Indications and contraindications for bronchoscopy

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

Target

Bronchoscopy occupies a leading place among instrumental methods of examination in tuberculosis. Examination of the trachea and bronchi, as well as collection of diagnostic material are of decisive importance in the diagnosis of tuberculosis of the respiratory organs, in the detection of concomitant non-specific endobronchitis, in the diagnosis and treatment of complications of tuberculosis. A wide range of tasks solved by bronchoscopy includes various endobronchial and transbronchial interventions, which allows us to distinguish diagnostic and therapeutic studies that often complement each other.

Both rigid bronchoscopy (RBS), performed under intravenous anesthesia with muscle relaxants, and fibrobronchoscopy (FBS) under local anesthesia are used.

Indications

It is advisable to perform diagnostic bronchoscopy on all patients with tuberculosis of the respiratory organs (both newly diagnosed and with chronic forms) to assess the condition of the bronchial tree and identify concomitant or complicating bronchial pathology.

Mandatory indications:

• clinical symptoms of tuberculosis of the trachea and bronchi:
• clinical symptoms of nonspecific inflammation of the tracheobronchial tree;
• unclear source of bacterial excretion;
• hemoptysis or bleeding;
• the presence of "inflated" or "blocked" cavities, especially with a fluid level;
• upcoming surgical intervention or creation of therapeutic pneumothorax;
• revision of the bronchial stump viability after surgery;
• unclear diagnosis of the disease;
• dynamic monitoring 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 tuberculosis of the respiratory organs:

• tuberculosis of the trachea or large bronchi, especially in the presence of lymphobronchial fistulas (to remove granulations and broncholiths);
• atelectasis or hypoventilation of the lung in the postoperative period;
• sanitation of the tracheobronchial tree after pulmonary hemorrhage;
• sanitation of the tracheobronchial tree in purulent nonspecific endobronchitis;
• introduction of anti-tuberculosis or other drugs into the bronchial tree;
• failure of the bronchial stump after surgery (for removal of ligatures or tantalum staples and administration of medications).

Contraindications

Absolute:

• cardiovascular diseases: aortic aneurysm, heart defect in the stage of decompensation, acute myocardial infarction;
• stage III pulmonary insufficiency not caused by 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;
• hypertension stage II-III;
• general severe condition of the patient (fever, shortness of breath, pneumothorax, presence of edema, ascites, etc.).

Preparation of the patient for bronchoscopy begins with a clinical examination: chest X-ray in direct and lateral projections, blood and urine tests, blood type and Rh factor, blood tests for HIV infection and viral hepatitis, ECG, spirography. In case of severe anxiety, the patient is prescribed one of the tranquilizers (10 mg of elenium, 5-10 mg of seduxen) the evening before the examination.

Bronchoscopic examination can be performed both inpatient and outpatient settings.

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

To perform a bronchoscopy, adequate anesthesia is necessary. The diagnostic and therapeutic capabilities of fibrobronchoscopy using local anesthesia and rigid bronchoscopy using general anesthesia are the same. When performing a bronchoscopy under general anesthesia, the anesthesiologist examines the patient the day before the examination and, if necessary, prescribes premedication.

Before the examination is scheduled and on the day of its implementation (before the use of anesthesia), the upper respiratory tract and oral cavity are examined. Information on the possibility of developing allergic reactions to medications is clarified, special attention is paid to the patient's tolerance to local anesthetics. Immediately before the examination, removable dental prostheses are removed, and the belts tightening the patient's chest and abdomen are loosened.

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