Bronchoscopy examination. What is bronchoscopy and how is it done? Conditions for using bronchoscopy

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 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. 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. (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: removal of foreign bodies from the respiratory tract,.
• Allows for diagnostic and therapeutic manipulations in the area of ​​the 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

Bronchoscopy can be used for both diagnostic and therapeutic purposes.

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 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);
• , characterized by a protracted course, difficult to treat;
• individual cases;
• pulmonary tuberculosis;
• the presence of shadows (or shadows), 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;
• , 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;
• for children 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;
• 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;
• 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 the study, the doctor tells the patient in detail the essence of the upcoming procedure, warns about possible complications, and the patient, in turn, signs 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 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 injected subcutaneously or into the patient.

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, a feeling of a lump appears in the throat, 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.

For patients, the names of the studies sometimes sound intimidating, and then they wonder - pulmonary bronchoscopy: what is it? This is a rather complex procedure that provides great therapeutic and diagnostic capabilities.

Bronchoscopy is associated with certain risks, but if the procedure is performed correctly, it is minimal. It is performed under almost the same conditions as a regular operation and with the same precautions.

Before carrying out the manipulation, you need to find out what it is intended for, where it can be performed, how long the rehabilitation period lasts, and what the price of bronchoscopy is.

General information

First you need to understand what diagnostic bronchoscopy is. In general, bronchoscopy of the lungs is an instrumental examination of the mucous membranes of the bronchi and trachea using a bronchoscope.

This method was first used in 1897. The manipulation was then very painful and caused serious injuries to the patient.

Early bronchoscopes were very far from perfect, and the first rigid, but safer for the patient, device was created only in the middle of the twentieth century. Doctors were able to become acquainted with a flexible bronchoscope only in the late 60s of the twentieth century.

Modern devices are equipped with LED lamps and can display video (video bronchoscopy) and photos. The main tube is inserted into the airway through the larynx.

There are 2 groups of modern devices:

1. Rigid bronchoscope - used for therapeutic purposes when it is impossible to manipulate a flexible device. For example, it expands the lumen of the bronchi and helps remove foreign objects. A fiberoptic bronchoscope is also inserted through it to examine the thin bronchi.
2. Fiber bronchoscope (flexible bronchoscope) is the optimal tool for diagnosing the lower sections of the bronchi and trachea, which cannot be penetrated with a rigid device. Fiberglass bronchoscopy can be performed even on a child, and a similar model of bronchoscope does not require anesthesia and is less traumatic.

Each group has its own specific applications and strengths.

Indications and contraindications

The bronchoscopy procedure is performed in cases where it is necessary to determine the extent of damage to the bronchial tree during various diseases of the bronchi and lungs, as well as for endoscopic operations and diagnosis of diseases.

Bronchoscopy is prescribed:

Bronchoscopy also allows you to administer aerosols and solutions of drugs, perform endoscopic operations, evaluate the effectiveness of operations, and, if necessary, used in resuscitation measures.

Bronchoscopy is accompanied by a high risk - the consequences of the procedure can be dangerous. This manipulation requires general or local anesthesia, which is not always easily tolerated. If carried out incorrectly Possible gag reflex, injuries to the bronchial mucosa (even bleeding is possible). During the procedure, breathing may stop.

After bronchoscopy, if the patient does not follow the rules for preparing and conducting the study, bleeding may occur, and a sharp deterioration in the patient’s condition is also possible.

Bronchoscopy cannot be performed if:

• There is a narrowing (stenosis) of the bronchi or larynx;
• During an exacerbation of COPD or an attack of bronchial asthma;
• With respiratory failure;
• With coarctation or aneurysm of the upper aorta;
• After a recent stroke or heart attack;
• In case of intolerance to anesthesia drugs;
• For bleeding disorders;
• For mental illness.

Old age may also be a contraindication to the procedure - many older people have poor tolerance to anesthesia drugs.

