Flexible Bronchoscopy Is Safe and Effective in Adult Subjects Supported With Extracorporeal Membrane Oxygenation

Abstract

BACKGROUND: Previous studies have demonstrated the safety of flexible bronchoscopy (FB) in mechanically ventilated subjects. However, the safety of FB in adult subjects receiving extracorporeal membrane oxygenation (ECMO) has not been described previously. METHODS: A retrospective review was conducted of all adult subjects who underwent FB while receiving ECMO support at the University of Alabama at Birmingham Hospital from January 1, 2013, to December 31, 2014. Physiologic variables, pre-and post-FB ECMO, and ventilator settings were recorded. RESULTS: 79 adult subjects underwent FB receiving ECMO with a total of 223 bronchoscopies. The most common indications for bronchoscopy included diagnostic evaluation of infection in subjects with pneumonia (29%) and clearance of excessive secretions (22%). In 70% of subjects, moderate or greater amounts of secretions were noted. FB yielded positive culture data in 37 subjects (47%), which resulted in a change to the antibiotic regimen in 14 subjects (38%) with positive culture data. No significant differences in mean P aO 2 /F IO 2 , mean ECMO flow, mean sweep gas, ventilator settings, or hemodynamic parameters (heart rate, oxygen saturation, and mean blood pressure) were noted before and after FB. Complications were mild and transient: blood-tinged secretions after FB in 21% cases, which resolved spontaneously, intraprocedural hypoxemia in 2.2% of cases, and dysrhythmia in <1% of cases. There were no episodes of ECMO cannula dislodgement or inadvertent extubation. CONCLUSIONS: FB can be used safely in adult subjects supported with ECMO and is not associated with significant hemodynamics changes, bleeding, or mechanical complications during ECMO support.

Flexible Fiberoptic Bronchoscopy: Indications, Diagnostic Yield and Complications

“…However, Taha et al reported that malignancy was the most common indication in his study [ 10 ]. Western studies have conflicting results as some categorized malignancy as the most frequent indication [ 11 , 12 ], while others reported that pneumonia is the leading indication to proceed with bronchoscopy [ 13 ].…”

Ecmo Pediátrico. Una Puesta Al Día

“…IC: infusión contínua. determinados por indicación de equipo tratante y se tomará en cuenta para búsqueda etiológica (14,15,16).…”

Veno‐Arterial ECMO Weaning Failure in the Operating Room: Have You Considered Preweaning Bronchoscopy?

“…Specifically and in conformity to the management strategy in adults and infants with respiratory failure supported with veno‐venous ECMO , we suggest routine bronchoscopy with bronchial hygiene and review of correct positioning of the tracheal tube in all vaECMO cases. In our view, the patient should not be scheduled for weaning in the OR until the lungs have been adequately recruited and the lower alveolar system is clear.…”

“…Weaning failure exposes the patient to avoidable perioperative stress, can result in significant depletion of patient functional reserves, and uses significant healthcare resources. Flexible bronchoscopy has been found to be both effective and safe in adult patients during ECMO . Bronchoscopy is known to improve both oxygenation and respiratory mechanics in patients with adult respiratory distress syndrome supported with ECMO .…”