Abstract
Background The factors affecting patient comfort during flexible bronchoscopy are not sufficiently addressed in resource-limited countries, and a need to devise strategies to improve patient experience is felt. The present study was undertaken to assess the effect of sedation and other factors on patient comfort during flexible bronchoscopy. Methods A total of 374 patients, aged ≥18 years undergoing flexible bronchoscopy, were enrolled in this prospective, single-center, cross-sectional study. The baseline clinical data of sedation and nonsedation groups were recorded. Anxiety level was assessed using Visual Analog Scale (VAS). Postprocedure VAS score (primary outcome measure) assessed the discomfort related to flexible bronchoscopy. Patient-reported willingness for a repeat procedure and occurrence of adverse events were used as secondary outcome measures. Based on the median of VAS score, the study population was divided into low discomfort and high discomfort groups, and the factors affecting comfort levels in these two groups were noted. Results Postprocedural VAS score (median (Q1, Q3)) for sedation and nonsedation groups was 20 (15, 30) and 25 (20, 40), respectively (<0.001). Willingness for a repeat procedure was significantly more in the sedation group (p=0.002). In the low and high discomfort groups, the preprocedural anxiety level (median (Q1, Q3)) was 20 (10, 25) and 30 (20, 40), respectively (p < 0.001). Conclusion Bronchoscopist-directed sedation significantly reduces patient discomfort and increases their willingness for a repeat procedure. Midazolam-fentanyl combination and lower prebronchoscopy anxiety are associated with lower discomfort levels during flexible bronchoscopy. This study is registered with the Clinical Trial Registry of India (CTRI/2018/11/016328).
Highlights
Flexible bronchoscopy, a commonly performed procedure in a pulmonary medicine unit, provides vital input by allowing direct observation of the airway and acquiring biological material for a comprehensive evaluation of the patients’ clinical condition. e use of sedation during this procedure is increasingly becoming the standard of care due to the expectations of the patient to experience a comfortable procedure [1, 2]
Patient-marked Visual Analog Scale (VAS) score for assessing discomfort related to flexible bronchoscopy was used as a primary outcome measure. e discomfort felt by patients in the sedation and nonsedation groups were assessed using this score. e median of the scores of the whole study population (N 374) was used to divide it into low discomfort and high discomfort groups [7]. e factors that affected comfort levels were noted based on this division
E median VAS score of the level of discomfort related to flexible bronchoscopy was 25 mm. e patients were divided into two groups based on this median of the VAS score: low discomfort (
Summary
A commonly performed procedure in a pulmonary medicine unit, provides vital input by allowing direct observation of the airway and acquiring biological material for a comprehensive evaluation of the patients’ clinical condition. e use of sedation during this procedure is increasingly becoming the standard of care due to the expectations of the patient to experience a comfortable procedure [1, 2]. Sedatives have a major impact on the level of comfort during flexible bronchoscopy, there are other factors that can influence it as well [5,6,7]. Ere is a pressing need to generate data from our country regarding the benefits and risks of bronchoscopist-directed conscious sedation and to understand the factors which impact patients’ level of comfort during flexible bronchoscopy. With this background, the present study was conducted to assess the effect of bronchoscopist-directed conscious sedation on patient comfort during flexible bronchoscopy and to study the factors affecting patient comfort during flexible bronchoscopy
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