Bronchoscopy of the lungs that shows. Bronchoscopy: how airway endoscopy is done, preparation for the procedure Consequences of lung bronchoscopy

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Update: October 2018

Bronchoscopy is a procedure that allows you to examine the inside of the trachea and bronchi, take for histological examination a section of suspicious tissue, remove a foreign body, clear the airways of viscous sputum. This is the most informative method for studying the tracheobronchial 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 best way to clear (lavage) the airways in those people who have to stay on machine breathing for a long time.

More about bronchoscopy

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

On the side of the bronchoscope there are holes where you can connect:

syringe: for washing the airways 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 a biopsy;
coagulator electrode - a device for cauterization of 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 evaluates the condition of the bronchi, looking not at the "tube" of the device itself, but looking at the monitor.

The bronchoscope is usually inserted through the mouth. Some doctors use a laryngoscope for this, a device that will simultaneously illuminate the path for the bronchoscope and wring out the root of the tongue and the epiglottis - cartilage against which the flexible bronchoscope can abut.

Because bronchoscopy is vital in many cases (for example, if there is damage or anomaly in the development of the neck, and breathing with a breathing machine must be achieved), the bronchoscope can be inserted through the nose.

Also, if the patient is breathing 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
main - 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 the tumor or inflammation is located there, computed or magnetic resonance imaging is performed.

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

Indications for bronchoscopy

You need to undergo a bronchoscopy if:

there is shortness of breath in the absence of pathologies of the heart or bronchial asthma;
tormented by cough, and radiography does not show anything;
there is hemoptysis;
often repeated bronchitis and / or pneumonia;
foul-smelling sputum is secreted;
there is a feeling of incomplete inhalation or exhalation, while heart disease and thoracic spine excluded;
there was a rapid weight loss in the absence of any diets;
have cystic fibrosis;
a disseminated process was found on an x-ray of the lungs - many areas of blackout, which can be both metastases and pulmonary tuberculosis;
according to computed tomography it is impossible to distinguish the site of suppuration from lung cancer with decay;
diagnosed with pulmonary tuberculosis;
it is necessary to establish the cause of severe pneumonia when the patient is on machine breathing;
it is necessary to evaluate the dynamics of treatment after resection of the lung, bronchus;
repeated bronchoscopy is needed after the tumor has been removed using this technique;
if the radiograph shows expansion or narrowing of the bronchi.

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

There are also medical procedure, which is used when:

a foreign body has entered the respiratory tract;
it is impossible to carry out tracheal intubation in order to transfer the patient to artificial ventilation: to perform surgery or in critical situations. This is a coma caused by various causes; conditions when breathing is turned off (injuries of the cervical spine spinal cord, botulism, myopathy);
you need to clear the airways of sputum or blood. This is extremely important in the treatment of pneumonia, especially against the background of cystic fibrosis, when the sputum is very viscous;
it is necessary to stop pulmonary bleeding;
one of the bronchi was blocked by a tumor, adhesions or sputum, resulting in atelectasis (turning off a lung area from breathing);
you need to remove the pus from the abscess of the lung, located near the bronchus;
pneumonia is difficult: it is better to introduce an additional antibiotic directly into the desired bronchus.

Basically, bronchoscopy is performed using a flexible bronchoscope - a fibrobronchoscope. It is quite thin and can be bent 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 bronchi that depart at an angle.

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

Virtual Bronchoscopy

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

The method is not so informative, but non-invasive. With it, you cannot take a sputum analysis, wash water or a biopsy of a suspicious area, you cannot get a foreign body or rinse the bronchi from sputum.

Preparation for a virtual biopsy is not required. According to the method of execution, it does not differ from computed tomography. The patient lies on a couch, which is placed inside the X-ray source.

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

How to prepare for manipulation

Preparation for bronchoscopy is very important, since the manipulation is very serious, belongs to the category of 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 consultations of narrow specialists are needed. So, if a person has had 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 an arrhythmia, he needs to reconsider antiarrhythmic therapy and possibly increase the dose of drugs or add some other antiarrhythmic. The same applies to diabetes and arterial hypertension.

Also, everyone needs to undergo such 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 the last planned pills. The need to take them in the morning is discussed separately.

Be sure to empty the intestines in the evening with an enema, microclysters "Microlax" ("Norgalax"), glycerin suppositories.

