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Background Percutaneous dilatational tracheostomy (PCDT) using fiber-optic bronchoscope (FOB) is a widely practiced technique, but its availability and cost remain a concern in nations with limited resources. Mini-surgical technique of PCDT incorporating minimal blunt dissection has shown improved results even without the use of FOB. The study is primarily intended to compare these two techniques and establish a safer cost-effective alternative to FOB-guided PCDTs. Patients and methods This randomized comparative study [registered (CTRI/2018/04/013191)] was conducted on 120 mechanically ventilated patients. In 60 patients, mini-surgical PCDT (group-M) was performed with 2 cm longitudinal skin incision and blunt dissection till pretracheal fascia without FOB guidance using Portex-Ultraperc™ sets. In remaining 60 patients, PCDT was performed under FOB vision with similar skin incision (without blunt dissection) using Portex-Ultraperc™ sets (group-F). Two techniques were compared with regard to procedural time and percentage of complications occurred during or after the procedure. Results Procedure time [group-M: 6.30 ± 1.28 minutes; group-F: 14.43 ± 1.84 minutes (p

BACKGROUND Haemoptysis is a symptom that warrants immediate attention. Chest radiograph is mandatory for patients with haemoptysis and it often shows abnormality, but many a time CXR may appear normal. The diagnosis of the cause of haemoptysis is often difficult, especially in patients presenting with a normal chest x-ray. This study has been performed to evaluate these patients using either computed tomography chest or fiber optic bronchoscopy. MATERIALS AND METHODS A prospective cross-sectional study done at a sanatorium of chest diseases in a tertiary care center where 409 cases of haemoptysis were recruited. Among these, 114 patients had CXR that appeared normal (27 %) and they were further evaluated with FOB and CT chest. CT scan was done in 53 and FOB in 80 patients with haemoptysis. RESULTS The use of CT chest, in patients with normal CXR an additional diagnosis was obtained in 37 patients (69.8%). High proportion of patients had bronchiectasis (n-22, 41.5%); carcinoma lung was diagnosed in 3 patients (11.3%). Among 114 patients with normal CXR, 80 underwent bronchoscopy and 3 cases of carcinoma lung were additionally diagnosed. CONCLUSION Computerized tomography and fiber optic bronchoscopy thus helped in increasing yield in diagnosis in 114 patients who had a normal CXR. Patients in whom diagnosis could not be obtained by conventional methods, CT scan increased yield in diagnosis by 32.5%. And with fiber optic bronchoscopy, carcinoma was diagnosed in another 2.6%.

Pulmonary infections are frequent complications in abdominal solid-organ transplantation (aSOT) which may threaten patient and allograft survival. Accurate diagnosis and treatment of pulmonary infections in this population can be challenging. Immunosuppressive therapy not only increases the risk of acquiring opportunistic and non-opportunistic infections, but it also impairs the inflammatory responses associated with microbial invasion which in an otherwise normal host produce clinical and radiologic responses that allow for early identification of the offending pathogen. Serologic testing is not a reliable diagnostic modality. Direct microbiological sampling is often necessary to make a definitive diagnosis early in the clinical course to optimize timely, targeted therapy while reducing the risk of developing antimicrobial resistance, and minimize adverse effects of therapy, if any. Fiber-optic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) or transbronchial lung biopsy (TBB) offers such diagnostic advantage and possesses a potential therapeutic value too. This comprehensive review discusses the potential benefits of FOB alongside its risks and complications, indications and contraindications, and techniques. Additionally, the essay highlights FOB's utility and yield specifically with regard to type and timing of infections in aSOT patients.

