Search

Background: Endobronchial administration of voriconazole is a potential therapeutic option for inoperable aspergilloma. Objective: This study aimed to assess the efficacy of endobronchial instillation of voriconazole for inoperable pulmonary aspergilloma. Method: Patients with mild to moderate hemoptysis, due to inoperable aspergilloma, were randomized to receive either medical therapy (MT) alone or bronchoscopic instillation of voriconazole with MT and followed up till 3 months. The primary objective of this study was to compare the percentage of patients achieving reduction in the severity of hemoptysis assessed on visual analogue scale (VAS) in intervention and control arm at 3 months. Results: This study included 60 patients (female = 47) with mean (SD) age of 40.6 (13.2) years who were randomized to receive either bronchoscopic instillation of voriconazole (n = 30) or MT alone (n = 30). At 3-month follow-up, the primary objective was achieved in 26/30 (86.7%) patients in intervention group as compared to 11/30 (36.7%) in the control group (p value <0.0001). The VAS score at 3 months was significantly lower in voriconazole group 13.9 (9.3) mm as compared to MT alone group 22.3 (11.5) mm, p value of 0.003. Bronchoscopic instillation of voriconazole was also associated with reduction in cough severity and size of the aspergilloma; however, there was no benefit of this therapy in terms of requirement of hospitalization and BAE. Conclusions: Our study shows that for nonoperable aspergilloma, bronchoscopic instillation of voriconazole is associated with reduction in the severity of hemoptysis. This therapy should be evaluated in large multi-center trials. [ABSTRACT FROM AUTHOR]

Background: Guidelines for flexible bronchoscopy in adults recommend both Cricothyroid and Spray‑as‑you‑go method as the acceptable techniques for lignocaine administration. No studies have compared these two methods for topical anesthesia during endobronchial ultrasound‑guided transbronchial needle aspiration (EBUS‑TBNA). Objectives: Co‑primary outcomes were the comparison of cough count and operator‑rated overall procedure satisfaction on a Visual Analog Scale (VAS) between the groups. The secondary outcomes were cumulative lignocaine dose, time from bronchoscope introduction to crossing the vocal cords, procedure duration, and complications between the groups. Methods: Consecutive participants (age >18 years) undergoing EBUS‑TBNA were randomized (1:1) to either cricothyroid or spray‑as‑you‑go methods for lignocaine administration. Results: Three hundred and sixty‑five participants were randomized (183: Cricothyroid and 182: Spray‑as‑you‑go). Cough count till reaching carina (median [interquartile range]) was significantly lower (cricothyroid, 1 [0–2] vs. spray‑as‑you‑go, 4 [2–6], P < 0.001) and operator rated overall procedure satisfaction, on VAS (mean ± standard deviation) (cricothyroid, 7.96 ± 1.48 vs. spray‑as‑you‑go, 7.29 ± 1.48, P < 0.001) significantly greater in the cricothyroid group. Cumulative lignocaine dose (163.28 ± 31.50 mg vs. 177.0 ± 30.12 mg, P < 0.0001) and time from bronchoscope introduction to crossing the vocal cords (20.80 ± 11.21 s vs. 38.08 ± 15.26 s, P < 0.001) was significantly lower in the cricothyroid group. Procedure duration was similar in both the groups. Minor complications occurred in three patients in cricothyroid and six patients in the spray‑as‑you‑go group (P = 0.31). Conclusions: Cricothyroid lignocaine administration is associated with less cough and superior operator‑rated procedure satisfaction during EBUS‑TBNA, at a lower cumulative lignocaine dose administered. [ABSTRACT FROM AUTHOR]