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

Be sure to familiarize the doctor who will carry out the procedure with past diseases and allergies, as well as constantly taking drugs.

The course of the procedure

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

The patient comes to 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.
He is given an injection under the skin - in the shoulder area. Usually this is the drug "Atropine" - a remedy that will suppress the secretion of saliva and bronchial contents. It makes your mouth dry and your heart rate increases.
The drug may be administered intramuscularly. It is soothing, so that manipulation is easier to bear.
Also, the preparations "Salbutamol" or "Berodual" are sprayed into the mouth. They are needed to expand the bronchi.
Next, the doctor performs local anesthesia. He sprays or lubricates with an anesthetic (usually 10% lidocaine) at the root of the tongue and a little deeper. The outer part of the bronchoscope is treated with the same solution.
After that, they begin to gently insert the bronchoscope into the mouth. Before insertion into the mouth, a mouthpiece can be inserted - a plastic device that holds the teeth. It is necessary so that the patient does not bite the bronchoscope.
If bronchoscopy is performed in a supine position, the doctor, bypassing the patient's head, can insert a laryngoscope device into his mouth and larynx. This is also accompanied by a spray of local anesthetic into the airways. The laryngoscope will open the way for the bronchoscope, so the latter will be inserted faster and safer.
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 language is affected. And there is not enough air, since the bronchoscope will take 3/4 of the diameter of the trachea. To eliminate both of these effects, you need to breathe quickly and superficially (“dog-like”).
The study is carried out rather quickly so as not to cause severe hypoxia. Oxygen levels should be monitored using a pulse oximeter. Its sensor - "clothespin" - is put on the finger.

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

If a bronchoscopy with biopsy is performed, it is painless. There is only discomfort behind the sternum. The mucous membrane of the bronchi has practically no pain receptors. The introduction of lidocaine before manipulation is due to the need to disable 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 given 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 forced into the lungs by a breathing apparatus (exhalation is obtained spontaneously), then a bronchoscope is inserted through the tube, and bronchoscopy is performed. How do bronchoscopy, a person does not feel.

The procedure under anesthesia is performed in childhood, people who are very afraid of the procedure, people with an unstable psyche. It is done to patients who were already on apparatus breathing, as well as, if necessary, surgical intervention.

After the procedure

After bronchoscopy, you feel:

heaviness or pressure behind the sternum - during the day;
numbness of the oral cavity and larynx - within 2-3 hours;
hoarseness or nasality - within a few hours;
blood-streaked sputum may be coughed up.

You need to follow these rules:

3 hours to be in the hospital under the supervision of staff;
Do not eat, drink or smoke for 3 hours. Food and nutrition can enter the trachea, while smoking impairs mucosal healing after manipulation;
within 8 hours do not drive, as drugs were introduced that significantly reduce the reaction rate;
2-3 subsequent days to exclude physical activity.

You also need to monitor your condition. Must not be:

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

Conclusion of bronchoscopy

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

Endobronchitis. This is an inflammation of the inner lining of the bronchus. If it is "catarrhal", then the mucous membrane was red. "Atrophic" - the shell is thinned. "Hypertrophic" - the bronchial membrane is thickened, therefore, the lumen of the bronchi is narrowed. "Purulent" - bacterial inflammation, antibiotics are needed. "Fibrous-ulcerative" - severe inflammation, led to the formation of ulcers, which are gradually replaced by scar (fibrous) tissue.
"Dense pale pink infiltrates, rise above the mucosa" - signs of tuberculosis.
"Narrowing of the diameter": inflammation, cystic fibrosis, tumors, tuberculosis.
“A wide base of the neoplasm, there are erosions, they bleed, are covered with necrosis, irregular contours” - signs of cancer.
"Thick sputum, narrowing of the lumen" - signs of cystic fibrosis.
"Fistulas" are signs of tuberculosis.
"Retraction of the bronchus wall, reduction of the lumen, edematous wall" - signs of a tumor growing from the outside of the bronchus.
"Spindle-shaped, sac-like dilatations of the bronchi, thick purulent sputum" are signs of bronchiectasis.
“The mucosa is edematous, reddened. The walls of the bronchi bulge. Sputum is a lot of transparent, not purulent” - signs of bronchial asthma.

