Abstract
Background: Transbronchial lung biopsy (TBBx) is a useful diagnostic procedure. Bleeding is the most feared complication of TBBx, seen more commonly with coagulopathy, renal dysfunction, thrombocytopenia and pulmonary hypertension. We hypothesized that TBBx performed through a guide sheath (GS), using it as an extended working channel (EWC) provides tamponade in the vicinity of the biopsy site, restricting bleeding to a smaller segment, and preventing worsening hypoxemia and its consequences in this high-risk subset.
Objectives: Examine the protective effect of the EWC in reducing spillover bleeding/hypoxemia in high-risk patients.
Methods: TBBx was performed through a GS (EWC) in high risk patients (EWC-HR-TBBx) over 4.5 years. High-risk groups were defined as those with “hypoxia’ ( SpO2 < 90%/PaO2 < 60 mm Hg on room air), impaired renal function (creatinine >1.5 or BUN > 25,), thrombocytopenia (< 50,000/mm3), moderate PAH (PASP > 40 mm Hg), systolic/diastolic cardiac dysfunction/valvular heart disease deemed high-risk by a cardiologist, or a combination of the above. Diagnostic yield was also analyzed.
Results: Of 804 TBBx in the study period, 105 (13.1%) high-risk procedures qualified for EWC-HR-TBBx. No significant bleeding or worsening hypoxemia was encountered with this strategy. Histopathology revealed adequate sampling in all cases.
Conclusion: A GS as an EWC as a ‘distal tamponade’ strategy can be used to reduce the bleeding risk in TBBx in high-risk patients. This simple innovation expands the spectrum of TBBx to high-risk subsets by preventing bleeding and resultant hypoxemia, without compromising sampling quality.
Footnotes
Cite this article as: European Respiratory Journal 2020; 56: Suppl. 64, 2848.
This abstract was presented at the 2020 ERS International Congress, in session “Respiratory viruses in the "pre COVID-19" era”.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2020