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Leiten, Elise Orvedal; Martinsen, Einar Marius Hjellestad; Bakke, Per Sigvald; Eagan, Tomas Mikal Lind; Grønseth, Rune (2016)
Publisher: Co-Action Publishing
Journal: European Clinical Respiratory Journal
Languages: English
Types: Article
Subjects: patient satisfaction, Diagnostic bronchoscopy; Safety; Adverse events; Patient satisfaction; Informed consent., Review Article, informed consent, Diseases of the respiratory system, diagnostic bronchoscopy, safety, RC705-779, adverse events
Objective: To identify bronchoscopy-related complications and discomfort, meaningful complication rates, and predictors.Method: We conducted a systematic literature search in PubMed on 8 February 2016, using a search strategy including the PICO model, on complications and discomfort related to bronchoscopy and related sampling techniques.Results: The search yielded 1,707 hits, of which 45 publications were eligible for full review. Rates of mortality and severe complications were low. Other complications, for instance, hypoxaemia, bleeding, pneumothorax, and fever, were usually not related to patient characteristics or aspects of the procedure, and complication rates showed considerable ranges. Measures of patient discomfort differed considerably, and results were difficult to compare between different study populations.Conclusion: More research on safety aspects of bronchoscopy is needed to conclude on complication rates and patient- and procedure-related predictors of complications and discomfort.Keywords: diagnostic bronchoscopy; safety; adverse events; patient satisfaction; informed consent(Published: 11 November 2016)Citation: European Clinical Respiratory Journal 2016, 3: 33324 - http://dx.doi.org/10.3402/ecrj.v3.33324
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 1. Introduction to bronchoscopy. Cambridge University Press; 2009.
    • 2. Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, et al. British thoracic society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax. 2013; 68(Suppl 1): i1 44.
    • 3. Wikipedia_contributors. PICO process: wikipedia, the free encyclopedia. 2016 [updated 9 January 2016 13:56 UTC]. Available from: https://en.wikipedia.org/w/index.php?title PICO_process& oldid 698981503 [cited 5 June 2016].
    • 4. Kanemoto K, Satoh H, Ishikawa H, Ishikawa S, Ohtsuka M, Sekizawa K. Prospective study of fever and pneumonia after flexible fiberoptic bronchoscopy in older people. J Am Geriatr Soc. 2006; 54: 827 30.
    • 5. Elston WJ, Whittaker AJ, Khan LN, Flood-Page P, Ramsay C, Jeffery PK, et al. Safety of research bronchoscopy, biopsy and bronchoalveolar lavage in asthma. Eur Respir J. 2004; 24: 375 7.
    • 6. Hattotuwa K, Gamble EA, O'Shaughnessy T, Jeffery PK, Barnes NC. Safety of bronchoscopy, biopsy, and BAL in research patients with COPD. Chest. 2002; 122: 1909 12.
    • 7. de Fenoyl O, Capron F, Lebeau B, Rochemaure J. Transbronchial biopsy without fluoroscopy: a five year experience in outpatients. Thorax. 1989; 44: 956 9.
    • 8. Alzeer AH, Al-Otair HA, Al-Hajjaj MS. Yield and complications of flexible fiberoptic bronchoscopy in a teaching hospital. Saudi Med J. 2008; 29: 55 9.
    • 9. Brimacombe J, Tucker P, Simons S. The laryngeal mask airway for awake diagnostic bronchoscopy. A retrospective study of 200 consecutive patients. Eur J Anaesthesiol. 1995; 12: 357 61.
    • 10. Pue CA, Pacht ER. Complications of fiberoptic bronchoscopy at a university hospital. Chest. 1995; 107: 430 2.
    • 11. Milam MG, Evins AE, Sahn SA. Immediate chest roentgenography following fiberoptic bronchoscopy. Chest. 1989; 96: 477 9.
    • 12. Ahmad M, Livingston DR, Golish JA, Mehta AC, Wiedemann HP. The safety of outpatient transbronchial biopsy. Chest. 1986; 90: 403 5.
