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

Abstract

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.

Benefit-to-risk balance of bronchoalveolar lavage in the critically ill. A prospective, multicenter cohort study

“…In the present study, adverse events collected were more frequent than in several previous studies [5][6][7][8]10]. This discrepancy may be due to differences in methods used for collecting and defining adverse events.…”

“…In the intensive care unit (ICU), it is often performed in patients with acute respiratory failure. The main risk brought by fiberoptic bronchoscopy in the critically ill is the worsening of hypoxemia [2][3][4], but in the few studies focused on fiberoptic bronchoscopy tolerance and comprising a significant number of BAL performed in ICU patients, BAL has been considered well tolerated in most of the cases [5][6][7][8][9][10][11]. Meanwhile, as less invasive diagnostic methods exist or are emerging (high-resolution CT scan imaging, molecular microbiological diagnosis on nasopharyngeal swab, or on tracheal aspirates, etc.…”

Diagnostic Performance and Safety of Bronchoalveolar Lavage in Thrombocytopenic Haematological Patients for Aspergillosis Diagnosis: A Monocentric, Retrospective Experience.

“…In a recent observational study of 1949 bronchoscopies performed in a series of non-HM patients, mild adverse events were reported in 7.2% of the cases, while moderate adverse events, such as hypoxemia and bleeding, were described in 4.9% and in 2.1%, respectively. Furthermore, the rate of severe adverse events requiring additional intervention was 0.5% (pneumothorax, 0.4%, severe bleeding with patient death, 0.1%) 11…”

Islet Transplantation in the Lung via Endoscopic Aerosolization: Investigation of Feasibility, Islet Cluster Cell Vitality, and Structural Integrity

“…Endoscopically assisted alveolar islet cell transplantation may reduce complication rates and risks related to the transplantation procedure. While bronchoscopy is not completely risk free, the occurrence of severe complications is rare 27 , 28 with bleeding, respiratory depression, and pneumothorax occurring in <1% of cases. Mortality is extremely rare with a reported death rate of 0%–0.04% 17 .…”