Complications Of Bronchoscopy Research Articles

Ten-year Single Center Experience of Pulmonary Carcinoid Tumors and Diagnostic Yield of Bronchoscopic Biopsy.

Bronchoscopic biopsy of pulmonary carcinoid tumors has been controversial, and no study to date is dedicated to investigate diagnostic yield or safety. We reviewed our single center experience with pulmonary carcinoid tumors over a 10-year time period and assessed the diagnostic yield and safety of bronchoscopic biopsy of these tumors. A retrospective analysis was conducted of all bronchopulmonary carcinoid tumors from January 2003 through January 2014 for patients treated at or referred to our tertiary care facility, including patient and tumor characteristics, diagnostic yield, and complications of bronchoscopy. Forty-nine patients with bronchopulmonary carcinoid tumors were identified. 75.5% of our patients were female, and the median age was 60.7years. 85.7% patients were white, and 53.1% were smokers. 83.7% had typical carcinoid tumors or tumorlets, and 85.7% had centrally located tumors. The median tumor size was 2.0cm. Thirty patients underwent bronchoscopy for diagnostic evaluation. 76.7% were diagnosed via bronchoscopic biopsy. Bronchoscopic yield was calculated at 65.7% yield, and two complications of moderate to severe bleeding occurred with no emergent thoracotomies, transfusions, or deaths. No other complications occurred from bronchoscopy. The diagnosis of pulmonary carcinoid tumors via bronchoscopic biopsy is safe and effective, and bronchoscopy is recommended as the initial diagnostic modality for these tumors.

A Retrospective Cross-Sectional Study on Prevalence of Major Complications of Bronchoscopy in a University Hospital

Background: Bronchoscopy is usually a safe procedure and major complications are extremely rare; however, it may also become complicated and lead to admission to the Intensive Care Unit. This study will assess the incidence of all causes of ICU admission and mortality rate among patients admitted to the ICU subsequent to bronchoscopy. Methods: In this cross-sectional retrospective study, all of the patients admitted to the intensive care unit of Masih Daneshvari Hospital from January 10, 2010 to January 10, 2015, subsequent to bronchoscopy related complications were assessed. Data such as demographic characteristics, type of bronchoscopy, and complications were collected in checklists and analyzed by descriptive statistics. Results: A total of 76 patients were enrolled in this study, including 34 males (44.7%) and 42 females (55.3%). The mean age was 48.5 ± 21.2 years. Most prevalent causes of ICU admission included resistant hypoxemia (32.8%), hemoptysis (18.4%), respiratory distress (7.9%), tracheal perforation (7.9%), and loss of consciousness (7.9%). A total of 85.7% of cases of hemoptysis and all cases of pneumothorax, loss of consciousness, pleural effusion, and cardiac arrest occurred in patients with lung malignancy. A total of 0.77% of patients, after a bronchoscopy procedure, needed ICU care during the years of the study. The mortality rate was 0.28%. Conclusions: The most prevalent and major causes of ICU admission were observed in high-risk patients. It’s supposed that the selection of expert operators for such patients and performing the procedure in a well-equipped Centre may significantly decrease the rate of complications, ICU admission, and mortality.

Diagnostic Yield and Complications of Bronchoscopy for Peripheral Lung Lesions. Results of the AQuIRE Registry.

