Safety of performing fiberoptic bronchoscopy in critically ill hypoxemic patients with acute respiratory failure
| Autor: | Elie Azoulay, Gaetan Beduneau, Alexandre Demoule, Hoang Nam Bui, Hélène Prodanovic, Muriel Fartoukh, Bernard Maitre, Cécile Chenivesse, Camille Taillé, Christine Lorut, Laurent Brochard, Christophe Cracco |
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| Přispěvatelé: | Unité de soins Continus (USC), Centre Hospitalier d'Angoulême (CH Angoulême), Réanimation Médicale, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Henri Mondor, CHU Tenon [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pitié-Salpêtrière [AP-HP], Medical ICU, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Groupe Hospitalier Saint Louis - Lariboisière - Fernand Widal [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Pneumologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Hôtel Dieu, Service de pneumologie, oncologie thoracique et soins intensifs respiratoires [Rouen], Université de Rouen Normandie (UNIROUEN), Normandie Université (NU)-Normandie Université (NU)-Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU), Service de Réanimation Médicale [CHU Bordeaux], CHU Bordeaux [Bordeaux]-Hôpital Pellegrin, Pneumologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-AP-HP - Hôpital Bichat - Claude Bernard [Paris], Institut Mondor de Recherche Biomédicale (IMRB), Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR10-Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Charles Nicolle [Rouen]-CHU Rouen, Normandie Université (NU)-Normandie Université (NU)-Université de Rouen Normandie (UNIROUEN) |
| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Adult
Male medicine.medical_specialty Critical Illness medicine.medical_treatment Critical Care and Intensive Care Medicine Article law.invention Bronchoscopies Positive-Pressure Respiration 03 medical and health sciences 0302 clinical medicine Bronchoscopy law Anesthesiology Intensive care medicine Humans Intubation [SDV.BBM]Life Sciences [q-bio]/Biochemistry Molecular Biology Prospective Studies 030212 general & internal medicine Hypoxia Aged Aged 80 and over COPD medicine.diagnostic_test business.industry Middle Aged medicine.disease Respiration Artificial Intensive care unit 3. Good health 030228 respiratory system Anesthesia Acute Disease Breathing Female Respiratory Insufficiency business |
| Zdroj: | Intensive Care Med Intensive Care Med, 2013, 39 (1), pp.45-52. ⟨10.1007/s00134-012-2687-9⟩ |
| DOI: | 10.1007/s00134-012-2687-9⟩ |
| Popis: | International audience; BACKGROUND: The safety of fiberoptic bronchoscopy (FOB) in nonintubated critically ill patients with acute respiratory failure has not been extensively evaluated. We aimed to measure the incidence of intubation and the need to increase ventilatory support following FOB and to identify predictive factors for this event. METHODS: A prospective multicenter observational study was carried out in eight French adult intensive care units. The study included 169 FOB performed in patients with a PaO(2)/FiO(2) ratio ≤ 300. The main end-point was intubation rate. The secondary end-point was rate of increased ventilatory support defined as an increase in oxygen requirement >50 %, the need to start noninvasive positive pressure ventilation (NI-PPV) or increase NI-PPV support. RESULTS: Within 24 h, an increase in ventilatory support was required following 59 bronchoscopies (35 %), of which 25 (15 %) led to endotracheal intubation. The existence of chronic obstructive pulmonary disease (COPD; OR 5.2, 95 % CI 1.6-17.8; p = 0.007) or immunosuppression (OR 5.4, 95 % CI 1.7-17.2; p = 0.004] were significantly associated with the need for intubation in the multivariable analysis. None of the baseline physiological parameters including the PaO(2)/FiO(2) ratio was associated with intubation. CONCLUSIONS: Bronchoscopy is often followed by an increase in ventilatory support in hypoxemic critically ill patients, but less frequently by the need for intubation. COPD and immunosuppression are associated with the need for invasive ventilation in the 24 h following bronchoscopy. |
| Databáze: | OpenAIRE |
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