Flexible bronchoscopy with moderate sedation in COPD: a case–control study

Abstract

Background

Flexible bronchoscopy is increasingly used for diagnostic and therapeutic purposes. We aimed to examine the safety of flexible bronchoscopy with moderate sedation in patients with COPD.

Methods

This study is a prospective, longitudinal, case–control, single-center study including 1,400 consecutive patients. After clinical and lung function assessments, patients were dichotomized in COPD or non-COPD groups. The primary end point was the combined incidence of complications.

Results

The incidence of complications was similar in patients with and without COPD and independent of forced expiratory volume in the first second % predicted. Patients with COPD more frequently required insertion of a naso- or oropharyngeal airway; however, this difference was no longer significant after adjustment for age, gender, and duration of the procedure. Hypotension was significantly more common among patients with COPD. The number of episodes of hypoxemia ≤90% did not differ between the groups. However, patients with COPD had a lower mean and nadir transcutaneous oxygen saturation. Transcutaneous carbon dioxide tension (PtcCO₂) change over the time course was similar in both groups, but both peak PtcCO₂ and time on PtcCO₂ >45 mmHg were higher in the COPD group. There were no differences in patient-reported outcomes.

Conclusion

The safety of flexible bronchoscopy is similar in patients with and without COPD. This finding confirms the suitability of the procedure for both clinical and research indications.

Keywords:

• bronchoalveolar lavage
• propofol
• complication
• risk
• respiratory insufficiency

Acknowledgments

We thank the endoscopy staff, particularly EP, and Anja Meyer RN for the support during the trial. We also thank Andy Schötzau and Christian Müller (Eudox AG) for statistical analyses. Daiana Stolz was supported by grants from the Swiss National Foundation (PP00P3_128412/1). Additional funding was provided by the Clinic of Pulmonary Medicine and Respiratory Cell Research, University Hospital Basel.

Some of the data of this manuscript have been honored with an oral presentation at the Chest Conference 2015, Montreal, Canada.

Author contributions

All authors contributed toward data analysis, drafting and critically revising the paper, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.