    • 13. Hummel M, Rudert S, Hof H, Hehlmann R, Buchheidt D. Diagnostic yield of bronchoscopy with bronchoalveolar lavage in febrile patients with hematologic malignancies and pulmonary infiltrates. Ann Hematol. 2008; 87: 291 7.
    • 14. Cazzadori A, Di Perri G, Todeschini G, Luzzati R, Boschiero L, Perona G, et al. Transbronchial biopsy in the diagnosis of pulmonary infiltrates in immunocompromised patients. Chest. 1995; 107: 101 6.
    • 15. Fruchter O, Fridel L, El Raouf BA, Abdel-Rahman N, Rosengarten D, Kramer MR. Histological diagnosis of interstitial lung diseases by cryo-transbronchial biopsy. Respirology. 2014; 19(5): 683 8.
    • 16. Kumar R, Gupta N. Role of bronchoscopy in evaluation of cases with sputum smear negative pulmonary tuberculosis, interstitial lung disease and lung malignancy: a retrospective study of 712 cases. Indian J Tuberc. 2015; 62: 36 42.
    • 17. Thornton JA. Recent advances in local analgesia. Clinical experience with prilocaine. Proc R Soc Med. 1965; 58: 418 20.
    • 18. Maranetra N, Pushpakom R, Bovornkitti S. Oxygen desaturation during fibreoptic bronchoscopy. J Med Assoc Thai. 1990; 73: 258 63.
    • 19. Van Vyve T, Chanez P, Bousquet J, Lacoste JY, Michel FB, Godard P. Safety of bronchoalveolar lavage and bronchial biopsies in patients with asthma of variable severity. Am Rev Respir Dis. 1992; 146: 116 21.
    • 20. Niwa H, Tanahashi M, Kondo T, Ohsaki Y, Okada Y, Sato S, et al. Bronchoscopy in Japan: a survey by the Japan Society for Respiratory Endoscopy in 2006. Respirology. 2009; 14: 282 9.
    • 21. Simpson FG, Arnold AG, Purvis A, Belfield PW, Muers MF, Cooke NJ. Postal survey of bronchoscopic practice by physicians in the United Kingdom. Thorax. 1986; 41: 311 7.
    • 22. Suratt PM, Smiddy JF, Gruber B. Deaths and complications associated with fiberoptic bronchoscopy. Chest. 1976; 69: 747 51.
    • 23. Herman PG, Hessel SJ. The diagnostic accuracy and complications of closed lung biopsies. Radiology. 1977; 125: 11 4.
    • 24. Facciolongo N, Patelli M, Gasparini S, Lazzari Agli L, Salio M, Simonassi C, et al. Incidence of complications in bronchoscopy. Multicentre prospective study of 20,986 bronchoscopies. Monaldi Arch Chest Dis. 2009; 71: 8 14.
    • 25. McWilliams TJ, Williams TJ, Whitford HM, Snell GI. Surveillance bronchoscopy in lung transplant recipients: risk versus benefit. J Heart Lung Transplant. 2008; 27: 1203 9.
    • 26. Izbicki G, Shitrit D, Yarmolovsky A, Bendayan D, Miller G, Fink G, et al. Is routine chest radiography after transbronchial biopsy necessary?: a prospective study of 350 cases. Chest. 2006; 129: 1561 4.
    • 27. Chhajed PN, Aboyoun C, Malouf MA, Hopkins PM, Plit ML, Glanville AR. Risk factors and management of bleeding associated with transbronchial lung biopsy in lung transplant recipients. J Heart Lung Transplant. 2003; 22: 195 7.
    • 28. Mtunthama N, Malamba R, French N, Molyneux ME, Zijlstra EE, Gordon SB. Malawians permit research bronchoscopy due to perceived need for healthcare. J Med Ethics. 2008; 34: 303 7.
    • 29. Fang WF, Chen YC, Chung YH, Woon WT, Tseng CC, Chang HW, et al. Predictors of oxygen desaturation in patients undergoing diagnostic bronchoscopy. Chang Gung Med J. 2006; 29: 306 12.
