Noninvasive Ventilation-assisted Bronchoscopy in High-risk Hypoxemic Patients
| Autor: | Onkar Kumar Jha, Gurmeet S Chabbra, Sandip Bhattacharya, Mrinal Sircar |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_treatment
Sedation Respiratory failure Critical Care and Intensive Care Medicine law.invention 03 medical and health sciences 0302 clinical medicine Bronchoscopy law FOB medicine Intubation Mechanical ventilation medicine.diagnostic_test business.industry 030208 emergency & critical care medicine medicine.disease Intensive care unit 030228 respiratory system Pneumothorax Anesthesia NIV Original Article medicine.symptom Complication business Noninvasive ventilation |
| Zdroj: | Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine |
| ISSN: | 0972-5229 |
| Popis: | Background and aims Hypoxemic patients undergoing fiber-optic bronchoscopy (FOB) are at risk of worsening of respiratory failure requiring mechanical ventilation due to FOB procedure itself and its complications. As patients with respiratory failure are frequently managed by non-invasive ventilation (NIV); feasibility of FOB through NIV mask has been evaluated in some studies to avoid intubation. We describe here our own case series. Materials and methods Clinical data of 28 FOB done through NIV mask in 27 intensive care unit (ICU) patients over 6 years period at our center was collected retrospectively and analysed. Results Study comprises 27 (17 male; 52±21.6 years age) hypoxemic (PaO2 71.3±14.2, on NIV and oxygen supplementation) patients. All FOB were done at bedside, 15 of them were given sedation for the procedure. Twenty four patients had bronchoalveolar lavage (BAL); three underwent bronchial biopsies, four brush cytology and seven transbronchial biopsies. In 10 patients lung or lobar collapse was reversed. There was no significant change between pre and post bronchoscopy ABG parameters except for improved post FOB PaO2 (p = 0.0032) and SpO2 (p = 0.0046). One patient (3.57%) developed late pneumothorax and 3 patients (10.7%) had bleeding after biopsy. Prior to bronchoscopy 17 (16 BIPAP, 1 CPAP) patients were already on NIV. Two patients required mechanical ventilation 6 hours after FOB due to subsequent clinical deterioration but could be weaned off later. One patient died on third day after FOB from acute myocardial infarction. Conclusion Hypoxemic patients in ICU can safely undergo bedside diagnostic and simple therapeutic bronchoscopy with NIV support while mostly avoiding intubation and with low complication rates. How to cite this article Sircar M, Jha OK, Chabbra GS, Bhattacharya S. Noninvasive Ventilation-assisted Bronchoscopy in High-risk Hypoxemic Patients. Indian J Crit Care Med 2019;23(8):363-367. |
| Databáze: | OpenAIRE |
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