Tan Tock Seng Hospital, Singapore, Singapore
Copyright 2016, American College of Chest Physicians. All Rights Reserved.
SESSION TITLE: Late-Breaking Abstracts
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 25, 2016 at 08:45 AM - 10:00 AM
PURPOSE: Bronchoscopy is frequently performed in the intensive care unit (ICU) for airway management and respiratory sampling.The single-use disposable bronchoscope (DB) is available at our tertiary referral centre.We compared the performance of the DB versus the reusable conventional bronchoscope (CB), in our ICU.
METHODS: With Institutional Review Board approval, retrospective evaluation of medical records of the 93 patients who underwent bronchoscopy in the ICU in the year 2015 was done. Data about indication for bronchoscopy, outcome, diagnostic yield, identification of need-to-performance of procedure time, number of personnel required, and financial resource utilisation were gathered. These parameters were used to compare the DB with the CB.
RESULTS: Of 107 ICU bronchoscopies,83(77.5%) were performed with the DB on 71 patients, and 24(22.4%) with the CB on 22 patients.Indications for DB in order of frequency were percutaneous tracheostomy(PCT):37/83(44.6%), respiratory sample-collection for microbiological evaluation:20/83(24.1%); airway inspection:8/83(9.6%); bronchial toilet: 8/83(9.6%); haemoptysis:5/83(6%) and endotracheal intubation:3/83(3.6%). For the same indications the CB was used in zero,10/22(45.5%),4/22(18.2%);2/22(9%);6/22(27.3%) and 1/22(4.5%) cases respectively.There was no conversion from DB to conventional bronchoscopy (CB) in any case.Microbiological yield of DB was 70% (14/20 positive cultures), same as for CB (7/10; 70%); p=1.0. Procedure costs were similar (SGD 450 for DB vs. SGD 472 for CB).The median interval between identification of indication-to-start of procedure time was shorter with DB (10 minutes), than with CB (66 minutes); p=0.01.Use of CB needed 5 personnel, and of DB needed 3 personnel.
CONCLUSIONS: In our study, the DB was equivalent to CB in performance, and diagnostic yield. DB was preferred for PCT. The DB (stored in ICU) could be made available faster than the CB, which had to be wheeled-in from the endoscopy suite, and needed sterilisation between procedures.The DB thus had a resource-sparing effect with respect to time, personnel, and cost of maintenance as compared to the CB.
CLINICAL IMPLICATIONS: The DB with almost no “wait-time” can be made available faster in the ICU, meeting the unplanned, time sensitive nature of indications of bronchoscopy in the ICU. Its performance for routine indications in ICU is satisfactory. Being disposable not only makes the DB suited for infection control, but its resource-sparing potential may help lower cost of bronchoscopy in the ICU.
DISCLOSURE: The following authors have nothing to disclose: Rucha Dagaonkar, Dominic Marshall, Yeow Chan, Anura Peters, Kin Tan Siew, Dessmon Tai, Soon Keng Goh, Albert Lim, Benjamin Ho, Sennen Jin Wen Lew, John Abisheganaden, Akash Verma
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