Objectives: To ascertain if topical lignocaine application in oropharynx prior to swab sampling to test for COVID-19 improves a patient's comfort and to assess its effect on the swab sample taken to conduct the RT-PCR. Methods: Adult patients testing positive on the RT-PCR COVID-19 test were sampled again within 48 h after administering topical oropharyngeal anaesthesia. Patients were asked to rate their discomfort on a visual analog scale (VAS) for both sample A and B. A qualitative real-time RT-PCR for detection of SARS-CoV-2 RNA, was performed, and the cycle threshold value (Ct), used as a surrogate marker for the viral load, was measured for the sample taken without lignocaine (sample A) and the sample taken post-lignocaine application (sample B). The difference in Ct values of both the groups was checked for any statistical significance using paired t-test. Wilcoxon signed rank test was used on VAS scores to determine any significant decrease in discomfort. Results: Forty patients were included in the study. Twenty-nine patients (72.5%) reported the procedure to be more comfortable post-lignocaine application. Median (IQR) discomfort on VAS decreased from 7 (1) to 5 (2) after lignocaine use, which was statistically significant (p < 0.05). Mean Ct value for sample A was 17.21 ± 5.25 and for sample B was 18.44 ± 4.8 (p > 0.05), indicating a non-significant effect of lignocaine on SARS-CoV-2 concentration in the sample. Conclusion: Topical lignocaine, while improving the comfort of the procedure of oropharyngeal sampling for patient did not alter the SARS-CoV-2 viral load that was detected in nasal and oropharyngeal samples taken together. [ABSTRACT FROM AUTHOR]

Background: Endobronchial Ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) is a standard of care modality for the evaluation of mediastinal lymphadenopathy. Transesophageal Bronchoscopic Ultrasound‐Guided Fine Needle Aspiration (EUS‐B‐FNA), wherein one introduces the EBUS bronchoscope through the esophageal route, is also a safe and efficacious diagnostic modality for sampling the mediastinal lymph nodes. The objective of this study was to compare the diagnostic yield and patient comfort with these two available approaches. Methods: We randomized subjects with predominant subcarinal or lower left paratracheal mediastinal lymph node enlargement to either EBUS‐TBNA or EUS‐B‐FNA (50 to each group). Co‐Primary objectives were the comparison of adequate and diagnostic aspirates between groups. Key secondary objectives were a comparison of Operator rated cough and Operator rated procedural comfort on Visual Analog scale (VAS), procedure duration and complications between the groups. Results: Baseline characteristics were comparable between the groups. The proportion of adequate (EBUS‐TBNA 46/50; 92% and EUS‐B‐FNA 48/50;96%, P = 0.4) and diagnostic aspirates (EBUS‐TBNA 38/50; 76% and EUS‐B‐FNA 36/50;74%, P = 0.4) were similar between the two groups. Operator rated cough was significantly less, and Operator rated patient comfort significantly higher with the EUS‐B‐FNA approach. Procedure duration was significantly shorter with EUS‐B‐FNA [18.1(14.4) minutes versus 16.4 (49.6) minutes, P < 0.001]. Minor complications occurred in one patient in the EBUS‐TBNA group and none in the EUS‐B‐FNA group. Conclusion: During the endosonographic evaluation for undiagnosed mediastinal lymphadenopathy located at predominantly the subcarinal or lower left paratracheal stations, EUS‐B‐FNA as compared with EBUS‐TBNA provides greater patient comfort with a similar diagnostic yield. [ABSTRACT FROM AUTHOR]

Background: Central airway obstruction (CAO) is a potentially lethal condition that requires urgent endobronchial intervention and may occur due to several nonmalignant causes. The effect of these interventions on clinically relevant outcomes such as symptomatic and functional status over a period of time is, however, sparsely studied. Materials and Methods: Consecutive patients with CAO due to nonmalignant causes and undergoing various therapeutic bronchoscopy procedures were evaluated. Symptoms were assessed using the Visual Analog Scale (VAS) and Speiser score, and functional status was assessed using the 6-min walk test, spirometry, and St. George Respiratory Questionnaire (SGRQ) score at baseline and after 48 h, 4 weeks, and 12 weeks postprocedure. Results: Over 2 years, 31 patients with CAO due to nonmalignant etiology underwent 41 therapeutic bronchoscopic procedures. Majority of procedures (96.8%) were done using the rigid bronchoscope under general anesthesia. Postintubation tracheal stenosis was the most common indication (32.2%). The various procedures included, controlled radial expansion balloon dilatation of the stenotic airway (53.6%), deployment of silicone stents (19.5%), and mechanical debulking of airway tumors (16.1%). Significant improvement occurred in dyspnea and cough scores and in the Speiser score from baseline to 48 h postprocedure, and further improved at 4 weeks and 12 weeks. Similarly, the 6 min walk distance, forced expiratory volume in 1 s, and SGRQ scores progressively improved from baseline to 12 weeks. Complications occurred in 26.8% of total procedures, with no procedure-related mortality. Conclusion: Therapeutic bronchoscopy interventions provide rapid and sustained benefits in symptoms and functional status of participants with CAO of nonmalignant etiology, with an acceptable safety profile. [ABSTRACT FROM AUTHOR]

