Centres of Excellence

The bronchoscope is a small, flexible tube which can be easily passed through a nose or mouth. The flexible tube carries a fiber-optic system that attaches to a video camera and light source. The image from the open end is transmitted through the fiber-optic system to a video camera.
 

A trans-nasal flexible fiber-optic bronchoscopy is a procedure where a physician examines various parts of the respiratory system through the bronchoscope. The following are some helpful definitions:

• Trans-nasal: The soft tube of the bronchoscope being passed through the child's nose
• Flexible bronchoscopes: Soft, flexible, and easily passed through the nose and airways in the lungs
• Fiber-optic: The ability of the bronchoscope to carry an image from the tip of the tube to video camera

Bronchoscopy is an evaluation of the respiratory system, including voice box (larynx), wind pipe (trachea), and the airways (bronchi) for evidence of any abnormality. The physician can see these structures during different stages of the breathing cycle. He or she can also take pictures and record the images on video. This video image is helpful for University of Chicago Comer Children's Hospital physicians to monitor the progress of any abnormalities.

In a bronchoalveolar lavage (BAL), the physician injects a small amount of saline through the bronchoscope into the airways and then sucks it back through the bronchoscope. The fluid obtained contains saline plus secretions from the lung, bacteria (if present), and cells. This sample is sent to the laboratory for various tests.

Bronchial biposy can be transbronchial or endobronchial. In transbronchial biopsy, bronchoscope is wedged in the diseased part of the lung and biopsy forcep is inserted through a channel present in the bronchoscope and 3-5 pieces of tissue are taken. In endobronchial biopsy, tissue is taken from the bronchial tree. In transbronchial needle aspiration needle is inserted through the channel and material is sucked after piercing through the bronchi into the desired tissue. The tissue/secretions obtained in these procedures are sent to the laboratory for various tests.

The patient is not allowed to eat or drink for four hours prior to the procedure. This is very important in order to avoid vomiting.
Once your patient arrives, our staff takes his or her height, weight, and vital signs. He or she is then brought to the procedure suite. You will be asked a series of questions and your patient will be examined.
Your patient will receive an intravenous (IV) line. Monitors are attached to the patient in order to watch vital signs. At Dr B L Kapur Memorial Hospital, our experts take every step available to ensure the safety and comfort of your patient. Typically, a flexible bronchoscopy is not done under general anesthesia, but the patient will be given medications via the IV for sedation. Your patient will be able to wake from this deep sleep and be able to cough, sneeze, or try to speak if directed.
Numbing drops will be used to numb the nose, back of the throat, larynx, trachea, and bronchi. Lidocaine prevents irritation, cough, and sneezing.
Once the numbing medication takes effect, the bronchoscope is inserted.

Once the IV is in and all monitoring equipment is attached, the procedure takes less than 15 minutes to complete. If a bronchial alveolar lavage or other procedures are needed, this takes a few additional minutes.
After the procedure, your patient will be monitored while the effect of sedation and numbing medicine wears off--usually about 30 minutes. In order for your patient to go home, he or she must be fully awake, able to drink clear fluids, and no longer exhibit signs of sedation. The full recovery process takes around an hour or two. Your patient’s physician or nurse will be able to tell you the approximate time for your patient.

Although each patient is different, there are usually little or no side effects from this procedure. Some of the possible side effects include:

• Fever: A mild fever may occur but is rare. Over-the-counter fever medicine will help.
• Nosebleed: Since the lining the nose is very delicate, a nosebleed may occur. Typically, it will stop on its own.
• Stridor: If your patient has stridor, it may temporarily get worse due to the effect of the medicine used during the procedure. A change in voice or noisy breathing may occur, but is also usually temporary.
• Wheezing: Some patient with a history of lung disease, such as asthma, may need additional medication to treat signs of wheeze both prior to and after the procedure.
• Patient may have some blood in the sputum after biopsy and needle aspiration, which usually resolves by itself after sometime.
• Air in the lung, usually rare, but can be treated effectively (seen only after transbronchial biopsy).

