An audit review of safety and complication rates, of rigid bronchoscopy and large airways intervention, in a London tertiary centre

Abstract

Introduction: Rigid bronchoscopy permits endobronchial laser therapy, tracheal and bronchial stenting, airway dilatation and proximal tumour biopsy. Though some can be performed at flexible bronchoscopy, rigid bronchoscopy allows for improved airway control, wide bore suction and ventilation and lung isolation capabilities. Limited studies illustrating its safety and complication rates are available. Aims: To audit our practice against previously reported complications and review indications. Methods: All rigid bronchoscopies, during the study period were retrospectively reviewed. Results: 1711 rigid bronchoscopies were performed. Indication for rigid bronchoscopy was: Nd Yag laser 578 (34%), stent insertion 399 (23%), proximal tumour biopsy 358 (21%), diagnostic inspection of airways 186 (11%), dilatation of proximal stricture 100 (6%), removal of foreign body 28 (2%), removal of stent 21 (1%), percutaneous tracheostomy insertion 16 (1%), application of bioglue 19 (1%) and application of mitomycin C 6 (0.04%). Complications were noted in 18 (1.1%) patients. There was 1 fatality (0.06%) due to tumour erosion and massive haemorrhage, prior to intervention. 7 (0.4%) patients had haemorrhage of ≥100mls and haemostasis was achieved in all endobronchially. Pneumothoraces in 7(0.4%), 5 of whom required chest drain insertion. 3 patients were admitted to the intensive care unit and subsequently discharged home. Conclusion: Large airway intervention using rigid bronchoscopy under general anaesthetic within the confines of a multidisciplinary team is safe, successful and well tolerated. Rigid bronchoscopy at our centre is progressively increasing.