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Respiratory diseases are considered one of the most dangerous ailments of our time. In hospitals, a special method is used to examine the bronchi and trachea - bronchoscopy. This procedure is sometimes called tracheobronchoscopy. Timely diagnosis of the tracheobronchial tree helps to avoid the development of many diseases.

What is bronchoscopy

Bronchoscopy or fibrobronchoscopy (FBS) is usually called a method of visual examination of the bronchi and mucous membranes. A biopsy of the respiratory system is performed using an endoscopic examination. Fiberoptic bronchoscopy is also used to obtain samples of secretions from the lungs.

During the procedure, doctors use a special device – a bronchoscope.

It provides direct access to:

• larynx;
• trachea;
• its bifurcation (division into 2 main bronchi);
• bronchi.

Indications

Bronchoscopy refers to invasive research methods, which implies the possibility of violating the external barriers of the body. During the procedure, the patient's mucous membrane, skin or blood vessels may be damaged. For this reason, FBS is allowed only as prescribed by a doctor. Indications for fibrobronchoscopy are:

1. Tumor of the bronchi.
2. Pathological processes on x-ray.
3. Suspicion of the presence of a foreign body.
4. Lung surgery.
5. Collection of contents for flora analysis.
6. Swelling of the trachea.
7. Recurrent pneumonia.
8. Bronchial asthma.
9. Heart failure.
10. Cysts and abscesses in the lungs.
11. Hemoptysis or severe shortness of breath.
12. Chronic inflammation of the bronchi.
13. Tuberculosis.
14. Cystic fibrosis.
15. Lungs' cancer.

Contraindications

Bronchoscopy is contraindicated in:

• arrhythmias;
• hypertension;
• acute myocardial infarction;
• attacks of suffocation;
• severe bronchospasm;
• blood clotting disorders;
• severe anemia;
• allergies to lidocaine;
• hemorrhagic diathesis.

Types of bronchoscopes

A modern bronchoscope is a hollow tube with a light source attached to the end. The device comes in two types - rigid and flexible.

The first option is a more outdated version; it is used only under anesthesia. A rigid bronchoscope is used in the following cases:

1. Bronchial lavage.
2. Administration of medicinal solutions.
3. Elimination of bleeding.
4. Removing foreign bodies from the lungs.
5. Search for lesions in the respiratory system.
6. Removal of tumors and scars.
7. Dilation and contraction of the bronchi.

Main elements of the device:

• aspirators;
• laser equipment;
• set of grippers and tongs;
• video or photographic equipment;
• manipulator for managing promotion.

A flexible bronchoscope is much safer and more convenient, and therefore causes less discomfort to the patient.

The device is able to penetrate the lower sections of the bronchi without injuring them. Due to the small diameter of the tubes, this type of equipment is often used in pediatrics. The procedure with a fiberoptic bronchoscope is performed without anesthesia. Components of the device:

• catheter;
• control handle;
• surgical and ultrasound equipment;
• optical system;
• controlled manipulator;
• optical cable;
• light guide

A flexible bronchoscope is used:

1. When removing small foreign bodies.
2. For diagnosing the lower sections of the bronchi or trachea.
3. During visualization of the mucous membrane of the respiratory tract.

Preparation for the procedure

Preparation for bronchoscopy is an important stage of the procedure. Some patients are prescribed additional tests before diagnosis, which may include:

• X-rays of light;
• electrocardiography;
• blood test;
• coagulogram.

It is important to promptly inform your doctor if you have allergies, chronic diseases, or are taking medications. All of the information listed can have a direct impact on preparation for the procedure. Experts recommend taking tranquilizers the day before bronchoscopy. This will help relieve anxiety.

The examination is carried out on an empty stomach.

Smoking is prohibited on the day of bronchoscopy. It is mandatory to have a bowel movement before visiting the hospital. For these purposes, you can use glycerin suppositories or an enema.

Bronchoscopy in children causes unpleasant associations. It is better not to reveal all the details of the procedure to your child to avoid a negative reaction. The examination takes place under general anesthesia, so children do not need to know all the intricacies of the process.

If the baby is very nervous, it is allowed to administer mild sedatives.

How is bronchoscopy done?

The procedure is performed in an endoscopy room with a high level of sterility. Fiberoptic bronchoscopy is performed by a doctor trained in bronchial examination. Depending on the type of equipment used, local anesthesia or general anesthesia is used. The procedure is carried out in several stages:

1. To ensure smooth advancement of the bronchoscope, the doctor administers bronchodilators. For example, Euphilin, Atropine sulfate, Salbutamol.
2. The patient must assume a sitting or supine position so that the device can easily penetrate the airway. It is forbidden to bend your chest or extend your head, as this can be traumatic.
3. To suppress the gag reflex when inserting a bronchoscope, it is recommended to breathe frequently and shallowly.
4. The device is inserted through the mouth or nostril during a deep breath. The diameter of the tube is much thinner than the respiratory tract, so the equipment easily penetrates the bronchi.
5. During the examination, discomfort may occur, but there should not be any painful sensations.
6. The examination begins with the glottis and larynx, then moves to the bronchi and trachea.
7. During the procedure, the specialist can perform a number of additional actions: take a piece of tissue for a biopsy, rinse the bronchi with a medicinal solution, and remove samples for further study.
8. Upon completion of the procedure, patients experience a feeling of numbness for half an hour.

Under anesthesia

At the preparation stage, the doctor determines which type of anesthesia is preferable for the patient. Bronchoscopy under anesthesia is indicated when using rigid equipment. Not all people are able to endure the pain of inserting a bronchoscope, and local anesthesia is ineffective in such situations.

Under anesthesia, the patient will feel absolutely nothing.

Under local anesthesia

This type of anesthesia is carried out using a 2-5% lidocaine solution. The drug causes the following reactions in patients:

• numbness of the palate;
• feeling of a lump in the throat;
• difficulty swallowing;
• mild nasal congestion.

Local anesthesia helps to successfully suppress the gag and cough reflex. The bronchoscope is introduced gradually, spraying with an anesthetic spray at each stage. First, the doctor irrigates the mucous membrane of the larynx, then goes lower to the vocal cords. Next, using screwing movements, the specialist advances the device to the bronchi and trachea.

What to do after bronchoscopy

According to doctors, following the recommendations below will help avoid complications:

1. It is not recommended to eat for 2 hours after bronchoscopy.
2. Smoking is allowed no earlier than 24 hours after FBS.
3. You should refrain from driving for 8 hours after the examination if the patient was taking sedatives.
4. To eliminate the risk of bleeding, it is recommended to spend a couple of hours in the hospital under the supervision of medical staff.

Possible complications

Bronchoscopy is considered a safe procedure for human health. However, any research carries a risk of complications. The patient's condition may worsen both during and after the procedure. The most common complications are:

1. Inflammation of the bronchi and lungs.
2. Pneumothorax.
3. Perforation of the bronchial wall.
4. Bronchial spasm.
5. Allergic reaction to sedatives.

There are many factors that influence the occurrence of complications. These include not only medical errors, but also patients’ neglect of specialist recommendations. In order to avoid health problems, it is important to follow your doctor's instructions before and after bronchoscopy. If complications occur, you should immediately seek medical help.

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Bronchoscopy is a diagnostic procedure that allows you to visualize the inner surface of the bronchi and trachea. The study is carried out using a special device - a fiberoptic bronchoscope. The drug is an endoscope with a flexible hose, a flashlight, a camera and a control handle. The appointment for the procedure is given by the doctor, who also determines the frequency of the study depending on the diagnosis and age of the person.

Indications for bronchoscopy:

• The presence of darkening in the bronchi or trachea, which is clearly visible on an x-ray.
• Suspicion of cancer.
• Determining the presence of a foreign body in organs.
• Constant, which occurs even at rest and is not caused by heart disease or excess weight.
• Presence of blood in sputum.
• Often recurrent or the presence of an inflammatory process in the bronchi.
• The presence of a cyst or abscess in the lungs.
• Bronchial asthma in a patient (the purpose of the study is to establish the cause of the disease).
• Pathological expansion or excessive narrowing of the lumen of the bronchi.
• Monitoring the condition of the respiratory system after surgery.

