interventional medicine presentation.pptx

intervensi

1. Interventional Pulmonary Medicine

2. RIGID BRONCHOSCOPY

3. lnterventional Flexible Bronchoscopy

4. LPR : Laser Photo Resection

5. Electrosurgery Endobronchial electrosurgery (EBES) is the application of electrical current to coagulate or vaporize tissue in the tracheobronchial tree. With development of grounded bronchoscopes, better probes, electrodes, and high-frequency electrical generators, a resurgence of interest in EBES for treatment of lung cancer has occurred. Moreover, equipment and maintenance costs are very much lower compared with the Nd:YAG laser Indications, Results, and Complications EBES has been used successfully to debulk tracheobronchial tumors and restore airway patency in 70-86% of patients [42,43]. Coulter et al. [43] reported 86% success when EBES was applied under local anesthesia to a select group of patients with small endobronchial polypoidal tumors.

6. Brachytherapy, Cryotherapy, and Photodynamic Therapy Airway lesions that do not require immediate restoration of airway patency can be treated with brachytherapy, cryotherapy, or photodynamic therapym (PDT). These techniques are used singly or in combination. Brachytherapy Indications Patients with endobronchial tumors from primary lung cancer or cancers metastatic to the airways and residual tumor following surgery are candidates for brachytherapy. However, the lesion to be treated must be visible on bronchoscopy, permit the passage and distal placement of a catheter, and located in the trachea or main stem or lower lobe bronchi. Results and Complications Outcome studies with brachytherapy revealed similar endobronchial response rates of 60-89% [47,48] with LOR and 54-94% [49,50] with HOR, as well as comparable survival rates [51]. The response to brachytherapy correlated with the tumor si~e , and good results were observed with small endobronchial [52] and peripherally located tumors

7. Cryotherapy Indications The most common indication for cryotherapy is in the relief of airway obstruction due to tumor, which may be malignant or benign. However, if the patient has impending respiratory failure from tracheobronchial obstruction, surgery, LPR, EBES, or a combination of modalities is the treatment of choice, as cryotherapy is often ineffective in removing tissue rapidly. The ideal lesion is a small polypoid tumor accessible to the cryoprobe, with a visible lumen and functioning lung distally. Results and Complications Cryotherapy is successful in 50-86% of the patients in relieving airway obstruction [59,60], and a synergistic response with chemotherapy and radiotherapy has been observed

8. Relief of Benign Airway Obstruction Balloon Dilation of Benign Tracheobronchial Stenosis

9. Airway Stents Indications, Results, and Complications Stents are commonly used for the palliation of inoperable tracheobronchial tumors (Table 6). They are classified as tube and metallic stents

10. Adult Airway Foreign Body Removal we are confident that FB will playa greater role in the management of FBA in the future. Accessories for the Flexible Bronchoscope Cryotherapy . Nd:YAG Laser Hal lain yang dapat dilakukan oleh FB Bronchoalveolar Lavage Aspiration of Mediastinal Cysts Drainage of Lung Abscess Massive Hemoptysis

11. Bronchoscopy in Intensive Care Unit Retained Secretions and Atelectasis Endotracheal Intubation Percutaneous Dilatational Tracheostomy

12. Laser Bronchoscopy for Malignant Disease

13. Cryotherapy Cold Therapy for the Tracheobronchial Tree The major indication for cryotherapy is the removal of endobronchial lesions, both benign and malignant.

14. Endobronchial electrosurgery / EBES Endobronchial electrosurgery is a safe and effective treatment option for a variety of malignant and benign endobronchial lesions which remains underutilized. Electrosurgery seems to be better suited for daily bronchoscopic practice than laser.

15. Endobronchial Brachytherapy Endobronchial brachytherapy is the most common lung brachytherapy technique. Here, the radiation is delivered from within the tracheobronchial lumen by one or more afterloading applicators/catheters appropriately positioned within the trachea or bronchus. The most logical patient for curative endobronchial brachytherapy would be one with in situ cancer of the bronchial mucosa that is detected on routine screening. The small number of such patients are usually treated with photodynamic therapy, and there is limited experience with radiation therapy in this setting.

16. Argon Plasma CoaguLator The latest development in the search for an ideal coagulation device for endoscopic procedures is the argon plasma coagulator.

17. Argon plasma coagulation ( APe ) is a noncontact form of electrocoagulation. Ionized argon gas, the so-called plasma, is used as a conductor for a high-frequency current between the monopolar electrode and the tissue.

18. Fluorescene Brochoscopy

19. Transbronchial Needle Aspiration

20. Medical Thoracoscopy

21. Medical Thoracoscopy Diagnosis of Pleural Pulmonary Disorders

22. Transtracheal Oxygen Therapy

23. Chest Tube Placement Chest tube placement (or tube thoracostomy) has been used for nearly a century, primarily for draining pleural space air or fluid or in the postthoracic surgical state.

24. Percutaneous Dilational Tracheostomy

25. Transthoracic Needle Aspiration and Biopsy*

26. Silikon airway stent

27. Metalic Airway Stent

28. Foreign Body Removal

29. Photodynamic Therapy

30. Photodynamic Therapy for Palliation of Lung Cancer

31. Bronchoscopic mediated gene theraphy

32. Whole Lung Lavage

33. SUMMARY