  • pus must be removed from a lung abscess located near
    bronchus;
  • pneumonia is difficult: an additional antibiotic is better
    enter directly into the desired bronchus.

Basically, bronchoscopy is performed using flexible
bronchoscope – fibrobronchoscopes. It is quite thin and can
bend in different directions. But in some cases it is necessary
the introduction of a hard (metal) device that does not bend and does not
can be entered into the bronchi, diverging at an angle.

Indications for bronchoscopy with a rigid bronchoscope are removal
foreign bodies, the expansion of constricted by inflammation or adhesive
bronchial processes. It is more convenient to put a stent on a hard bronchoscope
(hard corrugated plastic expansion tube), and
установить последний в суженный bronchus. It is better to use during
thoracic operations – in the treatment of conditions associated with
penetration into the pleural cavity of pus, air or fluid, and
also with pulmonary hemorrhage. Then the bronchoscope can be blocked
bronchus on the affected side, where surgeons work, and ventilate
the apparatus of the second lung.

Virtual Bronchoscopy

In addition to rigid and flexible bronchoscopy, another view has been developed.
research – virtual bronchoscopy. He is
computed tomography of the lungs and bronchi, which is processed
special computer program that recreates the three-dimensional image
bronchi.

The method is not so informative, but non-invasive. With him
sputum analysis, wash water or biopsy cannot be taken
suspicious area, you can not get a foreign body or wash
bronchi from sputum.

Preparation for a virtual biopsy is not required. According to the method
performing it is no different from computed tomography. A patient
lies on the couch, which is placed inside the source
x-ray radiation.

Although X-ray radiation is low dose, the method does not fit
for babies, pregnant.

How to prepare for manipulation

Preparation for bronchoscopy is very important, since the manipulation –
very serious, belongs to the category of invasive and requires only
special equipment and special skills at the doctor.

Therefore, we must begin with a detailed conversation with the attending therapist. is he
will tell you what kind of consultations specialists need. So if
a person suffered a myocardial infarction, he needs, in agreement with
cardiologist, 2 weeks before the study, increase the dose
beta blockers. If a person suffers from arrhythmia, he needs
review antiarrhythmic therapy and possibly increase the dose
drugs or add any other antiarrhythmic. Also
concerns and diabetes, and arterial hypertension.

Also everyone needs to go through such studies and show them.
results:

  • X-ray or CT scan of the lungs.
  • ECG.
  • Blood tests: general, biochemical, coagulogram.
  • Analysis of blood gases. This requires venous and arterial
    blood.

The last meal is no later than 8 pm. Then you can take
latest scheduled pills. The need to receive them in the morning
discussed separately.

It is imperative in the evening to empty the intestines with an enema,
microclysters “Mikrolaks” (“Norgalaks”), glycerin candles.

Do not smoke on the day of the study. Immediately before
procedure is necessary to empty the bladder. With a need
take a towel or diaper so that you can dry off
studies with arrhythmia – antiarrhythmic drugs,
suffering from bronchial asthma – inhaler. Removable dentures
will need to be removed.

Be sure to refer the doctor who will conduct
procedure, with previous diseases and allergies, as well as
constantly taken drugs.

Course of the procedure

Details on how bronchoscopy works. Let’s talk about
how this procedure is performed without anesthesia – under local
anesthesia:

