Standardized Definitions of Bleeding After Transbronchial Lung Biopsy

Folch, Erik; Mahajan, Amit; Oberg, Catherine L.; Maldonado, Fabien; Toloza, Eric M.; Krimsky, William; Oh, Scott; Bowling, Mark R.; Benzaquen, Sadia; Kinsey, C. Matthew; Mehta, Atul C.; Fernández-Bussy, Sebastián; Flandes, Javier; Lau, Kelvin; Krishna, Ganesh; Nead, Michael; Herth, Felix J.F.; Aragaki-Nakahodo, Alejandro; Barisione, Emanuela; Bansal, Sandeep; Zanchi, Dragos; Zgoda, Michael; Lutz, Peter O.; Lentz, Robert J.; Parks, Christopher; Salio, Mario; Perret, Kenneth; Keyes, Colleen; LeMense, Gregory P.; Hinze, John David; Majid, Adnan; Christensen, Merete; Kazakov, Jordan; Labarca, Gonzalo; Waller, E. Andrew; Studnicka, Michael; Teba, C.; Khandhar, Sandeep J.

doi:10.1016/j.chest.2020.01.036

Cited by 89 publications

(52 citation statements)

References 14 publications

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“…Fourteen patients (7%) required postprocedural observation or admission. Indications for overnight observation or hospitalization included 10 cases of pneumothorax (4.9%), 3 cases of hypoxia (1.5%), and 1 case of severe bleeding (0.5%) as defined by the Nashville Working Group [29]. In the case of significant bleeding, the patient was left intubated post-procedurally overnight with concurrent balloon occlusion and was successfully liberated from mechanical ventilation and discharged home the following day.…”

Section: Resultsmentioning

confidence: 99%

The safety profile of a protocolized transbronchial cryobiopsy program utilizing a 2.4 mm cryoprobe for interstitial lung disease

Oh¹,

Ronaghi²,

He³

et al. 2022

Respiratory Medicine

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Section: Resultsmentioning

confidence: 99%

The safety profile of a protocolized transbronchial cryobiopsy program utilizing a 2.4 mm cryoprobe for interstitial lung disease

Oh¹,

Ronaghi²,

He³

et al. 2022

Respiratory Medicine

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“…No serious adverse events were reported, including no pneumothorax or airway bleeding of any grade [ 10 , 11 ]. Two complications were reported, both of which were classified as Common Terminology Criteria for Adverse Event (CTCAE) grade 2 [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

Shape-sensing robotic-assisted bronchoscopy for pulmonary nodules: initial multicenter experience using the Ion™ Endoluminal System

et al. 2021

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Background Traditional bronchoscopy provides limited approach to peripheral nodules. Shape-sensing robotic-assisted bronchoscopy (SSRAB, Ion™ Endoluminal System) is a new tool for minimally invasive peripheral nodule biopsy. We sought to answer the research question: Does SSRAB facilitate sampling of pulmonary nodules during bronchoscopists’ initial experience? Methods The lead-in stage of a multicenter, single-arm, prospective evaluation of the Ion Endoluminal System (PRECIsE) is described. Enrolled subjects ≥ 18 years old had recent computed tomography evidence of one or more solid or semi-solid pulmonary nodules ≥ 1.0 to ≤ 3.5 cm in greatest dimension and in any part of the lung. Subjects were followed at 10- and 30-days post-procedure. This stage provided investigators and staff their first human experience with the SSRAB system; safety and procedure outcomes were analyzed descriptively. Neither diagnostic yield nor sensitivity for malignancy were assessed in this stage. Categorical variables are summarized by percentage; continuous variables are summarized by median/interquartile range (IQR). Results Sixty subjects were enrolled across 6 hospitals; 67 nodules were targeted for biopsy. Median axial, coronal and sagittal diameters were < 18 mm with a largest cardinal diameter of 20.0 mm. Most nodules were extraluminal and distance from the outer edge of the nodule to the pleura or nearest fissure was 4.0 mm (IQR: 0.0, 15.0). Median bronchial generation count to the target location was 7.0 (IQR: 6.0, 8.0). Procedure duration (catheter-in to catheter-out) was 66.5 min (IQR: 50.0, 85.5). Distance from the catheter tip to the closest edge of the virtual nodule was 7.0 mm (IQR: 2.0, 12.0). Biopsy completion was 97.0%. No pneumothorax or airway bleeding of any grade was reported. Conclusions Bronchoscopists leveraged the Ion SSRAB’s functionality to drive the catheter safely in close proximity of the virtual target and to obtain biopsies. This initial, multicenter experience is encouraging, suggesting that SSRAB may play a role in the management of pulmonary nodules. Clinical Trial Registration identifier and date NCT03893539; 28/03/2019.

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“…Forty-four guidelines, recommendations and consensus paper were identified, of which 37 had to be excluded (Fig. 1 ): Twenty-five papers did not give recommendations specific for bronchoscopy, two focussed on gastroscopy [ 11 , 12 ], two referred to bronchoscopy in children [ 13 , 14 ], two papers only dealt with the technical aspect of EBUS [ 15 , 16 ] and two papers dealt with precautions in bronchoscopy of COVID19-patients [ 17 , 18 ]. Four papers were excluded because they were only available in Chinese [ 19 – 22 ].…”

Section: Resultsmentioning

confidence: 99%

Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review

Strohleit¹,

Galetin²,

Kosse³

et al. 2021

BMC Pulm Med

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Background Patients undergoing bronchoscopy in spontaneous breathing are prone to hypoxaemia and hypercapnia. Sedation, airway obstruction, and lung diseases impair respiration and gas exchange. The restitution of normal respiration takes place in the recovery room. Nonetheless, there is no evidence on the necessary observation time. We systematically reviewed current guidelines on bronchoscopy regarding sedation, monitoring and recovery. Methods This review was registered at the PROSPERO database (CRD42020197476). MEDLINE and awmf.org were double-searched for official guidelines, recommendation or consensus statements on bronchoscopy from 2010 to 2020. The PICO-process focussed on adults (Patients), bronchoscopy with maintained spontaneous breathing (Interventions), and recommendations regarding the intra- and postprocedural monitoring and sedation (O). The guideline quality was graded. A catalogue of 54 questions was answered. Strength of recommendation and evidence levels were recorded for each recommendation. Results Six guidelines on general bronchoscopy and three expert statements on special bronchoscopic procedures were identified. Four guidelines were evidence-based. Most guidelines recommend sedation to improve the patient’s tolerance. Midazolam combined with an opioid is preferred. The standard monitoring consists of non-invasive blood pressure, and pulse oximetry, furthermore electrocardiogram in cardiac patients. Only one guideline discusses hypercapnia and capnometry, but without consensus. Two guidelines discuss a recovery time of two hours, but a recommendation was not given because of lack of evidence. Conclusion Evidence for most issues is low to moderate. Lung-diseased patients are not represented by current guidelines. Capnometry and recovery time lack evidence. More primary research in these fields is needed so that future guidelines may address these issues, too.

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Standardized Definitions of Bleeding After Transbronchial Lung Biopsy

Cited by 89 publications

References 14 publications

The safety profile of a protocolized transbronchial cryobiopsy program utilizing a 2.4 mm cryoprobe for interstitial lung disease

The safety profile of a protocolized transbronchial cryobiopsy program utilizing a 2.4 mm cryoprobe for interstitial lung disease

Shape-sensing robotic-assisted bronchoscopy for pulmonary nodules: initial multicenter experience using the Ion™ Endoluminal System

Guidelines on analgosedation, monitoring, and recovery time for flexible bronchoscopy: a systematic review

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