Name of the Procedure:

Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance (e.g., fibrin glue), if performed.

Summary

Bronchoscopy is a medical procedure where doctors use a thin tube called a bronchoscope to view the airways and lungs. This specific type includes the use of fluoroscopy (real-time X-ray), balloon occlusion to block part of the airway temporarily, assessing air leaks, and possibly administering an occlusive substance like fibrin glue to seal leaks.

Purpose

This procedure helps diagnose and treat conditions related to airway leaks. The primary goal is to find and seal any air leaks in the lungs, which can help improve breathing and prevent complications.

Indications

• Persistent air leaks in the lungs
• Post-surgical airway leaks
• Bronchopleural fistulas
• Trauma to the lungs
• Large lung cysts or cavities

This procedure is appropriate for patients showing symptoms like shortness of breath, persistent coughing, or sound of air escaping from the lung during breathing.

Preparation

• Fasting for a certain period before the procedure.
• Adjusting medications as advised by the physician, especially blood thinners.
• Pre-procedure diagnostic tests like chest X-rays or CT scans.

Procedure Description

1. The patient is sedated or given general anesthesia.
2. A bronchoscope is inserted through the mouth or nose into the airways.
3. Fluoroscopic guidance is used to navigate the bronchoscope.
4. A balloon catheter is used to temporarily occlude the airway.
5. The doctor assesses the air leak by inflating and deflating the balloon.
6. If an air leak is identified, fibrin glue or another occlusive substance may be administered to seal the leak.
7. The bronchoscope and balloon catheter are then removed.

Duration

The procedure typically lasts between 30 minutes to 1 hour.

Setting

The procedure is performed in a hospital or specialized outpatient surgical center.

Personnel

• Pulmonologist or thoracic surgeon
• Anesthesiologist
• Nursing staff
• Radiology technician (if fluoroscopy is used)

Risks and Complications

• Bleeding
• Infection
• Damage to the airways or lungs
• Reaction to anesthesia
• Rarely, worsening of the air leak

Benefits

• Immediate identification and treatment of air leaks.
• Improved lung function and breathing.
• Potential for quick return to normal activities if successful.

Recovery

• Monitored recovery in a hospital setting, typically for a few hours.
• Instructions on activity level, medications, and follow-up appointments.
• Expected recovery time ranges from a few days to a week, depending on the patient's overall health.

Alternatives

• Conservative management with observation and supportive care.
• Surgical repair of air leaks.
• Endobronchial valves or coils.

Each alternative has varying degrees of invasiveness, risk, and recovery time.

Patient Experience

• During the procedure, with sedation or anesthesia, patients typically feel no pain.
• Post-procedure, patients may experience a sore throat, mild discomfort in breathing, or coughing.
• Pain management and comfort measures such as analgesics will be provided as needed.