    • 30. Mitsumune T, Senoh E, Adachi M. Prediction of patient discomfort during fibreoptic bronchoscopy. Respirology. 2005; 10: 92 6.
    • 31. White P, Bonacum JT, Miller CB. Utility of fiberoptic bronchoscopy in bone marrow transplant patients. Bone Marrow Transplant. 1997; 20: 681 7.
    • 32. Dhillon DP, Haslam PL, Townsend PJ, Primett Z, Collins JV, Turner-Warwick M. Bronchoalveolar lavage in patients with interstitial lung diseases: side effects and factors affecting fluid recovery. Eur J Respir Dis. 1986; 68: 342 50.
    • 33. Straja AM, Munro DD, Gilbert RG. Bronchoscopy with the aid of diazepam. Can Anaesth Soc J. 1969; 16: 241 8.
    • 34. Shrader DL, Lakshminarayan S. The effect of fiberoptic bronchoscopy on cardiac rhythm. Chest. 1978; 73: 821 4.
    • 35. Hernandez Blasco L, Sanchez Hernandez IM, Villena Garrido V, de Miguel Poch E, Nunez Delgado M, Alfaro Abreu J. Safety of the transbronchial biopsy in outpatients. Chest. 1991; 99: 562 5.
    • 36. Afsar S, Choudhri AN, Talib A, Farooqi T, Pasha MJ. Oxygen desaturation during fiberoptic bronchoscopy. J Pak Med Assoc. 1992; 42: 263 5.
    • 37. Graham DR, Hay JG, Clague J, Nisar M, Earis JE. Comparison of three different methods used to achieve local anesthesia for fiberoptic bronchoscopy. Chest. 1992; 102: 704 7.
    • 38. Stather DR, MacEachern P, Chee A, Dumoulin E, Tremblay A. Trainee impact on procedural complications: an analysis of 967 consecutive flexible bronchoscopy procedures in an interventional pulmonology practice. Respiration. 2013; 85: 422 8.
    • 39. Joos L, Patuto N, Chhajed PN, Tamm M. Diagnostic yield of flexible bronchoscopy in current clinical practice. Swiss Med Wkly. 2006; 136: 155 9.
    • 40. Frazier WD, Pope TL Jr, Findley LJ. Pneumothorax following transbronchial biopsy. Low diagnostic yield with routine chest roentgenograms. Chest. 1990; 97: 539 40.
    • 41. Anders GT, Johnson JE, Bush BA, Matthews JI. Transbronchial biopsy without fluoroscopy. A seven-year perspective. Chest. 1988; 94: 557 60.
    • 42. Huang L, Hecht FM, Stansell JD, Montanti R, Hadley WK, Hopewell PC. Suspected Pneumocystis carinii pneumonia with a negative induced sputum examination. Is early bronchoscopy useful? Am J Respir Crit Care Med. 1995; 151: 1866 71.
    • 43. Mainland PA, Kong AS, Chung DC, Chan CH, Lai CK. Absorption of lidocaine during aspiration anesthesia of the airway. J Clin Anesth. 2001; 13: 440 6.
    • 44. Zainudin BM, Rafia MH, Sufarlan AW. Topical nasal anaesthesia for fibreoptic bronchoscopy: lignocaine spray or gel? Singapore Med J. 1993; 34: 148 9.
    • 45. Greig JH, Cooper SM, Kasimbazi HJ, Monie RD, Fennerty AG, Watson B. Sedation for fibre optic bronchoscopy. Respir Med. 1995; 89: 53 6.
    • 46. Teale C, Gomes PJ, Muers MF, Pearson SB. Local anaesthesia for fibreoptic bronchoscopy: comparison between intratracheal cocaine and lignocaine. Respir Med. 1990; 84: 407 8.
    • 47. Keane D, McNicholas WT. Comparison of nebulized and sprayed topical anaesthesia for fibreoptic bronchoscopy. Eur Respir J. 1992; 5: 1123 5.
    • 48. Hamad S, Al-Alawi M, Devaney N, Subramaniam A, Lane S. Evaluation of the efficacy of transcricoid lignocaine as adjunctive local anaesthesia for fiberoptic bronchoscopy. Ir J Med Sci. 2015; 184: 273 6.
