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Criterios broncoscópicos, laboratoriales y anatomopatológicos de enfermedad de la vía aérea en pacientes diagnosticados con granulomatosis con poliangitis
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Moreno Díaz, Claudia

; Jacomelli, Marcia

; Demarzo, Sergio Eduardo

; Mejia Palomino, Addy

; Pierre de Oliveira, Ellen

; Lins M de Assuncao, Gabriela

; Padilha de Toledo, Andréia

; Valente Barbas, Carmen Silvia

Revista argentina de reumatología

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dec 2023, Volume 34 N. 3 Pages 86 - 93

Abstract: En Es | Text: En Es | PDF: En | PDF: Es

Abstract Introduction: patients with granulomatosis with polyangiitis (GPA) may present upper airway (UA) and lower airway (LA) involvement. Objectives: we describe the endoscopic manifestations of the airways, histological findings from biopsied tissue and antineutrophilic cytoplasm antibody (ANCA) in a group of patients with GPA. Methods: retrospective study of medical records of patients with GPA undergoing bronchoscopy between 2012 and 2019. Airway findings, results of biopsies performed and ANCA results were analyzed. Results: 40 patients were included, with a mean age of 46.92±17.61 years and predominantly female (67.5%). Airway involvement was observed in 90% (n=36). The C-ANCA was reactive in 63.9%, P-ANCA in 25%, doubly reactive ANCA in 8.33% and non-reactive in 20%. The findings in upper airway (UA) were: chronic sinusitis (41.7%), destruction of the nasal septum (16.7%); and in lower airway (LA) were: tracheobronchial stenosis (38.9%) and tracheobronchitis (25%). The pathological findings most common of bronchoscopic biopsies were: polymorphonuclear inflammatory process (61.9%) and geographic necrosis (47.6%). Conclusion: the airway is involved in up to 90% of patients with GPA. Non-reactive ANCA does not rule out this possibility. Chronic sinusitis and tracheobronchial fibrostenotic processes were the most common endoscopic findings. Vasculitis in biopsies was found in a minority of cases.

Resumen Introducción: los pacientes con granulomatosis con poliangitis (GPA) pueden presentar compromiso de la vía aérea superior (VAS) o inferior (VAI). Objetivos: describimos las manifestaciones endoscópicas de las vías respiratorias, los hallazgos histológicos y los anticuerpos anticitoplasma de neutrófilos (ANCA) en un grupo de pacientes con GPA. Métodos: estudio retrospectivo de historias clínicas de pacientes con GPA sometidos a broncoscopia entre 2012 y 2019. Se analizaron hallazgos de la vía aérea, biopsias y ANCA. Resultados: se incluyeron 40 pacientes, con una edad media de 46,92±17,61 años, predominantemente del sexo femenino (67,5%). Se observó afectación de la vía aérea en el 90% (n=36). El C-ANCA fue reactivo en el 63,9%, P-ANCA en el 25%, ANCA doblemente reactivo en el 8,33% y no reactivo en el 20%. Los hallazgos comunes en la vía aérea superior (VS) fueron sinusitis crónica (41,7%), destrucción del tabique nasal (16,7%); y en la vía aérea inferior (AI): estenosis traqueobronquial (38,9%), traqueobronquitis (25%). Los hallazgos más frecuentes de las biopsias broncoscópicas fueron proceso inflamatorio polimorfonuclear (61,9%) y necrosis geográfica (47,6%). Conclusión: la vía aérea está comprometida hasta en un 90% de los pacientes con GPA. ANCA no reactivos no descartan esta posibilidad. La sinusitis crónica y los procesos fibroestenóticos traqueobronquiales fueron los hallazgos endoscópicos más comunes. La vasculitis en biopsias se encontró en una minoría de casos.

https://doi.org/10.47196/rar.v34i3.776

Predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS
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Barroso, Andreia

; Lin, Flávia

; Carrondo, Maria Cristina

; Palomino, Addy

; Demarzo, Sergio Eduardo

; Figueiredo, Viviane Rossi

; Jacomelli, Marcia

Jornal Brasileiro de Pneumologia

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2023, Volume 49 N. 4 elocation e20230097

