Análisis de 208 fibrobroncoscopias realizadas en una unidad de cuidados intensivos

Estella, Ángel

doi:10.1016/j.medin.2011.11.005

Cited by 18 publications

(13 citation statements)

References 30 publications

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“…Bronchoscopy must be properly indicated and performed in a safe and effective manner; still, it is an operator-dependent procedure and outcomes vary according to different methods and techniques. ( 2 , 4 , 6 ) More than one endoscopy specialist may be required in specific, exceptional situations.…”

Section: Discussionmentioning

confidence: 99%

Indications, clinical outcomes and complications of 1,949 flexible bronchoscopies

Costa¹,

Scordamaglio²,

Suzuki³

et al. 2018

Einstein (São Paulo)

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Objective To describe indications, clinical outcomes and complications of flexible bronchoscopy.Methods A descriptive observational study of bronchoscopies performed at the endoscopy service of Hospital Israelita Albert Einstein . Demographic (age, gender and origin) and medical (indications and results of endoscopy and diagnostic tests, such as biopsy collection, lavage, cytology and culture) data were analyzed. Electronic medical records with incomplete data or reporting interventional procedures were excluded.Results Over a three-year period (2013 to 2016), a total of 1,949 bronchoscopies were performed by respiratory endoscopy team and anesthesia specialists of the hospital. The mean age of patients was 57.7±21.9 years (range of 3 days to 99 years), with prevalence of males (56.4%). The procedures were mostly (86.3%) elective and 30.7% were carried out in the intensive care unit. Major indications for bronchoscopy were infection or secretion (42.4%), followed by suspected neoplasm (10.8%). Endoscopic changes were reported in 91.9% of cases, with more than one change described in approximately 6.9% of patients. Positive results were obtained via direct testing or culture in 36.3% and 53.9% of 1,399 bronchoalveolar lavages, respectively. The overall diagnostic yield (bronchoalveolar lavage and biopsy) was 72.6%. Mild adverse event rate was 7.2%. The rate of severe adverse events requiring additional intervention was 0.5% (pneumothorax, 0.4%; severe bleeding with patient death, 0.1%).Conclusion Lower airway endoscopy is critical for respiratory disease assessment, diagnosis and treatment. Flexible bronchoscopy is associated with good diagnostic yield and minimal inherent risk.

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Section: Discussionmentioning

confidence: 99%

Indications, clinical outcomes and complications of 1,949 flexible bronchoscopies

Costa¹,

Scordamaglio²,

Suzuki³

et al. 2018

Einstein (São Paulo)

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“…Relative changes of vital parameters with regard to baseline might provide a better assessment of the impact of invasive diagnostic techniques. The definitions for respiratory and hemodynamic complications in the present study were eventually based on pathophysiologic reasoning, earlier publications of bronchoscopy associated complications [ 17 , 18 ] and literature [ 19 ]. Haemodynamic instability in the study population was associated with a cardiovascular diagnosis at admission or presence of cardiovascular co-morbidity reflecting an expected causal relationship.…”

Section: Discussionmentioning

confidence: 99%

“…This is in line with previous studies concerning the safety of bronchoscopic diagnostic techniques in critical care patients. Table 4 provides an overview of the literature [ 17 , 18 , 20 – 25 ]. The studies differ in patient population, setting, applied diagnostic technique and length of observation.…”

Section: Discussionmentioning

confidence: 99%

Clinical course and complications following diagnostic bronchoalveolar lavage in critically ill mechanically ventilated patients

et al. 2015

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BackgroundFlexible, fibreoptic bronchoscopy (FFB) and bronchoalveolar lavage (BAL) have been used for diagnostic purposes in critically ill ventilated patients. The additional diagnostic value compared to tracheal aspirations in ventilator-associated pneumonia (VAP) has been questioned. Nevertheless, BAL can provide extra information for the differential diagnosis of respiratory disease and good antibiotic stewardship. These benefits should outweigh potential hazards caused by the invasiveness of this diagnostic technique. The focus of the present study was on the clinical course and complications of patients following BAL procedures up to 24 h.MethodsHundred sixty-four FFB guided BAL procedures for suspected pneumonia were analysed in an observational study. The clinical course of patients was monitored by respiratory and haemodynamic data before BAL, 1 and 24 h after BAL. Complications were defined and registered. Factors associated with complications were analysed by logistic regression.ResultsClinical course: a decrease in average pO2/FiO2 ratio 1 h after BAL from 29 kPa (218 mmHg) to 25 kPa (189 mmHg) (p < 0.05) was observed which fully recovered within 24 h. Respiratory complications: the incidence of procedure related hypo-oxygenation (SaO2 ≤ 88 %) and/or bronchospasm was 9 %; a decrease of >25 % PaO2/FiO2 ratio 1 h after BAL was found in 29 % of patients; no bleeding or pneumothorax were registered. Haemodynamic complications: there were no cases of hypertension and cardiac rhythm disturbances; haemodynamic instability within the first 24 h after BAL was recorded in 22 %; this was correlated with a cardiovascular diagnosis at admission (OR 2.9; 95 % CI 1.2 - 6.7) and the presence of cardiovascular co-morbidity (OR 3.5; 95 % CI 1.5 – 8.3). The incidence of bacteraemia was 7 %. There was no case of procedure related death.DiscussionFrequently occurring haemodynamic and respiratory instability but no cases of cardiac rhythm disturbances, bleeding, pneumothorax or procedure related death were attributable to diagnostic FFB and BAL. The procedures should be conducted under careful supervision by experienced physicians. Only a randomized controlled trial that compares diagnostic FFB and BAL with a non-invasive strategy could ultimately establish the safety profile and clinical utility of these procedures in critically ill ventilated patients.

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“…Its indication varies between diagnostic to therapeutic interventions including regular bronchoalveolar lavage for microbiological sampling, diagnosis of pulmonary hemorrhage, use in cases of difficult intubation, as a control in percutaneous tracheostomies, and aspirations of secretions. [ 2 ] Its use in clearing the airway because of mucus plug is considered as a standard practice particularly in patients where physiotherapy has failed to do so. However, its complications are infrequent.…”

mentioning

confidence: 99%

“…Most frequent complications cited in the literature are supraventricular tachycardia (3.8%), transient hypoxemia (6.7%), and slight bleeding of the bronchial mucosal membrane (2.4%). [ 2 ] Pneumothorax following flexible bronchoscopy has been reported infrequently in literature. Pue et al .…”

mentioning

confidence: 99%

Pneumothorax following flexible fiberoptic bronchoscopy: A rare occurrence

et al. 2014

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Análisis de 208 fibrobroncoscopias realizadas en una unidad de cuidados intensivos

Cited by 18 publications

References 30 publications

Indications, clinical outcomes and complications of 1,949 flexible bronchoscopies

Indications, clinical outcomes and complications of 1,949 flexible bronchoscopies

Clinical course and complications following diagnostic bronchoalveolar lavage in critically ill mechanically ventilated patients

Pneumothorax following flexible fiberoptic bronchoscopy: A rare occurrence

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