BACKGROUND: This study was conducted to compare the effectiveness of noninvasive ventilation (NIV) with pressure support (NIV-PSV) to noninvasive neurally-adjusted ventilatory assist (NIV-NAVA) during COPD exacerbation. METHODS: In this study, 40 subjects with COPD and acute hypercapnic respiratory failure were randomized to receive either NIV-NAVA (n = 20) or NIV-PSV (n = 20) via a critical care ventilator. Subjects' vital parameters, arterial blood gas values, patient-ventilator asynchrony events, and asynchrony index were noted at specific time intervals in both groups. The duration of NIV, rate of NIV failure, and length hospital stay were also recorded for these 2 modes of NIV. RESULTS: NIV-NAVA significantly reduced the total number (median [interquartile range]) of asynchrony events compared to NIV-PSV: 22 (15-32.5) versus 65 (50.75-104.25), respectively, P = .002. Severe asynchrony defined as asynchrony index > 10% was also significantly lower in NIV-NAVA than in NIV-PSV (P < .001). There was no significant difference between the 2 groups regarding improvement in gas exchange and vital parameters. Rate of failure of NIV (P = .73), duration of the requirement of ventilatory support (P = .40), and hospital length of stay (P = .46) were also comparable between the 2 modes of ventilation. CONCLUSIONS: Compared to NIV-PSV, NIV-NAVA was associated with better patient-ventilator synchrony and a reduction in the number of asynchrony events in subjects with an exacerbation of COPD, with similar effects on improvement in gas exchange, duration of NIV, hospital lenght of stay, and rate of NIV failure. [ABSTRACT FROM AUTHOR]

Background: Comparative characteristics of the cricothyroid injection and spray-as-you-go methods for lidocaine administration during diagnostic flexible bronchoscopy are not clear. Objectives: Co-primary outcomes were comparison of cough count from bronchoscope introduction until reaching carina and operator-rated overall procedure satisfaction on a Visual Analogue Scale (VAS) between groups. Secondary outcomes were cumulative lidocaine dose, procedure duration, assistant-rated cough, willingness to return for repeat procedure, and procedural complications between groups. Methods: Consecutive subjects were randomized (1:1) to either the cricothyroid or the spray-as-you-go method for topical anesthesia to the vocal cords and trachea. All received nasal 2% lidocaine gel and pharyngeal 10% lidocaine spray. Results: A total of 500 subjects were randomized, and 495 subjects were analyzed (248 cricothyroid and 247 spray-as-you-go). Cough count until reaching carina (median [range]) was significantly lower (cricothyroid, 1 [0–10], and spray-as-you-go, 4 [0–30], p < 0.0001) and operator-rated overall procedure satisfaction, VAS (mean ± standard deviation) (cricothyroid, 7.86 ± 1.39 and spray-as-you-go, 6.86 ± 1.59, p < 0.0001) significantly greater in the cricothyroid group. Patient willingness to return for repeat procedure was greater (87.1 vs. 70.5%, p < 0.001)) and cumulative lidocaine dose significantly lower (305.08 ± 13.40 vs. 322.18 ± 10.67 mg, p < 0.001) in the cricothyroid group. Minor complications occurred in 6 patients in the cricothyroid group and 9 patients in the spray-as-you-go group. Conclusion: Cricothyroid lidocaine administration is associated with less cough and superior operator-rated procedure satisfaction during bronchoscopy at a lower cumulative lidocaine dose. [ABSTRACT FROM AUTHOR]

