Safety and complications of bronchoscopy in an adult intensive care unit

Abstract

AIM: Bronchoscopy is a common procedure performed in adult intensive care units (ICU). However, very few studies report the safety and complications of the bronchoscopy and related procedures performed on critically ill patients. The primary aim of this study was to determine the incidence of complications following ICU bronchoscopy. We also assessed the indications and findings of these procedures. METHODS: We conducted a retrospective chart review of patients admitted to an adult ICU and underwent bronchoscopy with or without bronchoalveolar lavage (BAL) and other bronchoscopic procedures. Data included patient demographics, APACHE II score, hemodynamics, comorbidities, type of ventilation and procedure performed. Complications were identified using pre-specified definitions. Data from BAL, including cellular differential and microbiology, were also collected. RESULTS: We identified 120 patient charts between November 2011 to April 2012. 69% of the patients were male and average age was 52 ± 16 years. The average APACHEII score was 18 ± 6. 90% of the patients were on invasive mechanical ventilation. The most common indication for the procedure was to evaluate for pneumonia (58%), followed by post lung transplant bronchoscopy (29%). Other indications included lung collapse or atelectasis, diffuse lung disease, upper airway obstruction and hemoptysis. The most common procedures performed were bronchoscopy with BAL (62%) and inspection (26%). Other procedures included transbronchial biopsy, argon plasma coagulation (APC) and cryotherapy, balloon and stent placement, endobronchial biopsy and EBUS. Complications occurred in 18% of the patients, with hypoxia being the most common (7.5%), hypotension (5.8%) and hemorrhage (3.3%). No deaths occurred related to the procedures. 9% patients who had BAL or inspection had complications compared to 29% who underwent other procedures, though this was not statistically significant (p = 0.07). None of the complications were significantly affected by the underlying comorbidities, FiO2, mean arterial pressure before the procedure, type of ventilation and coagulopathy. Subgroup analysis conducted on patients undergoing BAL revealed significantly higher neutrophil counts (p=0.001) and higher APACHE II score (p=0.02) among those with BAL positive for bacteria and co-infection, than those with BAL positive for fungal, viral infection or mixed flora. Hospital mortality was higher among those with BAL positive for bacteria (p= 0.012). CONCLUSION: Bronchoscopy with BAL and inspection are relatively safe procedures even in critically ill patients. Hypoxia and hypotension are the most common complications, but did not lead to any increase in mortality. However, other interventional procedures should be performed with caution in the ICU. (Table Presented).