Bronch training

[lunaire]

Anyone here had any post-graduate training on interventional bronchoscopy procedures? Looking to learn to do bronchoscopic interventions for persistent pneumothorax/bronchopleural fistulas. I'm already pretty handy with the flexible bronch, and would prefer not to go through the full interventional pulm fellowship...

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[jdh71]

Anyone here had any post-graduate training on interventional bronchoscopy procedures? Looking to learn to do bronchoscopic interventions for persistent pneumothorax/bronchopleural fistulas. I'm already pretty handy with the flexible bronch, and would prefer not to go through the full interventional pulm fellowship...

You want to put in valves?

 

[lunaire]

Thinking more like glue/fibrin sealant, though I'd admit that I'm not 100% up to date on the best bronchoscopic management of persistent air leak.

 

[AdmiralChz]

Anyone here had any post-graduate training on interventional bronchoscopy procedures? Looking to learn to do bronchoscopic interventions for persistent pneumothorax/bronchopleural fistulas. I'm already pretty handy with the flexible bronch, and would prefer not to go through the full interventional pulm fellowship...

I’m not an intensivist so my opinion might not count for a ton, but these advanced bronch procedures are likely left for pulmonary (yeah, interventional I suppose). There is too much margin for error and since the pathologies you reference are fairly rare, probably better managed by a sub-specialist. Why not get the extra training?

I’m in cardiac anesthesia fellowship now, anecdotally at several institutions these pathologies have been managed much more by surgeons. But I can’t comment about that nationwide.

 

[lunaire]

Appreciate the input and mostly agree. My situation is that we don't have a good interventional pulm guy, and we do enough cardiothoracic surgery cases that we end up having several patients that stays forever in the census, with persistent pneumo. You can almost tell on POD# 7-14 that these patients will stay in the census forever, develop multiple co-morbidities in their weeks of admission, and may die on you on hospitalization day 70 (as we recently had).

I'm not particularly excited with having to learn & do more procedure, but that's what my practice currently needs.

 

[jdh71]

Thinking more like glue/fibrin sealant, though I'd admit that I'm not 100% up to date on the best bronchoscopic management of persistent air leak.

If there is any real data on that I'm unaware.

If you want to learn to put in valves contact the local device rep. They'll find you some training. But valves are still considered "experimental" and you'll have to get them through your hospital IRB as well.

 

[lunaire]

If there is any real data on that I'm unaware.

If you want to learn to put in valves contact the local device rep. They'll find you some training. But valves are still considered "experimental" and you'll have to get them through your hospital IRB as well.

Rep's a good idea. I'll look into it. There's some evidence on the bioglues, though they may work better on alveolar-pleural fistula. Pretty benign- if they fail, it just gets coughed out. I'd be more wary about the valves/stents, those might cause bigger complications.