  1. A patient приходит в кабинет, его просят раздеться до пояса и
    further or lie down on a couch in the middle of the room, or sit on a chair
    near the equipment.
  2. He is given an injection under the skin – in the shoulder area. This is usually a drug.
    �“Atropine” is a remedy that will inhibit the secretion of saliva and
    bronchial contents. It dries up in the mouth and quickens
    heartbeat.
  3. May enter the drug intramuscularly. It is soothing to
    manipulation was easier tolerated.
  4. Also in the mouth spray drugs “Salbutamol” or “Berodual.”
    is heи нужны для расширения bronchi.
  5. Next, the doctor conducts local anesthesia. is he брызгает или
    anesthetic lubricates (usually lidocaine 10%) root of the tongue and a little
    deeper. The same solution is treated and the outer part
    bronchoscope.
  6. After that, they begin to gently insert the bronchoscope into the mouth. Before
    mouthpiece can insert a mouthpiece – plastic
    the device that holds the teeth. is heо нужно для того, чтобы
    the patient did not bite the bronchoscope.
  7. If bronchoscopy is performed while lying down,
    the doctor, bypassing the patient’s head, may inject into his mouth and larynx
    device laryngoscope. This is also accompanied by splashing.
    local anesthetic to the respiratory tract. Laryngoscope will open the way
    for the bronchoscope, so the latter will be introduced faster and
    safer.
  8. Let’s be honest: the introduction of the bronchoscope will be accompanied by
    gag reflex, as well as a sense of lack of air. The first
    due to the fact that the effect on the root of the tongue. BUT
    there is not enough air because the bronchoscope take 3/4 of the diameter of the trachea.
    To eliminate both of these effects you need to often and superficially
    breathe (“like a dog”).
  9. The research is carried out fairly quickly, so as not to cause
    severe hypoxia. Oxygen control should be carried out
    on the device pulse oximeter. His gauge, the “clothespin,” is put on
    finger.

During the bronchoscopy can not bend, so as not to damage
respiratory tract bronchoscope (especially if hard
device).

If a bronchoscopy is performed with a biopsy, then it is painless.
Only discomfort behind the sternum is felt. Bronchial mucosa
practically has no pain receptors. Introduction of lidocaine before
manipulation due to the need to disable the vagal (from
the words “nervus vagus” – “vagus nerve”) reflexes from the root of the tongue and
vocal cords that can lead to cardiac arrest.

If bronchoscopy is performed under general anesthesia, it is performed in
position of the patient lying down. Then injections are given intravenously, and
a person falls asleep as a result. A tube is inserted into his trachea.
rigid polypropylene that connects to the respiratory
the apparatus. For some time air is forced into the lungs by respiratory
the device (the exhalation is obtained spontaneously), then through the tube
a bronchoscope is inserted, and bronchoscopy is performed. How do
bronchoscopy, the person does not feel.

The procedure under general anesthesia is performed in childhood, people
who are very afraid of the procedure, people with an unstable psyche. Her
do to patients who were already on the hardware breathing, and
also, if necessary, surgery.

After the procedure

After bronchoscopy are felt:

  • heaviness or pressure behind the sternum – during the day;
  • numbness of the mouth and larynx – within 2-3 hours;
  • hoarseness or nasalism – within a few hours;
  • sputum streaked with blood.

You need to follow these rules:

  • 3 hours in hospital under the supervision of staff;
  • 3 hours do not eat, drink or smoke. Food and food can get into
    trachea, whereas smoking impairs healing of the mucous after
    manipulations;
  • for 8 hours do not drive as introduced
    drugs that significantly reduce the reaction rate;
  • 2-3 days to eliminate physical activity.

It is also necessary to monitor their condition. Should not
be:

  • discharge from the airways of blood in the form of clots or liquid
    blood;
  • shortness of breath;
  • pain in the chest during breathing;
  • temperature increases;
  • nausea or vomiting;
  • wheezing.

Conclusion of bronchoscopy

The first results of the bronchoscopy doctor writes immediately after
research. These could be the words:

  1. Endobronchitis. This is an inflammation of the inner lining of the bronchus. If a
    he is “catarral”, so the mucous membrane was red.
    «BUTтрофический» – оболочка истончена. �”Hypertrophic” –
    the bronchial membrane is thickened, therefore, the lumen of the bronchi
    narrowed down. �“Purulent” – bacterial inflammation, antibiotics are needed.
    �”Fibrous-ulcerative” – ​​inflammation is strong, has led to the formation
    ulcers that are gradually replaced by scar (fibrous)
    cloth.
  2. �”Dense pale pink infiltrates, towering above the mucosa”
    – signs of tuberculosis.
  3. �”The narrowing of the diameter”: inflammation, cystic fibrosis, tumors,
    tuberculosis.
  4. �”The broad base of the neoplasm is eroded, they bleed,
    covered with necrosis, irregular contours “- signs of cancer.
  5. �”Thick sputum, narrowing of the lumen” – signs
    cystic fibrosis.
  6. «Свищи» – signs of tuberculosis.
  7. �”Bronchial wall tension, lumen reduction, swollen wall” –
    signs of a tumor growing from the outside of the bronchus.
  8. �”Fusiform, bag-like expansions of bronchial tubes, dense
    purulent sputum “- signs of bronchiectasis.
  9. �“The mucosa is swollen, reddened. The walls of the bronchi erupt.
    Sputum many transparent, not purulent “- signs of bronchial
    asthma.