Your patient's doctor will give you personalized instructions prior to the procedure. This information will instruct you not to feed your patient for four to six hours before the procedure.
Explain the procedure as much as you feel he or she can understand.
The following information will help ensure a smooth procedure:

• Pack a snack or lunch for you and your patient. He or she will have to eat before going home.
• Make sure you know the names and amount of any medications your patient is taking.
• If your patient has any other medical condition, you will need to tell the physician performing the procedure. For example, patient with heart problems may need antibiotics prior to and/or after the procedure.

Spirometry is the most basic and frequently performed test to measure lung function - the ability to move air into and out of the lungs. The test is performed using a spirometer, which is standardized according to the Indian standards. An individual breathes in and out as quickly as possible through a measurement device on the spirometer. Specific measurements from the person's test are compared to standard values obtained from a healthy population of similar race, age, gender, height and weight, thus comparing the individual's lung function against a norm.
 

When an individual blows into the spirometer, the machine monitors the amount of air that flows over a special sensor with time. When one exhales, the force and speed of the air exhaled is very fast at first and then decreases as the exhalation continues. The same is basically true with inhalation. The total amount of air the lungs can hold and the person exhales is called the forced vital capacity. The amount of air that is exhaled after one second is called the forced expired volume at one second. Both of these values are important in the determination of underlying lung problems. There are many other values that are determined by the spirometer and printed in tabular and graphical format which are then compared to predicted values. In other words, a spirometer measures airflow and volume over time in a very accurate manner.

Spirometry can play an important role in the evaluation of patients with asthma, COPD, ILD and other obstructive and restrictive disorders.
 

Spirometers vary widely and can perform a variety of testing. A spirometer to be used in an occupational medicine setting should always meet the criteria developed by the American Thoracic Society. Spirometers also require calibration, at least on a daily basis prior to use, and perhaps more frequently if there are changes in the environment in which the testing is to be performed (for example, changes in environmental temperature).

While some spirometers are programmed to review results and suggest interpretations, the results should always be reviewed by a physician provider or person of similar expertise. The reports need to be reviewed for accuracy of testing, consistency and reproducibility of measured functions in addition to making diagnostic determinations.

One of the diagnostic possibilities with spirometric evaluation is obstructive lung disease (inability to exhale air in a normal fashion). How much of the obstructive changes present is nonreversible and how much is reversible often can be determined using a bronchodilator challenge test. A bronchodilator is a medication, usually given by inhaler, that treats most reversible components of obstruction. The patient first undergoes regular spirometry and values are determined (pre-challenge test). A dosage of the bronchodilator is administered, and the test is repeated (the post-challenge test). The difference between the two tests is an indication of the reversibility of the underlying obstructive problems.
 

Polysomnogram is a test which measures body functions during sleep. Each test will vary depending on the individual case, and some measurements taken may include:

• Brain Waves(EEG) (surface electrodes on head)
• Heart Rate(EKG) (surface electrodes on chest)
• Eye Movements(EOG) (surface electrodes above and below eye)
• Muscle Movements(EMG) (surface electrodes on and under chin)
• Limb Movements(EMG) (surface electrodes on the lower leg and arm)
• Breathing (Nasal/Oral) (sensors placed onto the skin near the nose and mouth)
• Breathing(Respiratory Effort) (small, elastic hands placed around chest and/or surface electrodes placed on the ribcage)
• Blood Oxygen Levels(Sp02) (small probe attached to the finger, and not taken from actual blood samples)
• Esophageal Pressure(PES) (small pressure tube placed within the esophagus to monitor the wok of breathing)
• Other body functions may be recorded to answer special questions about such things as C02, pH, and impotence.
• Sensor attachment will be done utilizing collodion(a glue-like substance) which is easily removed. Please prepare for this process by washing hair thoroughly before your visit to the Sleep Clinic.
• A video recording will be done in some circumstances.

Disrupted sleep can disturb daytime activities, and sometimes, medical problems during sleep involve a risk to basic health. These parameters are recorded to obtain objective information about the quality of sleep to better define your sleep problem.

