Abstract
Introduction: The realization of fiberoptic Bronchoscopy (FBC) in patients with Severe Respiratory Failure (SRF), non-intubated and with high oxygen requirements, is contraindicated due to risk of serious arrhythmias or abrupt deterioration of ventilatory mechanics. Studies have shown that ventilation using non invasive (NIV) as support of breathing during the FBC in patients with SRF, is a safe and effective alternative to intubation, allowing an adequate gas exchange.
Methods: We prospectively assessed patients hospitalized in ICU, with SRF, not intubated requiring FBC and bronchoalveolar lavage on suspicion of nosocomial pneumonia. The procedure was performed through facial mask, connected to a double level of pressure generator, Bilevel, with an O2 port. During the study, tolerance, oxygen saturation and ventilatory parameters were monitorized.
Results: 22 patients (10 women) were included, the mean age was 55 years (range 13-82), 7 patients with lung transplant, heart transplant 2, 7 in postoperative cardiac surgery, 1 post-op Bariatric Surgery, 5 hospitalized for clinical reasons. Inspiratory Positive Airway Pressure levels used between 8 and 22 cmH2o and Expiratory Positive Airway Pressure levels between 4 and 10 cmh2o. The FiO2 was between 35% and 40%. The exhaled tidal volume average was 492 ml. The initial respiratory rate average was 25 and 26 at the end of the procedure. The media Sao2, at the beginning and at the end of the study was 96% and 95%, respectively.No patient presented arrhythmias or required intubation.
Conclusion: The use of NIV for the FBC represents a safe and effective alternative, avoiding intubation in patients with SRF.
- Copyright ©ERS 2015