During bronchoscopy, the following manipulations are possible:

If necessary, the procedure can be performed on newborns to assess the condition of the upper respiratory tract. For children, bronchoscopy is performed under general anesthesia.

Preparation for bronchoscopy and procedure for its implementation

It is important to properly prepare for bronchoscopy. First of all, it is necessary to undergo a series of diagnostic tests: a blood test, an X-ray examination of the lungs, a coagulogram (testing the blood for the rate of clotting). Additionally, the doctor prescribes laboratory tests for HIV, hepatitis A, B, C. Before the procedure, be sure to inform the doctor about any allergies to painkillers or other drugs, as well as chronic diseases.

Immediately before bronchoscopy, the following recommendations should be followed:

How is bronchoscopy done:

After bronchoscopy, complications may develop:

Contraindications to the procedure

In medicine, there are a number of contraindications for which bronchoscopy is strictly prohibited:

In some cases, bronchoscopy is performed even in the presence of contraindications - when the risk of not performing it is much higher than performing it.

Bronchoscopy is a safe and very informative procedure that allows you to establish a diagnosis with 100% accuracy and select the correct treatment. It does not cause pain, but is accompanied by discomfort. After the procedure, complications and the appearance of unpleasant symptoms are possible, which should be reported to the doctor.

This is the most informative method for studying the tracheo-bronchial tree. It allows you to see minimal formations and tumors, but only in the trachea, large and medium bronchi. Bronchoscopy of the bronchi is also the optimal way to clean (lavage) the airways in those people who have to be on mechanical breathing for a long time.

About bronchoscopy - more details

Bronchoscopy is a procedure that is performed only in a hospital. Under local (treatment of mucous membranes with lidocaine) or general anesthesia, the doctor inserts a special device into the respiratory tract - a bronchoscope, which is either a flexible or rigid tube. At one end of the device there is an illuminator, the other ends with an optical system, where the doctor looks directly with his eyes.

There are holes on the side of the bronchoscope where you can connect:

• syringe: for rinsing the respiratory tract or for aspirating sputum for analysis;
• electric suction: it will “suck” sputum or blood - the contents of the trachea and bronchi;
• special forceps or brushes for taking biopsies;
• coagulator electrode – a device for cauterizing bleeding vessels.

For these instruments, there is a special channel in the body of the device through which they pass. In addition, the device can communicate with video equipment so that the doctor assesses the condition of the bronchi, looking not into the “tube” of the device itself, but by looking at the monitor.

Typically the bronchoscope is inserted through the mouth. Some doctors use a laryngoscope for this - a device that will simultaneously illuminate the path for the bronchoscope and squeeze the root of the tongue and the epiglottis - the cartilage into which the flexible bronchoscope can rest.

Since bronchoscopy is vital in many cases (for example, if there is an injury or malformation of the neck and breathing needs to be done using a breathing apparatus), the bronchoscope can be inserted through the nose.

Also, if the patient breathes through a tracheostomy (an opening in the trachea through which a special cannula connected to a breathing apparatus is inserted), the bronchoscope is inserted directly into the tracheostomy opening. In this case, separate anesthesia is not required.

What does bronchoscopy show:

• trachea;
• the main ones are the right and left bronchi;
• lobar bronchi: three on the right, two on the left.

The bronchoscope does not visualize smaller bronchi and bronchioles. If there is a suspicion that a tumor or inflammation is located there, a computed tomography or magnetic resonance imaging scan is performed.

We hope that it is clearly explained what it is - bronchoscopy of the lungs, although it is more correct to call this manipulation simply bronchoscopy (it means “visualization of the bronchi”).

Indications for bronchoscopy

You need to undergo a bronchoscopy if:

• there is shortness of breath in the absence of heart pathologies or bronchial asthma;
• I have a cough, but X-rays show nothing;
• there is hemoptysis;
• bronchitis and/or pneumonia often recur;
• foul-smelling sputum is produced;
• there is a feeling of incomplete inhalation or exhalation, while diseases of the heart and thoracic spine are excluded;
• there was rapid weight loss in the absence of any diets;
• have cystic fibrosis;
• An X-ray of the lungs reveals a disseminated process - many areas of darkening, which can be either metastases or pulmonary tuberculosis;
• According to computed tomography data, it is impossible to distinguish an area of ​​suppuration from lung cancer with decay;
• a diagnosis of pulmonary tuberculosis has been established;
• it is necessary to establish the cause of severe pneumonia when the patient is on mechanical breathing;
• it is necessary to evaluate the dynamics of treatment after resection of the lung and bronchus;
• repeat bronchoscopy is needed after the tumor has been removed using this technique;
• if dilation or narrowing of the bronchi is visible on the x-ray.

This is a diagnostic bronchoscopy and is used to make a diagnosis.

There is also a treatment procedure that is used when:

• a foreign body has entered the respiratory tract;
• It is impossible to perform tracheal intubation in order to transfer the patient to artificial ventilation: for surgical intervention or in critical situations. This is a coma caused by various reasons; conditions when breathing is switched off (cervical spinal cord injuries, botulism, myopathies);
• you need to clear the airways of phlegm or blood. This is extremely important in the treatment of pneumonia, especially against the background of cystic fibrosis, when the sputum is very viscous;
• pulmonary bleeding must be stopped;
• one of the bronchi was blocked by a tumor, adhesions or sputum, resulting in atelectasis (exclusion of a section of the lung from breathing);
• it is necessary to remove pus from the lung abscess located near the bronchus;
• pneumonia is severe: it is better to inject an additional antibiotic directly into the desired bronchus.

Basically, bronchoscopy is performed using a flexible bronchoscope – fiberoptic bronchoscope. It is quite thin and can bend in different directions. But in some cases, it is necessary to introduce a rigid (metal) device that does not bend and cannot be inserted into the bronchi that extend at an angle.

Indications for bronchoscopy with a rigid bronchoscope are the removal of foreign bodies, expansion of bronchi narrowed by inflammation or adhesions. It is more convenient to put a stent (an expanding tube made of rigid corrugated plastic) on a rigid bronchoscope and install the latter into the narrowed bronchus. It is best used during thoracic operations - in the treatment of conditions associated with the entry of pus, air or liquid into the pleural cavity, as well as pulmonary hemorrhage. Then, using a bronchoscope, you can block the bronchus on the painful side, where surgeons work, and ventilate the second lung with the device.

Virtual bronchoscopy

In addition to rigid and flexible bronchoscopy, another type of examination has been developed - virtual bronchoscopy. It is a computed tomography scan of the lungs and bronchi, which is processed by a special computer program that recreates a three-dimensional image of the bronchi.

The method is not as informative, but it is non-invasive. With it, you cannot take a sputum test, rinsing water or a biopsy of a suspicious area, you cannot remove a foreign body or rinse the bronchi from sputum.

No preparation is required for a virtual biopsy. According to the method of execution, it does not differ from computed tomography. The patient lies down on a couch that is placed inside the X-ray source.

Although X-ray radiation is low-dose, the method is not suitable for children and pregnant women.

How to prepare for manipulation

Preparation for bronchoscopy is very important, since the manipulation is very serious, classified as invasive and requires only special equipment and special skills from the doctor.

Therefore, you need to start with a detailed conversation with your therapist. He will tell you what specialist consultations are needed. So, if a person has suffered a myocardial infarction, he needs, in agreement with the cardiologist, to increase the dose of beta blockers 2 weeks before the study. If a person suffers from arrhythmia, he needs to reconsider antiarrhythmic therapy and possibly increase the dose of drugs or add some other antiarrhythmic drug. The same applies to diabetes mellitus and arterial hypertension.

