Pulmonology

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Iatrogenic bleeding during flexible bronchoscopy : risk factors, prophylactic measures and management
(European Respiratory Society, 2017-03-18) Bernasconi, Maurizio; Koegelenberg, Coenraad F. N.; Koutsokera, Angela; Ogna, Adam; Casutt, Alessio; Nicod, Laurent; Lovis, Alban
ENGLISH ABSTRACT: Significant iatrogenic bleeding during flexible bronchoscopy is fortunately rare and usually self-limiting. Life-threatening bleeding, however, can occur, especially after conventional or cryoprobeassisted transbronchial biopsy. The aim of this review is to provide the practising pulmonologist with a concise overview of the incidence, severity and risk factors for bleeding, to provide sensible advice on prophylactic measures and to suggest a plan of action in the case of significant bleeding. Bronchoscopy units should have a standardised approach and plan of action in the case of life-threatening haemorrhage. Wedging the bronchoscope in the bleeding segment, turning the patient in an anti-Trendelenburg position and onto the side in order for the bleeding lung to be in the dependent position, installing vasoconstrictors and using a tamponade balloon early are the recommended first-line strategies. Involving a resuscitation team should be considered early in the case of massive bleeding, desaturation and haemodynamic instability.