Egyptian Journal of Chest Disease and Tuberculosis (Jan 2020)

Utility of fiberoptic bronchoscopy in the critical care unit: how far-reaching are the complications and outcomes?

  • Amr Darwish,
  • Rana El-Helbawy,
  • Ahmed El-Esdoudy,
  • Marwa D Khedr

DOI
https://doi.org/10.4103/ejcdt.ejcdt_169_19
Journal volume & issue
Vol. 69, no. 2
pp. 371 – 379

Abstract

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Background Fiberoptic bronchoscopy (FOB) is standard as a pre-eminent technique for diagnostic, palliative, and curative purposes in variable pulmonary insults. Objectives The objectives of this study were to identify the causation, technical aspects, pathophysiological impacts, and complications of FOB in critically ill patients, to discover the correlation between FOB outcomes and independent risk factors, and ultimately to anticipate predictors of mortality in critically ill patients who underwent FOB. Patients and methods This prospective cohort study was carried out in ICUs on 52 critically ill patients who were subjected to FOB for diagnostic or therapeutic purposes. They were grouped into the mechanical ventilation (MV) (28/52) and non-MV (24/52) groups. FOB outcomes and complications were encountered. Results Diagnostic indication of FOB was seen in 40/52 (77%) cases, while the therapeutic purposes of FOB were seen in 12/52 (23%) cases. FOB had a particular indication in the management of 12/52 cases (13.6%) for both pneumonic and inhalation lung injury cases, 10/52 (19.2%) cases for underlining focal lung lesion, 8/52 (15.4%) cases for hemoptysis, and 5/52 (9.6%) cases for either acute respiratory distress syndrome or atelectasis condition. There was a highly considerable variation between the MV and non-MV groups. Hypoxemia, bleeding, arrhythmia, bronchospasm, and laryngospasm were the most prevalent side effects of FOB, with unremarkable differences between both groups. FOB outcomes were as follows: 31/52 (59.6%) cases improved, 11/52 (21.2%) died, and 10/52 (19.2%) were referred to a tertiary health unit. There were significant negative correlations between outcomes and reasons for admission, time of onset of FOB, and radiological pattern. Older age, respiratory insult, immune-compromised state, nonventilatory assessment, and less frequency of FOB performance were predictors of mortality among critically ill patients who underwent FOB. Conclusion Flexible bronchoscopy is a safe and effective procedure for the diagnosis and treatment of pulmonary pathology in critically ill patients.

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