Utility Of Bronchoscopy Research Articles

Diagnostic yield of bronchoscopy in children with leukemia or post hematopoietic stem cell transplant.

The utility of bronchoscopy with bronchoalveolar lavage (BAL) in immunocompromised children is not well understood. We aim to describe the bronchoscopy diagnostic yield and complications and to investigate factors associated with diagnostic yield. This is a single-center, retrospective cohort study of 60 children with leukemia or post-hematopoietic stem cell transplant who had a bronchoscopy with BAL between 2017 and 2021. Comparisons were done with regression analysis. Of the 60 bronchoscopies performed, 46 (77%) revealed diagnostic information: 39 (65%) identified a pathogen, 14 (23.3%) found secretions/mucus plugging, and 6 (10%) found pulmonary hemorrhage. BAL results changed antimicrobial therapy in 27 (45%) cases. Bronchoscopies were performed in the intensive care unit (27/60) or operating room (33/60), with the former having a higher diagnostic yield (96% vs. 60%, p = 0.001). Half (50%) of bronchoscopies found a new infectious diagnosis. Respiratory symptoms (n = 58, 97%), supplemental oxygen use (n = 39, 65%), and antibiotic use (n = 56, 93%) before bronchoscopy were all common. The median volume of fluid instilled during bronchoscopy was 1.3 mL/kg (interquatile range [IQR]: 0.7, 2.6). None of these factors were associated with the diagnostic yield. Complications were rare and minor with only one child having self-resolved bleeding and four children, previously in room air requiring a nasal cannula. For the 27 (45%) children on mechanical ventilation when the bronchoscopy was performed, there was no difference in ventilator settings pre- and post-bronchoscopy. Bronchoscopies with BAL are useful, safe, and important in the diagnostic management of pulmonary complications in this cohort of children.

Fibreoptic Bronchoscopy-its Role in Pulmonary Medicine-Current Trends in Intensive Care Unit

Fibreoptic Bronchoscopy is an endoscopic procedure to visualize the tracheobronchial tree and also to obtain bronchial washings, biopsies, brush smears, transbronchial biopsies to arrive at an etiological diagnosis of the underlying disease process responsible for the nonresolving shadows in the lung, these can facilitate therapeutic decision. Utilization of bronchoscopy in the intensive care unit (ICU) has made the diagnosis and treatment of many diseases presenting as acute respiratory illness, more possible to interventional pulmonologists and intensivists although challenging in the critical ill cases, specially in ventilator support. We report our one year experience with the use of flexible fiberoptic bronchoscopy. A total 205 cases were undergone this procedure during Aug 2022 till July 2023 out of which 169 cases were taken up from the wards and rest 36 cases were taken up from the intensive care units. Pre-bronchoscopy screening was done. Of 205 patients, there were 124 Male patients and 81 Female patients. Mean age of the patients was 50.1 years. Among 169 cases in the ward were mainly non-resolving consolidation in 99 (58%) cases followed by pulmonary mass lesion in 31(18.3%) cases, Cavitary lesion in 22 (13%) cases, collapse with bronchiectasis-18(10.6%) and in 16 cases with hemoptysis with Normal X-ray. The diagnostic yield were Pulmonary infection - Non TB- 46 %, Tuberculosis-8%, Malignancy 17% – Squamous cell carcinoma-2 cases (18%), Adenocarcinoma 4 cases, Small Cell carcinoma -5 cases Bronchoscopy has ultimately lead to change in therapy in 70% cases, Bronchoscopy among 36 (17.5%)cases in ICU were mainly related to non-resolving consolidation 12(33%), hemoptysis 8(22.4%), for tracheal intubation-3(8.3%). Therapeutic bronchoscopy was performed in collapse due to retained secretion in 13(36%) cases. Complications were minimal indicating its safety in expert hands.

