Hämoptysen: Wann ist die Bronchoskopie besonders wertvoll?

2019 ◽  
Vol 7 (3) ◽  
pp. 146-148
Author(s):  
Manfred Wagner
Keyword(s):  
Diagnostic Accuracy ◽  
Detection Rate ◽  
Diagnostic Yield ◽  
Secondary Analysis ◽  
Endoscopic Examination ◽  
P Value ◽  
Etiological Diagnosis ◽  
Bleeding Source ◽  
Total Cohort ◽  
The Ideal

Background: Bronchoscopy plays a key role to diagnose the etiology, to localize the site, and to identify the sources of the bleeding in patients with hemoptysis, but the ideal timing of an endoscopic examination is still unclear. Methods: We performed a secondary analysis of an observational and multicenter study, aimed at evaluating the epidemiology of hemoptysis in Italy and the diagnostic yield of the most frequently prescribed examinations. The aim of the study was to evaluate whether an early bronchoscopy (i.e., performed during active bleeding/≤48 h after hemoptysis stopped) helps localize bleeding (i.e., site, lobe, lung) and increase diagnostic yield in comparison with a delayed examination. Results: Four hundred eighty-six consecutive adult patients (69.2% males; median [IQR] age: 67 [53-76] years) with hemoptysis requiring an etiological diagnosis and undergoing bronchoscopy were recruited. Bleeding focus could be located more frequently in case of moderate-severe bleedings than in cases of mild hemoptysis (site: 70/154, 45.4%, VS. 73/330, 22.1%; p-value < 0.0001; lobe: 95/155, 61.3%, VS. 95/331, 28.7%; p-value < 0.0001; lung: 101/155, 65.1%, VS. 111/331, 33.5%; p-value < 0.0001). Early bronchoscopy showed a higher detection rate of bleeding source in comparison with delayed examination (site: 76/214, 35.5%, VS. 67/272, 24.6%; p-value = 0.01; lobe: 98/214, 45.8%, VS. 92/272, 33.8%; p-value = 0.007; lung: 110/214, 51.4%, VS. 102/272, 37.5%; p-value = 0.002). Early bronchoscopy did not provide any advantages in terms of increased diagnostic yield, in the total cohort (113/214, 52.8%, VS. 123/272, 45.2%; p-value = 0.10) and in the severity subtypes (mild: 56/128, 43.8%, VS. 88/203, 43.4%; p-value = 0.94; moderate-severe: 57/86, 66.2%, VS. 35/69, 50.7%; p-value = 0.051). Conclusions: Early bronchoscopy helps detect bleeding sources, particularly in cases of moderate-severe hemoptysis, without increasing diagnostic accuracy. Trial registration: ClinicalTrials.gov (identifier: NCT02045394).

scholarly journals Clinical significance of Q waves in ischemic cardiomyopathy

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
E Rodenas Alesina ◽  
P Jordan ◽  
L Herrador ◽  
C Espinet-Coll ◽  
N Pizzi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Primary Endpoint ◽  
Ischemic Cardiomyopathy ◽  
Cox Regression ◽  
Cox Model ◽  
Cardiovascular Death ◽  
P Value ◽  
Heart Failure Hospitalization ◽  
Total Cohort

