Search Results (71)

Robotic-assisted bronchoscopy (RAB) represents a significant technological advance, providing superior precision, enhanced visualization, and increased maneuverability relative to conventional bronchoscopic methods. This review provides an overview of current research evaluating RAB’s diagnostic performance and exploring future prospects. Recent literature demonstrates advantages in navigating difficult-to-reach lung lesions with improved safety profiles compared to transthoracic approaches. Incorporating advanced imaging technologies has enhanced real-time decision-making during procedures, and artificial intelligence applications are emerging. RAB has been rapidly adopted at many high-volume centers based on favorable navigational success and safety data. As the field matures, ongoing prospective studies will further define its role in improving patient outcomes, cost-effectiveness, and optimal integration with lung cancer screening programs. RAB faces ongoing challenges including substantial capital costs, training requirements, and need for standardized protocols. Therapeutic applications show promise and are under active investigation. Full article

Aim: To undertake a prospective review to identify the intra-procedure complications in children undergoing flexible bronchoscopy with six-lobe lavage and a retrospective review to identify the rates of delayed discharge and readmission. Methods: The prospective review analysed consecutive procedures from August 2023 to August 2024 and collected data on intra-procedure and immediate post-procedure desaturations, laryngospasm, bronchospasm/wheeze, tachypnoea, pyrexia, hypothermia, and vomiting. The retrospective review analysed consecutive paediatric flexible bronchoscopies from October 2014 to August 2023 identifying discharge delays and readmissions. All children underwent flexible bronchoscopy at a single tertiary paediatric centre under general anaesthesia (GA) with a single aliquot BAL obtained from all six lobes. When cytology was required, the BAL from the right middle or most affected lobe was changed to triple aliquot. Results: Six hundred and twenty-two procedures performed on 540 children were analysed. This included 502 in the retrospective review and 120 in the prospective review. In the prospective group 4/120 (3.3%) children experienced a significant (<90%) desaturation requiring anaesthetic intervention; 11/120 (9.2%) experienced an immediate post-procedure complication such as desaturation, pyrexia, tachypnoea, wheeze, or vomiting; 53/622 (8.5%) had their discharge delayed overnight; and 13/120 (11%) children in the prospective group experienced hypothermia. A further 18/622 (3%) children re-attended hospital within 48 h of discharge. Conclusions: Flexible bronchoscopy with bronchoalveolar lavage in all six lobes under GA in children is a safe procedure with low incidence of major complications when performed by expert clinicians. Parents should be advised of a 9% risk of delayed overnight discharge. Full article

Background: Bronchoscopic thermal ablation has emerged as a minimally invasive therapeutic option for managing pulmonary nodules in patients unsuitable for surgery or radiotherapy. Robotic-assisted bronchoscopy (RAB) offers enhanced stability and precise navigation, potentially improving the safety and accuracy of bronchoscopic ablation. However, clinical data on RAB-guided microwave ablation (MWA) remains limited. Therefore, further evidence is needed to evaluate its feasibility, safety, and early therapeutic performance. Methods: We conducted a single-center retrospective feasibility study of shape-sensing RAB-guided MWA (ssRAB-MWA) for pulmonary nodules between October 2024 and September 2025. Eligible lesions (≤3.0 cm) included both primary lung cancers and metastatic nodules. All procedures were performed under general anesthesia using the ssRAB system integrated with cone-beam CT for intra-procedural confirmation. Technical success, safety outcomes, and short-term efficacy were assessed. Results: Nine patients (with 11 lesions: 3 primary, 8 metastatic) underwent ssRAB-MWA with 100% technical success. The median ablation time per nodule was 10 min (range, 1–26). One patient developed post-ablation pneumonia requiring hospitalization; no pneumothorax, major bleeding, or airway injury occurred. All lesions exhibited a transient increase in size immediately following MWA, followed by gradual reduction or stabilization over time. PET-CT evaluation demonstrated metabolic remission in primary lesions, with one patient achieving pathologic complete response after surgery. Conclusions: ssRAB-MWA appears to be a feasible and safe navigation-guided technique for small pulmonary lesions, offering encouraging early local control in both primary and metastatic lung cancers. This platform may expand the therapeutic spectrum of interventional pulmonology, bridging diagnosis and local therapy. Larger multicenter studies are warranted to validate long-term outcomes. Full article