Meta-Analysis on Utility of Bronchoscopy in Addition to Computed Tomography Thorax in the Investigation of Lung Cancer in Patients with Haemoptysis

Background: In patients with haemoptysis, many healthcare systems support bronchoscopy regardless of computed tomography (CT) findings. Objective: This meta-analysis aimed to address whether a normal CT alone is sufficient to out-rule lung cancer in patients with haemoptysis. Methods: A search was performed of the following databases: EBSCO (Medline), PubMed, Academic Search Complete, CINAHL, Cochrane Library, and Embase. Meta-Disc 1.4 and RevMan software were used to test for heterogeneity, risk of bias, and to summarize the test performance characteristics using forest plots and summary receiver operating characteristic (SROC) curves. SPSS was used to compare the diagnostic accuracy of CT and bronchoscopy. Results: A total of 14 studies (2,960 patients) were included. The pooled sensitivities for detection of lung cancer using CT scan and bronchoscopy were 0.99 (95% CI: 0.97–1.00) and 0.84 (95% CI: 0.78–0.88), respectively. The sensitivity of CT was higher than that of bronchoscopy (p < 0.001). The pooled specificities for CT scan and bronchoscopy were 0.99 (95% CI: 0.99–1.00) and 1.00 (95% CI: 0.99–1.00), respectively. Of 2,960 patients, 257 had lung cancer (8.7%) at initial investigation. 254 of these had a CT thorax, and the CT scan was false negative in 4/255 (1.6%), with bronchoscopy only identifying one cancer with a normal CT (0.4%). Conclusion: CT scan showed a higher diagnostic accuracy than bronchoscopy. This study indicated that bronchoscopy offers an insignificant additional value in the investigation of lung cancer in patients with haemoptysis and a negative CT scan.

Clinical application of transbronchial cryotherapy in the diagnosis and treatment of tracheobronchial tuberculosis in children

Objective: To explore the clinical utility of bronchoscopy and transbronchial cryotherapy in children with tracheobronchial tuberculosis (TBTB). Methods: Retrospective study was conducted to collect the clinical data of 10 hospitalized children who underwent bronchoscopy and were diagnosed as TBTB and in the Department of Pediatrics of Peking University First Hospital and the Department of Pediatric Respiratory Medicine of the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University from January 2011 to October 2019. The clinical characteristics of TBTB in children, and the efficacy and safety of bronchoscopy and transbronchial cryotherapy were summarized through descriptive analysis. Results: The onset age of 10 children (6 males and 4 females) ranged from 1-14 years. The clinical manifestations included fever (8/10), cough (7/10) and hemoptysis (2/10). Purified protein derivative test and interferon-γ release assay were performed in 9 and 10 patients respectively, the results were all positive. Chest CT examination was performed in all patients, and 8 patients had hilar and mediastinal lymphadenopathy. All patients underwent pediatric bronchoscopy in time, in 9 patients bronchus was found to be blocked in varying degrees by granulation tissue and caseous necrosis and in the remaining patient, obvious congestion and edema in bronchial mucosa. The bronchoscopic manifestations included 8 cases of lymph node fistula type, 1 case of granulation proliferative type and 1 case of inflammatory infiltration type. Pathological biopsies were performed in 7 cases, the findings were consistent with the pathological characteristics of tuberculosis. Nine patients were treated by pediatric bronchoscopic intervention, with 8 transbronchial cryotherapy by flexible bronchoscopy, and among them, 2 patients were treated by simultaneous rigid bronchoscopy. After 1-3 times of transbronchial cryotherapy, the blocked bronchial lumina in 8 cases were all recanalized, and the curative effect was significant without any serious complications. Conclusions: Bronchoscopy plays an important role in the diagnosis of TBTB in children and is helpful for its classification. Also, transbronchial cryotherapy has good efficacy and safety for TBTB in children, especially for the granuloproliferative type or lymph node fistula type.

Bronchoscopy in intubated and non-intubated intensive care unit patients with respiratory failure

