A total of 207 men and 75 women of median age 61 years were included in this study. Bronchoscopy was performed twice in 30 patients and 3 times in 2 patients, giving a total of 316 bronchoscopies in 282 patients. The most common underlying disease was acute myeloid leukemia (AML) including myelodysplastic syndromes (MDS)-overt AML (n = 134, 47.5%). One hundred and thirty-two patients had undergone HSCT (cord blood transplantation, n = 69; unrelated transplantation [n= 35] or related [n = 1] bone marrow transplantation; autologous [n = 15] or related [n = 12] peripheral blood stem cell transplantation). Median platelet count was 91,000/μL (3,000–568,000) in all patients, 126,000/μL (9,000–561,000) in patients who underwent TBLB and 64,000/μL (3,000–568,000) in those who did not undergo TBLB. Platelet transfusion was performed the day before or the day of the bronchoscopy in 134 procedures (42.4%). Median neutrophil count was 2,840/μL. Supplemental oxygen was administered before bronchoscopy at a rate of 0.5–6 L/min in 73 bronchoscopies (23.1%). Bronchial washing was included in 201 bronchoscopies (63.6%), bronchoalveolar lavage in 104 (32.9%), TBLB in 125 (39.6%), bronchial curettage in 6 (1.9%), and endobronchial ultrasound-guided transbronchial needle aspiration in 2 (0.6%). Pethidine was used in 261 bronchoscopies (82.6%), midazolam in 235 (74.4%), and atropine sulfate in 291 (92.1%).
Thirty-five bronchoscopies (11.1%) were complicated by hemoptysis and 7 patients developed pneumothorax, 4 of whom required thoracic drainage. There were no severe cardiovascular complications such as arrhythmia and hypotension requiring vasopressor. Two patients (0.6%) were intubated within 48 hours of the procedure. The first patient was intubated on the day after the procedure and died the following month; the second patient was intubated just after the procedure and underwent extubation the following day (Table 1). The oxygen desaturation data are summarized in Figure 1. Prolonged oxygen desaturation (>48 hours) occurred after 12 of the 316 bronchoscopies (3.8%). Oxygen desaturation did not recover in 5 of these 12 patients and was ultimately fatal. The data for these 12 patients are summarized in Table 1. Hemoptysis was found in 3 of the 12 patients, but none developed pneumothorax. Oxygen desaturation recovered in 7 patients (including 2 with organizing pneumonia, 2 with invasion of underlying disease, and 1 with pneumocystis pneumonia). The 5 patients with no recovery of oxygen desaturation included 2 patients with aspergillosis and 2 with cytomegalovirus pneumonia.
Univariate and multivariate analyses were performed to identify risk factors for prolonged oxygen desaturation (>48 hours) after bronchoscopy. Factors identified as statistically significant in univariate analysis were platelet count ≤20 × 103/µl, TBLB not performed, and midazolam not administered (Table 2). The multivariate analysis showed that only use of midazolam significantly reduced the risk of prolonged oxygen desaturation (hazard ratio 0.28, 95% confidence interval 0.09–0.85, p = 0.03; Table 2).
Univariate analysis for hemoptysis shows TBLB was the only significant risk factor. Multivariate analysis showed that TBLB significant increased the risk for hemoptysis (hazard ratio 10.40, 95% confidence interval 4.18–25.90, p = 0.00; Table 3), while use of midazolam significantly reduced the risk (hazard ratio 0.31, 95% confidence interval 0.14–0.73, p = 0.01; Table 3).