Guillaume Lacroix - Academia.edu (original) (raw)
Papers by Guillaume Lacroix
Journal of Trauma and Acute Care Surgery, 2020
Supplemental digital content is available in the text. BACKGROUND Management of critically ill pa... more Supplemental digital content is available in the text. BACKGROUND Management of critically ill patients requiring mechanical ventilation in austere environments or during disaster response is a logistic challenge. Availability of oxygen cylinders for mechanically ventilated patient may be difficult in such a context. A solution to ventilate patients requiring high fraction of inspired oxygen (FiO2) is to use a ventilator able to be supplied by a low-pressure oxygen source connected with two oxygen concentrators (OCs). We tested the Elisée 350 (ResMedBella Vista, Australia) ventilator paired with two Newlife Intensity 10 (Airsep, Ball Ground, Georgia) OCs and evaluated the delivered FiO2 across a range of minute volumes and combinations of ventilator settings. METHODS The ventilators were attached to a test lung, OC flow was adjusted with a Certifier FA ventilator test systems from 2 to 10 L/min and injected into the oxygen inlet port of the Elisée 350. The FiO2 was measured by the analyzer integrated in the ventilator, controlled by the ventilator test system. Several combinations of ventilator settings were evaluated to determine the factors affecting the delivered FiO2. RESULTS The Elisée 350 ventilator is a turbine ventilator able to deliver high FiO2 when functioning with two OCs. However, modifications of the ventilator settings such as an increase in minute ventilation affect delivered FiO2 even if oxygen flow is constant on the OC. CONCLUSION The ability of two OCs to deliver high FiO2 when used with a turbine ventilator makes this method of oxygen delivery a viable alternative to cylinders to ventilate patients requiring an FiO2 of ≥80% in austere place or during disaster response. LEVEL OF EVIDENCE Feasibility study on test bench, level V.
Annales françaises de médecine d'urgence, 2012
ABSTRACT Les plaies de la face sont un motif fréquent de recours au service d’accueil des urgence... more ABSTRACT Les plaies de la face sont un motif fréquent de recours au service d’accueil des urgences. Les blocs tronculaires de la face sont simples, efficaces et à faible risque iatrogène. Ils permettent une anesthésie efficace pour les gestes de petite chirurgie. Nous présentons les techniques d’anesthésie locorégionale de la face retenues par la conférence d’experts SFAR — SFMU de 2002: Pratique des anesthésies locales et locorégionales par des médecins non spécialisés en anesthésie-réanimation, dans le cadre des urgences. Les blocs supra-orbitaires et supra-trochléaires présentés dans cet article permettent l’anesthésie de la région frontale.
Revue des Maladies Respiratoires, 2013
Annales Françaises d'Anesthésie et de Réanimation, 2014
![Research paper thumbnail of [Treatment of inguinal hernia in a difficult environment: feasibility and efficacy of ilioinguinal and iliohypogastric blocks]](https://attachments.academia-assets.com/39729198/thumbnails/1.jpg)
](Médecine et santé tropicales, 2013
Hernia repair is a very frequent surgical procedure; it is estimated that one African in five und... more Hernia repair is a very frequent surgical procedure; it is estimated that one African in five undergoes this procedure during his lifetime. Patients and methods. We evaluated the feasibility of this surgery under ilioinguinal and iliohypogastric nerve blocks in difficult environments. The medical-surgical group supporting Operation Unicorn has treated 48 inguinal hernias as medical aid to population, including 34 with these nerve blocks. Results. The block did not fail in any case. The mean time until discharge was 6.85 h, which meant that outpatient surgery was possible. Discussion and conclusion. This type of anesthesia is interesting in difficult environments. It is a safe, inexpensive, and easy to learn technique. These qualities should promote its use in countries with a low GNP.
Critical care (London, England), 2012
We read with interest the study by Marie Paries and collaborators [1]. Many potential lung transp... more We read with interest the study by Marie Paries and collaborators [1]. Many potential lung transplants are lost because of hypoxemia after apnea test. Th e authors evaluated the positive eff ect of a single recruitment maneuver (RM) after the apnea test with encouraging eff ect. In light of the study from Mascia and collaborators [2], we think that the RM will not be necessary if the apnea test is performed with continuous positive airway pressure (CPAP; with positive pressure applied at the level of the positive end expiratory pressure used for ventilation). Using this method for the apnea test, Mascia and collaborators obtained a better PaO 2 /FiO 2 ratio (the ratio of arterial oxygen tension to fractional inspired oxygen) after the CPAP apnea maneu ver compared to the classical apnea maneuver but with out the hemodynamic risk.
