Management of iatrogenic airway bleeding with flexible bronchoscopy: Evidence or experience-based?

IF 0.7 Q4 RESPIRATORY SYSTEM Tuberkuloz ve Toraks-Tuberculosis and Thorax Pub Date : 2023-12-01 DOI:10.5578/tt.20239608
Oğuz Karcıoğlu, Ziya Toros Selçuk
{"title":"Management of iatrogenic airway bleeding with flexible bronchoscopy: Evidence or experience-based?","authors":"Oğuz Karcıoğlu, Ziya Toros Selçuk","doi":"10.5578/tt.20239608","DOIUrl":null,"url":null,"abstract":"<p><p>Iatrogenic bleeding during bronchoscopy may lead to early termination, insufficient sample collection, decreased diagnostic accuracy, and even death. Unlike rigid bronchoscopy, the management of bleeding during flexible fiberoptic bronchoscopy does not allow the use of methods such as cautery, direct pressure, etc. and is usually limited to the application of liquids. The management of endobronchial bleeding usually depends on two main mechanisms: 1) vasoconstriction; 2) enhancing coagulation to form fibrin clots. The data on cold saline, the most widely recognized agent, is based on case reports and the experience of centers, not randomized controlled trials. Vasoconstrictor agents consist of adrenaline, vasopressin analogues, phenylephrine, and xylometazoline hydrochloride. However, there are only a limited number of randomized controlled trials on adrenaline, and information on the remaining substances is limited to retrospective studies, case reports, and expert opinions. The endobronchial administration of tranexamic acid, which inhibits fibrin degradation, has been the subject of very few studies. Despite its documented efficacy, information regarding its dosage, frequency of use, and safety is lacking. Although Ankaferd Blood Stopper, which binds erythrocytes to the vascular endothelium, has been shown to be effective in controlling bleeding related to dental procedures, the gastrointestinal tract, and operations, only one retrospective study found it to be effective against endobronchial bleeding that could not be controlled with cold saline and adrenaline. Although there are a variety of agents that centers use in their routine procedures, there is not yet a consensus on the efficacy, dose, frequency, and safety of any of them.</p>","PeriodicalId":45521,"journal":{"name":"Tuberkuloz ve Toraks-Tuberculosis and Thorax","volume":"71 4","pages":"400-407"},"PeriodicalIF":0.7000,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11390090/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Tuberkuloz ve Toraks-Tuberculosis and Thorax","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5578/tt.20239608","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"RESPIRATORY SYSTEM","Score":null,"Total":0}
引用次数: 0

Abstract

Iatrogenic bleeding during bronchoscopy may lead to early termination, insufficient sample collection, decreased diagnostic accuracy, and even death. Unlike rigid bronchoscopy, the management of bleeding during flexible fiberoptic bronchoscopy does not allow the use of methods such as cautery, direct pressure, etc. and is usually limited to the application of liquids. The management of endobronchial bleeding usually depends on two main mechanisms: 1) vasoconstriction; 2) enhancing coagulation to form fibrin clots. The data on cold saline, the most widely recognized agent, is based on case reports and the experience of centers, not randomized controlled trials. Vasoconstrictor agents consist of adrenaline, vasopressin analogues, phenylephrine, and xylometazoline hydrochloride. However, there are only a limited number of randomized controlled trials on adrenaline, and information on the remaining substances is limited to retrospective studies, case reports, and expert opinions. The endobronchial administration of tranexamic acid, which inhibits fibrin degradation, has been the subject of very few studies. Despite its documented efficacy, information regarding its dosage, frequency of use, and safety is lacking. Although Ankaferd Blood Stopper, which binds erythrocytes to the vascular endothelium, has been shown to be effective in controlling bleeding related to dental procedures, the gastrointestinal tract, and operations, only one retrospective study found it to be effective against endobronchial bleeding that could not be controlled with cold saline and adrenaline. Although there are a variety of agents that centers use in their routine procedures, there is not yet a consensus on the efficacy, dose, frequency, and safety of any of them.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
使用柔性支气管镜处理先天性气道出血:基于证据还是经验?
支气管镜检查过程中的先天性出血可能导致检查提前终止、样本采集不足、诊断准确性降低,甚至死亡。与硬质支气管镜检查不同,柔性纤维支气管镜检查中的出血处理不能使用烧灼、直接加压等方法,通常仅限于涂抹液体。支气管内出血的处理通常取决于两个主要机制:1)血管收缩;2)加强凝血以形成纤维蛋白凝块。冷盐水是最广为人知的药物,其数据基于病例报告和各中心的经验,而非随机对照试验。血管收缩剂包括肾上腺素、血管加压素类似物、苯肾上腺素和盐酸羟甲唑啉。然而,关于肾上腺素的随机对照试验数量有限,其余物质的信息也仅限于回顾性研究、病例报告和专家意见。抑制纤维蛋白降解的氨甲环酸在支气管内给药方面的研究很少。尽管氨甲环酸具有记录在案的疗效,但有关其剂量、使用频率和安全性的信息却十分匮乏。安卡非德止血剂能将红细胞与血管内皮结合,已被证明能有效控制牙科手术、胃肠道和手术相关的出血,但只有一项回顾性研究发现它对冷盐水和肾上腺素无法控制的支气管内出血有效。尽管各中心在常规程序中使用的药剂种类繁多,但对于其中任何一种药剂的疗效、剂量、频率和安全性尚未达成共识。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
CiteScore
1.50
自引率
9.10%
发文量
43
期刊最新文献
A patient with widespread skin lesions presenting with massive pleural effusion. A perspective on the scope of videoconferencing-based telemedicine in respiratory diseases outpatient clinic. Analysis of one-year follow-up results and treatment costs of patients with PTE in a tertiary care center. Analysis of post-COVID symptoms and predisposing factors for chronic post-COVID syndrome. Characteristics of adverse reactions due to subcutaneous allergen immunotherapy applied between 2011-2021: Single center experience.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1