Advanced bronchoscopy techniques such as electromagnetic navigation (EMN) have been studied in clinical trials, but there are no randomized studies comparing EMN with standard bronchoscopy. To measure and identify the determinants of diagnostic yield for bronchoscopy in patients with peripheral lung lesions. Secondary outcomes included diagnostic yield of different sampling techniques, complications, and practice pattern variations. We used the AQuIRE (ACCP Quality Improvement Registry, Evaluation, and Education) registry to conduct a multicenter study of consecutive patients who underwent transbronchial biopsy (TBBx) for evaluation of peripheral lesions. Fifteen centers with 22 physicians enrolled 581 patients. Of the 581 patients, 312 (53.7%) had a diagnostic bronchoscopy. Unadjusted for other factors, the diagnostic yield was 63.7% when no radial endobronchial ultrasound (r-EBUS) and no EMN were used, 57.0% with r-EBUS alone, 38.5% with EMN alone, and 47.1% with EMN combined with r-EBUS. In multivariate analysis, peripheral transbronchial needle aspiration (TBNA), larger lesion size, nonupper lobe location, and tobacco use were associated with increased diagnostic yield, whereas EMN was associated with lower diagnostic yield. Peripheral TBNA was used in 16.4% of cases. TBNA was diagnostic, whereas TBBx was nondiagnostic in 9.5% of cases in which both were performed. Complications occurred in 13 (2.2%) patients, and pneumothorax occurred in 10 (1.7%) patients. There were significant differences between centers and physicians in terms of case selection, sampling methods, and anesthesia. Medical center diagnostic yields ranged from 33 to 73% (P = 0.16). Peripheral TBNA improved diagnostic yield for peripheral lesions but was underused. The diagnostic yields of EMN and r-EBUS were lower than expected, even after adjustment.

Safety and complications of bronchoscopy in an adult intensive care unit

Safety and complications of bronchoscopy in an adult intensive care unit

Complications of bronchoscopy: A concise synopsis.

Flexible and rigid bronchoscopes are used in diagnosis, therapeutics, and palliation. While their use is widespread, effective, and generally safe; there are numerous potential complications that can occur. Mechanical complications of bronchoscopy are primarily related to airway manipulations or bleeding. Systemic complications arise from the procedure itself, medication administration (primarily sedation), or patient comorbidities. Attributable mortality rates remain low at < 0.1% for fiberoptic and rigid bronchoscopy. Here we review the complications (classified as mechanical or systemic) of both rigid and flexible bronchoscopy in hope of making practitioners who are operators of these tools, and those who consult others for interventions, aware of potential problems, and pitfalls in order to enhance patient safety and comfort.

A study of clinical presentations and complications of foreign body in the bronchus - own experience.

In this study, we studied varied clinical presentations and complications of a foreign body in the airway and complications of bronchoscopy, if carried out. A prospective observational clinical study in a tertiary care centre from June 2010 to May 2012 included 46 paediatric patients aged less than 12 years, with suspected foreign body aspiration, all of whom underwent rigid bronchoscopy under general anaesthesia. All the patients were subjected to history taking, clinical examination, and investigations (pre- and post-op chest X-ray and CT virtual bronchoscopy, if required). The most common age of presentation was 1 to 3 years, within 48 hours from aspiration. A total of 87% of patients had a definite history of aspiration, with cough (69.5%), and unilateral decreased air entry (91.3%) being the most common symptom and clinical sign, respectively. Emphysema was the most frequent finding on chest X-ray (71.7%), and the sensitivity of CT virtual bronchoscopy was 80%. Majority of the foreign bodies were organic (84.7% - especially peanuts) and mostly found in the right bronchus (47.8%). Post-op complications were rare (pneumothorax, pneumonic patch), and were managed conservatively. None of the patients required a tracheostomy and there was zero mortality. A positive history is by itself an indication for bronchoscopy. Clinical signs and X-ray changes should guide the clinicians towards the possible location of the foreign body. CT virtual bronchoscopy can be carried out in suspected cases with no specific history or clinical signs. Bronchoscopy can be conducted with minimal complications when performed by co-ordination of an expert surgeon and an anaesthetist.

Bilateral Pneumothorax After Bronchoscopy Without Biopsy—A Rare Complication

Bronchoscopy and bronchoalveolar lavage (BAL) are widely accepted diagnostic procedures in various pulmonary etiologies. Complications of bronchoscopy are relatively infrequent and most often minor, namely, bleeding and infection. Pneumothorax is a rare complication of bronchoscopy with transbronchial biopsy. Bilateral pneumothorax developing after BAL without biopsy has been rarely described in the literature. A 51-year-old woman presented with symptoms suggestive of reactive airway syndrome and underwent bronchoscopy with BAL to rule out vocal cord paralysis and to investigate other potential causes of her symptoms. Immediately after BAL, she developed bilateral pneumothorax requiring chest tube placement. The pneumothorax was resolved with the chest tube and the patient recovered. However, the etiology of the pneumothorax remained unclear. We presume that cough-related increase in intrathoracic pressure might have led to interstitial air dissection and bilateral pneumothorax.