Background/Objectives: Rigid bronchoscopy poses safety challenges due to airway leakage. Although apnoeic oxygenation is a potential strategy, concerns over carbon dioxide (CO₂) retention have limited its adoption. The introduction of high-flow nasal cannula (HFNC) has renewed interest by potentially mitigating CO₂ accumulation during prolonged apnoea. This study investigated changes in the arterial partial pressure of CO₂ (PaCO₂) during apnoeic oxygenation using Optiflow™. Methods: We retrospectively analysed patients undergoing rigid bronchoscopy with HFNC (70 L·min⁻¹) from 2020 to 2022. The apnoeic period was defined from the onset of apnoeic oxygenation to ventilation resumption. Arterial blood gas levels and complications, including arrhythmia and desaturation, were evaluated. Regression analysis was used to evaluate changes over time. Results: Apnoeic oxygenation was performed in 10 male patients (mean age 65 ± 14 years; body mass index 24.75 ± 4.18 kg·m⁻²). The mean duration of apnoea was 33.7 ± 13.7 min, with PaCO₂ rising linearly at 1.50 mmHg/min. No interventions were required to maintain SpO₂ above 91% for all patients. Except for one case of atrial fibrillation that occurred during emergence rather than the apnoeic period, no significant complications were observed. Conclusions: The observed increase in PaCO₂ was lower than in previously reported studies using HFNC via the nares, suggesting that direct delivery of oxygen to the distal airway via bronchoscopy may enhance CO₂ clearance through more effective washout. Apnoeic oxygenation with HFNC could potentially overcome airway leakage for selected patients, but vigilant monitoring remains essential throughout the apnoeic period. Further research is warranted to enhance patient safety. Full article

The field of pediatric bronchoscopy is rapidly expanding and enables diagnostic tests and therapeutic maneuvers, benefiting many children suffering from respiratory disease. However, due to a paucity of pediatric providers trained in bronchoscopy, many institutions rely on adult interventionalists collaborating with pediatric care teams to complete these procedures. In this article, we address the adult interventionalist taking on these cases and offer insight into key differences in pediatric anatomy and physiology, unique challenges encountered in this population and explore the equipment available in pediatric sizes. We also consider the future of the field, including broadening pediatric training to enhance capacity to complete these necessary procedures. Full article

Background: Gastroesophageal reflux disease (GERD) has been implicated in recurrent wheezing, but mechanisms and diagnostic markers remain debated. Multichannel intraluminal impedance-pH (MII-pH) monitoring improves reflux detection compared to pH-metry, while bronchoalveolar lavage (BAL) cytology may provide evidence of aspiration-related airway inflammation. Objectives: This study aims to examine the relationship between reflux characteristics, BAL cytology and clinical outcomes in preschool children with severe recurrent wheeze. Methods: Preschool-aged children undergoing combined MII-pH and bronchoscopy for severe recurrent wheeze were included. BAL samples were assessed for lipid-laden macrophages (LLM). Associations between reflux parameters, BAL cytology and response to antireflux treatment were analysed. Results: GERD was identified in 70% of participants, with weakly acidic and proximal reflux episodes predominating. Children with GERD exhibited significantly higher percentages of LLM compared with those without GERD (12% vs. 1%, p < 0.001). LLM percentage correlated with multiple reflux characteristics, including weakly acidic, liquid and proximal reflux (p < 0.047; p < 0.047 and p < 0.047, respectively), as well as symptom indices (p < 0.001). Following antireflux therapy, wheezing episodes were substantially reduced. Conclusions: GERD, particularly weakly acidic and proximal reflux, is associated with airway inflammation and recurrent wheeze in preschool children. BAL LLM percentage may serve as a surrogate marker of reflux-related microaspiration. MII-pH monitoring enhances diagnostic accuracy beyond pH-metry and may help guide targeted antireflux interventions. Full article