Background The increase in immunohistochemical and molecular predictive tests in lung cancer requires new strategies for managing small samples taken during bronchoscopic procedures. The value of Rapid On Site Evaluation (ROSE) during conventional bronchoscopic procedures on endobronchial neoplasms in optimizing small biopsies and cytologlogical tissue specimens for diagnostic testing, and ancillary studies was evaluated. Method ROSE on touch imprint cytology (TIC) and brushing was performed on 690 consecutive cases of patients undergoing biopsies, using fiber optic bronchoscopy. Immunohistochemical assay for PD-L1, ALK, and ROS1 and molecular testing, via next generation technique for EGFR, KRAS, and BRAF, were performed. Results The concordance between ROSE and final diagnoses was almost perfect for brushing (sensitivity: 0.84; specificity: 0.96), and less so for touch preparations (sensitivity: 0.77; specificity: 0.89). Immunohistochemical assay for PD-L1 was evaluated on 256 bioptic cases with only six unsuitable samples. Material available for immunohistochemistry for ALK was sufficient in 151 biopsies with no inadequate cases. ROS1 was evaluated in 132 biopsies, with only two unsuitable samples. Molecular analysis was performed on 128 biopsies, 29 TIC, and 17 brushing. Out of these, only ten were considered to be unsuitable. Conclusions ROSE is an effective procedure for monitoring the quality and quantity of material taken during conventional bronchoscopic procedures for evaluating the suitability of small samples that must undergo immunohistochemical and molecular assay.

A 31-year non-smoker man, working in plastic making industry for 12 years presented with cough and streaking hemoptysis for 2 days. Computed tomography (CT) of chest showed patchy ground glass opacities with interlobular septal thickening in bilateral lung parenchyma. Fiber optic bronchoscopy (FOB) was done. Sequential lavage was taken which showed progressively increasing hemorrhagic fluid. His diffusion capacity for carbon monoxide (DLCO) was 38.08 mL/mmHg/Mi (126%) predicted on day 2 of admission, 32.36 ml/mmHg/Mi (106%) predicted on discharge and 39.63 mL/mmHg/Mi (130%) predicted on going back to work. He was diagnosed with plastic fume exposure related pulmonary alveolar hemorrhage.

Introduction: Fiber-optic bronchoscopy (FOB) is commonly performed in the first line in diagnostic process of haemoptysis. However, lots of evidences suggest that in haemoptysis FOB do not always provide additional, useful information to radiological diagnostics. Therefore, this study aimed to evaluate the validity of performing FOB as a method of choice in first line diagnostics of haemoptysis. Material and methods: Data comprised consecutively collected results from patients referred for FOB assessment for clinical purposes were retrospectively analysed. We included all examinations, which were performed due to haemoptysis as the only indication, excluding any other lung-related conditions. Results: 114 patients were finally included to the study. The median age was 59 (IQR: 46–64.75). Active bleeding was visualized during examination of 13 (11.4%) patients. Patients with active bleeding did not differ significantly according to age: 59 (54–69) vs. 59 (45–64) years; W = 532.5, p-value = 0.27, and gender: c2 = 1.68, p-value = 0.2. On the other hand, in 29 (25.44%) patients, FOB revealed no visible abnormalities. This subgroup of patients was significantly younger — 46 (34–62) years vs. 60 (53–67) years; W = 782, p-value = 0.003. Conclusion: Low number of visualized active bleeding sites suggest overuse of bronchoscopy in diagnosis of haemoptysis. Indications for this examination should be reconsidered especially in young patients with non-massive haemoptysis.

Objective: To compare the efficacy, safety, and incidence of complications between fiber-optic bronchoscopy-guided percutaneous dilatational tracheostomy (FOB-PDT) and ultrasound-guided percutaneous dilatational tracheostomy (US-PDT) and to determine whether US-PDT is a viable alternative to FOB-PDT. Methods: This randomized prospective study was carried out in 80 patients who were randomly divided into US-PDT and FOB-PDT groups. Demographic data and Acute Physiology and Chronic Health Evaluation II (APACHE II), procedure duration, hemorrhage status, complications, procedure difficulty, displacement of entry location after US, and hemodynamic data were evaluated in both groups. Tracheal incision was performed with real-time US and a transverse probe position in the out-of-plane mode. Results: No significant differences were observed between the 2 groups in terms of demographic data, oral intubation time, APACHE II values, difficulty of the procedure, or the number of needle interventions ( P > .05). The mean hemorrhage ratio of the FOB-PDT group was significantly higher than that of the US-PDT group ( P < .05). The entry location was changed in 6 patients in the US-PDT group following neck examination with US. The mean duration of the procedure for the FOB-PDT group was significantly longer than that for the US-PDT group ( P < .05). Conclusion: Ultrasound-guided percutaneous dilatational tracheostomy is a safe procedure for critically ill patients and has the advantages of a low complication rate, short duration of procedure, being informative with regard to neck anatomy, and facilitating prevention of vascular puncture. Thus, US-PDT can be used as an alternative to FOB-PDT.

