Survey of flexible fibreoptic bronchoscopy in the United Kingdom

Abstract

The practice of flexible bronchoscopy is not standardized. Current guidelines are concerned primarily with safety aspects of the procedure. In view of this, and the authors9 own observations of individual variation in preparation and technique, a national survey of bronchoscopic procedure was performed to assess physicians9 methods. A structured questionnaire was mailed to 547 consultant physicians in adult respiratory medicine. Physicians9 routines of patient preparation, drug therapy, sampling methods, and experience of complications with the flexible bronchoscope were assessed. A 60% response (328 physicians) was obtained. Patient consent was obtained by a junior doctor in 31% of replies. 205 (63%) physicians gave benzodiazepine sedation, 46 (14%) used opioid, and 38 (12%) administered both. Ninety-four (29%) physicians prescribed an antimuscarinic agent, and 235 (74%) gave antibiotics to patients with mechanical heart valves. Only 22% of physicians monitored electrocardiogram and 10% monitored blood pressure during all procedures. Marked variance was noted in sampling routines of suspected lung tumours. Physicians who used fluoroscopic guidance for transbronchial lung biopsy reported a significantly lower incidence of pneumothorax requiring drain insertion over the previous 12 months compared to those who did not (2.68 of 1000 versus 9.17 of 1000, (pv0.03)), but no difference in the total incidence of pneumothorax. Only 87 (27%) of responders had performed transbronchial needle aspiration sampling over the previous 12 months. The preparation and practice of flexible bronchoscopy varies greatly for each physician. Use of radiographical screening for performing transbronchial lung biopsy was associated with a lower likelihood of pneumothorax requiring chest tube drainage. This study was funded by the East Cheshire NHS trust. It is now w30 yrs since IKEDA [1] introduced the technique of flexible fibreoptic bronchoscopy, and this procedure has been established throughout the UK for w20 yrs. Despite this, bronchoscopic practice in UK hospitals is not standardized. National guidelines on flexible bronchoscopy concentrate predominantly on safety aspects of the procedure, rather than practical aspects of the technique [2]. In view of this, the authors undertook a national survey of flexible bronchoscopy which focused primarily on physicians9 preferences for patient preparation, monitoring during the procedure, drug therapy and tissue sampling methods. Information concerning physicians9 experiences of complications and of performing therapeutic procedures with the flexible bronchoscope was also sought. The aims of the study were to assess the extent of variation in physicians9 common practice, to compare activity with evidence-based data, and to assess the degree of adherence to accepted standards of practice. Method Consultant physicians in adult respiratory medicine in the UK were identified by the national directory of the British Thoracic Society. A structured questionnaire was sent by post to the hospital addres...

Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly

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“…Although there is a debate concerning the need for sedation in FOB [28,29], we always performed non-sedated bronchoscopy with very few exceptions. Rather old studies suggested that sedation was implicated as the cause of major averse events resulting from FOB [3,30].…”

An Autopsy Case of Asphyxia Caused by Uncontrolled Hemorrhage Following Transbronchial Lung Biopsy

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Evaluation of discomfort and tolerability to bronchoscopy according to different sedation procedures with midazolam

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