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Iced Saline Lavage during Bronchoscopy

1976; Elsevier BV; Volume: 69; Issue: 1 Linguagem: Inglês

10.1378/chest.69.1.131b

1931-3543

Hamid Sahebjami,

Esophageal and GI Pathology

To the Editor: Iced water lavage has been used with variable success in the management of acute upper gastrointestinal bleeding1Isselbacher KJ Koff RS Alterations in gastrointestinal function.in: Wintrobe MM Thom GW Adams RD Harrison's Principles of Internal Medicine. 7th ed. McGraw-Hill Inc, New York1974: 220Google Scholar Hemostasis is thought to be achieved as the result of local vasoconstriction and decreased blood flow. Intrabronchial hemorrhage due to the fragility of the mucosal and endobronchial lesions or hemoptysis of any cause may interfere with bronchoscopie examination by obscuring the view. Recently, I used iced isotonic saline solution for lavage successfully in order to control acute intrabronchial bleeding which had made proper visualization and diagnostic maneuvers impossible in previous attempts. Therefore, this technique is herewith introduced as a useful approach in the management of bleeding during diagnostic bronchoscopic examination. A 66-year-old man was admitted to the Cincinnati Veterans Administration Hospital in October 1974 for evaluation of weight loss and an unresolved left lower-lobe infiltrate. Findings from physical examination were normal, except for a few rales over the left lower lung field. Laboratory investigations were unrewarding. Fiberoptic bronchoscopic examination was attempted, but as soon as the bronchoscope was introduced into the left main-stem bronchus, profuse active bleeding from the left lower-lobe bronchus made evaluation impossible. Despite vigorous lavage with isotonic saline, the bleeding continued. Blind biopsy specimens were taken, and the suspicious area was brushed. Microscopic examination showed only clotted blood. Also, in the presence of blood, the bronchial washing was unsuited for cytologic evaluation. Fiberoptic bronchoscopic examination was repeated a few days later. Again the procedure was unsuccessful. The third bronchoscopic examination was performed using iced isotonic saline solution for lavage. Five-milliliter aliquots were introduced into the left lower-lobe bronchus and after about one minute were removed by suction. This maneuver was repeated seven times using a total of 35 ml of iced saline solution, by which time bleeding stopped completely. After clots were removed, an endobronchial mass was clearly visualized occluding about 80 percent of the left lower-lobe bronchus. Biopsy and brush specimens were taken under direct vision, and bronchial washings were collected. The procedure was uneventful, and the patient developed no complications during or following the procedure. The biopsy specimen showed a well-differentiated squamous cell carcinoma of the bronchus, and the patient received a course of radiation therapy. Endobronchial hemorrhage during bronchoscopic examination could present a major problem in terms of adequate localization of the lesions and diagnostic maneuvers. This could sometimes be managed by lavage with saline solution or topical application of epinephrine solution. But in certain instances, such as the present case, the usual measures fail to allow a successful study to be performed. Therefore, more complicated surgical procedures, such as mediastinoscopy and thoracotomy, may become necessary. I have found that iced isotonic saline solution is helpful in the control of bleeding and that it could save the patient from other more traumatic procedures. This technique has potential value in the diagnostic approach to the problem of hemoptysis in general. Endobronchial bleeding in the majority of cases is unifocal, originating from a segment2Smiddy JF Elliott RC The evaluation of hemoptysis with fiberoptic bronchoscopy.Chest. 1973; 64: 158-162Crossref PubMed Scopus (37) Google Scholar Therefore, iced saline lavage of the diseased segment should not cause any significant degree of physiologic derangement, even when large volumes of saline solution are used. I believe that iced saline lavage was of definite value in the case reported and that clinical trials are justified to assess its value in bronchoscopic diagnosis and management of diseases associated with intrabronchial bleeding.