It is time for patients to undergo bronchoscopy without discomfort

Thirty years ago, when I started performing bronchoscopy, sedation for flexible bronchoscopy was not a very common practice. At that time, some authors suggested that routine sedation could do little for patients undergoing the procedure and that bronchoscopy could be carried out without pre-medication [1–3]. However, over the last few decades, several things have changed. Patients’ need for comfort, and the desire to avoid anxiety and distress in patients undergoing medical procedures has increased generally. Furthermore, the advent and routine use of new bronchoscopic techniques and technologies have made diagnostic bronchoscopy a more complex procedure that requires prolonged time, the absence of cough, and patient cooperation and comfort. In this new scenario, the problem of sedation during bronchoscopy requires careful re-evaluation in order to definitively assess its indication and also to define the best sedative drugs to be used. The British Thoracic Society guidelines on diagnostic flexible bronchoscopy recommend that sedation should be offered to patients when there is no contraindication [4], and in surveys conducted in the USA and in the UK in 1999 and in 2002, respectively, only 4 and 10% of physicians performed bronchoscopy without sedation [5, 6]. The old argument that up to half of the major complications of bronchoscopy are sedation related [7] is not confirmed by several more recent studies. In fact, even after comparing different sedative drugs versus placebo, no difference in the complication rate between sedated and nonsedated patients has been found [8–14], except for a slight but manageable increase in hypoxaemia risk with the use of midazolam and alfentanil [14] and a prolonged hospital stay after the procedure [10]. In fact, the use of sedation, when compared with placebo, resulted in improved …

Uvular Necrosis as an Unusual Complication of Bronchoscopy Via the Nasal Approach

Bronchoscopy can cause post-procedural throat discomfort due to oropharyngeal irritation. We report a rare complication of bronchoscopy that resulted in similar symptoms. A 30-year-old man complained of severe throat discomfort a day after bronchoscopy. Examination revealed a swollen, elongated uvula. The lower half of the uvula was completely white, consistent with uvular necrosis. He was managed conservatively with topical lidocaine and antihistamines. At a follow-up examination 2 weeks later his symptoms had substantially improved and the necrosed uvula had separated, leaving a shortened uvula with an irregular border. Simple precautions taken during bronchoscopy can avoid this rare complication that causes persistent symptoms.

Pediatric Flexible Bronchoscopy: Clinical Experience of 100 Cases of Bronchoscopy from a Single Institute

Purpose: Flexible bronchoscopy is effectively used in the diagnosis and treatment of respiratory diseases in children. This report attempted to analyze the indication, effectiveness, and complications of bronchoscopy in children who visited a single tertiary care, university-based hospital in Korea. Methods : A retrospective review was conducted of the medical records of a total of 100 cases of flexible bronchoscopy that were performed at the Department of Pediatrics of the Catholic University of Korea Seoul St. Mary`s Hospital from April 8, 2007 to June 16, 2010. Results: A total of 85 patients (48 males and 37 females) were involved in the study. The range in age was 5 days old to 18 years old. Eighty cases were for diagnosis, 7 cases for treatment, and 13 cases for both. The purpose of flexible bronchoscopy was accomplished in 67 of 100 cases. In 60 cases where bronchoalveolar lavage was provided, microbial organisms were identified in 38 cases. Minor complications were observed in 12 cases. Conclusion: Pediatric flexible bronchoscopy is shown to be an effective and safe diagnostic and interventional tool, even in young or immunocompromised hosts. This study also found that children under one year of age were more frequently treated with bronchoscopy and that the detection rate in microbiological diagnosis was improved due to the introduction of the virus polymerase chain reaction method. (Pediatr Allergy Respir Dis(Korea) 2011;21:313-318)

