scholarly journals Safety profile and risk factors for bleeding in transbronchial cryobiopsy using a two-scope technique for peripheral pulmonary lesions

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Toshiyuki Nakai ◽  
Tetsuya Watanabe ◽  
Yuto Kaimi ◽  
Koichi Ogawa ◽  
Yoshiya Matsumoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diagnostic Yield ◽  
Multivariable Analysis ◽  
Bleeding Risk ◽  
Balloon Occlusion ◽  
Ground Glass ◽  
Pulmonary Lesions ◽  
Life Threatening ◽  
Peripheral Pulmonary Lesions ◽  
Clinically Significant

Abstract Background A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs. Methods Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them. Results A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features (P < 0.001, odds ratio: 9.30) were associated with clinically significant bleeding. The diagnostic yields of conventional biopsy and cryobiopsy were 76.3% and 81.3%, respectively (P = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone (P < 0.001). Conclusions The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions.

Safety Profile and Risk Factors for Bleeding in Transbronchial Cryobiopsy Using a Two-Scope Technique for Peripheral Pulmonary Lesions

2021 ◽  
Author(s):  
Toshiyuki Nakai ◽  
Tetsuya Watanabe ◽  
Yuto Kaimi ◽  
Koichi Ogawa ◽  
Yoshiya Matsumoto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diagnostic Yield ◽  
Multivariable Analysis ◽  
Bleeding Risk ◽  
Balloon Occlusion ◽  
Ground Glass ◽  
Pulmonary Lesions ◽  
Life Threatening ◽  
Peripheral Pulmonary Lesions ◽  
Clinically Significant

Abstract Background A balloon occlusion technique is suggested for use in cryobiopsy for interstitial lung diseases because of the bleeding risk. However, it may interfere with selection of the involved bronchus for peripheral pulmonary lesions (PPLs). A two-scope technique, in which two scopes are prepared and hemostasis is started using the second scope immediately after cryobiopsy, has also been reported. This study aimed to evaluate the safety and diagnostic utility of transbronchial cryobiopsy using the two-scope technique for PPLs. Methods Data of patients who underwent conventional biopsy followed by cryobiopsy using the two-scope technique for PPLs from November 2019 to March 2021 were collected. The incidence of complications and risk factors for clinically significant bleeding (moderate to life-threatening) were investigated. Diagnostic yields were also compared among conventional biopsy, cryobiopsy, and the combination of them. Results A total of 139 patients were analyzed. Moderate bleeding occurred in 25 (18.0%) patients without severe/life-threatening bleeding. Although five cases required transbronchial instillation of thrombin, all bleeding was completely controlled using the two-scope technique. Other complications included two pneumothoraces and one asthmatic attack. On multivariable analysis, only ground-glass features (P < 0.001, odds ratio: 9.30) were associated with clinically significant bleeding. The diagnostic yields of conventional biopsy and cryobiopsy were 76.3% and 81.3%, respectively (P = 0.28). The total diagnostic yield was 89.9%, significantly higher than conventional biopsy alone (P < 0.001). Conclusions The two-scope technique provides useful hemostasis for safe cryobiopsy for PPLs, with a careful decision needed for ground-glass lesions.

Efficacy and Safety of Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Combined with Endobronchial Ultrasound in Peripheral Pulmonary Lesions

Respiration ◽  
2021 ◽  
pp. 1-9
Author(s):  
Kai-Lun Yu ◽  
Shun-Mao Yang ◽  
Huan-Jang Ko ◽  
Hui-Yu Tsai ◽  
Jen-Chung Ko ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Propensity Score ◽  
Cone Beam Computed Tomography ◽  
Diagnostic Yield ◽  
Endobronchial Ultrasound ◽  
Cone Beam ◽  
Complication Rates ◽  
Efficacy And Safety ◽  
Pulmonary Lesions ◽  
Peripheral Pulmonary Lesions

<b><i>Background:</i></b> The diagnostic yield of peripheral pulmonary lesions (PPLs) using radial endobronchial ultrasound (EBUS) remains challenging without navigation systems. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) represents a recently developed technique, and its clinical utility remains to be investigated. <b><i>Objectives:</i></b> The aim of this study was to investigate the diagnostic yield of transbronchial biopsy (TBB) using a combination of CBCT-AF and radial EBUS. <b><i>Methods:</i></b> We recruited consecutive patients with PPLs who underwent radial EBUS-guided TBB, with or without AF, between October 2018 and July 2019. Following propensity score 1:1 matching, we recorded the procedure-related data and measured their efficacy and safety. <b><i>Results:</i></b> While 72 patients received EBUS-plus-AF, 235 patients received EBUS only. We included 53 paired patients following propensity score matching. The median size of lesions was 2.8 and 2.9 cm in the EBUS-plus-AF group and EBUS-only group, respectively. Diagnostic yield was higher in the former group (75.5 vs. 52.8%; <i>p</i> = 0.015). The diagnostic yield for the EBUS-plus-AF group was significantly higher for lesions ≤30 mm (73.5 vs. 36.1%; <i>p</i> = 0.002). Moreover, there was no significant difference in the complication rates (3.8 vs. 5.7%; <i>p</i> = 1.000). Twenty-four nodules (45.3%) were invisible by fluoroscopy in the EBUS-plus-AF group. All of them were identifiable on CBCT images and successfully annotated for AF. The mean radiation dose of total procedure, CBCT, and fluoroscopy was 19.59, 16.4, and 3.17 Gy cm<sup>2</sup>, respectively. <b><i>Conclusions:</i></b> TBB using a combination of CBCT-AF and EBUS resulted in a satisfactory diagnostic yield and safety.

