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16.06.2017

Pneumothorax After Transbronchial Biopsy in Pulmonary Fibrosis: Lessons from the Multicenter COMET Trial

verfasst von: Jonathan A. Galli, Nicholas L. Panetta, Nathaniel Gaeckle, Fernando J. Martinez, Bethany Moore, Thomas Moore, Anthony Courey, Kevin Flaherty, Gerard J. Criner, for the COMET investigators

Erschienen in: Lung | Ausgabe 5/2017

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Abstract

Purpose

Some patients with diffuse interstitial lung disease (ILD) undergo bronchoscopy with transbronchial biopsy (TBB) as part of their diagnostic evaluation. It is unclear what the incidence and risk factors for pneumothorax (PTX) following TBB are in this patient population.

Methods

Ninety-seven subjects with pulmonary fibrosis who underwent a research bronchoscopy with TBB as part of the multicenter correlating outcomes with biochemical markers to estimate time-progression in idiopathic pulmonary fibrosis (COMET) trial were retrospectively reviewed. We compared subjects who developed a PTX during research bronchoscopy with TBB versus those who did not.

Results

Seven patients (7.2%) experienced a PTX during research bronchoscopy with TBB. Subjects who experienced PTX during TBB had significantly lower DLCO percent predicted (29 ± 8 vs. 45 ± 15, P = 0.006) and had lower resting room air saturation of peripheral oxygen (SPO2) on 6-min walk testing (91 ± 10 vs. 95 ± 3, P = 0.02). No differences between groups were found with respect to age, gender, race, BMI, HRCT characteristics, or the number of transbronchial biopsies performed.