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): CIBER-CV AIMS The scintigraphic translation of Q waves in patients with ischemic cardiomyopathy and LVEF &lt; 40% has not yet been assessed. The aim of this study was to explore the relationship between Q waves and necrotic tissue and to analyze their impact in prognosis. METHODS AND RESULTS A retrospective study enrolling 487 consecutive patients (67,0 [57,4 – 75,4] years), with ischemic cardiomyopathy, LVEF &lt;40% and narrow QRS who underwent stress-rest SPECT was conducted. Patients with Q waves (320 patients [65,7%]) had less comorbidity and ischemia, but more necrosis. Q waves correlated poorly with lack of viability (AUC = 0,63) and were independently associated with the subendocardial extent of the necrosis. After a follow-up of 5,07 years, the primary outcome (cardiovascular death, heart failure hospitalization or myocardial infarction) occurred in 192 (39,4%) patients, without differences between groups in multivariate analysis. After accounting for non-cardiovascular death as a competitive risk, the interaction between &gt;10% of ischemia and revascularization remained in Cox model both in the total cohort (aHR= 0,46 [0,24 – 0,86]), and in patients with Q waves (aHR = 0,27 [0,11–0,69]). CONCLUSION Patients with ischemic cardiomyopathy with Q waves have larger subendocardial scarring and more transmural necrosis, although correlation between Q waves and transmural scarring is poor. Revascularization if &gt;10% ischemia is present is associated with a better prognosis. Ischemia burden should be assessed and accordingly treated in these patients, and no differences in management should be made in the presence of Q waves. Table 1. Cox proportional hazards model Total cohort (N = 471) Patients with Q waves (N = 315) aHR p-value 95% CI aHR p-value 95% CI Age (per year) 1,02 0,007 1,01 - 1,04 n.s. Diabetes mellitus 1,35 0,047 1,00 - 1,81 1,54 0,016 1,09 - 2,20 eGFR &lt; 60 ml/min 1,59 0,005 1,15 - 2,21 1,96 &lt;0,001 1,36 - 2,82 Previous HF hospitalization 1,71 0,002 1,23 - 2,38 1,76 0,007 1,17 - 2,64 Previous PCI 1,32 0,069 0,98 - 1,78 n.s. Previous CABG n.s. 1,77 0,009 1,15 - 2,72 Angina or dyspnea 1,68 0,001 1,24 - 2,28 1,71 0,004 1,19 - 2,46 Indexed TDV (per quartile) 1,16 0,047 1,02 - 1,33 n.s. Revascularization*ischemia &gt; 10% 0,46 0,015 0,24 - 0,86 0,27 0,006 0,11 - 0,69 Cox regression for the primary endpoint (cardiovascular death, heart failure hospitalization or myocardial infarction), accounting for non-cardiovascular death as a competitive risk. Abstract Figure. Survival for the primary endpoint

scholarly journals Diagnostic yield and appropriate indication of upper endoscopy in Jordanian children

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eyad Altamimi ◽  
Yousef Odeh ◽  
Tuka Al-quraan ◽  
Elmi Mohamed ◽  
Naif Rawabdeh
Keyword(s):  
Abdominal Pain ◽  
Diagnostic Yield ◽  
Failure To Thrive ◽  
University Hospital ◽  
P Value ◽  
Upper Endoscopy ◽  
Detection Rates ◽  
Common Indication ◽  
Histopathological Findings ◽  
Endoscopic Findings

Abstract Background Upper endoscopy is an essential tool for diagnosing pediatric gastrointestinal issues. This study aimed to assess the indications, diagnostic yields, concordance between histopathological and endoscopic findings and suitability of upper endoscopies performed at a tertiary university hospital in Jordan. Methods Hospital records of children who underwent upper endoscopy were retrospectively reviewed. Demographics, endoscopic details (e.g., indications, findings and any complications), and histopathological findings were collected. The relationship between endoscopic findings and histopathological abnormalities was reported. Results The study included 778 patients (age, 92.5 ± 54.5 months; 380 girls, 48.8%). The most common age group was children younger than 60 months (273 patients, 34.3%). The most common indication for endoscopy was abdominal pain, followed by vomiting and failure to thrive or weight loss. Normal upper endoscopy was reported in 411 patients (52.8%). Age below 60 months, abdominal pain, dysphagia/odynophagia, and heartburn were predictive of abnormal endoscopy in multivariate analysis with p-value 0.000, 0.048, 0.001 and 0.01 respectively. Abnormal endoscopy showed 67.3% sensitivity and 69.9% specificity to predict histopathological abnormalities. Of those performed, 13.6% endoscopies were described as inappropriate indication. The suitability of the procedure was a sensitive predictor for abnormal endoscopic and histopathological findings. Conclusions Abdominal pain is the most common indication for upper endoscopy in our population. It is associated with a higher chance of abnormal endoscopy. Concordance between endoscopic and histopathological findings is not high. Normal endoscopic findings shouldn`t discourage the endoscopist from obtaining tissue biopsies. Considering more biopsies may improve pathological detection rates. Compliance with established endoscopy guidelines may reduce unnecessary procedures.

scholarly journals Value of Three-Dimensional Digital Subtraction Angiography for Detection and Classification of Intracranial Aneurysm Remnants After Clipping

2021 ◽  
Author(s):  
Serge Marbacher ◽  
Matthias Halter ◽  
Deborah R Vogt ◽  
Jenny C Kienzler ◽  
Christian T J Magyar ◽  
...  
Keyword(s):  
Intracranial Aneurysm ◽  
Digital Subtraction Angiography ◽  
Diagnostic Yield ◽  
Three Dimensional ◽  
P Value ◽  
Digital Subtraction ◽  
Patient Demographics ◽  
Included Patient ◽  
2D And 3D