Post-thyroidectomy bleeding: analysis of risk factors from a national registry

2021 ◽  
Author(s):  
H E Doran ◽  
S M Wiseman ◽  
F F Palazzo ◽  
D Chadwick ◽  
S Aspinall
Keyword(s):  
Risk Factors ◽  
Total Thyroidectomy ◽  
Thyroid Surgery ◽  
Multivariable Analysis ◽  
Significant Risk ◽  
Bleeding Risk ◽  
Redo Surgery ◽  
Day Case ◽  
Increased Risk ◽  
Male Sex

Abstract Background Post-thyroidectomy haemorrhage occurs in 1–2 per cent of patients, one-quarter requiring bedside clot evacuation. Owing to the risk of life-threatening haemorrhage, previous British Association of Endocrine and Thyroid Surgeons (BAETS) guidance has been that day-case thyroidectomy could not be endorsed. This study aimed to review the best currently available UK data to evaluate a recent change in this recommendation. Methods The UK Registry of Endocrine and Thyroid Surgery was analysed to determine the incidence of and risk factors for post-thyroidectomy haemorrhage from 2004 to 2018. Results Reoperation for bleeding occurred in 1.2 per cent (449 of 39 014) of all thyroidectomies. In multivariable analysis male sex, increasing age, redo surgery, retrosternal goitre and total thyroidectomy were significantly correlated with an increased risk of reoperation for bleeding, and surgeon monthly thyroidectomy rate correlated with a decreased risk. Estimation of variation in bleeding risk from these predictors gave low pseudo-R2 values, suggesting that bleeding is unpredictable. Reoperation for bleeding occurred in 0.9 per cent (217 of 24 700) of hemithyroidectomies, with male sex, increasing age, decreasing surgeon volume and redo surgery being risk factors. The mortality rate following thyroidectomy was 0.1 per cent (23 of 38 740). In a multivariable model including reoperation for bleeding node dissection and age were significant risk factors for mortality. Conclusion The highest risk for bleeding occurred following total thyroidectomy in men, but overall bleeding was unpredictable. In hemithyroidectomy increasing surgeon thyroidectomy volume reduces bleeding risk. This analysis supports the revised BAETS recommendation to restrict day-case thyroid surgery to hemithyroidectomy performed by high-volume surgeons, with caution in the elderly, men, patients with retrosternal goitres, and those undergoing redo surgery.

The Diagnostic Yield of Endobronchial Ultrasound With a Guide Sheath in Small Peripheral Pulmonary Lesions

CHEST Journal ◽  
2010 ◽  
Vol 138 (4) ◽  
pp. 845A
Author(s):  
Jamsak Tscheikuna ◽  
Supawadee Makanut ◽  
Supparerk Disayabutr
Keyword(s):  
Diagnostic Yield ◽  
Endobronchial Ultrasound ◽  
Pulmonary Lesions ◽  
Peripheral Pulmonary Lesions

scholarly journals Cone-Beam Computed Tomography-Derived Augmented Fluoroscopy Improves the Diagnostic Yield of Endobronchial Ultrasound-Guided Transbronchial Biopsy for Peripheral Pulmonary Lesions

Diagnostics ◽  
2021 ◽  
Vol 12 (1) ◽  
pp. 41
Author(s):  
Ching-Kai Lin ◽  
Hung-Jen Fan ◽  
Zong-Han Yao ◽  
Yen-Ting Lin ◽  
Yueh-Feng Wen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Success Rate ◽  
Diagnostic Yield ◽  
Study Groups ◽  
Transbronchial Biopsy ◽  
Endobronchial Ultrasound ◽  
Cone Beam ◽  
Ultrasound Guided ◽  
Pulmonary Lesions ◽  
Peripheral Pulmonary Lesions

