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Tang F, Zhu F, Wang Y, Zha X, Lyu L, Ma D. Role of bronchoscopy in the management of patients with suspected or suffering from ventilator-associated pneumonia: A meta-analysis. Heliyon 2024; 10:e32751. [PMID: 39183884 PMCID: PMC11341318 DOI: 10.1016/j.heliyon.2024.e32751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 04/22/2024] [Accepted: 06/07/2024] [Indexed: 08/27/2024] Open
Abstract
Background The utility of bronchoscopy in the treatment of patients with ventilator-associated pneumonia (VAP) has been proposed, although prior research has yielded inconclusive findings. This systematic review and meta-analysis were conducted to examine the impact of bronchoscopy on mortality rates, duration of mechanical ventilation (MV), and length of stay in the intensive care unit (ICU) among patients with VAP. Methods Relevant randomized controlled trials (RCTs) and cohort studies were acquired by conducting a comprehensive search in the PubMed, Embase, and Cochrane Library databases. To account for the potential heterogeneity, a random-effects model was utilized to combine the findings and incorporate its potential influence. Results Eight RCTs and three cohort studies, including 3907 patients with highly suspected or clinically diagnosed VAP, were included. Compared to the controls, bronchoscopy use was not associated with a significant effect on all-cause mortality (relative risk [RR]: 0.81, 95 % confidence interval [CI]: 0.62 to 1.05, p = 0.12; I2 = 57 %). Subgroup analysis showed that bronchoscopy used for the microbiological diagnosis of VAP was not associated with reduced mortality (RR: 0.92, 95 % CI: 0.75 to 1.13), while therapeutic bronchoscopy use was associated with significantly reduced mortality (RR: 0.53, 95 % CI: 0.35 to 0.81). The duration of MV or length of ICU stay was not significantly different between groups. Conclusions Bronchoscopy use for the purpose of the microbiological diagnosis of VAP did not reduce short-term mortality compared to diagnosis without bronchoscopy use, while therapeutic bronchoscopy use was associated with reduced mortality in these patients.
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Affiliation(s)
- Fei Tang
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, 230031, China
| | - Feng Zhu
- Department of Thoracic Surgery, Anhui Chest Hospital, Hefei, 230031, China
| | - Yueming Wang
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, 230031, China
| | - Xiankui Zha
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, 230031, China
| | - Liping Lyu
- Department of Interventional Pulmonology and Endoscopic Diagnosis and Treatment Center, Anhui Chest Hospital, Hefei, 230031, China
| | - Dongchun Ma
- Department of Thoracic Surgery, Anhui Chest Hospital, Hefei, 230031, China
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2
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Ahn C, Park Y, Oh Y. Early bronchoscopy in severe pneumonia patients in intensive care unit: insights from the Medical Information Mart for Intensive Care-IV database analysis. Acute Crit Care 2024; 39:179-185. [PMID: 38476070 PMCID: PMC11002625 DOI: 10.4266/acc.2023.01165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Pneumonia frequently leads to intensive care unit (ICU) admission and is associated with a high mortality risk. This study aimed to assess the impact of early bronchoscopy administered within 3 days of ICU admission on mortality in patients with pneumonia using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. METHODS A single-center retrospective analysis was conducted using the MIMIC-IV data from 2008 to 2019. Adult ICU-admitted patients diagnosed with pneumonia were included in this study. The patients were stratified into two cohorts based on whether they underwent early bronchoscopy. The primary outcome was the 28-day mortality rate. Propensity score matching was used to balance confounding variables. RESULTS In total, 8,916 patients with pneumonia were included in the analysis. Among them, 783 patients underwent early bronchoscopy within 3 days of ICU admission, whereas 8,133 patients did not undergo early bronchoscopy. The primary outcome of the 28-day mortality between two groups had no significant difference even after propensity matched cohorts (22.7% vs. 24.0%, P=0.589). Patients undergoing early bronchoscopy had prolonged ICU (P<0.001) and hospital stays (P<0.001) and were less likely to be discharged to home (P<0.001). CONCLUSIONS Early bronchoscopy in severe pneumonia patients in the ICU did not reduce mortality but was associated with longer hospital stays, suggesting it was used in more severe cases. Therefore, when considering bronchoscopy for these patients, it's important to tailor the decision to each individual case, thoughtfully balancing the possible advantages with the related risks.
