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Lung cancer
Comparative outcomes of inpatients with lung collapse managed by bronchoscopic or conservative means
  1. Omesh Gopal Toolsie1,
  2. Muhammad Adrish2,
  3. Syed Arsalan Akhter Zaidi3 and
  4. Gilda Diaz-Fuentes4
  1. 1Pulmonary Fellow; Division of Pulmonary and Critical Care Medicine, BronxCare Health System affiliated with Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  2. 2Clinical Assistant Professor, Medicine, BronxCare Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, Bronx, New York, USA
  3. 3Internal Medicine Resident, Department of Medicine, BronxCare Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  4. 4Associate Professor of Clinical Medicine, Division of Pulmonary and Critical Care Medicine, BronxCare Hospital Center, Affiliated with Icahn School of Medicine at Mount Sinai, New York City, New York, USA
  1. Correspondence to Dr Omesh Gopal Toolsie; omeshtoolsie{at}gmail.com

Abstract

Background Although the incidence and prevalence of atelectatic lung collapse is unknown, such events are common among inpatients, and there are no guidelines for optimally instituting bronchoscopic techniques. The aim of this study was to evaluate the outcomes of patients with complete or near-complete lung collapse managed via interventional flexible fibreoptic bronchoscopy or a conservative approach.

Methods Retrospective analysis of all adult patients admitted to BronxCare Health System between January 2011 and October 2017 with a diagnosis of lung collapse/atelectasis. The primary outcome was radiological resolution. Timing of bronchoscopy relative to radiological resolution and mortality served as secondary outcomes.

Results Of the 177 patients meeting inclusion criteria, 149 (84%) underwent bronchoscopy and 28 (16%) were managed through conservative measures only. A significantly greater number of patients in the bronchoscopy group achieved complete or near-complete resolution on chest X-ray, compared with the conservative group (p=0.007). Timing of bronchoscopy had no impact on the rate of radiological resolution, and mortality in the two groups was similar. New endobronchial malignancies were identified in 21 patients (14%).

Conclusions Our data support the central role of bronchoscopy in instances of complete or near-complete lung collapse, ensuring better radiological outcomes. Judicious use of conservative management is warranted to avoid missing significant pathology. A prime consideration in this setting is obstructive malignancy.

  • Atelectasis
  • Lung collapse
  • Bronchoscopy
  • Endobronchial lesions

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjresp-2019-000427

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    Footnotes

    • Contributors OGT: made substantial contributions to data acquisition of data and drafted the initial manuscript. He was also involved in the analysis and interpretation of data. Additionally, he was involved in the editing of the manuscript and approved the final version to be considered for publication. He had agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. MA: principal investigator was involved in the conception and design of the study as well as analysis and interpretation of the data. He also critically revised the drafted manuscript and approved the final version to be considered for publication. He had agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. SAAZ: this author had made significant contributions to the acquisition of data, revised the drafted manuscript and had provided approved the final version to be considered for publication. He had agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. GD-F: this author was involved in the conception and design of the study as well as analysis and interpretation of the data. She also critically revised the drafted manuscript and approved the final version to be considered for publication. She had agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval This study protocol adhered to the amended Declaration of Helsinki and was approved by our Institutional Review Board (approval number 11091702).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data are available on reasonable request.