REVIEW  COMPETENCE IN INTERVENTIONAL PULMONOLOGY Free access

Panminerva Medica 2019 September;61(3):386-400

DOI: 10.23736/S0031-0808.18.03543-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Competence in pulmonary endoscopy emergencies

Claudio F. SIMONASSI ¹ ✉, Maria MAJORI ², Maria G. COVESNON ¹, Annalisa BRIANTI ¹, Luigi LAZZARI AGLI ³, Eleonora MEONI ⁴, Antonella IELPO ⁵, Lorenzo CORBETTA ⁶

¹ Unit of Pulmonology, Villa Scassi Hospital, Genoa, Italy; ² Unit of Pulmonology, Thoracic Endoscopy, University Hospital of Parma, Parma, Italy; ³ Unit of Pulmonology, AUSL Romagna, Rimini, Italy; ⁴ Emergency Unit, SS Cosma e Diamiano Hospital Pescia, Pistoia, Italy; ⁵ University of Parma, Parma, Italy; ⁶ Unit of Interventional Pulmonology, University Hospital of Careggi, Florence, Italy

In clinical practice, interventional pulmonologists face several situations which can lead to dramatic consequences especially regarding ventilation and require immediate intervention. We describe the main pathological conditions where an urgent bronchoscopy is crucial because they act through mechanisms such as airway obstructions or alteration of the anatomic integrity of the tracheobronchial tree. We point out the problems resulting from inhalation of foreign bodies, one of the most dramatic respiratory emergencies typical in childhood which needs not only the appropriate endoscopic equipment suitable for the age, but also great experience in the management of the possible related complications. Massive hemoptysis is then discussed in order to help to choose the right endoscope and to clarify the steps requested to face this dramatic event. Lastly, iatrogenic tracheal injuries are described, in spite of their low occurrence. The correct endoscopic assessment of the lesions enables to select the proper multidisciplinary therapeutic approach together with surgeons and anesthetists. Due to their peculiarities, emergencies do not allow classic training so it is difficult to estimate the procedure volume necessary to achieve an adequate endoscopic experience. We think, in this field, it is advisable to refer to numbers proposed for elections endoscopic procedures. For these reasons, we consider desirable the use of simulators and clinic case discussions during interventional pulmonologist’s training.

KEY WORDS: Endoscopic procedures - Foreign bodies - Inhalation - Hemoptysis