Background

Proper manipulation of fibreoptic bronchoscopes is essential for successful tracheal intubation or diagnostic bronchoscopy. Failure of proper navigation and rotation of the fibrescope may lead to difficulties in advancing the fibrescope and might also be responsible for (unnecessary) difficulties and delays in fibreoptic tracheal intubation, with subsequent hypoxaemia. The present study, therefore, aimed to assess the effectiveness of tip rotation in flexible bronchoscopes in different experimental conditions.

Methods

Five differently sized pairs of fibrescopes (outer diameters of 2.2, 2.4, 3.5, 4.2, and 5.2 mm) were inserted into paediatric airway manikins via an appropriately sized laryngeal mask and were turned clockwise or anticlockwise at the fibrescope body or cord to 45, 90, and 180°, with the cord held either straight or bent. The primary outcome measure was the ratio of rotation measured at the tip over the rotation performed with the fibrescope body or cord.

Results

Overall, the ‘body’ turn was significantly less effective when a bent cord was present (mean difference ranging from 29.8% (95% confidence interval 8.8–50.9) to 117.4% (93.6–141.2). This difference was diminished when the ‘cord’ turn was performed. Smaller fibrescopes, with outer diameters of 2.2 and 2.4 mm, were inferior with respect to the transmission of ‘body’ rotation to the tip.

Conclusions

‘Cord’ turning of the fibrescope appears to be more effective in rotating the tip than a turn of the fibrescope ‘body’ only. Straightening the fibrescope cord and combined ‘body’ and ‘cord’ turning are recommended.

中文翻译：

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纤维支气管镜在不同实验条件下针尖旋转的有效性：一项体外交叉研究

背景

正确操作纤维支气管镜对于成功气管插管或诊断性支气管镜检查至关重要。纤维镜的正确导航和旋转失败可能会导致纤维镜前进的困难，也可能是造成（不必要的）困难和延迟气管插管以及随后的低氧血症的原因。因此，本研究旨在评估在不同实验条件下柔性支气管镜中针头旋转的有效性。

方法

通过适当尺寸的喉罩将五对不同尺寸的纤维镜（外径分别为2.2、2.4、3.5、4.2和5.2 mm）插入小儿气道人体模型中，并在纤维镜主体或绳索处顺时针或逆时针旋转至45、90 ，然后将其保持在180°的位置，并保持笔直或弯曲。主要的测量结果是在尖端测得的旋转率与用光纤镜体或绳索进行的旋转率之比。

结果

总体而言，当存在弯曲的绳索时，“身体”转向的效果明显较差（平均差异范围为29.8％（95％置信区间8.8-50.9）至117.4％（93.6-141.2）。较小的外径为2.2和2.4 mm的纤维镜在“身体”旋转到尖端的传递方面较差。

结论

光纤镜的“线”旋转似乎比仅光纤镜的“身体”旋转更有效地旋转尖端。建议拉直光纤镜线，并结合“身体”和“软线”转动。