Indications and contraindications to bronchoscopy

Bronchoscopy is one of the most informative instrumental methods of studying the tracheobronchial tree.

Goal

Bronchoscopy takes the leading place among the instrumental methods of research in tuberculosis. Inspection of the trachea and bronchial tubes, as well as the collection of diagnostic material, are crucial in the diagnosis of respiratory tuberculosis, in the identification of concomitant nonspecific endobronchitis, in the diagnosis and treatment of complications of tuberculosis. A wide range of problems solved by bronchoscopy. Includes various endobronchial and transbronchial interventions, which allows us to identify diagnostic and therapeutic studies, which often complement each other.

Apply as rigid bronchoscopy (RBS), conducted under intravenous anesthesia with muscle relaxants, and fibrobronchoscopy (FBS) under local anesthesia.

Indications

Diagnostic bronchoscopy is desirable for all patients with respiratory tuberculosis (both newly diagnosed and chronic forms) to assess the state of the bronchial tree and identify concomitant or complicating the main process of bronchial pathology.

Mandatory indications:

• clinical signs of tuberculosis of the trachea and bronchi:
• clinical symptoms of nonspecific inflammation of the tracheobronchial tree;
• an unclear source of bacterial excretion;
• hemoptysis or bleeding;
• presence of "bloated" or "blocked" caverns, especially with liquid level;
• upcoming surgical intervention or the creation of a medical pneumothorax;
• revision of the consistency of the stump of the bronchus after surgery;
• unclear disease diagnosis;
• dynamic observation of previously diagnosed diseases (tuberculosis of the trachea or bronchus, nonspecific endobronchitis);
• postoperative atelectasis;
• foreign bodies in the trachea and bronchi.

Indications for therapeutic bronchoscopy in patients with respiratory tuberculosis:

• tuberculosis of the trachea or major bronchi, especially in the presence of lymphoblocchial fistula (to remove granulation and bronchitis);
• atelectasis or hypoventilation of the lung in the postoperative period;
• sanation of the tracheobronchial tree after pulmonary hemorrhage;
• sanation of the tracheobronchial tree with purulent nonspecific endobronchitis;
• the introduction of anti-tuberculosis or other drugs into the bronchial tree;
• inconsistency of the stump of the bronchus after surgery (to remove ligatures or tantalum braces and the introduction of medications).

Contraindications

Absolute:

• diseases of the cardiovascular system: aneurysm of the aorta, heart disease in the stage of decompensation, acute myocardial infarction;
• Pulmonary insufficiency III degree, not due to the obstruction of the tracheobronchial tree;
• uremia, shock, thrombosis of the vessels of the brain or lungs. Relative:
• active tuberculosis of the upper respiratory tract;
• intercurrent diseases:
• menstrual period;
• hypertensive disease II-III stages;
• the general severe condition of the patient (fever, dyspnea, pneumothorax, the presence of edema, ascites, etc.).

Preparation of the patient for the bronchoscopy begins with a clinical examination: chest radiography in the direct and lateral projections, blood and urine tests, blood group and Rh factor, blood tests for HIV and viral hepatitis, ECG, spirography. In the case of severe anxiety, the patient is assigned one of the tranquilizers (10 mg elenium, 5-10 mg Seduxenum) on the evening before the study.

Bronchoscopic examination can be performed in both inpatient and outpatient settings.

Before the planned bronchoscopy it is necessary to conduct a full clinical and radiological examination of the patient. The doctor of endoscopic diagnostics should examine the patient in advance and become familiar with his medical history. The attending physician and the doctor of endoscopic diagnostics must necessarily conduct a psycho-prophylactic conversation with the patient. Particular attention should be paid to children, during the bronchoscopy, the presence of a doctor is desirable.

For bronchoscopy, adequate anesthesia is necessary. Diagnostic and therapeutic possibilities of fibrobronchoscopy with the application of local anesthesia and rigid bronchoscopy with the use of anesthesia are the same. When carrying out bronchoscopy under anesthesia, an anesthesiologist examines the patient the day before the study and, if necessary, prescribes premedication.

Before the appointment of the study and on the day of its conduct (prior to the application of anesthesia), examine the upper respiratory tract and oral cavity. Clarify the information on the possibility of developing allergic reactions to medications, pay special attention to the tolerability of local anesthetics to patients. Immediately before the study removes removable dentures, relax the chest and stomach tightening the patient's belt.

[1], [2], [3], [4], [5], [6],