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Precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy

Bronchoscopy in thrombocytopenic patients remains a controversial topic as traditionally varying platelet thresholds have been stablished as “safe,” ranging from 20,000 to 50,000. A lower threshold may be safe for a routine airway inspection with bronchoalveolar lavage but will be far from safe for...

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Autores principales: Fernandez‐Bussy, Sebastian, Abia‐Trujillo, David, Patel, Neal M., Pascual, Jorge M., Majid, Adnan, Folch, Erik E, Reisenauer, Janani S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons, Ltd 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193863/
https://www.ncbi.nlm.nih.gov/pubmed/34136261
http://dx.doi.org/10.1002/rcr2.794
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author Fernandez‐Bussy, Sebastian
Abia‐Trujillo, David
Patel, Neal M.
Pascual, Jorge M.
Majid, Adnan
Folch, Erik E
Reisenauer, Janani S.
author_facet Fernandez‐Bussy, Sebastian
Abia‐Trujillo, David
Patel, Neal M.
Pascual, Jorge M.
Majid, Adnan
Folch, Erik E
Reisenauer, Janani S.
author_sort Fernandez‐Bussy, Sebastian
collection PubMed
description Bronchoscopy in thrombocytopenic patients remains a controversial topic as traditionally varying platelet thresholds have been stablished as “safe,” ranging from 20,000 to 50,000. A lower threshold may be safe for a routine airway inspection with bronchoalveolar lavage but will be far from safe for more invasive interventions such as needle biopsy, transbronchial biopsy, or cryo‐biopsy. Currently, a minimal platelet threshold during robotic‐assisted bronchoscopy (RAB) has not been established. In addition, the absolute platelet number does not guarantee appropriate platelet function. The literature regarding the safety of bronchoscopy and its bleeding risk, considering broader and more functional tests such as thromboelastography (TEG), is also lacking. We present our RAB approach to safely sample lung nodules in a patient with thrombocytopenia. Our precautionary strategy for high‐risk bleeding cases during RAB utilizing TEG and parallel flexible bronchoscopy with segmental balloon occlusion may be an appropriate technique to minimize bleeding risk.
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spelling pubmed-81938632021-06-15 Precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy Fernandez‐Bussy, Sebastian Abia‐Trujillo, David Patel, Neal M. Pascual, Jorge M. Majid, Adnan Folch, Erik E Reisenauer, Janani S. Respirol Case Rep Case Reports Bronchoscopy in thrombocytopenic patients remains a controversial topic as traditionally varying platelet thresholds have been stablished as “safe,” ranging from 20,000 to 50,000. A lower threshold may be safe for a routine airway inspection with bronchoalveolar lavage but will be far from safe for more invasive interventions such as needle biopsy, transbronchial biopsy, or cryo‐biopsy. Currently, a minimal platelet threshold during robotic‐assisted bronchoscopy (RAB) has not been established. In addition, the absolute platelet number does not guarantee appropriate platelet function. The literature regarding the safety of bronchoscopy and its bleeding risk, considering broader and more functional tests such as thromboelastography (TEG), is also lacking. We present our RAB approach to safely sample lung nodules in a patient with thrombocytopenia. Our precautionary strategy for high‐risk bleeding cases during RAB utilizing TEG and parallel flexible bronchoscopy with segmental balloon occlusion may be an appropriate technique to minimize bleeding risk. John Wiley & Sons, Ltd 2021-06-11 /pmc/articles/PMC8193863/ /pubmed/34136261 http://dx.doi.org/10.1002/rcr2.794 Text en © 2021 The Authors. Respirology Case Reports published by John Wiley & Sons Australia, Ltd on behalf of The Asian Pacific Society of Respirology. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Case Reports
Fernandez‐Bussy, Sebastian
Abia‐Trujillo, David
Patel, Neal M.
Pascual, Jorge M.
Majid, Adnan
Folch, Erik E
Reisenauer, Janani S.
Precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy
title Precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy
title_full Precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy
title_fullStr Precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy
title_full_unstemmed Precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy
title_short Precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy
title_sort precautionary strategy for high‐risk airway bleeding cases during robotic‐assisted bronchoscopy
topic Case Reports
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193863/
https://www.ncbi.nlm.nih.gov/pubmed/34136261
http://dx.doi.org/10.1002/rcr2.794
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