Abstract: En Pt | Text: En Pt | PDF: En | PDF: Pt

ABSTRACT Objective: To assess predictive factors for improved diagnostic accuracy with the use of radial-probe EBUS (RP-EBUS). Methods: This was a retrospective review of consecutive patients undergoing RP-EBUS between February of 2012 and January of 2020. Parameters including the presence of a bronchus sign on CT scans, the position of the radial EBUS probe, lesion size, lesion location, and lesion type were analyzed in relation to two defined outcomes (final diagnosis or no diagnosis). Univariate analysis was used in order to explore the individual effects of each parameter on diagnostic accuracy. Multivariate logistic regression was performed to identify significant predictors of diagnostic accuracy. Results: RP-EBUS was used for diagnostic purposes in 101 patients. The lesion was < 3 cm in size in 59 patients (58.4%) and predominantly solid in 60.3%. There was a positive correlation between radial EBUS probe position and diagnostic accuracy (p = 0.036), with 80.9% of the patients showing a bronchus sign on CT scans. Furthermore, 89% of the patients showed a bronchus sign on CT scans and a correlation with diagnostic accuracy (p = 0.030), with 65.8% of the lesions being located in the left/right upper lobe (p = 0.046). When the radial EBUS probe was within the target lesion, the diagnostic yield was = 80.8%. When the probe was adjacent to the lesion, the diagnostic yield was = 19.2%. A bronchus sign on CT scans was the only parameter that independently influenced diagnostic accuracy (adjusted OR, 3.20; 95% CI, 1.081-9.770; p = 0.036). Conclusions: A bronchus sign on CT scans is a powerful predictor of successful diagnosis by RP-EBUS.

RESUMO Objetivo: Avaliar fatores preditivos de maior precisão diagnóstica com EBUS com sonda radial. Métodos: Revisão retrospectiva de pacientes consecutivos submetidos a EBUS radial entre fevereiro de 2012 e janeiro de 2020. Parâmetros como a presença do sinal brônquico na TC, a posição da sonda radial de EBUS, o tamanho da lesão, a localização da lesão e o tipo de lesão foram analisados em relação a dois desfechos definidos (diagnóstico final ou sem diagnóstico). A análise univariada foi usada para explorar os efeitos individuais de cada parâmetro na precisão do diagnóstico. A regressão logística multivariada foi realizada para identificar preditores significativos de precisão diagnóstica. Resultados: O EBUS radial foi usado para fins diagnósticos em 101 pacientes. A lesão era < 3 cm em 59 pacientes (58,4%) e predominantemente sólida em 60,3%. Houve correlação positiva entre a posição da sonda radial de EBUS e a precisão do diagnóstico (p = 0,036), sendo que 80,9% dos pacientes apresentaram o sinal brônquico na TC. Além disso, 89% dos pacientes apresentaram o sinal brônquico na TC e correlação com a precisão do diagnóstico (p = 0,030), sendo que 65,8% das lesões localizavam-se no lobo superior esquerdo/direito (p = 0,046). Com a sonda radial de EBUS dentro da lesão-alvo, o rendimento diagnóstico foi de 80,8%. Com a sonda adjacente à lesão, o rendimento diagnóstico foi de 19,2%. O sinal brônquico na TC foi o único parâmetro que influenciou de forma independente a precisão do diagnóstico (OR ajustada = 3,20; IC95%: 1,081-9,770; p = 0,036). Conclusões: O sinal brônquico na TC é um poderoso preditor de diagnóstico bem-sucedido por meio de EBUS radial.

https://doi.org/10.36416/1806-3756/e20230097

Analysis of 108 flexible bronchoscopies for the removal of foreign bodies from the airways
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Costa Jr., Altair da Silva

; Palomino, Addy Lidvina Mejia

; Suzuki, Iunis

; Garcia, Rodrigo Gobbo

; Scordamaglio, Paulo Rogerio

; Gregorio, Marcelo Gervilla

; Oliveira, Felipe Nominando Diniz

; Gonçalves, Manoel Ernesto Peçanha

; Jacomelli, Marcia

einstein (São Paulo)

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2023, Volume 21 elocation eAO0391

Abstract: En | Text: En | PDF: En

ABSTRACT Objective To describe the clinical, bronchoscopic, diagnostic, and therapeutic aspects between children and adults. Methods This retrospective study compared the clinical and bronchoscopic characteristics of adults and children who underwent bronchoscopy for suspected foreign body aspiration. Data on sex, outpatient or emergency origin, bronchoscopy results, characteristics of the aspirated foreign body, and complications were analyzed. Results In total, 108 patients were included in the analysis, with foreign body aspiration diagnosed in 69% of patients (30 children and 44 adults). In 91% of patients, there was a clinical history suggestive of aspiration. The mean age of the adults was 65.89 (±19.75) years, and that of the children was 2.28 (±1.78) years. Most of the children were under 3 years of age (80%), while adults were mostly 70 years of age or older (54.5%). Emergency care was more common among children than adults. The most common foreign bodies found in both age groups were organic bodies, primarily seeds. The most frequent locations of foreign bodies were the lobar bronchi in adults and the main bronchi in children. Flexible bronchoscopy is the primary method for diagnosis and treatment. Transient hypoxemia occurred particularly frequently in children (5%). Conclusion Foreign body aspiration, particularly that involving seeds, is more common in the extremes of age. A clinical history suggestive of aspiration is crucial in determining the need for bronchoscopy, which should be performed as early as possible. Flexible bronchoscopy is an effective and safe diagnostic technique.

https://doi.org/10.31744/einstein_journal/2023ao0391

Bronchoscopy in COVID-19 inpatients: experience of a university hospital in the first outbreak of the disease in Brazil
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Demarzo, Sergio Eduardo

