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DOI: 10.1055/s-0029-1242692
© Georg Thieme Verlag KG Stuttgart · New York
Erfolgreiches Risikomanagement bei der flexiblen Bronchoskopie
Successful risk management in flexible bronchoscopyPublikationsverlauf
eingereicht: 10.3.2009
akzeptiert: 13.8.2009
Publikationsdatum:
05. November 2009 (online)

Zusammenfassung
Die flexible Bronchoskopie ist ein bedeutender Pfeiler der pneumologischen Diagnostik. Der Untersucher operiert hierbei in einem vital notwendigen Organ und daher beinhaltet die Untersuchung ein nicht unerhebliches Gefährdungspotential für den Patienten. Dieser Artikel gibt eine Übersicht über alle wesentlichen Komplikationen, welche in diesem Zusammenhang auftreten können und legt dar, wie das Risiko minimiert werden kann. Ein erfahrenes Untersuchungsteam, eine sicherheitsbetonte Patientenüberwachung sowie ein umfassendes Notfallinstrumentarium sind die Basis für eine geringe Rate an schwerwiegenden Komplikationen.
Summary
Flexible bronchoscopy is one of the most important diagnostic procedures in respiratory medicine. The investigator operates in a vital organ and therefore must face a broad range of potential complications. This article provides an overview of all important complications associated with flexible bronchoscopy. It is further discussed how this risk can be minimized. A skillfull team, close monitoring and readily available resuscitation facilities are mandatory to avoid and to deal with major complications.
Schlüsselwörter
flexible Bronchoskopie - Komplikationen - Risikominimierung
Keywords
flexible bronchoscopy - complications - risk mitigation
Literatur
- 1
American Society
of Anesthesiologists Task Force on Sedation and Analgesia by Non-Anesthesiologists .
Practice guidelines for sedation and analgesia by non-anesthesiologists.
Anesthesiology.
2002;
96
1004-1017
MissingFormLabel
- 2
Bauer T T, Torres A, Ewig S. et
al .
Effects of bronchoalveolar lavage volume on arterial
oxygenation in mechanically ventilated patients with pneumonia.
Intensive Care Med.
2001;
27
384-393
MissingFormLabel
- 3
Bein T, Pfeifer M, Keyl C, Metz C, Taeger K.
Right
ventricular function and plasma atrial natriuretic peptide levels
during fiberbronchoscopic alveolar lavage in critically ill, mechanically
ventilated patients.
Chest.
1995;
108
1030-1035
MissingFormLabel
- 4
Blacker D J, Wijdicks E F, McClelland R L.
Stroke risk in anticoagulated
patients with atrial fibrillation undergoing endoscopy.
Neurology.
2003;
61
964-968
MissingFormLabel
- 5
Blasco L H, Sánchez Hernández I M, Villena G arrido V. et al .
Safety of the transbronchial biopsy in outpatients.
Chest.
1991;
99
562-565
MissingFormLabel
- 6
British Thoracic Society guidelines
on diagnostic flexible bronchoscopy.
Thorax.
2001;
56:(suppl I)
i1-i21
MissingFormLabel
- 7
Davies L, Mister R, Spence D P, Calverley P M, Earis J E, Pearson M G.
Cardiovascular
consequences of fibreoptic bronchoscopy.
Eur Respir J.
1997;
10
695-698
MissingFormLabel
- 8
Day R O, Chalmers D R, Williams K M, Campbell T J.
The
death of a healthy volunteer in a human research project: Implications
for Australian clinical research.
Med J Austr.
1998;
168
449-451
MissingFormLabel
- 9
Dombret M C, Juliard J M, Farinotti R.
Risques de l’endoscopie bronchique chez le coronarien.
Rev Mal Respir.
1990;
3
313-317
MissingFormLabel
- 10
Dweik R A, Mehta A C, Meeker D P, Arroliga A C.
Analysis
of the safety of bronchoscopy after recent acute myocardial infarction.
Chest.
1996;
110
825-828
MissingFormLabel
- 11
Ernst A, Eberhardt R, Wahidi M. et al .
Effect of routine clopidogrel use on bleeding
complications after transbronchial biopsy in humans.
Chest.