Bronchoscopy is one of the important tool for the pulmonary and critical care physicians to diagnose and treat various pulmonary conditions. It is increasingly being used by the intensivist due to its safety and portability. The utilization of bronchoscopy in the intensive care unit (ICU) has made the diagnosis and treatment of many conditions more feasible to intensivists. Sedation, topical or intravenous, usually helps better tolerate the procedure. However, the risks and benefits of bronchoscopy should be carefully considered in critically ill patients. The hypoxic patients in ICU pose a challenge as hypoxemia is one of the known complications of bronchoscopy, and this risk is exacerbated in patients with hypoxic respiratory failure. Bronchoscopy is relatively contraindicated in patients with severe hypoxemia and coagulopathy. However, bronchoscopy in hypoxic patients can have diagnostic as well as therapeutic implications. In patients with hypoxic respiratory failure, the use of non-invasive ventilation (NIV) during bronchoscopy has been shown to reduce the risk of intubation. On the other hand, bronchoscopy in mechanically ventilated patients is not contraindicated and has been widely used. Staying focused, monitoring vital signs closely, limiting the scope time in the airway, and understanding patient’s physiology may help decrease risk of complications. In this review, we discuss indications, techniques, complications, and yield associated with bronchoscopy in critically ill hypoxic patients.

Utility of Bronchoscopy with Bronchoalveolar Lavage among Hematologic Transplant Recipients in the Era of Noninvasive Testing

Background: Pulmonary complications are common among hematologic stem cell transplant (HSCT) recipients. Their evaluation can be pursued through bronchoscopy with bronchoalveolar lavage (BAL) and a variety of available noninvasive studies, which include newer molecular markers for detecting a variety of infectious agents. Objective: The objective of this study is to evaluate the diagnostic yield of BAL among HSCT patients relative to the yield of noninvasive testing. Method: This is a retrospective analysis of HSCT recipients who underwent both BAL and noninvasive testing at a cancer center in 2013 and 2014. Results: There were 210 diagnostic results among 98 HSCT recipients. There were 84 unique findings on noninvasive testing that were not evident on BAL, and 36 unique findings on BAL that were not evident on noninvasive testing. Noninvasive testing tended to yield bacterial and viral infections more commonly, while BAL yielded mycobacterial isolates more commonly. Conclusion: While both noninvasive testing and BAL are helpful in this population, each appeared more precise than the other with individual lung diseases. Bronchoscopy with BAL and noninvasive testing should be considered complementary strategies in the workup of pulmonary complications among HSCT patients.

Comparison of the Patient Diagnostic Yield of Fibre-optic Bronchoscopy with Conventional Tracheal Aspirate

Objective: To know the efficacy of Bronchoalveolar Lavage (BAL) in establishing diagnosis and its impact on overall health status of the patients.&#x0D; Methods: A single center, longitudinal study involving 40 patients aged &gt; 18 years old with septic shock with similar baseline characteristics was conducted. Two study arms, 20 patients in intervention arm - patient with utilization of Bronchoscopy and BAL in aiding diagnosis and 20-patients in conservative- arm without Bronchoscopy were compared in terms of establishing diagnosis primarily and secondarily in terms of length of stay and 30-day mortality. We were able to identify following organisms in BAL sample: Mycobacterium tuberculosis- 4, Acinetobacter baumanii- 3, Pseudomonasaeruginosa- 2, Klebsiella oxytica- 2, E. coli- 2, Streptococcus pneumoniae- 2, Staphyloccus aureus-&#x0D; Results: We were able to identify various infectious agents as mentioned above 16/20 in BAL group compared to 8/20 in conventional arm; neoplasm in 4 out of 20 subjects in BAL group. In 80% of cases, BAL helped in identifying the organisms compared to only 40% in tracheal aspirate group. In addition, six cases in Intervention arm vs. nine cases in conventional arm had more than &gt; 14 days hospital stay with the p-value 0 .492091. Interventional arm had lesser mortality 5 cases vs. 7 cases in Conventional arm with the p-value of 0.490153 which was not statistically significant.&#x0D; Conclusion: We conclude that the diagnostic bronchoscope and related procedures among critically ill patients are helpful in identifying the pathogens and in detecting malignancy.

