Fiberoptic bronchoscopy in coronary care unit patients - Indications, safety, and clinical implications

Study objectives: To evaluate the indications, safety, therapeutic impact, and outcome of fiberoptic bronchoscopy (FOB) in coronary care unit (CCU) patients. Design: Retrospective review of all CCU patients undergoing FOE during a 6-year period. Setting: Tertiary care university hospital. Results: Among 8,330 patients admitted to the CCU; 40 (0.5%) patients underwent FOB to evaluate pulmonary abnormalities, most often (78%) to appraise clinically suspected pneumonia, Thirty-five (88%) patients were intubated and 21 (53%) had acute myocardial infarction (MI) before FOE. There were two major complications (bleeding, intubation) occurring within 24 h of FOE, one of which appeared due to the procedure. No episodes of chest pain or ischemic events were recorded and no significant increase in major complications was noted in MI patients (3% vs 5%), Patients having FOE within 10 days of MI had higher survival(79%) than those undergoing FOE later (29%) (p = 0.05), Seven different bacterial pathogens were isolated in 6 (15%) patients, probably reflecting prior empiric antibiotics in 32 (80%) patients. Therapy was changed in 64% of patients in whom a potential pathogen was identified. Despite alterations in treatment, patients with clinically suspected pneumonia and any organisms isolated by FOE had greater mortality (79% vs 31%, p = 0.003) than those with sterile FOE cultures. Conclusion: FOE may be diagnostically useful in the evaluation of pulmonary abnormalities in selected patients with acute cardiac disease, can be performed safely, and may influence management decisions, Positive bronchoscopy cultures often influence therapy but are associated with higher mortality, suggesting a lethal effect of nosocomial pneumonia in this subset of CCU patients, The risks of FOE must be weighed with the impact of FOE results on patient outcome, and its role requires fur ther investigation.