Also, everyone needs to undergo the following studies and show their results:

• X-ray or CT scan of the lungs.
• Blood tests: general, biochemical, coagulogram.
• Blood gas analysis. This requires venous and arterial blood.

The last meal is no later than 8 pm. Then you can take your last scheduled pills. The need to take them in the morning is discussed separately.

Be sure to empty your bowels in the evening using an enema, Microlax microenema (Norgalax), glycerin suppositories.

You are not allowed to smoke on the day of the test. Immediately before the procedure, you need to empty your bladder. You must take a towel or diaper with you so that you can dry yourself after the examination; for those suffering from arrhythmia - antiarrhythmic drugs; for those suffering from bronchial asthma - an inhaler. Removable dentures will need to be removed.

It is imperative to familiarize the doctor who will perform the procedure with previous diseases and allergies, as well as medications that you are constantly taking.

Course of the procedure

Learn more about how bronchoscopy is performed. First, let's talk about how this procedure is performed without anesthesia - under local anesthesia:

1. The patient comes into the office, he is asked to undress to the waist and then either lie down on a couch in the middle of the room, or sit on a chair near the equipment.
2. He is given an injection under the skin - in the shoulder area. Usually this is the drug “Atropine” - a drug that will suppress the secretion of saliva and bronchial contents. It makes your mouth dry and your heart rate increases.
3. The drug can be administered intramuscularly. This is soothing to make the manipulation easier to bear.
4. Also, the drugs “Salbutamol” or “Berodual” are sprayed into the mouth. They are needed to expand the bronchi.
5. Next, the doctor administers local anesthesia. He sprays or lubricates an anesthetic (usually lidocaine 10%) at the root of the tongue and a little deeper. The outer part of the bronchoscope is also treated with the same solution.
6. After this, they begin to carefully insert the bronchoscope into the mouth. Before insertion, a mouthpiece, a plastic device that holds the teeth, may be inserted into the mouth. This is necessary to ensure that the patient does not bite through the bronchoscope.
7. If bronchoscopy is performed in a supine position, the doctor, going around the patient’s head, can insert a laryngoscope into his mouth and larynx. This is also accompanied by spray of local anesthetic into the respiratory tract. The laryngoscope will open the way for the bronchoscope, so the latter will be inserted faster and safer.
8. Let's be honest: the introduction of a bronchoscope will be accompanied by a gag reflex, as well as a feeling of lack of air. The first is due to the fact that the root of the tongue is affected. But there is not enough air, since the bronchoscope will take up 3/4 of the diameter of the trachea. To eliminate both of these effects, you need to breathe frequently and shallowly (“like a dog”).
9. The study is carried out quite quickly so as not to cause severe hypoxia. Oxygen levels should be monitored using a pulse oximeter. Its sensor – a “clothespin” – is put on your finger.

During bronchoscopy, do not bend over so as not to damage the airways with the bronchoscope (especially if a rigid device is used).

If bronchoscopy with biopsy is performed, it is painless. There is only discomfort behind the sternum. The bronchial mucosa has virtually no pain receptors. The introduction of lidocaine before manipulation is due to the need to turn off vagal (from the word “nervus vagus” - “vagus nerve”) reflexes from the root of the tongue and vocal cords, which can lead to cardiac arrest.

If bronchoscopy is performed under anesthesia, it is performed with the patient lying down. Then the injections are performed intravenously, and the person falls asleep as a result. A rigid polypropylene tube is inserted into his trachea, which is connected to a breathing apparatus. For some time, air is pumped into the lungs with a breathing apparatus (exhalation occurs spontaneously), then a bronchoscope is inserted through the tube, and bronchoscopy is performed. A person does not feel how a bronchoscopy is done.

The procedure under anesthesia is performed in children, people who are very afraid of the procedure, and people with unstable mental health. It is performed on patients who have already been on mechanical breathing, as well as when surgical intervention is necessary.

After the procedure

After bronchoscopy you feel:

The following rules must be followed:

• stay in the hospital for 3 hours under the supervision of staff;
• Do not eat, drink or smoke for 3 hours. Food and food can enter the trachea, while smoking impairs the healing of the mucosa after manipulation;
• do not drive for 8 hours, as drugs have been administered that significantly reduce the reaction rate;
• Avoid physical activity for the next 2-3 days.

It is also necessary to monitor your condition. Must not be:

• discharge from the respiratory tract of blood in the form of clots or liquid blood;
• shortness of breath;
• chest pain when breathing;
• temperature rise;
• nausea or vomiting;
• wheezing.

Conclusion of bronchoscopy

The doctor writes the first results of bronchoscopy immediately after the examination. These words could be:

1. Endobronchitis. This is an inflammation of the inner lining of the bronchus. If it is “catarrhal,” it means that the mucous membrane was red. “Atrophic” - the membrane is thinned. “Hypertrophic” - the bronchial membrane is thickened, therefore, the lumen of the bronchi is narrowed. “Purulent” is a bacterial inflammation; antibiotics are needed. “Fibro-ulcerative” - severe inflammation, leading to the formation of ulcers, which are gradually replaced by scar (fibrous) tissue.
2. “Dense pale pink infiltrates, rising above the mucous membrane” are signs of tuberculosis.
3. “Narrowing of diameter”: inflammation, cystic fibrosis, tumors, tuberculosis.
4. “The neoplasm has a wide base, there are erosions, they bleed, are covered with necrosis, and have irregular contours” - signs of cancer.
5. “Thick sputum, narrowing of the lumen” are signs of cystic fibrosis.
6. “Fistulas” are signs of tuberculosis.
7. “Retraction of the bronchial wall, decreased lumen, edematous wall” are signs of a tumor growing from outside the bronchus.
8. “Spindle-shaped, sac-like dilatations of the bronchi, thick purulent sputum” are signs of bronchiectasis.
9. “The mucous membrane is swollen, reddened. The walls of the bronchi bulge. There is a lot of clear sputum, not purulent” - signs of bronchial asthma.

Who should not undergo bronchoscopy?

There are such contraindications to bronchoscopy (namely diagnostic):

• arterial hypertension with diastolic (“lower”) pressure more than 110 mm Hg;
• mental illness;
• immobility (ankylosis) of the lower jaw;
• recent myocardial infarction or stroke (less than 6 months ago);
• aortic aneurysm;
• significant rhythm disturbances;
• coagulation disorders;
• significant narrowing (stenosis) of the larynx;
• chronic respiratory failure stage III.

In these cases, virtual bronchoscopy can be performed.

The procedure should be postponed during an acute infectious disease, exacerbation of bronchial asthma, for women - during menstruation and from the 20th week of pregnancy.

When bronchoscopy is intended to assist intubation, or is needed to remove foreign bodies, bronchial stenting or other therapeutic purposes, there are no contraindications. This procedure is carried out jointly by an endoscopist and an anesthesiologist, under anesthesia, after proper intensive preparation.

Complications of the procedure

With bronchoscopy, the consequences may be as follows:

• bronchospasm - compression of the walls of the bronchi, which causes oxygen to stop flowing into the lungs;
• laryngospasm - the same as the previous complication, only the glottis (larynx) spasms and closes;
• pneumothorax – entry of air into the pleural cavity;
• bleeding from the bronchial wall (may occur during biopsy);
• pneumonia – due to infection of the small bronchi;
• allergic reactions;
• mediastinal emphysema - entry of air from the bronchus into the tissue surrounding the heart, large vessels extending from it, the esophagus and trachea;
• in those suffering from arrhythmia, it increases.

Bronchoscopy in children

Bronchoscopy can be performed in children from the neonatal period, provided that the hospital has a device of such a small diameter. The procedure is carried out only under anesthesia, and after it antibiotics are prescribed.