Abstract BACKGROUND The current gold standard for evaluation of the surgical result after intracranial aneurysm (IA) clipping is two-dimensional (2D) digital subtraction angiography (DSA). While there is growing evidence that postoperative 3D-DSA is superior to 2D-DSA, there is a lack of data on intraoperative comparison. OBJECTIVE To compare the diagnostic yield of detection of IA remnants in intra- and postoperative 3D-DSA, categorize the remnants based on 3D-DSA findings, and examine associations between missed 2D-DSA remnants and IA characteristics. METHODS We evaluated 232 clipped IAs that were examined with intraoperative or postoperative 3D-DSA. Variables analyzed included patient demographics, IA and remnant distinguishing characteristics, and 2D- and 3D-DSA findings. Maximal IA remnant size detected by 3D-DSA was measured using a 3-point scale of 2-mm increments. RESULTS Although 3D-DSA detected all clipped IA remnants, 2D-DSA missed 30.4% (7 of 23) and 38.9% (14 of 36) clipped IA remnants in intraoperative and postoperative imaging, respectively (95% CI: 30 [ 12, 49] %; P-value .023 and 39 [23, 55] %; P-value = &lt;.001), and more often missed grade 1 (&lt; 2 mm) clipped remnants (odds ratio [95% CI]: 4.3 [1.6, 12.7], P-value .005). CONCLUSION Compared with 2D-DSA, 3D-DSA achieves a better diagnostic yield in the evaluation of clipped IA. Our proposed method to grade 3D-DSA remnants proved to be simple and practical. Especially small IA remnants have a high risk to be missed in 2D-DSA. We advocate routine use of either intraoperative or postoperative 3D-DSA as a baseline for lifelong follow-up of clipped IA.

Abstract P066: A Refined Carbohydrate Diet Attenuates Weight Loss in Insulin Resistant Individuals

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Kristina A Harris ◽  
Sheila G West ◽  
Jack P Vanden Heuvel ◽  
Penny M Kris-Etherton
Keyword(s):  
Weight Loss ◽  
Waist Circumference ◽  
Secondary Analysis ◽  
Density Lipoprotein ◽  
Whole Grains ◽  
Interaction Time ◽  
P Value ◽  
Refined Grains ◽  
Cholesterol Ratio ◽  
Insulin Resistant

Introduction: Weight loss is attenuated in individuals with insulin resistance (IR) who follow a traditional high-carbohydrate, calorie-restricted diet. However, the type of carbohydrate may modulate this response. We studied the effects of whole grains vs. refined grains on weight loss in individuals with increased waist circumference (M: >102 cm, F: >88 cm) and at least 1 other metabolic syndrome characteristic. Hypothesis: In a secondary analysis, we hypothesized that IR individuals (estimated by a triglyceride:high-density lipoprotein cholesterol ratio > 3.5) would lose more weight on a hypocaloric diet with whole grains vs. refined grains. Methods: Overweight or obese (BMI 25–42 kg/m2) men and women (n=50) 35–55 yrs were randomized to a controlled-feeding diet with whole vs. refined grains for 12 weeks [6 weeks isocaloric then 6 weeks hypocaloric (∼500 kcal/d)]. Results: [All comparisons represented as IR mean±SEM vs. insulin sensitive (IS) mean±SEM, p-value)]. Compared to the IS group (n=29), the IR group (n=21) was predominately male (14 M/7 F vs. 11M/18F, p=0.04), weighed more (107.5±3.3 vs. 93.9±3.0 kg, p=0.005), and had increased waist circumference (113±2.2 vs. 106±1.5 cm, p=0.02). IR status did not affect overall percent body weight (%BW) lost over the course of the study (−4.0±0.4 vs. −4.5±0.3 %BW; p for interaction, time x IR status = 0.34). However, IR status did affect %BW lost when the type of carbohydrate was considered (p for interaction, time x IR status x diet = 0.04; Figure ). Post-hoc analysis revealed that within the refined grain group, IR participants lost less %BW than the IS participants (−4.14±0.4 vs. −5.84±0.5 %BW, adjusted p=0.04). On the whole grains diet, %BW lost was similar in the IS and IR groups. Conclusion: In conclusion, IR individuals lost less %BW than IS individuals on the hypocaloric refined grain diet. Limiting refined grains may improve the efficacy of traditional weight loss diets in IR individuals. Figure. %BW lost in IR and IS groups on refined grain diet, *p=0.04.