Médecine tropicale : revue du Corps de santé colonial, 2011
Noma causes tissue degeneration of the face resulting in impaired mouth opening with secondary ma... more Noma causes tissue degeneration of the face resulting in impaired mouth opening with secondary malnutrition and metabolic disorders. Reconstructive plastic surgery for noma can be lifesaving but requires special airway and ventilation techniques because of limited mouth opening. In addition, the African context imposes logistic and budgetary constraints. The purpose of this article is to describe an upper airway management strategy that takes into account disease factors and available resources.
Anaesthesia and intensive care, 2011
Tracheostomy is considered the airway management of choice for patients who require prolonged mec... more Tracheostomy is considered the airway management of choice for patients who require prolonged mechanical ventilation. The development of percutaneous techniques offers many advantages including the ability to perform the procedure in the intensive care unit. The aim of this study was to compare the controlled rotating dilation method (PercuTwist) and the Griggs' forceps dilational tracheostomy. Patients over 18 years of age undergoing tracheostomy in the intensive care unit were included in the study. They were divided in two random samples--either PercuTwist or forceps dilational tracheostomy. Data collected prospectively included demographic characteristics, procedure duration, blood gas analysis, intracranial pressure, arterial blood pressure and heart rate before and after the procedure. Any complications during or after the procedure due to the tracheostomy were also recorded. Contrary to the main hypothesis, PercuTwist technique took significantly longer to perform than fo...
![Research paper thumbnail of [Fatal fulminant viral hepatitis A complicated by acute pancreatitis]](https://attachments.academia-assets.com/42225500/thumbnails/1.jpg)
](Médecine et maladies infectieuses, 2010
Mots clés : Virus hépatite A ; Hépatite fulminante ; Pancréatite aiguë
Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine, Jan 13, 2015
Knee arthroplasty causes significant blood loss. Different blood-saving measures exist like retra... more Knee arthroplasty causes significant blood loss. Different blood-saving measures exist like retransfusion of unwashed salvaged blood. Some studies question the quality of this blood and in particular its ability to clot. These studies use "static" coagulation tests reflecting only partially the reality, unlike viscoelastic methods. The main objective of this study was to evaluate the salvaged blood thromboelastometric profile using ROTEM(®) system and to compare these results with patient venous blood. We performed an observational, prospective, single-center study conducted over 3months in 2013. Agreement of local ethical committee and patient consent were obtained beforehand. All adult patients who underwent a primary total knee arthroplasty were included. A thromboelastometric profile and standard laboratory tests (hemoglobin, platelets count, PT, aPTT, fibrinogen) were performed in the same time on patient venous blood and on unwashed salvaged blood in the PACU. Twenty...
The American Journal of Emergency Medicine, 2014
Face and/or neck burn (FNB) exposes patients to the double respiratory risk of obstruction and hy... more Face and/or neck burn (FNB) exposes patients to the double respiratory risk of obstruction and hypoxia, and these risks may require a tracheal intubation. This study aims to describe the incidence and the characteristics of difficult intubation in FNB patients. We conducted a 5-year retrospective, single-center study including all patients meeting the following criteria: 18 years of age or older, an FNB at least 1% of burned surface area with a severity equal to or greater than the superficial second degree, and intubation and a burn center admission within the first 24 hours after the burn. Patients were compared according to the difficulty of their intubation. Between January 2007 and December 2011, we included 134 patients. The incidence of difficult intubation was 11.2% but was greater in the burn center than in the pre-burn center: 16.9% vs 3.5% (P = .02). The most important difference between patients with or without difficult intubation was the time between the burn injury and the intubation: 210 (105-290) vs 120 (60-180) minutes (P = .047). After multivariate analysis, an intubation performed at a burn center was independently associated with difficult intubation: odds ratio = 3.2; 95% confidence interval, 1.1-528. This study underlines the high incidence of difficult intubation in FNB patients, greater than 11.2%, and demonstrates that intubation is more difficult when realized at a burn center, probably because it is performed later, allowing for development of cervical and laryngeal edema.