; Melo, Júlia Bamberg Cunha

; Carranza, Mariasol Ximena Martínez

; Oliveira, Felipe Nominando Diniz

; Ferreira, Anarégia de Pontes

; Palomino, Addy Lidvina Mejia

; Figueiredo, Viviane Rossi

; Jacomelli, Marcia

einstein (São Paulo)

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2022, Volume 20 elocation eAO6858

Abstract: En | Text: En | PDF: En

ABSTRACT Objective: To describe the indications and endoscopic findings of bronchoscopy performed at a reference university hospital for inpatients diagnosed with COVID-19 during the first outbreak of the disease in Brazil. Methods: A retrospective analysis of medical records of adult patients diagnosed with COVID-19 who underwent bronchoscopy at the intensive care units of Instituto do Coração and Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, from March to August 2020. Results: A total of 132 bronchoscopies were performed in 103 patients diagnosed with COVID-19. Mean age was 56.1±14.5 years, and distribution was similar in both sexes. More than one test was performed in 16 patients. The most frequent indications were diagnostic endoscopic evaluation and therapeutic procedures in 78.6% of cases (n=81) and material collection in 21.4% of cases (n=22). The most frequent endoscopic findings were presence of secretion or clots in 34% of cases, the presence of acute inflammatory changes in 22.3%, and tracheal wall laceration in 20.4%. In 27.2% of patients, no relevant bronchoscopic findings were observed. In three patients, bronchoscopy was indicated to assess hemoptysis, but there was only one case of active bleeding. Procedure-related complications were not observed in this group of patients. Conclusion: Bronchoscopy proved to be a safe and effective procedure to assist in treatment of COVID-19 patients, and the most frequent indications were related to investigation of airway involvement or to evaluate infectious and inflammatory pulmonary processes.

https://doi.org/10.31744/einstein_journal/2022ao6858

Sleep endoscopy as a complementary diagnostic method for snoring and sleep apnea
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Mota, Dalila Araújo

; Gregorio, Marcelo Gervilla

; Costa Jr., Altair da Silva

; Fomin, Denilson Stork

; Jacomelli, Marcia

einstein (São Paulo)

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2022, Volume 20 elocation eMD8035

Abstract: En | Text: En | PDF: En

ABSTRACT Obstructive sleep apnea is a disorder characterized by complete or incomplete and recurrent upper airway collapse induced by sleep. Several diagnostic methods for obstructive sleep apnea are used, but only sleep endoscopy allows an endoscopic assessment of pharyngeal collapse during sedation. It is essential to carry out sleep endoscopy following a systematic institutional protocol, in preestablished stages, to ensure better reproducibility and reliability of the results found. Sleep endoscopy has few limitations and is a safe test, with a low risk of complications.

https://doi.org/10.31744/einstein_journal/2022md8035

New endobronchial ultrasound (EBUS) techniques
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Gilberto, Guilherme Moratti

; Falsarella, Priscila Mina

; Rocha Júnior, Eserval

; Terra, Ricardo Mingarini

; Jacomelli, Marcia

; Garcia, Rodrigo Gobbo

einstein (São Paulo)

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2022, Volume 20 elocation eCE0159

Abstract: En | Text: En | PDF: En

https://doi.org/10.31744/einstein_journal/2022ce0159

EBUS-TBNA versus surgical mediastinoscopy for mediastinal lymph node staging in potentially operable non-small cell lung cancer: a systematic review and meta-analysis
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Figueiredo, Viviane Rossi

; Cardoso, Paulo Francisco Guerreiro

; Jacomelli, Marcia

; Santos, Lilia Maia

; Minata, Mauricio

; Terra, Ricardo Mingarini

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 6 elocation e20190221

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: O câncer de pulmão (CP) é uma das principais causas de morte no mundo. Um estadiamento mediastinal preciso é obrigatório para avaliação do prognóstico e seleção de pacientes para tratamento cirúrgico. EBUS-TBNA é um procedimento minimamente invasivo que permite a amostragem de linfonodos mediastinais. Alguns estudos sugerem que a EBUS-TBNA é preferível que a mediastinoscopia cirúrgica no estadiamento mediastinal do CP. O objetivo desta revisão sistemática e meta-análise foi comparar a eficácia da EBUS-TBNA e da mediastinoscopia no estadiamento linfonodal mediastinal do câncer de pulmão de células não pequenas (CPCNP) potencialmente operável. Métodos: Foram pesquisados diversos bancos de dados. Estudos comparando a precisão da EBUS-TBNA e da mediastinoscopia no estadiamento linfonodal mediastinal em pacientes com CPCNP foram incluídos. Na meta-análise, foram calculadas sensibilidade e especificidade, bem como razões de verossimilhança positiva e negativa. A diferença de risco de complicações relatadas para cada procedimento também foi analisada. Resultados: A pesquisa identificou 4.201 artigos, dos quais 5 foram selecionados para a meta-análise (total combinado de 532 pacientes). Não houve diferenças estatisticamente significativas entre EBUS-TBNA e mediastinoscopia: sensibilidade (81% vs. 75%), especificidade (100% para ambas), razão de verossimilhança positiva (101,03 vs. 95,70) e razão de verossimilhança negativa (0,21 vs. 0,23). A área sob a curva summary ROC para EBUS-TBNA e para mediastinoscopia foi de 0,9881 e 0,9895, respectivamente. Embora o número de complicações tenha sido maior para mediastinoscopia, não foi encontrada diferença significativa (diferença de risco: −0,03; IC95%: −0,07 to 0,01; I2 = 76%). Conclusões: EBUS-TBNA e mediastinoscopia apresentaram resultados semelhantes no estadiamento mediastinal do CPCNP. EBUS-TBNA pode ser o procedimento de primeira escolha no estadiamento linfonodal em pacientes com CPCNP.