Acquired tracheoesophageal fistulas (TEF) are a rare but severe complication in post-coma neurorehabilitation patients, particularly those requiring long-term tracheostomy and enteral nutrition. Early recognition and proper surgical management are critical to prevent life-threatening outcomes and functional deterioration. However, variability in clinical presentation and the lack of standardized multidisciplinary pathways often delay referral to thoracic surgeons. We present the case of a young patient with severe traumatic brain injury, prolonged tracheostomy, and percutaneous endoscopic gastrostomy (PEG), who developed a TEF due to tracheal ischemic injury. Clinical suspicion arose from indirect signs—such as recurrent aspiration and air in the PEG system—the diagnosis was confirmed by bronchoscopy and sagittal CT imaging. Surgical planning was carried out in close collaboration between rehabilitation physicians and thoracic surgeons, based on shared criteria involving ventilator weaning, nutritional status, and clinical stability. This case highlights the importance of a multidisciplinary, protocol-driven approach in managing TEF. Current literature supports timely but carefully selected surgical intervention, particularly in patients who are no longer ventilator-dependent, significantly reducing perioperative mortality (reported up to 60% in ventilated patients). Recent reviews advocate for standardized surgical techniques—such as single-stage repair with muscle flap interposition—and emphasize the value of early diagnosis using a combination of bronchoscopy, videofluoroscopy, and sagittal CT. We propose a structured clinical pathway integrating neurorehabilitation and thoracic surgery, aimed at optimizing timing and surgical outcomes in patients with acquired TEF. This model may serve as a foundation for future guidelines, improving both safety and efficiency in the multidisciplinary management of this complex complication. Full article

Background: Lung cancer remains the leading cause of cancer-related mortality worldwide. Timely and accurate diagnosis and staging are crucial for treatment decisions. Objective: To assess the feasibility, safety, and diagnostic/staging yield of a bronchoscopy-based pathway supported by EBUS-TBNA in a regional Romanian center. Bronchoscopy combined with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) may reduce the need for surgical confirmation, yet its implementation in regional centers is inconsistent. Materials and Methods: This retrospective study included 67 patients with suspected lung cancer evaluated at a regional oncology center between December 2023 and February 2024. All patients underwent bronchoscopy, and EBUS-TBNA was performed in those with mediastinal lymphadenopathy on imaging, with endoscopic tissue biopsies (endobronchial/EBUS-TBNA). Demographic, clinical, histological, and molecular data were collected and analyzed using descriptive statistics and chi-square/Fisher’s exact tests. Results: Among the 67 patients, 42 (62.7%) underwent EBUS-TBNA. The majority were diagnosed in advanced stages (stage III–IV: 83.6%), with adenocarcinoma being the most frequent histological subtype. PD-L1 expression was positive in 52.2% of cases, and p63 in 67.2%. No significant procedural complications occurred, and adequate tissue sampling for histopathological and molecular analyses was achieved in all cases. Associations were found between PD-L1 and advanced TNM stage (p = 0.026), as well as between p63 status and TNM stage (p = 0.002). Conclusions: This study supports the feasibility and safety of a bronchoscopy-based diagnostic and staging algorithm supported by EBUS-TBNA, achieving reliable sampling and avoiding surgical confirmation in a regional oncology setting. Further prospective studies are warranted to validate these findings. Full article

Background/Objectives: Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive fibrosing interstitial disease that incurs significant healthcare costs due to diagnostic and treatment needs. This study aimed to estimate healthcare expenses related to IPF diagnosis, treatment, and follow-up, including factors affecting overall expenditure. Methods: This retrospective cohort study included 276 IPF patients from a tertiary hospital (2013–2022). Diagnostic and treatment costs were analyzed, including antifibrotic medications (pirfenidone and nintedanib), diagnostic tests (pulmonary function tests and performance evaluation tests), and interventions (fiberoptic bronchoscopy, imaging modalities). Costs in Turkish Lira were converted to United States dollars. Statistical analysis was performed using non-parametric tests to evaluate expenditure correlations with demographic, clinical, and treatment parameters, which included the Mann–Whitney and Spearman Rank Correlation tests when appropriate. Results: The median healthcare expenditure was USD 429.1 (9.13–21,024.57). Inpatient costs (USD 582.67; USD 250.22 to USD 1751, 25th and 75th percentile, respectively) were higher than outpatient costs (USD 192.36; USD 85.75 to USD 407.47, 25th and 75th percentile, respectively). Antifibrotic regimens did not differ significantly in cost or duration (Z = 0.657; p = 0.511) (mean pirfenidone duration: 1.1 ± 1.0 years; mean nintedanib duration: 0.6 ± 0.9 years). Diagnostic tests, particularly pulmonary function tests (PFT) (p: 0.001, Rho: 0.337), diffusing capacity of the lungs for carbon monoxide (DLCO) (p: 0.001, Rho: 0.516), and high-resolution computed tomography (HRCT) (p: 0.001, Rho: 0.327), were the primary drivers of costs. Longer treatment duration was positively correlated with expenditure (Rho: 0.264, p: 0.001 and Rho: 0.247, p: 0.006 for pirfenidone and nintedanib, respectively) while age showed a weak negative correlation (Rho = −0.184, p = 0.002). Gender and type of antifibrotic regimen did not show any significant effect on costs. Discussion: Diagnostic and follow-up testing were the main contributors to costs, driven by reimbursement requirements and the progressive nature of IPF. Antifibrotic medications, although expensive, provided clinical stability, potentially reducing hospitalization needs but increasing long-term care expenses. Variations in healthcare systems affect expenditures, with Turkey’s universal coverage lowering costs compared to Western countries. The study’s main limitations include being a single-center, retrospective study and its inability to include comorbidities and disease severity in the statistical analysis. Conclusions: IPF management is resource-intensive, with diagnostic tests and follow-up driving costs independent of demographics and treatment modality. Anticipating higher expenditures with prolonged survival and evolving treatment options is crucial for healthcare budget planning. Preparation of healthcare policies accordingly to these observations, which must include an overall increase in cost due to treatment duration and survival, remains a crucial aspect of budget control. Full article

