Expert comments

Comments on this technology were invited from clinical experts working in the field and relevant patient organisations. The comments received are individual opinions and do not represent NICE's view.

Three experts contributed to the development of this briefing. One expert has experience using the technology and another in using the predecessor model for difficult intubation in theatre. The third expert used the technology in intensive care in a difficult airway setting, in percutaneous tracheostomies, ventilation unit, routine diagnostic and sampling settings. Two experts said that the technology is increasingly used for diagnostic and therapeutic purposes in critical care environments. One of the experts was not aware of its use in routine respiratory medicine for diagnostic bronchoscopy. An expert reported that Ambu aScope 4 Broncho is available as back up for high usage times and when there are down times of their own endoscope reprocessing facility in surgical theatre.

Level of innovation

Experts said that this is not a major innovation, but it has simplified access in the event of needing a bronchoscope urgently and provides quality improvement for patient care. The quality of the technology has improved over time, with the range of different scope sizes providing more flexibility of use. The scopes are light, easy to use and robust, enabling the user to move from a difficult airway setting to more routine use, particularly in the acute setting and critical care.

One expert saw the technology as an alternative to standard care in hospital settings such as in theatre, the emergency department and critical care. Another expert said that if current standard care is regarded as the use of expensive reusable devices which need careful and expensive reprocessing between patients, then this has the potential to replace current standard care.

All the experts highlighted the availability of other single-use endoscopes to the NHS.

Potential patient impact

An expert said that cross-infection reduction is a potential patient benefit of using the technology. Another expert mentioned that the technology would be beneficial for critically ill inpatients requiring urgent bronchoscopy for the management of an airway problem, in tracheostomy complications such as displacement, and in a percutaneous tracheostomy procedure. The expert added that the technology would benefit patients with lung collapse and mucus plugging in an acute setting such as critical care. The technology is also beneficial in routine sampling of airways.

Potential system impact

Two experts noted the key benefit that the equipment is readily available, which increases accessibility. Single-use devices provide an "off the shelf solution" with very little start-up costs. They also provide a solution for the inevitable downtime from using endoscope washers and drier or storage units and can buffer the unpredictable peak usage requirements so that smaller numbers of reusable devices are needed. The technology has the functionality and capability to be adopted for routine endoscopies.

Experts had mixed views on the potential of the technology to change the current pathway or clinical outcomes to benefit the healthcare system. An expert said the technology did not have potential. But another expert said that the accessibility and ease of use in acute settings has led to a change in care pathways in many trusts, having the single-use scopes on resuscitation trolleys in theatre and critical care and on ventilation units. The technology reduces risks from transferring the patient to an endoscopy unit and needing to move endoscopy unit equipment. In addition, the single-use bronchoscope technology improves and simplifies staff training on the equipment. The experts thought that the technology would cost less than standard care (reusable endoscopes). There would be minimal change in clinical facilities, apart from needing an area to store the aView 2 Advance monitor and scopes within easy reach. Two experts highlighted that staff already experienced in endoscopy would need minimal training on understanding some functions such as video recording, taking images and using the Ambu aScope 4 BronchoSampler.

General comments

One expert highlighted that the harms from single-use bronchoscopes are the same as those from reusable ones. The harms include risks from sedation leading to oxygen desaturation and respiratory failure, bleeding from airways and trauma. The experts added that a theoretical harm would be failure to undertake the procedure because of device failure or unsuitability for the procedure. Technical problems may include poor image quality or inability to access lower airway subdivisions. The other expert reported that the optical display of Ambu aScope 4 is not as good as that of the reusable scope.

The expert said that the key efficacy outcomes for the technology would be optical view, and suction and lavage performance. The other experts said that accessibility, time to set up for procedure, time to undertake procedure and ability to undertake procedure and interventions compared to reusable scopes were the key efficacy outcomes of the technology.

Experts said there are no uncertainties or concerns about the efficacy and safety of the technology and mentioned that the technology would be suitable in most or all general hospitals. Another expert mentioned that the uncertainty lies in costs and the impact on the global environment because of increased reliance on single-use technologies within healthcare.

According to an expert, the additional benefit of the technology is the range of scope sizes for different uses. For example, the larger scope is useful for clearing secretions and mucus plugs. The slim scope is mostly used in the difficult airway setting, for percutaneous dilatational tracheostomies and is easier to pass through the nose (nasendoscopy). The regular scope is multi‑purpose.

An expert said that there is a need for additional research modelling the costs of reprocessing reusable endoscopes, compared against the cost of pre‑existing reprocessing facilities and the need for endoscope washers for other endoscopy services.