David E Ost1, Armin Ernst2, Horiana B Grosu3, Xiudong Lei4, Javier Diaz-Mendoza5, Mark Slade6, Thomas R Gildea7, Michael Machuzak8, Carlos A Jimenez3, Jennifer Toth9, Kevin L Kovitz10, Cynthia Ray11, Sara Greenhill12, Roberto F Casal13, Francisco A Almeida7, Momen Wahidi14, George A Eapen3, Lonny B Yarmus15, Rodolfo C Morice3, Sadia Benzaquen16, Alain Tremblay17, Michael Simoff5. 1. Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: dost@mdanderson.org. 2. The Reliant Medical Group, Boston, MA. 3. Pulmonary Department (Drs Ost, Grosu, The University of Texas MD Anderson Cancer Center, Houston, TX. 4. Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX. 5. The Department of Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI. 6. Department of Thoracic Oncology, Papworth Hospital, Cambridge, England. 7. Department of Pulmonary, Allergy, and Critical Care, Cleveland Clinic Foundation, Cleveland, OH. 8. Department of Pulmonary Medicine, Cleveland Clinic, Cleveland, OH. 9. Penn State Cancer Institute, Hershey, PA. 10. University of Illinois Hospital & Health Sciences Center, Chicago, IL. 11. Department of Internal Medicine, Henry Ford Hospital, Detroit, MI. 12. Chicago Chest Center Interventional Pulmonology, Elk Grove Village, IL. 13. Department of Pulmonary, Critical Care, and Sleep Medicine, Baylor College of Medicine, Houston, TX. 14. Department of Internal Medicine, Division of Pulmonary, Allergy and Critical Care Medicine, Duke University Medical Center, Raleigh, NC. 15. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD. 16. Division of Pulmonary, Critical Care and Sleep Medicine, University of Cincinnati, Cincinnati, OH. 17. Department of Medicine, University of Calgary, Calgary, AB, Canada.
Abstract
BACKGROUND: There are significant variations in how therapeutic bronchoscopy for malignant airway obstruction is performed. Relatively few studies have compared how these approaches affect the incidence of complications. METHODS: We used the American College of Chest Physicians (CHEST) Quality Improvement Registry, Evaluation, and Education (AQuIRE) program registry to conduct a multicenter study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was the incidence of complications. Secondary outcomes were incidence of bleeding, hypoxemia, respiratory failure, adverse events, escalation in level of care, and 30-day mortality. RESULTS: Fifteen centers performed 1,115 procedures on 947 patients. There were significant differences among centers in the type of anesthesia (moderate vs deep or general anesthesia, P < .001), use of rigid bronchoscopy (P < .001), type of ventilation (jet vs volume cycled, P < .001), and frequency of stent use (P < .001). The overall complication rate was 3.9%, but significant variation was found among centers (range, 0.9%-11.7%; P = .002). Risk factors for complications were urgent and emergent procedures, American Society of Anesthesiologists (ASA) score > 3, redo therapeutic bronchoscopy, and moderate sedation. The 30-day mortality was 14.8%; mortality varied among centers (range, 7.7%-20.2%, P = .02). Risk factors for 30-day mortality included Zubrod score > 1, ASA score > 3, intrinsic or mixed obstruction, and stent placement. CONCLUSIONS: Use of moderate sedation and stents varies significantly among centers. These factors are associated with increased complications and 30-day mortality, respectively.
BACKGROUND: There are significant variations in how therapeutic bronchoscopy for malignant airway obstruction is performed. Relatively few studies have compared how these approaches affect the incidence of complications. METHODS: We used the American College of Chest Physicians (CHEST) Quality Improvement Registry, Evaluation, and Education (AQuIRE) program registry to conduct a multicenter study of patients undergoing therapeutic bronchoscopy for malignant central airway obstruction. The primary outcome was the incidence of complications. Secondary outcomes were incidence of bleeding, hypoxemia, respiratory failure, adverse events, escalation in level of care, and 30-day mortality. RESULTS: Fifteen centers performed 1,115 procedures on 947 patients. There were significant differences among centers in the type of anesthesia (moderate vs deep or general anesthesia, P < .001), use of rigid bronchoscopy (P < .001), type of ventilation (jet vs volume cycled, P < .001), and frequency of stent use (P < .001). The overall complication rate was 3.9%, but significant variation was found among centers (range, 0.9%-11.7%; P = .002). Risk factors for complications were urgent and emergent procedures, American Society of Anesthesiologists (ASA) score > 3, redo therapeutic bronchoscopy, and moderate sedation. The 30-day mortality was 14.8%; mortality varied among centers (range, 7.7%-20.2%, P = .02). Risk factors for 30-day mortality included Zubrod score > 1, ASA score > 3, intrinsic or mixed obstruction, and stent placement. CONCLUSIONS: Use of moderate sedation and stents varies significantly among centers. These factors are associated with increased complications and 30-day mortality, respectively.
Authors: S Sasano; T Onuki; T Adachi; K Oyama; T Ikeda; M Kanzaki; H Kuwata; M Sakuraba; T Matsumoto; S Nitta Journal: Jpn J Thorac Cardiovasc Surg Date: 2001-05
Authors: David E Ost; Armin Ernst; Horiana B Grosu; Xiudong Lei; Javier Diaz-Mendoza; Mark Slade; Thomas R Gildea; Michael S Machuzak; Carlos A Jimenez; Jennifer Toth; Kevin L Kovitz; Cynthia Ray; Sara Greenhill; Roberto F Casal; Francisco A Almeida; Momen M Wahidi; George A Eapen; David Feller-Kopman; Rodolfo C Morice; Sadia Benzaquen; Alain Tremblay; Michael Simoff Journal: Chest Date: 2015-05 Impact factor: 9.410
Authors: Horiana B Grosu; George A Eapen; Rodolfo C Morice; Carlos A Jimenez; Roberto F Casal; Francisco A Almeida; Mona G Sarkiss; David E Ost Journal: Chest Date: 2013-08 Impact factor: 9.410
Authors: Chris T Bolliger; Albrecht Breitenbuecher; Martin Brutsche; Markus Heitz; Franz Stanzel Journal: Respiration Date: 2004 Jan-Feb Impact factor: 3.580