Preparing the patient for bronchoscopy

Bronchoscopy is a long and complex process that requires compliance with certain rules, highly qualified medical personnel, proper preparation of the patient, caution during manipulation, as well as medical supervision after.

Before the procedure, you need to prepare. Usually an X-ray of the lungs is taken (bronchography is also performed), where pathological changes are visible - increased pulmonary pattern, lesions throughout the lungs, emphysema or the appearance of areas of atelectasis.

Based on the results of radiography, a decision is made on the need and advisability of bronchoscopy.

Before prescribing bronchoscopy, the doctor prescribes other tests for the patient - coagulography, ECG, biochemical blood test. These studies are necessary to assess the safety of the procedure for the patient.

The doctor will conduct a preliminary survey, finding out what chronic diseases the patient has in his medical history. It is especially important to find out whether the patient has bleeding disorders, heart disease, autoimmune and allergic diseases, or intolerance to various drugs.

When all indications and contraindications are taken into account, the attending physician prescribes bronchoscopy. The night before the examination, you can take a sleeping pill, since the manipulation is accompanied by stress, and lack of sleep can aggravate it. You need to eat 8 hours before the procedure, and smoking is also prohibited on the day of the examination.. The evening before the procedure or the morning of the day, it is necessary to cleanse the intestines, possibly rinsing with an enema.

Patients with bronchial asthma should take their inhaler with them.

For diseases of the cardiovascular system, when bronchoscopy is not contraindicated, the following medications are necessarily prescribed:

• Antihypertensive drugs;
• Antiarrhythmics;
• Anticoagulants and antiplatelet agents;
• Beta blockers;
• Sedatives.

This treatment technique reduces the risk of complications.

How is bronchoscopy done?

Bronchoscopy can be performed exclusively in a specially equipped room in compliance with all antiseptic and aseptic conditions. The doctor performing the manipulation must be highly qualified to prevent damage to the bronchi during the manipulation process.

Performing bronchoscopy has the following algorithm:

What to do after the procedure?

During the postoperative period, the patient may experience slight hemoptysis, which is considered normal. Patients with bronchial asthma may have an attack, so you need to have an inhaler with you. If the patient suffers from pathologies of the cardiovascular system, then pressing, mild pain in the heart may occur.

After local anesthesia, disturbances in swallowing, sensitivity and speech persist; this can last 2-3 hours. Until the residual effects pass, it is recommended not to drink water or eat food - this may cause pieces of food to enter the respiratory tract. Sedatives slow down the reaction, so you should not perform work that requires increased attention and concentration for 8-9 hours. It is also necessary to refrain from smoking during the day.

After general anesthesia, the patient must remain in the hospital for at least a day to avoid the negative consequences of strong anesthesia. If the condition allows, the patient is discharged the next day. However, in any case, symptoms of weakness and dizziness, orthostatic hypotension, which will last up to several days, may be observed. At this time, it is advisable to refrain from activities that pose a risk to health and life.

An ambulance is needed immediately if the following symptoms appear after bronchoscopy:

• Hemoptysis;
• Chest pain;
• Difficulty breathing, wheezing;
• Nausea, vomiting;
• The temperature rose after the procedure and chills were observed.

The above symptoms are signs of bleeding in the bronchi or infection. It is necessary to consult a doctor in a timely manner so that these complications do not pose a threat to life.

Video:

– a diagnostic method that allows you to diagnose diseases of the large bronchi and trachea. To carry out the procedure, a bronchoscope is used - a flexible tube with a light source and a built-in video camera. The device is placed in the oral cavity, after which it is carried deeper and moved into one of the bronchi.

Types of bronchoscopy

There are two types of procedure:

1. Rigid bronchoscopy. It is carried out using a rigid bronchoscope. This procedure allows you to detect foreign bodies in the respiratory tract, and it is also used for bleeding of the respiratory system. Rigid bronchoscopy is performed under general anesthesia.
2. Flexible bronchoscopy. It is carried out using an elastic fiber-optic bronchoscope. This procedure is the most common because it does not require general anesthesia. It is performed under local anesthesia. Flexible bronchoscopy allows you to examine the inner surface of the upper respiratory tract.

