Bronchoscopy Flashcards
(17 cards)
What is bronchoscopy?
Visual examination of the airways with diagnostic and therapeutic maneuvers
It can be performed using rigid or flexible (fiberoptic) instruments.
What is a major advantage of rigid bronchoscopes?
Large open channel for passing instruments
Sizes range from 3 to 7 mm in diameter and 20 to 50 cm in length.
What are the characteristics of flexible bronchoscopes used in pediatrics?
Diameter of 2.8 mm or 3.5 mm, with a suction channel of approximately 1.2 mm
They rely on glass fibers to transmit images.
What must be done to bronchoscopes before use in patients?
They must be cleaned and sterilized
Bronchoscopy is not a sterile procedure since instruments pass through nonsterile areas.
What are some indications for diagnostic bronchoscopy?
- Stridor > 2 weeks
- Cough > 1 month
- Atelectasis > 6 weeks
Other indications include hemoptysis and suspected aspiration.
What are relative contraindications to bronchoscopy?
- Cardiovascular instability
- Bleeding diatheses
- Severe bronchospasm
- Hypoxemia
- Severe airway obstruction
- Massive hemoptysis
There are no absolute contraindications to bronchoscopy.
Define bronchoalveolar lavage (BAL).
Instillation into and recovery from the distal airways of saline to recover fluid from the alveolar surface
It is used for diagnostic and therapeutic purposes.
What are indications for bronchoalveolar lavage?
- Diagnosis of infectious processes
- When sputum cannot be obtained or is equivocal
- Evaluation of suspected aspiration
- Therapeutic removal of materials
Includes conditions like pulmonary alveolar proteinosis and interstitial lung diseases.
What is the typical volume of saline used for BAL in children?
10 to 20 mL in 2 to 4 aliquots regardless of body weight
Some adjust volume based on the patient’s functional residual capacity.
What is a normal finding in BAL fluid regarding cell types?
Normal BAL fluid has < 5% neutrophils
Usually, it is around 1% to 2% neutrophils.
What do increased neutrophils in BAL fluid indicate?
- Active bacterial infection
- Chronic inflammatory states
- ARDS
- Alveolitis
- Scleroderma
- Asthma
Neutrophils can also be increased due to aspiration.
What is the significance of finding eosinophils in BAL fluid?
Significant numbers suggest an allergic state
Conditions include eosinophilic pneumonia and parasitic infections.
What does contamination in BAL fluid indicate?
Presence of bacteria without neutrophils
Except in neutropenic patients, this suggests contamination rather than infection.
What is the Gomori-Grocott stain used for?
Detection of fungi, especially P. jirovecii
It can be diagnostic for certain infections.
What are some risks associated with bronchoscopy?
- Death of the patient
- Pneumothorax
- Mucosal edema
- Hemorrhage
The risk is generally greater with rigid bronchoscopy.
What are the therapeutic goals of bronchoscopy?
- Restoration of airway patency
- Removal of foreign bodies
- Treatment of mucus plugs or blood clots
- Management of mass lesions
Intractable air leaks can also be addressed through bronchoscopic intubation.
What is the purpose of periodic acid-Schiff (PAS) staining?
Characterization of diffuse proteinaceous material in pulmonary alveolar proteinosis
It helps in diagnosis and understanding the condition.
