From the Guidelines
A proper airway description during bronchoscopy should include a systematic assessment of all anatomical structures from the upper to lower airways, as this approach ensures all clinically relevant findings are captured, allowing for accurate diagnosis, treatment planning, and comparison during follow-up examinations 1.
Key Components of Airway Description
- Begin with the nasal passages (if used for entry), then describe the oropharynx, larynx (including vocal cord appearance and function), trachea (noting any tracheomalacia or stenosis), carina (sharp or widened), and the bronchial tree.
- For each bronchial segment, document the patency, presence of secretions, mucosal appearance (color, inflammation, friability), any anatomical abnormalities (stenosis, malacia, external compression), and presence of lesions (endobronchial masses, granulation tissue).
- Note any dynamic airway changes during respiration.
- Include the extent of the examination (which segments were visualized) and any limitations encountered.
- Document any interventions performed during the procedure such as bronchoalveolar lavage, biopsies, or therapeutic maneuvers.
Importance of Standardized Description
The standardized description facilitates clear communication among healthcare providers and establishes a baseline for monitoring disease progression or treatment response 1.
Equipment and Techniques
Rigid bronchoscopy may require various types of equipment, including classic ventilating bronchoscopes, rigid instruments for endoscopy in tracheal disorders, bronchoscopes for distal airway endoscopy, and various angled telescopes that can be attached to video cameras to provide excellent airway visualization and documentation 1.
Patient Monitoring and Safety
Patients should be monitored by oximetry during bronchoscopy, and oxygen supplementation should be used to achieve an oxygen saturation of at least 90% to reduce the risk of significant arrhythmias during the procedure and also in the postoperative recovery period 1.
Sedation and Anesthesia
Sedatives should be used in incremental doses to achieve adequate sedation and amnesia, and general anesthesia/deep sedation may be suggested over moderate sedation for therapeutic bronchoscopy 1.
From the Research
Proper Airway Description with Bronchoscopy
A proper airway description with bronchoscopy should include several key elements, such as:
- Location and extent of the stenosis or lesion
- Severity of the stenosis or lesion
- Presence of any obstructions or foreign bodies
- Condition of the airway mucosa and surrounding tissue
- Any other relevant findings, such as tumors or inflammatory conditions
Elements of Airway Description
The description should be based on a thorough evaluation involving clinical exam, laboratory workup, pulmonary function test, chest imaging, and bronchoscopy 2. The use of advanced technologies such as endobronchial ultrasound (EBUS) and electromagnetic navigational bronchoscopy (ENB) can also provide valuable information for the diagnosis and management of airway disease 3.
Importance of Accurate Description
An accurate and detailed description of the airway is crucial for the diagnosis and management of tracheobronchial stenosis and other airway diseases. It allows for the development of an effective treatment plan, which may include bronchoscopic interventions such as dilatation, stenting, or scar tissue resection 4, 5. In cases where surgery is not possible, bronchoscopic management can be an effective alternative treatment option 5.
Bronchoscopic Interventions
Bronchoscopic interventions can be used to provide symptomatic relief and improve airway patency. These interventions may include: