Department of Emergency Medicine, Kaiser Permanente Medical Center, San Diego, CA, USA.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
Am J Emerg Med. 2022 Aug;58:114-119. doi: 10.1016/j.ajem.2022.05.040. Epub 2022 May 28.
Flexible bronchoscopy has been safely used for decades in ambulatory and critical care settings to aid in the diagnosis and treatment of tracheobronchial tree disorders. Although emergency physicians have the requisite skills to operate and interpret flexible bronchoscopy, no reports exist on the use of bronchoscopy by emergency physicians apart from endotracheal tube placement and confirmation.
The primary goal of this study was to describe the indications, outcomes and complications of flexible bronchoscopy performed by emergency physicians in an urban academic emergency department.
This was a single-center retrospective cohort study involving chart and video review of 146 patients over a 10.5-year study period. Patients of any age were included if they had been tracheally intubated or mechanically ventilated and underwent flexible bronchoscopy in the emergency department. After patients were identified, manual chart and video review was used to collect data on patient demographics, indications for intubation, indications for bronchoscopy, details of the bronchoscopy procedure, procedural findings, outcomes of the procedure, complications, provider training levels, and additional bronchoscopies performed after admission. The data was analyzed using descriptive statistics.
146 patients were included in the study and all bronchoscopies were performed or supervised by attending emergency physicians. After bronchoscopy, 24% of patients displayed improvement in oxygenation or lobar collapse while most patients had no change in clinical status. One patient had temporary hypoxemia after bronchoscopy. When another physician performed a subsequent bronchoscopy during admission, the findings were in agreement with the ED bronchoscopy 86% of the time.
At our institution, emergency physicians can safely and effectively use flexible bronchoscopy to diagnose and treat critically ill patients.
几十年来，在门诊和重症监护环境中，柔性支气管镜已安全用于辅助诊断和治疗气管支气管树疾病。尽管急诊医师具备操作和解释柔性支气管镜的必要技能，但除了气管内管放置和确认外，尚无关于急诊医师使用支气管镜的报道。
本研究的主要目的是描述在城市学术急诊部门由急诊医师进行的柔性支气管镜检查的适应证、结果和并发症。
这是一项单中心回顾性队列研究，涉及在 10.5 年的研究期间对 146 名患者的图表和视频进行回顾。纳入任何年龄的患者，只要他们已经气管插管或机械通气，并在急诊科进行了柔性支气管镜检查。在确定患者后，通过手动图表和视频回顾收集患者人口统计学数据、插管指征、支气管镜检查指征、支气管镜检查程序细节、程序结果、程序并发症、提供者培训水平以及入院后进行的其他支气管镜检查。使用描述性统计分析数据。
本研究纳入了 146 名患者，所有支气管镜检查均由主治急诊医师进行或监督。支气管镜检查后，24%的患者氧合或肺叶塌陷情况有所改善，而大多数患者临床状况无变化。一名患者支气管镜检查后出现短暂低氧血症。当另一名医生在住院期间进行后续支气管镜检查时，发现结果与急诊科支气管镜检查的一致性为 86%。
在我们的机构中，急诊医师可以安全有效地使用柔性支气管镜来诊断和治疗危重症患者。
