Options for inserting a bronchoscope through the upper respiratory tract

Inserting a flexible bronchoscope into the tracheobronchial tree involves the use of natural entrance gates: the nasal cavity (a nasal approach) and the oral cavity (an oral approach). The paper is devoted to the comparative analysis of the advantages and disadvantages of both approaches, which is to decide which access should be considered a priority. Material and methods. The investigators analyzed the advantages and disadvantages of using natural approaches during 5000 (100%) bronchoscopies and also estimated the frequency of painful sensations, retching (before anesthesia of the vocal folds), the possibility of using routine techniques for respiratory protection of bronchoscopy, as well as the frequency of early termination of bronchoscopy due to subjective intolerance in the study patient. For statistical assessment of the findings, the x2 test was used for two independent samples. Results and discussion. Transnasal and oral approaches were applied to perform 4562 (91.24%) and 438 (8.76%) bronchoscopies, respectively. A bronchoscope was inserted using the oblique direction in 755 (15.1%) patients undergoing the transnasal access. In 1300 (26%) patients undergoing the transnasal approach, nose pain sensations occurred, which went away in the absolute majority (1246 [24.92%]) of cases as the distal end of the bronchoscope was advanced into the nasopharynx. With the oral access, nausea or retching was significantly more common, as well as forced early termination of bronchoscopy; during which the differences reached the level for statistical significance. When applying the oral access, it was impossible to use this option of respiratory protection of bronchoscopy as a bronchological version of the non-return mask system. Conclusion. The transnasal approach is preferred. The oral approach should only be used if it is impossible to apply the transnasal access.

otorhinolaryngology, bronchoscopy, bronchoscope insertion, transnasal access for insertion of a bronchoscope, oral access for insertion of a bronchoscope