Category Archives: Pulmonary Function

Bronchoscopy in North America: The ACCP Survey (19)

Bronchoscopy in North America: The ACCP Survey (19)Special Comments by Survey Participants All the special comments written by the survey participants are grouped into several areas of bronchoscopy practice and are listed in Table 11. There were disagreements on whether the ACCP should set guidelines. (more…)

Bronchoscopy in North America: The ACCP Survey (18)

Training and Competence in Bronchoscopy When asked how many bronchoscopic procedures must be performed to become and to remain competent in the procedure, more than 60 percent of the respondents recorded that at least 50 procedures were necessary to become competent (Table 9). More than half the survey participants noted that one should perform at least 25 bronchoscopic procedures per year to remain competent. (more…)

Bronchoscopy in North America: The ACCP Survey (17)

Bronchoscopy in North America: The ACCP Survey (17)Almost all listed suspicious lesions (nodules and masses) on chest roentgenographs as one of the five most common indications. Hemoptysis, pneumonia/ infection, difiuse pulmonary process, and therapeutic reasons were also mentioned among the five most common indications by more than 50 percent. Nearly one fourth mentioned cough as one of the five indications. Another interesting finding was the relatively significant number (15 percent) of physicians who listed acquired immunodeficiency syndrome and immunocompromise in a patient with lung disease among the five most common indications. (more…)

Bronchoscopy in North America: The ACCP Survey (16)

Laser Bronchoscopy Only 11.3 percent (98) of the 871 respondents were involved in laser bronchoscopy. Of these, 38.8 percent (38) used the FFB exclusively, 18.4 percent (18) used only the rigid bronchoscope, 42.8 percent (42) used each at some point in their practice, and one did not provide an answer. The Nd:YAG laser was used by 83.7 percent (82) of the 98 respondents; the argon dye laser, by 4.1 percent (4); the C02 laser, by 3.1 percent (3); and other types of lasers, by the rest. (more…)

Bronchoscopy in North America: The ACCP Survey (15)

Bronchoscopy in North America: The ACCP Survey (15)Another interesting finding was the relatively low rate of routine use of transtracheal/transbronchial needle aspiration (TBNA) in malignant and nonmalig-nant diseases (11.8 percent and 2.3 percent, respectively). Poor results were noted by a significant number. The majority of those who wrote individual comments mentioned damage to the bronchoscope as one of the major problems with this procedure. These comments reflect the reported experience with TBN A-needle-induced damage to the bronchoscope. Others complained about problems with the needle, unacceptability of the specimens to the pathologist, and lack of training in the procedure. Of all the individual procedures, TBNA received the most negative comments. (more…)

Bronchoscopy in North America: The ACCP Survey (14)

Indications for the oral route mentioned by several bronchoscopists included difficult nasal introduction, bleeding diathesis, and TBLB. The nasal route was employed by 84 percent of 231 physicians surveyed for a 1986 British study. The use of an endotracheal tube was uncommon except in certain situations (Table 6). Fewer than one fourth of respondents routinely performed bronchoalveolar lavage to evaluate a pulmonary process in nonimmunocompromised patients. Additionally, many indicated that this procedure should be reserved for research purposes and should not be used in routine clinical practice. In immunocompromised patients, however, 77 percent of the respondents performed bronchoalveolar lavage. (more…)

Bronchoscopy in North America: The ACCP Survey (13)

Bronchoscopy in North America: The ACCP Survey (13)The recovery area used following bronchoscopy was listed as an area adjacent to the bronchoscopy suite by 56.5 percent (492) and as a separate area, such as an outpatient waiting area, the procedure room itself, or the emergency room, by 42.6 percent (371), 9.1 percent (79) reported using both of these settings. Comments: The British study reported that general anesthesia was used by 12 percent of the bronchoscopists surveyed. Our survey did not look into the use of topical anesthetics, although we surmise that most bronchoscopists use lidocaine. While an overwhelming majority of our survey respondents reported using supplemental oxygen during bronchoscopy, as recommended in several publications,’' only 18 percent of the British bronchoscopists surveyed routinely provided supplemental oxygen. (more…)

Bronchoscopy in North America: The ACCP Survey (12)

A report from the United Kingdom observed that 6 percent of the brochoscopists performed bronchoscopy without routinely using any sedatives, 17 percent used intravenous sedation during the procedure, and 19 percent used both intravenous sedation and premedication. The wide choice of intravenous sedative drugs and drug combinations routinely used by the bronchoscopists in our survey is noteworthy. (more…)

Bronchoscopy in North America: The ACCP Survey (11)

Bronchoscopy in North America: The ACCP Survey (11)An overwhelming majority (87 percent) of 231 British bronchoscopists surveyed reported that they used an anticholinergic drug; 71 percent used atropine, and 16 percent used scopolamine. The mail survey in the United Kingdom revealed that 47 percent of the bronchoscopists used a sedative premedication 30 min or more before the procedure. (more…)

Bronchoscopy in North America: The ACCP Survey (10)

A significant number (13.9 percent) suggested addition of other tests to the list. Comments: A significant number (13.9 percent) of respondents suggested addition of other tests to the list. The British postal survey reported that 66 percent of bronchoscopists routinely performed pulmonary function testing before bronchoscopy, and that routine investigations before TBLB included a platelet count by 75 percent of bronchoscopists, prothrombin time or clotting screen by 65 percent, blood grouping by 22 percent, and cross-matching of blood by 6.5 percent. (more…)