Bronchoscopy is performed in children when:

• severe difficulty breathing, most likely caused by a foreign body;
• accurately determining the presence of a foreign body in the respiratory tract;
• severe pneumonia, especially against the background of cystic fibrosis;
• bronchial tuberculosis - to make a diagnosis or stop bleeding;
• if, in the presence of shortness of breath, an area of ​​atelectasis is visible on the x-ray;
• lung abscess.

Children are more likely to develop laryngo- or bronchospasm due to the rich blood supply to the respiratory tract. Therefore, general anesthesia is often supplemented with local anesthesia.

In addition, complications may include collapse (a sharp decrease in blood pressure) and anaphylactic shock. Tracheal perforations are extremely rare, since bronchoscopy is performed with flexible bronchoscopes.

Bronchoscopy for tuberculosis

Bronchoscopy for tuberculosis is an important diagnostic and treatment procedure. It allows:

• using aspiration of bronchial contents and its bacteriological examination, isolate Mycobacterium tuberculosis (especially if the culture was negative) and determine sensitivity to anti-tuberculosis drugs;
• drain cavities (tuberculous cavities) from necrosis;
• administer anti-tuberculosis drugs locally;
• dissect fibrous (scar) tissue in the bronchi;
• stop the bleeding;
• assess the dynamics of treatment (this requires repeated bronchoscopy);
• inspect the stitches after surgery to remove a lung;
• cleanse the bronchi from necrotic masses and pus when they have broken through there from the cavity or intrathoracic lymph nodes;
• assess the condition of the bronchi before surgery;
• remove fistulas - connections between the focus of pulmonary tuberculosis and the bronchus.

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Bronchoscopy of the lungs

One of the most important research methods in pulmonology is bronchoscopy. In some cases, it is used not only as a diagnostic method, but also as a therapeutic method that allows one to effectively eliminate certain pathological changes. We will talk about what lung bronchoscopy is, what are the indications and contraindications for this study, what is the methodology for conducting it, in this article.

What is bronchoscopy

Bronchoscopy, or tracheobronchoscopy, is a method of examining the lumen and mucous membrane of the trachea and bronchi using a special device - a bronchoscope. The latter is a system of tubes - flexible or rigid - with a total length of up to 60 cm. At the end, this device is equipped with a video camera, the image from which, magnified many times, is displayed on the monitor, i.e. the specialist conducting the study personally observes the condition of the respiratory tract in the mode real time. In addition, the resulting image can be saved in the form of photographs or video recordings, so that in the future, comparing the results of the current study with the previous one, it is possible to assess the dynamics of the pathological process. (Read about bronchography in our other article.)

A little history

Bronchoscopy was first performed back in 1897 by the doctor G. Killian. The purpose of the procedure was to remove a foreign body from the respiratory tract, and since it was very traumatic and painful, cocaine was recommended to the patient as an anesthetic. Despite the large number of complications after bronchoscopy, it was used in this form for more than 50 years, and already in 1956, the scientist H. Fidel invented a safe diagnostic device - a rigid bronchoscope. Another 12 years later, in 1968, a fiberoptic bronchoscope, a flexible bronchoscope made from fiber optics, appeared. An electronic endoscope, which allows you to repeatedly enlarge the resulting image and save it to a computer, was invented not so long ago - in the late 1980s.

Types of bronchoscopes

Currently, there are 2 types of bronchoscopes - rigid and flexible, and both models have their advantages and are indicated in certain clinical situations.

Flexible bronchoscope or fiberoptic bronchoscope

• This device uses fiber optics.
• It is primarily a diagnostic device.
• It easily penetrates even into the lower sections of the bronchi, minimally damaging their mucous membrane.
• The examination procedure is performed under local anesthesia.
• Used in pediatrics.

Consists of a smooth flexible tube with an optical cable and light guide inside, a video camera at the inner end and a control handle at the outer end. There is also a catheter for removing fluid from the respiratory tract or supplying a drug into it, and, if necessary, additional equipment for diagnostic and surgical procedures.

Rigid or rigid bronchoscope

• It is often used for the purpose of resuscitation of patients, for example, in case of drowning, to remove fluid from the lungs.
• Widely used for medical procedures: removing foreign bodies from the respiratory tract, expanding the lumen of the trachea and bronchi.
• Allows for diagnostic and therapeutic manipulations in the area of ​​the trachea and main bronchi.
• If necessary, in order to examine thinner bronchi, a flexible bronchoscope can be inserted through a rigid bronchoscope.
• If certain pathological changes are detected during the study by this device, they can be eliminated immediately.
• When examining with a rigid bronchoscope, the patient is under general anesthesia - he is asleep, which means he does not experience fear of the examination or the expected unpleasant sensations.

A rigid bronchoscope includes a system of rigid hollow tubes with a light source, video or photographic equipment at one end, and a manipulator for controlling the device at the other. The kit also includes various mechanisms for therapeutic and diagnostic procedures.

Indications for bronchoscopy

Indications for fibrobronchoscopy are:

• suspicion of the presence of a tumor in the lungs;
• the patient has symptoms that are inadequate to the diagnosed disease, such as a prolonged unexplained cough, a prolonged intense cough when its severity does not correspond to other symptoms, severe shortness of breath;
• bleeding from the respiratory tract - in order to determine the source and directly stop the bleeding;
• atelectasis (collapse of part of the lung);
• pneumonia, characterized by a protracted course, difficult to treat;
• isolated cases of pleurisy;
• pulmonary tuberculosis;
• the presence of a shadow (or shadows) on the chest x-ray, the nature of which needs to be clarified;
• upcoming lung surgery;
• blockage of the bronchi with a foreign body or blood, mucus, purulent masses - in order to restore the lumen;
• purulent bronchitis, lung abscesses - for washing the respiratory tract with medicinal solutions;
• stenoses (pathological narrowings) of the respiratory tract - in order to eliminate them;
• bronchial fistulas - in order to restore the integrity of the bronchial wall.

Examination using a rigid bronchoscope is the method of choice in the following cases:

• with large foreign bodies present in the trachea or proximal (closest to the trachea) bronchi;
• with intense pulmonary bleeding;
• if a large amount of stomach contents mixed with food enters the respiratory tract;
• when examining the respiratory tract of a child under 10 years of age;
• for the purpose of treating bronchial fistulas, stenotic (narrowing the lumen) scar or tumor processes in the trachea and main bronchi;
• for washing the trachea and bronchi with medicinal solutions.

In some cases, bronchoscopy is necessary not as a planned, but as an emergency medical intervention necessary to quickly make a correct diagnosis and eliminate the problem. The main indications for this procedure are:

• intense bleeding from the respiratory tract;
• foreign body of the trachea or bronchi;
• ingestion (aspiration) of stomach contents by the patient;
• thermal or chemical burn of the respiratory tract;
• status asthmaticus with blockage of the bronchial lumen by mucus;
• airway damage due to trauma.

For most of the above pathologies, emergency bronchoscopy is performed in intensive care conditions through an endotracheal tube.

Contraindications to bronchoscopy

In some cases, bronchoscopy is dangerous for the patient. Absolute contraindications are:

• allergy to painkillers administered to the patient before the study;
• acute cerebrovascular accident;
• myocardial infarction suffered in the last 6 months;
• severe arrhythmias;
• severe heart or pulmonary failure;
• severe essential arterial hypertension;
• stenosis of the trachea and/or larynx of the 2nd–3rd degree;
• exacerbation of bronchial asthma;
• acute stomach;
• some diseases of the neuropsychic sphere - consequences of a traumatic brain injury, epilepsy, schizophrenia, etc.;
• oral diseases;
• pathological process in the cervical spine;
• ankylosis (lack of mobility) of the temporomandibular joint;
• aortic aneurysm.

The last 4 pathologies are contraindications only for rigid bronchoscopy, and fiber-optic bronchoscopy is acceptable in these cases.

