Incidence of Fever Following Endobronchial Ultrasound–Guided Transbronchial Needle Aspiration

Abstract

BackgroundEndobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic method for mediastinal and hilar lymphadenopathy. This study aimed to investigate the incidence of fever following EBUS-TBNA.MethodsA total of 684 patients who underwent EBUS-TBNA from May 2010 to July 2012 at Seoul National University Hospital were retrospectively reviewed. The patients were evaluated for fever by a physician every 6–8 hours during the first 24 hours following EBUS-TBNA. Fever was defined as an increase in axillary body temperature over 37.8℃.ResultsFever after EBUS-TBNA developed in 110 of 552 patients (20%). The median onset time and duration of fever was 7 hours (range, 0.5–32 hours) after EBUS-TBNA and 7 hours (range, 1–52 hours), respectively, and the median peak body temperature was 38.3℃ (range, 37.8–39.9℃). In most patients, fever subsided within 24 hours; however, six cases (1.1%) developed fever lasting longer than 24 hours. Infectious complications developed in three cases (0.54%) (pneumonia, 2; mediastinal abscess, 1), and all three patients had diabetes mellitus. The number or location of sampled lymph nodes and necrosis of lymph node were not associated with fever after EBUS-TBNA. Multiple logistic regression analysis did not reveal any risk factors for developing fever after EBUS-TBNA.ConclusionFever is relatively common after EBUS-TBNA, but is transient in most patients. However, clinicians should be aware of the possibility of infectious complications among patients with diabetes mellitus.

Ultrasonography of the Mediastinum: Techniques, Current Practice, and Future Directions

“…In these patients, endoscopic ultrasound is usually preferred to EBUS because of its tolerability. 133 Infectious complications, such as mediastinitis and mediastinal abscess formation, were the main severe adverse events (overall rate of 0.14%) reported by von Bartheld et al 132 Only 2 cases of severe infectious complications in patients with lung cancer has been found, mostly in patients at risk (patients affected by diabetes mellitus, 134 sarcoidosis, or cystic lesions). Patients with infections, potentially life-threatening, should require an adequate antibiotic therapy or may undergo surgery.…”

“…134 In the majority of cases, fever develops during the day after the procedure and recedes within a day; 6 subjects (1.1%) presented with fever for Ͼ24 h, and 3 subjects developed infectious complications (0.54%). 134 However, the incidence of fever and infectious complications was underestimated because there was no long-term follow-up, and 39% of subjects who were febrile received antibiotic treatment. 134 The cause of this fever remained unknown, and it seems to have no relationship with bronchoscopic procedures.…”

“…134 However, the incidence of fever and infectious complications was underestimated because there was no long-term follow-up, and 39% of subjects who were febrile received antibiotic treatment. 134 The cause of this fever remained unknown, and it seems to have no relationship with bronchoscopic procedures. 134 Only 2 more studies reported fever after EBUS-TBNA, with the limitation of estimating its incidence through a questionnaire survey: the Japanese nationwide survey (4 cases of fever [0.05%]) 139 and a study, of 3,123 cases, that evaluates only fever that lasted Ͼ24 h. 141 In a recent retrospective analysis of Ͼ1,000 procedures performed in a single center during 5 y, all the subjects were observed for a minimum of 2 h after EBUS-TBNA.…”

“…134 The cause of this fever remained unknown, and it seems to have no relationship with bronchoscopic procedures. 134 Only 2 more studies reported fever after EBUS-TBNA, with the limitation of estimating its incidence through a questionnaire survey: the Japanese nationwide survey (4 cases of fever [0.05%]) 139 and a study, of 3,123 cases, that evaluates only fever that lasted Ͼ24 h. 141 In a recent retrospective analysis of Ͼ1,000 procedures performed in a single center during 5 y, all the subjects were observed for a minimum of 2 h after EBUS-TBNA. 142 Complications recorded included fever and chills, excessive coughing, chest pain, bradycardia (heart rate Ͻ60 beats/min), sustained hypoxemia (fall in pulse oximetric saturation of Ͻ88% for Ͼ1 min), respiratory failure or arrest, pneumothorax, bleeding, and escalation of the level of care.…”

DEGUM Recommendations on Infection Prevention in Ultrasound and Endoscopic Ultrasound

“…Eine multizentrische Umfrage-Analyse aus Japan ergab allerdings nach EBUS-TBNA ein mit dem der EUS-FNA vergleichbares Risiko infektiöser Komplikationen und von Fieber in 0,24 % der Fälle, darunter Mediastinitis in 0,1 %, Pneumonie in 0,05 %, selbstlimitierendes Fieber in 0,05 % und andere infektiöse Komplikationen in 0,03 % [142]. In einer koreanischen Arbeit, die 552 EBUS-TBNA analysierte, wurden infektiöse Komplikationen in 0,54 % der Fälle berichtet, bei insgesamt 20 % aller Patienten wurde allerdings überwiegend transientes Fieber beobachtet [143]. Vergleichbare Daten mit einer Häufigkeit schwerer infektiöser Komplikationen nach EBUS-TBNA von 0,16 % wurden aus drei türkischen Zentren berichtet [144].…”