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Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, Korea
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Yoonseok Oh
- Data engineer, SciAL Tech Inc., Seoul, Korea
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3
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Zhang L, Li S, Yuan S, Lu X, Li J, Liu Y, Huang T, Lyu J, Yin H. The Association Between Bronchoscopy and the Prognoses of Patients With Ventilator-Associated Pneumonia in Intensive Care Units: A Retrospective Study Based on the MIMIC-IV Database. Front Pharmacol 2022; 13:868920. [PMID: 35754471 PMCID: PMC9214225 DOI: 10.3389/fphar.2022.868920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In intensive care units (ICUs), the morbidity and mortality of ventilator-associated pneumonia (VAP) are relatively high, and this condition also increases medical expenses for mechanically ventilated patients, which will seriously affect the prognoses of critically ill patients. The purpose of this study was to determine the impact of bronchoscopy on the prognosis of patients with VAP undergoing invasive mechanical ventilation (IMV). Methods: This was a retrospective study based on patients with VAP from the Medical Information Mart for Intensive Care IV database. The outcomes were ICU and in-hospital mortality. Patients were divided based on whether or not they had undergone bronchoscopy during IMV. Kaplan-Meier (KM) survival curves and Cox proportional-hazards regression models were used to analyze the association between groups and outcomes. Propensity score matching (PSM) and propensity score based inverse probability of treatment weighting (IPTW) were used to further verify the stability of the results. The effect of bronchoscopy on prognosis was further analyzed by causal mediation analysis (CMA). Results: This study enrolled 1,560 patients with VAP: 1,355 in the no-bronchoscopy group and 205 in the bronchoscopy group. The KM survival curve indicated a significant difference in survival probability between the two groups. The survival probabilities in both the ICU and hospital were significantly higher in the bronchoscopy group than in the no bronchoscopy group. After adjusting all covariates as confounding factors in the Cox model, the HRs (95% CI) for ICU and in-hospital mortality in the bronchoscopy group were 0.33 (0.20–0.55) and 0.40 (0.26–0.60), respectively, indicating that the risks of ICU and in-hospital mortality were 0.67 and 0.60 lower than in the no-bronchoscopy group. The same trend was obtained after using PSM and IPTW. CMA showed that delta-red blood cell distribution width (RDW) mediated 8 and 7% of the beneficial effects of bronchoscopy in ICU mortality and in-hospital mortality. Conclusion: Bronchoscopy during IMV was associated with reducing the risk of ICU and in-hospital mortality in patients with VAP in ICUs, and this beneficial effect was partially mediated by changes in RDW levels.
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Affiliation(s)
- Luming Zhang
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shaojin Li
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
| | - Shiqi Yuan
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Neurology, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
| | - Xuehao Lu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jieyao Li
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yu Liu
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Tao Huang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, China
| | - Haiyan Yin
- Department of Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Nannapaneni S, Silvis J, Curfman K, Chung T, Simunich T, Morrissey S, Dumire R. Bronchoscopy Decreases Ventilator-Associated Pneumonia in Trauma Patients. Am Surg 2021; 88:653-657. [PMID: 34879745 DOI: 10.1177/00031348211058639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Health care-associated pneumonias (HAPs) are a significant comorbidity seen in hospitalized patients. Traumatic injury is a known independent risk factor for the development of HAP. Trauma-related injuries also contribute to an increase in the rate of pneumonia in mechanically ventilated patients requiring intensive care unit (ICU) treatment. In 2011, the ventilator-associated pneumonia (VAP) rate among ICU patients at our institution (CMMC) increased dramatically. As a result, our infection control specialists performed a focused review of these patients and found a likely association between these infections and patients requiring pre-hospital intubation. Their determination prompted a July 2012 revision of the CMMC Trauma/Surgery Admission ICU protocol for ventilated patients to include bronchoscopy for all patients who have been intubated pre-hospital providing no contraindications were present. Our aim was to ascertain any influence of the protocol change on the rate of VAP. We conducted a retrospective medical record review of trauma patients who were intubated in the field or ED and seen at our institution (an accredited Level 1 trauma center) from 2012 to 2018. Applying the current definition of VAP from the Centers for Disease Control and Prevention (CDC) to data collected from the CMMC trauma registry, we observed a 13% lower VAP rate in the bronchoscopy group (YB) as compared to the group that did not receive bronchoscopy (NB) (P < .025). Based on our results, we determined that bronchoscopy performed in this setting does support a statistically significant decrease in the rate of ventilator-associated pneumonia.