Journal of Trauma and Acute Care Surgery, 2013
New England Journal of Medicine, 2013
ABSTRACT To the Editor: The description in the Case Record by Getahun et al. of uterine rupture d... more ABSTRACT To the Editor: The description in the Case Record by Getahun et al. of uterine rupture during labor (Nov. 8 issue)(1) raises awareness about the possibility of this catastrophic event, which occurs far too often in low-resource settings, even when obstetric services are available.(2) Uterine rupture occurs almost exclusively in multiparous women, often with prolonged labor. In nulliparous women, neglected obstructed labor is more likely to result in a vesicovaginal fistula. We have witnessed women in whom a fistula developed in their first pregnancy and ruptured the uterus in a subsequent pregnancy. The use of partography is essential in the . . .
Neurocritical Care, 2012
Cerebral vasospasm is the main cause of neurological mortality and morbidity following subarachno... more Cerebral vasospasm is the main cause of neurological mortality and morbidity following subarachnoid hemorrhage. Basilar artery vasospasm (BAVS) is associated with a high morbidity and may have multiple clinical presentations. We report the case of a 43 years-old man with BAVS presenting as a reversible locked-in syndrome (LIS) after stopping sedation. The symptoms were successfully managed by intra-arterial infusion of vasodilators and balloon angioplasty. Magnetic resonance imaging did not reveal any brainstem lesion 48 h after the complication, demonstrating a hemodynamic mechanism. LIS can reveal BAVS. Its diagnosis relies on clinical examination. In this case, rapid neuro-interventional treatment permitted reversal of symptoms. This could not have been possible under sedation.
The Journal of Emergency Medicine, 2012
The Journal of Emergency Medicine, 2013
Injury, 2012
Hypothermia remains one of the major factors limiting surgery in extensively burned patients. We ... more Hypothermia remains one of the major factors limiting surgery in extensively burned patients. We evaluated the effectiveness of an intravascular rewarming technique using CoolGard 3000™ system and Icy™ catheter to maintain normothermia during surgeries of severe burned patients and compared these findings to a historical control group. This was a controlled non-randomised trial conducted between March 2008 and August 2009. Patients with burns greater than or equal to 40% of the total body surface area were included. Before the first burn excision, the Icy™ catheter was placed in the inferior vena cava via the femoral vein. Warming was then initiated and maintained until the bladder temperature reached over 37.5°C. The bladder temperature was recorded every 30min during surgery and for the first hour post-operatively and compared to a historical control group. We enrolled 4 patients and 11 surgeries in the CoolGard™ group and compared them to 3 patients and 10 surgeries in the historical cohort. All intraoperative bladder temperatures from T=30 were statistically different in the two groups. In the CoolGard™ group, no patient became hypothermic and no surgery was aborted because the patient's temperature had rapidly fallen below the threshold temperature (35.5°C). No device-related complication was reported. The use of an intravenous warming catheter is a novel approach to maintain normothermia during surgery in burn victims and may be more effective than traditional methods.
Emergency Medicine Journal, 2010
Emergency Medicine Journal, 2012
Critical Care, 2013
Introduction: Health care-associated pneumonia (HCAP) has been proposed as a new category of resp... more Introduction: Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection to identify patients at risk of multidrug-resistant (MDR) pathogens. The American Thoracic Society's recommendation for HCAP treatment is to use broad-spectrum and multiple antibiotics. However, this strategy may be economically expensive and promote antimicrobial resistance when a multisensitive pathogen is not identified. Methods: We prospectively included all patients presenting with HCAP in the emergency department. Blood cultures and fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL) were performed in each patient. Empirical antibiotic therapy was adapted when microbiological findings were available. The primary objective was to assess whether FODP mini-BAL is more efficient than blood cultures in identifying pathogens with the ratio of identification between both techniques as principal criteria. Results: We included 54 patients with HCAP. Pathogens were identified in 46.3% of cases using mini-BAL and in 11.1% of cases using blood cultures (P <0.01). When the patient did not receive antibiotic therapy before the procedure, pathogens were identified in 72.6% of cases using mini-BAL and in 9.5% of cases using blood cultures (P <0.01). We noted multidrug-resistant pathogens in 16% of cases. All bronchoscopic procedures could be performed in patients without complications.
