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CICM 2021 ASM: Respiratory
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Endoscopic interventional pulmonology

Presentation Description

Interventional pulmonology techniques and procedures have become more complex over the past decade.  There are a multitude of procedures for both diagnostic and therapeutic purposes available to the clinician.  These range from Endobronchial Ultrasound (EBUS) for accurate diagnosis of malignant and non-malignant conditions, to Bronchial Thermoplasty for therapy in moderate to severe asthma, to stent insertion for airway obstruction or tracheo-oesophageal fistula.  Not all procedures are relevant to current Intensive Care Medicine practice.  
This presentation will focus on three procedures relevant to Intensive Care Medicine.   Firstly, the use of endobronchial valves in the management of persistent air leaks from broncho/alveolar-pleural fistulae.  This technique allows resolution of air leaks in patients on mechanical ventilation, who may not be fit for surgical intervention.   This is a novel use of these devices, which were originally designed for endoscopic lung volume reduction in COPD. Secondly, the technique of cryobiopsy for diagnosis of parenchymal lung disease and the risk of pneumothorax and significant haemorrhage with this procedure.  Significant haemorrhage has been described after cryobiopsy and may need ICU admission, if life threatening.  The use of a bronchial blocker at the time of the procedure reduces bleeding risk.  Lastly, the therapeutic modality of bronchial thermoplasty (BT) for moderate to severe asthma and the risk of exacerbation post procedure.  BT requires three separate bronchoscopic procedures, three weeks apart.  Patients are at risk of exacerbations of asthma up until six weeks after the last procedure.  A lower FEV1 predicts the risk for post procedure hospitalisation.