Pulmonary Fellow; Division of Pulmonary and Critical Care Medicine, BronxCare Health System affiliated with Icahn School of Medicine at Mount Sinai, New York City, New York, USA.
Clinical Assistant Professor, Medicine, BronxCare Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA.
BMJ Open Respir Res. 2019 Aug 26;6(1):e000427. doi: 10.1136/bmjresp-2019-000427. eCollection 2019.
Although the incidence and prevalence of atelectatic lung collapse is unknown, such events are common among inpatients, and there are no guidelines for optimally instituting bronchoscopic techniques. The aim of this study was to evaluate the outcomes of patients with complete or near-complete lung collapse managed via interventional flexible fibreoptic bronchoscopy or a conservative approach.
Retrospective analysis of all adult patients admitted to BronxCare Health System between January 2011 and October 2017 with a diagnosis of lung collapse/atelectasis. The primary outcome was radiological resolution. Timing of bronchoscopy relative to radiological resolution and mortality served as secondary outcomes.
Of the 177 patients meeting inclusion criteria, 149 (84%) underwent bronchoscopy and 28 (16%) were managed through conservative measures only. A significantly greater number of patients in the bronchoscopy group achieved complete or near-complete resolution on chest X-ray, compared with the conservative group (p=0.007). Timing of bronchoscopy had no impact on the rate of radiological resolution, and mortality in the two groups was similar. New endobronchial malignancies were identified in 21 patients (14%).
Our data support the central role of bronchoscopy in instances of complete or near-complete lung collapse, ensuring better radiological outcomes. Judicious use of conservative management is warranted to avoid missing significant pathology. A prime consideration in this setting is obstructive malignancy.
尽管肺不张塌陷的发病率和患病率尚不清楚，但此类事件在住院患者中很常见，而且目前也没有关于最佳实施支气管镜技术的指南。本研究旨在评估通过介入性纤维支气管镜或保守方法治疗完全或接近完全性肺塌陷患者的结局。
回顾性分析 2011 年 1 月至 2017 年 10 月期间在 BronxCare 医疗系统就诊的所有成人患者，这些患者的诊断为肺塌陷/肺不张。主要结局是影像学缓解。支气管镜检查的时间与影像学缓解和死亡率是次要结局。
在符合纳入标准的 177 例患者中，149 例（84%）接受了支气管镜检查，28 例（16%）仅接受了保守治疗。与保守组相比，支气管镜组有更多的患者在胸部 X 光片上实现了完全或接近完全的缓解（p=0.007）。支气管镜检查的时间对影像学缓解率没有影响，两组的死亡率相似。21 例（14%）患者新确诊为支气管内恶性肿瘤。
我们的数据支持在完全或接近完全性肺塌陷的情况下，支气管镜检查起着核心作用，可确保更好的影像学结局。需要谨慎地采用保守治疗，以避免漏诊重要的病理学。在这种情况下，首要考虑因素是阻塞性恶性肿瘤。
