To patients with chronic obstructive pulmonary disease (COPD) studied at rest, nifedipine releases hypoxic pulmonary vasoconstriction (HPV), diverts blood flow to poorly ventilated lung units, and worsens gas exchange. During exercise, release of HPV in COPD by nifedipine blunts the increase in pulmonary artery pressure (Ppa) and lowers the severity of pulmonary hypertension. However, the [...]
Bronchoalveolar lavage is often used in adult patients for a variety of diagnostic purposes. In children, standards for technique, as well as normal values, have yet to be defined. There are several potential pitfalls. If the tip of the bronchoscope is not wedged into an airway, much of the saline solution instilled through the suction [...]
Bronchoscopists, especially pediatric bronchoscopists, cannot be medical unitarians. Children frequently have multiple abnormalities in their airways. Even when a finding explains the child’s symptoms, other abnormalities may lurk around the corner. For example, in 15 percent of children whom I have examined for stridor and in whom a plausible explanation for the stridor was found [...]
Inadequate or inappropriate monitoring of the patient during the procedure is another major potential pitfall. Bronchoscopy is fun and interesting. Often everyone in the bronchoscopy suite becomes so engrossed in the endoscopic findings that it is easy to forget about the patient and his physiologic status. Bronchoscopists hypnosis is a real phenomenon! Even with otherwise [...]
Bronchoscopy may be very helpful in the evaluation of a patient with lower airway infection, especially if there are unusual features of the clinical picture or if the patient cannot produce sputum. However, just as expectorated material may not be representative of the lower airways, or may be contaminated with upper airway or oral secretions, [...]
Abnormal airway dynamics (laryngomalacia, tracheomalacia, bronchomalacia) are frequently seen during pediatric bronchoscopy. One must be careful not to overdiagnose dynamic changes in airway caliber as pathologic states. In general, one should be able to visualize change in the airway size sufficient to cause symptoms before making a diagnosis of tracheomalacia or bronchomalacia. In other words, [...]
use of inappropriate instruments for bronchoscopy is a major potential pitfall. Flexible bronchoscopes at least partially obstruct the airway, and the instrument used should be small enough to allow adequate ventilation if possible. On the other hand, it is also possible to employ an instrument which is inappropriately small for the task at hand. The [...]