Bronchoscopy relies on two techniques: fiber-optic bronchoscopy, which is the most common, and rigid bronchoscopy, which is technically more difficult. Local anesthesia facilitates a quick and immediate examination, which makes it the most widely used. It requires subsequent clinical and vital signs monitoring. General anesthesia prevents the operator from cooperating with the patient and from having access to a few fine observations. Fiber-optic bronchoscopy allows to observe and diagnose trachea–bronchial diseases; it also makes it possible to collect samples for pathology and infectious diseases.

Although tuberculosis is a rather common disease in the Indian subcontinent, tracheobronchial involvement in tuberculosis is still rare. Fistula formation between bronchi is very rare considering that only four cases have been published in the English literature. We present a case of multislice computed tomography (CT) and virtual bronchoscopy diagnosis of interbronchial fistula in a patient with tuberculosis along with a review of literature of the same. This happens to be the smallest of the interbronchial fistula identified on imaging so far and the first case from the Indian subcontinent. This is also the first instance where the diagnosis appears to have been made using only multislice CT generated virtual bronchoscopy without the aid of fiber optic bronchoscopy.

Introduction: Contrast enhanced computed tomography (CECT) thorax & Fibre Optic Bronchoscopy (FOB) are main investigations in patients of hemoptysis with normal chest X-ray. But there are limited data on their diagnostic yield especially from South East Asia. Methods : An observational study on 60 patients with hemoptysis with normal chest X -ray was conducted from April 2012 to April 2014. CECT thorax and FOB were done in all of them. Results : Out of 60 patients 38 (63.3%) were male with even age distribution. Yield of CECT was 40% (24 patients) and main diagnosis were bronchiectesis (25%) and tuberculosis (11.6%). Diagnostic yield of FOB was 47% (28 patients) with predominant diagnosis of tuberculosis (18.33%), bronchitis (18.33%) and bronchogenic carcinoma (6.66%). Overall diagnostic yield was 76.6% (46 cases). Bronchogenic carcinoma cases were all male smokers and 3 of them were more than 40 years old. Conclusion : CECT thorax and FOB are complimentary to each other in evaluation of hemoptysis with normal chest x-ray. Bronchogenic carcinoma and tuberculosis cases require specific treatment and they were diagnosed in confirm way only by FOB. So, FOB have advantage over CT scan, especially among patients with increased risk of bronchogenic carcinoma (male-smokers with age > 40 years).

An elderly, bed ridden patient with a history of stroke was admitted for management of aspiration pneumonia. Two days after insertion of a nasopharyngeal airway, sudden respiratory distress prompted further investigations which led to the eventual diagnosis and removal of the nasopharyngeal airway that had been aspirated. The device was removed under conscious sedation with fiber optic bronchoscopy. Keywords: Nasopharyngeal airway, Aspiration, Respiratory distress, X-ray

a b s t r a c t Background: The development of percutaneous dilatational tracheostomy techniques (PDT) has facilitated the procedure in Intensive Care Units (ICU). Objective: To describe the early intra and post-operative complications in ICU patients requiring percutaneous dilatational tracheostomy using the Ciaglia Blue Rhino technique, without fiber optic bronchoscopy. Patients and methods: We collected data from eighty ICU patients during three years. The demographic variables were recorded, in addition to severity, number of days in mechanical ventilation prior to the procedure and intraoperative as well as early postoperative complications.