ABSTRACT Objective: Lung cancer (LC) is one of the leading causes of death worldwide. Accurate mediastinal staging is mandatory in order to assess prognosis and to select patients for surgical treatment. EBUS-TBNA is a minimally invasive procedure that allows sampling of mediastinal lymph nodes (LNs). Some studies have suggested that EBUS-TBNA is preferable to surgical mediastinoscopy for mediastinal staging of LC. The objective of this systematic review and meta-analysis was to compare EBUS-TBNA and mediastinoscopy in terms of their effectiveness for mediastinal LN staging in potentially operable non-small cell lung cancer (NSCLC). Methods: This was a systematic review and meta-analysis, in which we searched various databases. We included studies comparing the accuracy of EBUS-TBNA with that of mediastinoscopy for mediastinal LN staging in patients with NSCLC. In the meta-analysis, we calculated sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. We also analyzed the risk difference for the reported complications associated with each procedure. Results: The search identified 4,201 articles, 5 of which (with a combined total of 532 patients) were selected for inclusion in the meta-analysis. There were no statistically significant differences between EBUS-TBNA and mediastinoscopy in terms of the sensitivity (81% vs. 75%), specificity (100% for both), positive likelihood ratio (101.03 vs. 95.70), or negative likelihood ratio (0.21 vs. 0.23). The area under the summary ROC curve was 0.9881 and 0.9895 for EBUS-TBNA and mediastinoscopy, respectively. Although the number of complications was higher for mediastinoscopy, the difference was not significant (risk difference: −0.03; 95% CI: −0.07 to 0.01; I2 = 76%). Conclusions: EBUS-TBNA and mediastinoscopy produced similar results for mediastinal staging of NSCLC. EBUS-TBNA can be the procedure of first choice for LN staging in patients with NSCLC.

https://doi.org/10.36416/1806-3756/e20190221 1029 downloads

Early complications in flexible bronchoscopy at a university hospital
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Jacomelli, Marcia

; Margotto, Stephania Silva

; Demarzo, Sergio Eduardo

; Scordamaglio, Paulo Rogério

; Cardoso, Paulo Francisco Guerreiro

; Palomino, Addy Lidvina Mejia

; Figueiredo, Viviane Rossi

Jornal Brasileiro de Pneumologia

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2020, Volume 46 N. 4 elocation e20180125

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: Analisar as complicações relacionadas à broncoscopia flexível (BF) e a seus procedimentos de coleta em diferentes doenças pulmonares e de vias aéreas em pacientes ambulatoriais e internados em um hospital universitário. Métodos: Foram analisadas retrospectivamente complicações precoces que ocorreram durante e após BF (em até 2 h) registrados no banco de dados do Serviço de Endoscopia Respiratória de um complexo hospitalar localizado na cidade de São Paulo (SP) entre janeiro de 2012 e dezembro de 2013. Resultados: Foram analisadas 3.473 BF. Complicações ocorreram em 185 procedimentos (5,3%): sangramento moderado a acentuado, em 2,2%; pneumotórax, em 0,7%; broncoespasmo grave, em 0,8%; complicações gerais (hipoxemia, agitação psicomotora, arritmias, vômitos e hipotensão), em 1,6%; e parada cardiorrespiratória, em 0,03%. Não houve óbitos relacionados aos procedimentos. Especificamente, nos 1.728 pacientes submetidos a biópsias, escovado brônquico e punção aspirativa por agulha fina, houve sangramentos em 75 (4,3%.) Entre os 1.191 pacientes que realizaram biópsia transbrônquica, pneumotórax (com necessidade de drenagem torácica) ocorreu em 24 (2,0%). Conclusões: Neste grupo de pacientes, a BF se mostrou um método seguro com baixo índice de complicações. A formação adequada e continuada dos médicos especialistas e da equipe de enfermagem, bem como a elaboração de protocolos de atendimento padronizados, são importantes nesse sentido.

