Abstract
Introduction: PH is common in the sicker subsets of ILD. ILD transbronchial cryobiopsy (ILD-C) guidelines (Hetzel 2018, Dhooria et al 2019) mention PH [echocardiographic pulmonary artery pressure (PASP) > 40mmHg] as a relative contraindication (RC) due to risk of bleeding and worsening hypoxemia. These recommendations are extrapolated from surgical sampling.
Aim: We analysed ILD-C high-PH (PASP > 40mmHg) in real world situations, and the role of pre-optimization in facilitating ILD-C in this group, otherwise contraindicated for ILD-C.
Methods: Retrospective review of 150 ILD-C procedures, identifying patients with PASP > 40mmHg (RC-PH group), evaluating complications such as bleeding, pneumothorax (PTX), worsening hypoxemia and mortality in this subset. RC-PH patients were admitted pre-procedure for optimisation with titrated supplemental oxygen and diuretic therapy. ILD-C was done after PASP was <45mm Hg with general anaesthesia, rigid bronchoscopy and Fogarty blocker. Outcomes were compared with the guideline-compatible PH group (GC-PH, PASP < 40mmHg).
Results: There were 23 (15.3%) patients in the RC-PH group, and 127 (84.7%) in the GC-PH group. Average PASP in the RC-PH groups was 52 ± 11 (Range 41-90mm of Hg). There was no statistically significant difference in bleeding (>20ml), PTX, length of stay(LOS) and hypoxemia requiring escalated care between the 2 groups.
Conclusion: In ILD-C patients with PASP >40mmHg contraindicated for biopsy, pre-optimization can help in reducing PH, and facilitating a safe procedure. This needs further study and incorporation into guidelines to widen the spectrum of ILD-C, particularly as surgical lung biopsy is contraindicated in these patients
Footnotes
Cite this article as: European Respiratory Journal 2019; 54: Suppl. 63, OA1621.
This is an ERS International Congress abstract. No full-text version is available. Further material to accompany this abstract may be available at www.ers-education.org (ERS member access only).
- Copyright ©the authors 2019