Conclusion

The incidence of PTX following research bronchoscopy with TBB in patients with pulmonary fibrosis was found to be 7.2% in this study. Patients who developed a pneumothorax had greater impairments in gas exchange at baseline evidenced by a lower DLCO  % predicted and a lower resting room air SPO2 compared with subjects without PTX as a complication.
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Literatur
1.
Zurück zum Zitat Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK et al (2011) An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: Evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 183(6):788–824CrossRefPubMedPubMedCentral Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK et al (2011) An official ATS/ERS/JRS/ALAT statement: idiopathic pulmonary fibrosis: Evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 183(6):788–824CrossRefPubMedPubMedCentral
2.
Zurück zum Zitat American Thoracic Society (2002) European Respiratory Society. American thoracic Society/European respiratory society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 165(2):277–304CrossRef American Thoracic Society (2002) European Respiratory Society. American thoracic Society/European respiratory society international multidisciplinary consensus classification of the idiopathic interstitial pneumonias. Am J Respir Crit Care Med 165(2):277–304CrossRef
3.
Zurück zum Zitat Pue CA, Pacht ER (1995) Complications of fiberoptic bronchoscopy at a university hospital. Chest 107(2):430–432CrossRefPubMed Pue CA, Pacht ER (1995) Complications of fiberoptic bronchoscopy at a university hospital. Chest 107(2):430–432CrossRefPubMed
4.
Zurück zum Zitat Selman M, King TE, Pardo A (2001) American Thoracic Society, European Respiratory Society, American College of Chest Physicians. Idiopathic pulmonary fibrosis: prevailing and evolving hypotheses about its pathogenesis and implications for therapy. Ann Intern Med 134(2):136–151CrossRefPubMed Selman M, King TE, Pardo A (2001) American Thoracic Society, European Respiratory Society, American College of Chest Physicians. Idiopathic pulmonary fibrosis: prevailing and evolving hypotheses about its pathogenesis and implications for therapy. Ann Intern Med 134(2):136–151CrossRefPubMed
5.
Zurück zum Zitat Costabel U, King TE (2001) International consensus statement on idiopathic pulmonary fibrosis. Eur Respir J 17(2):163–167CrossRefPubMed Costabel U, King TE (2001) International consensus statement on idiopathic pulmonary fibrosis. Eur Respir J 17(2):163–167CrossRefPubMed
6.
Zurück zum Zitat Boskovic T, Stojanovic M, Stanic J et al (2014) Pneumothorax after transbronchial needle biopsy. Thorac Dis. 6:427–434 Boskovic T, Stojanovic M, Stanic J et al (2014) Pneumothorax after transbronchial needle biopsy. Thorac Dis. 6:427–434
7.
Zurück zum Zitat Hankinson JL, Odencrantz JR, Fedan KB (1999) Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 159(1):179–187CrossRefPubMed Hankinson JL, Odencrantz JR, Fedan KB (1999) Spirometric reference values from a sample of the general U.S. population. Am J Respir Crit Care Med 159(1):179–187CrossRefPubMed
8.
Zurück zum Zitat Crapo RO, Morris AH (1981) Standardized single breath normal values for carbon monoxide diffusing capacity. Am Rev Respir Dis 123(2):185–189PubMed Crapo RO, Morris AH (1981) Standardized single breath normal values for carbon monoxide diffusing capacity. Am Rev Respir Dis 123(2):185–189PubMed
9.
Zurück zum Zitat Izbicki G, Shitrit D, Yarmolovsky A, Bendayan D, Miller G, Fink G et al (2006) Is routine chest radiography after transbronchial biopsy necessary?: a prospective study of 350 cases. Chest 129(6):1561–1564CrossRefPubMed Izbicki G, Shitrit D, Yarmolovsky A, Bendayan D, Miller G, Fink G et al (2006) Is routine chest radiography after transbronchial biopsy necessary?: a prospective study of 350 cases. Chest 129(6):1561–1564CrossRefPubMed
10.
Zurück zum Zitat Puar HS, Young RC Jr, Armstrong EM (1985) Bronchial and transbronchial lung biopsy without fluoroscopy in sarcoidosis. Chest 87(3):303–306CrossRefPubMed Puar HS, Young RC Jr, Armstrong EM (1985) Bronchial and transbronchial lung biopsy without fluoroscopy in sarcoidosis. Chest 87(3):303–306CrossRefPubMed
11.
Zurück zum Zitat Joyner LR, Scheinhorn DJ (1975) Transbronchial forceps lung biopsy through the fiberoptic bronchoscope: diagnosis of diffuse pulmonary disease. Chest 67(5):532–535CrossRefPubMed Joyner LR, Scheinhorn DJ (1975) Transbronchial forceps lung biopsy through the fiberoptic bronchoscope: diagnosis of diffuse pulmonary disease. Chest 67(5):532–535CrossRefPubMed