In some conditions, bronchoscopy is not contraindicated, but it should be temporarily postponed until the pathological process resolves or clinical and laboratory parameters stabilize. So, relative contraindications are:

• 2nd and 3rd (especially 3rd) trimesters of pregnancy;
• period of menstruation in women;
• diabetes mellitus with high blood sugar levels;
• alcoholism;
• 3rd degree enlargement of the thyroid gland.

Preparing for the study

Before bronchoscopy, the patient must undergo a series of examinations prescribed by the doctor. As a rule, this is a general blood test, biochemical blood test, pulmonary function tests, chest x-ray or others, depending on the disease of the individual patient.

Immediately before the study, the patient will be asked to sign a consent for this procedure. It is important not to forget to inform the doctor about any allergies to medications, especially to anesthesia drugs, if any, pregnancy, medications taken, acute or chronic diseases, since in some cases (see above) bronchoscopy is absolutely contraindicated.

As a rule, a planned study is carried out in the morning. In this case, the patient has dinner the night before, and is prohibited from eating in the morning. At the time of the study, the stomach should be empty to reduce the risk of reflux of its contents into the trachea and bronchi.

If the patient is very worried about the upcoming bronchoscopy, he may be prescribed mild sedatives a few days before the examination.

How is bronchoscopy performed?

Bronchoscopy is a serious procedure that is performed in a room specially equipped for this purpose in compliance with all sterile conditions. Bronchoscopy is performed by an endoscopist or pulmonologist who has been trained in this type of examination. An endoscopist assistant and an anesthesiologist also take part in the study.

Before the examination, the patient must remove glasses, contact lenses, dentures, hearing aids, jewelry, unbutton the top button of his shirt if the collar is tight enough, and empty his bladder.

During bronchoscopy, the patient is in a sitting or supine position. When the patient is sitting, his torso should be slightly tilted forward, his head slightly back, and his hands should be lowered between his legs.

When performing fibrobronchoscopy, local anesthesia is used, for which a lidocaine solution is used. When using a rigid bronchoscope, general anesthesia, or anesthesia, is required - the patient is put into a state of medicated sleep.

In order to dilate the bronchi for easy advancement of the bronchoscope, a solution of atropine, aminophylline or salbutamol is administered to the patient subcutaneously or by inhalation.

When the above drugs have taken effect, a bronchoscope is inserted through the nose or mouth. The patient takes a deep breath and at this moment the bronchoscope tube is passed through the glottis, after which it is inserted deeper into the bronchi with rotational movements. To reduce the gag reflex at the time of insertion of the bronchoscope, the patient is advised to breathe shallowly and as often as possible.

The doctor assesses the condition of the respiratory tract as the bronchoscope moves from top to bottom: first examines the larynx and glottis, then the trachea, after which the main bronchi. The examination with a rigid bronchoscope is completed at this level, and during fiberoptic bronchoscopy the underlying bronchi are also examined. The most distant bronchi, bronchioles and alveoli have a very small lumen diameter, so their examination with a bronchoscope is impossible.

If any pathological changes are detected during bronchoscopy, the doctor can carry out additional diagnostic or direct therapeutic manipulations: take swabs from the bronchi, sputum or a piece of pathologically altered tissue (biopsy) for examination, remove the contents blocking the bronchus, and rinse them with an antiseptic solution.

As a rule, the study lasts for 30–60 minutes. All this time, specialists monitor the level of blood pressure, heart rate and the degree of oxygen saturation of the patient’s blood.

Patient sensations during bronchoscopy

Contrary to the anxious expectations of most patients, they do not feel any pain during bronchoscopy.

With local anesthesia, after administration of the drug, there is a feeling of a lump in the throat, nasal congestion, the palate becomes numb, and it becomes difficult to swallow. The bronchoscope tube has a very small diameter, so it does not interfere with the patient’s breathing. As the tube moves through the airways, slight pressure may be felt in them, but the patient does not experience any discomfort.

During general anesthesia, the patient sleeps and therefore does not feel anything.

After research

Recovery after bronchoscopy takes no more than 2–3 hours. 30 minutes after the end of the study, the effect of the anesthetic will wear off - during this time the patient is in the endoscopy department under the supervision of medical personnel. You can eat and drink after 2 hours, and smoke no earlier than after 24 hours - such actions minimize the risk of bleeding from the respiratory tract after bronchoscopy. If the patient received certain sedatives before the study, he is strictly not recommended to drive a vehicle for 8 hours after taking them.

Complications of bronchoscopy

As a rule, this study is well tolerated by patients, but sometimes, extremely rarely, complications still arise, such as:

• arrhythmia;
• inflammatory process in the respiratory tract;
• voice change;
• bleeding of varying intensity from the respiratory tract (if a biopsy was taken);
• pneumothorax (also in case of biopsy).

I would like to repeat that bronchoscopy is a very important diagnostic and therapeutic procedure, for which there are both indications and contraindications. The need and advisability of bronchoscopy is determined in each specific case by a pulmonologist or therapist, but it is performed exclusively with the consent of the patient after his written confirmation.

What is lung bronchoscopy and how is this procedure done?

Lung bronchoscopy is an invasive procedure for examining and assessing the condition of the mucous membranes of the bronchi and trachea. The manipulation is carried out both in medical hospitals and on an outpatient basis using specialized endoscopes.

What is pulmonary bronchoscopy? It is an informative procedure that allows the doctor to visually assess the processes occurring in the human respiratory system.

For manipulation, 2 types of bronchofiberscopes are used - soft and hard. This device is a flexible tube with control handles, a light source, cameras for video recording, and manipulators for medical procedures and diagnostic studies.

Indications for tracheobronchoscopy

Examination of the respiratory system using an endoscope is used for therapeutic purposes and as an auxiliary method to clarify the patient’s diagnosis.

Indications for diagnostic fibrobronchoscopy:

• The presence of cavities in the respiratory system in which exudate accumulates. The presence of purulent masses in the bronchi causes a prolonged cough and the production of sputum in quantities of 350 ml per day.
• Suspicion of tuberculosis.
• Inflammatory processes in the bronchi - prolonged bronchitis of various origins.
• Hemoptysis.
• Pathologies and diseases of the trachea.
• Sarcoidosis.
• Suspicion of fungal diseases of the respiratory system.
• Inspection of the bronchial stump after surgery.
• Suspicion of oncological processes in the respiratory system, which cannot yet be confirmed or refuted by radiography.
• Suspicion of internal injuries of the trachea, bronchi, and lungs.

Indications for therapeutic bronchoscopy:

• Narrowing of the trachea.
• Tissue biopsy for suspected oncological process in the bronchi.
• Administration of medications.
• Removal of foreign bodies.
• Trachea injuries, restoration of organ patency.
• Installation of medical equipment for stenosis or scar processes in the trachea and bronchi.
• Search and drainage of purulent foci during the development of an abscess.
• Lung lavage.
• Stop bleeding in pulmonary hemorrhage, pneumothorax.

Classification and contraindications

Depending on the purpose of the manipulation, different types of bronchoscopes are used - soft or bendable and hard.

1. Soft – used for diagnostic examination only. The patient is fully conscious. Local anesthesia is indicated. If the patient has a history of intolerance to anesthetics, the procedure is performed in the intensive care unit. In this case, general anesthesia is indicated, but with preservation of spontaneous breathing.

A flexible endoscope is similar in appearance to a gastroscopy probe. The length of the tube does not exceed 60 cm, and the diameter is 0.5 cm. The introduction of a soft bronchoscope is possible both through the nasal passages and through the oral cavity. The diameter of the probe does not interfere with natural nasal breathing.

1. Hard – indicated only for medical procedures, removal of foreign objects, and stopping bleeding in the respiratory system. The patient is put into medicated sleep. The manipulation is carried out only in an operating room.

A rigid bronchoscope is an endoscope with a tube diameter of 9 to 13 mm and is equipped with a system for forced ventilation of the lungs. The probe is inserted only through the oral cavity. During the manipulation, the connection of the patient to the condition monitoring system is shown.