    • 49. Griff S, Schonfeld N, Ammenwerth W, Blum TG, Grah C, Bauer TT, et al. Diagnostic yield of transbronchial cryobiopsy in non-neoplastic lung disease: a retrospective case series. BMC Pulm Med. 2014; 14: 171.
    • 50. Gilbert CR, Lerner A, Baram M, Awsare BK. Utility of flexible bronchoscopy in the evaluation of pulmonary infiltrates in the hematopoietic stem cell transplant population a single center fourteen year experience. Arch Bronconeumol. 2013; 49: 189 95.
    • 51. Middleton RM, Shah A, Kirkpatrick MB. Topical nasal anesthesia for flexible bronchoscopy. A comparison of four methods in normal subjects and in patients undergoing transnasal bronchoscopy. Chest. 1991; 99: 1093 6.
    • 52. Charalampidou S, Harris E, Chummun K, Hawksworth R, Cullen JP, Lane SJ. Evaluation of the efficacy of nebulised lignocaine as adjunctive local anaesthesia for fibreoptic bronchoscopy: a randomised, placebo-controlled study. Ir Med J. 2006; 99: 8 10.
    • 53. Dunagan DP, Baker AM, Hurd DD, Haponik EF. Bronchoscopic evaluation of pulmonary infiltrates following bone marrow transplantation. Chest. 1997; 111: 135 41.
    • 54. Shannon VR, Andersson BS, Lei X, Champlin RE, Kontoyiannis DP. Utility of early versus late fiberoptic bronchoscopy in the evaluation of new pulmonary infiltrates following hematopoietic stem cell transplantation. Bone Marrow Transplant. 2010; 45: 647 55.
    • 55. D'Ippolito R, Foresi A, Castagnetti C, Gesualdi S, Castagnaro A, Marangio E, et al. Indications for flexible fiberoptic bronchoscopy and its safety in the very elderly. Monaldi Arch Chest Dis. 2007; 67: 23 9.
    • 56. Diaz-Guzman E, Vadi S, Minai OA, Gildea TR, Mehta AC. Safety of diagnostic bronchoscopy in patients with pulmonary hypertension. Respiration. 2009; 77: 292 7.
    • 57. Dang D, Robinson PC, Winnicki S, Jersmann HP. The safety of flexible fibre-optic bronchoscopy and proceduralistadministered sedation: a tertiary referral centre experience. Intern Med J. 2012; 42: 300 5.
    • 58. Jain P, Sandur S, Meli Y, Arroliga AC, Stoller JK, Mehta AC. Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates. Chest. 2004; 125: 712 22.
    • 59. Grendelmeier P, Kurer G, Pflimlin E, Tamm M, Stolz D. Feasibility and safety of propofol sedation in flexible bronchoscopy. Swiss Med Wkly. 2011; 141: w13248.
    • 60. Schlatter L, Pflimlin E, Fehrke B, Meyer A, Tamm M, Stolz D. Propofol versus propofol plus hydrocodone for flexible bronchoscopy: a randomised study. Eur Respir J. 2011; 38: 529 37.
    • 61. Grendelmeier P, Tamm M, Pflimlin E, Stolz D. Propofol sedation for flexible bronchoscopy: a randomised, noninferiority trial. Eur Respir J. 2014; 43: 591 601.
    • 62. Carr IM, Koegelenberg CF, von Groote-Bidlingmaier F, Mowlana A, Silos K, Haverman T, et al. Blood loss during flexible bronchoscopy: a prospective observational study. Respiration. 2012; 84: 312 8.
    • 63. Ni YL, Lo YL, Lin TY, Fang YF, Kuo HP. Conscious sedation reduces patient discomfort and improves satisfaction in flexible bronchoscopy. Chang Gung Med J. 2010; 33: 443 52.
    • 64. Herth FJ, Becker HD, Ernst A. Aspirin does not increase bleeding complications after transbronchial biopsy. Chest. 2002; 122: 1461 4.
