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A prospective cooperative study of complications following flexible fiberoptic bronchoscopy
Abstract:
The frequency of complications following flexible fiber-optic bronchoscopic procedures was studied prospectively in 908 patients from 13 cooperating hospitals. Major complications (respiratory arrest, pneumonia, pneumothorax, and obstruction of airways) occurred in 1.7 per cent (15) of the procedures. There was one death, yielding a mortality of 0.1%. Minor complications, including vasovagal reactions, fever, cardiac arrhythmias, bleeding, obstruction of airways, nausea and vomiting, pneumothorax, psychotic reaction, and aphonia, occurred in 6.5% of the procedures. Pneumothorax occurred after 5% (four) of 85 transbronchial biopsies. Although serious complications occur more frequently than previously reported from retrospective studies, complications after fiberoptic bronchoscopic procedures are still quite infrequent. The relative risks and benefits must always be carefully weighed in patients being considered for a fiberoptic bronchoscopic procedure.
Insights
Complications from flexible fiber-optic bronchoscopy are infrequent, with major events in 1.7% and mortality at 0.1%. Careful risk-benefit assessment is crucial for patients undergoing this common pulmonary diagnostic procedure.
Area of Science:
- Pulmonology
- Medical Procedures
- Patient Safety
Background:
- Flexible fiber-optic bronchoscopy is a widely used diagnostic and therapeutic tool in respiratory medicine.
- Previous estimates of complication rates often relied on retrospective data, potentially underestimating risks.
- Understanding the prospective incidence of adverse events is vital for informed clinical decision-making.
Purpose of the Study:
- To prospectively evaluate the frequency and types of complications associated with flexible fiber-optic bronchoscopic procedures.
- To establish a reliable incidence rate for major and minor complications.
- To compare findings with previous retrospective studies.
Main Methods:
- Prospective study involving 908 patients undergoing flexible fiber-optic bronchoscopy across 13 hospitals.
- Systematic recording of all immediate complications, categorized as major or minor.
- Specific analysis of complications related to transbronchial biopsies.
Main Results:
- Major complications occurred in 1.7% of procedures (15/908), including respiratory arrest, pneumonia, pneumothorax, and airway obstruction.
- A single death (0.1% mortality) was recorded.
- Minor complications were observed in 6.5% of procedures, encompassing vasovagal reactions, fever, arrhythmias, bleeding, and more.
- Pneumothorax occurred in 5% of transbronchial biopsies (4/85).
Conclusions:
- While complications are more frequent than suggested by retrospective data, flexible fiber-optic bronchoscopy remains a relatively safe procedure.
- The prospective data confirm the low overall incidence of serious adverse events.
- Clinicians must meticulously weigh the benefits against the potential risks for each patient considered for bronchoscopy.