Who should not have a bronchoscopy

There are such contraindications to bronchoscopy (specifically 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 III degree.

In these cases, virtual bronchoscopy can be performed.

It is necessary to postpone the procedure during an acute infectious disease, exacerbations of bronchial asthma, for women - during menstruation and from the 20th week of pregnancy.

When bronchoscopy is intended to assist intubation, or is needed for removal of 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, due to which oxygen ceases to flow into the lungs;
laryngospasm - the same as the previous complication, only the glottis (larynx) spasms and closes;
pneumothorax - air entering the pleural cavity;
bleeding from the wall of the bronchus (may be with a biopsy);
pneumonia - due to infection of the small bronchi;
allergic reactions;
emphysema of the mediastinum - the ingress 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 - its strengthening.

Bronchoscopy in children

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

Bronchoscopy for children is performed with:

severe shortness of breath caused, in all likelihood, by a foreign body;
accurate determination of the presence of a foreign body in the respiratory tract;
severe pneumonia, especially against the background of cystic fibrosis;
tuberculosis of the bronchi - to diagnose 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 airways. Therefore, general anesthesia is often supplemented with local anesthesia.

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

Bronchoscopy for tuberculosis

Bronchoscopy in tuberculosis is an important therapeutic diagnostic procedure. It allows:

with the help of aspiration of bronchial contents and its bacteriological examination - to isolate Mycobacterium tuberculosis (especially if bakposev was negative) and determine the sensitivity to anti-tuberculosis drugs;
drain caverns (tuberculous cavities) from necrosis;
administer anti-tuberculosis drugs locally;
dissect fibrous (scar) tissue in the bronchi;
stop the bleeding;
evaluate the dynamics of treatment (this requires repeated bronchoscopy);
inspect the stitches after the operation to remove the lung;
clear the bronchi from necrotic masses and pus when they broke through 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.

IN modern medicine There are many ways to study the respiratory tract and identify their diseases. The question of what bronchoscopy is can be answered as follows: it is a procedure that makes it possible to carefully examine the lungs with a special thin hose (bronchoscope). The diagnostic device is equipped with a light and small camera that provides video recording of the organ mucosa. The bronchoscope gently moves through the mouth or nose into the throat, trachea and respiratory tract, after which the specialist examines the gaps between the branches of the organ.

The essence of the procedure

There are two types of diagnostic devices: flexible and rigid type. They may vary in width.

The use of a flexible bronchoscope is more common. The tool is able to move into smaller branches in depth - bronchioles. It is used for the following procedures:

Organization of oxygen access.
Collection of liquid secretions and sputum.
Supply of medicines to organs.

An anesthetic bronchoscopy is performed with a rigid type of machine that is used to check for wide air gaps. Scope of its application:

Removal of excessive liquid and blood secretions.
Controlling bleeding.
Exemption from third-party particles (including in children).

Bronchoscopy is performed in the operating room with the introduction of anesthetic substances.

When is the procedure scheduled?

What is bronchoscopy and when is it indicated? The considered method is appropriate for the following cases:

Detection of benign tumors.
When diagnosing oncological disease bronchi.
Detection of obstruction processes of the respiratory tract (scientifically - obstruction).
Places of narrowing of the area in the bronchopulmonary node.
Diagnosis of inflammatory and infectious processes, including tuberculosis, interstitial diseases.
Identification of the causes of chronic cough and bloody discharge.
Confirmation or exclusion of the diagnosis by reflecting spots on chest x-ray.

Bronchoscopy of the lungs - what is it and how is it done?

Before carrying out this procedure, it is necessary to completely free yourself from jewelry, jewelry, false jaw prostheses, contact lenses, and the like. It is advisable to visit the toilet first. Diagnosis is carried out with a minimum amount of clothing on the patient.

When conducting a study with a flexible bronchoscope is not needed. Local anesthesia by injection of the drug by spraying in the oral cavity or nose is quite sufficient. The patient is in a supine or semi-lying position. The specialist inserts the device, moves it further through the throat to the organ under study.

Peculiarities

What is a bronchoscopy in progress? The display shows a picture of the passed area with its gradual advancement to the bronchi and lungs. If the procedure is also aimed at clearing bronchial mucus, at the same time a spray of therapeutic saline solution to this organ.

