Safety of Bronchoscopy in Elderly

Risk Factors for Predicting Hypoxia in Adult Patients Undergoing Bronchoscopy under Sedation

BACKGROUND

Flexible bronchoscopy is one of the essential procedures for the diagnosis and treatment of pulmonary diseases. The purpose of this study was to identify the risk factors associated with the occurrence of hypoxia in adults undergoing flexible bronchoscopy under sedation.

METHODS

We retrospectively analyzed 2,520 patients who underwent flexible bronchoscopy under sedation at our tertiary care university hospital in South Korea January 1, 2013-December 31, 2014. Hypoxia was defined as more than 5%-point reduction in the baseline percutaneous oxygen saturation (SpO2) or SpO2 <90% for >1 minute during the procedure.

RESULTS

The mean age was 64.7±13.5, and 565 patients developed hypoxia during the procedure. The mean sedation duration and midazolam dose for sedation were 31.1 minutes and 3.9 mg, respectively. The bivariate analysis showed that older age, a low forced expiratory volume in one second (FEV1), use of endobronchial ultrasound, the duration of sedation, and the midazolam dose were associated with the occurrence of hypoxia during the procedure, while the multivariate analysis found that age >60 (odds ratio [OR], 1.32), a low FEV1 (OR, 0.99), and a longer duration of sedation (>40 minutes; OR, 1.33) were significant risk factors.

CONCLUSION

The findings suggest that patients older than age 60 and those with a low FEV1 tend to develop hypoxia during the bronchoscopy under sedation. Also, longer duration of sedation (>40 minutes) was a significant risk factor for hypoxia.

Safety and efficacy of diagnostic flexible bronchoscopy in very old patients with lung cancer

INTRODUCTION

Although there is a remarkable increase in diagnostic flexible bronchoscopy (FB) in old patients, safety and efficacy of FB in very old patients remain to be elucidated. In this study, we aimed to evaluate the complications and diagnostic yield of FB in patients aged ≥ 80 years with lung cancer compared with those aged < 80 years.

MATERIALS AND METHODS

We retrospectively analysed the medical records of 668 consecutive patients, which included 89 patients aged ≥ 80 years (older group) and 579 patients aged < 80 years (younger group) who underwent bronchoscopy for the diagnosis or staging of lung cancer between April 2011 and March 2016.

RESULTS

The median age of the patients was 82 and 69 years in the older and younger groups, respectively. Performance status and Charlson comorbidity index were comparable between the study groups. Diagnostic yield in the older and younger groups was equivalent, and stage distribution in both the groups was similar. Sixty-one patients (68.5%) received anticancer treatment including surgery, radiation and chemotherapy with cytotoxic or molecular-targeted agents in the older group. There were no statistical differences in the occurrence of overall complications between the two groups.

CONCLUSIONS

Safety and efficacy of FB in the diagnosis of lung cancer in very old patients are comparable with those of younger patients. Accurate diagnosis established by bronchoscopy leads to appropriate treatment decision in very old patients.

Risk factors for bronchoscopic complications in patients over 75 years of age

AIM

Bronchoscopy is a widely used, well-tolerated diagnostic and therapeutic intervention and has a low complication rate. The aim of this study was to describe the rates of bronchoscopic complications and risk factors in a group of patients 75 years' old and above.

METHODS

To investigate the rate of complications and risk factors in the older patients, we carried out a retrospective cohort study of 240 patients above 75 years of age who had bronchoscopy for various reasons.

RESULTS

Complication rate was found to be 3.7% in the older patients group which was not different from the control group (1.2%, p > 0.05). No significant relationship was found between age group and complication development (p > 0.05). The type of procedures did not show any effect on complication development between age groups and individually. We found that anemia (OR 7.2, 95% CI 1.2-41.2), percutaneous gastrostomy (OR 9.9, 95% CI 1.6-58), immobility (OR 11.9, 95% CI 2.6-33.5) and procedures performed in the intensive care unit (OR 7.4, 95% CI 1.4-37.5) were significant risk factors for complication.

CONCLUSIONS

In the older patients group, bronchoscopy is a safe procedure regardless of the type of procedures performed and age. It has been shown that anemia, PEG presence, immobility and intensive care patients are associated with increased complication.