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Affiliation(s)
| | - Jennifer Silvis
- Department of Surgrey, 21654UConn Health, Farmington, CT, USA
| | - Karleigh Curfman
- Department of Surgrey, 4157Conemaugh Health System, Johnstown, PA, USA
| | - Timothy Chung
- Department of Surgrey, 4157Conemaugh Health System, Johnstown, PA, USA
| | | | - Shawna Morrissey
- Department of Surgrey, 4157Conemaugh Health System, Johnstown, PA, USA
| | - Russell Dumire
- 22465Conemaugh Memorial Medical Center, Johnstown, PA, USA
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5
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Chen QY, He YS, Liu K, Cao J, Chen YX. Bronchoscopy for diagnosis of COVID-19 with respiratory failure: A case report. World J Clin Cases 2021; 9:1132-1138. [PMID: 33644177 PMCID: PMC7896661 DOI: 10.12998/wjcc.v9.i5.1132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/24/2020] [Accepted: 01/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Although the imaging features of coronavirus disease 2019 (COVID-19) are starting to be well determined, what actually occurs within the bronchi is poorly known. Here, we report the processes and findings of bronchoscopy in a patient with COVID-19 accompanied by respiratory failure.
CASE SUMMARY A 65-year-old male patient was admitted to the Hainan General Hospital on February 3, 2020 for fever and shortness of breath for 13 d that worsened for the last 2 d. The severe acute respiratory syndrome coronavirus 2 nucleic acid test was positive. Routine blood examination on February 28 showed a white blood cell count of 11.02 × 109/L, 86.9% of neutrophils, 6.4% of lymphocytes, absolute lymphocyte count of 0.71 × 109/L, procalcitonin of 2.260 ng/mL, and C-reactive protein of 142.61 mg/L. Oxygen saturation was 46% at baseline and turned to 94% after ventilation. The patient underwent video bronchoscopy. The tracheal cartilage ring was clear, and no deformity was found in the lumen. The trachea and bilateral bronchi were patent, while the mucosa was with slight hyperemia; no neoplasm or ulcer was found. Moderate amounts of white gelatinous secretions were found in the dorsal segment of the left inferior lobe, and the bronchial lumen was patent after sputum aspiration. The right inferior lobe was found with hyperemia and mucosal erosion, with white gelatinous secretion attachment. The patient’s condition did not improve after the application of therapeutic bronchoscopy.
CONCLUSION For patients with COVID-19 and respiratory failure, bronchoscopy can be performed under mechanical ventilation to clarify the airway conditions. Protection should be worn during the process. Considering the risk of infection, it is not necessary to perform bronchoscopy in the mild to moderate COVID-19 patients.
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Affiliation(s)
- Qing-Yun Chen
- Department of Respiratory and Critical Care Medicine, Hainan General Hospital, Haikou 570311, Hainan Province, China
| | - Yu-Sheng He
- Department of Internal Medicine, Hainan Province's Fucheng Drug Rehabilitation Centre, Haikou 570311, Hainan Province, China
| | - Kai Liu
- Department of Respiratory and Critical Care Medicine, Hainan General Hospital, Haikou 570311, Hainan Province, China
| | - Jing Cao
- Infection Department, Hainan General Hospital, Haikou 570311, Hainan Province, China
| | - Yong-Xing Chen
- Department of Respiratory and Critical Care Medicine, Hainan General Hospital, Haikou 570311, Hainan Province, China
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6
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Yang H, Chen H, Gao B, Xiong W, Zhang X, Hogarth DK, Sun J, Ke M, Herth FJF. Expert panel consensus statement on the applications and precaution strategies of bronchoscopy in patients with COVID-19. Endosc Ultrasound 2020; 9:211-219. [PMID: 32769235 PMCID: PMC7529002 DOI: 10.4103/eus.eus_45_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 06/11/2020] [Indexed: 12/23/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus with higher transmissibility compared with SARS coronavirus (SARS-CoV) and Middle East respiratory distress syndrome coronavirus. Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 is an unprecedented global crisis that has not been experienced, which is still disrupting health systems, economies, and societies around the world by the rapid spread. Bronchoscopy plays an important role in diagnosis and therapy of pulmonary diseases, especially in patients with severe pulmonary infection, however, application of bronchoscopy in patients suspected or confirmed SARS-CoV-2 infection is extremely limited for the potential airborne transmission from aerosol generated during the procedure. This consensus statement was completed by expert panel of Interventional & Minimally Invasive Respiratory Committee of China Medical Education Association, and the issues were summarized as seven key topics to define the indications of bronchoscopy and matters needing attentions on the bronchoscopy procedures in patients with COVID-19, as well as the protective precaution strategies to avoid nosocomial SARS-CoV-2 infection.
