title: Flexible bronchoscopy-induced massive bleeding: A 12-year multicentre retrospective cohort study.
abstract: OBJECTIVE
  Although massive bleeding is the most life-threatening complication caused by flexible bronchoscopy, data on flexible bronchoscopy-induced massive bleeding are scarce, and the associated clinical characteristics and prognostic factors are unknown.
  
  
  METHODS
  This was a multicentre retrospective cohort study of all patients who underwent flexible bronchoscopy in 33 tertiary hospitals from January 2001 to June 2013. The clinical characteristics and outcomes were collected and analysed.
  
  
  RESULTS
  A total of 194 patients with massive bleeding were identified among 520 343 patients who underwent flexible bronchoscopy. The average blood loss reached up to 378 mL. The overall incidence and mortality were 0.037% and 0.004%, respectively, and the overall fatality was 10.8%. The risk of massive bleeding induced by therapeutic bronchoscopies was significantly higher than that induced by diagnostic bronchoscopies (incidence: 0.059% vs 0.031%, P < 0.001; mortality: 0.012% vs 0.003%, P < 0.001; fatality: 20% vs 8.4%, P = 0.068). Multivariate analysis showed that age ≥65 years, tracheal bleeding, blood loss ≥500 mL and occurrence of shock were independent factors predicting poor outcome, while emergency surgery was an independent protective factor. Re-bleeding occurred in six patients, resulting in three deaths within a month.
  
  
  CONCLUSIONS
  Flexible bronchoscopy-induced massive bleeding is rare but life-threatening. Age, bleeding location, bleeding volume, circulation condition and emergency surgery were independent prognostic factors.
authors.affiliation: Department of Respiratory Medicine, Center of Interventional Pulmonology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Guo-Wu
authors.initials: GW
authors.lastname: Zhou
authors.affiliation: Department of Respiratory Medicine, Center of Interventional Pulmonology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Respiratory Medicine, Center of Interventional Pulmonology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Yu-Chao
authors.initials: YC
authors.lastname: Dong
authors.affiliation: Department of Respiratory Medicine, Center of Interventional Pulmonology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Hai-Dong
authors.initials: HD
authors.lastname: Huang
authors.affiliation: Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha.
authors.forename: Chengping
authors.initials: C
authors.lastname: Hu
authors.affiliation: Department of Respiratory Medicine, Shanghai Thorax Hospital, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Jiayuan
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an.
authors.forename: Faguang
authors.initials: F
authors.lastname: Jin
authors.affiliation: Department of Respiratory Medicine, Shanghai Pulmonary Hospital, Tongji University, Shanghai, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Gu
authors.affiliation: Department of Respiratory Medicine, Center of Interventional Pulmonology, Changhai Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Li
authors.affiliation: Department of Respiratory Medicine, Guangzhou Institute of Respiratory Disease, Guangzhou, China.
authors.forename: Shiyue
authors.initials: S
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000401:mortality / Q000503:physiopathology; D001810:Blood Volume; D001999:Bronchoscopy / Q000009:adverse effects* / Q000379:methods; D002681:China / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012771:Shock, Hemorrhagic / Q000209:etiology / Q000401:mortality / Q000601:surgery
keywords: flexible bronchoscopy; incidence; massive bleeding; mortality; prognosis