Bronchoscopy is an invasive procedure and has a number of contraindications. Manipulation is not prescribed in the following cases:

• patient's asthmatic status;
• bronchitis in the acute stage;
• asthma during exacerbation and regular attacks;
• arrhythmias of any origin, heart attack;
• stroke, other cerebrovascular accidents;
• III degree of heart and pulmonary failure;
• mental disorders, history of epilepsy;
• cases of loss of consciousness after head injuries of unknown origin;
• aortic aneurysm;
• elevated blood pressure in the stage of decompensation;
• general poor condition of the patient;
• atrioventricular atrial block.

Preparation for manipulation

The success of the procedure depends on proper preparation for the examination. Bronchoscopy is performed exclusively in a hospital setting in a specially equipped operating room or manipulation room.

Preparation for a bronchoscopic examination is simple, but is carried out in several stages:

1. X-ray examinations of the respiratory organs are mandatory.
2. A number of laboratory tests are shown - blood gases, coagulation indicators, urea in the blood. The patient is given a cardiogram.
3. The endoscopist who will conduct the study examines and interviews the patient. The details of the medical history and treatment methods are clarified. The patient must inform the doctor about any medications taken on an ongoing basis, or allergic reactions to any medications.
4. The procedure is carried out exclusively on an empty stomach. This will prevent the risk of vomit entering the respiratory system. The last meal is no later than 21:00.
5. On the day of manipulation, it is forbidden to drink water or any other liquids. No smoking.
6. If the patient is taking any medications on an ongoing basis and cannot stop taking them, then they should discuss with their doctor the timing of taking the medication.
7. If necessary, sedatives are prescribed before the examination.
8. You should take a towel to the manipulation room, as hemoptysis may occur at the end of the study.

Methodology of the procedure

How to perform bronchoscopy of the lungs, the path of insertion of the endoscope is determined by the endoscopist. There are 2 ways to insert the instrument - through the nasal passages and through the mouth. The first method is mainly used, as this reduces the risk of vomiting.

General procedure for manipulation:

1. The study is carried out only on the basis of a medical hospital. The doctor must have a specialization as an endoscopist.
2. The patient must remove all jewelry, piercings, and dentures.
3. 40 minutes before the start of bronchoscopy, the administration of sedatives, decongestants, and antispasmodics is indicated to prevent bronchospasms. For patients with bronchitis and those with an asthmatic component, allow them to inhale the Salbutamol aerosol from a can immediately before administering anesthesia drugs.
4. With soft bronchoscopy, the examination is carried out through the nasal passages. The position of the patient during the manipulation is determined by the doctor - lying or sitting.
5. The nasopharynx is treated with an anesthetic in the form of a spray to suppress the gag reflex.
6. The doctor inserts the endoscope tube into the nasal cavity and slowly passes it through the trachea into the bronchi, examining the respiratory system. Modern bronchoscopes make it possible to examine even small branches of the bronchi. If the nasal septum is deviated or the nasal passages are narrowed, the endoscope tube is inserted through the oral cavity.
7. The study is video recorded.
8. According to indications, further manipulations are carried out - administration of medications, collection of material for biopsy.
9. Removing the device from the respiratory system.

Possible complications

The procedure is invasive, so complications may develop. These include:

• sensation of a lump or foreign body in the larynx;
• difficulty swallowing due to the action of the anesthetic.

These symptoms last no more than a day after the procedure and do not require medical intervention. In severe cases, during bronchoscopy the following may occur:

• injuries of the larynx and respiratory system;
• pneumothorax;
• breathing problems;
• bleeding;
• bronchospasms;
• patient infection;
• inflammatory processes in the bronchi.

Eating and drinking liquids is allowed only after the anesthetic drugs wear off. If a rigid bronchoscopy was performed with the collection of material for a biopsy, then eating is allowed only after examination by a doctor.

Bronchoscopy of the lungs is not the most pleasant therapeutic or diagnostic procedure. But this is an important step towards making the correct diagnosis, which allows you to select adequate treatment for a particular individual. Instrumental examination of the bronchi and trachea increases the patient's chances of recovery.

Bronchoscopy or tracheobronchoscopy is a method of direct examination and assessment of the condition of the mucous membranes of the tracheobronchial tree, trachea and bronchi. Bronchoscopy of the lungs is carried out using special devices: bronchofiberscope, rigid respiratory bronchoscope, and a variety of endoscopes.

Indications

Indications for bronchoscopy: determination of suspected inflammation or tumor; removal of foreign bodies; removal of blood and pus; administration of medications directly to the lesion; elimination of lung collapse; restoration of tracheal patency. Diagnostic bronchoscopy is inextricably linked with biopsy in cases where it is necessary to find out about the nature of the formation.

Preparation

Preparation for bronchoscopy consists of a number of procedures: chest radiography, determination of urea levels and blood saturation, electrocardiography. Eating is allowed at least 10 hours before surgery, since bronchoscopy is performed on an empty stomach. Contraindications to bronchoscopy: stenosis of the larynx and trachea of ​​II and III degrees; respiratory failure degree III; acute period of bronchial asthma; aortic aneurysm; myocardial infarction and cerebral infarction (stroke) suffered less than six months ago; blood clotting disorder; intolerance to anesthesia drugs; mental illness. Bronchoscopy of a child is performed only for compelling indications and under general anesthesia. There are no age restrictions for bronchoscopy.

Bronchoscopy - how is it done? Types and indications for research

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The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

What is bronchoscopy?

Endoscopic research methods are methods that allow us to examine organs that have at least some minimal cavity ( "endo" means inside, and copy means to explore.) Thus, the purpose of endoscopic methods is to examine the internal cavity of the organ. When carrying out these diagnostic methods, rigid and flexible instruments are used ( endoscopes). The first includes metal tubes of various diameters, and the second includes fiber optics devices. At the end of the endoscope there is a light bulb that illuminates the cavity being examined, and a video camera that is connected to the monitor. When performing bronchoscopy, flexible endoscopes are used ( synonym - fiberscope), which made a real revolution in medicine. They consist of many glass fibers ( LEDs) through which the image is transmitted. Due to the phenomenon of total reflection at the boundary of two media, the resulting picture is highly informative. During bronchoscopy, a fiberscope is inserted into the bronchi through natural openings, that is, through the nose or mouth.

How is bronchoscopy done?

Anatomy of the bronchi and bronchial tree
The human lower respiratory tract consists of the trachea, the main ( right and left) bronchi and bronchial tree. The trachea or windpipe is divided into the right and left main bronchus. Secondary bronchi depart from them, which, in turn, are divided into small branches, and those into even smaller ones. The set of all secondary bronchi and their branches is called the bronchial tree. Thus, conditionally, the lower respiratory tract can be expressed as follows. Trachea – left and right main bronchus – secondary bronchi – bronchial tree. During bronchoscopy, the fiberscope examines the trachea, main and secondary bronchi, then it passes into the middle and small branches of the bronchi. However, the fiberscope cannot penetrate the smallest bronchioles due to their small diameter. To study smaller branches, other diagnostic methods are used, for example, virtual bronchoscopy.

Bronchoscopy method

A fiberscope is inserted through the nose or mouth, which passes into the larynx, and from it into the trachea and bronchi. Through an eyepiece connected at the other end, the doctor examines the passing paths. Further tactics depend on the purpose of bronchoscopy. For aspiration ( ventilation) pathological fluid in the bronchi or sanitation ( washing) of the purulent cavity, a special aspiration tip is inserted into the lumen of the bronchi, through which the liquid is sucked out. If the purpose of bronchoscopy is to wash the bronchial tree, then a solution for washing the bronchial tree is first introduced through the fiberscope tube ( it could be a solution of furatsilin). The liquid is introduced in small portions and then removed. By alternating the processes of fluid administration and aspiration, sanitation is carried out ( simple rinsing) bronchi.

