Safety of bronchoscopy in patients with malignant hematologic disorders
- PDF / 619,385 Bytes
- 6 Pages / 595.276 x 790.866 pts Page_size
- 73 Downloads / 170 Views
RESEARCH ARTICLE
Open Access
Safety of bronchoscopy in patients with malignant hematologic disorders Hironori Uruga1,2,3*† , Toshitaka Sato1,4†, Aya Nishida5,6†, Naoyuki Uchida5, Masanori Tsuji5, Shuhei Moriguchi1, Yui Takahashi1, Kazumasa Ogawa1, Kyoko Murase1, Shigeo Hanada1,2, Hisashi Takaya1,2†, Atsushi Miyamoto1,2, Nasa Morokawa1,2, Muneyoshi Kimura7, Hideki Araoka3,7, Rumiko Tsuchihashi5, Yuki Asano-Mori5, Atsushi Wake3,5,6, Shuichi Taniguchi3,5 and Kazuma Kishi1,2,3,8
Abstract Background: Factors affecting the safety of bronchoscopy in patients with malignant hematologic disorders have not been well described. We evaluated the safety of bronchoscopy and describe factors affecting its complication rate in such patients. Methods: Between January 2009 and December 2018, 316 bronchoscopies in 282 patients with malignant hematologic disorders and pulmonary infiltrates were performed at our institution. The bronchoscopic procedure used and its complications were evaluated. Results: The most common underlying disease was acute myeloid leukemia (134/282 patients, 47.5%). Platelet transfusion was performed the day before or the day of bronchoscopy in 42.4%, supplemental oxygen was administered before the procedure in 23.1%, and midazolam was used in 74.4%. Thirty-five bronchoscopies (11.1%) were complicated by hemoptysis and 7 patients developed pneumothorax, 4 of whom required thoracic drainage. Two patients (0.6%) were intubated within 48 h of the procedure and prolonged oxygen desaturation (> 48 h) occurred in 3.8%. Multivariate analysis showed that only use of midazolam significantly reduced the risk of prolonged oxygen desaturation (hazard ratio 0.28, 95% confidence interval 0.09–0.85, p = 0.03). Transbronchial lung biopsy significantly increased the risk of hemoptysis (hazard ratio 10.40, 95% confidence interval 4.18–25.90, p = 0.00), while use of midazolam significantly reduced the risk (hazard ratio 0.31, 95% confidence interval 0.14–0.73, p = 0.01). Conclusions: Bronchoscopy is relatively safe in patients with malignant hematologic disorders. Caution and judicious use of sedatives may improve the patient’s procedural tolerance and lower complications. Keywords: Bronchoscopy, Acute myeloid leukemia, Myelodysplastic syndrome, Malignant lymphoma, Hematopoietic stem cell transplantation, Midazolam
* Correspondence: [email protected] † Hironori Uruga, Toshitaka Sato, Aya Nishida and Hisashi Takaya contributed equally to this work. 1 Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, Tokyo, Japan 2 Department of Respiratory Medicine, Toranomon Hospital Kajigaya, Kawasaki, Kanagawa, Japan Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creati
Data Loading...
