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Safety of Flexible Bronchoscopy in Critically ill Adult Patients Supported With Extracorporeal Membrane Oxygenation FREE TO VIEW

Timothy Peters, MD; Keith Wille, MD; Tejaswini Kulkarni, MD; Enrique Diaz-Guzman, MD; Nirmal Sharma, MD
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UAB, Birmingham, AL

Chest. 2015;148(4_MeetingAbstracts):290A. doi:10.1378/chest.2280778
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SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Previous studies have demonstrated the safety of flexible bronchoscopy (FB) in ARDS. With the increasing use of extracorporeal membrane oxygenation (ECMO) to support adult patients with ARDS, FB is used for diagnostic and therapeutic purposes in critically ill patients supported with ECMO. The safety of FB in adult ECMO patients has not been previously described.

METHODS: A retrospective chart review of all patients who underwent FB while on ECMO support at the University of Alabama at Birmingham Hospital from January to November 2014 was conducted. Physiologic variables, and pre and post FB ECMO and ventilator settings were recorded. Variables were expressed as means (standard deviations), proportions and compared using paired t-test.

RESULTS: 50 adult patients underwent FB on ECMO (73.6% Veno-Venous, 20.8% Veno-Arterial and 5.6% mixed configuration) with a total of 163 bronchoscopies. Mean age of the patients was 44 (12.7) years with each patient undergoing an average of 3 bronchoscopies. Indications for bronchoscopy included diagnostic evaluation of infection in patients with abnormal imaging (60%), clearance of thick secretions (32%) and bloody airway secretions (2%). In 70% of the patients thick mucoid or mucopurulent secretions were noted. Bronchoalveolar lavage was performed in 36% of the bronchoscopies. Mean PaO2 (91.6 (51.4) mmHg pre vs 92.4(58.4) mmHg post, p=0.8) and PF ratio (152.8 (112.7) pre vs 163.5 (141.9) post, p=0.3)) were not significantly different before and an hour after bronchoscopy. No significant differences in ECMO settings such as mean flow rate (3.93 (0.65) pre vs 3.91 (0.69) post, p=0.8) and mean sweep gas (4.03 (2.08) pre vs 4.0 (2.16) post, p= 0.9) were noted before and after FB. Similarly, no significant changes were seen in the ventilator setting and hemodynamic parameters such as heart rate and blood pressure. Complications were mild and transient: blood tinged secretions after FB in 26% cases which resolved spontaneously, intra-procedural hypoxia in 2.4% cases that resolved immediately on withdrawal of the bronchoscope, intra-procedural hypotension and dysrhythmia that occurred in less than 1% cases with spontaneous resolution or after intravenous fluid bolus therapy. No incidence of ECMO cannula dislodgement, inadvertent extubation, fevers or pneumothorax was noted.

CONCLUSIONS: FB is a well-tolerated and safe procedure in adult patients supported with ECMO.

CLINICAL IMPLICATIONS: FB is safe and has both a diagnostic and therapeutic benefit in management of adult ECMO patients.

DISCLOSURE: The following authors have nothing to disclose: Timothy Peters, Keith Wille, Tejaswini Kulkarni, Enrique Diaz-Guzman, Nirmal Sharma

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