Frequency and Outcomes of Bronchoscopy-Related Pneumothorax

Abstract

SESSION TITLE: Interventional Pulmonology SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: With computed-tomography lung cancer screening becomes more widely utilized and the development of interventional pulmonology as a sovereign subspecialty of pulmonary medicine, the number of diagnostic and therapeutic tools used during flexible bronchoscopy (FB) is proliferating and the total use of FB is increasing. Traditionally, FB has been associated with a low risk for pneumothorax (Ptx), even when sampling lesions in the lung parenchyma, while transthoracic needle sampling (TTNS) of lung lesions is associated with a 15-40% of Ptx. Only a fraction of the Ptx detected during TTNS require intervention and affect clinical course. Our aim is to identify the frequency of Ptx requiring clinical intervention or affecting clinical outcome following FB. METHODS: With IRB approval, data was collected using a validated electronic medical record data base. We retrospectively identified all patients who underwent FB outside the intensive care unit and subsequently developed pneumothorax in our institution, between January 2006 and December 2016. Clinical consequences of FB-associated Ptx were recognized by medical record revision RESULTS: Our institution perform an annual average of 2110 FB. Of these procedures, 66 were complicated by Ptx in the last 10 years. Of these Ptx, 55 (83.33%) were associated with bronchoscopic lung biopsy (BLBx), 45 patients (68%) required chest tube (CT) drainage, 20 (30%) required large-bore (greater than 14-French) CT, 6 (9%) required more than 1 CT, 62 (94%) required hospital admission, 4 (6%) required ICU admission, 4 (6%) required mechanical ventilation, and 3 (5%) required additional pleural intervention. CONCLUSIONS: Ptx following FB is rare. Unlike with TTNS, however, the Ptx that do happen following FB most commonly have significant clinical consequences. CLINICAL IMPLICATIONS: This study demonstrates the morbidity of Ptx following FB is high compared to Ptx following TTNS and should be considered when weighing the relative risk and benefits of FB in the diagnosis or treatment of pulmonary disorders. DISCLOSURE: The following authors have nothing to disclose: Xavier Fonseca Fuentes, Govind Pandompatam, Dante Schiavo No Product/Research Disclosure Information