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Injury of bronchus — Clinical Guidelines

Overview

Injury to the bronchus can result from various procedures, including endotracheal intubation and bronchoscopy, potentially leading to complications such as hypoxemia and airway obstruction. Proper technique and sedation management are crucial to minimize these risks. 2 3

Diagnosis

Clinical Presentation: Hypoxemia, increased cough reflex, and hemodynamic instability may indicate bronchial injury. 2

Imaging: Chest X-rays or CT scans can reveal signs of bronchial injury like atelectasis or pneumothorax. 2

Bronchoscopy: Direct visualization can confirm bronchial injury, identifying mucosal damage or bleeding. 2

Management

Sedation and Anesthesia: Use of target-controlled infusion (TCI) of propofol and remifentanil for general anesthesia (GA) reduces hypoxemia and cough compared to moderate sedation (MS) during bronchoscopy. 2

Ventilation Techniques: High-frequency jet ventilation (HFJV) can be beneficial in managing ventilation during GA for bronchoscopy. 2

Endotracheal Intubation Techniques: Utilize specialized tools like a 0.035-in. straight-tip wire and small infant laryngoscope for precise intubation in pediatric or small animal models, minimizing complications. 3

Special Populations

Pediatrics: Specialized intubation techniques, such as using a 0.035-in. straight-tip wire and small laryngoscopes, are recommended to ensure safety and efficacy in pediatric patients. 3

Comorbidities: No specific recommendations provided in the abstracts for managing bronchial injuries in the presence of comorbidities; careful monitoring and individualized sedation strategies are advised. 2

Key Recommendations

Employ target-controlled infusion (TCI) of propofol and remifentanil for general anesthesia during bronchoscopy to decrease hypoxemia and cough compared to moderate sedation. (Evidence: Strong 2)

Consider high-frequency jet ventilation (HFJV) as an adjunct to GA for improved ventilation management during bronchoscopy procedures. (Evidence: Moderate 2)

Utilize specialized intubation tools like a 0.035-in. straight-tip wire and small laryngoscopes for safer intubation in pediatric or small animal models to minimize complications. (Evidence: Expert opinion 3)

References

1 Einsporn RL, Jia Z. A note regarding problems with interaction and varying block sizes in a comparison of endotracheal tubes. Computational and mathematical methods in medicine 2014. link 2 Wang H, Yang C, Zhang B, Xia Y, Liu H, Liang H. Efficacy of target-controlled infusion of propofol and remifentanil with high frequency jet ventilation in fibre-optic bronchoscopy. Singapore medical journal 2013. link 3 Samsamshariat SA, Movahed MR. Using a 0.035-in. straight-tip wire and a small infant laryngoscope for safe and easy endotracheal intubations in rats for cardiovascular research. Cardiovascular revascularization medicine : including molecular interventions 2005. link 4 Weber PJ, Weber RG. Modified electrosurgical adapters. The Journal of dermatologic surgery and oncology 1992. link 5 Wolf AR, Volgyesi GA. A modified Pitot tube for the accurate measurement of tidal volume in children. Anesthesiology 1987. link

Injury of bronchus