Diagnostic utility of bronchoscopy in newly diagnosed acute leukemia patients.

e19510 Background: Over 40% of newly diagnosed acute leukemia patients receiving induction therapy develop acute respiratory failure. Bronchoscopy is a valuable tool for evaluating airway disease, but its diagnostic yield in this setting has not been fully explored. Methods: We performed a retrospective chart review of 75 newly diagnosed acute leukemia patients who had bronchoscopies. Data recorded prior to bronchoscopy included age, diagnosis, induction treatment regimen, chest imaging, assisted ventilation, duration of neutropenia and antibiotic therapy and microbiological studies. Bronchoalveolar lavage (BAL) cultures were sorted by organism, as well as by other pathologic findings. The primary outcome was antibiotic change supported by culture data. Results: The study population is summarized in the table. Induction regimen backbones included 7+3 (51), 7+4+ATRA (2), decitabine (12), hyperCVAD (2), AYA (3), other (1) and none (4); 18 patients were treated on clinical trial. Average days of neutropenia was 10.92 and average days of antibiotic therapy was 10.57. Thirty-eight patients had chest infiltrates, 11 received NIPPV, and 17 were mechanically ventilated. We identified 24 patients with +BAL studies. Of these, 37.5% (9) had + blood, urine or sputum studies before bronchoscopy, but only 3 had cultures positive for the same organism as the BAL. Of 51 patients with –BAL studies, 33.3% (17) had prior negative cultures. Infections were most commonly bacterial (15, 62.5%), followed by viral (5, 20.8%) and fungal (4, 16.7%). The most common organisms were rhinovirus, vancomycin sensitive Enterococcus (4, 16.7% each) followed by VRE, Candida albicans and MRSA (2, 8.3% each). Five patients (6.7%) had alveolar hemorrhage. Of the 24 patients with +BAL cultures, bronchoscopy findings supported changing antibiotics in 18. In contrast, antibiotics were changed in 16 patients without +BAL cultures. Conclusions: We investigated the utility of bronchoscopy on AL patients during their initial admission. BAL cultures were positive in 32% of newly diagnosed AL patients undergoing bronchoscopy. However, +BAL cultures identified a new organism in 87.5% and guided antibiotic therapy in 75% of these patients. Further studies will be needed to establish predictors of bronchoscopy findings in this patient population. [Table: see text]

Bronchoscopic Myths and Legends: Utility of Bronchoscopy in ILD: A Review Article

Interstitial lung diseases (ILDs) also known as diffuse parenchymal lung diseases can be a diagnostic dilemma, as treatment and prognosis depend largely on an accurate diagnosis. A multidisciplinary approach has become standard of care and has been shown to be the key to making the correct diagnosis with the least invasive approach. This usually comprises pulmonologists, rheumatologists, radiologists, and pathologists, and is essential to reach the correct and final diagnosis. Histologic diagnosis was considered in the past to be the end and be all for the definite diagnosis of ILDs. However, this is not the case anymore. It is now possible to make a definite diagnosis of certain ILDs such as idiopathic pulmonary fibrosis based off clinical presentation, serologies, and high-resolution computed tomography of the chest if it has typical features without the need for bronchoalveolar lavage or histology. Not all suspected ILDs need to be biopsied! An accurate diagnosis is essential due to differences in etiology, clinicopathologic features, therapeutic options, and prognosis. This article reviews where the literature stands now on the utility of bronchoscopy in diagnosing ILDs.

Indications and Complications of Flexible Fiberoptic Bronchoscopy in Children: A 5-Year Experience at a Tertiary Care Hospital in Iran

Background: Flexible fiberoptic bronchoscopy (FFB) is known as an important diagnostic and therapeutic modality in the evaluation of respiratory disorders in pediatric population. Objectives: The study aims to highlight common indications and risk of complications associated with bronchoscopy in our population. Methods: This retrospective evaluation was performed in all patients that underwent flexible bronchoscopy at Children's Medical Center (affiliated to Tehran University of Medical Sciences) between April 2011 and September 2016. Results: Of 800 bronchoscopies, 574 (71.7%) were performed for diagnostic and 226 (28.2%) for therapeutic purposes. Major indications included radiographic abnormalities (30%), a foreign body or suspected foreign body (28.5% of all FFBs) and stridor or wheezing (25% of all FBB). The incidence of major complications associated with FFBs was 0.87%. The most frequent complication was pneumothorax, followed by lung hemorrhage, and respiratory failure. Conclusions: Our findings support early intervention and utilization of bronchoscopy in the pediatric population with variable respiratory complaints.

The utility of bronchoscopy in immunocompromised patients: a review.

