THE Effect of OVERWEIGHT on BRONCHOSCOPY OUTCOME

Abstract

Bronchoscopy is an essential tool in respiratory medicine, which allows visualization and sampling from the main airways. It is a very safe technique which can be performed with or without conscious sedation. Recent developments increased diagnostic sensitivity and facilitated image guided biopsies of masses beyond the airways. The therapeutic role of bronchoscopy is also expanding from lung cancer to airways disease (Shah, 2008). The prevalence of overweight has dramatically increased during recent years in all parts of the world (James, 2014). The major respiratory complications of obesity on the respiratory system include a heightened demand for ventilation and elevated work of breathing (Parameswaran et al., 2006). There is deficient data and studies on the relation of overweight and the bronchoscopy outcome. This study aimed to assess the outcomes of bronchoscopy in overweight patients in comparison to non-overweight patients undergoing either rigid or flexible bronchoscopy. This was a prospective study which recruited adult patients (≥18 years old) who underwent flexible or rigid bronchoscopy in Brochosocpy unit in Chest department, Ain Shams University hospital during the period from July 2013 till July 2014. The data was collected from all patients includes demographic data, comorbid illness, indications ,type of bronchoscopy, procedures, route of intubation, anesthesia type and dose in case of local anesthesia, shifting from flexible to rigid bronchoscopy, sedation usage and doses, oxygen requirements and saturations, duration of bronchoscopy, degree of pain, difficulty of intubation by bronchoscopist in felixible under local anesthesia using VAS, completion of planned procedure, diagnostic or therapeutic goal achieved, admission to higher care level, complications and mortalityi. The current study was conducted on Total 153 patient divided into 93 patients in overweight group (BMI≥25) and 60 patients in non-overweight group (BMI<25) based on the BMI according to the WHO Definition of overweight in 2011. These results were achieved:  The smokers are more common in non-overweight groups with higher smoking index among non-overweight.  The bronchial asthma is the only comorbidity in the study that had significant difference. It is more prevelant in overweight patients than non-overweight patients.  There was no statistically significant difference between overweight and non-overweight groups as regard indications of bronchoscopy, bronchoscopic sampling, bronchoscopic interventions, route of intubation, shifting from flexible to rigid bronchoscopy, oxygen requirements and doses during (only in flexible) and post bronchoscopy (in flexible and rigid bronchoscopy) and duration of bronchoscopy.  No significant different for visual analogue score for patient (for pain) and for bronchoscopist (for difficulty of intubation ) in the overweight and non-overweight patients (only was done) in cases with local anesthesia.  No significant difference in the usage of local anesthesia versus general anesthesia, usage of sedation (midazolam) and the doses of local anesthesia and sedation.  As regard outcome of bronchoscopy; completion of bronchoscopy, goal achievement, transferal to higher care level, complications and mortality, no statistically significant difference between overweight and non-overweight groups when using the flexible or rigid bronchoscopy. From the results of this study, it could be concluded that: the outcomes of bronchoscopy did not differ in overweight versus non-overweight patients.