When removing a foreign body from the bronchi, special forceps are used that grasp the object ( it could be a pea, bean) and remove it. For bronchial bleeding, a procedure called bronchial tamponade is used. In this case, take a piece of foam rubber, which should be twice the diameter of the bronchi. It is rolled up tightly, moistened in an antiseptic solution and placed in the cavity of the bronchus, thus closing its lumen. In order to insert this foam into the bronchus, hard forceps are used, which are passed through a fiberscope. When the fiberscope reaches the bleeding site, the forceps unclench, and the foam expands and fills the lumen. In this “compacted” state, the foam rubber remains in the lumen of the bronchial tree until the bleeding stops.

If the bleeding is minor, then instead of tamponade, irrigation of the bleeding vessel with a solution of adrenaline can be used. Adrenaline is a substance that causes a sharp constriction of blood vessels and stops bleeding ( if the vessel is small).

Preparing for bronchoscopy and performing the procedure

Preparation for bronchoscopy includes the following activities:

• conducting medical examinations;
• preliminary medical consultation;
• psychological preparation of the patient;
• maintaining a special diet;
• taking sedatives;
• performing a series of actions immediately before the procedure.

Conducting medical examinations

Preparation for bronchoscopy involves the following studies:

• X-ray of the lungs. To get a picture of the lungs ( radiography), a beam of X-rays is passed through the chest and then imaged on film. Since bones absorb radiation, they appear white in the image, while air cavities appear black. Soft tissues are indicated in gray on x-rays. Based on the image, the doctor sees the location of pathological foci and subsequently pays special attention to them during bronchoscopy.
• Cardiogram. The examination is carried out in order to obtain a graphical display of the work of the heart. Special electrodes are installed on the patient's chest, arms and legs, which monitor the heart rhythm and transmit it to a computer, where the data is compiled into a cardiogram. In order for the examination to be as informative as possible, the patient should not eat 2–3 hours before the procedure. Using the cardiogram, the doctor determines whether there is a risk of negative consequences for the heart during bronchoscopy.
• Blood analysis. To exclude the possibility of infectious processes and other diseases that could become an obstacle to bronchoscopy, the patient is prescribed blood tests. For biochemical analysis, blood is taken from a vein, for general analysis - from a finger or also from a vein. For the results to be reliable, the analysis must be performed on an empty stomach, which requires not eating 8 hours before the procedure. It is also recommended to give up alcohol and fatty foods for 1–2 days.
• Coagulogram. To conduct this study, blood is taken from the patient's vein, which is then tested for clotting. A coagulogram is prescribed to eliminate the risk of bleeding during and after bronchoscopy. As with other blood tests, the patient must not eat 8 hours before the procedure and not consume alcoholic beverages or high-fat foods for 1–2 days.

Psychological preparation of the patient
The emotional state has a great influence on the quality of bronchoscopy and the results obtained. During the procedure, the patient should be relaxed and calm, since otherwise it will be difficult for the doctor to carry out the necessary manipulations with the bronchoscope. The best way to help the patient calm down is to become familiar with all aspects of the procedure. To get a complete picture of how bronchoscopy is performed, the patient should, during the preliminary consultation, ask the doctor all the questions that concern him. The duration of the procedure, the nature of the sensations before and after bronchoscopy, the type of planned anesthesia - these and other questions that the patient may have must be discussed with the doctor.

In addition to medical consultation, the patient should also independently work on his emotional state. To put your mind at ease, it is recommended to think about the fact that bronchoscopy significantly speeds up the healing process, regardless of the purpose for which it is performed ( diagnostic or therapeutic). You should also take into account the fact that there are no pain receptors in the bronchial mucosa. Therefore, discomfort during bronchoscopy is more due to psychological than physical factors. The day before the examination, it is not recommended to watch films or programs of a negative nature. Also, if possible, you should limit the influence of various household or professional stress factors.

Following a special diet before bronchoscopy

There are the following food products that cause gas formation:

• any legumes;
• all varieties of cabbage;
• radish, turnip, radish;
• mushrooms, artichokes;
• apples, pears, peaches;
• milk and any products made from it;
• all drinks that contain gases.

When performing bronchoscopy, the patient's intestines must be empty. Otherwise, due to intra-abdominal pressure, involuntary emptying may occur during the procedure. Therefore, in the morning, before visiting the clinic, you should empty your bowels. Some patients, due to anxiety or characteristics of the gastrointestinal tract, have difficulty with morning bowel movements. In such cases, the patient is prescribed a cleansing enema.

Taking sedatives
To reduce anxiety, most patients are prescribed sedatives before bronchoscopy ( calming) actions. These medications should be taken in the evening, the day before the examination. In some cases, repeated use of sedatives is indicated, 1 to 2 hours before the procedure.

Performing a series of actions immediately before the procedure
Before the bronchoscopy, the patient must visit the toilet to empty the bladder. If a person has jewelry on the neck or on such parts of the body as the nose, tongue, lips, they must be removed, as they will prevent the doctor from carrying out the necessary manipulations. The bronchoscope can be obstructed by braces and other devices that are attached to the teeth, so if possible, these should also be removed.

Bronchoscopy results

Types of endobronchitis are:

• catarrhal endobronchitis– characterized only by redness and swelling of the bronchial mucosa;
• atrophic endobronchitis– manifested by thinning and dryness of the mucous membrane, but at the same time the cartilaginous pattern is enhanced;
• hypertrophic endobronchitis– characterized by thickening of the mucosa, which leads to a uniform narrowing of the lumen of the bronchi;
• purulent endobronchitis– the main symptom is purulent discharge accumulating in the lumen of the bronchi;
• fibrous-ulcerative endobronchitis– characterized by the formation of ulcerative lesions on the mucosa, which are subsequently replaced by fibrous tissue.

In addition to inflammatory changes, bronchoscopy can diagnose a violation of the tone of the bronchial tree. As a rule, hypotonic dyskinesia is diagnosed, which is characterized by an increase in respiratory mobility and collapse of the bronchi during exhalation.

Due to the proliferation of tumor tissue or frequent inflammatory changes, the lumen of the bronchi may narrow. This is also visible on bronchoscopy. In this case, the doctor performing the bronchoscopy can assess the degree of narrowing. In the first degree, the lumen is narrowed by no more than one-eighth, in the second degree - by half, and in the third degree - by more than two-thirds.

Types of bronchoscopy

Types of bronchoscopy include:

• therapeutic bronchoscopy;
• diagnostic bronchoscopy;
• virtual bronchoscopy.

Therapeutic bronchoscopy of the lungs

Indications for therapeutic bronchoscopy include:

• lavage of the bronchial tree;
• washing and draining the purulent cavity;
• removal of foreign bodies - most often in children;
• clearing airway blockages that may be caused by mucus or pus;
• treatment of fistulas.

Like any study, therapeutic bronchoscopy also has contraindications.

Contraindications to therapeutic bronchoscopy are:

• second and third degree arterial hypertension;
• serious condition of the patient;
• exudative pleurisy;
• aortic aneurysm;
• pathology of the larynx ( for example, tuberculosis);
• mediastinal tumors.

Diagnostic bronchoscopy

Indications for diagnostic bronchoscopy are:

• suspected lung cancer;
• tuberculosis;
• persistent, prolonged cough;
• pathological changes in lung tissue that were identified on x-ray;
• smoking for more than 5 years;
• decline ( atelectasis) lung.

Contraindications for diagnostic bronchoscopy include:

• exacerbation of bronchial asthma;
• recent myocardial infarction;
• heart rhythm disturbance in the form of blockade or arrhythmia;
• heart failure or pulmonary failure;
• mental and neurological diseases, such as epilepsy;
• condition after traumatic brain injury.