With the introduction of a hard-type bronchoscope, the health worker starts manipulations after the patient receives general anesthesia. The whole operation takes no more than 40-50 minutes. The invasive (alien) nature of the procedure requires a certain short rehabilitation. After bronchoscopy, you need to refrain from eating, drinking, cigarettes for 2-3 hours. Also, do not drive a vehicle.

Risks and prohibitions

What is bronchoscopy and what are its consequences? This question can be answered almost unequivocally: manipulation is not pleasant, like most medical research, but pathological complications are extremely rare.

Possible adverse effects:

The appearance of bleeding, most often occurs during a biopsy.
There is a small percentage of the occurrence of an infectious disease.
Sometimes there is difficulty in breathing.
During the procedure, the level of oxygen in the blood may decrease.

Contraindications for bronchoscopy:

Severe narrowing or blockage of the trachea (stenosis).
Increased blood pressure in the lungs blood vessels(hypertension).
Nadryvny coughing or severe vomiting.

The patient who has high level carbon dioxide in the blood, a special breathing machine may be needed before manipulation. This technique provides a direct supply of oxygen to the lungs.

Preparatory process

First of all, you need to consult a specialized physician about all possible consequences, objectivity and reliability of the results of this procedure. The specialist must adequately navigate the terminology, the name of the drugs, have an understanding of the patient's history and information about the presence of allergic reactions to drugs.

An absolutely normal phenomenon is considered to be a referral for blood donation or other tests before diagnosis. This practice is quite common before most diagnostic manipulations. 10-12 hours before the bronchoscopy, you should stop eating.

Bronchoscopy refers to an endoscopic method for examining changes inside the body. This method is indispensable when radiography is not able to detect a developing pathology.

Bronchoscopy is used to detect diseases respiratory system

general characteristics

Bronchoscopy is a method of examining the tracheal tree and diagnosing pathologies of the respiratory system using a special device - a bronchoscope. A bronchoscope is a thin tube with a microscopic camera and a light at the end. For medicinal purposes, a laser and forceps are attached to the bronchoscope. The purpose of the procedure is to determine the cause, signs of the disease, identify the complications of bronchial asthma with further treatment.

Kinds

Depending on the purpose of the study, the following types of bronchoscopy are distinguished:

Medical procedure. Indications for carrying out - cough, discharge of blood from the bronchi, extraction of foreign objects, etc.
diagnostic procedure. Indications for carrying out - assessment of the condition of the bronchial mucosa, cough of an unclear nature.

The bronchoscopy procedure is performed for therapeutic and diagnostic purposes.

virtual procedure. Indications for carrying out - detection of lung cancer. The chest is emitted with X-rays that create a three-dimensional image of the lungs.

According to the type of instrument used, bronchoscopy is divided into rigid and flexible. Analysis using a rigid instrument is carried out with bleeding of the lung, removal of neoplasms and other foreign objects.

However, the diagnostic procedure with a rigid tube is not possible if there are contraindications. For example, it is unacceptable to use when doing bronchoscopy for children. Analysis with an elastic device is carried out to determine the condition of the lower respiratory tract.

Indications for examination

Bronchoscopy diagnoses the respiratory system when the following indications are present:

persistent dry cough;

coughing up blood;
persistent shortness of breath;
cyst growth;
detection of pathologies of the lungs of tobacco-dependent people;
ambiguity of pathologies in the x-ray image;
presumptive diagnosis of lung cancer;
presumptive diagnosis of tuberculosis;
presumptive diagnosis of pneumonia.

Typically, such indications are diagnosed in a flexible way. Indications for therapeutic procedures using bronchoscopy are:

extraction of foreign particles;

Bronchoscopy may be performed to flush the pleural cavity

lavage of the lung cavity;
treatment of clogged bronchi;
developing infections in the lungs;
removal of fluid, blood from the respiratory cavity;
infusion of drugs into the bronchial cavity.

Contraindications for examination

Bronchoscopy cannot be performed if there are any of the following contraindications:

obstruction of the trachea;
acute phase of bronchial asthma;
narrowing of the vessels of the larynx;

Bronchoscopy is contraindicated in patients with exacerbations of bronchial asthma.

diseases of the cardiovascular system;
mental illnesses;
allergic reactions to anesthesia;
pregnancy;
menstrual bleeding;
infectious diseases;
lung failure.