Advantages and disadvantages

Bronchoscopy is considered a virtually harmless diagnostic procedure. This method effectively allows us to find out the causes of many respiratory diseases when other studies are inconclusive. The use of a fiberoptic bronchoscope makes it possible to carefully examine the lower respiratory tract and penetrate the bronchi as deeply as possible.

The main disadvantage of bronchoscopy is the discomfort experienced by patients. Also, the procedure often causes a slight sore throat and slight bleeding of the mucous membrane. These symptoms go away without additional treatment, but if they intensify, medical help is necessary.

Indications for use

Bronchoscopy can be prescribed for many reasons: identifying the cause of a prolonged cough, difficulty breathing, foreign bodies entering the respiratory tract, and diagnosis before lung surgery. Direct indications for bronchoscopy are:

• tuberculosis;
• suspected lung cancer;
• pulmonary atelectasis;
• smoker experience for more than 5 years;
• chronic bronchitis, bronchial asthma;
• hemoptysis;
• obstructive pulmonary diseases.

Bronchoscopy can be both diagnostic and therapeutic. During diagnostic tests, doctors simply monitor the condition of the lungs and bronchi. Therapeutic is intended to remove foreign bodies or pathological contents of the bronchi; this method can also be used to administer medications.

Contraindications

Bronchoscopy of the lungs is contraindicated in people with laryngeal stenosis (a shrinkage of the larynx that makes breathing difficult) and heart rhythm disturbances. Patients with the following diseases should refuse the study:

• cardiovascular failure;
• bronchospasm;
• acute stroke;
• myocardial infarction;
• hypertonic disease.

In addition, the procedure is contraindicated for people with hypersensitivity to medications used for anesthesia. In the presence of neuropsychiatric diseases such as schizophrenia, epilepsy or consequences of traumatic brain injury, bronchoscopy is contraindicated.

Preparation for the procedure

Preparation for bronchoscopy consists of a number of procedures: determination of urea levels and blood saturation, electrocardiography. As a rule, the procedure is carried out in the first half of the day. Eating is allowed at least 10 hours before surgery, since bronchoscopy is performed on an empty stomach. This is necessary to avoid food debris getting into the respiratory tract.

If the patient takes medications daily, the day before the test, you should consult with your doctor about the medication schedule. On the day when bronchoscopy of the lungs is performed, you should not drink water or smoke.

Carrying out the procedure

To begin with, doctors use local anesthetics. They are applied by spraying onto the mucous membrane of the nasal cavity and oropharynx. Anesthesia will not only help reduce pain as much as possible, but will also help suppress coughing. When the drugs begin to take effect, the patient experiences numbness in the throat and tongue, and a feeling of a warm lump in the throat appears. A similar effect is caused by anesthesia performed by dentists.

Then the specialist decides in which position it is better to carry out the procedure: lying on a couch or sitting on a chair. After that, the endoscope is inserted into the respiratory tract through the nasal cavity, sometimes the device is inserted through the mouth. The procedure is painless. Since the lumen of the bronchi is much larger than the diameter of the bronchoscope, there is no breathing discomfort during the procedure.

After the examination, the patient may experience minor pain in the larynx. This is a temporary effect, to combat which doctors prescribe special lozenges and gargles. Due to the use of anesthetics, the mucous membrane of the pharynx loses sensitivity, which leads to difficulty swallowing. All reflexes are restored a few hours after the procedure, so you have to abstain from eating and drinking for some time.

To quickly remove the contrast agent from the bronchi, breathing exercises or postural drainage are prescribed. At the same time, the patient takes the desired position, which helps cleanse the bronchial tree.

Possible complications

After bronchoscopy, a person returns to everyday life almost immediately, but in rare cases the following complications occur:

• bleeding;
• swelling of the throat;
• infection;
• damage to the vocal cords;
• irregular pulse;
• lung puncture.

