P200 Six Year Experience with Rigid Bronchoscopy: Complications, Indications and Changing Referral Patterns
Introduction and Objectives The objective of this study was to determine the indications and outcomes of the last 500 referrals for rigid bronchoscopy at a tertiary referral centre and to review the referral frequency over the last 6 years.
Methods We reviewed monthly referrals for rigid bronchoscopy since 2007 and analysed indications, physiological parameters and outcomes for the last 500 cases.
Results Referrals and consequently the number of rigid bronchoscopies have risen from 10 to 30 per month over the last 6 years (see graph 1). Of the most recent 500 consecutive referrals only one case was considered unsuitable (requesting therapeutic intervention for a small subsegmental tumour with end stage interstitial lung disease and pulmonary hypertension). Indications were: laser of granulation tissue n=180; biopsy of proximal tumour n=166 (100% diagnostic); insertion of stent (bronchial and tracheal) n=86; dilation of stricture n=24; percutaneous tracheostomy insertion n=16; stent removal n=11; bioglue administration n=10 and foreign body removal n=7. Median preoperative PaO2 was 7.8 kPa (range 6.4–11.8kPa) and CO2 5.9 kPa (range 4.9–7.2kPa). There were no fatalities and 2 patients (0.4%) were transferred to intensive care post procedure. Three procedures were complicated by pneumothorax (2 required drain insertion) and 5 resulted in haemorrhage >100mls (100, 200, 250, 400, 600mls). Haemostasis was achieved in all cases. No other complications were observed.
Conclusions The annual referral rate for rigid bronchoscopy has been rising since 2007. These results demonstrate the varying diagnostic and therapeutic modalities available and highlight the favourable morbidity rates and 100% diagnostic rates for this safe procedure, despite many patients with respiratory failure. It is important that respiratory physicians are aware of the potential benefit that large airway intervention can offer.