Bronchoscopy use in adults with acute respiratory failure increased in recent years
From 2012 to 2018, bronchoscopy use increased among hospitalized patients in the U.S. treated with invasive mechanical ventilation, researchers reported in Chest.
“Despite being an established, widely available and multi-purpose procedure, there are limited guidelines to inform how and when to use bronchoscopy in the ICU. For some potential indications ... there is strong evidence that bronchoscopy is not beneficial,” Max T. Wayne, MD, pulmonologist in the division of pulmonary and critical care medicine at University of Michigan, Ann Arbor, and colleagues wrote.
The observational study included a cohort of 6,101,070 hospitalized adults who were treated with invasive mechanical ventilation from 2012 to 2018. Researchers measured the proportion of those treated with invasive mechanical ventilation who also received bronchoscopy and assessed bronchoscopy use trends over time.
Overall, 609,405 hospitalized adults treated with invasive mechanical ventilation underwent bronchoscopy (mean age, 61 years; 41.8% women). The in-hospital mortality rate was 30.8%.
Researchers reported an increase in the percentage of hospitalized adults treated with invasive mechanical ventilation who underwent bronchoscopy, from 9.5% in 2012 to 10.8% in 2018 (P < .001).
In a subgroup analysis, the proportion of invasive mechanical ventilation hospitalizations with an immunocompromised comorbidity that underwent bronchoscopy increased from 13.6% in 2012 to 15% in 2018 (P < .001), the researchers reported.
Bronchoscopy use varied from 0% to 57.1% in 2018 among 1,787 hospitals with at least 25 invasive mechanical ventilation hospitalizations. In multi-level models adjusted for patient and hospital characteristics, 16% of variation was explained at the hospital level, according to the researchers.
The researchers reported the odds of receiving bronchoscopy increased 113% if moving from a lower-use to a higher-use hospital (OR = 2.13; 95% CI, 2.05-2.21).
“However, use varied markedly across hospitals, and was not completely explained by differences in patient or hospital characteristics,” they wrote. “This variation suggests potentially unwarranted practice variation and need for further studies to clarify which patients benefit from bronchoscopy.”