Front Cover
IFC
Practical Guide to Interventional Pulmonology
Copyright Page
Contributors
Contents
Video Table of Contents
1 Introduction
Interventional Pulmonology
Section 1 Advanced Diagnostic Bronchoscopy Proceduresโ
2 Linear Endobronchial Ultrasound
Introduction
Preprocedure Preparation
Indications for Linear Endobronchial Ultrasound
Equipment
Staff
Setting
Procedural Techniques
General Linear EBUS/EBUS-TBNA Preparation
EBUS/EBUS-TBNA of Specific Lesions
EBUS/EBUS-TBNA of Lymph Nodes for Lung Cancer Staging
Complications
Evidence
Lung Cancer
Nodal Staging in Lung Cancer
Ultrasound Image Analysis of Lymph Nodes
Restaging After Neoadjuvant Therapy
Molecular Testing Using EBUS-TBNA Samples
Lymphoma
Sarcoidosis
Tuberculosis, Mediastinal Cysts, and Other Malignant Diseases
EBUS Needles
19-G EBUS-TBNA Needle
25-G EBUS-TBNA Needle
Therapeutic Endobronchial Ultrasound-Guided Transbronchial Needle Injection
Summary
References
3 Radial Endobronchial Ultrasound
Introduction
Preprocedure Preparation
Patient Selection
Equipment
Staff
Setting
Procedural Techniques
Radial EBUS Without Guide Sheath
Radial EBUS Plus Guide Sheath
Radial EBUS Plus Guide Sheath and Guiding Curette
Complications
Evidence
Summary
References
4 Electromagnetic Navigation Bronchoscopy
Introduction
Preprocedural Preparation
Equipment Needed for Electromagnetic Navigation Bronchoscopy
Staff
Procedural Techniques
Veran SPiN System
Planning
Registration
Navigation and Biopsy
EMTTNA
superDimension Navigation System
Planning
Procedural Registration
Navigation, Local Reregistration With Fluoroscopic Navigation Technology, and Biopsy
Electromagnetic Navigational Bronchoscopy-Guided Fiducial Placement
Precautions and Caveats
Complications
Evidence
Summary
References
5 Transbronchial Cryobiopsy for Diffuse Lung Diseases
Introduction
Preprocedure Preparation
Patient Selection
Equipment
Staff
Setting
Procedural Techniques
Flexible Bronchoscopy Approach
Rigid Bronchoscopy Approach
Complications
Evidence
Overall Pooled Diagnostic Yield of Transbronchial Cryobiopsy
Transbronchial Cryobiopsy Versus Transbronchial Biopsy
Transbronchial Cryobiopsy Versus SLB
Future Directions
Summary
References
Section 2 Therapeutic Bronchoscopy Proceduresโ
6 Rigid Bronchoscopy
Rigid Bronchoscopy
Background
Indications
Preprocedural Planning
Patient Assessment
Equipment
Staffing and Procedural Setting
Anesthesia and Ventilation
Anesthetics
Conventional Ventilation
Jet Ventilation
Procedural Techniques
Procedure
Adjunct Procedures
Precautions and Caveats
Contraindications
Other Considerations
Complications
Evidence
Benign and Malignant Central Airway Obstruction
Management of Massive Hemoptysis
Foreign Body Removal
Rigid Bronchoscopy Training
Summary
Acknowledgment
References
7 Mechanical Debridement
Mandatory DoD Disclaimer
Introduction to Mechanical Debridement
Rigid Coring
Role of Instrument
Equipment Details
Method of Use
Pitfalls
Airway Dilatation (Balloon or Rigid)
Role of Instrument
Equipment Details
Methods of Use
Pitfalls
Rigid Forceps
Role of Instrument
Equipment Details
Method of Use
Pitfalls
Flexible Forceps
Role of Instrument
Equipment Details
Method of Use
Pitfalls
Microdebrider
Role of Instrument
Equipment Details
Method of Use
Pitfalls
Cryorecanalization
Role of Instrument
Equipment Details
Method of Use
Pitfalls
Summary
References
8 Rapid Ablative Techniques
Introduction
General Considerations For Rapid Ablative Techniques
General Indications
General Technical Considerations
Laser
General Principles of Laser Bronchoscopy
Preprocedural Preparation
Technique of Laser Bronchoscopy
Complications of Laser
Precautions and Pearls
Evidence
Electrocautery
General Principles of Bronchoscopic Electrocautery
Preprocedural Preparation
Electrocautery Technique
Blunt Electrocautery Probe Technique
Hot Forceps
Electrocautery Knife
Electrocautery Snare
Complications Of Electrocautery
Precautions and Pearls
Evidence
Summary
Argon Plasma Coagulation
General Principles of APC
Preprocedural Preparation
APC Technique
Complications of APC
Precautions and Pearls
Evidence
Summary
Summary of Rapid Ablative Techniques
References
9 Delayed Ablation Techniques: Photodynamic Therapy and Cryotherapy
Photodynamic Therapy
Introduction
Preprocedure Preparation
Patient Selection
Injection Encounter
Equipment
Staff
Setting
Procedural Techniques
Complications
Evidence
Summary
Cryotherapy
Introduction
Mechanism of Action
Preprocedural Preparation
Indications
Contraindications
Equipment
Staff
Setting
Anesthesia Considerations
Advantages of Cryotherapy Over Other Ablative Modalities
Disadvantages of Cryotherapy
Procedural Techniques
Complications
Evidence
Summary
References
10 Stent Placement
Introduction
History
Types of Stents
Indications for Airway Stenting
Preprocedural Planning
Deploying Metallic Stents
Deploying Silicone Stents
Postprocedural Care
Complications
Summary
References
