Interventional bronchoscopy is a new and non-surgical diagnostic, therapeutic and palliative approach to patient with bronchial pathologies. It consists mostly of rigid endobronchial broncoscopy under general anesthesia, with the use of (1) Nd- YAG or KTP laser (2) Cryotherapy (3) Endobronchial prostheses (4) Photodynamic therapy (5) Brach therapy and, (6) Thermo coagulation. The idea is to treat by non-surgical measures, most of the early stage tracheobronchial cancer (insitu or micro invasive). The other utility is to associate this technique as an adjuvant treatment with chemo-radiotherapy in advance lung carcinoma. Treatments of benign structural or endobronchial pathologies as well as control of hemoptysis and foreign body removal are the other indications. In the future, interventional bronchoscopy will be a leader to diagnose and treat bronchial diseases.

Background: Foreign body aspiration (FBA) is a life-threatening problem that can be lethal in some cases. It usually occurs in children between 1– 3 years old. Bronchoscopy is the best way for recognition, treatment and management of this problem. We aimed to evaluate the use of fiberoptic bronchoscopy after rigid bronchoscopy in foreign body aspiration in pediatric population. Materials and Methods: 275 pediatric patients with a history of choking were entered to this cross-sectional study, from August 2015 to September 2018. The study was done in a Dr. Sheikh hospital, Mashhad, Iran. The age and gender of the patients were recorded individually. Rigid bronchoscopy was done for all patients. After that, fiberoptic bronchoscopy was performed immediately or 72 hours after the first procedure based on the patients' symptoms, time and personnel conditions. Data were analyzed by the SPSS software version 16. 0. Results: Among 275 patients, 175 cases (63. 6%) were male. The patients' age was 3 months to 15 years old. In rigid bronchoscopy, 85 cases had no foreign body and in 190 cases, foreign body was found. In 43 cases fiberoptic bronchoscopy found a residual organic material in spite of negative rigid bronchoscopy. The most residual organic material pertained to 0-3 year age group and the cases with residue in males were more than females. There was a significant difference between FBA and age and gender (p <0. 001). Conclusion: FBA in airway branches may not be seen by rigid bronchoscope due to the limited access to the distal branches. We suggest fiberoptic bronchoscopy as a complementary management along with rigid bronchoscopy to investigate distal branches, especially if the foreign body is soft in material.

A significant reduction in arterial blood oxygen saturation during fiberoptic bronchoscopy has been proved but it is not yet known whether all patients need supplemental oxygen during this procedure. The aim of study is to examine the relationship between peak expiratory flow rate (PEFR) before bronchoscopy and oxygen desaturation during bronchoscopy. Measurement of PEFR (% predicted) performed before bronchoscopy and arterial O2 desaturation was assessed with a pulse oximeter during bronchoscopy. Study performed in 66 patients with a median age 53 years, who had been referred to our bronchoscopy unit. None of the patients received supplemental oxygen before the procedure. Thirty nine cases (59%) had an episode of O2 desaturation during bronchoscopy. Of them 25 cases (38%) had sustained O2 desaturation, requiring oxygen therapy while 14 cases (21%) had momentary desaturation (< 20s) not requiring O2 therapy. Oxygen therapy was administered in 58% of cases with PEFR % < 60 and in 83% of cases with PEFR % less than 45 (P, 0.008 and 0.001, respectively). We also observed a significant fall in mean O2 saturation during bronchoscopy (88 ± 4 %) compared to prebronchoscopy levels (95 ± 2 %) (P <0.0001). It is concluded that PEFR < 60% and especially < 45% is a reliable predictor of hypoxemia and the need to O2 therapy during bronchoscopy.

Avicenna (Abu Ali Sina in Persian) was a Persian polymath and the foremost physician and philosopher of his time and the ensuing decades. He was born around 980 in Greater Khorasan, to a Persian family. During the Islamic Golden Ages, Avicenna created an extensive corpus of works….