Journal of Trauma and Acute Care Surgery, 2020
Supplemental digital content is available in the text. BACKGROUND Management of critically ill pa... more Supplemental digital content is available in the text. BACKGROUND Management of critically ill patients requiring mechanical ventilation in austere environments or during disaster response is a logistic challenge. Availability of oxygen cylinders for mechanically ventilated patient may be difficult in such a context. A solution to ventilate patients requiring high fraction of inspired oxygen (FiO2) is to use a ventilator able to be supplied by a low-pressure oxygen source connected with two oxygen concentrators (OCs). We tested the Elisée 350 (ResMedBella Vista, Australia) ventilator paired with two Newlife Intensity 10 (Airsep, Ball Ground, Georgia) OCs and evaluated the delivered FiO2 across a range of minute volumes and combinations of ventilator settings. METHODS The ventilators were attached to a test lung, OC flow was adjusted with a Certifier FA ventilator test systems from 2 to 10 L/min and injected into the oxygen inlet port of the Elisée 350. The FiO2 was measured by the analyzer integrated in the ventilator, controlled by the ventilator test system. Several combinations of ventilator settings were evaluated to determine the factors affecting the delivered FiO2. RESULTS The Elisée 350 ventilator is a turbine ventilator able to deliver high FiO2 when functioning with two OCs. However, modifications of the ventilator settings such as an increase in minute ventilation affect delivered FiO2 even if oxygen flow is constant on the OC. CONCLUSION The ability of two OCs to deliver high FiO2 when used with a turbine ventilator makes this method of oxygen delivery a viable alternative to cylinders to ventilate patients requiring an FiO2 of ≥80% in austere place or during disaster response. LEVEL OF EVIDENCE Feasibility study on test bench, level V.
Annales françaises de médecine d'urgence, 2012
ABSTRACT Les plaies de la face sont un motif fréquent de recours au service d’accueil des urgence... more ABSTRACT Les plaies de la face sont un motif fréquent de recours au service d’accueil des urgences. Les blocs tronculaires de la face sont simples, efficaces et à faible risque iatrogène. Ils permettent une anesthésie efficace pour les gestes de petite chirurgie. Nous présentons les techniques d’anesthésie locorégionale de la face retenues par la conférence d’experts SFAR — SFMU de 2002: Pratique des anesthésies locales et locorégionales par des médecins non spécialisés en anesthésie-réanimation, dans le cadre des urgences. Les blocs supra-orbitaires et supra-trochléaires présentés dans cet article permettent l’anesthésie de la région frontale.
Revue des Maladies Respiratoires, 2013
Annales Françaises d'Anesthésie et de Réanimation, 2014
Médecine et santé tropicales, 2013
Hernia repair is a very frequent surgical procedure; it is estimated that one African in five und... more Hernia repair is a very frequent surgical procedure; it is estimated that one African in five undergoes this procedure during his lifetime. Patients and methods. We evaluated the feasibility of this surgery under ilioinguinal and iliohypogastric nerve blocks in difficult environments. The medical-surgical group supporting Operation Unicorn has treated 48 inguinal hernias as medical aid to population, including 34 with these nerve blocks. Results. The block did not fail in any case. The mean time until discharge was 6.85 h, which meant that outpatient surgery was possible. Discussion and conclusion. This type of anesthesia is interesting in difficult environments. It is a safe, inexpensive, and easy to learn technique. These qualities should promote its use in countries with a low GNP.
Critical care (London, England), 2012
We read with interest the study by Marie Paries and collaborators [1]. Many potential lung transp... more We read with interest the study by Marie Paries and collaborators [1]. Many potential lung transplants are lost because of hypoxemia after apnea test. Th e authors evaluated the positive eff ect of a single recruitment maneuver (RM) after the apnea test with encouraging eff ect. In light of the study from Mascia and collaborators [2], we think that the RM will not be necessary if the apnea test is performed with continuous positive airway pressure (CPAP; with positive pressure applied at the level of the positive end expiratory pressure used for ventilation). Using this method for the apnea test, Mascia and collaborators obtained a better PaO 2 /FiO 2 ratio (the ratio of arterial oxygen tension to fractional inspired oxygen) after the CPAP apnea maneu ver compared to the classical apnea maneuver but with out the hemodynamic risk.
