Pulmonary Procedures |

The Safety and Role of Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) in the Medical Intensive Care Unit (MICU) FREE TO VIEW

Astha Chichra, MD; Viera Lakticova, MD; Seth Koenig, MD
Author and Funding Information

North Shore - Long Island Jewish Health System, Fresh Meadows, NY

Chest. 2015;148(4_MeetingAbstracts):787A. doi:10.1378/chest.2263317
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SESSION TITLE: Bronchoscopy Poster Discussions

SESSION TYPE: Original Investigation Poster Discussion

PRESENTED ON: Wednesday, October 28, 2015 at 11:00 AM - 12:15 PM

PURPOSE: EBUS-TBNA has revolutionized the diagnosis of mediastinal and hilar lymphadenopathy as well as the staging of many common cancers, particularly bronchogenic tumors. However, limited data exist regarding the utility, accuracy, and safety of performing EBUS-TBNA in the MICU on patients who have developed respiratory failure necessitating endotracheal intubation. We wanted to determine the safety and utility of diagnosis in patients who underwent EBUS-TBNA while receiving mechanical ventilation for respiratory failure in the MICU.

METHODS: Retrospective chart review of all EBUS-TBNA performed in the MICU on patients with hilar and mediastinal lymphadenopathy where diagnosis may help with treatment and/or prognosis. Data was extracted for reason for MICU admission/respiratory failure, oxygen requirements prior to procedure, complications during the procedure, accuracy of diagnosis, and outcomes of patients.

RESULTS: Eight consecutive cases of EBUS-TBNA were analyzed. Reasons for ICU admission included hypoxemic respiratory failure (7/8) and hemoptysis (1/8). Level 4, 7 and 10 lymph node stations were biopsied. Average fraction of inspired oxygen on the ventilator was 0.4. A diagnosis was made in 6/8 cases, 1/8 was non diagnostic and 1/8 revealed reactive lymphadenopathy. Malignancy was diagnosed in 4/8 cases. Of these, 2/4 were adenocarcinoma of lung, 1/4 was squamous cell carcinoma and 1/4 was metastatic prostate cancer. Additional diagnosis included included cryptococcosis, and fibrosing mediastinitis. Diagnosis led to change in management in 5/8 cases. No peri-procedural complications were observed. The diagnosis obtained led to palliative care measures being pursued in 4/8 cases.

CONCLUSIONS: EBUS-TBNA can be performed safely on intubated patients in the MICU and may provide valuable accurate information regarding the etiology of the respiratory failure, therapeutic decision making, and prognostication. This may allow for changes in management of the patient.

CLINICAL IMPLICATIONS: EBUS-TBNA provides a safe diagnostic tool in the MICU and needs to be considered as a valuable tool even in patients with respiratory failure.

DISCLOSURE: The following authors have nothing to disclose: Astha Chichra, Viera Lakticova, Seth Koenig

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