The role of nebulized lignocaine administration for flexible bronchoscopy is unclear. Methods: In this randomized, double‑blind, placebo‑controlled trial, subjects undergoing diagnostic flexible bronchoscopy were randomized to receive either nebulized lignocaine (2.5 ml of 4% lignocaine) or nebulized (2.5 ml of 0.9%) saline (placebo). All received 10% lignocaine pharyngeal spray (4 sprays) and 5‑ml nasal 2% lignocaine gel. 1% lignocaine solution was used for spray‑as‑you‑go administration in all. Co‑primary outcomes were Operator‑rated overall procedure satisfaction and Operator‑rated cough scores on Visual Analog Scale (VAS). Secondary objectives were cumulative lignocaine dose, proportion of subjects receiving >8.2‑mg/kg lignocaine, and complications between the groups. Results: Two hundred and twenty subjects were randomized and 217 (109 – nebulized lignocaine and 108 – placebo) received the intervention. Baseline characteristics were comparable. Operator‑rated overall procedure satisfaction scores on VAS (7.30 ± 1.54 nebulized lignocaine and 7.50 ± 1.31 placebo group, P = 0.85) and Operator‑rated cough scores on VAS (3 [2–5] nebulized lignocaine and 3 [2–4] placebo group, P = 0.18) were similar. Cumulative lignocaine dose was significantly greater in nebulized lignocaine group (331.46 ± 9.41 mg vs. 232.22 ± 12.77 mg, P < 0.001), and a significantly greater number of subjects in this group received lignocaine dose >8.2 mg/kg. Minor complications occurred in 6 and 9 subjects in nebulized lignocaine and placebo groups, respectively, P = 0.41. Conclusion: Administration of nebulized lignocaine in addition to pharyngeal lignocaine spray, during no‑sedation bronchoscopy, increases the cumulative lignocaine dose without improved procedural comfort. Additional nebulized lignocaine during bronchoscopy is not recommended. [ABSTRACT FROM AUTHOR]

Background and Objectives: No previous study has compared different concentrations of lignocaine for topical anesthesia during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). In this pilot study, we compared 1% versus 2% lignocaine for topical airway anesthesia during EBUS-TBNA. Methods: In this double-blind, randomized trial, subjects were randomized to receive either 1% or 2% lignocaine for “spray-as-you-go" administration. All received combined moderate intravenous sedation (midazolam and fentanyl). Ten percent pharyngeal lignocaine spray (two sprays) and nebulized lignocaine (2.5 ml of 4% solution) were administered to all subjects. Administration of additional lignocaine was allowed at operator's discretion. The primary endpoints were operator-rated overall procedural satisfaction and cough, each assessed on visual analog scale (VAS), while the secondary outcomes included patient-rated faces pain scale scores, cumulative lignocaine dose, number of subjects receiving lignocaine >8.2 mg/kg, doses of midazolam/fentanyl between groups, and adverse events during procedure. Results: The mean (standard deviation [SD]) VAS scores for operator-rated procedure satisfaction were 64.2 (25.6) and 68.7 (23.7) in 1% and 2% group, respectively (P = 0.35). The median (interquartile range) VAS scores for operator-rated cough were 48.4 (23.9-69.9) in 1% group and 38.7 (18.6-69.5) in 2% group (P = 0.24). The mean [SD] cumulative lignocaine received in the 2% lignocaine group (248.6 [29.1] mg) was significantly greater than in 1% lignocaine group (178.5 [14.6] mg) (P < 0.01). Conclusion: One percent lignocaine is equally efficacious as 2% lignocaine for topical anesthesia during EBUS-TBNA, at a significantly lower cumulative lignocaine dose. [ABSTRACT FROM AUTHOR]