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Evaluation of the patient undergoing respiratory endoscopic procedures
Resumo
Resumen
As técnicas endoscópicas podem ser consideradas razoavelmente seguras dado que são amplamente utilizadas e o índice de complicações é extremamente reduzido. Ainda assim, ocorrem complicações e, para as evitar, a avaliação do paciente antes e depois de qualquer intervenção, é da maior importância. Neste artigo, serão abordadas as questões relacionadas com a preparação do paciente e o consentimento esclarecido, a avaliação geral historial médico, medicação actual, exame físico, testes de laboratório, avaliação radiológica e análise da indicação e planeamento. A avaliação após a intervenção também será discutida, para detectar e tratar complicações e determinar a orientação final para o paciente, após a alta.
Existem muito poucos estudos ou publicações actualizados que abordem estas áreas, o nível de evidência permanece baixo e a maioria das recomendações baseiam-se no bom senso e na opinião de peritos.
Palavras-chave: Técnicas endoscópicas. Broncoscopia. Toracoscopia. Pré-avaliação. Pós-avaliação.
Introdução
Introduction Endoscopic techniques, flexible, rigid bronchoscopy and thoracoscopy are central tools in the evaluation and treatment of respiratory disorders and their use has been steadily growing.The first rigid bronchoscopy was performed in 1897 when Gustav Killian removed a piece of pork bone from the bronchus of a 63-year-old farmer, thus avoiding a tracheotomy.1, 2 IKEDA3 in the late 60s pioneered fiberoptic bronchoscopy as a tool to enter subsegmental bronchi and obtain specimens for early diagnosis of lung cancer. During the last 30 years the flexible bronchoscope has become the diagnostic instrument of choice for visualization of the bronchial tree as it is less invasive, does not require general anaesthesia and provides much better visualization of the smaller peripheral airways. The introduction of laser technology into the tracheobronchial tree and the advent of airway stents in the early 1990s caused a resurgence of rigid bronchoscopy in the management of both benign and malignant central airway obstruction.4, 5, 6 Thoracoscopy began in 1908 with Jacobeus,7 and was extensively used in the treatment of tuberculosis, for pneumothorax induction and lyses of adhesions. When effective treatment for TB was discovered, interest in this technique disappeared. With technical improvements during the 90s, thoracoscopy regained popularity for dealing with undiagnosed pleural effusion. These techniques can be considered safe since they are widely used and the rate of complications is extremely low.8, 9, 10 A recent retrospective analysis of 23.682 patients undergoing bronchoscopy over a period of 11 years showed a mortality rate of 0.013% with a complication rate of...Bibliografia
1. Becker HD, Marsh BR. History of the rigid bronchoscope. Interventional bronchoscopy. Prog Respir Res. vol. 30. Basel: Karger; 2000. 2-15.
2. Edell ES, Sanderson DR. History of bronchoscopy. En: Prakash U.S.B., editors. Bronchoscopy. New York: Raven; 1994. 7-11.
3. Ikeda S. Flexible bronchofiberscope. Ann Otol. 1970; 79:916.
4. Bolliger CT, Mathur PN, Beamis JF, Becker HD, Cavaliere S, Colt H, et-al. ERS/ATS statement on interventional pulmonology. Eur Respir J. 2002; 19:356-73.
Pubmed
5. Ernst A, Silvestri GA, Johnstone D. Interventional pulmonary procedures: guidelines from the American College of Chest Physicians. Chest. 2003; 123:1693-717.
Pubmed
6. Ayers ML, Beamis JF. Rigid bronchoscopy in the twenty first century. Clin Chest Med. 2001; 21:355-64.
7. Jacobeus H. The practical importance of thoracoscopy in surgery of the chest. Surg Gynecol Obstet. 1921; 32:493-500.
8. British Thoracic Society bronchoscopy Guidelines Committee. British Thoracic Society guidelines on diagnostic flexible bronchoscopy. Thorax. 2001; 56(Suppl. I):i1-i21.
Pubmed
9. Jin F, Mu D, Chu D, Fu E, Xie Y, Liu T. Severe complications of bronchoscopy. Respiration. 2008; 76:429-33.
Pubmed
10. Drummond M, Magalhães A, Hespanhol V. Rigid bronchoscopy: complications in a university hospital. J Bronchol. 2003; 10:177-82.
11. Colt HG. Thoracoscopy. A prospective study of safety and outcome. Chest. 1995; 108:324-9.
Pubmed
12. Poi PJH, Chuah SY, Liam CK. Common fears of patients undergoing bronchoscopy. Eur Respir J. 1998; 11:1147-9.
Pubmed
13. Aabakken L, Baasland I, Lygren I, Osnes M. Development and evaluation of written patient information endoscopic procedures. Endoscopy. 1997; 29:23-6.
Pubmed
14. Andews LS, Gamble E. Patient education: pre-teaching the bronchoscopy patient:ignorance isn’t bliss. Soc Gastrintest J. 1985; 1:46-9.
