Diagnostic Fibrobronchoscopy

After visual inspection of the bronchial tree, the light guide probe of the device with a laser radiation wavelength of 0.63 μm was carried out through the fibrobronchoscope biopsy channel and, under visual control, was mounted on the mucous membrane 1.5 cm distal to the spur of the right upper lobe bronchus (Fig. 1). The rationale for the above localization was that there is no aortic pulsation in the right parts of the bronchial tree, which can interfere with the recording of Doppler, in addition, the right main bronchus is anatomically shorter and wider than the left, hence the installation of the light guide on the mucosa is simplified. The displacement of 1.5 cm in the distal direction from the spur of the upper lobe bronchus is optimal,since in this case the recording is made at some distance from the main vessels of interbronchial spurs and high activity of the tussogenic zones, thus minimizing the errors in the study. With this topic, the fixation of the probe is facilitated, since the installation on the spur is difficult due to the high probability of its “slippage”. In patients in the sitting position, they recorded the Doppler patterns for 3 minutes using an application computer program (LDF version 2.20.0 507WL) with the output of quantitative indicators on the monitor screen in real time. The following indicators were evaluated: PM – microhemocirculation parameter, σ – mean square deviation of PM, Kv – coefficient of variation, Ae – amplitude of oscillations in the endothelial range, An – amplitude of oscillations in the neurogenic range,Am is the amplitude of oscillations in the myogenic range, Hell is the amplitude of oscillations in respiratory range, Ac – amplitude of oscillations in the cardiac range, calculated using continuous wavelet transform (Fig. 1). To increase the efficiency of the data we obtained, the conditions for standardization of LDF, proposed by the European Contact Dermatitis Society, were observed.

Peak flowmetry was performed in order to monitor the state of the function of external respiration with the determination of peak expiratory flow rate in the morning, evening hours and the calculation of daily fluctuations.

Pneumotachography was performed to determine the magnitude of bronchial resistance (pneumotachograph of the Kazan Scientific Production Association “Medinstrument”).

Determination of CSF and blood gas composition was carried out using an automatic gas analyzer AVL-995 Hb (Austria) and EasyStat (USA). The following indicators were analyzed: the activity of hydrogen ions (pH); carbon dioxide partial pressure (pCO 2 ); oxygen partial pressure (pO 2 ); arterial-alveolar difference in partial pressure of O 2 (AaDO 2 ); hemoglobin oxygen saturation (O 2 sat); total oxygen content dissolved and bound in blood (O 2 cont).

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