Background: Endobronchial ultrasound-guided transbronchial biopsy (EBUS-TBB) is used for the diagnosis of peripheral pulmonary lesions (PPLs), but the diagnostic yield is not adequate. Cone-beam computed tomography-derived augmented fluoroscopy (CBCT-AF) can be utilized to assess the location of PPLs and biopsy devices, and has the potential to improve the diagnostic accuracy of bronchoscopic techniques. The purpose of this study was to verify the contribution of CBCT-AF to EBUS-TBB. Methods: Patients who underwent EBUS-TBB for diagnosis of PPLs were enrolled. The navigation success rate and diagnostic yield were used to evaluate the effectiveness of CBCT-AF in EBUS-TBB. Results: In this study, 236 patients who underwent EBUS-TBB for PPL diagnosis were enrolled. One hundred fifteen patients were in CBCT-AF group and 121 were in non-AF group. The navigation success rate was significantly higher in the CBCT-AF group (96.5% vs. 86.8%, p = 0.006). The diagnostic yield was even better in the CBCT-AF group when the target lesion was small in size (68.8% vs. 0%, p = 0.026 for lesions ≤10 mm and 77.5% vs. 46.4%, p = 0.016 for lesions 10–20 mm, respectively). The diagnostic yield of the two study groups became similar when the procedures with a failure of navigation were excluded. The procedure-related complication rate was similar between the two study groups. Conclusion: CBCT-AF is safe, and effectively enhances the navigation success rate, thereby increasing the diagnostic yield of EBUS-TBB for PPLs.

scholarly journals Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

2016 ◽  
Vol 42 (4) ◽  
pp. 248-253 ◽  
Author(s):  
Marcia Jacomelli ◽  
Sergio Eduardo Demarzo ◽  
Paulo Francisco Guerreiro Cardoso ◽  
Addy Lidvina Mejia Palomino ◽  
Viviane Rossi Figueiredo
Keyword(s):  
Diagnostic Yield ◽  
Pulmonary Nodules ◽  
High Sensitivity ◽  
Needle Aspiration ◽  
Tertiary Hospital ◽  
Target Lesion ◽  
Transbronchial Needle Aspiration ◽  
Pulmonary Lesions ◽  
Mean Diameter ◽  
Peripheral Pulmonary Lesions

ABSTRACT Objective: Conventional bronchoscopy has a low diagnostic yield for peripheral pulmonary lesions. Radial-probe EBUS employs a rotating ultrasound transducer at the end of a probe that is passed through the working channel of the bronchoscope. Radial-probe EBUS facilitates the localization of peripheral pulmonary nodules, thus increasing the diagnostic yield. The objective of this study was to present our initial experience using radial-probe EBUS in the diagnosis of peripheral pulmonary lesions at a tertiary hospital. Methods: We conducted a retrospective analysis of 54 patients who underwent radial-probe EBUS-guided bronchoscopy for the investigation of pulmonary nodules or masses between February of 2012 and September of 2013. Radial-probe EBUS was performed with a flexible 20-MHz probe, which was passed through the working channel of the bronchoscope and advanced through the bronchus to the target lesion. For localization of the lesion and for collection procedures (bronchial brushing, transbronchial needle aspiration, and transbronchial biopsy), we used fluoroscopy. Results: Radial-probe EBUS identified 39 nodules (mean diameter, 1.9 ± 0.7 cm) and 19 masses (mean diameter, 4.1 ± 0.9 cm). The overall sensitivity of the method was 66.7% (79.5% and 25.0%, respectively, for lesions that were visible and not visible by radial-probe EBUS). Among the lesions that were visible by radial-probe EBUS, the sensitivity was 91.7% for masses and 74.1% for nodules. The complications were pneumothorax (in 3.7%) and bronchial bleeding, which was controlled bronchoscopically (in 9.3%). Conclusions: Radial-probe EBUS shows a good safety profile, a low complication rate, and high sensitivity for the diagnosis of peripheral pulmonary lesions.

scholarly journals Significant Bradycardia in Critically Ill Patients Receiving Dexmedetomidine and Fentanyl

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Channing Hui ◽  
Maria Cardinale ◽  
Balaji Yegneswaran
Keyword(s):  
Risk Factors ◽  
Heart Rate ◽  
Critically Ill Patients ◽  
Infusion Rate ◽  
Case Series ◽  
Life Threatening ◽  
Sedation And Analgesia ◽  
Clinically Significant ◽  
Dexmedetomidine Infusion ◽  
Community Teaching

Purpose. To report a case series of three patients who developed significant bradycardia while receiving the combination of dexmedetomidine and fentanyl for sedation and analgesia. Materials and Methods. This is a case series of patients obtained from a mixed medical, surgical, and cardiac ICU in a community teaching hospital. Three intubated patients receiving fentanyl and dexmedetomidine infusion developed sudden bradycardia requiring intervention. In all three cases, adjustments to therapy were required. Results. All three patients experienced significant bradycardia, with a heart rate less than 50 bpm, and one patient briefly developed asystole. In Case  1, the fentanyl infusion rate was reduced by 67% and the dexmedetomidine infusion rate was reduced by 25%. In Case  2, the sedation was changed to midazolam, and in Case  3, both fentanyl and dexmedetomidine were discontinued. In all three cases, there were no further incidences of significant bradycardia following intervention. Conclusions. Fentanyl used in combination with dexmedetomidine can result in clinically significant bradycardia. Further study is warranted to identify risk factors and elucidate the mechanisms that result in life-threatening bradycardia.

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