PURPOSE: The safety of performing interventional flexible bronchoscopy (IFB) under moderate sedation in patients with poor lung function may be questioned. We examined the effectiveness and safety of IFB in such patients.
METHODS: Data including demographics, diagnosis, indications, anaesthesia, outcomes and complications were extracted from a prospective IFB database. Inclusion criteria were a pre-procedure forced expiratory volume in 1 second (FEV1) ≤1 liter, or < 40% predicted.
RESULTS: 67 IFB meeting the inclusion criteria were performed in 55 patients (25 male, 45%). The underlying diagnosis was non-small cell lung cancer in 41 patients (75%). The mean (standard deviation) pre-procedure FEV1 was 0.83L (0.25L). 46 (69%) IFB were day-cases, 18 inpatients and following 3 procedures an increased level of care was required. No patient required admission to intensive care. Stents were inserted during 26 (39%) IFB, and an ablation procedure (cryotherapy, electrocautery or argon plasma coagulation) in 42 (63%). There was a 41.8% improvement in FEV1 post procedure, from mean FEV1 0.83L to 1.17L (p=1.76E-06, Student t-test). Complications occurred within 24 hours after 15 procedures (22%), of which 4 were stent-related, and 4 were transient hypoxia (SaO2 < 88%). Death occurred within 24 hours in one patient (1.5%), and within 30 days of IFB in 13 cases (19%), including all three patients with anaplastic thyroid carcinoma. Death was related to IFB in 5/13 cases (38%), due to pneumonia in 2 cases, massive haemoptysis in 1 and progressive respiratory failure in 2.
CONCLUSIONS: In patients with borderline lung function, IFB can often be performed under moderate sedation and is effective in improving lung function. Most patients do not require admission overnight. Complications are frequent but usually not life-threatening. Patients with anaplastic thyroid cancer have a poor prognosis irrespective of IFB outcome.
CLINICAL IMPLICATIONS: It may not be appropriate to insist upon general anaesthesia and rigid bronchoscopy for all patients with borderline lung function requiring airway intervention.
DISCLOSURE: The following authors have nothing to disclose: Mark Slade, Ute Oltmanns, Catherine Hardy, Charlotte Yip
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