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Affiliation(s)
- Huizhen Yang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
- Department of Respiratory Endoscopy and Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Huidong Chen
- Department of Respiratory Endoscopy, Jinyintan Hospital of Wuhan, Wuhan, Hubei Province, China
| | - Baoan Gao
- Institute of Respiratory Disease, China Three Gorges University, Yichang Central Hospital, Yichang, Sichuan Province, China
| | - Weining Xiong
- Department of Respiratory and Critical Care Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoju Zhang
- Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
| | - D. Kyle Hogarth
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Jiayuan Sun
- Department of Respiratory Endoscopy and Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Mingyao Ke
- Department of Respiratory Centre, The second Affiliated Hospital of Xiamen Medical College, Xiamen, Fujian Province, China
| | - Felix J. F. Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Heidelberg, Germany
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7
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Jarosz K, Kubisa B, Andrzejewska A, Mrówczyńska K, Hamerlak Z, Bartkowska-Śniatkowska A. Adverse outcomes after percutaneous dilatational tracheostomy versus surgical tracheostomy in intensive care patients: case series and literature review. Ther Clin Risk Manag 2017; 13:975-981. [PMID: 28860781 PMCID: PMC5560236 DOI: 10.2147/tcrm.s135553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Tracheostomy is a routinely done procedure in the setting of intensive care unit (ICU) in patients requiring prolonged mechanical ventilation. There are two ways of making a tracheostomy: an open surgical tracheostomy and percutaneous dilatational tracheostomy. Percutaneous dilatational tracheostomy is associated with fewer complications than open tracheostomy. In this study, we would like to compare both techniques of performing a tracheostomy in ICU patients and to present possible complications, methods of diagnosing and treating and minimizing their risk.
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Affiliation(s)
- Konrad Jarosz
- Department of Clinical Nursing, Pomeranian Medical University
| | - Bartosz Kubisa
- Thoracic Surgery and Transplantation Department, Pomeranian Medical University
| | - Agata Andrzejewska
- Anaesthesiology and Intensive Care Department, Pomeranian Medical University
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8
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Lee HW, Min J, Park J, Lee YJ, Kim SJ, Park JS, Yoon HI, Lee JH, Lee CT, Cho YJ. Clinical impact of early bronchoscopy in mechanically ventilated patients with aspiration pneumonia. Respirology 2015; 20:1115-22. [PMID: 26147124 DOI: 10.1111/resp.12590] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 03/22/2015] [Accepted: 04/22/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE A handful of studies have reported that bronchoscopies influence the clinical outcome of mechanically ventilated patients with aspiration pneumonia. The purpose of the present study is to elucidate the therapeutic role of early bronchoscopy in patients with aspiration who are mechanically ventilated. METHODS A retrospective cohort study was conducted via medical record review from 2003 through 2013 in a tertiary hospital. All the diagnoses of pneumonia were supported by the probability of aspiration and consolidation of dependent areas confirmed by computed tomography. Patients who underwent bronchoscopy within 24 h after intubation were categorized as the early bronchoscopy group and the others as the late bronchoscopy group. We compared the demographics, clinical parameters and outcomes between the two groups. RESULTS Of the 154 patients who were included, the early bronchoscopy group (n = 93) showed significantly lower in-intensive care unit (ICU) mortality and 90-day mortality (in-ICU: 4.9% vs 24.6%; 90-day: 11.8 vs 32.8%) regardless of the initial empirical antibiotics. In addition, their sequential organ failure assessment score on day 7 tended to decrease more rapidly. Among the survivors, patients in the early bronchoscopy group were extubated earlier with a higher success rate, had a shorter length of mechanical ventilation and had a shorter ICU stay. The early bronchoscopy was associated with lower 90-day mortality in multivariate analysis (odds ratio: 0.412; 95% confidence interval: 0.192-0.883). CONCLUSIONS Early bronchoscopy could benefit the clinical outcomes of mechanically ventilated patients with aspiration pneumonia.
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Affiliation(s)
- Hyun Woo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jinsoo Min
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jisoo Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Yeon Joo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Se Joong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jong Sun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Ho Il Yoon
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Jae-Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Choon-Taek Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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