title: Bronchoscopy assessment of acute respiratory failure in interstitial lung disease.
abstract: Acute respiratory failure (ARF) in patients with interstitial lung disease (ILD) is associated with significant morbidity and mortality. Recommended assessment for acute exacerbation (AE) of ILD includes exclusion of secondary causes via fibreoptic bronchoscopy. Our aim is to assess the role of bronchoscopy during ARF-ILD.
  
  
  
  Consecutive ILD patients (2002-2014) hospitalized with ARF who underwent bronchoscopy were included. Baseline demographics, underlying ILD diagnoses and presenting clinical features were reviewed. Characteristics of bronchoscopy including diagnostic findings, management and complications were collated.
  
  
  
  One hundred and six patients accounted for 119 unique bronchoscopies. Sixteen (13%) were abnormal (12 infections and 4 haemorrhages). Baseline presenting clinical features did not differ between those with and without abnormal findings. About half were performed in an intensive care unit (ICU) (53%), with 25% of bronchoscopies performed in a general floor setting resulting in ICU transfer; 71% of whom resulted in immediate mechanical ventilation. Overall management of ARF in those with positive bronchoscopy findings was similar to those without, resulting in similar in-hospital mortality.
  
  
  
  Bronchoscopy in the clinical assessment of ARF-ILD is often performed with only a 13% yield in this large retrospective cohort. As management and in-hospital mortality were similar, routine diagnostic bronchoscopy in ARF-ILD should be further studied given its low yield and high procedural risk.
authors.affiliation: Department of Respiratory Diseases, University of Sassari, Sassari, Italy.|Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Antonella
authors.initials: A
authors.lastname: Arcadu
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Teng
authors.initials: T
authors.lastname: Moua
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D019468:Disease Management; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000379:methods; D012131:Respiratory Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D012189:Retrospective Studies; D000067251:Symptom Flare Up
keywords: bronchoscopy; connective tissue disease-associated lung disease; idiopathic pulmonary fibrosis; interstitial fibrosis