Surprisingly, most people sleep well. The body sensors are applied in a manner that will allow you to turn and move during sleep. Generally, you will not be aware that you are wearing the devices after they have been on for a short time. Our staff makes the environment as comfortable as possible, and many patients report that they actually sleep better here than at home. Remember that this is not a performance test, but merely a recording of how you sleep.

NO! Sometimes, in rubbing the skin, there are mild temporary irritations. You may experience temporary discomfort associated with the Pes procedure. However, this does not generally cause any significant pain.

Technologist will greet you at 8:15 pm in the waiting room. There will be additional paperwork to complete. We will apply electrodes and sensors over a period of 1-2 hours with frequent breaks. You may watch television and/or videotapes during this procedure. We will provide instruction on CPAP and BIPAP usage if prescribed. This may be conducted in a group setting. You may go to sleep at your normal bedtime within the constraints of the sleep clinic protocol. During the recording process, your sleeping patterns will be observed, and a Polysomnographic Technologist will assist you as needed during the entire recording process. We typically awaken patients between 6am-7am unless an earlier wake up time is desirable. Please keep in mind that the equipment takes 15 minutes to remove.

In most cases, sleeping pills are not needed, but if you are having a difficult time sleeping, we may consider using a medication to help you sleep.

PLEASE DO NOT STOP ANY OF YOUR MEDICATION WITHOUT FIRST CONSULTING YOUR SLEEP PHYSICIAN.

Some patients also participate in daytime testing. This test consists of a series of 20-minutes nap opportunities. We record information similar to the polysomnogram. The naps are conducted every two hours throughout the day. During the nap period you are encouraged to sleep and during the breaks you must stay awake, otherwise the study is compromised. In general this study is concluded between 5pm-6pm.

The following things are must -

• You must bring bedclothes (preferably two piece pajamas or shorts and T-shirt). Something to read or to work on during non-sleep periods. You may bring a favourite video / laptop to view in your room prior to bedtime.
• Limited family members/friends (1-2) are welcome to accompany you until bedtime. Please note: We do not provide sleeping accommodations (recliner) except for those attending to children and/or disabled persons.
• Personal toiletries (toothpaste, toothbrush, comb, brush, shampoo etc.) and a change of clothes for the next day. The Sleep Clinic provides towels and bedding, and there are toilet and shower facilities available.
  ANY NEEDED MEDICATIONS! Please bring a list of medications you have taken during the past month.
• You may bring a special pillow, stuffed animal, or white noise device if desired. Children should bring favorite blankets, books or toys. Please do not bring pets.
• If you have used a CPAP/BIPAP machine, please bring your ancillary equipment (mask and headgear), please do not bring the machine.

The Sleep Disorders Clinic is an outpatient facility. Meal service is not provided. Please eat dinner prior to arrival at 8:30pm! Please plan to bring snacks and drinks or refreshments, if you so desire during your stay in the Sleep Clinic.

The reception and scheduling offices closes at 5:00pm. The Sleep Medicine Services re-opens at 8:00pm for overnight studies. IT IS IMPORTANT THAT YOU ARRIVE ON TIME: If you need to cancel your overnight sleep appointment or are running late after our office closes, please call at 011-30653257, 3259 and leave a message.
If you have difficulty staying alert while driving please make arrangements for transportation to and from the Sleep Clinic.
No Smoking is allowed inside the room according to building, hospital, and state regulations. There is a smoking area outside the building.

Our Outpatient services are routinely covered by most major insurance companies. We recommend that you check with your company about the details, regarding coverage for sleep testing, treatment and follow-up care (durable medical equipment). We will provide medical descriptions of the tests provided if this is useful for insurance purposes. If you have any insurance questions or concerns, please contact the number provided above.

The record of your sleep test will probably be about 1,000 pages long, and is stored on paper or optical disk. It will be analyzed in detail by a technologist and interpreted by a physician. The information will then be forwarded to your referring physician and you the patient. You will be contacted as soon as possible with a preliminary impression. You are also asked to make a return office visit appointment to discuss the results and a treatment plan with your respiratory physician.