Hypercapnia in COPD Patients Undergoing Endobronchial Ultrasound under Local Anaesthesia and Analgosedation: A Prospective Controlled Study Using Continuous Transcutaneous Capnometry

Respiration ◽  
2021 ◽  
pp. 1-11
Author(s):  
Thomas Galetin ◽  
Daniel Strohleit ◽  
Friederike Sophie Magnet ◽  
Jost Schnell ◽  
Aris Koryllos ◽  
...  
Keyword(s):  
Needle Aspiration ◽  
Observation Time ◽  
Endobronchial Ultrasound ◽  
Controlled Study ◽  
Transbronchial Needle Aspiration ◽  
Copd Patients ◽  
Examination Time ◽  
Alveolar Hypoventilation ◽  
The Impact ◽  
Prospective Controlled Study

<b><i>Background:</i></b> Flexible bronchoscopy (FB) in analgosedation causes alveolar hypoventilation and hypercapnia, the more so if patients suffer from COPD. Nonetheless, neither is capnometry part of standard monitoring nor is there evidence on how long patients should be monitored after sedation. <b><i>Objectives:</i></b> We investigated the impact of COPD on hypercapnia during FB with endobronchial ultrasound (EBUS) in sedation and how the periprocedural monitoring should be adapted. <b><i>Methods:</i></b> Two cohorts of consecutive patients – with advanced and without COPD – with the indication for FB with EBUS-guided transbronchial needle aspiration in analgosedation received continuous transcutaneous capnometry (p<sub>tc</sub>CO<sub>2</sub>) before, during, and for 60 min after the sedation with midazolam and alfentanil. <b><i>Main Results:</i></b> Forty-six patients with advanced COPD and 44 without COPD were included. The mean examination time was 26 ± 9 min. Patients with advanced COPD had a higher peak p<sub>tc</sub>CO<sub>2</sub> (53.7 ± 7.1 vs. 46.8 ± 4.8 mm Hg, <i>p</i> &#x3c; 0.001) and mean p<sub>tc</sub>CO<sub>2</sub> (49.5 ± 6.8 vs. 44.0 ± 4.4 mm Hg, <i>p</i> &#x3c; 0.001). Thirty-six percent of all patients reached the maximum hypercapnia after FB in the recovery room (8 ± 11 min). Patients with COPD needed more time to recover to normocapnia (22 ± 24 vs. 7 ± 11 min, <i>p</i> &#x3c; 0.001). They needed a nasopharyngeal tube more often (28 vs. 11%, <i>p</i> &#x3c; 0.001). All patients recovered from hypercapnia within 60 min after FB. No intermittent ventilation manoeuvres were needed. <b><i>Conclusion:</i></b> A relevant proportion of patients reached their peak-pCO<sub>2</sub> after the end of intervention. We recommend using capnometry at least for patients with known COPD. Flexible EBUS in analgosedation can be safely performed in patients with advanced COPD. For patients with advanced COPD, a postprocedural observation time of 60 min was sufficient.

Utility of Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Malignant and Nonmalignant Disease

2018 ◽  
Vol 62 (5-6) ◽  
pp. 380-385 ◽  
Author(s):  
Pietro Gianella ◽  
Paola M. Soccal ◽  
Jérôme Plojoux ◽  
Isabelle Frésard ◽  
Jean-Claude Pache ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Daily Practice ◽  
Needle Aspiration ◽  
Multivariate Model ◽  
Endobronchial Ultrasound ◽  
Moderate Increase ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
The Difference ◽  
The Impact

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate procedure to sample mediastinal tissue. Rapid on-site cytologic evaluation (ROSE) has been advocated to improve the performance of this procedure, but its benefit remains controversial. Our objective is to assess the utility of ROSE for EBUS-TBNA diagnostic accuracy among unselected patients. Methods: We prospectively collected data from all consecutive EBUS-TBNA procedures performed between 2008 and 2014. ROSE was introduced since 2011 in our daily practice. The accuracy of EBUS-TBNA with and without ROSE was compared in a univariate and multivariate model accounting for confounding factors. The impact of ROSE was then analyzed according to the etiology and size of the lesions. Results: Among 348 EBUS-TBNA procedures analyzed, 213 were performed with ROSE. The overall accuracy tended to be better with ROSE than without (90.6 vs. 84.4%; p = 0.082). After adjustment in a multivariate model, the benefit of ROSE still did not reach statistical significance (adjusted odds ratio 1.86; 95% confidence interval 0.79–4.41). Similar results were obtained in subgroups of patients with malignant disease or sarcoidosis. The size of the lesion did not influence the impact of ROSE on accuracy. Conclusions: ROSE was associated with a moderate increase in the accuracy of EBUS-TBNA, but the difference was not statistically significant. The same effect of ROSE was observed in malignant and nonmalignant lesions and this effect was not influenced by the lesion’s size.

scholarly journals Impact of Moderate Sedation versus Monitored Anesthesia Care on Outcomes and Cost of Endobronchial Ultrasound Transbronchial Needle Aspiration

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Ziad Boujaoude ◽  
Rohan Arya ◽  
Aseem Shrivastava ◽  
Melvin Pratter ◽  
Wissam Abouzgheib
Keyword(s):  
Diagnostic Yield ◽  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Anesthesia Care ◽  
Monitored Anesthesia Care ◽  
Transbronchial Needle Aspiration ◽  
Moderate Sedation ◽  
Academic Center ◽  
The Difference ◽  
The Impact

