Safety of bronchoscopy in patients with malignant hematologic disorders

Abstract

Background Factors affecting the safety of bronchoscopy in patients with malignant hematologic disorders have not been well described. We evaluated the safety of bronchoscopy and describe factors affecting its complication rate in such patients. Methods Between January 2009 and December 2018, 316 bronchoscopies in 282 patients with malignant hematologic disorders and pulmonary infiltrates were performed at our institution. The bronchoscopic procedure used and its complications were evaluated. Results The most common underlying disease was acute myeloid leukemia (134/282 patients, 47.5%). Platelet transfusion was performed the day before or the day of bronchoscopy in 42.4%, supplemental oxygen was administered before the procedure in 23.1%, and midazolam was used in 74.4%. Thirty-five bronchoscopies (11.1%) were complicated by hemoptysis and 7 patients developed pneumothorax, 4 of whom required thoracic drainage. Two patients (0.6%) were intubated within 48 h of the procedure and prolonged oxygen desaturation (> 48 h) occurred in 3.8%. Multivariate analysis showed that only use of midazolam significantly reduced the risk of prolonged oxygen desaturation (hazard ratio 0.28, 95% confidence interval 0.09–0.85, p = 0.03). Transbronchial lung biopsy significantly increased the risk of hemoptysis (hazard ratio 10.40, 95% confidence interval 4.18–25.90, p = 0.00), while use of midazolam significantly reduced the risk (hazard ratio 0.31, 95% confidence interval 0.14–0.73, p = 0.01). Conclusions Bronchoscopy is relatively safe in patients with malignant hematologic disorders. Caution and judicious use of sedatives may improve the patient’s procedural tolerance and lower complications.

Safety of Bronchoalveolar Lavage in Hematological Patients With Thrombocytopenia – A Retrospective Cohort Study

“…6,11,14 The rates of non-major bleeding were higher in severely thrombocytopenic patients, approaching significance only due to very minor, spontaneously resolving bleeding. Echoed in some previous reports 4,7,12 and considerably lower than others, 11 this observation is consistent with our understanding of platelet function in primary hemostasis. Namely, superficial bleeding (e.g., petechiae and purpura) is the major clinical manifestation of isolated thrombocytopenia.…”

“…While the reported rates of bronchoscopy complications range between 1 percent to 12%, various retrospective studies have demonstrated the incidence of serious complications (i.e., major bleeding halting procedure, need for ventilatory support or death) to be consistently in the range of 0.7-0.9%. 4,6,7,[11][12][13] Interestingly, the rates of both serious complications in general and major bleeding, in particular, are similar when examining large cohorts of BAL in the general population and in patients with various degrees of thrombocytopenia, which could serve as a weak, albeit ecological, corroboration to the lack of a direct link between platelet counts and major complications in bronchoscopy. 6,11,14 The rates of non-major bleeding were higher in severely thrombocytopenic patients, approaching significance only due to very minor, spontaneously resolving bleeding.…”

“…3 This is particularly true in patients with platelet counts below 50x10 3 /μL, prompting most providers to consider prophylactic platelet transfusions (particularly in very low platelet counts below 10x10 3 /μL) in an attempt to mitigate the risk of periprocedural complications. 4 Nonetheless, there are no universally accepted platelet count thresholds for BAL or the decision to transfuse periprocedurally. Previous observational studies have described vanishingly low complication rates above 20x10 3 /μL 5 or even 10x10 3 /μL.…”

Hemorrhage Risk of Patients Receiving Bronchoscope Examination or Treatment

“…A few studies reported the complications and the incidence in bronchoscopy [2,[9][10][11][12] . According to a study of 20,986 bronchoscopies [4] , the most common complications were hemorrhage, oxyhemoglobin desaturation, pneumothorax, and pulmonary edema.…”