11 The Endoscopic Application of Medication to the Airway
Introduction
Malignant Thoracic Disease
Transbronchial Needle Injections
EBUS-Guided TBNI
Endobronchial Balloon Drug Delivery Catheter
Gene Therapy
Nonmalignant Thoracic Disease
Postintubation or Tracheostomy Laryngotracheal Stenosis
Granulomatosis With Polyangiitis
Sarcoidosis
Idiopathic Laryngotracheal Stenosis
Recurrent Respiratory Papillomatosis
Lung TransplantโAssociated Bronchial Stenosis
Endoscopic Application of Medications and Choice of Technique
Summary
References
12 Bronchial Thermoplasty
Introduction
Scientific Basis For Bronchial Thermoplasty
Clinical Evidence From Human Studies
Preprocedure Management Overview and Patient Selection
Patient Preparation
Immediate Preprocedure Assessment
Bronchial Thermoplasty Equipment
Bronchial Thermoplasty Procedure Overview
Postprocedure Assessment and Follow-Up
Complications and Safety Profile of Bronchial Thermoplasty
Bronchial Thermoplasty and Biologic Therapy in Severe Uncontrolled Asthma
Summary
References
13 Bronchoscopic Lung Volume Reduction
Introduction
Definition
Preprocedural Preparation
Patient Selection and Initial Patient Evaluation
Equipment and Procedural Techniques
One-Way Valves
Zephyr Endobronchial Valve
Spiration Valve System
Coils
Thermal Vapor Ablation
Biological Lung Volume Reduction
Notable Complications of BLVR Procedures
Management and Mitigation of Treatment-Specific Complications
Evidence
Zephyr Endobronchial Valve
Intrabronchial Valves: Spiration Valve System
Coils
Thermal Vapor Ablation
Biological Lung Volume Reduction
Summary
References
14
Multimodality Approach to Malignant Airway Obstruction
Introduction
Types of Malignant Central Airway Obstruction
Indications for Bronchoscopy in Patients with Malignant Central Airway Obstruction
Technical Success
Impact on Dyspnea and HRQOL
Hazard of Delay in Therapeutic Bronchoscopy Versus Procedural Risks
Preprocedural Management
Intraprocedural Management
Postprocedural Management
References
15
Multimodality Approach to Benign Central Airway Obstruction
Introduction
Classification Systems
Etiology of Benign Central Airway Obstruction
Lung Transplant
PITS/PTTS
Chemical Injury
Systemic/Inflammatory Disease
Cartilaginous Processes
Granulomatous Processes
Infiltrative Process
Infections
Idiopathic
Clinical Presentation
Diagnostic Tests
Pulmonary Function Tests With Flow-Volume Loops
Imaging
Bronchoscopy Evaluation
Benign central Airway Obstruction Management
Bronchoscopic Treatments
Mechanical Dilation
Electrocautery
Cryospray
Mitomycin C
Steroids
Stent
Surgery
Summary
References
Section 3 Pleural Diseaseโ
16 Chest Tubes and Indwelling Pleural Catheters
Chest Tubes
Definition
History
Anatomy and Physiology
Procedural Technique
Medication Administration Via Chest Tube forย Pleural Space Infections
Medication Administration Via Chest Tube for Pleurodesis
Troubleshooting and Removal of Chest Tubes
Future Horizons for Chest Tubes
Indwelling Pleural Catheters
Definition
General Considerations
Procedural Technique
Care and Drainage of Indwelling Pleural Catheters
Removal of Indwelling Pleural Catheters
Benefits of Indwelling Pleural Catheters Versus Mechanical/Chemical Pleurodesis
Talc Slurry Pleurodesis Via Indwelling Pleural Catheter
Management of Indwelling Pleural Catheter Complications
Troubleshooting Indwelling Pleural Catheters
Utility of Indwelling Pleural Catheters in Nonmalignant Pleural Effusions
Future Horizons of Indwelling Pleural Catheters
References
17 Medical Thoracoscopy
Introduction
Equipment
Rigid Instruments
Flex-Rigid Pleuroscope
Contraindications
Patient Preparation
Anesthesia
Technique
Thoracoscopic-Guided Biopsy of Parietal Pleura
Management of Hemorrhage
Thoracoscopic Talc Poudrage
Complications
Clinical Applications
Pleural Effusion of Unknown Etiology
Lung Cancer
Malignant Mesothelioma
Tuberculous Pleural Effusion
Summary
References
Section 4 Additional IP Topicsโ
18 Percutaneous Tracheostomy
Introduction
Surgical Tracheostomy Technique
Types of Percutaneous Dilational Tracheostomy
Indications
Contraindications
Timing of Tracheostomy
Tracheostomy Tubes and Types
Percutaneous Tracheostomy Kit
Bronchoscopy
Ultrasound Guidance During Percutaneous Dilational Tracheostomy
Evaluation of Patient for Tracheostomy
Anticoagulation or Antiplatelet Therapy Management in Percutaneous Dilational Tracheostomy
Preparation for Percutaneous Dilational Tracheostomy
Setup and Technique
Personnel
Patient Monitoring, Airway, and Ventilator Management
Technique
Post-Tracheostomy Care
Long-Term Management
Common Procedural Complications
Training and Procedural Competency
Summary
Acknowledgment
References
19 How to Start an Interventional Pulmonology Program
Introduction
Needs Assessment
Business Plan
Market Analysis
Service Line Analysis
Marketing
Financial Overview
Equipment
Interventional Pulmonology Team
Monitoring
Summary
References
Index
IBC