Airway management in inhalation injury: a case series

Inhalation injury is a serious consequence of a fire or an explosion, with potential airway compromise and respiratory complications. We present a case series of five patients with inhalational burns who presented to Singapore General Hospital and discuss our approach to their early management, including early evaluation and planning for the upper and lower airway, coexisting cutaneous burns, and monitoring their ICU (intensive care unit) severity of illness, sepsis and acute respiratory distress syndrome. All five patients suffered various grades of inhalation injury. The patients were initially assessed by nasolaryngoscopy, and three patients were prophylactically intubated before being sent to the emergency operating theatre for definitive airway and burns management with fibreoptic bronchoscopy. All patients were successfully extubated and discharged stable. Various complications can arise as a result of an inhalation injury. Based on our cases and literature review, we propose a standardised workflow for patients with inhalation injury.     

Novel bronchoscopic strategies for the diagnosis of peripheral lung lesions: Present techniques and future directions

The diagnosis of the peripheral lung lesion has been a long‐standing clinical challenge—balancing accuracy with patient safety. With recent data revealing mortality benefits with lung cancer screening via low‐dose computed tomography, now more than ever, clinicians will be challenged with the task of providing the means to provide a safe and minimally invasive method of obtaining accurate tissue diagnostics for the pulmonary nodule. In this review, we present available technologies to aid clinicians in attempts at minimally invasive techniques and the data supporting their use. In addition, we review novel tools under investigation that may further increase yield and provide additional benefit in obtaining an early diagnosis of lung cancer.     

ERAB在硬质支气管镜介入治疗中的应用

硬质支气管镜是开展呼吸内镜介入治疗的重要工具,可在直视下进行多种操作。硬质支气管镜介入下治疗需在全凭静脉麻醉和喷射通气下操作,麻醉在硬质支气管镜介入治疗中起到举足轻重的作用。基于加速康复外科的理念,笔者根据多年的临床经验和理论体系,提出加速康复支气管镜的理念。本文针对介入治疗的不同环节,从术前准备、麻醉、术中操作、术后观察等方面总结探讨治疗的最佳路径,提高硬质支气管镜围术期患者的安全性、舒适度,以促进患者术后快速康复。     

Bronchoscopic treatments for early‐stage peripheral lung cancer: Are we ready for prime time?

Lung cancer is the leading cause of cancer‐related death worldwide and surgical lobectomy remains the preferred therapy for patients with early‐stage NSCLC. Medical comorbidities and advanced age preclude resection in many patients and minimally invasive ablative therapies are needed for treatment. Stereotactic ablative radiation is established as an effective modality in this patient group, although may be contraindicated in some patients with prior radiation exposure, comorbidities or centrally positioned tumours. Percutaneous ablative methods are available, although are frequently associated with significant complications. Numerous endoscopic ablative techniques are under evaluation. With a more favourable safety profile and the ability to provide diagnosis and staging information potentially within a single procedure, there is a strong rationale for development of bronchoscopic ablative modalities. In the following article, the authors aim to explore the role bronchoscopic ablation may play in treatment of peripheral lung tumours, and to describe a pathway to establishing these modalities as part of routine care. The current status of several bronchoscopic ablative options is discussed in detail.     

Airway stenting: Technological advancements and its role in interventional pulmonology

AS offers rapid and sustained relief of symptoms in most patients treated for malignant or benign CAO and can also be curative in itself in cases of benign tracheobronchial stenosis. In the past 30 years, this field has seen significant progress, from the misuse of vascular non‐covered metallic stents to the development of silicone airway stents with an increasingly large panel of shapes and of hybrid, partially or fully covered, SEMS customized to the airways. This study aims to offer an overview on: (i) the respective advantages and drawbacks of these two main categories of devices; (ii) the main indications for AS and the rationale behind the choice of stent in each situation; and (iii) the main promises borne from the progress made in the field in the past few years, including the development of drug‐eluting, biodegradable or patient‐specific customized AS.