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Correspondence |

The Emperor Wears No Clothes FREE TO VIEW

Daniel R. Ouellette, MD, FCCP
Author and Funding Information

Henry Ford Hospital Detroit, MI

Correspondence to: Daniel R. Ouellette, MD, FCCP, Henry Ford Hospital, Pulmonary Disease Service, 2799 West Grand Blvd, Detroit, MI 48202; e-mail: douelle1@hfhs.org


The author has reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(5):1402. doi:10.1378/chest.08-2705
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To the Editor:

I would like to congratulate Ernst and colleagues1 for their report in CHEST (September 2008) concerning the development of a database for therapeutic bronchoscopic interventions. This database will include prospective information gathered from multiple institutions and may ultimately allow physicians to carefully assess patient outcomes from such procedures. The current article represents a robust first step, reporting results from 554 procedures performed at four different hospitals.

The enthusiasm generated by this project must be mitigated by the reported results, however. The morbidity and mortality associated with these procedures were very high. The authors reported a complication rate of 19.8% and a 30-day mortality rate of 7.8%. Even in patients with “benign” disease, 13 of 302 patients died. The data in this study were uncontrolled so that the reader cannot compare the outcomes associated with performing these procedures to outcomes expected from a more conservative approach. The correlation of outcomes with scores from illness severity indexes or compelling statements that procedures were performed on an “urgent” basis should not dissuade the medical community from demanding controlled outcome data for high-risk procedures.

A few decades ago, the use of pulmonary artery catheters was widespread in ICUs. Today, such catheters are infrequently used, mainly because of controlled, prospective data that failed to show improvements in patient outcomes. Considerable time elapsed for this transition in practice to take place. Let us hope that we have learned from this lesson, and that patient outcomes from therapeutic bronchoscopic procedures are subjected to close scrutiny. In my opinion, such procedures should not be performed outside of centers of excellence, and such centers should enroll their patients in prospective controlled clinical trials.

Ernst A, Simoff M, Ost D, et al. Prospective risk-adjusted morbidity and mortality outcome analysis after therapeutic bronchoscopic procedures. Chest. 2008;134:514-519. [PubMed] [CrossRef]
 

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Ernst A, Simoff M, Ost D, et al. Prospective risk-adjusted morbidity and mortality outcome analysis after therapeutic bronchoscopic procedures. Chest. 2008;134:514-519. [PubMed] [CrossRef]
 
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