Médecine tropicale : revue du Corps de santé colonial, 2011
Noma causes tissue degeneration of the face resulting in impaired mouth opening with secondary ma... more Noma causes tissue degeneration of the face resulting in impaired mouth opening with secondary malnutrition and metabolic disorders. Reconstructive plastic surgery for noma can be lifesaving but requires special airway and ventilation techniques because of limited mouth opening. In addition, the African context imposes logistic and budgetary constraints. The purpose of this article is to describe an upper airway management strategy that takes into account disease factors and available resources.
Anaesthesia and intensive care, 2011
Tracheostomy is considered the airway management of choice for patients who require prolonged mec... more Tracheostomy is considered the airway management of choice for patients who require prolonged mechanical ventilation. The development of percutaneous techniques offers many advantages including the ability to perform the procedure in the intensive care unit. The aim of this study was to compare the controlled rotating dilation method (PercuTwist) and the Griggs' forceps dilational tracheostomy. Patients over 18 years of age undergoing tracheostomy in the intensive care unit were included in the study. They were divided in two random samples--either PercuTwist or forceps dilational tracheostomy. Data collected prospectively included demographic characteristics, procedure duration, blood gas analysis, intracranial pressure, arterial blood pressure and heart rate before and after the procedure. Any complications during or after the procedure due to the tracheostomy were also recorded. Contrary to the main hypothesis, PercuTwist technique took significantly longer to perform than fo...
Médecine et maladies infectieuses, 2010
Mots clés : Virus hépatite A ; Hépatite fulminante ; Pancréatite aiguë
Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine, Jan 13, 2015
Knee arthroplasty causes significant blood loss. Different blood-saving measures exist like retra... more Knee arthroplasty causes significant blood loss. Different blood-saving measures exist like retransfusion of unwashed salvaged blood. Some studies question the quality of this blood and in particular its ability to clot. These studies use "static" coagulation tests reflecting only partially the reality, unlike viscoelastic methods. The main objective of this study was to evaluate the salvaged blood thromboelastometric profile using ROTEM(®) system and to compare these results with patient venous blood. We performed an observational, prospective, single-center study conducted over 3months in 2013. Agreement of local ethical committee and patient consent were obtained beforehand. All adult patients who underwent a primary total knee arthroplasty were included. A thromboelastometric profile and standard laboratory tests (hemoglobin, platelets count, PT, aPTT, fibrinogen) were performed in the same time on patient venous blood and on unwashed salvaged blood in the PACU. Twenty...
The American Journal of Emergency Medicine, 2014
Face and/or neck burn (FNB) exposes patients to the double respiratory risk of obstruction and hy... more Face and/or neck burn (FNB) exposes patients to the double respiratory risk of obstruction and hypoxia, and these risks may require a tracheal intubation. This study aims to describe the incidence and the characteristics of difficult intubation in FNB patients. We conducted a 5-year retrospective, single-center study including all patients meeting the following criteria: 18 years of age or older, an FNB at least 1% of burned surface area with a severity equal to or greater than the superficial second degree, and intubation and a burn center admission within the first 24 hours after the burn. Patients were compared according to the difficulty of their intubation. Between January 2007 and December 2011, we included 134 patients. The incidence of difficult intubation was 11.2% but was greater in the burn center than in the pre-burn center: 16.9% vs 3.5% (P = .02). The most important difference between patients with or without difficult intubation was the time between the burn injury and the intubation: 210 (105-290) vs 120 (60-180) minutes (P = .047). After multivariate analysis, an intubation performed at a burn center was independently associated with difficult intubation: odds ratio = 3.2; 95% confidence interval, 1.1-528. This study underlines the high incidence of difficult intubation in FNB patients, greater than 11.2%, and demonstrates that intubation is more difficult when realized at a burn center, probably because it is performed later, allowing for development of cervical and laryngeal edema.
