PS01.13: Transbronchial Lung Biopsy on Mechanical Ventilation: Is It Safe To Do?

Abstract

Flexible bronchoscopy with transbronchial lung biopsy (TBLB) is commonly used for diagnosis of lung diseases. However, the safety of the procedure on positive pressure mechanical ventilation has been controversial due to presumed risk of pneumothorax and there is limited data available. In this study, we compared complications of TBLB with mechanical ventilation to those with non-mechanical ventilation for non-ventilator dependent patients. A retrospective review of non-ventilator dependent patients who underwent TBLB from January 2010 to May 2016 in our hospital was performed. Mechanical ventilation (Group A) and non-mechanical ventilation (Group B) groups were compared with patient’s demographics, numbers of lobes biopsied (single or multiple), pre-procedure diagnoses, post-procedure tissue diagnoses and post-procedure complications. Complications were defined as pneumothorax of any size, major hemorrhage, prolonged intubation and re-intubation within 72 hours from TBLB. A p-value of <0.05 is considered statistically significant. A total of 390 patients were identified. Group A had 350 patients with mean age of 64.6±14.8 yr and Group B had 40 patients with mean age of 60.4±17.4yr. There were no significant differences with regards to age, gender or number of lobes biopsied (p>0.10). The most common reason for TBLB was assessment of lung mass or nodule in both groups. Group A included 132 patients (38%) with navigational guided TBLB. There was no significant difference in the occurrence of pneumothorax (5% vs 5%, p=1.00), bleeding (2% vs 2%, p=0.53), or prolonged intubation or re-intubation (3% vs 2%, p=1.00) between the two groups. There was no significant difference observed in the rate of complications between mechanically and non-mechanically ventilated patient groups. The overall rate of pneumothorax with TBLB was small at 5%. Mechanical ventilation for TBLB is safe and could create a more controlled environment during the procedure.