ObjectiveA significant reduction in arterial blood oxygen saturation during fiberoptic bronchoscopy has been proved but it is not yet known whether all patients need supplemental oxygen during this procedure. The aim of this study is to examine the relationship between PEFR before bronchoscopy and oxygen desaturation during bronchoscopy.Material and Methods Measurement of PEFR (% predicted) performed before bronchoscopy and arterial O2 desaturation was assessed with a pulse oximeter during bronchoscopy. Study performed on 66 patients with a median age of 53 years, who had been referred to our bronchoscopy unit. None of the patients received supplemental oxygen before the procedure.Results39 cases (59%) had an episode of O2 desaturation during bronchoscopy. Of them 25 cases (38%) had sustained O2 desaturation, requiring oxygen therapy while 14 cases (21%) had momentary desaturation (<20s) not requiring O2 therapy. Oxygen therapy was administered in 58 % of cases with PEFR % < 60 and in 83 % of cases with PEFR % less than 45 (p=0.008 and 0.001, respectively). We also observed a significant fall in mean O2 saturation during bronchoscopy (88±%4) compared to prebronchoscopy levels (95±2%) (p<0.0001 ).ConclusionIt is concluded that PEFR % < 60 and especially < 45 is a reliable predictor ofhypoxemia and the need to O2 therapy during bronchoscopy.

BACKGROUND & OBJECTIVE: In mechanically ventilated patients, fiberoptic bronchoscopy via endotracheal tube may be accompanied with serious complications such as hypoxemia, hypercapnia, increased airway pressures cardiac arrythmias and hemodynamic abnormality, especially in patient with underlying cardiopulmonary disease. The aim of this study was to evaluate feasibility and safety of transglottic fiberoptic bronchoscopy in mechanically ventilated patients.METHODS: This study was performed on 37 mechanically ventilated patients with diagnostic or therapeutic indications. Initially fiberoptic bronchoscopy (FOB) was passed through nose and if there was enough space between endotracheal tube and vocal cords, bronchoscopy was moved to trachea and then endotracheal cuff reinflated with minimal leak. FINDINGS: Transglottic fiberoptic bronchoscopy (TGFOB) was feasible in 32 patients (85.5%). With exception of mild tachycardia (103±17.2 vs 99±16.0), all of hemodynamic and ventilatory parameters of the patients were stable. There were not any immediate or late complications (up to 48 hours).CONCLUSION: This study reveals feasibility and safety of TGFOB with minimal complication.

Background and objectives: The term of malacia refers to softness and in medical terminolog refers to weakness of bone or cartilage. Laryngomalacia is the most common congenital abnormality of larynx and the patient may suffer from recurrent aspiration. Tracheomalacia refers to tracheal weakness and usually results in airway collapse due to cartilage defect. Bronchomalacia is used to describe the weakness and collapsibility of one or both main bronchus. All of the above mentioned diseases can be diagnosed by bronchoscopy but this method is invasive and may interfere with diagnosis, on the other hand it is intolerable in young individual and severly ill, and patients with coagulopathy. This study was conducted to show the role of virtual bronchoscopy in diagnosis of laryngo-tracheo-bronchomalacia. Method and materials: In a peri- experimental study during 3years (Nov 2003-0ct 2006) 35 patients who had clinical sign and symptom of airway malacia were studied via virtual bronchoscopy. Results: From 35 patients percentage of male and female was 65/7% and 34/3%, Respectively and the mean age was 3/7±1/6 months. The result of virtual bronchoscopy for laryngomalcia, bronchomalacia, tracheomalacia, laryngotracheomalacia and laryngobronchomalacia was 42.8% ,25.7%, 20% , 8.5% and 2.9%, respectively. Conclusion: Virtual bronchoscopy because of non-invasive and speed imaging and excellent ability of assessment of airway stenosis, can be considered as substitution for bronchoscopy.