A complication of peroral bronchoscopy

To the Editors: Flexible fibreoptic bronchoscopy is a safe procedure with a major complication rate of 4,000 bronchoscopies, major complications (respiratory failure, pneumothorax and pulmonary haemorrhage of >50 mLs) occurred in 0.5% of procedures and minor complications (laryngospasm, vomiting, bronchospasm, vasovagal syncope and epistaxis) in 0.8% of procedures 2. Herein we report an important, rare complication of bronchoscopy that, once recognised, is treatable by prompt action. A 49-yr-old female underwent elective flexible bronchoscopy during investigation for suspected Mycobacterium tuberculosis . The oropharynx was sprayed with a topical local anaesthetic and intravenous midazolam was used as a sedative. An Olympus BF-260 bronchoscope (Olympus Medical Systems Corporation, Tokyo, Japan) was introduced via a plastic mouth guard (Olympus Endoscope Mouthpiece, 20 mm×27 mm; Olympus Keymed Ltd, Southend-on-Sea, UK). No endobronchial abnormalities were noted …

Flexible Bronchoscopy for Diagnosis and Follow Up of Childhood Endobronchial Tuberculosis

In this study, our aim was to determine the clinical and bronchoscopic outcome of the endobronchial tuberculosis (ETB). Patients with suspected tuberculosis (TB) or TB patients with an inadequate response to 8 weeks of antituberculosis treatment were enrolled in the study. Seventy patients were included to the study and 118 flexible bronchoscopies were performed. ETB was present in 33 (47%) patients. There was isolated compression in 14 cases, caseous lesions in 13, granuloma formation in 6, polypoid lesions in 2, adenopathy protrusion in 1, and mucosal erosion in 1 case. The mean duration of bronchoscopic resolution of endobronchial lesions was 5.50 +/- 2.74 months. Mycobacterium tuberculosis was isolated from gastric lavage in 10% and from bronchoalveolar lavage in 12.8% of 70 cases. When both of the procedures were performed concurrently, the isolation rate increased to 20%. Transient hypoxia resolving with nasal O2 was observed in 3 patients as a complication of bronchoscopy. Bronchoscopy offered a safe and rapid means of confirming the diagnosis of ETB.

Tracheobronchial foreign bodies in children: Experience at ORL clinic Tuzla, 1954–2004

To determine the clinical characteristics and the results of bronchoscopic treatment of children due to foreign body aspiration in a university hospital. Department of Otorhinolaryngology and Maxillofacial Surgery, University Clinical Center Tuzla, Bosnia and Hercegovina. The analysis of the cases of aspirated foreign bodies within the period from January 1954 to December 2004. The analyzed patients were the children up to 14 years of age. All cases underwent the bronchoscopy. Each patient was analyzed for age, sex, nature and location of the foreign body, results of bronchoscopic removal, complications of bronchoscopy and presence of foreign bodies in the airways. Six hundred and sixty-two children who underwent bronchoscopy for removal of foreign body in the airways were evaluated. From evaluated children 66.8% were boys, ages ranging from 9 months to 14 years. Foreign bodies were more frequent in children under 3 years of age (65.2%). Most of the foreign bodies removed were organic (87.1%) and more frequently found in the right bronchial tree (53%). More attention is necessary to the prevention of aspirations. Prevention of aspiration of foreign bodies is better than cure. Public awareness through mass media needs attention to prevent foreign body inhalation.

Pneumatocele as a Complication of Bronchoscopy: A Case Report and Review of Literature

We report a case of pneumatocele (PC) caused by bronchoscopy and bronchoalveolar lavage performed in a patient with human immunodeficiency virus infection. We speculate that coughing during the bronchoscopy may have contributed to the pathophysiology. A PC is a gas-filled cystic cavity in the lung parenchyma and the mechanism of formation is a 1-way valve that only allows airflow into the cavity. PCs have been described as a congenital malformation, in necrotizing infections, in chronic obstructive pulmonary disease, in hydrocarbon ingestion with aspiration, in human immunodeficiency virus positive adults with Pneumocystis jiroveci pneumonia, and as a result of blunt thoracic trauma. These lesions frequently resolve spontaneously. Most investigators suggest that the treatment is conservative with close follow-up, and invasive approaches should be reserved for patients who develop complications. Features such as fever, cough, and tachypnea, more than 50% involvement of hemithorax, persistent atelectasis, presence of a bronchopleural fistula, and infection in a PC should prompt image-guided transthoracic aspiration and catheter drainage or surgery.