    • 65. von Bartheld MB, Dekkers OM, Szlubowski A, Eberhardt R, Herth FJ, in 't Veen JC, et al. Endosonography vs conventional bronchoscopy for the diagnosis of sarcoidosis: the GRANULOMA randomized clinical trial. JAMA. 2013; 309: 2457 64.
    • 66. Bilaceroglu S, Gunel O, Cagirici U, Perim K. Comparison of endobronchial needle aspiration with forceps and brush biopsies in the diagnosis of endobronchial lung cancer. Monaldi Arch Chest Dis. 1997; 52: 13 7.
    • 67. Diette GB, Wiener CM, White P Jr. The higher risk of bleeding in lung transplant recipients from bronchoscopy is independent of traditional bleeding risks: results of a prospective cohort study. Chest. 1999; 115: 397 402.
    • 68. Hetzel J, Eberhardt R, Herth FJ, Petermann C, Reichle G, Freitag L, et al. Cryobiopsy increases the diagnostic yield of endobronchial biopsy: a multicentre trial. Eur Respir J. 2012; 39: 685 90.
    • 69. Khan A, Aggarwal AN, Agarwal R, Bal A, Gupta D. A randomized controlled trial of electrocoagulation-enabled biopsy versus conventional biopsy in the diagnosis of endobronchial lesions. Respiration. 2011; 81: 129 33.
    • 70. Williams T, Brooks T, Ward C. The role of atropine premedication in fiberoptic bronchoscopy using intravenous midazolam sedation. Chest. 1998; 113: 1394 8.
    • 71. Choi CM, Yoon HI, Lee SM, Yoo CG, Kim YW, Han SK, et al. Oral insertion of a flexible bronchoscope is associated with less discomfort than nasal insertion for Korean patients. Int J Tuberc Lung Dis. 2005; 9: 344 8.
    • 72. Hirose T, Okuda K, Ishida H, Sugiyama T, Kusumoto S, Nakashima M, et al. Patient satisfaction with sedation for flexible bronchoscopy. Respirology. 2008; 13: 722 7.
    • 73. Tukey MH, Wiener RS. Population-based estimates of transbronchial lung biopsy utilization and complications. Respir Med. 2012; 106: 1559 65.
    • 74. Kaur H, Dhooria S, Aggarwal AN, Gupta D, Behera D, Agarwal R. A randomized trial of 1% vs 2% lignocaine by the spray-as-you-go technique for topical anesthesia during flexible bronchoscopy. Chest. 2015; 148: 739 45.
    • 75. Tapanainen L, Lindqvist A, Halme M, Laitinen LA. Investigative bronchoscopy and endobronchial biopsy is well tolerated in hyperreactive asthma patients. Respir Med. 2002; 96: 466 8.
    • 76. Lo YL, Lin TY, Fang YF, Wang TY, Chen HC, Chou CL, et al. Feasibility of bispectral index-guided propofol infusion for flexible bronchoscopy sedation: a randomized controlled trial. PLoS One. 2011; 6: e27769.
    • 77. Ogawa T, Imaizumi K, Hashimoto I, Shindo Y, Imai N, Uozu S, et al. Prospective analysis of efficacy and safety of an individualized-midazolam-dosing protocol for sedation during prolonged bronchoscopy. Respir Investig. 2014; 52: 153 9.
    • 78. Fruchter O, Tirosh M, Carmi U, Rosengarten D, Kramer MR. Prospective randomized trial of bispectral index monitoring of sedation depth during flexible bronchoscopy. Respiration. 2014; 87: 388 93.
    • 79. Ryu JH, Lee SW, Lee JH, Lee EH, Do SH, Kim CS. Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy. Br J Anaesth. 2012; 108: 503 11.
    • 80. Rosell A, Xaubet A, Agusti C, Castella J, Puzo C, Curull V, et al. A new BAL fluid instillation and aspiration technique: a multicenter randomized study. Respir Med. 2006; 100: 529 35.
    • 81. Gibson PG, Breit SN, Bryant DH. Hypoxia during bronchoalveolar lavage. Aust N Z J Med. 1990; 20: 39 43.