Bronchoscopy is an important tool for the diagnosis of pulmonary disorders in immunocompromised patients. The addition of biopsies to bronchoalveolar lavage improves the diagnostic yield of non-infectious etiologies, although the underlying etiology of the immunocompromised state must be considered and may be influential. Certain unknowns remain, including timing of bronchoscopy and its impact on medical management and mortality. The ongoing role of non-invasive testing for infectious complications prior to bronchoscopy also remains to be defined. This review addresses the role of bronchoscopy in immunocompromised states related to underlying hematologic malignancies, prescription drug use or chemotherapy, and other disorders that predispose patients to infectious or non-infectious pulmonary diseases.

The Clinical and Research Utility of Bronchoscopy in Cystic Fibrosis

The Clinical and Research Utility of Bronchoscopy in Cystic Fibrosis

Confirmation of endotracheal tube placement using disposable fiberoptic bronchoscopy in the emergent setting.

Patients intubated in the prehospital setting require quick and definitive confirmation of endotracheal (ET) tube placement upon arrival to the emergency department (ED). Direct and adjunct strategies exist, but each has limitations and there is no definitive gold standard. The utility of bronchoscopy in ED intubation has been studied, but scant literature exists on its use for ET tube confirmation. This study aims to assess effectiveness, ease and speed with which ET tube placement can be confirmed with disposable fiberoptic bronchoscopy. Emergency medicine residents recruited from a 3-year urban residency program received 5 minutes of active learning on a simulation mannequin using a disposable, flexible Ambu aScope interfaced with a monitor. With residents blinded, the researcher randomly placed the ET tube in the trachea, esophagus or right mainstem. Residents identified ET tube position by threading the bronchoscope through the tube and viewing distal anatomy. Each resident underwent 4 trials. Accuracy, speed and perceptions of difficulty were measured. Residents accurately identified the location of the ET tube in 88 out of 92 trials (95.7%). The median time-to-guess was 7.0 seconds, IQR (5.0-10.0). Average perceived difficulty was 1.6 on a scale from 1-5 (1 being very easy and 5 being very difficult). No tubes were damaged or dislodged. While simulation cannot completely replicate the live experience, fiberoptic bronchoscopy appears to be a quick and accurate method for ET tube confirmation. Further studies directly comparing this novel approach to established practices on actual patients are warranted.

Does bronchoscopy help in resolving the etiology of Non-resolving Pneumonia? Experience in a Tertiary Care Center

Background : Normal resolution time of pneumonia is variable. Non-resolving pneumonia is a challenging clinical problem. Etiological, patient and treatment-related factors affect outcomes. Bronchoscopy is initial diagnostic technique in evaluating these patients. The study explored the utility of bronchoscopy in diagnosing of non-resolving pneumonia.Material and Methods: Records of the patients diagnosed with non-resolving pneumonia who underwent bronchoscopy from 20th January 2017 to 19th January 2018 were analysed. The data analyzed included demographic characteristics, clinical profile, bronchoscopic findings, chest imaging, and hospital discharge status. Non-resolving pneumonia was defined as focal infiltrates with symptoms of acute pulmonary infection and lack of clinical and radiological improvement within 12 weeks despite a minimum of 10 days treatment. For analysis descriptive statistics like mean and percentage and tabular and graphical presentation were made.Results: Forty-five patients had non resolving Pneumonia. A total 75.0% were males with age range of 25 to 85 years and commons symptom were cough with fever (75.0%) followed by hemoptysis, chest pain, and breathlessness. Bronchoscopically multiple ulcerated lesions, inflamed tracheobronchial tree with mucopurulent secretions and mass lesions were common. Etiologically 66.6 % patients had TB, followed by lung cancer, bronchiectasis and pneumonia.Conclusion: Bronchoscopy has better utility and is the diagnostic modality of choice in establishing etiology of non-resolving pneumonia. Journal of Nobel Medical CollegeVolume 7, Number 1, Issue 12, January-June 2018, page : 1-5

458 - Utility of Bronchoscopy and Broncho Alveolar Lavage (BAL) in the Management of Post-Stem Cell Transplant Pulmonary Complications in 100 Days of Transplant

458 - Utility of Bronchoscopy and Broncho Alveolar Lavage (BAL) in the Management of Post-Stem Cell Transplant Pulmonary Complications in 100 Days of Transplant

