Fibrobronchoscopy versus laryngotracheal aspiration for bronchial toileting in patients with aspiration pneumonia in the emergency department. FBS-ASaP prospective case-control study

Abstract

Aspiration pneumonia (AP) is common in patients with pneumonia evaluated in Emergency Department (ED). The therapeutic management of these patients often involves secretion suctioning through two main techniques: laryngotracheal aspiration (LTA) and fibrobronchoscopic aspiration (FBA). Despite both techniques being employed, there are no studies comparing the clinical outcomes. This prospective single-center observational case control study was conducted in the ED of Careggi University Hospital in Italy. Adult patients with radiological evidence of pneumonia, clinical diagnosis of AP and need for oxygen therapy were included from the 12th December 2023 to the 31st December 2024. The primary endpoints were 30 day-mortality and the length of hospital stay. Secondary endpoints included admission setting, changes in Horowitz index and O2 delivery device, and procedure-related complications. Statistical analysis was conducted on the entire sample and subsequently on a selected population using propensity score matching (PSM). 257 patients with a mean age of 78.0 ± 15.2 years were included in the study. There were no significant differences between LTA and FAB groups regarding 30-day mortality (37.7% FBA group vs 32% LTA group; p = 0.28) and length of hospital stay (11.8 ± 11.0 days FBA vs 9.5 ± 9.1 days LTA group; p = 0.45). No significant differences were observed for all secondary outcomes among the two groups. Also considering selected population based on PSM, no significant differences were observed. No significant differences were found in terms of mortality, length of hospital stay, morbidity and procedure-related complications among patients with AP treated with LTA or FBA.

Keywords: Aspiration pneumonia; Bronchoscopy; Emergency department.