Virtual bronchoscopy

Virtual bronchoscopy is based on the X-ray method. Rotating, the X-ray tube produces an image, which is subsequently converted into three-dimensional. Thus, using a special program, a complete image of the entire bronchial tree is reconstructed ( main and small bronchi). In this case, all layers of the bronchi, including the mucous membrane, are visible in the picture. The advantage of this method is the ability to examine even the smallest bronchi, which cannot always be seen with conventional bronchoscopy.

Pros and cons of virtual bronchoscopy

Bronchoscopy in children

The procedure is carried out to establish the true causes of certain diseases of the respiratory system. Using the device, the doctor can obtain a secretion ( slime) from deep-lying parts of the bronchial tree for further bacteriological research. This procedure can also involve tissue sampling ( biopsy) for subsequent analyses, removal of foreign objects or neoplasms. Bronchoscopy allows you to deliver drugs directly to the lesions, remove pathological mucus and carry out other treatment procedures with a high therapeutic effect.

Indications for bronchoscopy in children

Another common reason for bronchoscopy is tuberculosis. The procedure is prescribed in order to confirm or refute the presence of changes in the bronchi or lungs characteristic of tuberculosis. Bronchoscopy is also indicated for obtaining mucus in order to identify the causative agent of the disease. In older children, tuberculosis can cause bleeding in the lungs, and in such cases a procedure is prescribed to stop this process. There are other pathological conditions for which bronchoscopy in children is indicated.

There are the following indications for bronchoscopy in children:

• developmental anomalies of the bronchopulmonary system;
• pulmonary atelectasis ( a pathology in which the lung ceases to participate in gas exchange);
• cystic fibrosis ( disease of mucus-producing organs, including the lungs);
• lung abscess ( the formation of a cavity filled with pus in the lung);
• expectoration of blood and/or pulmonary hemorrhage;
• neoplasms in the lungs;
• bronchial asthma ( chronic inflammation of the respiratory system);
• diseases of the lungs and bronchi of unknown origin.

Preparing a child for bronchoscopy

List of preliminary examinations ( blood test, radiography, cardiogram) is determined by the doctor, who takes into account the child’s age, general condition and other factors. The child should not be fed 6–8 hours before bronchoscopy, and should not drink anything 3–4 hours before the bronchoscopy. Children who are breastfed can be fed for the last time 4 hours before the procedure.

Features of bronchoscopy in children

During the procedure, the child is in a horizontal position, which increases the likelihood of bronchospasm. Therefore, before performing pediatric bronchoscopy, medical personnel prepare the necessary equipment for artificial ventilation. After manipulation of the bronchoscope, the child must be prescribed antibiotics in order to prevent the development of infection.

Indications for bronchoscopy

Bronchoscopy for tuberculosis

Bronchoscopy for lung cancer

Sometimes the test may involve inserting catheters ( straws) into the small bronchi to obtain a smear. This procedure is called catheterization and is necessary to diagnose peripheral cancer. If cancer has already been confirmed and bronchoscopy is performed for observation purposes, then a biopsy of the lymph nodes is also required. It is necessary to determine metastases.

Bronchoscopy for bronchial asthma

Despite the heterogeneity of opinions, it should be emphasized that at the moment, pulmonary bronchoscopy is one of the most accurate methods for establishing the correct diagnosis for suspected bronchial asthma. Also, in some cases, bronchoscopy is the only possible method of performing a particular treatment procedure.

Indications for bronchoscopy for bronchial asthma

Therapeutic bronchoscopy is prescribed to reduce symptoms and improve the patient’s well-being.

The following indications for therapeutic bronchoscopy for asthma are distinguished:

• lack of results from previous treatment;
• copious mucus secretion, when there is a high probability of developing bronchial obstruction;
• coughing up purulent contents;
• convergence and compression of the pulmonary walls, as a result of which air disappears from the lung bubbles and the organ is switched off from gas exchange.

Features of bronchoscopy for asthma

Consequences and complications of bronchoscopy

Consequences of bronchoscopy
Typically, patients complain of difficulties that arise in the process of swallowing, the sensation of a foreign body in the throat, and numbness of the pharynx. In some cases, after the procedure, small blood clots may be present in the coughed up mucus. Blood appears because during bronchoscopy the device injures the mucous membrane of the respiratory tract. Also, some patients have temporary nasal congestion. To reduce discomfort and prevent the development of more serious complications, people should follow certain rules after bronchoscopy.

• You should not eat or drink water until the effect of the anesthetic wears off ( The doctor will tell you the exact time);
• while the anesthesia continues to act, saliva should be spat out and not swallowed, because otherwise the patient may choke;
• You should stop smoking for 24 hours after the procedure;
• before the first meal, you need to take a small sip of water to check whether the sensitivity of the pharynx has been restored;
• the patient is not recommended to drive until the end of the day;
• During the day after bronchoscopy, it is prohibited to drink any alcohol or hot drinks;
• Ice cream and other types of cold foods/drinks should not be consumed within the next 24 hours.

Complications of bronchoscopy

Complications that occur during the procedure may be caused by the drugs used for anesthesia. If you are allergic to local or general anesthesia, the patient may experience seizures or develop anaphylactic shock. A sharp drop in blood pressure, breathing problems, and heart rhythm disturbances are also possible.
It should be noted that an allergic reaction to anesthesia occurs in rare cases, and the direct presence of a doctor can quickly normalize the patient’s condition. Another cause of complications during the procedure may be damaged blood vessels, which causes bleeding. The likelihood of bleeding is highest when a biopsy is performed during bronchoscopy ( pinch off a fragment of the lung or bronchi with forceps).

Factors that provoke complications after the procedure can be various infections or mistakes made during bronchoscopy.

There are the following complications that develop after bronchoscopy:

• Pneumothorax. With this pathology in the pleural cavity ( space under the outer lining of the lungs) air appears, which compresses the lung, as a result of which the organ ceases to participate in the breathing process. This complication develops due to damage to the pleura by the bronchoscope or forceps used to perform the biopsy. Pneumothorax is manifested by sharp pain in the chest, which becomes stronger with inspiration and can radiate to the shoulder. The patient's breathing becomes rapid and shallow, and a dry cough is possible. The heart rate quickens, sweat appears on the skin, and general weakness develops.
• Bacteremia. If there is an infectious process in the respiratory tract and damage to the integrity of the bronchi during the procedure, infectious agents enter the blood and bacteremia develops. This pathology manifests itself with such symptoms as chills, nausea, vomiting, general weakness and apathy.
• Perforation of the bronchial wall. It is one of the rarest complications and occurs when various sharp objects are removed from the patient’s respiratory tract ( wire, nails, pins). Symptoms of a violation of the integrity of the bronchi are coughing, expectoration of blood ( not always), severe chest pain.
• Inflammation of the bronchi and lungs. When an infection enters the respiratory tract, the patient may develop complications such as bronchitis and pneumonia. Signs of inflammation are chest pain, fever, and cough.

Prices for bronchoscopy

The following factors determine the cost of bronchoscopy:

• Method of carrying out the procedure. Thus, a standard endoscopic examination costs significantly less than a virtual one ( computer) bronchoscopy. In the case of conventional bronchoscopy, the price may also vary depending on which device ( hard or flexible) research is being carried out.
• Institution. The location of the clinic, namely the distance from the city center or from public transport stops, sometimes plays a large role in determining the cost of this procedure. Also influenced by the quality of equipment, the competence of specialists and other factors that determine the prestige of a medical institution.
• Additional manipulations. The cost of the anesthesia used may determine the price of the bronchoscopy. In most cases, a procedure using local anesthetics will cost the patient less. Additional manipulations also include performing a biopsy and subsequent cytological examination.

Sign up for a study

To make an appointment with a doctor or diagnostics, you just need to call a single phone number
+7 495 488-20-52 in Moscow

+7 812 416-38-96 in St. Petersburg

The operator will listen to you and redirect the call to the desired clinic, or accept an order for an appointment with the specialist you need.

Prices for bronchoscopy in Moscow and other Russian cities

Facilities that offer bronchoscopy