Emergency Department, Hospital Braunschweig, Braunschweig, Germany.
Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.
Respiration. 2021;100(7):600-610. doi: 10.1159/000515134. Epub 2021 Apr 13.
Bronchoscopy is widely used and regarded as standard of care in most intensive care units (ICUs). Data concerning recommendations for on-call bronchoscopy are lacking.
Evaluation of recommendations, complications, and outcome of on-call bronchoscopies.
A retrospective single-centre analysis was conducted in a large university hospital. All on-call bronchoscopies performed outside normal working hours in the year before (period 1) and after (period 2) establishing a catalogue of recommendations for indications of on-call bronchoscopy on November 1, 2016, were included.
Overall, 924 bronchoscopies in 538 patients were analysed. A relative reduction of 83.6% from 794 bronchoscopies in 432 patients (1.84 per patient) during period 1 to 130 in 107 patients (1.21 per patient) during period 2 was observed. Most bronchoscopies (812/924, 87.9%) were performed in ICUs, and 416 patients (77.3%) were intubated. Bronchoscopies for excessive secretions decreased significantly during period 2. Fifty-three of 130 bronchoscopies (40.8%) fulfilled the specified recommendations during period 2, in comparison with 16.8% in period 1 (p < 0.001). Complications were recorded in 58 of 924 procedures (6.3%) and were more frequent in period 2, especially moderate bleeding. In-hospital mortality of patients undergoing on-call bronchoscopy did not differ between periods and was 28.7 and 30.2% in periods 1 and 2, respectively.
The introduction of recommendations for on-call bronchoscopy led to a significant decline of on-call bronchoscopies without negatively affecting outcome. More evidence is needed in on-call bronchoscopy, especially for ICU patients with intrinsic higher complication rates.
支气管镜检查在大多数重症监护病房（ICU）中广泛应用，并被视为标准治疗方法。目前缺乏有关紧急支气管镜检查推荐意见、并发症和结果的数据。
评估紧急支气管镜检查的推荐意见、并发症和结果。
对一家大型大学医院进行回顾性单中心分析。纳入 2016 年 11 月 1 日建立紧急支气管镜检查适应证推荐意见目录之前（第 1 期）和之后（第 2 期）所有在非工作时间进行的紧急支气管镜检查。
共分析了 538 例患者的 924 次支气管镜检查。与第 1 期的 794 次支气管镜检查（432 例患者，1.84 次/例）相比，第 2 期的 130 次支气管镜检查（107 例患者，1.21 次/例）相对减少了 83.6%。大多数支气管镜检查（812/924，87.9%）在 ICU 进行，416 例（77.3%）患者插管。第 2 期过度分泌的支气管镜检查明显减少。与第 1 期（16.8%）相比，第 2 期符合指定推荐意见的支气管镜检查有 53 次（40.8%）（p<0.001）。924 次操作中记录了 58 次并发症（6.3%），第 2 期更为常见，尤其是中度出血。接受紧急支气管镜检查的患者住院死亡率在两个时期没有差异，分别为第 1 期和第 2 期的 28.7%和 30.2%。
紧急支气管镜检查推荐意见的引入显著减少了紧急支气管镜检查的次数，而没有对结果产生负面影响。在紧急支气管镜检查方面需要更多的证据，特别是对于 ICU 患者，他们的并发症发生率更高。