Contraindications can not be with the threat of death of the patient.

Preparation for the procedure

Preparation for bronchoscopy begins with the delivery of tests. For admission to the survey, you need to conduct some research:

donate blood to general analysis;

Before the bronchoscopy procedure, a complete blood count should be taken.

donate blood for clotting analysis;
donate blood to determine the level of urea;
make an ECG;
take a chest x-ray.

During the preparatory consultation, the doctor determines if there are any allergic reactions, how the patient tolerates anesthesia. Typically, the doctor uses local anesthesia with flexible bronchoscopy. General anesthesia is required for rigid bronchoscopy and if bronchoscopy is performed in children. During the consultation, the doctor advises:

Stop drinking alcohol for a week.
Do not eat for 8 hours before the procedure. Bronchoscopy is performed on an empty stomach.
Take an enema before leaving the house.

Patients tolerate the bronchoscopy procedure more easily if they drink a sedative the day before.

For a couple of hours, take a sedative.
Emptying in an hour Bladder and intestines.
Before the procedure, remove jewelry that interferes with the introduction of the bronchoscope.

Failure to follow the preparatory procedures increases the risk of complications.

How is the examination

The patient lies on his back on the couch. The doctor injects anesthesia. Narcosis suppresses gag reflexes. After the introduction of anesthesia, the oral cavity becomes numb, a slight stuffiness of the nasal passage is felt, coughing is excluded.

The bronchoscope is inserted into oral cavity rotational movements, slightly pushing to the bronchi. The patient breathes calmly, deeply and slowly. The doctor examines the mucous cavity of the lungs and bronchi. Then slowly removes the tube from the larynx. Bronchoscopy lasts 30-50 minutes. For two hours, the patient is in the ward under supervision in order to prevent negative consequences. In order not to develop complications, you need to eat and drink after 3-4 hours.

During a bronchoscopy, the doctor examines the bronchi and lungs.

As a result of the bronchoscopy reveals signs various diseases. For example:

Gaps on the walls of the bronchi, swelling of the mucous membrane, its erosion, narrowing of the airways indicate the development of tuberculosis.
Inflammation and swelling of the mucous cavity of the bronchi, its bleeding and thinning, the inability to view the vessels, purulent secretion indicate the occurrence of endobronchitis.
Narrowing of the lumen of the bronchi by more than two times, bruising on the walls of the mucosa, sputum stagnation are signs of cystic fibrosis.
Neoplasms on the membrane wall of the trachea, its thickening, a hard, rough surface of the bluish tint of the bronchi, erosion and bleeding of the mucous membrane of the cavity, liquid or air in the bronchi, narrowing of the lumen are signs of a developing malignant cancerous tumor.
At bronchial asthma swelling of the mucous membrane, fluid discharge without purulent admixture, changes in the color of the bronchi are observed.

Depending on the condition of the bronchial mucosa, the doctor can diagnose the disease.

Possible Complications

The risk of complications after bronchoscopy is extremely low. Complications occur in only 1% of the examined patients. This group of patients has the following indications:

nausea, vomiting;
blueing of the skin;
temperature;
spasms of breathing, suffocation;
hoarseness in voice, hoarse cough.

In this case, you should immediately seek advice from your doctor. Conducting a survey in exceptional cases causes more serious consequences, for example:

pulmonary edema;

There is a small risk of developing pulmonary edema after bronchoscopy

the development of emphysema - the flow of oxygen into the bronchi without further exhalation;
development of atelectasis - the impossibility of oxygen supply to part of the lung;
purulent inflammation of the trachea or bronchi;
infection of the blood with outgoing pus;
allergic reactions to anesthesia.

As a rule, such complications are diagnosed during bronchoscopy or after the first hour of observation of the patient. Therefore, measures are taken immediately and the consequences are eliminated. Bronchoscopy is a rather unpleasant procedure. However, there is nothing to be afraid of. The examination takes place under anesthesia, which makes the examination process comfortable and painless for the patient.

The video will introduce the features of bronchoscopy:

Bronchoscopy is one of the most informative instrumental methods for examining the tracheobronchial tree, which allows not only to establish a diagnosis, but also, if necessary, to carry out a number of therapeutic measures (sanation, removal of a foreign body, taking swabs, etc.). Before bronchoscopy without fail an x-ray or CT scan of the chest is performed.