Non-small-cell lung cancer (NSCLC) is a widespread and aggressive form of cancer, and in cases of its occurrence, accurate diagnosis and precise staging play a crucial role in determining treatment and estimating prognosis. Flexible bronchoscopy (FB) is a minimally invasive method used to assess the local and regional extent of the disease. FB facilitates the identification of endobronchial lesions and the collection of biopsy samples for histopathological diagnosis. It also enables the evaluation of regional lymph node involvement via advanced techniques such as endobronchial ultrasound with fine-needle aspiration (EBUS-TBNA). This method has high sensitivity and specificity, reducing the need for more invasive interventions like mediastinoscopy. The integration of endobronchial ultrasound (EBUS) has revolutionized NSCLC staging by providing detailed images and guiding biopsies of suspicious lymph nodes. Additionally, FB is valuable in staging the extent of primary tumor growth, providing critical information about the invasion of adjacent structures. In conclusion, FB, supported by advanced technologies, is important for the staging of NSCLC, improving medical practice and patient prognosis. Full article

Background: Coronavirus disease 2019 (COVID-19) has led to the expansion of the spectrum of invasive fungal infections beyond traditional immunocompromised populations. Although COVID-19-associated pulmonary aspergillosis is increasingly being recognised, COVID-19-associated mucormycosis remains rare, particularly in non-endemic regions. Concurrent COVID-19-associated invasive tracheobronchial aspergillosis and pulmonary mucormycosis with histopathological confirmation is exceedingly uncommon and poses significant diagnostic and therapeutic challenges. Case presentation: We report the case of a 57-year-old female with myelodysplastic syndrome who underwent haploidentical allogeneic haematopoietic stem cell transplantation. During post-transplant recovery, she developed COVID-19 pneumonia, complicated by respiratory deterioration and radiological findings, including a reverse halo sign. Bronchoscopy revealed multiple whitish plaques in the right main bronchus. Despite negative serum and bronchoalveolar lavage fluid galactomannan assay results, cytopathological examination revealed septate hyphae and Aspergillus fumigatus was subsequently identified. Given the patient’s risk factors and clinical features, liposomal amphotericin B therapy was initiated. Subsequent surgical resection and histopathological analysis confirmed the presence of Rhizopus microsporus. Following antifungal therapy and surgical intervention, the patient recovered and was discharged in stable condition. Conclusions: This case highlights the critical need for heightened clinical suspicion of combined invasive fungal infections in severely immunocompromised patients with COVID-19, even in non-endemic regions for mucormycosis. Early tissue-based diagnostic interventions and prompt initiation of optimal antifungal therapy are essential for obtaining ideal outcomes when co-infection is suspected. Full article

Lung transplantation remains the standard of care for end-stage lung disease, yet a persistent gap exists between donor lung availability and growing clinical demand. Expanding the donor pool and optimising donor lung management are therefore critical priorities. However, no universally accepted management protocols are currently in place. This narrative review examines evidence-based strategies to improve lung utilisation across three donor categories: donors after brain death (DBD), controlled donors after circulatory death (cDCD), and uncontrolled donors after circulatory death (uDCD). A systematic literature search was conducted to identify interventions targeting lung preservation and function, including protective ventilation, recruitment manoeuvres, fluid and hormonal management, and ex vivo lung perfusion (EVLP). Distinct pathophysiological mechanisms—sympathetic storm and systemic inflammation in DBD, ischaemia–reperfusion injury in cDCD, and prolonged warm ischaemia in uDCD—necessitate tailored approaches to lung preservation. In DBD donors, early application of protective ventilation, bronchoscopy, and infection surveillance is essential. cDCD donors benefit from optimised pre- and post-withdrawal management to mitigate lung injury. uDCD donor lungs, uniquely vulnerable to ischaemia, require meticulous post-mortem evaluation and preservation using EVLP. Implementing structured, evidence-based lung management strategies can significantly enhance donor lung utilisation and expand the transplantable organ pool. The integration of such practices into clinical protocols is vital to addressing the global shortage of suitable lungs for transplantation. Full article

