PURPOSE: We conducted a retrospective review detailing possible risk factors for respiratory failure in patients undergoing bronchoscopy. We hope to highlight the potential financial burdens of our defined high risk patient.
METHODS: We retrospectively reviewed all complications within our bronchoscopy unit between January 2005 and March 2009. 26 patients were reported to have hypoxemic respiratory failure during bronchoscopy. Mild was defined as needing up to 6 liters of nasal cannula, moderate up to 100% non-rebreather face mask, severe requiring intubation and mechanical ventilation to maintain pulse oximetry above 90%. Our comparison group consisted of 78 patients controlling for operator experience. Wilcoxon two sample test was used to compare continuous groups. Categorical variables were assessed using Chi-square, Fischer exact, and Kruskal-Wallis tests. We evaluated the cost of care for those patients admitted to the Intensive Care Unit (ICU) after bronchoscopy compared to screening all patients within our study group using the statistically significant variables.
RESULTS: During our study period 26 patients were reported to have hypoxia with bronchoscopy. Mean age for our study group was 66.1 years, male 65.4% (n=17), body mass index (BMI) 26.1 kg/m2 (SD, 7.6). Study group mean albumin was 2.9 g/dL (SD, 0.6) compared to 3.3 g/dL (SD, 0.7, p-value=0.0019), study group hematocrit 32.4% (SD, 5.7) compared to 37.9% (SD, 5.5, p-value=0.0241), study group FEV1/FVC ratio was 65.0 (SD, 15.8) compared to 78.0 (SD, 18.8, p-value=0.0133), study group FEV1 59.5% compared to 71.2% (p-value=0.0606). Study group mean pCO2 was 53.7 mmHg (SD, 18.6). 4 patients required ICU admission after bronchoscopy, there total cost of care at our institution was 80,353 dollars. The average length of ICU stay was 6 days. Total cost of screening all 26 study patients with statistically significant variables at our institution is 3,588 dollars.
CONCLUSIONS: Predictors of hypoxia seem to correlate best with baseline hypercapnea, obstructive physiology on spirometry, low hematocrit and albumin levels.
CLINICAL IMPLICATIONS: Prescreening of selected patients may be helpful in reducing respiratory failure and total cost of medical care.
DISCLOSURE: The following authors have nothing to disclose: Fares Mouchantaf, Eugene Shostak, Carla Lamb
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