Bronchoscopy in the emergency department.

Bronchoscopy / adverse effects Emergency Service, Hospital Humans Intubation, Intratracheal / methods Pulmonary Atelectasis Retrospective Studies
Airway management Emergency bronchoscopy Flexible bronchoscopy

Journal

The American journal of emergency medicine
ISSN: 1532-8171
Titre abrégé: Am J Emerg Med
Pays: United States
ID NLM: 8309942

Informations de publication

Date de publication:
08 2022
Historique:
received: 04 02 2022
revised: 20 05 2022
accepted: 21 05 2022
pubmed: 10 6 2022
medline: 20 7 2022
entrez: 9 6 2022
Statut: ppublish

Résumé

Flexible bronchoscopy has been safely used for decades in ambulatory and critical care settings to aid in the diagnosis and treatment of tracheobronchial tree disorders. Although emergency physicians have the requisite skills to operate and interpret flexible bronchoscopy, no reports exist on the use of bronchoscopy by emergency physicians apart from endotracheal tube placement and confirmation. The primary goal of this study was to describe the indications, outcomes and complications of flexible bronchoscopy performed by emergency physicians in an urban academic emergency department. This was a single-center retrospective cohort study involving chart and video review of 146 patients over a 10.5-year study period. Patients of any age were included if they had been tracheally intubated or mechanically ventilated and underwent flexible bronchoscopy in the emergency department. After patients were identified, manual chart and video review was used to collect data on patient demographics, indications for intubation, indications for bronchoscopy, details of the bronchoscopy procedure, procedural findings, outcomes of the procedure, complications, provider training levels, and additional bronchoscopies performed after admission. The data was analyzed using descriptive statistics. 146 patients were included in the study and all bronchoscopies were performed or supervised by attending emergency physicians. After bronchoscopy, 24% of patients displayed improvement in oxygenation or lobar collapse while most patients had no change in clinical status. One patient had temporary hypoxemia after bronchoscopy. When another physician performed a subsequent bronchoscopy during admission, the findings were in agreement with the ED bronchoscopy 86% of the time. At our institution, emergency physicians can safely and effectively use flexible bronchoscopy to diagnose and treat critically ill patients.

Sections du résumé

BACKGROUND
Flexible bronchoscopy has been safely used for decades in ambulatory and critical care settings to aid in the diagnosis and treatment of tracheobronchial tree disorders. Although emergency physicians have the requisite skills to operate and interpret flexible bronchoscopy, no reports exist on the use of bronchoscopy by emergency physicians apart from endotracheal tube placement and confirmation.
OBJECTIVE
The primary goal of this study was to describe the indications, outcomes and complications of flexible bronchoscopy performed by emergency physicians in an urban academic emergency department.
METHODS
This was a single-center retrospective cohort study involving chart and video review of 146 patients over a 10.5-year study period. Patients of any age were included if they had been tracheally intubated or mechanically ventilated and underwent flexible bronchoscopy in the emergency department. After patients were identified, manual chart and video review was used to collect data on patient demographics, indications for intubation, indications for bronchoscopy, details of the bronchoscopy procedure, procedural findings, outcomes of the procedure, complications, provider training levels, and additional bronchoscopies performed after admission. The data was analyzed using descriptive statistics.
RESULTS
146 patients were included in the study and all bronchoscopies were performed or supervised by attending emergency physicians. After bronchoscopy, 24% of patients displayed improvement in oxygenation or lobar collapse while most patients had no change in clinical status. One patient had temporary hypoxemia after bronchoscopy. When another physician performed a subsequent bronchoscopy during admission, the findings were in agreement with the ED bronchoscopy 86% of the time.
CONCLUSION
At our institution, emergency physicians can safely and effectively use flexible bronchoscopy to diagnose and treat critically ill patients.

Identifiants

DOI: 10.1016/j.ajem.2022.05.040 PMID: 35679653
pubmed: 35679653
pii: S0735-6757(22)00345-X
doi: 10.1016/j.ajem.2022.05.040
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

114-119

Informations de copyright

Copyright © 2022 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of Competing Interest None.

Auteurs

Daniel H Lee (DH)

Department of Emergency Medicine, Kaiser Permanente Medical Center, San Diego, CA, USA. Electronic address: Leex7159@umn.edu.

Brian E Driver (BE)

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

Matthew E Prekker (ME)

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Division of Pulmonary/Critical Care, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

Michael A Puskarich (MA)

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

David Plummer (D)

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

Erika Y Mojica (EY)

University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA.

Jennifer C Smith (JC)

Eastern Virginia Medical School, Norfolk, VA, USA.

Paige A DeVries (PA)

Kansas City University, Kansas City, MO, USA.

Jamie L Stang (JL)

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

Robert F Reardon (RF)

Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.

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Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie thoracique › Procédures de chirurgie pulmonaire › Bronchoscopie › Bronchoscopy in the emergency department.
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › Bronchoscopy in the emergency department.
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Bronchoscopy in the emergency department.
questionsmedicales.fr › Techniques d'investigation › Intubation › Intubation trachéale › Bronchoscopy in the emergency department.
questionsmedicales.fr › Maladies de l'appareil respiratoire › Maladies pulmonaires › Atélectasie pulmonaire › Bronchoscopy in the emergency department.
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Bronchoscopy in the emergency department.