Evaluation of a 24-hour emergency bronchoscopy service in a tertiary care hospital.
BACKGROUND
Flexible bronchoscopy has become an important diagnostic and therapeutic tool for the management of patients with various diseases of the chest. Availability of a 24-hour bronchoscopy service equipped with experienced personnel is becoming increasingly important especially for intensive care patients. However, such services have been implemented only in a few medical centres. The aim of this study was to evaluate the usage of a 24-hour emergency service in a large university hospital with a 1 year prospective analysis of emergency bronchoscopy service in a tertiary care centre.


METHODS
Frequencies, indications and efficiency of therapeutic interventions were evaluated after each bronchoscopy using a specially designed questionnaire. All bronchoscopies were performed as emergency procedures out of operational schedule. A total of 614 emergency bronchoscopies were performed, 88% of them in intensive care units.


RESULTS
The vast majority (84.5%) of the procedures were necessary for therapeutic interventions; that is, atelectasis, airway secretion, aspiration or bronchopulmonary bleeding. According to prespecified criteria, 37.6% (n = 195) of therapeutic procedures were assessed as 'very helpful' and 3.9% (n = 20) as 'life saving'. Diagnostic bronchoscopies were performed mainly to collect airway material for microbiological evaluations in immunocompromised patients. In these cases, the diagnostic yield was approximately 50%.


CONCLUSIONS
The availability of a 24-hour bronchoscopy service has been found to improve patient care and was occasionally considered life saving. Thus, comparable services should be made more widely available.
Fuehner
Thomas
T
Department of Respiratory Medicine, Medizinische Hochschule Hannover, Hannover, Germany. fuehner.thomas@mh-hannover.de
Lueders
Detlef
D
Niedermeyer
Jost
J
Ziesing
Stefan
S
Welte
Tobias
T
Hoeper
Marius M
MM
D001999:Bronchoscopy / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000458:organization & administration; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005858:Germany; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D011446:Prospective Studies; D001261:Pulmonary Atelectasis / Q000601:surgery; D012121:Respiration, Artificial; D012139:Respiratory Therapy Department, Hospital / Q000458:organization & administration*; D014139:Tracheostomy