In any case, you need to urgently seek help from your doctor. To avoid other undesirable consequences, upon returning home you should follow the recommendations of doctors, including following a diet.

Pulmonology is a broad branch of medicine that studies diseases and pathologies of the human respiratory system. Pulmonologists are involved in the development of methods and measures for diagnosing diseases, preventing and treating the respiratory tract.

When diagnosing diseases of the respiratory system, the patient is first examined externally, the chest is palpated and tapped, and also carefully listened to. And only then pulmonologists can resort to instrumental research methods:

• spiriography (measurement of respiratory volumes of the lungs);
• pneumotachography (registration of the volumetric flow rate of inhaled and exhaled air);
• bronchoscopy;
• radiation research methods;
• thoracoscopy (examination of the pleural cavity using a thoracoscope);
• radioisotope research.

Most procedures are unfamiliar to ordinary people without medical education, so quite often you can come across questions like - how is bronchoscopy done? What is this, in general, and what to expect after the procedure?

General information

First of all, you should understand what bronchoscopy is. In short, bronchoscopy of the lungs is an instrumental examination of the mucous membranes of the trachea and bronchi using a bronchoscope.

This method was first used back in 1897. The manipulation was painful and seriously injured the patient. Early bronchoscopes were far from perfect. The first rigid, but safer for the patient, device was developed only in the 50s of the twentieth century, and doctors became acquainted with a flexible bronchoscope only in 1968.

Modern devices are equipped with LED lamps and have the ability to display photos and videos on the screen. The main working tube is inserted through the larynx into the airway.

There are two groups of modern devices:

1. Fiber bronchoscope (flexible)- excellent for diagnosing the lower parts of the trachea and bronchi, where a rigid device cannot penetrate. FBS bronchoscopy can be used even in pediatrics. This model of bronchoscope is less traumatic and does not require anesthesia.
2. Rigid bronchoscope- is actively used for medicinal purposes that cannot be achieved with a flexible device. For example, to expand the lumen of the bronchi, remove foreign objects. In addition, a flexible bronchoscope is inserted through it to examine the thinner bronchi.

Each group has its own strengths and specific areas of application.

In pediatric practice, bronchoscopy is most often used to remove foreign objects from the respiratory tract.

Purpose of the procedure and indications for use

Bronchoscopy is performed not only for diagnostic purposes, but also to perform a number of therapeutic procedures:

• taking a biopsy sample for histological examination;
• excision of small formations;
• removal of foreign objects from the bronchi;
• cleansing from purulent and mucous exudate;
• achieving a bronchodilator effect;
• washing and administration of medications.

Bronchoscopy has the following indications:

• X-rays revealed small foci and pathological cavities in the lung parenchyma, filled with air or liquid contents.
• There are suspicions of a malignant formation.
• There is a foreign object in the respiratory tract.
• Prolonged shortness of breath, but not due to bronchial asthma or cardiac dysfunction.
• For tuberculosis of the respiratory system.
• Hemoptysis.
• Multiple foci of inflammation of the lung tissue with its disintegration and the formation of a cavity filled with pus.
• Sluggish chronic pneumonia of unknown nature.
• Developmental defects and congenital lung diseases.
• Preparatory stage before lung surgery.

In each individual case, doctors use an individual approach when prescribing such manipulation.

Preparation for the procedure

Preparing for bronchoscopy involves the following steps:

1. There should be a thorough preliminary discussion between the doctor and the patient. The patient must report any allergic reactions, chronic diseases and medications taken on a regular basis. The doctor is obliged to answer all questions that concern the patient in simple and accessible language.
2. You should not eat food 8 hours before the procedure, so that leftover food does not enter the respiratory tract during the procedure.
3. To ensure proper rest and reduce anxiety the night before, the patient is recommended to take a sleeping pill in combination with a tranquilizer before going to bed.
4. In the morning of the day of the procedure, it is recommended to cleanse the intestines (enema, laxative suppositories), and empty the bladder before the bronchoscopy itself.
5. Smoking on the day of the procedure is strictly prohibited.
6. Before the procedure begins, the patient may be given a sedative to reduce anxiety.