ABSTRACT Objective: To analyze the complications related to flexible bronchoscopy (FB) and its collection procedures in outpatients and inpatients with various lung and airway diseases treated at a university hospital. Methods: This was a retrospective analysis of complications occurring during or within 2 h after FB performed between January of 2012 and December of 2013, as recorded in the database of the respiratory endoscopy department of a hospital complex in the city of São Paulo, Brazil. Results: We analyzed 3,473 FBs. Complications occurred in 185 procedures (5.3%): moderate to severe bleeding, in 2.2%; pneumothorax, in 0.7%; severe bronchospasm, in 0.8%; general complications (hypoxemia, psychomotor agitation, arrhythmias, vomiting, or hypotension), in 1.6%; and cardiopulmonary arrest, in 0.03%. There were no deaths related to the procedures. Specifically, among the 1,728 patients undergoing biopsy, bronchial brushing, or fine-needle aspiration biopsy, bleeding occurred in 75 (4.3%). Among the 1,191 patients undergoing transbronchial biopsy, severe pneumothorax (requiring chest tube drainage) occurred in 24 (2.0%). Conclusions: In our patient sample, FB proved to be a safe method with a low rate of complications. Appropriate continuing training of specialist doctors and nursing staff, as well as the development of standardized care protocols, are important for maintaining those standards.

https://doi.org/10.36416/1806-3756/e20180125 734 downloads

Endobronchial ultrasound: a minimally invasive technology to assist diagnosis of thoracic diseases
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Costa Jr, Altair da Silva

; Palomino, Addy Lidvina Mejia

; Suzuki, Iunis

; Scordamaglio, Paulo Rogerio

; Gregorio, Marcelo Gervilla

; Jacomelli, Marcia

einstein (São Paulo)

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2019, Volume 17 N. 3 elocation eMD4921

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO A ultrassonografia endobrônquica é uma técnica minimamente invasiva que associa simultaneamente broncoscopia à ultrassonografia, com a finalidade de visualizar nódulos ou massas pulmonares, paredes das vias aéreas, e estruturas ao redor de toda a árvore traqueobrônquica. A ultrassonografia endobrônquica foi incorporada à prática clínica em todo o mundo devido a seu baixo risco e elevado rendimento diagnóstico em doenças neoplásicas e não neoplásicas.

ABSTRACT The endobronchial ultrasound is a minimally invasive technique that simultaneously associates ultrasound and bronchoscopy, to visualize lung nodule or masses, airway wall, and structures adjacent to the tracheobronchial tree. Endobronchial ultrasound has been incorporated into clinical practice all over the world because of its low risk and high diagnostic yield in neoplastic and non-neoplastic disease.

https://doi.org/10.31744/einstein_journal/2019md4921 1032 downloads

10.

Multiple laryngeal neuromas: rare benign tumor
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Costa Jr., Altair da Silva

; Suzuki, Iunis

; Palomino, Addy Lidvina Mejia

; Gregorio, Marcelo Gervilla

; Scordamaglio, Paulo Rogerio

; Jacomelli, Marcia

einstein (São Paulo)

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2019, Volume 17 N. 3 elocation eAI4465

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.31744/einstein_journal/2019ai4465 952 downloads

11.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in diagnosis of mediastinal lesions
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Santos, Ricardo Sales dos

; Jacomelli, Marcia

; Franceschini, Juliana Pereira

; Suzuki, Iunis

; Costa Jr., Altair da Silva

; Shiang, Christina

; Palomino, Addy Lidvina Mejia

einstein (São Paulo)

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2018, Volume 16 N. 2 elocation eAO4094

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Descrever os resultados da utilização de punção aspirativa por agulha guiada por ultrassom endobrônquico na definição do diagnóstico em casos de lesões mediastinais por diferentes causas. Métodos Estudo transversal retrospectivo de pacientes submetidos à punção aspirativa por agulha guiada por ultrassom endobrônquico em instituição privada, entre junho de 2013 e outubro de 2016. Foram incluídos todos os casos referenciados para coleta de materiais de linfonodos ou massas peritraqueais/peribrônquicas por punção aspirativa por agulha guiada por ultrassom endobrônquico, estudados com tomografia ou PET-CT. Os procedimentos foram realizados por pneumologistas intervencionistas e cirurgiões torácicos com experiência no método. Rapid on-site evaluation da punção aspirativa por agulha fina foi realizada por patologista experiente. A análise do material incluiu citologia dos esfregaços em lâminas e análise citopatológica do emblocado celular. Outras análises específicas (imunocitoquímica, pesquisas e culturas de agentes infecciosos) foram realizadas se necessárias. Resultados Foram incluídos 72 pacientes; destes, 6 foram excluídos por apresentarem lesões endobrônquicas passíveis de biópsia broncoscópica convencional ou lesões intratorácicas não acessíveis a punção aspirativa por agulha guiada por ultrassom endobrônquico. Assim, a média de idade dos 66 pacientes incluídos para análise foi 61,17 anos (±14,67 anos), com predomínio do sexo masculino (64%). A punção aspirativa por agulha guiada por ultrassom endobrônquico foi definitivo para o diagnóstico em 60 casos (91%). Três casos (4,5%) foram inconclusivos. Não houve complicações maiores relacionadas ao procedimento. Conclusão A punção aspirativa por agulha guiada por ultrassom endobrônquico teve elevado rendimento diagnóstico, com mínima morbidade, constituindo excelente opção na abordagem diagnóstica de pacientes com linfadenopatia ou lesões intratorácicas e no estadiamento de neoplasias.