2006;
129
734-737
MissingFormLabel
- 12
Facciolongo N, Patelli M, Gasparini S. et al .
Incidence of complications in bronchoscopy.
Multicentre prospective study of 20,986 bronchoscopies.
Monaldi Arch
Chest Dis.
2009;
71
8-14
MissingFormLabel
- 13
Gerci G, Pisello F, Sciumè C. et al .
Complication of flexible fiberoptic bronchoscopy.
Literature review.
Ann Ital Chir.
2007;
78
183-192
MissingFormLabel
- 14
Gillis S, Dann E J, Berkman N, Koganox Y, Kramer M R.
Fatal haemophilus influenzae septicaemia following bronchoscopy
in a splenectomized patient.
Chest.
1993;
104
1607-1609
MissingFormLabel
- 15
Hage R, de la Rivière A B, Seldenrijk C A, van den Bosch J M.
Update in pulmonary carcinoid tumors: a review article.
Ann
Surg Oncol.
2003;
10
697-704
MissingFormLabel
- 16
Hermens F HW, Van Engelenburg T CA, Visser F J. et al .
Diagnostic yield
of transbronchial histology needle aspiration in patients with medistinal
lymph node enlargement.
Respiration.
2003;
70
631-635
MissingFormLabel
- 17
Herth F J, Becker H D, Ernst A.
Aspirin does not increase bleeding complication after transbronchial
biopsy.
Chest.
2002;
122
1461-1464
MissingFormLabel
- 18
Herth F J, Eberhardt R, Vilmann P, Krasnik M, Ernst A.
Real-time endobronchial ultrasound guided transbronchial needle
aspiration for sampling mediastinal lymph nodes.
Thorax.
2006;
61
795-798
MissingFormLabel
- 19
Herth F JF, Rabe K F, Gasparini S, Annema J T.
Transbronchial
and transoesophageal (ultrasound-guided) needle aspirations for
the analysis of mediastinal lesions.
Eur Respir J.
2006;
28
1264-1275
MissingFormLabel
- 20
Izbicki G, Shitrit D, Yarmolovsky A. et al .
Is routine chest radiography after tranbronchial
biopsy necessary? A prospective study of 350 cases.
Chest.
2006;
129
1561-1565
MissingFormLabel
- 21
Katz A S, Michelson E L, Stawicki J, Holford F D.
Cardiac
arrhythmias, frequency during fiberoptic bronchoscopy and correlation
with hypoxemia.
Arch Intern Med.
1981;
141
603-606
MissingFormLabel
- 22
Kvale P A.
Prevention and management of hypoxemia during fiberoptic bronchoscopy.
Chest.
2002;
121
1021-1022
MissingFormLabel
- 23
Lang N P, Wait G M, Read R R.
Cardio-cerebrovascular complications from Nd:YAG
Laser treatment of lung cancer.
Am J Surg.
1991;
162
629-632
MissingFormLabel
- 24
Leitlinie zur Sedierung und Analgesie
(Analgosedierung) von Patienten durch Nicht-Anästhesisten.
Anästh Intensivmed.
2002;
43
639-641
MissingFormLabel
- 25
Lundgren R, Häggmark S, Reiz S.
Hemodynamic effects of flexible fiberoptic bronchoscopy performed
under topical anesthesia.
Chest.
1982;
3
295-299
MissingFormLabel
- 26
Matot I, Kramer M R, Glantz L. et al .
Myocardial ischemia in sedated patients undergoing
fiberoptic bronchoscopy.
Chest.
1997;
112
1454-1458
MissingFormLabel
- 27
Naber C K, Al-Nawas B, Baumgartner H. et al .
Prophylaxe der infektiösen Endokarditis.
Der Kardiologe.
2007;
1
243-250
MissingFormLabel
- 28
Osseiran K, Barchfeld T, Dellweg D, Haidl P.
Cerebral arterial gas
embolism as complication during the therapeutic endobronchial use
of argon plasma coagulation.
neumologie.
2008;
62
353-354
MissingFormLabel
- 29
Ouellette D R.
The safety of bronchoscopy in a pulmonary fellowship program.
Chest.
