A Summary of Nine Years’ Cleveland Clinic Experience and Review of the Literature

F lexible fiberoptic bronchoscopy is a frequently performed procedure that is generally well tolerated with few adverse effects. The commonly recognized complications include vasovagal reaction, fever, cardiac arrhythmias, bleeding, bronchospasm, pneumonia, and pneumothorax. Fortunately, fatalities occurring during or directly following the procedure have been rare. Credie et al2 noted three deaths among 24,52i procedures, yielding a mortality rate of 0.Oi percent. Surratt and associates3 determined a mortality rate of 0.03 percent from approximately 48,000 procedures. Pereira and co-workers’ recorded one death following bronchoscopic procedures in 908 patients, yielding a mortality rate of 0. i percent, and Ahmad et al noted no death among 688 outpatients undergoing FFB. The highest recorded mortality rate of 0.5 percent was noted by Dreisin et al in a series of 205 bronchoscopic procedures. General guidelines to enhance the safety and patient tolerance of the procedure have been proposed in the literature.#{176} Of the most frequently encountered complications, bleeding is perhaps the most distressing and difficult management problem for the bronchoscopist. In order to better define the patient population most prone to bleeding, factors predisposing to this complication and management of bronchoscopically induced hemorrhage, we reviewed the bronchoscopy literature, as well as our experience with bleeding produced by bronchoscopy, and outlined a management protocol for this complication.