ABSTRACT Objective To describe the results of endobronchial ultrasound-guided transbronchial needle aspiration in making diagnosis of mediastinal injuries associated to different causes. Methods A retrospective cross-sectional study of patients submitted to Endobronchial ultrasound-guided transbronchial needle aspiration at a private organization, between June 2013 and October 2016. All cases referred for collection of lymph nodes or peritracheal/peribronchial masses by endobronchial ultrasound-guided transbronchial needle aspiration, and evaluated through tomography or PET-CT were included. Interventional pulmonologists and thoracic surgeons with experience in the method did the procedures. Rapid on-site evaluation of fine needle aspiration was performed by an experienced pathologist. Material analysis included cytological smear and cytopathological analysis of paraffin-embedded cell blocks. Other specific analyses (immunocytochemistry, tests and cultures of infectious agents) were performed whenever necessary. Results We included 72 patients; 6 were excluded for presenting endobronchial lesions in which bronchoscopic biopsy could be performed, or intrathoracic lesions that were not accessible by endobronchial ultrasound-guided transbronchial needle aspiration. The mean age of 66 patients included for analysis was 61.17 years (±14.67 years), with a predominance of males (64%). Endobronchial ultrasound-guided transbronchial needle aspiration was definitive for diagnosis in 60 cases (91%). Three cases (4.5%) had inconclusive test results. There were no major complications related to the procedure. Conclusion Endobronchial ultrasound-guided transbronchial needle aspiration had a high diagnosis yield, with minimal morbidity, being an excellent option for diagnostic approach of patients with lymphadenopathy or intrathoracic lesions, and for neoplasm staging.

https://doi.org/10.1590/s1679-45082018ao4094 3267 downloads

12.

Indications, clinical outcomes and complications of 1,949 flexible bronchoscopies
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Costa Jr, Altair da Silva

; Scordamaglio, Paulo Rogerio

; Suzuki, Iunis

; Palomino, Addy Lidvina Mejia

; Jacomelli, Marcia

einstein (São Paulo)

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2018, Volume 16 N. 4 elocation eAO4380

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo Descrever as indicações, os resultados clínicos e as complicações associadas à broncoscopia flexível. Métodos Foi realizado um estudo observacional descritivo das broncoscopias realizadas no serviço de endoscopia do Hospital Albert Einstein. Foram analisados: informações demográficas, como idade, gênero e procedência; dados clínicos sobre a indicação do exame; e resultados endoscópicos e dos exames diagnósticos realizados, como biópsias, lavados, citologias e culturas. Os fatores de exclusão foram dados incompletos no sistema e procedimentos intervencionistas. Resultados No período de 3 anos, de 2013 a 2016, foram realizadas 1.949 broncoscopias no hospital pela equipe da endoscopia respiratória e anestesiologista. A média de idade dos pacientes foi de 57,7±21,9 anos, (variação: 3 dias a 99 anos), com prevalência do gênero masculino (56,4%). A maioria dos exames (86,3%) foi eletiva e 30,7% foram realizados na terapia intensiva. A indicação médica mais frequente para realização da broncoscopia foi infecção ou secreção (42,4%), seguida de suspeita de neoplasia (10,8%). Nas alterações endoscópicas das broncoscopias realizadas, obtivemos os dados em 91,9% dos exames. Cerca de 6,9% dos pacientes apresentaram mais de uma alteração endoscópica. Foram realizados 1.399 lavados, com positividade de 36,3% nas pesquisas diretas e 53,9% nas culturas. O rendimento geral com lavados broncoalveolares e biópsia foi de 72,6%. Em nossa série, a taxa de eventos adversos leves foi de 7,2%. Os eventos adversos graves, nos quais foi necessária alguma intervenção adicional, somaram 0,5%: 0,4% de pneumotórax e 0,1% de hemorragia grave com óbito. Conclusão A endoscopia das vias aéreas inferiores é imprescindível para avaliação, diagnóstico e tratamento de doenças respiratórias. A broncoscopia flexível tem bom rendimento diagnóstico e risco mínimo associado.

