Survey of management of iatrogenic bleeding following bronchoscopic sampling

We read with interest the recent papers by Abuqayyas et al . [1] and Pathak et al . [2] as well as the associated editorial by Herth [3], which all highlighted the safety issues of bronchoscopy with antithrombotic agents. However, there is also a significant issue with regard to a bronchoscopist's ability to manage bleeding and their level of training. Flexible bronchoscopy as an investigative modality is very safe, with an estimated mortality between 1:1000 and 1:10 000 patients [4]. The most feared complication is severe bleeding following sampling, which can potentially lead to asphyxiation and/or exsanguination, although the risk of severe bleeding is extremely low at 0.26% [4]. However, this rarity means that screening for excess bleeding risk may not always occur and the bronchoscopist may not have the skill set or equipment to deal with an acute severe haemorrhage. This survey has revealed significant deficits in anticipating those at risk of severe bleeding from bronchoscopy