12.
Zurück zum Zitat de Fenoyl O, Capron F, Lebeau B, Rochemaure J (1989) Transbronchial biopsy without fluoroscopy: a 5 year experience in outpatients. Thorax 44(11):956–959CrossRefPubMedPubMedCentral de Fenoyl O, Capron F, Lebeau B, Rochemaure J (1989) Transbronchial biopsy without fluoroscopy: a 5 year experience in outpatients. Thorax 44(11):956–959CrossRefPubMedPubMedCentral
13.
Zurück zum Zitat Rittirak W, Sompradeekul S (2007) Diagnostic yield of fluoroscopy-guided transbronchial lung biopsy in non-endobronchial lung lesion. J Med Assoc Thai 90(Suppl 2):68–73PubMed Rittirak W, Sompradeekul S (2007) Diagnostic yield of fluoroscopy-guided transbronchial lung biopsy in non-endobronchial lung lesion. J Med Assoc Thai 90(Suppl 2):68–73PubMed
14.
Zurück zum Zitat Anders GT, Johnson JE, Bush BA, Matthews JI (1988) Transbronchial biopsy without fluoroscopy. A 7 year perspective. Chest 94(3):557–560CrossRefPubMed Anders GT, Johnson JE, Bush BA, Matthews JI (1988) Transbronchial biopsy without fluoroscopy. A 7 year perspective. Chest 94(3):557–560CrossRefPubMed
15.
Zurück zum Zitat Milman N, Faurschou P, Munch EP, Grode G (1994) Transbronchial lung biopsy through the fibre optic bronchoscope. Results and complications in 452 examinations. Respir Med 88(10):749–753CrossRefPubMed Milman N, Faurschou P, Munch EP, Grode G (1994) Transbronchial lung biopsy through the fibre optic bronchoscope. Results and complications in 452 examinations. Respir Med 88(10):749–753CrossRefPubMed
16.
Zurück zum Zitat Herf SM, Suratt PM (1978) Complications of transbronchial lung biopsies. Chest 73(5 Suppl):759–760CrossRefPubMed Herf SM, Suratt PM (1978) Complications of transbronchial lung biopsies. Chest 73(5 Suppl):759–760CrossRefPubMed
17.
Zurück zum Zitat Hernandez Blasco L, Sanchez Hernandez IM, Villena Garrido V, de Miguel Poch E, Nunez Delgado M, Alfaro Abreu J (1991) Safety of the transbronchial biopsy in outpatients. Chest 99(3):562–565CrossRefPubMed Hernandez Blasco L, Sanchez Hernandez IM, Villena Garrido V, de Miguel Poch E, Nunez Delgado M, Alfaro Abreu J (1991) Safety of the transbronchial biopsy in outpatients. Chest 99(3):562–565CrossRefPubMed
18.
Zurück zum Zitat Hernandez Borge J, Alfageme Michavila I, Munoz Mendez J, Villagomez Cerrato R, Campos Rodriguez F, Pena Grinan N (1998) Factors related to diagnostic yield and complications of transbronchial biopsy. Arch Bronconeumol 34(3):133–141CrossRefPubMed Hernandez Borge J, Alfageme Michavila I, Munoz Mendez J, Villagomez Cerrato R, Campos Rodriguez F, Pena Grinan N (1998) Factors related to diagnostic yield and complications of transbronchial biopsy. Arch Bronconeumol 34(3):133–141CrossRefPubMed
19.
Zurück zum Zitat Ellis JH Jr (1975) Transbronchial lung biopsy via the fiberoptic bronchoscope. Experience with 107 consecutive cases and comparison with bronchial brushing. Chest 68(4):524–532CrossRefPubMed Ellis JH Jr (1975) Transbronchial lung biopsy via the fiberoptic bronchoscope. Experience with 107 consecutive cases and comparison with bronchial brushing. Chest 68(4):524–532CrossRefPubMed
20.
Zurück zum Zitat Mitchell DM, Emerson CJ, Collins JV, Stableforth DE (1981) Transbronchial lung biopsy with the fibreoptic bronchoscope: analysis of results in 433 patients. Br J Dis Chest. 75(3):258–262CrossRefPubMed Mitchell DM, Emerson CJ, Collins JV, Stableforth DE (1981) Transbronchial lung biopsy with the fibreoptic bronchoscope: analysis of results in 433 patients. Br J Dis Chest. 75(3):258–262CrossRefPubMed
21.
Zurück zum Zitat Frazier WD, Pope TL Jr, Findley LJ (1990) Pneumothorax following transbronchial biopsy. low diagnostic yield with routine chest roentgenograms. Chest 97(3):539–540CrossRefPubMed Frazier WD, Pope TL Jr, Findley LJ (1990) Pneumothorax following transbronchial biopsy. low diagnostic yield with routine chest roentgenograms. Chest 97(3):539–540CrossRefPubMed
22.
Zurück zum Zitat Sinha S, Guleria R, Pande JN, Pandey RM (2004) Bronchoscopy in adults at a tertiary care centre: indications and complications. J Indian Med Assoc 102(3):152–156PubMed Sinha S, Guleria R, Pande JN, Pandey RM (2004) Bronchoscopy in adults at a tertiary care centre: indications and complications. J Indian Med Assoc 102(3):152–156PubMed
23.
Zurück zum Zitat Ahmad M, Livingston DR, Golish JA, Mehta AC, Wiedemann HP (1986) The safety of outpatient transbronchial biopsy. Chest 90(3):403–405CrossRefPubMed Ahmad M, Livingston DR, Golish JA, Mehta AC, Wiedemann HP (1986) The safety of outpatient transbronchial biopsy. Chest 90(3):403–405CrossRefPubMed