ABSTRACT Objective To describe indications, clinical outcomes and complications of flexible bronchoscopy. Methods A descriptive observational study of bronchoscopies performed at the endoscopy service of Hospital Israelita Albert Einstein . Demographic (age, gender and origin) and medical (indications and results of endoscopy and diagnostic tests, such as biopsy collection, lavage, cytology and culture) data were analyzed. Electronic medical records with incomplete data or reporting interventional procedures were excluded. Results Over a three-year period (2013 to 2016), a total of 1,949 bronchoscopies were performed by respiratory endoscopy team and anesthesia specialists of the hospital. The mean age of patients was 57.7±21.9 years (range of 3 days to 99 years), with prevalence of males (56.4%). The procedures were mostly (86.3%) elective and 30.7% were carried out in the intensive care unit. Major indications for bronchoscopy were infection or secretion (42.4%), followed by suspected neoplasm (10.8%). Endoscopic changes were reported in 91.9% of cases, with more than one change described in approximately 6.9% of patients. Positive results were obtained via direct testing or culture in 36.3% and 53.9% of 1,399 bronchoalveolar lavages, respectively. The overall diagnostic yield (bronchoalveolar lavage and biopsy) was 72.6%. Mild adverse event rate was 7.2%. The rate of severe adverse events requiring additional intervention was 0.5% (pneumothorax, 0.4%; severe bleeding with patient death, 0.1%). Conclusion Lower airway endoscopy is critical for respiratory disease assessment, diagnosis and treatment. Flexible bronchoscopy is associated with good diagnostic yield and minimal inherent risk.

https://doi.org/10.31744/einstein_journal/2018ao4380 2746 downloads

13.

Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions
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Guarize, Juliana

; Donghi, Stefano

; Saueressig, Maurício Guidi

; Jacomelli, Marcia

; Demarzo, Sergio Eduardo

; Cardoso, Paulo Francisco Guerreiro

; Palomino, Addy Lidvina Mejia

; Figueiredo, Viviane Rossi

Jornal Brasileiro de Pneumologia

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feb 2017, Volume 43 N. 1 Pages 76 - 77

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/s1806-37562016000000379 1332 downloads

14.

Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions
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Jacomelli, Marcia

; Demarzo, Sergio Eduardo

; Cardoso, Paulo Francisco Guerreiro

; Palomino, Addy Lidvina Mejia

; Figueiredo, Viviane Rossi

Jornal Brasileiro de Pneumologia

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aug 2016, Volume 42 N. 4 Pages 248 - 253

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

RESUMO Objetivo: A broncoscopia convencional possui baixo rendimento diagnóstico para lesões pulmonares periféricas. A ecobroncoscopia radial (EBUS radial) emprega um transdutor ultrassonográfico rotatório na extremidade de uma sonda que é inserida no canal de trabalho do broncoscópio. O EBUS radial facilita a localização de nódulos pulmonares periféricos, aumentando assim o rendimento diagnóstico. O objetivo deste estudo foi apresentar nossa experiência inicial com o uso de EBUS radial para o diagnóstico de lesões pulmonares periféricas em um hospital terciário. Métodos: Foi realizada uma análise retrospectiva de 54 pacientes submetidos à broncoscopia guiada por EBUS radial para a investigação de nódulos ou massas pulmonares entre fevereiro de 2012 e setembro de 2013. O EBUS radial foi realizado com uma sonda flexível de 20 MHz, que foi inserida no canal de trabalho do broncoscópio até chegar à lesão-alvo. A fluoroscopia foi usada para localizar a lesão e realizar procedimentos de coleta (escovado brônquico, aspiração transbrônquica com agulha e biópsia transbrônquica). Resultados: O EBUS radial identificou 39 nódulos (média de diâmetro: 1,9 ± 0,7 cm) e 19 massas (média de diâmetro: 4,1 ± 0,9 cm). A sensibilidade global do EBUS radial foi de 66,7% (79,5% para as lesões visíveis pelo método e 25% para as lesões não visíveis pelo método). Nas lesões visíveis pelo método, a sensibilidade foi de 91,7% para massas e de 74,1% para nódulos. As complicações foram pneumotórax (3,7%) e sangramento brônquico controlado broncoscopicamente (9,3%). Conclusões: O EBUS radial apresenta bom perfil de segurança, baixo índice de complicações e alta sensibilidade para o diagnóstico de lesões pulmonares periféricas.

ABSTRACT Objective: Conventional bronchoscopy has a low diagnostic yield for peripheral pulmonary lesions. Radial-probe EBUS employs a rotating ultrasound transducer at the end of a probe that is passed through the working channel of the bronchoscope. Radial-probe EBUS facilitates the localization of peripheral pulmonary nodules, thus increasing the diagnostic yield. The objective of this study was to present our initial experience using radial-probe EBUS in the diagnosis of peripheral pulmonary lesions at a tertiary hospital. Methods: We conducted a retrospective analysis of 54 patients who underwent radial-probe EBUS-guided bronchoscopy for the investigation of pulmonary nodules or masses between February of 2012 and September of 2013. Radial-probe EBUS was performed with a flexible 20-MHz probe, which was passed through the working channel of the bronchoscope and advanced through the bronchus to the target lesion. For localization of the lesion and for collection procedures (bronchial brushing, transbronchial needle aspiration, and transbronchial biopsy), we used fluoroscopy. Results: Radial-probe EBUS identified 39 nodules (mean diameter, 1.9 ± 0.7 cm) and 19 masses (mean diameter, 4.1 ± 0.9 cm). The overall sensitivity of the method was 66.7% (79.5% and 25.0%, respectively, for lesions that were visible and not visible by radial-probe EBUS). Among the lesions that were visible by radial-probe EBUS, the sensitivity was 91.7% for masses and 74.1% for nodules. The complications were pneumothorax (in 3.7%) and bronchial bleeding, which was controlled bronchoscopically (in 9.3%). Conclusions: Radial-probe EBUS shows a good safety profile, a low complication rate, and high sensitivity for the diagnosis of peripheral pulmonary lesions.