Effect of Using Silver Nylon Dressings on Postoperative Pain after Cesarean Delivery

2021 ◽  
Author(s):  
Sheila Connery ◽  
Jean Paul Tanner ◽  
Linda Odibo ◽  
Olivia Raitano ◽  
Dusan Nikolic-Dorschel ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Cesarean Delivery ◽  
Secondary Analysis ◽  
Single Site ◽  
Secondary Outcome ◽  
P Value ◽  
Scar Assessment ◽  
Patient Reported ◽  
The Impact ◽  
Nonopioid Analgesic

Objective Silver dressings have been associated with a decrease in postoperative pain in selected populations, but it is unknown if the benefit can be observed after cesarean deliveries. We sought to evaluate the impact of silver nylon dressings in reducing postoperative pain after cesarean delivery. Study Design A secondary analysis of data from a blinded randomized clinical trial of women undergoing cesarean delivery scheduled and unscheduled at a single site was conducted. Women were recruited for participation from a single site and randomized to a silver nylon dressing or an identical-appearing gauze wound dressing. Wounds were evaluated in the outpatient clinic at 1 and 6 weeks after delivery and patient responded to the modified patient scar assessment scale. The primary outcome of this analysis was inpatient opioid and nonopioid analgesic dispensed. The secondary outcome was patient-reported pain at the 1- and 6-week postpartum visits. Data were analyzed using chi-square test, Student's t-test, Fisher's exact test, Wilcoxon–Mann–Whitney's test, and logistic regression where appropriate. A p-value of < 0.05 was considered significant. Results Among the 649 participants, women allocated to the silver nylon dressing group, when compared with the gauze group, were similar in the amount of dispensed opioid and nonopioid analgesic medications (morphine equivalent milligrams of opioids dispensed [82.5 vs. 90 mg, p = 0.74], intravenous nonsteroidal anti-inflammatory drugs (NSAIDs) [120 vs. 120 mg, p = 0.55], and oral NSAIDs [4,800 vs. 5,600 mg in the gauze group, p = 0.65]). After adjusting for confounding variables, postoperative wound infection (adjusted odds ratio [aOR]: 11.70; 95% confidence interval [CI]: 4.51–30.31) at 1-week postoperative and again at 6-week postoperative (aOR: 5.59; 95% CI: 1.03–30.31) but not gauze dressing was associated with patient-reported postoperative pain. Conclusion Among women undergoing cesarean delivery, silver nylon dressing was not associated with a reduction in postoperative pain. Key Points

scholarly journals Reassessing the value of gastroscopy for the investigation of dyspepsia

2017 ◽  
Vol 9 (1) ◽  
pp. 62-66 ◽  
Author(s):  
Hey-Long Ching ◽  
Melissa F Hale ◽  
Reena Sidhu ◽  
Mark E McAlindon
Keyword(s):  
Patient Management ◽  
Diagnostic Yield ◽  
Evaluation Study ◽  
Service Evaluation ◽  
Proton Pump Inhibitor Therapy ◽  
Endoscopic Examination ◽  
Teaching Hospitals ◽  
Outpatient Basis ◽  
Non Invasive ◽  
Royal Hallamshire Hospital

ObjectiveTo evaluate the diagnostic yield of investigating dyspepsia with oesophagogastroduodenoscopy (OGD) with or without mucosal biopsy.DesignRetrospective service evaluation study.SettingTwo teaching hospitals: The Royal Hallamshire Hospital and Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, UK.Patients500 patients, 55 years of age and over, who underwent OGD to investigate dyspepsia were included. The study period included a 3-month window. All OGDs were performed on an outpatient basis.InterventionsData were extracted from electronic OGD records within the study period.Main outcome measuresDiagnostic yield provided by endoscopic examination and histological assessment.Results378 patients (75.6%) were reported to have some form of endoscopic abnormality, and 417 patients (83.4%) had biopsies taken. The most common findings at OGD were gastritis (47.2%) and oesophagitis (24.4%). Oesophagogastric malignancy was seen in 1%. Diagnoses made endoscopically or histologically that would not have been appropriately managed by empirical therapies were seen in 16.2%.ConclusionOGD in dyspepsia influences patient management in approximately one-sixth of cases. However, the majority of patients are sufficiently managed with Helicobacter pylori testing and eradication and/or a trial of proton pump inhibitor therapy. Further non-invasive approaches are needed to identify patients who need endoscopy for biopsy or therapy.

