Management of iatrogenic airway bleeding with flexible bronchoscopy: Evidence or experience-based?

IF 0.7 Q4 RESPIRATORY SYSTEM Tuberkuloz ve Toraks-Tuberculosis and Thorax Pub Date : 2023-12-01 DOI:10.5578/tt.20239608
Oğuz Karcıoğlu, Ziya Toros Selçuk
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Abstract

Iatrogenic bleeding during bronchoscopy may lead to early termination, insufficient sample collection, decreased diagnostic accuracy, and even death. Unlike rigid bronchoscopy, the management of bleeding during flexible fiberoptic bronchoscopy does not allow the use of methods such as cautery, direct pressure, etc. and is usually limited to the application of liquids. The management of endobronchial bleeding usually depends on two main mechanisms: 1) vasoconstriction; 2) enhancing coagulation to form fibrin clots. The data on cold saline, the most widely recognized agent, is based on case reports and the experience of centers, not randomized controlled trials. Vasoconstrictor agents consist of adrenaline, vasopressin analogues, phenylephrine, and xylometazoline hydrochloride. However, there are only a limited number of randomized controlled trials on adrenaline, and information on the remaining substances is limited to retrospective studies, case reports, and expert opinions. The endobronchial administration of tranexamic acid, which inhibits fibrin degradation, has been the subject of very few studies. Despite its documented efficacy, information regarding its dosage, frequency of use, and safety is lacking. Although Ankaferd Blood Stopper, which binds erythrocytes to the vascular endothelium, has been shown to be effective in controlling bleeding related to dental procedures, the gastrointestinal tract, and operations, only one retrospective study found it to be effective against endobronchial bleeding that could not be controlled with cold saline and adrenaline. Although there are a variety of agents that centers use in their routine procedures, there is not yet a consensus on the efficacy, dose, frequency, and safety of any of them.

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使用柔性支气管镜处理先天性气道出血:基于证据还是经验?
支气管镜检查过程中的先天性出血可能导致检查提前终止、样本采集不足、诊断准确性降低,甚至死亡。与硬质支气管镜检查不同,柔性纤维支气管镜检查中的出血处理不能使用烧灼、直接加压等方法,通常仅限于涂抹液体。支气管内出血的处理通常取决于两个主要机制:1)血管收缩;2)加强凝血以形成纤维蛋白凝块。冷盐水是最广为人知的药物,其数据基于病例报告和各中心的经验,而非随机对照试验。血管收缩剂包括肾上腺素、血管加压素类似物、苯肾上腺素和盐酸羟甲唑啉。然而,关于肾上腺素的随机对照试验数量有限,其余物质的信息也仅限于回顾性研究、病例报告和专家意见。抑制纤维蛋白降解的氨甲环酸在支气管内给药方面的研究很少。尽管氨甲环酸具有记录在案的疗效,但有关其剂量、使用频率和安全性的信息却十分匮乏。安卡非德止血剂能将红细胞与血管内皮结合,已被证明能有效控制牙科手术、胃肠道和手术相关的出血,但只有一项回顾性研究发现它对冷盐水和肾上腺素无法控制的支气管内出血有效。尽管各中心在常规程序中使用的药剂种类繁多,但对于其中任何一种药剂的疗效、剂量、频率和安全性尚未达成共识。
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CiteScore
1.50
自引率
9.10%
发文量
43
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