Abstract
BackgroundFactors affecting the safety of bronchoscopy in patients with malignant hematologic disorders have not been well described. We evaluated the safety of bronchoscopy and describe factors affecting its complication rate in such patients.MethodsBetween January 2009 and December 2018, 316 bronchoscopies in 282 patients with malignant hematologic disorders and pulmonary infiltrates were performed at our institution. The bronchoscopic procedure used and its complications were evaluated.ResultsThe most common underlying disease was acute myeloid leukemia (134/282 patients, 47.5%). Platelet transfusion was performed the day before or the day of bronchoscopy in 42.4%, supplemental oxygen was administered before the procedure in 23.1%, and midazolam was used in 74.4%. Thirty-five bronchoscopies (11.1%) were complicated by hemoptysis and 7 patients developed pneumothorax, 4 of whom required thoracic drainage. Two patients (0.6%) were intubated within 48 h of the procedure and prolonged oxygen desaturation (> 48 h) occurred in 3.8%. Multivariate analysis showed that only use of midazolam significantly reduced the risk of prolonged oxygen desaturation (hazard ratio 0.28, 95% confidence interval 0.09–0.85, p = 0.03). Transbronchial lung biopsy significantly increased the risk of hemoptysis (hazard ratio 10.40, 95% confidence interval 4.18–25.90, p = 0.00), while use of midazolam significantly reduced the risk (hazard ratio 0.31, 95% confidence interval 0.14–0.73, p = 0.01).ConclusionsBronchoscopy is relatively safe in patients with malignant hematologic disorders. Caution and judicious use of sedatives may improve the patient’s procedural tolerance and lower complications.
Highlights
Factors affecting the safety of bronchoscopy in patients with malignant hematologic disorders have not been well described
Bronchial washing was included in 201 bronchoscopies (63.6%), bronchoalveolar lavage in 104 (32.9%), transbronchial lung biopsy (TBLB) in 125 (39.6%), bronchial curettage in 6 (1.9%), and endobronchial ultrasound-guided transbronchial needle aspiration in 2 (0.6%)
Pethidine was used in 261 bronchoscopies (82.6%), midazolam in 235 (74.4%), and atropine sulfate in 291 (92.1%)
Summary
Factors affecting the safety of bronchoscopy in patients with malignant hematologic disorders have not been well described. We evaluated the safety of bronchoscopy and describe factors affecting its complication rate in such patients. Pulmonary complications occur in up to 40–60% of patients with hematologic diseases and have a considerable influence on morbidity and mortality [1]. These complications include infiltration of underlying disease, opportunistic infections, and various pulmonary infiltrates after hematopoietic stem cell transplantation (HSCT), such as idiopathic pneumonia syndrome. Several studies have demonstrated the utility of bronchoscopy in patients with hematologic disorders [2,3,4,5,6], but the factors affecting the safety of bronchoscopy in such patients have not been well described. We evaluated the safety of bronchoscopy at our institution and its complication rate with the aim of elucidating these factors
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