Who should not conduct bronchoscopy

There are such contraindications to bronchoscopy (namely
diagnostic):

  • arterial hypertension with diastolic (“lower”) pressure
    more than 110 mm Hg;
  • mental illness;
  • stiffness (ankylosis) of the lower jaw;
  • recent myocardial infarction or stroke (less than 6 months
    back);
  • aortic aneurysm;
  • significant rhythm disturbances;
  • coagulation disorders;
  • significant narrowing (stenosis) of the larynx;
  • chronic respiratory failure III degree.

In these cases, virtual
bronchoscopy.

Postpone procedure is necessary during acute infectious
diseases, exacerbations of asthma, for women – during
menstruation and from the 20th week of pregnancy.

When bronchoscopy is intended to help intubation, or is needed for
extraction of foreign bodies, bronchial stenting or other medical
goals, contraindications do not exist. This procedure is carried out
together an endoscopist and an anesthesiologist, under general anesthesia, after
proper intensive training.

Complications of the procedure

When bronchoscopy effects may be as follows:

  • bronchospasm – compression of the walls of the bronchi, due to which oxygen
    ceases to flow into the lungs;
  • laryngism is the same as the previous complication, only
    spasm and closes the glottis (larynx);
  • pneumothorax – ingress of air into the pleural cavity;
  • bleeding from the wall of the bronchus (may be a biopsy);
  • pneumonia – due to infection of the small bronchi;
  • allergic reactions;
  • mediastinal emphysema – air entering from the bronchus into the fiber,
    the surrounding heart, large vessels, the esophagus and
    trachea;
  • in those suffering from arrhythmia – strengthening it.

Bronchoscopy in children

Bronchoscopy can be performed in children with a neonatal period.
– provided that the hospital has an apparatus of such a small
diameter. The procedure is performed only under general anesthesia, and after it.
antibiotics are prescribed.

Bronchoscopy children spend when:

  • sudden breathing difficulties, most likely caused by
    foreign body;
  • accurate determination of the presence of a foreign body in the respiratory
    ways;
  • severe pneumonia, especially against cystic fibrosis;
  • bronchial tuberculosis – for diagnosis or stopping
    bleeding;
  • if in the presence of dyspnea on radiography visible area
    atelectasis;
  • lung abscess.

Children are more likely to develop laryngo or bronchospasm.
due to the rich blood supply to the respiratory tract. Therefore common
anesthesia is often supplemented by local.

In addition, a collapse (a sharp decrease in
blood pressure), anaphylactic shock. Perforation of the trachea
extremely rare, as bronchoscopy is performed flexible
bronchoscopes.

Bronchoscopy for tuberculosis

Bronchoscopy for tuberculosis is an important therapeutic and diagnostic
procedure. It allows you to:

  • using aspiration of bronchial contents and
    bacteriological his research – isolate mycobacterium
    tuberculosis (especially if the bacposus was negative) and determine
    anti-TB drug sensitivity;
  • drain caverns (tuberculosis cavities) from necrosis;
  • administer anti-TB drugs topically;
  • dissect fibrous (scar) tissue in the bronchi;
  • stop the bleeding;
  • evaluate the dynamics of treatment (for this you need repeated
    bronchoscopy);
  • inspect the stitches after a lung removal operation;
  • clear the bronchi from necrotic masses and pus when they
    burst there from the cavern or hilar lymph nodes;
  • assess the condition of the bronchi before the operation;
  • remove fistulas – connections between pulmonary tuberculosis and
    bronchus

BUTвтор: Кривега Мария Салаватовна врач-реаниматолог

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