Patients with tuberculosis undergo bronchoscopy quite often to monitor the course of the disease and carry out therapeutic measures.

In addition, you should undergo a number of diagnostic measures in advance:

• X-rays of light;
• clinical blood test;
• coagulogram;
• blood gas analysis;
• blood urea test.

Since short spitting of blood is expected after the procedure, the patient should have a towel or napkins with him. And for those who suffer from bronchial asthma, it is important not to forget their inhaler.

A bronchoscopy of the lungs is performed in a special room for various endoscopic procedures. Strict asepsis rules must be observed there. The procedure must be performed by an experienced doctor who has undergone special training.

Bronchoscopic manipulation proceeds as follows:

1. The patient is administered bronchodilators subcutaneously or in aerosol form to dilate the bronchi for unhindered passage of the bronchoscopic instrument.
2. The patient sits down or takes a supine position. It is important to ensure that the head does not stretch forward and the chest does not arch. This will protect against injury to the mucous membrane during insertion of the device.
3. From the moment the procedure begins, frequent and shallow breathing is recommended, this will reduce the gag reflex.
4. There are two ways to insert the bronchoscope tube - the nose or the mouth. The device enters the airway through the glottis when the patient takes a deep breath. To go deeper into the bronchi, the specialist will perform rotational movements.
5. The research is proceeding in stages. First of all, it is possible to study the larynx and glottis, and then the trachea and bronchi. Thin bronchioles and alveoli have too small a diameter, so it is unrealistic to examine them.
6. During the procedure, the doctor can not only examine the respiratory tract from the inside, but also take a biopsy sample, extract the contents of the bronchi, perform therapeutic lavage or any other necessary manipulation.
7. The anesthesia will be felt for another 30 minutes. After the procedure, you should refrain from eating and smoking for 2 hours so as not to cause bleeding.
8. It is better to remain under the supervision of medical personnel at first in order to promptly identify any complications that arise.

How long the procedures will take depends on what purpose is being pursued (diagnostic or therapeutic), but in most cases the process takes from 15 to 30 minutes.

During the procedure, the patient may feel compression and lack of air, but he will not experience pain. Bronchoscopy under anesthesia is done when using rigid bronchoscope models. It is also recommended in children's practice and for people with unstable psyches. While in a state of medicinal sleep, the patient will not feel anything at all.

Bronchoscopy is the only way to take a lung biopsy without resorting to open surgery

Contraindications and consequences

Despite the fact that the procedure is very informative and in some cases cannot be avoided, there are serious contraindications to bronchoscopy:

• Significant reduction or complete closure of the lumen of the larynx and trachea. In these patients, insertion of the bronchoscope is difficult and breathing problems may occur.
• Shortness of breath and bluish skin may indicate a sharp narrowing of the bronchi, which increases the risk of damage.
• Status asthmaticus, in which the bronchioles swell. If you carry out the procedure at this moment, you can only aggravate the patient’s already serious condition.
• Saccular protrusion of the aorta. During bronchoscopy, patients experience severe stress, and this, in turn, can lead to aortic rupture and severe bleeding.
• Recent heart attack or stroke. Manipulation of a bronchoscope causes stress, and hence vasospasm. In addition, there is some lack of air in the process. All this can provoke a recurrence of a serious illness associated with poor circulation.
• Problems with blood clotting. In this case, even minor damage to the mucous membrane of the respiratory tract can provoke life-threatening bleeding.
• Mental illnesses and conditions after traumatic brain injury. The bronchoscopy procedure can cause convulsions due to stress and lack of oxygen.

If the procedure was performed by an experienced specialist, then the consequences of bronchoscopy will be minimized, however, they do occur:

• mechanical obstruction of the airways;
• perforation of the bronchial wall;
• bronchospasm;
• laryngospasm;
• accumulation of air in the pleural cavity;
• bleeding;
• temperature (febrile state);
• penetration of bacteria into the blood.

