INTENSIVE CARE

BAL AND AIRWAY CLEARANCE TREATMENT

CHALLENGE
In intensive care, bronchial endoscopy is a common practice in indications for treatment of atelectasis and the clearance of bronchial secretions.

A bronchoscope is also often used in intensive care to collect microbiological samples in the event of suspected pneumonia.(1,2)

PERCUTANEOUS TRACHEOSTOMY

CHALLENGE

Percutaneous tracheostomy is a procedure commonly performed in intensive care. The use of a bronchoscope during this procedure is recommended by several medical societies.(3,4)

With a bronchoscope, it is possible to identify the incision point and to check the tube’s position during and at the end of the procedure.

Broncoflex® Benefits

    • The small size of the insertion tube limits negative overpressure phenomena that can be induced when too little air circulates through the endoscope inserted into an intubation tube.
    • This prevents barotrauma and atelectasis from developping during bronchial suction.
    • It is accepted that the diameter of the endoscope must not exceed 50% of the internal surface of any intubation tube into which it is inserted.
    •  
Effect of the introduction of a 5.7 mm diameter in various tracheal tubes 

The Broncoflex®  Vortex, by its design, has optimised suction performances, minimising loss of flow. The high position and the constant diameter of the 2.8 mm working channel ensure maximum suction efficiency with a smaller, 5.6 mm insertion tube diameter.

OPERATING ROOM

DIFFICULT INTUBATION

CHALLENGE
Airway management covers a set of techniques which are commonly practised in anaesthesia and outside the operating theatre.

Several studies have shown that in intensive care or in the emergency department, the rate of complications is higher where tracheal intubation fails.(5)

Medical societies agree on the need for a bronchoscope to be immediately available in intensive care departments in order to cope with unexpected events arriving during difficult intubation.(6)

The Broncoflex® , in its sterile packaging, can be easily stored and is always ready for use in all circumstances and at any time.

SINGLE-LUNG VENTILATION

CHALLENGE

The recent developments in video-assisted thoracoscopic surgery (VATS) have led to a significant increase in one-lungventilation techniques (OLV)(7)

The use of a bronchoscope is recommended for the placement and verification of the position of double-lumen endobronchial tubes, and this, throughout the procedure.(8,9)

The Broncoflex® , because it is always available and with its high quality image, provides physicians with the possibility of performing visual control in the best conditions.

BRONCOFLEX®  AGILE

Used in combination with endotracheal tubes, Broncoflex®  Agile makes it easier to guide tubes through the anatomical structures and insert them thanks to the rigdity of its braided Pebax® insertion tube. 

The correct positioning of double-lumen endotracheal tubes can be verified with the size of 35 Fr or more.

ENDOSCOPY SUITE

BAL AND AIRWAY CLEARANCE TREATMENT

CHALLENGE
In intensive care, bronchial endoscopy is a common practice in indications for treatment of atelectasis and the clearance of bronchial secretions.

A bronchoscope is also often used in intensive care to collect microbiological samples in the event of suspected pneumonia.(1,2)
The Broncoflex® , through its high availability, helps reduce treatment or sampling time by bronchoscopy for screening of common infections in intensive care.

BIOPSY

Accessories can be used along with the bronchoscopes to perform biopsies.

The constant and wide diameter working channel facilitates the use of instruments. The good angulation hold and the resistance of the system facilitate navigation with an instrument in the working channel.

BRONCOFLEX® VORTEX

Its shaped distal tip is narrower than other single-use bronchoscopes with 2.8 mm working channel. This miniaturisation aids exploration of the distal bronchi, benefiting from the smaller diameter of the inserted part with wide working channel. The Broncoflex®  Vortex can be inserted into endotracheal tubes of 6 mm or more.

EMERGENCY SUITE

DIFFICULT INTUBATION

CHALLENGE
Airway management covers a set of techniques which are commonly practised in anaesthesia and outside the operating theatre.

Several studies have shown that in intensive care or in the emergency department, the rate of complications is higher where tracheal intubation fails.(5) Medical societies agree on the need for a bronchoscope to be immediately available in intensive care departments in order to cope with unexpected events arriving during difficult intubation.(6)

The Broncoflex®, in its sterile packaging, can be easily stored and is always ready for use in all circumstances and at any time.

FOREIGN BODY REMOVAL

Foreign body removal is a very common procedure in children under 3 years old, less common in adults but can still occur.

The constant and wide diameter working channel facilitates the use of instruments. The good angulation hold and the resistance of the system facilitate navigation with an instrument in the working channel. 

EDUCATION AND TRAINING

TRAINING

CHALLENGE
A bronchoscope is a device used in many important clinical practices. It is also used by numerous medical specialities.

This technique that is difficult to learn has a variable learning curve, depending on the student and the teaching provided.(10) Although essential to learning, having access to a bronchoscope for training students is often a problem, but necessary in order to be able to practice on a dummy.(11)

The Broncoflex®  makes up for constraints of access to a bronchoscope for staff training. It can be handled by students without fear of breakage likely to lead to extended unavailability and often high repair costs.(10)

References to read:

(1) Jean-Louis et al. Fiberoptic Bronchoscopy in Ventilated PatientsTrouillet, CHEST , Volume 97 , Issue 4 , 927 – 93

(2) S. Turner et al. Fiberoptic bronchoscopy in the intensive care unit – A prospective study of 147 procedures in 107 patients. Critical care medicine. (1994) 22. 259-64. 10.1097/00003246-199402000-00017.

(3) Société de Réanimation en Langue Française, trachéotomie en réanimation (2016)

(4) Madsen, Kristian & Guldager, Henrik & Rewers, Mikael & Weber, Sven-Olaf & Kobke-Jacobsen, Kurt & White, Jonathan. (2015). Danish Guidelines 2015 for Percutaneous Dilatational Tracheostomy in the Intensive Care Unit. Danish Medical Journal. 62.

(5) Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society)

(6) Intubation difficile et extubation en anesthésie chez l’adulte – Société française d’anesthésie et de réanimation (Sfar).

(7) Campos JH. Progress in lung separation. Thorac Surg Clin 2008; 15: 71-832.- Campos JH. Current techniques for perioperative lung isolation in adults. Anesthesiology

(8) S H Pennefather, G N Russell; Placement of double lumen tubes–time to shed light on an old problem., BJA: British Journal of Anaesthesia, Volume 84, Issue 3, 1 March 2000, Pages 308–310

(9) Bellis, M.D., Accardo, R.R., Maio, M.D., Manna, C.L., Rossi, G.B., Pace, M.C., Romano, V., & Rocco, G. (2011). Is flexible bronchoscopy necessary to confirm the position of double-lumen tubes before thoracic surgery? European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 40 4, 912-6.

(10) P.G. Dalal, et al. Learning curves of novice anesthesiology residents performing simulated fibreoptic upper airway endoscopy, Can J Anaesth, 58 (9) (2011), pp. 802-809

(11) Société Française d’Anesthésie et de Réanimation, Société de Réanimation de Langue Française, intubation et extubation du patient en réanimation (2016)