Fiberoptic bronchoscopy during nasal non-invasive ventilation in acute respiratory failure.

摘要

BACKGROUND: Various methods have been described for safely performing fiberoptic bronchoscopy (FB) while applying non-invasive positive pressure ventilation (NIPPV) in patients with acute respiratory failure (ARF). OBJECTIVES: To evaluate the safety of a new method to perform FB in patients with ARF. METHODS: Patients with ARF in whom FB was indicated were studied. The primary end-point was a mean drop in oxygen saturation (S(a)O(2)) after the procedure. During nasal NIPPV, FB was performed via the mouth using a bite block sealed with an elastic glove finger allowing bronchoscope insertion. RESULTS: Thirty-five patients were included in the final study (63 +/- 17 years, 74% men, P(a)O(2)/F(i)O(2) ratio 168 +/- 63). A total of 35 bronchoaspirates, 21 protected brushings, 11 bronchoalveolar lavages and 8 bronchial biopsies were done. The cardiorespiratory variables at the start and end of FB were: S(a)O(2) 93 +/- 3 to 94 +/- 5%, heart rate 95 +/- 17 to 99 +/- 22 b.p.m. and respiratory rate 24 +/- 11 to 25 +/- 11 respirations/min. The lowest S(a)O(2) value reached during the procedure was 86 +/- 3% and the maximal ETCO(2) rise was 41 +/- 4 mm Hg. Leakage was <50 ml/s in 32 patients. The clinical course was favorable in 66%. Invasive ventilation was necessary in 11%, 5 +/- 4 days after FB. Twelve patients (33%) died 3 +/- 2 days after FB as a result of their underlying disease. CONCLUSIONS: The system allowed to perform FB safely in patients with ARF. Although there is a relatively high rate of intubation and invasive mechanical ventilation due to illness severity, there was no worsening of oxygenation or complications attributable to the procedure.