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Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside

Background and Objective: Although rigid bronchoscopy is generally performed in the operating room (OR), the intervention is sometimes emergently required at the intensive care unit (ICU) bedside. The aim of this study is to evaluate the safety of rigid bronchoscopy at the ICU bedside. Materials and...

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Autores principales: Kim, Sang Hyuk, Chang, Boksoon, Ahn, Hyun Joo, Kim, Jie Ae, Yang, Mikyung, Kim, Hojoong, Jeong, Byeong-Ho
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9782846/
https://www.ncbi.nlm.nih.gov/pubmed/36556963
http://dx.doi.org/10.3390/medicina58121762
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author Kim, Sang Hyuk
Chang, Boksoon
Ahn, Hyun Joo
Kim, Jie Ae
Yang, Mikyung
Kim, Hojoong
Jeong, Byeong-Ho
author_facet Kim, Sang Hyuk
Chang, Boksoon
Ahn, Hyun Joo
Kim, Jie Ae
Yang, Mikyung
Kim, Hojoong
Jeong, Byeong-Ho
author_sort Kim, Sang Hyuk
collection PubMed
description Background and Objective: Although rigid bronchoscopy is generally performed in the operating room (OR), the intervention is sometimes emergently required at the intensive care unit (ICU) bedside. The aim of this study is to evaluate the safety of rigid bronchoscopy at the ICU bedside. Materials and Methods: We retrospectively analyzed medical records of patients who underwent rigid bronchoscopy while in the ICU from January 2014 to December 2020. According to the location of rigid bronchoscopic intervention, patients were classified into the ICU group (n = 171, cases emergently performed at the ICU bedside without anesthesiologists) and the OR group (n = 165, cases electively performed in the OR with anesthesiologists). The risk of intra- and post-procedural complications in the ICU group was analyzed using multivariable logistic regression, with the OR group as the reference category. Results: Of 336 patients, 175 (52.1%) were moribund and survival was not expected without intervention, and 170 (50.6%) received invasive respiratory support before the intervention. The most common reasons for intervention were post-intubation tracheal stenosis (39.3%) and malignant airway obstruction (34.5%). Although the overall rate of intra-procedural complications did not differ between the two groups (86.0% vs. 80.6%, p = 0.188), post-procedural complications were more frequent in the ICU group than in the OR group (24.0% vs. 12.1%, p = 0.005). Severe complications requiring unexpected invasive management occurred only post-procedurally and were more common in the ICU group (10.5% vs. 4.8%, p = 0.052). In the fully adjusted model, the ICU group had increased odds for severe post-procedural complications, but statistical significance was not observed (odds ratio, 2.54; 95% confidence interval, 0.73–8.88; p = 0.144). Conclusions: Although general anesthesia is generally considered the gold standard for rigid bronchoscopy, our findings indicate that rigid bronchoscopy may be safely performed at the ICU bedside in selective cases of emergency. Moreover, adequate patient selection and close post-procedural monitoring are required to prevent severe complications.
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spelling pubmed-97828462022-12-24 Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside Kim, Sang Hyuk Chang, Boksoon Ahn, Hyun Joo Kim, Jie Ae Yang, Mikyung Kim, Hojoong Jeong, Byeong-Ho Medicina (Kaunas) Article Background and Objective: Although rigid bronchoscopy is generally performed in the operating room (OR), the intervention is sometimes emergently required at the intensive care unit (ICU) bedside. The aim of this study is to evaluate the safety of rigid bronchoscopy at the ICU bedside. Materials and Methods: We retrospectively analyzed medical records of patients who underwent rigid bronchoscopy while in the ICU from January 2014 to December 2020. According to the location of rigid bronchoscopic intervention, patients were classified into the ICU group (n = 171, cases emergently performed at the ICU bedside without anesthesiologists) and the OR group (n = 165, cases electively performed in the OR with anesthesiologists). The risk of intra- and post-procedural complications in the ICU group was analyzed using multivariable logistic regression, with the OR group as the reference category. Results: Of 336 patients, 175 (52.1%) were moribund and survival was not expected without intervention, and 170 (50.6%) received invasive respiratory support before the intervention. The most common reasons for intervention were post-intubation tracheal stenosis (39.3%) and malignant airway obstruction (34.5%). Although the overall rate of intra-procedural complications did not differ between the two groups (86.0% vs. 80.6%, p = 0.188), post-procedural complications were more frequent in the ICU group than in the OR group (24.0% vs. 12.1%, p = 0.005). Severe complications requiring unexpected invasive management occurred only post-procedurally and were more common in the ICU group (10.5% vs. 4.8%, p = 0.052). In the fully adjusted model, the ICU group had increased odds for severe post-procedural complications, but statistical significance was not observed (odds ratio, 2.54; 95% confidence interval, 0.73–8.88; p = 0.144). Conclusions: Although general anesthesia is generally considered the gold standard for rigid bronchoscopy, our findings indicate that rigid bronchoscopy may be safely performed at the ICU bedside in selective cases of emergency. Moreover, adequate patient selection and close post-procedural monitoring are required to prevent severe complications. MDPI 2022-11-30 /pmc/articles/PMC9782846/ /pubmed/36556963 http://dx.doi.org/10.3390/medicina58121762 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Kim, Sang Hyuk
Chang, Boksoon
Ahn, Hyun Joo
Kim, Jie Ae
Yang, Mikyung
Kim, Hojoong
Jeong, Byeong-Ho
Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside
title Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside
title_full Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside
title_fullStr Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside
title_full_unstemmed Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside
title_short Safety of Rigid Bronchoscopy for Therapeutic Intervention at the Intensive Care Unit Bedside
title_sort safety of rigid bronchoscopy for therapeutic intervention at the intensive care unit bedside
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9782846/
https://www.ncbi.nlm.nih.gov/pubmed/36556963
http://dx.doi.org/10.3390/medicina58121762
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