470 - Utility of Bronchoscopy and Bronchoalveolar Lavage (BAL) in the Management of Post-Stem Cell Transplant Pulmonary Complications in 101 to 1000 Days of Transplant

470 - Utility of Bronchoscopy and Bronchoalveolar Lavage (BAL) in the Management of Post-Stem Cell Transplant Pulmonary Complications in 101 to 1000 Days of Transplant

The Weekend Effect in Hospitalizations for COPD Exacerbation: A Nationwide Analysis

SESSION TITLE: COPD 3 SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, November 1, 2017 at 01:30 PM - 02:30 PM PURPOSE: Chronic Obstructive Pulmonary Disease (COPD) affects 30 million individuals in the United States. Hospital admissions relating to exacerbations of this condition incur significant costs to the healthcare system. The aim of our study was to determine in-hospital outcomes including measures of morbidity and resource utilization in patients with COPD exacerbation admitted over the weekend versus weekday. METHODS: This was a retrospective cohort study using the 2013 National Inpatient Sample (NIS), the largest publically available inpatient database in the United States. The inclusion criteria were age >18 years and an ICD-9 CM code for primary diagnosis of COPD. There were no exclusion criteria. The primary outcome was in-hospital mortality. There were two secondary outcomes: (1) morbidity, as measured by need for intensive care unit (ICU) admission, and presence of shock or acute respiratory failure, and (2) resource utilization, as measured by mean length of hospital stay (LOS), total hospitalization charges, and utilization of bronchoscopy and thoracentesis. Analyses were performed by using Stata, version 13.0. Odds ratios and means were adjusted for the following confounders using multivariate regression analysis models: age, gender, race, Charlson Comorbidity Index, primary insurance, and hospital teaching status. Group 1: COPD admission on the weekend, Group 2: COPD admission on a weekday. RESULTS: 631,664 patients with a primary diagnosis of COPD were included in the study. The mean age was 68 years and 56% of patients were female. The in-hospital mortality rate was not increased in COPD patients admitted over the weekend (OR 1.09; p=0.13) throughout the examined time period. Patients admitted on weekends (group 1) were more likely to have an ICU stay during their hospitalization (OR 1.15; p<0.01) and acute respiratory failure (OR 1.11; p<0.01). Looking at resource utilization, group 1 did not have increased total mean hospital charges ($28,776 vs. $28,615; p=0.503), utilization of bronchoscopy (OR 0.84; p=0.12) and thoracentesis (OR 1.08; p =0.463). In addition, group 1 was not more likely to have shock (OR 0.968; p=0.80). On the other hand, mean length of stay was shorter in group 1 (4.19 vs 4.30 days; p<0.01). CONCLUSIONS: There was no difference in mortality between patients admitted for COPD exacerbation during the weekend versus weekday however those admitted on a weekend had a higher likelihood of ICU admission and acute respiratory failure. Total hospitalization charges, and utilization of bronchoscopy and thoracentesis were not significantly different between the two groups. Weekend admissions had a lower LOS. CLINICAL IMPLICATIONS: There has been an increasing amount of medical literature showing worse outcomes in patients admitted for medical and surgical conditions on the weekend. This has been coined “the weekend effect.” The data presented shows no statistical difference in primary and secondary outcomes of patients admitted over the weekend. DISCLOSURE: The following authors have nothing to disclose: Navid Gholitabar, Caroline Dooley, Syed Ahsan, Farid Gholitabar, Joseph Mathew No Product/Research Disclosure Information