Does invasive diagnosis of nosocomial pneumonia during off-hours delay treatment?

We examined whether invasive lung-specimen collection-to-treatment times for intensive care unit patients with suspected ventilator-associated pneumonia (VAP) differ with to the work shift during which specimens were collected. We compared weekday day shifts and off-hours (from 6:30 p.m. to 8:29 a.m. the next day for night shifts, from Saturday 1:00 p.m. to Monday 8:29 a.m. for weekends, and from 8:30 a.m. to 8:29 a.m. the following morning for public holidays). Single-center, observational study in the intensive care unit in an academic teaching hospital. 101 patients who developed 152 episodes of bacteriologically confirmed VAP. Of the 152 VAP episodes 66 were diagnosed during off-hours. Neither more bronchoscopy complications nor more inappropriate initial antimicrobial treatments for patients were observed between day and off-hour shifts. Indeed, the overall time from brochoalveolar lavage to antibiotic administration was shorter for off-hours than day-shifts due to shorter specimen collection-to-antibiotic prescription times, but antibiotic prescription-to-administration times were the same. An invasive strategy based on bronchoscopy to diagnose VAP was not associated with a longer time to first appropriate antibiotic administration when clinical suspicion of VAP occurs during off-hours.

Complications of bronchoscopy for foreign body removal: experience in 1035 cases

BACKGROUNDTracheobronchial foreign body aspirations, which threaten lives in childhood, also carry potential risks during and after bronchoscopy. The aim of this study is to review complications and precautions that need to be taken against possible risks.METHODSFrom 1987 to 2005, bronchoscopy was done in 1035 children in our department on suspicion of foreign body aspiration. The average age of these patients, mostly male (55%), was 4.1 years. Medical history, physical examination, radiological methods and bronchoscopy were used in the diagnosis. Bronchoscopy was applied under general anaesthesia, and the respiratory and cardiac systems were closely observed for 4 hours after the process.RESULTSNine hundred eleven of 1035 patients (88%) had a foreign body in the tracheobronchial system. In 42 of the patients, infection required aggressive medication; in 30, hypoxia and bradycardia occurred as a result of obstruction during bronchoscopy; in 37, laryngeal edema, laryngeal spasm and/or bronchospasm required ventilation support; in 6 patients, tracheobronchial system bleeding occurred; in 2 patients pneumothorax occurred, in 1 patient pneumomediastinum was observed and 6 patients needed thoracotomies because of foreign body aspiration. In this series there were 8 deaths.CONCLUSIONBronchoscopy, performed for tracheobronchial foreign body aspiration, carries a potential life-threatening risk during and after the process. The clinician needs to be aware of these risks, take proper precautions, and perform bronchoscopy by taking the medical condition of the patient and characteristics of the inspired foreign body into consideration.

THE EFFECTS OF THE AGE DURING FLEXIBLE BRONCHOSCOPY: PREDICTORS OF COMPLICATIONS

PURPOSE: Elderly patients generally show a good tolerance of flexible bronchoscopy (FBS). Patients’ age has not emerged as a specific risk factor for bronchoscopy complications; FBS is well tolerated in the elderly, so that major modifications of the procedure because of patients’ age alone are generally unnecessary. (Clin Chest Med 2001;22.2:301). In contrast, Davies et al. reported that 21% of patients over 60 yrs developed potentially serious, albeit transient, cardiac ischaemic events/rhythm disturbances (ERJ 1997;10:695). The aim of our study was to evaluate predictors of complications in FBS related to the patients’ age.

Methemoglobinemia as a Complication of Topical Anesthesia During Bronchoscopy

Abstract:Methemoglobinemia, although uncommon, is a potentially life-threatening complication of topical anesthetics. We describe a case of a 46-year-old man developed a severe methemoglobinemia after routine bronchoscopy. After administration of 1 mg/kg intravenous methylene blue, the patient's con