    • 82. Stolz D, Chhajed PN, Leuppi J, Pflimlin E, Tamm M. Nebulized lidocaine for flexible bronchoscopy: a randomized, doubleblind, placebo-controlled trial. Chest. 2005; 128: 1756 60.
    • 83. Silvestri GA, Vincent BD, Wahidi MM, Robinette E, Hansbrough JR, Downie GH. A phase 3, randomized, doubleblind study to assess the efficacy and safety of fospropofol disodium injection for moderate sedation in patients undergoing flexible bronchoscopy. Chest. 2009; 135: 41 7.
    • 84. Meduri GU, Stover DE, Greeno RA, Nash T, Zaman MB. Bilateral bronchoalveolar lavage in the diagnosis of opportunistic pulmonary infections. Chest. 1991; 100: 1272 6.
    • 85. Krause A, Hohberg B, Heine F, John M, Burmester GR, Witt C. Cytokines derived from alveolar macrophages induce fever after bronchoscopy and bronchoalveolar lavage. Am J Respir Crit Care Med. 1997; 155: 1793 7.
    • 86. Pereira W, Kovnat DM, Khan MA, Iacovino JR, Spivack ML, Snider GL. Fever and pneumonia after flexible fiberoptic bronchoscopy. Am Rev Respir Dis. 1975; 112: 59 64.
    • 87. Gonza´lez Aguirre JE, Chavarria Martinez U, Rodriguez Mier D, Acosta Moreno M, Mercado Longoria R. Bronchoscope insertion route and patient comfort during flexible bronchoscopy. Int J Tuberc Lung Dis. 2015; 19: 356 61.
    • 88. Yigla M, Oren I, Bentur L, Solomonov A, Elias N, Altshuler R, et al. Incidence of bacteraemia following fibreoptic bronchoscopy. Eur Respir J. 1999; 14: 789 91.
    • 89. Webb AR, Fernando SS, Dalton HR, Arrowsmith JE, Woodhead MA, Cummin AR. Local anaesthesia for fibreoptic bronchoscopy: transcricoid injection or the 'spray as you go' technique? Thorax. 1990; 45: 474 7.
    • 90. Watts MR, Geraghty R, Moore A, Saunders J, Swift CG. Premedication for bronchoscopy in older patients: a double-blind comparison of two regimens. Respir Med. 2005; 99: 220 6.
    • 91. Stolz D, Chhajed PN, Leuppi JD, Brutsche M, Pflimlin E, Tamm M. Cough suppression during flexible bronchoscopy using combined sedation with midazolam and hydrocodone: a randomised, double blind, placebo controlled trial. Thorax. 2004; 59: 773 6.
    • 92. Humbert M, Robinson DS, Assoufi B, Kay AB, Durham SR. Safety of fibreoptic bronchoscopy in asthmatic and control subjects and effect on asthma control over two weeks. Thorax. 1996; 51: 664 9.
    • 93. Diette GB, Lechtzin N, Haponik E, Devrotes A, Rubin HR. Distraction therapy with nature sights and sounds reduces pain during flexible bronchoscopy: a complementary approach to routine analgesia. Chest. 2003; 123: 941 8.
    • 94. Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A. Patient satisfaction with conscious sedation for bronchoscopy. Chest. 1999; 115: 1437 40.
    • 95. Yoon HI, Kim JH, Lee JH, Park S, Lee CT, Hwang JY, et al. Comparison of propofol and the combination of propofol and alfentanil during bronchoscopy: a randomized study. Acta Anaesthesiol Scand. 2011; 55: 104 9.
    • 96. Hwang J, Jeon Y, Park HP, Lim YJ, Oh YS. Comparison of alfetanil and ketamine in combination with propofol for patient-controlled sedation during fiberoptic bronchoscopy. Acta Anaesthesiol Scand. 2005; 49: 1334 8.
    • 97. Schwarz Y, Greif J, Lurie O, Tarrasch R, Weinbroum AA. Dextromethorphan premedication reduces midazolam requirement: objective and subjective parameters in peribronchoscopy. Respiration. 2007; 74: 314 9.
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