15. Triller N, Erzen D, Duh S, Petrinec Primozic M, Kosnik M. Music during bronchoscopic examination: the physiological effects. A randomized trial. Respiration. 2006; 73:95-9.
Pubmed
16. Pratter MR. Music improves patient comfort level during outpatient bronchoscopy. Chest. 1995; 108:129-30.
Pubmed
17. General Medical Council. Seeking patients’ consent: the ethical considerations. London, November 1998.
18. Peacock M, Johnson J, Blanton H. Complications of flexible bronchoscopy in patients with severe obstructive pulmonary disease. J Bronchol. 1994; 1:181-6.
19. Antonelli M, Conti G, Riccioni L, Meduri GU. Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients. Chest. 1996; 110:724-8.
Pubmed
20. Milman N, Faurschou P, Grode G, Jørgensen A. Pulse oximetry during fibreoptic bronchoscopy in local anaesthesia: frequency of hypoxaemia and effect of oxygen supplementation. Respiration. 1994; 61:342-7.
Pubmed
21. Chhajed PN, Glanville AR. Management of hypoxemia during flexible bronchoscopy. Clin Chest Med. 2003; 24:511-6.
Pubmed
22. Gorman FR, Beamis JF. Complications of flexible bronchoscopy. Clin Pulm Med. 2005; 12:177-83.
23. Ernst A, Eberhardt R, Wahidi M, Becker HD, Herth FJ. Effect of routine Clopidogrel use on bleeding complications after transbronchial biopsy in humans. Chest. 2006; 129:734-7.
Pubmed
24. Herth FJF, Becker HD, Ernst A. Aspirin does not increase bleeding complications after transbronchial biopsy. Chest. 2002; 122:1461-4.
Pubmed
25. Wahidi MM, Rotcha AT, Hollingsworth JW, Gover JA, Feller-Kopman D, Ernst A. Contraindications and safety of transbronchial lung biopsy via flexible bronchoscopy. A survey of pulmonologists and review of the literature. Respiration. 2005; 72:285-95.
Pubmed
26. Knox A, Mascie-Taylor B, Page R. Fibreoptic bronchoscopy in the elderly: 4 year's experience. Br J Dis Chest. 1988; 82:290-5.
Pubmed
27. Macfarlane JT, Storr A, Wart MJ, Smith WH. Safety, usefulness and acceptability of fibreoptic bronchoscopy in the elderly. Age Ageing. 1981; 10:127-31.
Pubmed
28. Steinberg KP, Mitchell DR, Maunder RJ, Milberg JA, Whitcomb ME, Hudson LD. Safety of bronchoalveolar lavage in patients with adult respiratory distress syndrome. Am Rev Respir Dis. 1993; 148:556-61.
Pubmed
29. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et-al. Prevention of infective endocarditis. Circulation. 2007; 116:1736-54.
Pubmed
30. Cowl CT, Prakash UB, Kruger BR. The role of anticholinergics in bronchoscopy. A randomized clinical trial. Chest. 2000; 118:188-92.
Pubmed
31. Maguire GP, Rubinfield AR, Trembath PW, Pain MC. Patients prefer sedation for fibreoptic bronchoscopy. Respirology. 1998; 3:81-5.
Pubmed
32. Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A. Patient satisfaction with conscious sedation for bronchoscopy. Chest. 1999; 115:1437-40.
Pubmed
33. Brady M, Kinn S, Stuart P. Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev. 2003; 4:CD004423.
Pubmed
34. Bolliger CT, Sutedja TG, Strausz J, Freitag L. Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents. Eur Respir J. 2006; 27:1258-71.
Pubmed
35. Wahidi MM, Herth FJF, Ernst A. State of the art: interventional pulmonology. Chest. 2007; 131:261-74.
Pubmed
36. Rahman NM, Ali NJ, Brown G, Chapman SJ, Dvies RJ, Downer NJ, et al. Local anesthetic thoracoscopy: British Thoracic Society pleural desease guideline 2010.
37. Kristensen MS, Milman N, Jarnvig IL. Pulse oximetry at fibre-optic bronchoscopy in local anaesthesia: indication for postbronchoscopy oxygen supplementation?. Respir Med. 1998; 92:432-7.
Pubmed
38. Matsuo T, Colt H. Evidence against routine scheduling of surveillance bronchoscopy after stent insertion. Chest. 2000; 118:1455-9.
Pubmed
39. Davies HE, Musk AW, Lee YC. Prophylactic radiotherapy for pleural puncture sites in mesothelioma: the controversy continues. Curr Opin Pulm Med. 2008; 14(July (4)):326-30.
Pubmed
Magalhães, A.a
aBronchoscopy Unit, Pulmonology Department, Hospital de São João, Porto, Portugal
Este artigo pertence a revista Revista Portuguesa de Pneumologia
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