Bronchoscopy for evaluation of foreign body aspiration in children

Purpose: The aim of this study was to present the entire spectrum of pediatric bronchoscopy performed for foreign body aspiration (FBA), with emphasis on accuracy of diagnostic tools, technical aspects, and predictors of complications. Methods: Records of patients who underwent bronchoscopy for evaluation of FBA in our unit from 1991 to 2000, inclusive, were reviewed retrospectively. Age, sex, history of FBA, symptoms, results of radiologic studies, bronchoscopy findings, complications, and outcome were recorded and statistically analyzed to find out the most accurate diagnostic tool. Results: A total of 740 bronchoscopies were done in 663 children (402 boys, 261 girls) presenting with a mean age of 3.1 ± 0.1 years. FBA was confirmed in 563 (85%) patients, whereas normal bronchoscopic findings, signs of pulmonary infection, and endobronchial mass were noted in 43 (6%), 54 (8%), and 3 (0.4%) patients, respectively. There was significant difference between patients with and without FBA with regard to presence of definite history (91% v 54%), normal physical examination findings (14% v 46%), and normal radiologic findings (13% v 31%). However, none of these parameters or their associations were found to be reliable to predict the presence of FBA or clinical complications. Presence of history was the most sensitive (91%), accurate (84%), and specific (46 %) diagnostic tool. Bronchoscopic removal of-foreign bodies was succeeded in 558 (99%) children. Worsening of respiratory tract infection (n = 13), cardiac arrest (n = 6), laryngeal edema (n = 5), pneumothorax (n = 5), pneumomediastinum (n = 2), tracheal laceration (n = 2), and bronchospasm (n = 2) were the life-threatening complications observed in 21 (4%) patients with FBA and 14 (14%) patients without FBA ( P < .05). There were 5 (0.8%) deaths. Of these, 2 patients presented with cardiopulmonary arrest immediately after FBA. Although foreign bodies were removed as quickly as possible, cardiac arrest was irreversible. The remaining 3 patients died of complications of bronchoscopy as irreversible cardiac arrest during bronchoscopy (n = 1) and worsening of respiratory tract infection after bronchoscopy (n = 2). Conclusions: The third year of the life carries the highest risk for FBA. There are no specific symptoms and signs to make a clear-cut differential diagnosis between FBA and respiratory tract infection. Bronchoscopy is invariably indicated on the basis of reliable history alone even when symptoms are minimal, and imaging studies are negative. Secondary bronchoscopy should be done in patients with persistent signs and symptoms to rule out overlooked organic foreign body particles or to remove persistent granulation tissue to avoid long-term complications necessitating lobectomy. The long duration of the procedure, presence of dense granulation tissue, and type of foreign body are important predictors of complications. Bronchoscopy should be regarded as an expert procedure and done with great care to avoid lethal complications. Differential diagnosis of respiratory tract infection by various diagnostic tools is of utmost important to avoid morbidity and mortality related to needless bronchoscopy.

Foreign body in children’s airways

OBJECTIVE: To determine the clinical characteristics and the results of bronchoscopic treatment of children due to foreign body aspiration in a university hospital. METHOD: Time series of children who underwent bronchoscopies for foreign bodies aspirated into the airway between March 1993 and July 2002. Each patient was analyzed for age, sex, initial clinical diagnosis, nature and location of the foreign body, duration of symptoms between aspiration and bronchoscopy, radiological findings, results of bronchoscopic removal, complications of bronchoscopy and presence of foreign bodies in the airways. RESULTS: Thirty-four children, 20 (59%) boys, ages ranging from nine months to nine years (median = 23 months). In 32 (94%) children the foreign body was removed by rigid bronchoscope, and two resulted in thoracotomy. Foreign bodies were more frequent in children under three years of age (66%). A clinical history of foreign body inhalation was obtained in 27 (80%) cases. Most of the foreign bodies removed were organic (65%) and more frequently found in the right bronchial tree (59%). Foreign bodies were removed within 24 hours in 18 (53%) cases. The most frequent radiographic findings were: unilateral air trapping, atelectasis and radiopac foreign body. Major bronchoscopy complications occurred in seven children (22%), and there were no deaths. CONCLUSIONS: More attention is necessary to the respiratory symptoms of aspirations, mainly in boys at early ages, with clinical history and compatible radiological findings. Most foreign bodies removed were of organic nature. In this case series, therapeutic rigid bronchoscopy was effective with few complications.