SESSION TITLE: Hot Topics in COPD
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 27, 2015 at 11:00 AM - 12:15 PM
PURPOSE: FB is increasingly used for diagnostic and therapeutic purposes in patients with COPD. We aimed to compare the incidence of complications between patients with and without COPD undergoing FB. In addition, the development of subclinical respiratory compromise and patient-reported outcomes (PRO) were evaluated.
METHODS: Prospective, controlled, case-control study including 1400 consecutive patients undergoing diagnostic or therapeutic bronchoscopy at a tertiary care center in Switzerland. Patients were classified as COPD or non-COPD according to lung function performed within 72 hours prior to bronchoscopy. Respiratory compromise was assessed by transcutaneous capnography.
RESULTS: Main indications for bronchoscopy were suspicion of infection (35.9%) and bronchus carcinoma (22.0%). Most frequent procedures included BAL (67.5%), endobronchial Bx (15.4%) and TBB (14.7%). Patients with COPD (n=440) were significantly older (66.5±10.2 yo), had poorer lung function (Post-BD FEV1%pred 56.9%±24.4; DLCO 57.4%±22.7), higher ASA-scores, more comorbidities and co-medication. At baseline, pO2 was lower and pCO2 higher than non-COPD patients. Patients with COPD required lower propofol dosis pro kg/min (p=0.002) and a longer examination (p<0.0001). Overall, the incidence of complications (Chin support, artificial airway, intubation, bleeding, pneumothorax, need for abortion or ICU, death) were similar in both groups. Individually, placement of an artificial airway more commonly required in COPD patients (11.7% vs. 7.4%, p=0.021). This difference was no longer significant after adjustment for the duration of bronchoscopy. Patients with COPD had a longer time with SO2<88% (1.16 min [0.07-5.105] vs. 0.16 min [0-1.44], p=0.001) and a lower lowest SO2 (85% [83-90] vs. 87% [80-88], p=0.004) during examination. Patients with and without COPD presented different hemodynamic responses to sedation but similar increased in paCO2 as assessed by capnography. There were no differences in PROs. In total, 98.5% of patients with COPD would undergo another bronchoscopy if indicated.
CONCLUSIONS: Flexible bronchoscopy in patients with COPD is safe.
CLINICAL IMPLICATIONS: Flexible bronchoscopy with propofol can be safely performed in patients with and without COPD. Importantly, patients with COPD will require a lower propofol dosis as compared to patients without COPD. Patients with COPD present lower paO2 and higher paCO2 baseline levels and a different hemodynamic response to propofol as compared to those without COPD.
DISCLOSURE: The following authors have nothing to disclose: Peter Grendelmeier, Michael Tamm, Kathleen Jahn, Eric Pflimlin, Daiana Stolz
No Product/Research Disclosure Information