Background: Fiberoptic bronchoscopy requires effective sedation to ensure patient comfort while preserving gas exchange, hemodynamic stability, and predictable recovery. Remimazolam, a novel ultra-short-acting benzodiazepine, has emerged as a potential alternative to traditional sedatives. However, its safety and efficacy compared with those of other sedatives remain under investigation. This meta-analysis evaluated the safety and efficacy of remimazolam versus dexmedetomidine, midazolam, and propofol in adults undergoing fiberoptic bronchoscopy. Methods: A systematic review of randomized controlled trials (RCTs) was conducted using 5 databases through January 2026. Outcomes included respiratory depression, hypotension, bradycardia, time to target sedation depth, procedure success rate, emergence time, and postanesthesia care unit (PACU) stay. Relative risks (RR) or mean differences (MD) with 95% CI were calculated using a random-effects model. Results: Sixteen RCTs (2325 patients) were included. Remimazolam significantly reduced respiratory depression (RR: 0.51, 95% CI: 0.36-0.73, P <0.001), hypotension (RR: 0.50, 95% CI: 0.34-0.73, P <0.001), and bradycardia (RR: 0.37, 95% CI: 0.22-0.65, P =0.001) versus controls. Sedation onset was faster than dexmedetomidine (MD: –2.19 min), but slower than propofol (MD: 0.49 min). Success rates were comparable across groups (RR: 1.12, 95% CI: 0.98-1.28, P =0.097). Compared with dexmedetomidine and midazolam, remimazolam shortened emergence (MD: –1.79 and –4.37 min, respectively) and PACU stay (MD: –3.58 and –6.70 min). Conclusion: Remimazolam provides effective sedation for fiberoptic bronchoscopy with advantages in terms of respiratory and hemodynamic safety, rapid recovery, and procedural efficiency.
Background: Robotic-assisted bronchoscopy (RAB) uses fluoroscopy and cone-beam CT (CBCT), which can expose procedural staff to ionizing radiation. Real-time, role-specific occupational dosimetry data from live RAB procedures remain limited. Methods: We prospectively collected continuous personal dosimetry from attending physicians, anesthesia providers, and scrub nurses during 51 consecutive RAB procedures at a single academic center using a standardized low-dose imaging protocol and shielding. Collar-badge readings were converted to estimated effective dose using a conservative upper-bound conversion factor. Role-specific dose distributions were compared, and scenario-based annual estimates were generated by bootstrap resampling. Results: Median per-procedure estimated dose was 1.27 µSv for attending physicians, 0.58 µSv for anesthesia providers, and 0.55 µSv for scrub nurses. Exposure differed by role, with the primary operator receiving the highest dose. CBCT cases were associated with higher staff and patient radiation measures but also involved smaller lesions and longer fluoroscopy times, indicating confounding by procedural complexity. Patient BMI was independently associated with physician exposure. Projected annual exposures remained well below the ICRP 20 mSv occupational limit across all roles. Conclusion: Occupational radiation exposure during RAB was low across all staff roles under an optimized imaging workflow. Role-specific dosimetry captures exposure differences across the procedural team and supports standardized low-dose imaging and shielding as core safety practices.