Bronchoscopy allows with an accuracy higher than 97% diagnose lung cancer, pneumonia of any type, chronic bronchitis and other diseases of the respiratory system.

In the diagnostic department of the Central Clinical Hospital of the Russian Academy of Sciences in Moscow, bronchoscopy can be done at any time convenient for the patient at an affordable price. Important: endoscopy of the lungs, bronchi or trachea - should be carried out by an experienced specialist in conditions equipped with advanced anesthesia and diagnostic equipment. So the patient can count on the absence of discomfort and the guaranteed informativeness of the result.

Indications and contraindications for the procedure

Endoscopic examination of the lungs and other organs of the respiratory system is indicated in the following cases:

For removing small objects from the respiratory tract.
To expand the respiratory lumen.
To remove small tumors.
To ensure the possibility of taking a sample of the material for a biopsy.
To cleanse the respiratory tract (in case of accumulation of mucus, pus, etc.)
For the administration of medicinal solutions.

Preparation

Before an endoscopic examination of the tracheobronchial tree for patients of both sexes, radiography and CT of the chest organs are mandatory.

Holding

Endoscopic examination of the lungs and other organs of the respiratory system is carried out as follows:

The patient is given drugs that have a bronchodilator effect to facilitate the passage of the bronchoscope.
The patient is seated in a special chair equipped with progressive anesthesia equipment.
Anesthesia of the larynx and vocal cords is performed.
The bronchoscope is inserted during a deep breath. Further, its passage through the respiratory tract is performed by careful rotational movements.
During the examination, the necessary manipulations can be performed - the treatment of organs with drug solutions, the collection of material for a biopsy, etc.
After the study, the bronchoscope is carefully removed, after which the patient is not recommended to eat and buy for 2 hours.

Bronchoscopy as a way to make a diagnosis

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 therapeutic method that allows you to effectively eliminate certain pathological changes. We will talk about what bronchoscopy of the lungs is, what are the indications and contraindications for this study, what is the methodology for conducting it, in this article.

What is bronchoscopy

Bronchoscopy is a method of examining the bronchi using a long flexible tube with an optical system at the end - a bronchoscope.

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. real time. In addition, the resulting image can be saved as photographs or video, so that in the future, by comparing the results of the current study with the previous one, it will be possible to evaluate the dynamics pathological process. (in our other article.)

A bit of history

For the first time, bronchoscopy was 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 as an anesthetic for the patient. 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 fibrobronchoscope, a flexible bronchoscope made of light-fiber optics, appeared. The electronic endoscope, which makes it possible to multiply 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 fiber bronchoscope

This instrument uses fiber optics.
It is primarily a diagnostic tool.
Easily penetrates even into the lower sections of the bronchi, minimally injuring their mucous membrane.
The examination procedure is carried out under local anesthesia.
Used in pediatrics.

It consists of a smooth flexible tube with an optical cable and a light guide inside, a video camera at the inner end and a control handle at the outer end. A catheter is also available to remove fluid from or supply airways medicinal product and, if necessary, additional equipment for diagnostic and surgical manipulations.

Rigid or rigid bronchoscope

It is often used for the purpose of resuscitation of patients, for example, when drowning, to remove fluid from the lungs.
It is widely used for medical procedures: removal of foreign bodies from the respiratory tract,.
Allows you to carry out diagnostic and therapeutic manipulations in the area and the main bronchi.
If necessary, in order to study thinner bronchi, a flexible one can be inserted through a rigid bronchoscope.
If any pathological changes are detected during the study, this device can immediately eliminate them.
When examining with a rigid bronchoscope, the patient is under general anesthesia - he is sleeping, which means that he does not experience fear of the study or the unpleasant sensations he expects.

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. Also included are various mechanisms for medical and diagnostic procedures.

Indications for bronchoscopy

Bronchoscopy can be used for both diagnostic and therapeutic purposes.