https://doi.org/10.1590/s1806-37562015000000079 3498 downloads

15.

Recomendações brasileiras de ventilação mecânica 2013. Parte 2
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Barbas, Carmen Sílvia Valente

; Ísola, Alexandre Marini

; Farias, Augusto Manoel de Carvalho

; Cavalcanti, Alexandre Biasi

; Gama, Ana Maria Casati

; Duarte, Antonio Carlos Magalhães

; Vianna, Arthur

; Serpa Neto, Ary

; Bravim, Bruno de Arruda

; Pinheiro, Bruno do Valle

; Mazza, Bruno Franco

; Carvalho, Carlos Roberto Ribeiro de

; Toufen Júnior, Carlos

; David, Cid Marcos Nascimento

; Taniguchi, Corine

; Mazza, Débora Dutra da Silveira

; Dragosavac, Desanka

; Toledo, Diogo Oliveira

; Costa, Eduardo Leite

; Caser, Eliana Bernadete

; Silva, Eliezer

; Amorim, Fabio Ferreira

; Saddy, Felipe

; Galas, Filomena Regina Barbosa Gomes

; Silva, Gisele Sampaio

; Matos, Gustavo Faissol Janot de

; Emmerich, João Claudio

; Valiatti, Jorge Luis dos Santos

; Teles, José Mario Meira

; Victorino, Josué Almeida

; Ferreira, Juliana Carvalho

; Prodomo, Luciana Passuello do Vale

; Hajjar, Ludhmila Abrahão

; Martins, Luiz Claudio

; Malbouisson, Luis Marcelo Sá

; Vargas, Mara Ambrosina de Oliveira

; Reis, Marco Antonio Soares

; Amato, Marcelo Brito Passos

; Holanda, Marcelo Alcântara

; Park, Marcelo

; Jacomelli, Marcia

; Tavares, Marcos

; Damasceno, Marta Cristina Paulette

; Assunção, Murillo Santucci César

; Damasceno, Moyzes Pinto Coelho Duarte

; Youssef, Nazah Cherif Mohamed

; Teixeira, Paulo José Zimmermann

; Caruso, Pedro

; Duarte, Péricles Almeida Delfino

; Messeder, Octavio

; Eid, Raquel Caserta

; Rodrigues, Ricardo Goulart

; Jesus, Rodrigo Francisco de

; Kairalla, Ronaldo Adib

; Justino, Sandra

; Nemer, Sergio Nogueira

; Romero, Simone Barbosa

; Amado, Verônica Moreira

Revista Brasileira de Terapia Intensiva

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sep 2014, Volume 26 N. 3 Pages 215 - 239

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

O suporte ventilatório artificial invasivo e não invasivo ao paciente grave tem evoluído e inúmeras evidências têm surgido, podendo ter impacto na melhora da sobrevida e da qualidade do atendimento oferecido nas unidades de terapia intensiva no Brasil. Isto posto, a Associação de Medicina Intensiva Brasileira (AMIB) e a Sociedade Brasileira de Pneumologia e Tisiologia (SBPT) - representadas por seu Comitê de Ventilação Mecânica e sua Comissão de Terapia Intensiva, respectivamente, decidiram revisar a literatura e preparar recomendações sobre ventilação mecânica, objetivando oferecer aos associados um documento orientador das melhores práticas da ventilação mecânica na beira do leito, com base nas evidências existentes, sobre os 29 subtemas selecionados como mais relevantes no assunto. O projeto envolveu etapas que visaram distribuir os subtemas relevantes ao assunto entre experts indicados por ambas as sociedades, que tivessem publicações recentes no assunto e/ou atividades relevantes em ensino e pesquisa no Brasil, na área de ventilação mecânica. Esses profissionais, divididos por subtemas em duplas, responsabilizaram-se por fazer uma extensa revisão da literatura mundial. Reuniram-se todos no Fórum de Ventilação Mecânica, na sede da AMIB, na cidade de São Paulo (SP), em 3 e 4 de agosto de 2013, para finalização conjunta do texto de cada subtema e apresentação, apreciação, discussão e aprovação em plenária pelos 58 participantes, permitindo a elaboração de um documento final.

https://doi.org/10.5935/0103-507X.20140034 89689 downloads

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