Journal of Trauma and Acute Care Surgery, 2013
New England Journal of Medicine, 2013
ABSTRACT To the Editor: The description in the Case Record by Getahun et al. of uterine rupture d... more ABSTRACT To the Editor: The description in the Case Record by Getahun et al. of uterine rupture during labor (Nov. 8 issue)(1) raises awareness about the possibility of this catastrophic event, which occurs far too often in low-resource settings, even when obstetric services are available.(2) Uterine rupture occurs almost exclusively in multiparous women, often with prolonged labor. In nulliparous women, neglected obstructed labor is more likely to result in a vesicovaginal fistula. We have witnessed women in whom a fistula developed in their first pregnancy and ruptured the uterus in a subsequent pregnancy. The use of partography is essential in the . . .
Neurocritical Care, 2012
Cerebral vasospasm is the main cause of neurological mortality and morbidity following subarachno... more Cerebral vasospasm is the main cause of neurological mortality and morbidity following subarachnoid hemorrhage. Basilar artery vasospasm (BAVS) is associated with a high morbidity and may have multiple clinical presentations. We report the case of a 43 years-old man with BAVS presenting as a reversible locked-in syndrome (LIS) after stopping sedation. The symptoms were successfully managed by intra-arterial infusion of vasodilators and balloon angioplasty. Magnetic resonance imaging did not reveal any brainstem lesion 48 h after the complication, demonstrating a hemodynamic mechanism. LIS can reveal BAVS. Its diagnosis relies on clinical examination. In this case, rapid neuro-interventional treatment permitted reversal of symptoms. This could not have been possible under sedation.
The Journal of Emergency Medicine, 2012
The Journal of Emergency Medicine, 2013
Injury, 2012
Hypothermia remains one of the major factors limiting surgery in extensively burned patients. We ... more Hypothermia remains one of the major factors limiting surgery in extensively burned patients. We evaluated the effectiveness of an intravascular rewarming technique using CoolGard 3000™ system and Icy™ catheter to maintain normothermia during surgeries of severe burned patients and compared these findings to a historical control group. This was a controlled non-randomised trial conducted between March 2008 and August 2009. Patients with burns greater than or equal to 40% of the total body surface area were included. Before the first burn excision, the Icy™ catheter was placed in the inferior vena cava via the femoral vein. Warming was then initiated and maintained until the bladder temperature reached over 37.5°C. The bladder temperature was recorded every 30min during surgery and for the first hour post-operatively and compared to a historical control group. We enrolled 4 patients and 11 surgeries in the CoolGard™ group and compared them to 3 patients and 10 surgeries in the historical cohort. All intraoperative bladder temperatures from T=30 were statistically different in the two groups. In the CoolGard™ group, no patient became hypothermic and no surgery was aborted because the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s temperature had rapidly fallen below the threshold temperature (35.5°C). No device-related complication was reported. The use of an intravenous warming catheter is a novel approach to maintain normothermia during surgery in burn victims and may be more effective than traditional methods.
Emergency Medicine Journal, 2010
Emergency Medicine Journal, 2012
Critical Care, 2013
Introduction: Health care-associated pneumonia (HCAP) has been proposed as a new category of resp... more Introduction: Health care-associated pneumonia (HCAP) has been proposed as a new category of respiratory infection to identify patients at risk of multidrug-resistant (MDR) pathogens. The American Thoracic Society's recommendation for HCAP treatment is to use broad-spectrum and multiple antibiotics. However, this strategy may be economically expensive and promote antimicrobial resistance when a multisensitive pathogen is not identified. Methods: We prospectively included all patients presenting with HCAP in the emergency department. Blood cultures and fiberoptic bronchoscope-guided distal protected small volume bronchoalveolar lavage (FODP mini-BAL) were performed in each patient. Empirical antibiotic therapy was adapted when microbiological findings were available. The primary objective was to assess whether FODP mini-BAL is more efficient than blood cultures in identifying pathogens with the ratio of identification between both techniques as principal criteria. Results: We included 54 patients with HCAP. Pathogens were identified in 46.3% of cases using mini-BAL and in 11.1% of cases using blood cultures (P <0.01). When the patient did not receive antibiotic therapy before the procedure, pathogens were identified in 72.6% of cases using mini-BAL and in 9.5% of cases using blood cultures (P <0.01). We noted multidrug-resistant pathogens in 16% of cases. All bronchoscopic procedures could be performed in patients without complications.