一次性支气管镜临床应用专家共识

Expert consensus on the clinical application of single-use(disposable)flexible bronchoscopes

一次性支气管镜在国内外广泛应用于临床工作,已成为呼吸系统疾病诊断和治疗的重要工具。一次性支气管镜的轻量化、便携化及不重复使用,使其应用不仅类似于常规的可弯曲支气管镜,更有其特殊的应用需求及适用场景。一次性支气管镜目前已经被应用于呼吸学科、重症学科、传染病学科、麻醉学科和急诊室等各种场合。经过近十年的临床应用实践,已经积累了不少经验,为规范和合理使用一次性支气管镜,中国呼吸内镜专家经多次线上、线下讨论和问卷调查,广泛征求意见后,制定了我国一次性支气管镜临床应用专家共识。本共识收集了九个一次性支气管镜相关的核心问题,内容包括定义、结构、优势、应用场景、术前准备、镇静、麻醉的要求、消毒流程以及培训要求等。最终形成了12条推荐意见。共识使用调整后的推荐分级的评估、制定和评价方法对证据评价和推荐意见进行分级。希望通过本共识,规范中国一次性支气管镜的应用。

Single-use(disposable)flexible bronchoscope is widely used clinically both in China and abroad and has become an important tool for diagnostic and therapeutic procedures in respiratory diseases.The lightweight,portability,and non-reusability of the single-use flexible bronchoscope makes its use not only similar to that of conventional flexible bronchoscope,but with additional applications and indications.Currently,single-use flexible bronchoscopes are used in pulmonology,critical care medicine,infectious diseases,anesthesia,emergency departments and other clinical settings.Chinese Respiratory Endoscopy Experts have developed a consensus on the clinical application of disposable bronchoscopy in China after extensive online and offline consultation,questionnaire surveys and extensive solicitation of opinions.This consensus was developed using clinical experiences gained and lessons learned during clinical practices over the past ten years to standardize and rationalize use of single-use flexible bronchoscope.The consensus addressed nine key issues concerning single-use flexible bronchoscope:definition,construction,benefits,application scenarios,preoperative preparation,sedation,anesthesia requirements,disinfection processes and training requirement ans management.Finally,twelve recommendations were developed.The consensus used the modified GRADE methodology to grade the evidence evaluation and recommendations.This is the current state of consensus on single-use flexible bronchoscope in China,and we hope to improve the standardized application of single-use flexible bronchoscope in China in the future.Summary of consensus opinions1.Definition and structure of single-use flexible bronchoscope.A single-use flexible bronchoscope,also known as a disposable flexible bronchoscope,includes two parts:a portable touch screen display and different types of bronchoscopes.2.The advantages of single-use flexible bronchoscope.[Consensus Opinion 1]:Single-use flexible bronchoscope is sterile(strongly recommended 86.7%).[Consensus Opinion 2]:The cost of single-use flexible bronchoscope is relatively low(strongly recommended at 53.3%).[Consensus Opinion 3]:Single-use flexible bronchoscope is portable and easy to use(strongly recommended at 80%).[Consensus Opinion 4]:Single-use flexible bronchoscope can be used as a complementary tool for teaching and scientific research(strongly recommended at 80%).3.The value of single-use flexible bronchoscope in the diagnosis and treatment of pulmonary infection.[Consensus Opinion 5]:For infectious diseases,unexplained pneumonia,and multi-drug resistant organisms(MDRO),the use of disposable bronchoscopy is recommended(strongly recommended at 90%).4.Application of single-use flexible bronchoscope in the diagnosis and treatment of critically ill patients.[Consensus Opinion 6]:Single-use flexible bronchoscope can be used immediately to manage patients with difficult airways in emergency situations(strongly recommended 53.3%).[Consensus Opinion 7]:Single-use flexible bronchoscope can be used immediately for the management of airway foreign bodies and hemoptysis in emergency situations(strongly recommended 80%).5.Application of single-use flexible bronchoscope in the diagnosis and treatment with complex bronchoscopic procedures.[Consensus Opinion 8]:For complex bronchoscopic procedures,when multiple endoscopic surgeries are required in addition to current endoscopic procedures,given the vulnerability of reusable bronchoscope to damage during the procedures,the use of a single-use flexible bronchoscope combined with a reusable bronchoscope for"dual endoscopic surgery"is recommended(strongly recommended 26.7%).6.Application of single-use flexible bronchoscope in preoperative preparation.[Consensus Opinion 9]:When managing critically ill patients or patients requiring emergency airway management,preoperative preparation can be temporarily delayed(strongly recommended 93.7%).7.Application of single-use flexible bronchoscope in sedation and anesthesia.[Consensus Opinion 10]:Use of single-use flexible bronchoscope for topical anesthesia.For complex procedures,choose topical anesthesia with tracheal intubation or supraglottic airways in general anesthesia(66.7%is strongly recommended).8.Does single-use flexible bronchoscope require standardized training?[Consensus Opinion 11]:The use of disposable bronchoscope requires standardized and systematic training(strongly recommended 93.3%).9.Cleaning and disinfection requirements for single-use flexible bronchoscope.[Consensus Opinion 12]:Single-use flexible bronchoscope is disposable and does not require disinfection(strongly recommended 93.3%).