2006;
130
1185-1190
MissingFormLabel
- 30
Pereira W, Kovnat D M, Khan M A. et al .
Fever and pneumonia after
flexible fiberoptic bronchoscopy.
Am Rev Respir Dis.
1975;
112
59-64
MissingFormLabel
- 31
Pereira W, Kovnat D M, Snider G L.
A prospective kooperative study of complications
following flexible fiberoptic bronchoscopy.
Chest.
1978;
73
813-816
MissingFormLabel
- 32
Picard E, Goldberg S, Virgilis D. et al .
A single dose of dexamethasone to prevent
postbronchoscopy fever in children. A randomized placebo-controlled trial.
Chest.
2007;
13
201-205
MissingFormLabel
- 33
Popp W, Merkle M, Schreiber B. et al .
How much brushing is enough for the diagnosis
of lung tumors?.
Cancer.
1992;
70
2278-2280
MissingFormLabel
- 34
Pue C A, Pacht E R.
Complications
of fiberoptic bronchoscopy at a university hospital.
Chest.
1995;
107
430-432
MissingFormLabel
- 35 Reichle G. Persönliche Mitteilung.
MissingFormLabel
- 36
Ross D J, Mohsenifar Z, Potkin R T. et al .
Pathogenesis of cerebral air embolism during
Neodymium-YAG laser photoresection.
Chest.
1988;
94
660-662
MissingFormLabel
- 37
Shelley M P, Wilson P, Norman J.
Sedation for fiberoptic bronchoscopy.
Thorax.
1989;
44
769-775
MissingFormLabel
- 38
Shetty P G, Fatterpekar G M, Manohar S, Sujit V, Varsha J, Zarir U.
Fatal cerbral air embolism
as a complication of transbronchoscopic lung biopsy: a case report.
Australas Radiol.
2001;
45
215-217
MissingFormLabel
- 39
Shrader D L, Lakshminarayan S.
The effect of
fiberoptic bronchoscopy on cardiac rhythm.
Chest.
1978;
73
821-824
MissingFormLabel
- 40
Shure D.
Transbronchial biopsy and needle aspiration.
Chest.
1989;
95
1130-1138
MissingFormLabel
- 41
Tellidis G, Ugurlu B S, Kim R W, Hammond G L.
Pathogenesis
of systemic air embolism during bronchoscopic Nd:YAG laser operations.
Ann Thorac Surg.
1998;
65
930-934
MissingFormLabel
- 42
Tournoy K G, Rintoul R C, van Meerbeeck J P. et al .
EBUS-TBNA for
the diagnosis of central parenchymal lung lesions not visible at
routine bronchoscopy.
Lung Cancer.
2009;
63
45-49
MissingFormLabel
- 43
Um S W, Choi C M, Lee C T. et al .
Prospective analysis of
clinical characteristics and risk factors of postbronchoscopy fever.
Chest.
2004;
125
945-952
MissingFormLabel
- 44
Wherrett C G, Mehran R J, Beaulieu M A.
Cerebral arterial gas embolism following
diagnostic bronchoscopy: delayed treatment with hyperbaric oxygen.
Can J Anaesth.
2002;
49
96-99
MissingFormLabel
- 45
Wilson W, Taubert K A, Gewitz M. et al .
American Heart Association. Prevention of
infective endocarditis: guidelines from the American Heart Association:
a guideline from the American Heart Association Rheumatic Fever,
Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular
Disease in the Young, and the Council on Clinical Cardiology, Council
on Cardiovascular Surgery and Anesthesia, and the Quality of Care
and Outcomes Research Interdisciplinary Working Group.
Circulation.
2007;
116
1736-1754
MissingFormLabel
- 46
Yigla M, Oren I, Bentur L. et
al .
Incidence of bacteraemia following fibreoptic bronchoscopy.
Eur Respir J.
1999;
14
789-791
MissingFormLabel
Dr. med. Kaid Darwiche
Thoraxzentrum Ruhrgebiet, Evangelisches Krankenhaus Herne-Betriebsstelle
Eickel, Klinik für Pneumologie und Infektiologie
Hordeler Str. 7–9
44651 Herne
Telefon: 02323/498-92454
eMail: k.darwiche@evk-herne.de