Safety and Utility of Bronchoscopy in the Very Elderly

SESSION TITLE: Interventional Pulmonary Procedures SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, November 1, 2017 at 02:45 PM - 04:15 PM PURPOSE: To evaluate if flexible bronchoscopy (FB) in the very elderly provides clinically useful information that affects treatment decisions with an acceptable risk profile. There are several studies evaluating the safety and utility of bronchoscopy in the elderly, but this study describes the oldest population studied to date. METHODS: All bronchoscopies performed in the San Antonio Military Health System over a five year period were reviewed and all patients aged over 85 years old with bronchoscopies performed outside of the ICU were included. A control group of patients aged 65-79 with bronchoscopies performed during the same time period was collected. Procedural data was collected from the electronic medical record including, age at time of procedure, type of bronchoscopy, sampling techniques, medication doses, complications, diagnostic yield, and subsequent treatment. Variables were analyzed with a student’s t-test or a fisher’s exact test. RESULTS: 73 bronchoscopies were performed in the study group, with a mean age of 87.1 (85-96 y). The patient complication rate in the study group was similar to the control group, 9.6% vs 8.2%, p > 0.99. Hypoxia occurred in 5 patients, 3 post procedure ICU transfers, 2 deaths within 30 days, and 1 each of pneumothorax, intubation, bipap use. There were no instances of oversedation requiring reversal agents and no deaths within 72 hours of procedure. Evaluation for malignancy was the most common indication for bronchoscopy(68% vs 59%, p = 0.3) and the most common finding (48% vs 38%, p = 0.24). The study group had statistically significant differences from the control group in the following categories: higher mean age(p < 0.001), higher ASA class(p = 0.03), lower mean midazolam dose (2mg vs 2.6 mg, p = 0.004), and fewer cancer patients who underwent lobectomy (0% vs 5%, p = 0.03). There were no statistically significant differences in the indications for bronchoscopy (p = 0.15), patients undergoing transbronchial biopsy (29% vs 25%, p = 0.7), the diagnostic yield (44% vs 33%, p = 0.17), or the number of patients diagnosed with cancer who received any form of cancer therapy (66% vs 70%, p = 0.79). CONCLUSIONS: This is the oldest cohort of patients undergoing FB studied for procedural complications and diagnostic yield. Despite the fact that the study group was older with a higher average ASA class, the results suggest that bronchoscopy is has essentially the same safety profile for the very elderly. Additionally, it suggests the information obtained from bronchoscopy is utilized in guiding therapy and age does not prevent patients from receiving therapy for malignancy. The lower rate of lobectomies in the study group may reflect poorer functional status and inability to tolerate surgical intervention, or it may be a result of higher TNM stage at time of diagnosis. CLINICAL IMPLICATIONS: These results demonstrate FB in the very elderly has a similar complication rate and diagnostic yield when compared to a younger population, and that malignancy is treated at the same frequency in the very elderly as a younger population. This suggests FB is a safe and efficacious procedure in the very elderly. DISCLOSURE: The following authors have nothing to disclose: Cameron Mclaughlin, Ellis Easterling, Andrew Skabelund No Product/Research Disclosure Information

Utility of bronchoscopy in the definitive diagnosis of patients with haematological malignancies presenting with radiological abnormalities.

Patients with haematological malignancies usually have a plethora of respiratory complications. Bronchoscopy is one of the most important procedures used to diagnose respiratory complications. Despite enormous benefit, patients should be carefully selected for bronchoscopy as the process is invasive; however, there are only few reports evaluating the contributing factors of bronchoscopy that result in the definitive diagnosis of respiratory complications in these patients. This study aimed to elucidate and identify the contributing factors of bronchoscopy for definitive diagnosis in patients with haematological malignancies. We retrospectively analysed 275 patients with haematological malignancies who later showed respiratory complications, requiring consultation with pulmonologists. We found that 62 patients underwent bronchoscopy. Our data analysis focused on this particular subset of patients to identify the factors crucial for definitive diagnosis via bronchoscopy. Bronchoscopy provided definitive diagnosis for 25 patients (diagnostic yield = 40.3%). We determined that nodular shadow was associated with high diagnostic yields by multivariate logistic regression [odds ratio (OR): 6.6 (2.1-23)]. Furthermore, in several bronchoscopic procedures, biopsy also contributed to definitive diagnosis of patients with nodular shadow [OR: 17 (1.5-180)]. Life-threatening complications were not observed due to bronchoscopy in our study. Our study demonstrated that patients with haematological malignancies who showed lung nodular shadows are more likely to be definitively diagnosed by bronchoscopy, whereas transbronchial biopsy may also be beneficial for these patients.

Ingenuity of Radical Operation for Type-C Esophageal Atresia: A Method of TEF Block Using a Fogarty Catheter and the Utility of Bronchoscopy

Ingenuity of Radical Operation for Type-C Esophageal Atresia: A Method of TEF Block Using a Fogarty Catheter and the Utility of Bronchoscopy