If after bronchoscopy the patient experiences chest pain, unusual wheezing, fever, chills, nausea, vomiting or prolonged hemoptysis, he should urgently seek help from a medical facility.

Bronchoscopy of the lungs is an instrumental examination of the mucous membranes of the trachea and bronchi using a special device - a bronchoscope. With this type of intervention, it is possible to identify or eliminate any pathology, flush the airways, or administer a medicinal substance.

Lung bronchoscopy is a pulmonological method for studying the bronchial tree, showing even minimal problems that threaten the patient’s health.

This medical procedure is needed to:

• assess the internal condition of the bronchi and trachea;
• take a sample of a suspicious area of ​​tissue for histological examination;
• remove a foreign body from the trachea.

Indications for use

Indications for the procedure:

• detection of tumors that are benign;
• diagnosis of bronchial cancer;
• identification of stagnant processes in the respiratory organs (sanitation bronchoscopy is required);
• suspicion of infection and inflammation;
• establishing the causes of bloody discharge when coughing;
• a feeling of shortness of breath, incomplete inhalation and exhalation (when heart disease and asthma are excluded);
• excessive production of mucus that has an unpleasant odor;
• pronounced symptoms of chronic cough.

Contraindications

Contraindications for the study:

• narrowing of a pathological nature, in which the endoscope is unable to penetrate the trachea and bronchi;
• the patient has asthma or diseases of the vascular or cardiac system;
• mental problems;
• respiratory failure;
• hypertension (high blood pressure);
• pregnancy.

Advantages and disadvantages

Advantages and disadvantages of the procedure:

Does it hurt or not?

Bronchoscopy of the lungs does not cause pain, but the insertion of the device is accompanied by:

• numbness of the palate;
• lump in throat;
• difficulty swallowing.

Bronchoscopy can be unpleasant at the initial stage of the procedure, but then the negative sensations disappear.

What does it reveal?

This examination method reveals:

• neoplasms of various etiologies;
• bronchial deformations;
• tuberculosis;
• stenosis of the branches of the windpipe;
• decreased tone of large bronchi.

The Health-Saving Channel briefly describes what bronchoscopy shows and determines.

Types of research

Types of bronchoscopy differ depending on the type of device used, as well as the purpose of the procedure.

Depending on the device

Depending on the bronchoscope, there are:

Fiberglass bronchoscopy (FBS) is a study using a flexible endoscope and is used when there are no direct indications for using another type of instrument. The thin tubes of the device make it easy to move into the lower parts of the bronchi.

Bronchoscopy of the lungs using a rigid device has another name - rigid. It is used to examine large bronchi and is widely used for resuscitation purposes.

Depending on the purpose of the event

Depending on the purpose of bronchoscopy, there are:

• diagnostic;
• medicinal;
• virtual.

Diagnostic bronchoscopy

The purpose of the procedure is to examine the respiratory organs to identify certain lesions that can confirm the doctor’s preliminary diagnosis.

Diagnostic bronchoscopy is:

1. Fluorescent. It involves administering a special acid to the patient, after which the light system of the device can determine the red zone (indicating the presence of a tumor).
2. Autofluorescent. Also used to detect various tumors. A special light system causes a green glow of the bronchus (its submucosal layer).

Therapeutic bronchoscopy

The need for therapeutic bronchoscopy may arise when:

• rinsing of the airways to remove blood clots or sputum is required;
• the patient suffers from a severe form of pneumonia, in which it is recommended to administer an antibiotic to a specific bronchus;
• you have to stop bleeding in the lungs;
• it is necessary to get rid of pus if the accumulation is located near the bronchus.

Virtual bronchoscopy

Features of virtual bronchoscopy:

• represents an alternative study - CT scan of the bronchi;
• X-ray sections and a special program allow you to see the smallest details and pathologies;
• This method does not involve external intervention.

