Fiberoptic Bronchoscopy during Nasal Non-Invasive Ventilation in Acute Respiratory Failure
2010; Karger Publishers; Volume: 80; Issue: 4 Linguagem: Inglês
10.1159/000314074
ISSN1423-0356
AutoresEusebi Chiner, José N. Sancho-Chust, Mónica Llombart, Cristina Senent, Ana María Camarasa Belmonte, Jaime Signes‐Costa,
Tópico(s)Respiratory Support and Mechanisms
Resumo<i>Background:</i> 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). <i>Objectives:</i> To evaluate the safety of a new method to perform FB in patients with ARF. <i>Methods:</i> Patients with ARF in whom FB was indicated were studied. The primary end-point was a mean drop in oxygen saturation (S<sub>a</sub><i>O</i><sub>2</sub>) 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. <i>Results:</i> Thirty-five patients were included in the final study (63 ± 17 years, 74% men, P<sub>a</sub><i>O</i><sub>2</sub>/F<sub>i</sub><i>O</i><sub>2</sub> 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<sub>a</sub><i>O</i><sub>2</sub> 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<sub>a</sub><i>O</i><sub>2</sub> value reached during the procedure was 86 ± 3% and the maximal ET<i>C</i><i>O</i><sub>2</sub> 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. <i>Conclusions:</i> 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.
Referência(s)