The Experts below are selected from a list of 279 Experts worldwide ranked by ideXlab platform
David H Faegenburg - One of the best experts on this subject based on the ideXlab platform.
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utility of Fiberoptic Bronchoscopy in nonresolving pneumonia
Chest, 1990Co-Authors: Steven H Feinsilver, Alan M Fein, Michael S Niederman, Douglas E Schultz, David H FaegenburgAbstract:Although Fiberoptic Bronchoscopy (FOB) has been traditionally used to evaluate nonresolving pneumonia, its efficacy is unknown. We, therefore, reviewed FOB in 35 consecutive patients who had (1) a roentgenographic infiltrate, (2) cough, (3) either temperature >38.1°C, leukocytosis, or sputum production, (4) symptoms present for at least ten days, and antibiotic therapy for at least one week. Known lung cancer and AIDS were excluded. Fiberoptic Bronchoscopy was diagnostic in 86 percent (12/14) in whom a specific cause was found. No patient had endobronchial cancer. Two patients with nondiagnostic FOB and persistent systemic symptoms had open lung biopsy specimens showing Wegener's granulomatosis and bronchiolitis obliterans with organizing pneumonia (BOOP). Twenty-one patients with nondiagnostic FOB had no final diagnoses other than community-acquired pneumonia. We conclude that FOB is extremely useful in finding a specific diagnosis for a nonresolving pneumonia when a specific diagnosis can be made. Fiberoptic Bronchoscopy was most likely to yield a specific diagnosis in nonsmoking patients with multilobar infiltrates of long duration and could have been avoided in older, smoking, or otherwise compromised patients with lobar or segmental infiltrates with no decrease in diagnostic yield in our series.
Steven H Feinsilver - One of the best experts on this subject based on the ideXlab platform.
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utility of Fiberoptic Bronchoscopy in nonresolving pneumonia
Chest, 1990Co-Authors: Steven H Feinsilver, Alan M Fein, Michael S Niederman, Douglas E Schultz, David H FaegenburgAbstract:Although Fiberoptic Bronchoscopy (FOB) has been traditionally used to evaluate nonresolving pneumonia, its efficacy is unknown. We, therefore, reviewed FOB in 35 consecutive patients who had (1) a roentgenographic infiltrate, (2) cough, (3) either temperature >38.1°C, leukocytosis, or sputum production, (4) symptoms present for at least ten days, and antibiotic therapy for at least one week. Known lung cancer and AIDS were excluded. Fiberoptic Bronchoscopy was diagnostic in 86 percent (12/14) in whom a specific cause was found. No patient had endobronchial cancer. Two patients with nondiagnostic FOB and persistent systemic symptoms had open lung biopsy specimens showing Wegener's granulomatosis and bronchiolitis obliterans with organizing pneumonia (BOOP). Twenty-one patients with nondiagnostic FOB had no final diagnoses other than community-acquired pneumonia. We conclude that FOB is extremely useful in finding a specific diagnosis for a nonresolving pneumonia when a specific diagnosis can be made. Fiberoptic Bronchoscopy was most likely to yield a specific diagnosis in nonsmoking patients with multilobar infiltrates of long duration and could have been avoided in older, smoking, or otherwise compromised patients with lobar or segmental infiltrates with no decrease in diagnostic yield in our series.
Javier H. Campos - One of the best experts on this subject based on the ideXlab platform.
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Fiberoptic Bronchoscopy for Positioning Double-Lumen Tubes and Bronchial Blockers
Principles and Practice of Anesthesia for Thoracic Surgery, 2019Co-Authors: Javier H. CamposAbstract:Flexible Fiberoptic Bronchoscopy is a diagnostic and therapeutic procedure of great value in the clinical practice of thoracic anesthesia. [1] The most common method to perform flexible Fiberoptic Bronchoscopy is with the use of a single-lumen endotracheal tube. Once the tube is advanced beyond the vocal cords and inside the trachea, the tip of the endotracheal tube should come to rest 3-4 cm above the tracheal carina. A Portex Fiberoptic bronchoscope (SSL American, Inc. Norcross, Georgia USA) swivel adapter with a self-sealing valve is used to facilitate ventilation and manipulation of the bronchoscope at the same time. When using a large single-lumen endotracheal tube, an adult Fiberoptic bronchoscope should be used (i.e. 4.1 mm inner diameter). Another alternative to perform Fiberoptic Bronchoscopy is with the use of a laryngeal mask airway (LMA). This technique allows visualization of the vocal cords and subglottic structures with lower resistance than a single-lumen endotracheal tube when the bronchoscope is inserted.
