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Published on: January 22, 2013
Fiberoptic bronchoscopy in the presence of space-occupying intracranial lesions
M K Bajwa1, S Henein, S L Kamholz
1Department of Medicine, State University of New York, Brooklyn 11203.
Abstract:
The performance of flexible fiberoptic bronchoscopy (FFB) has anecdotally been considered to carry a high risk of neurologic complications in patients with raised intracranial pressure (ICP). There is no evidence in the literature to support this concern. We evaluated this risk by reviewing hospital records of 132 patients who underwent FFB and computer tomography of the central nervous system (CNS-CT) during the same hospitalization. Twenty-nine patients had CT evidence of increased ICP. For the purpose of analysis, patients were divided into two groups: 17 patients had evidence of raised ICP prior to the performance of FFB and had received treatment with an intent to lower the ICP, and 12 patients in whom increased ICP was not suspected at the time of FFB and therefore did not receive any form of pretreatment. There was no evidence of neurologic complications in either group during the first postbronchoscopy week. We conclude that FFB carries a low risk in patients with elevated ICP.
Insights
Flexible fiberoptic bronchoscopy (FFB) is considered safe for patients with elevated intracranial pressure (ICP). A review of 132 patients found no neurologic complications, challenging previous concerns about FFB risks.
Area of Science:
- Neurology
- Pulmonology
- Critical Care Medicine
Background:
- Flexible fiberoptic bronchoscopy (FFB) is an essential diagnostic tool.
- Anecdotal concerns suggest FFB may pose a high risk of neurologic complications in patients with elevated intracranial pressure (ICP).
- Existing literature lacks evidence to substantiate these concerns.
Purpose of the Study:
- To evaluate the actual risk of neurologic complications associated with FFB in patients with confirmed elevated ICP.
- To provide evidence-based data on the safety of FFB in this specific patient population.
Main Methods:
- Retrospective review of hospital records for 132 patients who underwent FFB and central nervous system computed tomography (CNS-CT) during the same hospitalization.
- Patients were categorized into two groups: 17 with pre-existing elevated ICP treated to lower it, and 12 with no suspected ICP requiring no pretreatment.
- Neurologic complications were monitored during the first week post-bronchoscopy.
Main Results:
- Twenty-nine patients demonstrated CT evidence of increased ICP.
- No neurologic complications were observed in either the pretreated or non-pretreated elevated ICP groups within the first week after FFB.
- The findings indicate a low incidence of adverse neurologic events.
Conclusions:
- Flexible fiberoptic bronchoscopy (FFB) appears to be a low-risk procedure for patients with elevated intracranial pressure (ICP).
- The study challenges the previously held anecdotal concerns regarding FFB-associated neurologic risks in this cohort.
- Further prospective studies may be warranted to confirm these findings.