ファイバースコープ（FOB）ガイド下挿管ではFOB越しに気管チューブを挿入する際に難渋する場合があり，FOB損傷の危険性もある．この問題点を解決するためにFOBを気管内に誘導した後にガイドワイヤを挿入し，これをガイドとしてチューブエクスチェンジャーを気管内に誘導し，その後に気管チューブを挿入する方法を考案した．チューブエクスチェンジャーはFOBよりも固いため気管チューブの誘導が容易であり，この方法ならFOBを損傷することもない．使用するFOBも気管チューブのサイズに合わせる必要がない．従来の方法に比べやや煩雑であるが，安全で確実な方法であると思われる．この方法に関して紹介する．

One-lung ventilation (OLV) is a sine qua non of thoracic surgery and requires knowledge and talent. Close familiarity with equipments used for OLV as well as bronchoscopy and respiratory tract anatomy is important for successful OLV. We aim to outline the bronchoscopic anatomy of the tracheobronchial tree and OLV equipment for anesthetists and thoracic surgeons in this review. The recorded preoperative and intraoperative bronchoscopic applications of the patients hospitalized in our Thoracic Surgery clinic for diagnosis and treatment have been evaluated from an anesthetist's perspective. Anatomic landmarks were identified in the bronchoscopic evaluation. Optimal and misplacement images of double-lumen tubes (DLT) and bronchial blockers (BB) used for OLV in our clinic were obtained via fiber optic bronchoscopy. While left lung isolation can be made more safely due to the anatomy of the left main bronchus, placement of both DLTs and BBs to the right main bronchus requires greater care. Success in OLV procedures would increase with anesthetists being well informed about the fiber optic bronchoscopic anatomy of the tracheobronchial tree and in close cooperation with the surgical team.

Objective : The aim of this study was to compare the results of virtual bronchoscopy (VB) images in defining tracheobronchial pathologies with those of fiber-optic bronchoscopy (FOB) in patients with clinical indication for bronchoscopy. Methods : Twenty-two patients with bronchoscopy indication were evaluated with FOB and VB. The VB results were evaluated blindly, independent of the FOB results. Results : In 19 of the 22 patients, tracheobronchial abnormalities were present on FOB, whereas 3 patients had normal findings on FOB. In 17 of 19 patients, VB demonstrated the FOB diagnosis of tracheobronchial abnormality. While FOB detected 11 endoluminal lesions, VB detected 6. While FOB detected 20 obstructive lesions, VB detected 26. In evaluating external compression, FOB detected 2 lesions and VB detected 15. Conclusions : VB is a non-invasive, uncomplicated, and reproducible examination method in patients with an indication for thorax examination. Virtual bronchoscopy could find a clinically broader field of application in the future.

Severe anterior post-burn contracture of the neck poses the anaesthesiologist some difficult problems and results in difficultintubation when extension of the atlanto-occipital joint is impaired. Such patients must therefore have the post-burncontracture scar released before other procedures are performed, in order to ensure airway control. The fiber optic bronchoscope is considered safe and reliable in the difficult endotracheal intubation. Fiber optic bronchoscopyis felt to be the technique of choice when intubation is difficult especially when there are contractures or deformitiesof the larynx, manidible, or cervical spine.

Pulmonary mucormycosis is rare life‐threatening infection affecting mostly immunocompromised individuals such as diabetes mellitus, hematological malignancies, chronic renal failure, post transplantation etc. Based on the anatomic site involved, mucormycosis can be one of several forms, such as rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and uncommon presentations that include endocarditis, osteomyelitis, peritonitis, and renal infection. Pulmonary infection is the most common form of mucormycosis recognized in patients with hematological malignancy and remains the second most common presentation after rhinocerebral infection in diabetic patients. Its presentation in the lungs may mimic cavitary diseases like tuberculosis, mass lesions as in malignancies and non-resolving pneumonias. Here we report a case of isolated pulmonary mucormycosis in an uncontrolled diabetic male patient with a cavitary lesion. Diagnosis was made with a bronchoscopic biopsy and treatment was completely medical with liposomal amphotericin B.

Endobronchial aspergilloma is a rare, noninvasive aspergillosis. It may be associated with a parenchymal lesion and/or cavity. We describe a case of endobronchial aspergillosis mimicking bronchogenic carcinoma subsequently removed completely through fiber-optic bronchoscope itself. This case report, while highlighting the existence of this unique clinical entity, also throws light on potential treatment option which can be curative.