Background and Objectives. The ideal type of sedation for endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) is not known. Two previous studies comparing the diagnostic yield between moderate sedation (MS) and deep sedation/general anesthesia (DS/GA) had provided conflicting results with one study clearly favoring the latter. No study had addressed cost. This is concerning for pulmonologists without routine access to anesthesia services. Our objective was to assess the impact of MS and Monitored Anesthesia Care (sedation administered and monitored by an anesthesiologist) on the outcomes and cost of EBUS-TBNA. Materials and Methods. We performed a retrospective review of prospectively collected data on consecutive EBUS-TBNA performed under two different types of sedation in a single academic center. A diagnostic TBNA was defined as an aspirate yielding any specific diagnosis or if subsequent surgery or follow-up of nondiagnostic/normal aspirates showed no pathology. Current Medicare time-based allowances were used for professional charges calculation. Results. There was no difference observed between MS and MAC in regards of the diagnostic yield (92.9% versus 91.9%), procedure duration, number, location, and size of lymph node (LN) sampled, but there were more passes per LN with MAC. The average charges were 74.30 USD for MS and 319.91 for MAC. There were more hypotensive and desaturations episodes with MAC but none required escalation of care. Conclusions. When performed under MS, EBUS-TBNA has similar diagnostic yield as under MAC but may be associated with less side effects. The difference in sedation cost is modest; however, an additional 245$ for each EBUS done under MAC would have significant cost implications on the health system. These findings are of critical importance for bronchoscopists without routine access to anesthesia services and for optimization of healthcare cost and resource utilization.

scholarly journals Systematic endobronchial ultrasound-guided transbronchial needle aspiration improves radiotherapy planning in non-small cell lung cancer

2019 ◽  
Vol 5 (3) ◽  
pp. 00004-2019 ◽  
Author(s):  
Aidan Joseph Cole ◽  
Nicholas Hardcastle ◽  
Guy-Anne Turgeon ◽  
Roshini Thomas ◽  
Louis B. Irving ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Needle Aspiration ◽  
Small Cell ◽  
Radiotherapy Planning ◽  
Endobronchial Ultrasound ◽  
Small Cell Lung ◽  
Transbronchial Needle Aspiration ◽  
Pet Ct ◽  
The Impact

ObjectivesPatients suitable for radical chemoradiotherapy for lung cancer routinely have radiotherapy (planning) volumes based on positron emission tomography (PET)-computed tomography (CT) imaging alone. Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) can identify PET-occult malignancy and benign PET-avid regions. We investigated the impact of EBUS-TBNA on curative-intent radiotherapy in non-small cell lung cancer (NSCLC).MethodsA prospective multicentre trial was undertaken, investigating the impact of systematic EBUS-TBNA in addition to PET-CT for patients considered for radical chemoradiotherapy with NSCLC. A subset analysis of patients with discordant findings between PET-CT and EBUS-TBNA was performed. Radiotherapy plans investigated tumour coverage and dose to critical organs at risk (OARs) using PET-CT alone in comparison to PET-CT and EBUS-TBNA.ResultsOf 30 patients enrolled, 10 had discordant findings between PET-CT and EBUS-TBNA. EBUS-TBNA-derived plans allowed for reduction in dose to OARs in patients downstaged by EBUS-TBNA, and reduced the risk of geographic miss in treating PET-occult disease in four patients where EBUS-TBNA identified malignant involvement of PET-negative lymphadenopathy. With the addition of EBUS-TBNA to radiotherapy planning, reductions were noted of 5.7%, 3.7% and 12.5% for the risks of symptomatic pneumonitis, mean heart dose and mean oesophageal dose, respectively.ConclusionsThis study demonstrates for the first time that systematic EBUS-TBNA prior to radical-intent radiotherapy significantly improves coverage of subclinical disease through detection of PET-occult metastases. Identification of false-positive lymph node involvement in highly selected cases may reduce radiation dose to critical structures, and risk of organ toxicity.

THE IMPACT OF AN ENDOBRONCHIAL ULTRASOUND PROGRAM ON TRANSBRONCHIAL NEEDLE ASPIRATION

CHEST Journal ◽  
2009 ◽  
Vol 136 (4) ◽  
pp. 1S
Author(s):  
Lonny B. Yarmus ◽  
Gail Levin ◽  
Rex C. Yung ◽  
David J. Feller-Kopman
Keyword(s):  
Needle Aspiration ◽  
Endobronchial Ultrasound ◽  
Transbronchial Needle Aspiration ◽  
The Impact

Acute pericarditis and mediastinal lymph node abscess developing after endobronchial ultrasound guided transbronchial needle aspiration

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Shingo Nishikawa ◽  
Ryo Ariyasu ◽  
Tomoaki Sonoda ◽  
Masafumi Saiki ◽  
Takahiro Yoshizawa ◽  
...  
Keyword(s):  
Lymph Node ◽  
Mediastinal Lymph Node ◽  
Tumor Therapy ◽  
Needle Aspiration ◽  
Lymph Node Biopsy ◽  
Endobronchial Ultrasound ◽  
Tumor Treatment ◽  
Ultrasound Guided ◽  
Transbronchial Needle Aspiration ◽  
Acute Pericarditis

A 27-year-old man was diagnosed with inflammatory myofibroblastic tumor, and multiple lymph node and subcutaneous metastases. After several administrations of anti-tumor therapy, he underwent mediastinal lymph node biopsy using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) to confirm tumor relapse. Five weeks later, he complained of chest pain, then rapidly developed shock due to acute pericarditis. Although he was treated with antibiotics for anaerobic bacterial infection and cardiac drainage, mediastinal lymph node abscess and pericarditis did not improve. After the surgical procedure, his physical condition dramatically improved and he was treated with another molecularly targeted therapy. Pericarditis associated with EBUS-TBNA is extremely rare. In this case, salvage was achieved by surgical drainage of the lymph node abscess and pericarditis, and long survival was obtained with further administration of anti-tumor treatment.

Sign in / Sign up

Export Citation Format

Share Document