Contrast-enhanced spectral mammography in patients with MRI contraindications

2017 ◽  
Vol 59 (7) ◽  
pp. 798-805 ◽  
Author(s):  
Vivien Richter ◽  
Valerie Hatterman ◽  
Heike Preibsch ◽  
Sonja D Bahrs ◽  
Markus Hahn ◽  
...  
Keyword(s):  
Problem Solving ◽  
Diagnostic Accuracy ◽  
Breast Imaging ◽  
Diagnostic Yield ◽  
Therapy Response ◽  
Lesion Size ◽  
Size Estimation ◽  
Imaging Data ◽  
Technical Problems ◽  
Contrast Enhanced

Background Contrast-enhanced spectral mammography (CESM) is a novel breast imaging technique providing comparable diagnostic accuracy to breast magnetic resonance imaging (MRI). Purpose To show that CESM in patients with MRI contraindications is feasible, accurate, and useful as a problem-solving tool, and to highlight its limitations. Material and Methods A total of 118 patients with MRI contraindications were examined by CESM. Histology was obtained in 94 lesions and used as gold standard for diagnostic accuracy calculations. Imaging data were reviewed retrospectively for feasibility, accuracy, and technical problems. The diagnostic yield of CESM as a problem-solving tool and for therapy response evaluation was reviewed separately. Results CESM was more accurate than mammography (MG) for lesion categorization (r = 0.731, P < 0.0001 vs. r = 0.279, P = 0.006) and for lesion size estimation (r = 0.738 vs. r = 0.689, P < 0.0001). Negative predictive value of CESM was significantly higher than of MG (85.71% vs. 30.77%, P < 0.0001). When used for problem-solving, CESM changed patient management in 2/8 (25%) cases. Superposition artifacts and timing problems affected diagnostic utility in 3/118 (2.5%) patients. Conclusion CESM is a feasible and accurate alternative for patients with MRI contraindications, but it is necessary to be aware of the method’s technical limitations.

Dilemmas in Prenatal Chromosomal Diagnosis Revealed Through a Single Center's 30 Years' Experience and 90,000 Cases

2015 ◽  
Vol 38 (3) ◽  
pp. 218-232 ◽  
Author(s):  
Christopher Konialis ◽  
Constantinos Pangalos ◽  
. InterGenetics
Keyword(s):  
Detection Rate ◽  
Chromosomal Abnormalities ◽  
Diagnostic Yield ◽  
Prenatal Testing ◽  
Minimal Invasive ◽  
Molecular Diagnostic ◽  
Comparative Genomic ◽  
High Detection Rate ◽  
Molecular Approaches ◽  
The One

Introduction: The aim of this article is to provide a perspective of prenatal chromosomal diagnosis (PCD) derived from a single center's evolving experience from ∼90,000 consecutive prenatal cases and to highlight important issues and current dilemmas. Materials and Methods: Prenatal cases in this study (1985-2013) were referred for various indications, and PCD was performed by standard karyotype in 84,255 cases, multiplex ligation-dependent probe amplification (MLPA) panel in 3,010 cases and standalone array comparative genomic hybridization (aCGH) in 3,122 cases. Results: Classic karyotype revealed 1.7 and 7.9% of pathological cases in amniotic fluid and CVS samples, respectively, with common aneuploidies accounting for 59.6 and 64.3% of the total abnormal. Molecular approaches increased the diagnostic yield by 0.6% for MLPA and 1.6% for aCGH, uncovering pathogenic chromosomal abnormalities undetectable by karyotype analysis. Conclusions: Current molecular diagnostic capabilities and the recent introduction of noninvasive prenatal testing (NIPT) point to one current major dilemma in PCD, with serious implications in genetic counseling, relating on the one hand to reaping the benefits from the high detection rate afforded through aCGH but accepting an invasive risk, and on the other hand, offering a lower detection rate practically only for Down syndrome, with minimal invasive risk.

scholarly journals Diagnostic accuracy of initial chest radiograph compared to SARS-CoV-2 PCR in patients with suspected COVID-19

