Fiberoptic Bronchoscopy in Coronary Care Unit Patients
| Autor: | Edward F. Haponik, Henry L. Burke, Robert Chin, Donnie P. Dunagan, Suzanne L. Aquino, Norman E. Adair |
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| Rok vydání: | 1998 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty medicine.diagnostic_test business.industry medicine.medical_treatment Respiratory disease Retrospective cohort study Critical Care and Intensive Care Medicine Chest pain medicine.disease Surgery Pneumonia Bronchoscopy Internal medicine medicine Coronary care unit Intubation Myocardial infarction medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Chest. 114:1660-1667 |
| ISSN: | 0012-3692 |
| DOI: | 10.1378/chest.114.6.1660 |
| Popis: | Study objectives To evaluate the indications, safety, therapeutic impact, and outcome of fiberoptic bronchoscopy (FOB) in coronary care unit (CCU) patients. Design Retrospective review of all CCU patients undergoing FOB during a 6-year period. Setting Tertiary care university hospital. Results Among 8,330 patients admitted to the CCU; 40 (0.5%) patients underwent FOB to evaluate pulmonary abnormalities, most often (78%) to appraise clinically suspected pneumonia. Thirty-five (88%) patients were intubated and 21 (53%) had acute myocardial infarction (MI) before FOB. There were two major complications (bleeding, intubation) occurring within 24 h of FOB, one of which appeared due to the procedure. No episodes of chest pain or ischemic events were recorded and no significant increase in major complications was noted in MI patients (3% vs 5%). Patients having FOB within 10 days of MI had higher survival (79%) than those undergoing FOB later (29%) (p = 0.05). Seven different bacterial pathogens were isolated in 6 (15%) patients, probably reflecting prior empiric antibiotics in 32 (80%) patients. Therapy was changed in 64% of patients in whom a potential pathogen was identified. Despite alterations in treatment, patients with clinically suspected pneumonia and any organisms isolated by FOB had greater mortality (79% vs 31%, p = 0.003) than those with sterile FOB cultures. Conclusion FOB may be diagnostically useful in the evaluation of pulmonary abnormalities in selected patients with acute cardiac disease, can be performed safely, and may influence management decisions. Positive bronchoscopy cultures often influence therapy but are associated with higher mortality, suggesting a lethal effect of nosocomial pneumonia in this subset of CCU patients. The risks of FOB must be weighed with the impact of FOB results on patient outcome, and its role requires further investigation. |
| Databáze: | OpenAIRE |
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