Increased hypoxemia in patients with COPD and pulmonary hypertension undergoing bronchoscopy with biopsy.
BACKGROUND AND OBJECTIVE
Patients with pulmonary hypertension (PH) are considered to be at risk for complications associated with flexible bronchoscopy (FB), but data concerning the degree of PH are often lacking. We investigated whether COPD patients with PH who undergo bronchoscopy are at greater risk for complications.


METHODS
This prospective study included 207 consecutive COPD patients undergoing FB. All underwent an echo-Doppler to evaluate pulmonary artery pressure on the day of the bronchoscopy procedure. Pulmonologists were blinded to the echocardiogram results.


RESULTS
A total of 167 patients (80.7%) had normal pulmonary pressure. The remaining 40 patients (19.3%) had PH: 27 (13.0%) mild, eight (3.9%) moderate, and five (2.4%) severe. Noninvasive hemodynamic parameters between groups before and after FB were similar. Two patients with normal pulmonary pressure developed supraventricular tachycardia. None developed hemodynamically significant dysrhythmia. Bleeding episodes between groups in bronchoalveolar lavage (BAL) and transbronchial biopsy (TBB) did not differ. PH patients who underwent BAL and TBB had decreased O2 saturation during the procedure compared with the non-PH group (23.5% vs 6.9%, P=0.033). No deaths were attributable to FB.


CONCLUSION
PH is common among COPD patients undergoing FB. PH patients undergoing BAL and TBB are at higher risk of decreased O2 saturation than those without PH. Further studies should assess the risk among COPD patients with moderate-to-severe PH.
['Neuman|Yoram|Y|', 'Koslow|Matthew|M|', 'Matveychuk|Alona|A|', 'Bar-Sef|Avigdor|A|', 'Guber|Alexander|A|', 'Shitrit|David|D|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D062186:Arterial Pressure D015415:Biomarkers D001706:Biopsy D018893:Bronchoalveolar Lavage D001999:Bronchoscopy D015150:Echocardiography, Doppler D005260:Female D006801:Humans D006976:Hypertension, Pulmonary D000860:Hypoxia D015994:Incidence D007557:Israel D008168:Lung D008297:Male D008875:Middle Aged D010100:Oxygen D011237:Predictive Value of Tests D011446:Prospective Studies D011651:Pulmonary Artery D029424:Pulmonary Disease, Chronic Obstructive D018570:Risk Assessment D012307:Risk Factors D012720:Severity of Illness Index
hypoxemia pulmonary hypertension bronchoscopy