Hemoptysis is a very common symptom in the practice of pulmonary physicians of India. We present a case of uncontrolled hemoptysis managed with bronchial artery embolization. Bronchial artery embolization is an effective treatment for patients with hemoptysis. Serious complications are rare, but may occur if the arterial supply to other structures is compromised.

Compare virtual bronchoscopy (VB) to fiberoptic bronchoscopy (FOB) for scoring smoke inhalation injury (SII).Swine underwent computerized tomography (CT) with VB and FOB before (0) and 24 and 48 h after SII. VB and FOB images were scored by 5 providers off line.FOB and VB scores increased over time (p0.001) with FOB scoring higher than VB at 0 (0.30±0.79 vs. 0.03±0.17), 24 h (4.21±1.68 vs. 2.47±1.50), and 48h (4.55±1.83 vs. 1.94±1.29). FOB and VB showed association with PaO2-to-FiO2 ratios (PFR) with areas under receiver operating characteristic curves (ROC): for PFR≤300, VB 0.830, FOB 0.863; for PFR≤200, VB 0.794, FOB 0.825; for PFR≤100, VB 0.747, FOB 0.777 (all p0.001). FOB showed 80.3% specificity, 77% sensitivity, 88.8% negative-predictive value (NPV), and 62.3% positive-predictive value (PPV) for PFR≤300 and VB showed 67.2% specificity, 85.5% sensitivity, 91.3% NPV, and 53.4% PPV.VB provided similar injury severity scores to FOB, correlated with PFR, and reliably detected airway narrowing. VB performed during admission CT may be a useful screening tool specifically to demonstrate airway narrowing induced by SII.

Context: Non-resolving pneumonia is often an area of concern for pulmonologists. Fiber optic bronchoscopy (FOB) may have a special role in etiologic evaluation of non-resolving pneumonias. There is paucity of recent studies in this field. Aims: This study aimed to assess the patients of non-resolving or slowly resolving pneumonia with special emphasis on efficacy of FOB and computed tomography (CT)-guided fine needle aspiration cytology (FNAC) in diagnosis. Settings and Design: Prospective, observational study conducted in a tertiary care institute over a period of one year. Materials and Methods: After fulfilling the definition of non-resolving pneumonia by clinical and radiological parameters, patients were evaluated by FOB with relevant microbiological, cytological, histopathological investigations and CT scan of thorax. CT-guided FNAC was done in selected cases where FOB was inconclusive. Results: Sixty patients were enrolled in the study. Mean age was 51.33 ± 1.71 years with male to female ratio 2:1. Right lung was more commonly involved (65%), and right upper lobe was the commonest site (25%). Pyogenic infection was the commonest etiology (53.3%), bronchogenic carcinoma and tuberculosis accounted for 26.7% and 16.7% cases, respectively. Both, FOB (85.7%) and CT-guided FNAC (91.67%) were very useful for etiological diagnosis of non-resolving pneumonia. Both the procedures were safe, and no major complication was observed. Conclusions: Because of the high yield of FOB, it is very useful and safe diagnostic tool for evaluation of non-resolving pneumonia. CT-guided FNAC also gives good yield when cases are properly selected.

The problem of prophylaxis of incompetence of bronchialstump and bronchial fistula is many sided. Notwithstandingthe development of new technologies, perfection of surgicaltechnique, its frequency still remains on high level thatpersistently requests the search of new ways for resolving this problem, which preserved its topicality till nowadays. We have found that: The most efficiency of BFS is achieved during treatment of bronchial fistulas with diameter up to 3mm and with effectiveness at 83.2% patients after right­sidePE and at 92.3% patients after left­side PE.In case of BPF with diameter more than 3 mm the numberof satisfactory results of BFS reaches only 33.3%. but, it isnecessary to mention that among patients with BPF sized over 3 mm after left­side PE the effectiveness of BFS significantly exceeds as general index (50.0% against 33.3%) so after right­side PE (50.0% against 25.0%).