Background: Persistent air leak (PAL) and bronchopleural fistula (BPF) are uncommon but important complications in children, particularly with necrotizing pneumonia, postoperative injury, malignancy, or extracorporeal membrane oxygenation (ECMO). When conservative therapy fails or surgery is high-risk, endobronchial or intrabronchial valve placement has emerged as a minimally invasive bronchoscopic option. This systematic review summarizes the published pediatric experience, focusing on indications, procedural approach, and outcomes. Methods: PubMed/MEDLINE, Embase, Scopus, and Web of Science were searched from inception to June 2026, with Google Scholar and reference lists screened; no language limits applied. Eligible studies reported pediatric or late-adolescent patients who underwent bronchoscopic valve placement for PAL, BPF, or pneumothorax with ongoing air leak. Case reports, case series, and observational studies with extractable pediatric data were included. Two reviewers independently screened, assessed eligibility, and abstracted data; findings were synthesized narratively. Results: Thirteen reports were included. Valve placement achieved rapid or eventual air-leak improvement in selected children, including those with necrotizing pneumonia, postoperative air leak, chronic ventilator dependence, malignancy, and ECMO support. Reported complications included valve migration or loosening, granulation tissue, minor hemoptysis, atelectasis, contralateral pneumothorax, and recurrent air leak, although many children underwent valve removal without complication. Conclusion: Endobronchial or intrabronchial valve placement may be a useful rescue or bridge therapy for carefully selected children with refractory PAL or BPF. Evidence remains low certainty owing to small samples, retrospective design, inconsistent outcome definitions, and possible publication bias. Prospective multicenter registries with standardized reporting are needed to define optimal selection, timing, and safety.
Background: Balloon tracheobronchial dilation is a key technique for managing central airway stenosis. Conventional occlusive balloons interrupt ventilation and oxygenation, limiting the duration and safety of dilation. The objective of this study was to evaluate the clinical outcomes of tracheobronchial stenosis dilation using a nonocclusive balloon and to describe relevant technical aspects of its application. Methods: A retrospective cross‑sectional study was conducted, including all patients with central airway stenosis who underwent dilation with a nonocclusive balloon at a tertiary center. In all cases, stenosis severity was ≥50%, confirmed by endoscopic or tomographic assessment, and associated with compatible symptoms. Demographic characteristics, stenosis features, procedural details, oxygenation parameters, and complications were collected. Results: Sixteen procedures were performed in 11 patients; 6 stenoses (54.5%) were malignant. The trachea was the most frequent location (n=8; 72.7%). The median stenosis severity was 83%. The mean minimum oxygen saturation during the procedure was 96.1%±3.6%, increasing to 98.6%±0.8% at the end of the procedure ( P =0.009). Most procedures (n=14; 87.5%) included 3 consecutive dilation cycles. In 2 cases (12.5%), a single prolonged cycle was performed, lasting 300 and 600 seconds, respectively. Airway stents were placed in 6 procedures (38%), all in malignant stenosis. Mild complications occurred in 2 patients (13%), consisting of minor or moderate bleeding, not related to balloon dilation. Conclusion: Nonocclusive balloon dilation provides effective treatment of tracheobronchial stenosis while maintaining ventilation and oxygenation. This technique enables longer, safer dilation cycles by eliminating the need for apnea.
Background: Cone-beam computed tomography (CBCT)- guided bronchoscopy is an established technique for diagnosing peripheral pulmonary lesions, offering 3-dimensional imaging for both navigation and confirmation. However, its usability as a stand-alone modality is limited by a substantial learning curve and a lack of integrated planning tools. This study evaluates the feasibility and performance of navigation bronchoscopy-specific CBCT software that enables preprocedural CT-planning fusion with intraprocedural CBCT imaging and provides intraprocedural support algorithms. Methods: This prospective, single-center clinical feasibility study exploratively assessed the usability of the AirWaze investigational software. Usability was measured using a standardized system usability score, with scores of 70 or higher considered indicative of good usability (range, 0-100). The performance of the individual software components (‘planning,’ ‘image fusion,’ and ‘guidance’) was evaluated. An ultralow-dose CBCT protocol was compared with conventional CBCT scans for accuracy and radiation exposure. Results: The study enrolled 34 patients with 37 lesions. The investigational software achieved a system usability score of 45. The planning component was available in all cases and was unanimously rated by the endoscopists as accurate and intuitive. In contrast, the image fusion and guidance components were rated as insufficient. The ultralow-dose CBCT protocol provided clinically accurate imaging in 84% of cases and reduced the radiation dose by 94%. Conclusion: Integrating planning and procedural guidance within stand-alone CBCT-guided navigation bronchoscopy procedures has great potential. Although several components of the investigational software were considered valuable, further development is required to ensure comprehensive procedural guidance.