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update on tracheobronchial anatomy and flexible Fiberoptic Bronchoscopy in thoracic anesthesia
Current Opinion in Anesthesiology, 2009Co-Authors: Javier H. CamposAbstract:Purpose of reviewThis review is focused on tracheobronchial anatomy and the use of flexible Fiberoptic Bronchoscopy in thoracic anesthesia.Recent findingsA complete knowledge of tracheobronchial anatomy is a key factor in determining proper position of lung isolation devices, namely double-lumen end
Peter D Potgieter - One of the best experts on this subject based on the ideXlab platform.
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Fiberoptic Bronchoscopy in the intensive care unit a prospective study of 147 procedures in 107 patients
Critical Care Medicine, 1994Co-Authors: John S Turner, Paul A Willcox, Michael D Hayhurst, Peter D PotgieterAbstract:OBJECTIVE: To determine the value and safety of Fiberoptic Bronchoscopy in an intensive care unit (ICU). DESIGN: Prospective survey. SETTING: ICUs at a tertiary care hospital (except for seven procedures that were performed at a peripheral hospital ICU). PATIENTS: A total of 107 patients with a mean age of 43.9 yrs (range 15 to 84). INTERVENTIONS: One hundred forty-seven Fiberoptic Bronchoscopy procedures (116 performed on patients who were undergoing mechanical ventilation) were performed on 107 patients. Ninety-four procedures were for diagnostic reasons (upper and lower airway inspection, focal and diffuse pulmonary infiltrates), 37 for therapeutic reasons (bronchial toilet, pulmonary hemorrhage, endotracheal intubation), and 16 for both reasons. Topical anaesthesia was used for Fiberoptic Bronchoscopy; sedation was rarely needed. Appropriate diagnostic and therapeutic procedures were performed. MEASUREMENTS AND MAIN RESULTS: Oxygen saturation, electrocardiogram, and blood pressure were monitored. Transbronchial biopsies (all on mechanical ventilation) for diffuse pulmonary infiltrates were diagnostic in five of seven cases, and were suggestive of the diagnosis in a further case. Endobronchial biopsies were not diagnostic in any of three cases. Bronchial brushings for microbiology were positive in nine of 50 procedures and for cytology in one of nine procedures. Protected specimen brushes for pulmonary infiltrates gave positive microbiology findings in five of 23 procedures. In pulmonary hemorrhage, focal bleeding was found in five cases, diffuse bleeding in four, and no bleeding source in three. In lobar atelectasis, bronchial toilet led to full reexpansion (n = 20 procedures), partial reexpansion (n = 5), and no change (n = 3). Intubation with Fiberoptic Bronchoscopy was successful in four of five patients. Hypoxemia (oxygen saturation < 90%) occurred in 29 procedures; it caused no problems. Complications included hemorrhage (n = 2), supraventricular tachycardia (n = 1), pneumothorax (n = 1), pneumatocele (n = 1), and bronchospasm (n = 1). No deaths were attributable to Fiberoptic Bronchoscopy. CONCLUSIONS: Fiberoptic Bronchoscopy in the ICU is safe, contributes valuable diagnostic information, and is useful for therapeutic purposes.
Yongseok Oh - One of the best experts on this subject based on the ideXlab platform.
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comparison of alfetanil and ketamine in combination with propofol for patient controlled sedation during Fiberoptic Bronchoscopy
Acta Anaesthesiologica Scandinavica, 2005Co-Authors: Jungwon Hwang, Youngtae Jeon, Hee Pyoung Park, Yongseok OhAbstract:Background: During Fiberoptic Bronchoscopy, propofol, ketamine, benzodiazepines, and opiates are most commonly used, alone or in combination for sedation. The aim of this study was to compare the clinical efficacy of propofol/ketamine with propofol/alfentanil for patient-controlled sedation (PCS) during Fiberoptic Bronchoscopy. Method: Patients undergoing Fiberoptic Bronchoscopy were randomly assigned to receive either propofol/alfentanil (PA group; n = 138) or propofol/ketamine (PK group; n = 138) via a patient-controlled analgesia (PCA) device for sedation and analgesia. Changes in blood pressure, heart rate (HR), and oxygen saturation were monitored. Degree of patient and bronchoscopist satisfaction was evaluated using a 10-cm visual analog scale (VAS) (0 = extremely uncomfortable to 10 = extremely comfortable). Results: After sedation, systolic arterial pressure (SAP) decreased in the PA group, but SAP was stable in the PK group. Compared with values immediately before starting Bronchoscopy, SAP and HR increased during the procedure in both groups (P < 0.05). Patients in the PK group showed more satisfaction [(9.5 (6–10) vs. 9.0 (6–10)), P < 0.05] and amnesia (82% vs. 61%, P < 0.01). Despite these differences, the majority (greater than 90%) of the patients in both groups stated that they were comfortable during the procedure. Conclusion: Our results show that although both techniques proved effective for sedation in patients undergoing Fiberoptic Bronchoscopy, ketamine is superior to alfentanil when used in combination with propofol because of the high patient satisfaction and amnesia.