BJR|Open ◽  
2020 ◽  
Vol 2 (1) ◽  
pp. 20200034
Author(s):  
Maria Tsakok ◽  
Robert Shaw ◽  
Andrew Murchison ◽  
Sarim Ather ◽  
Cheng Xie ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Chest Radiograph ◽  
Hospital Setting ◽  
Clinical Suspicion ◽  
Reference Test ◽  
Chain Reaction ◽  
Total Cohort ◽  
Initial Cohort ◽  
Polymerase Chain ◽  
Pcr Test

Objective: The chest radiograph (CXR) is the predominant imaging investigation being used to triage patients prior to either performing a SARS-CoV-2 polymerase chain reaction (PCR) test or a diagnostic CT scan, but there are limited studies that assess the diagnostic accuracy of CXRs in COVID-19. To determine the accuracy of CXR diagnosis of COVID-19 compared with PCR in patients presenting with a clinical suspicion of COVID-19. Methods and materials: The CXR reports of 569 consecutive patients with a clinical suspicion of COVID-19 were reviewed, blinded to the PCR result and classified into the following categories: normal, indeterminate for COVID-19, classic/probable COVID-19, non-COVID-19 pathology, and not specified. Severity reporting and reporter expertise were documented. The subset of this cohort that had CXR and PCR within 3 days of each other were included for further analysis for diagnostic accuracy. Results: Classic/probable COVID-19 was reported in 29% (166/569) of the initial cohort. 67% (382/569) had PCR tests. 344 patients had CXR and PCR within 3 days of each other. Compared to PCR as the reference test, initial CXR had a 61% sensitivity and 76% specificity in the diagnosis of COVID-19. Conclusion: Initial CXR is useful as a triage tool with a sensitivity of 61% and specificity of 76% in the diagnosis of COVID-19 in a hospital setting. Advances in knowledge: . Diagnostic accuracy does not differ significantly between specialist thoracic radiologists and general radiologists including trainees following training. There was a 40% prevalence of PCR positive disease in the cohort of patients (n = 344) having CXR and PCR within 3 days of each other. Classic/probable COVID-19 was reported in 29% of total cohort of patients presenting with clinical suspicion of COVID-19 (n = 569). Initial CXR is useful as a triage tool with a sensitivity of 61% and specificity of 76% in the diagnosis of COVID-19 in a hospital setting

Comparison of the Patient Diagnostic Yield of Fibre-optic Bronchoscopy with Conventional Tracheal Aspirate

2020 ◽  
Vol 3 (1) ◽  
pp. 66-72
Author(s):  
Subodh Sagar Dhakal ◽  
Navin Kumar Mishra ◽  
Karuna Bhatta ◽  
Milan Shrestha ◽  
Rohit Karna ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Tracheal Aspirate ◽  
P Value ◽  
Infectious Agents ◽  
Single Center ◽  
Acinetobacter Baumanii ◽  
E Coli ◽  
Baseline Characteristics ◽  
Staphyloccus Aureus ◽  
Overall Health Status

Objective: To know the efficacy of Bronchoalveolar Lavage (BAL) in establishing diagnosis and its impact on overall health status of the patients. Methods: A single center, longitudinal study involving 40 patients aged > 18 years old with septic shock with similar baseline characteristics was conducted. Two study arms, 20 patients in intervention arm - patient with utilization of Bronchoscopy and BAL in aiding diagnosis and 20-patients in conservative- arm without Bronchoscopy were compared in terms of establishing diagnosis primarily and secondarily in terms of length of stay and 30-day mortality. We were able to identify following organisms in BAL sample: Mycobacterium tuberculosis- 4, Acinetobacter baumanii- 3, Pseudomonasaeruginosa- 2, Klebsiella oxytica- 2, E. coli- 2, Streptococcus pneumoniae- 2, Staphyloccus aureus- Results: We were able to identify various infectious agents as mentioned above 16/20 in BAL group compared to 8/20 in conventional arm; neoplasm in 4 out of 20 subjects in BAL group. In 80% of cases, BAL helped in identifying the organisms compared to only 40% in tracheal aspirate group. In addition, six cases in Intervention arm vs. nine cases in conventional arm had more than > 14 days hospital stay with the p-value 0 .492091. Interventional arm had lesser mortality 5 cases vs. 7 cases in Conventional arm with the p-value of 0.490153 which was not statistically significant. Conclusion: We conclude that the diagnostic bronchoscope and related procedures among critically ill patients are helpful in identifying the pathogens and in detecting malignancy.

Sign in / Sign up

Export Citation Format

Share Document