Analysis of 208 flexible bronchoscopies performed in an intensive care unit

Estella, Ángel

doi:10.1016/j.medine.2012.08.001

Cited by 16 publications

(16 citation statements)

References 30 publications

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“…As we found in this paper, other series describe FOB in the ICU as feasible and safe, even in the presence of mechanical ventilation [5,6,28,44] or when performed by intensivists [27].…”

Section: Discussionsupporting

confidence: 59%

“…Reports of overall utility of FOB in the ICU range from 38% to 71% [6,13,27,31]. Overall utility in this paper was 75%, higher than that reported in previous series.…”

Section: Discussionmentioning

confidence: 48%

“…Not uncommon, correct artificial airway placement and patency are also indications for FOB examination [13,16,27,28]. In this series, suspicion of malignancy was an indication for FOB in only one case where endobronchial biopsies were positive for metastases of esophageal cancer.…”

Section: Discussionmentioning

confidence: 82%

“…In our series, although a decrease of >5% was present in 65%, a SpO 2 <90% during FOB was observed in 31% of cases, with 14% of cases having pre-FOB values ≤90%. Dunagan et al [44], and more recently Estella [27], described an incidence of desaturation during FOB of 13% and 6.7%, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

et al. 2013

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is properly cited.Purpose. We describe characteristics, utility, and safety of fiberoptic bronchoscopy (FOB) in an intensive care unit (ICU). Methods. Prospective and descriptive cohort of patients admitted to a respiratory ICU from March 2010 to June 2012. Results. A total of 102 FOBs were performed in 84 patients among 580 patients that were admitted to the ICU. Mean age was 48 ± 17 years. FOB was useful in 65% of diagnostic procedures and 83% of therapeutic procedures, with an overall utility of 75%. Indications and utility according to indication were pneumonia in 31 cases, utility of 52%; percutaneous tracheostomy guidance in 26 cases, utility of 100%; atelectasis in 25 cases, utility of 76%; airway exploration in 16 cases, utility of 75%; hemoptysis in two cases, utility of 100%; and difficult airway intubation in two cases, utility of 100%. A decrease in oxygen saturation (SpO 2 ) of >5% during FOB was present in 65% of cases, and other minor complications were present in 3.9% of cases. Conclusions. Reasons for performing FOB in the ICU have remained relatively stable over time with the exception of the addition of percutaneous tracheostomy guidance. Our series documents current indications and also the utility and safety of this procedure.

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“…As we found in this paper, other series describe FOB in the ICU as feasible and safe, even in the presence of mechanical ventilation [5,6,28,44] or when performed by intensivists [27].…”

Section: Discussionsupporting

confidence: 59%

“…Reports of overall utility of FOB in the ICU range from 38% to 71% [6,13,27,31]. Overall utility in this paper was 75%, higher than that reported in previous series.…”

Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

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Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

et al. 2013

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“…This is in line with the FB culture yield of 35-71% reported in studies conducted in critically ill subjects not receiving ECMO. 8,[27][28][29][30] Our literature search did not yield any studies evaluating the safety of bronchoscopy in adult ECMO patients. However, our results were comparable with those of 3 studies describing the safety of FB in pediatric ECMO subjects.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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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.

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A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy

et al. 2021

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Background: Bronchoscopy is widely used and regarded as standard of care in most intensive care units (ICUs). Data concerning recommendations for on-call bronchoscopy are lacking. Objectives: Evaluation of recommendations, complications, and outcome of on-call bronchoscopies. Method: A retrospective single-centre analysis was conducted in a large university hospital. All on-call bronchoscopies performed outside normal working hours in the year before (period 1) and after (period 2) establishing a catalogue of recommendations for indications of on-call bronchoscopy on November 1, 2016, were included. Results: Overall, 924 bronchoscopies in 538 patients were analysed. A relative reduction of 83.6% from 794 bronchoscopies in 432 patients (1.84 per patient) during period 1 to 130 in 107 patients (1.21 per patient) during period 2 was observed. Most bronchoscopies (812/924, 87.9%) were performed in ICUs, and 416 patients (77.3%) were intubated. Bronchoscopies for excessive secretions decreased significantly during period 2. Fifty-three of 130 bronchoscopies (40.8%) fulfilled the specified recommendations during period 2, in comparison with 16.8% in period 1 (p < 0.001). Complications were recorded in 58 of 924 procedures (6.3%) and were more frequent in period 2, especially moderate bleeding. In-hospital mortality of patients undergoing on-call bronchoscopy did not differ between periods and was 28.7 and 30.2% in periods 1 and 2, respectively. Conclusion: The introduction of recommendations for on-call bronchoscopy led to a significant decline of on-call bronchoscopies without negatively affecting outcome. More evidence is needed in on-call bronchoscopy, especially for ICU patients with intrinsic higher complication rates.

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Analysis of 208 flexible bronchoscopies performed in an intensive care unit

Cited by 16 publications

References 30 publications

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

Indications and Efficacy of Fiberoptic Bronchoscopy in the ICU: Have They Changed Since Its Introduction in Clinical Practice?

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

A Before-and-After Study of Evidence-Based Recommendations for On-Call Bronchoscopy

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