Background: We hypothesized that fiberoptic bronchoscopy can contribute to mesenteric ischemia and bacterial translocation.
Objective: To test this hypothesis we investigated in patients undergoing bronchoscopy mesenteric blood flow and markers in association with ischemia reperfusion injury.
Patient: Forty-seven consecutive patients requiring diagnostic fiberoptic bronchoscopy were studied.
Measurements: Parameters evaluated were superior mesenteric artery Doppler sonography, oxidative stress mediators, arterial blood gases, blood cultures pre-fiberoptic bronchoscopy, and 1st, 4th, and 24th hr post-fiberoptic bronchoscopy.
Main Results: After bronchoscopy; Pao2 decreased by 21.8% ± 1.5% (range 6-40), and remained low at all time points (p = 0.0001, p = 0.0001, p = 0.008). Flow volume decreased by 38.8% ± 14.9% (range 6-72), and remained low at 1st and 4th hr (p = 0.0001, p = 0.01). Resistive and pulsatile index increased at 1st hr (p = 0.0001, p = 0.001) and 4th hr (p = 0.018, p = 0.045). Myeloperoxidase and malondialdehyde increased at 1st hr (p = 0.0001) and 4th hr (p = 0.037, p = 0.028). Corresponding glutathione and catalase decreased at 1st hr (p = 0.0001), and glutathione remained significant at 4th and 24th hr (p = 0.0001, p = 0.003). Correlation between flow volume and Pao2 (r = .71, p = 0.0001), myeloperoxidase (r = -.39, p = 0.05), glutathione (r = .41, p = 0.03) was significant. Nine of 47 (19.1%) had fever, and 3 of 47 (6.4%) had gram-negative bacteremia.
Conclusion: Fiberoptic bronchoscopy is associated with decreased mesenteric blood flow, which may place the patient at risk for mesenteric ischemia and gastrointestinal bacterial translocation.
LEARNING OBJECTIVES: On completion of this article, the reader should be able to:
1. List complications of bronchoscopy.
2. Explain risk factors for complications of bronchoscopy.
3. Use this information in a clinical setting.
The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.
All faculty and staff in a position to control the content of this CME activity have disclosed that they have no financial relationship with, or financial interests in, any commercial companies pertaining to this educational activity.
Lippincott CME Institute, Inc., has identified and resolved all faculty conflicts of interest regarding this educational activity.
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