Indications for fibrobronchoscopy are:

suspicion of a neoplasm in the lungs;
the patient has symptoms that are inadequate for the diagnosed disease, such as 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 bleeding;
atelectasis (collapse of part of the lung);
, characterized by a protracted course, poorly treatable;
individual cases;
pulmonary tuberculosis;
the presence on the shadow (or shadows), the nature of which needs to be clarified;
upcoming surgical intervention on the lungs;
blockage of the bronchi by a foreign body or blood, mucus, purulent masses - in order to restore the lumen;
, abscesses of the lungs - for washing the respiratory tract with medicinal solutions;
stenosis (pathological narrowing) of the airways - in order to eliminate them;
bronchial fistulas - in order to restore the integrity of the bronchial wall.

Examination with 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;
in case of inhalation of a large amount of stomach contents mixed with food;
at the age of up to 10 years;
for the purpose of treating bronchial fistulas, stenosing (narrowing the lumen) cicatricial 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 for the speedy establishment of the correct diagnosis and elimination of the problem. The main indications for this procedure are:

heavy bleeding from the respiratory tract;
foreign body of the trachea or bronchi;
swallowing (aspiration) by the patient of the contents of the stomach;
thermal or chemical burns of the respiratory tract;
with blockage of the lumen of the bronchi with mucus;
airway injury due to trauma.

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

Contraindications for bronchoscopy

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

allergy to painkillers administered to the patient before the study;
acute violation of cerebral circulation;
myocardial infarction in the last 6 months;
severe arrhythmias;
severe heart or lung failure;
severe essential arterial hypertension;
stenosis of the trachea and / or larynx of the 2nd or 3rd degree;
acute abdomen;
some diseases of the neuropsychic sphere - the consequences of a traumatic brain injury, epilepsy, schizophrenia, etc .;
diseases of the oral cavity;
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 fibrobronchoscopy in these cases is acceptable.

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;
the period of menstruation in women;
diabetes mellitus with high blood sugar levels;
alcoholism;
increase thyroid gland 3rd degree.

Study preparation

Before the examination, the doctor tells the patient in detail the essence of the upcoming procedure, warns about possible complications, and the patient, in turn, signs the consent to 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 analysis blood tests, lung function tests, chest x-rays, or others, depending on the disease of the individual patient.

Immediately before the study, the patient will be asked to sign a consent to this procedure. It is important to remember to tell your doctor if you have any allergies to medications, especially to anesthetics, if any, if you are pregnant, if you are taking any medications, 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 evening before, and in the morning he is forbidden to eat. 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, a few days before the study, he may be prescribed light sedatives.

How is a bronchoscopy performed?

Bronchoscopy is a serious procedure that is carried out in a specially equipped room for this purpose in compliance with all sterile conditions. A bronchoscopy is performed by an endoscopist or pulmonologist 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 the shirt if the collar is tight enough, and empty the 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 arms should be lowered between his legs.

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

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

When the above drugs have worked, 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 the introduction of the bronchoscope, the patient is advised to breathe shallowly and as often as possible.

The doctor evaluates the state of the respiratory tract as the bronchoscope moves - from top to bottom: first, it examines the larynx and glottis, then the trachea, after which - the main bronchi. The study with a rigid bronchoscope is completed at this level, and with fibrobronchoscopy, the underlying bronchi are also subject to examination. 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 perform additional diagnostic or directly therapeutic manipulations: take swabs from the bronchi, sputum or a piece of pathologically altered tissue (biopsy) for examination, remove the contents that clog the bronchus, and wash 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 blood saturation of the subject with oxygen.

Patient sensations during bronchoscopy

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

With local anesthesia, after the administration of the drug, there is a feeling of a coma in the throat, the palate becomes numb, it becomes difficult to swallow. The bronchoscope tube has a very small diameter, so it does not interfere with the breathing of the subject. While the tube is moving along the airways, a slight pressure may be felt in them, but the patient does not experience any discomfort.

During general anesthesia, the patient is asleep, which means that he does not feel anything.

After research

Recovery after bronchoscopy takes no more than 2-3 hours. 30 minutes after the end research will be the action of the anesthetic - 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 a day later - such actions minimize the risk of bleeding from the respiratory tract after bronchoscopy. If the patient before the study received certain sedatives, within 8 hours after taking them, he is categorically not recommended to drive a vehicle.

Complications of bronchoscopy

Usually, this study well tolerated by patients, but sometimes, extremely rarely, complications still occur, 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 necessity and expediency of bronchoscopy in each case is determined by a pulmonologist or therapist, but it is performed only with the consent of the patient after his written confirmation.