Preparation for the procedure

Preparation for bronchoscopy includes:

• preliminary analyses;
• consultation with a doctor;
• diet and taking sedatives.

What research needs to be done?

Before the procedure you need to do:

• radiography;
• electrocardiography;
• take blood tests: general and biochemical, coagulation tests;
• determine the level of gases in the blood.

Consultation with a doctor

With the results obtained, you should consult your physician. He will tell you whether additional examinations are required from specialized specialists, and will also answer all questions about the procedure. If no contraindications are found, the specialist will refer the patient to undergo pulmonary bronchoscopy.

Proper diet and sedatives

The following rules will help the patient prevent negative consequences:

1. You should eat eight hours before the procedure. It is important not to eat heavy foods or those that cause bloating. You also need to limit yourself in fluid intake.
2. So that the patient can fully rest, the specialist will prescribe sedatives and sleeping pills.

What should you do immediately before bronchoscopy?

Immediately before the procedure you need to:

• calm down and set yourself in a positive mood;
• empty your bladder;
• take a towel for examination - after completion of the examination, a short cough with blood discharge is likely to occur;
• refrain from smoking;
• in the morning, before visiting the clinic, cleanse the intestines (using an enema or replacing with glycerin suppositories).

How is bronchoscopy done?

If the manipulation takes place without the use of general anesthesia, the procedure involves the following algorithm of actions:

1. The patient undresses to the waist and lies down on the couch, or remains in a sitting position on a chair; the rules of behavior during the procedure and how it goes are explained to him.
2. An injection with a special drug is injected into the shoulder area, which has a suppressive effect on salivation.
3. A sedative is administered.
4. Drugs are sprayed into the mouth area to dilate the bronchi.
5. Local anesthesia is given to the root of the tongue and the device itself (its outer part) is treated with the same solution.
6. The bronchoscope tube is passed through the mouth or nose while the patient takes a deep breath and begins to look at the respiratory organs.
7. An endoscopy is performed strictly according to the scheme, first examining the glottis and larynx. When there is a need for a biopsy, material is collected for research.

After completing the bronchoscopy, the patient is given a protocol of the completed examination with photographs.

General or local anesthesia?

Most bronchoscopy cases require only local anesthesia.

The need to use general anesthesia may be due to the peculiarities of the patient’s mental state or his age. This type of anesthesiology is used to examine children and patients in stress and shock.

How long does the procedure take?

Bronchoscopy of the lungs takes no more than half an hour. The duration depends on the purpose of its implementation, but as practice shows, this is a fairly quick study.

How is bronchoscopy performed on children?

For children, bronchoscopy is done as follows:

1. The child is reassured and explained in detail how to behave.
2. The baby's nasal cavity is thoroughly cleaned.
3. Anesthesia (narcosis) is administered.
4. The procedure is performed while you sleep, using a small-diameter bronchoscope.

Consequences and possible complications

Consequences and possible complications may be as follows:

• opening of bleeding;
• allergic reactions to the painkiller used during the procedure;
• bronchospasms;
• increased arrhythmia;
• for children - a decrease in blood pressure, in addition, anaphylactic shock is possible.

Decoding the results

The results of the study may be as follows:

Disease	Endoscopic picture
Polyp on vocal cords	A neoplasm that prevents the ligaments from closing completely. Has different lengths.
Tuberculosis	Sputum of cloudy and viscous consistency on the walls of the bronchi. The mucous membrane is thickened and inflamed.
Foreign body present	Visualized at the level of the junction of the pharynx and esophagus. These can be pieces of food, small toys (for children).
Malignant formation	Narrowing of the lumen, proliferation of the bronchus on the mucous membrane, some blood clots. The tumor has an irregular shape
Bronchitis (chronic)	In the lumen there is a small amount of mucus with a thick consistency.

Alternative to bronchoscopy

An alternative to bronchoscopy, computed tomography of the lungs, also has advantages and disadvantages.