24.
Zurück zum Zitat Ulmeanu R, Mihaltan F, Crisan E, Alexe M, Grigore P, Andreescu I et al (2007) Practical issues of transbronchial lung biopsy (TLB) in pneumology. Pneumologia 56(2):59–67PubMed Ulmeanu R, Mihaltan F, Crisan E, Alexe M, Grigore P, Andreescu I et al (2007) Practical issues of transbronchial lung biopsy (TLB) in pneumology. Pneumologia 56(2):59–67PubMed
25.
Zurück zum Zitat Hanson RR, Zavala DC, Rhodes ML, Keim LW, Smith JD (1976) Transbronchial biopsy via flexible fiberoptic bronchoscope; results in 164 patients. Am Rev Respir Dis 114(1):67–72PubMed Hanson RR, Zavala DC, Rhodes ML, Keim LW, Smith JD (1976) Transbronchial biopsy via flexible fiberoptic bronchoscope; results in 164 patients. Am Rev Respir Dis 114(1):67–72PubMed
26.
Zurück zum Zitat Alzeer AH, Al-Otair HA, Al-Hajjaj MS (2008) Yield and complications of flexible fiberoptic bronchoscopy in a teaching hospital. Saudi Med J 29(1):55–59PubMed Alzeer AH, Al-Otair HA, Al-Hajjaj MS (2008) Yield and complications of flexible fiberoptic bronchoscopy in a teaching hospital. Saudi Med J 29(1):55–59PubMed
28.
Zurück zum Zitat Pereira W Jr, Kovnat DM, Snider GL (1978) A prospective cooperative study of complications following flexible fiberoptic bronchoscopy. Chest 73(6):813–816CrossRefPubMed Pereira W Jr, Kovnat DM, Snider GL (1978) A prospective cooperative study of complications following flexible fiberoptic bronchoscopy. Chest 73(6):813–816CrossRefPubMed
29.
Zurück zum Zitat Jain P, Sandur S, Meli Y, Arroliga AC, Stoller JK, Mehta AC (2004) Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates. Chest 125(2):712–722CrossRefPubMed Jain P, Sandur S, Meli Y, Arroliga AC, Stoller JK, Mehta AC (2004) Role of flexible bronchoscopy in immunocompromised patients with lung infiltrates. Chest 125(2):712–722CrossRefPubMed
30.
Zurück zum Zitat Koonitz CH, Joyner LR, Nelson RA (1976) Transbronchial lung biopsy via the fiberoptic bronchoscope in sarcoidosis. Ann Intern Med 85(1):64–66CrossRefPubMed Koonitz CH, Joyner LR, Nelson RA (1976) Transbronchial lung biopsy via the fiberoptic bronchoscope in sarcoidosis. Ann Intern Med 85(1):64–66CrossRefPubMed
31.
Zurück zum Zitat Kopp C, Perruchoud A, Heitz M, Dalquen P, Herzog H (1983) Transbronchial lung biopsy in sarcoidosis. Klin Wochenschr 61(9):451–454CrossRefPubMed Kopp C, Perruchoud A, Heitz M, Dalquen P, Herzog H (1983) Transbronchial lung biopsy in sarcoidosis. Klin Wochenschr 61(9):451–454CrossRefPubMed
32.
Zurück zum Zitat Chen W, Ji C, Li Y, Xu D (1990) Diagnostic value of transbronchial lung biopsy in diffuse or peripheral lung lesions. Hua Xi Yi Ke Da Xue Xue Bao 21(3):330–333PubMed Chen W, Ji C, Li Y, Xu D (1990) Diagnostic value of transbronchial lung biopsy in diffuse or peripheral lung lesions. Hua Xi Yi Ke Da Xue Xue Bao 21(3):330–333PubMed
33.
Zurück zum Zitat Cazzadori A, Di Perri G, Todeschini G, Luzzati R, Boschiero L, Perona G et al (1995) Transbronchial biopsy in the diagnosis of pulmonary infiltrates in immunocompromised patients. Chest 107(1):101–106CrossRefPubMed Cazzadori A, Di Perri G, Todeschini G, Luzzati R, Boschiero L, Perona G et al (1995) Transbronchial biopsy in the diagnosis of pulmonary infiltrates in immunocompromised patients. Chest 107(1):101–106CrossRefPubMed
34.
Zurück zum Zitat Sindhwani G, Shirazi N, Sodhi R et al (2015) Transbronchial lung biopsy in patients with diffuse parenchymal lung disease without ‘idiopathic pulmonary fibrosis pattern’ on HRCT scan- Experience from a tertiary care center of North India. Lung India 32:453–456CrossRefPubMedPubMedCentral Sindhwani G, Shirazi N, Sodhi R et al (2015) Transbronchial lung biopsy in patients with diffuse parenchymal lung disease without ‘idiopathic pulmonary fibrosis pattern’ on HRCT scan- Experience from a tertiary care center of North India. Lung India 32:453–456CrossRefPubMedPubMedCentral
Metadaten
Titel
Pneumothorax After Transbronchial Biopsy in Pulmonary Fibrosis: Lessons from the Multicenter COMET Trial
verfasst von
Jonathan A. Galli
Nicholas L. Panetta
Nathaniel Gaeckle
Fernando J. Martinez
Bethany Moore
Thomas Moore
Anthony Courey
Kevin Flaherty
Gerard J. Criner
for the COMET investigators
Publikationsdatum
16.06.2017
Verlag
Springer US
Erschienen in
Lung / Ausgabe 5/2017
Print ISSN: 0341-2040
Elektronische ISSN: 1432-1750
DOI
https://doi.org/10.1007/s00408-017-0028-z

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