This case report describes the acute and multidisciplinary management anesthesiologists performed for an intra-operative bronchobiliary fistula during a routine endoscopic retrograde cholangiopancreatography for a patient with intrahepatic cholangiocarcinoma. During the procedure, an unexpected rapid airway deterioration was encountered due to bile infiltration of the right bronchus and anesthesia circuit, necessitating (1) emergent extubation and reintubation with bronchoscopy, (2) extubation and reintubation with double-lumen endotracheal tube with right-bronchial blocker, and (3) transportation of the patient from endoscopy to interventional radiology for biliary drain placement. Overall, this case highlights a rare but serious consideration for patients with intrahepatic cholangiocarcinoma who may present with a bronchobiliary fistula and the steps taken to prevent total airway compromise and ensure rapid patient stabilization through coordination with advanced gastroenterology, interventional pulmonology, and interventional radiology. Full article

Background: Among patients with congenital heart disease, particularly those with a history of undergoing the Fontan operation, pregnancy presents a significant maternal–fetal risk, especially when complicated by severe valvular dysfunction. Lung reperfusion syndrome (LRS) is a rare but life-threatening complication occurring following valve intervention. Multidisciplinary management, including by Cardio-Obstetrics teams, is essential for optimizing outcomes in such high-risk cases. Methods: We present the case of a 37-year-old pregnant patient with previously repaired tetralogy of Fallot (via the Fontan procedure) who presented at 24 weeks gestation with worsening severe pulmonary stenosis and right-ventricular dysfunction. The patient had been lost to cardiac follow-up for over a decade. She experienced recurrent arrhythmias, including supraventricular and non-sustained ventricular tachycardia, prompting hospital admission. A multidisciplinary team recommended transcatheter pulmonic valve replacement (TPVR), performed at 28 weeks’ gestation. Results: Post-TPVR, the patient developed acute hypoxia and hypotension, consistent with Lung Reperfusion Syndrome, necessitating intensive cardiopulmonary support. Despite initial stabilization, progressive maternal respiratory failure and fetal compromise led to an emergent cesarean delivery. The neonate’s neonatal intensive care unit (NICU) course was complicated by spontaneous intestinal perforation, while the mother required intensive care unit (ICU)-level care and a bronchoscopy due to new pulmonary findings. She was extubated and discharged in stable condition on postoperative day five. Conclusions: This case underscores the complexity of managing severe congenital heart disease and valve pathology during pregnancy. Lung reperfusion syndrome should be recognized as a potential complication following TPVR, particularly in pregnant patients with Fontan physiology. Early involvement of a multidisciplinary Cardio-Obstetrics team and structured peripartum planning are critical to improving both maternal and neonatal outcomes. Full article

Diffuse alveolar hemorrhage (DAH), a catastrophic complication of connective tissue disorders (CTDs), manifests as rapid-onset hypoxemia, alveolar infiltrates, and progressive bleeding into the airways. While immune-mediated alveolar–endothelial injury primarily drives its pathophysiology, diagnosis is based on bronchoscopy and chest imaging. The clinical urgency lies in securing the compromised airway and stabilizing respiratory failure, a challenge increased by CTD-specific anatomical alterations such as cervical spine instability, cricoarytenoid arthritis, and subglottic stenosis. High-dose corticosteroids and immunosuppression are essential, while severe cases require extracorporeal membrane oxygenation or plasmapheresis. This comprehensive review introduces two novel approaches to address fundamental gaps in the management of CTD-induced DAH: a structured algorithm for a CTD-specific airway risk stratification tool, integrating anatomical screening and the application of lung ultrasounds (LUSs) for post-intubation CTD-induced DAH ventilation management. The need for a multidisciplinary team approach is also discussed. Despite aggressive care, mortality remains high (25–50%), underscoring the necessity for improved early recognition and intervention strategies for these high-risk patients. Full article