The Science Journal of the American Association for Respiratory Care

2006 OPEN FORUM Abstracts

FIBEROPTIC BRONCHOSCOPY (FOB) DURING NONINVASIVE POSTIVE PRESSURE VENTILATION (NIMV). INTERFACE OPTIONS, EQUIPMENTS AND METHODOLOGY

Esquinas A (1), Chiner E(2), Huidobro S(3), Carrillo A, Gomez Merino E (2), Signes-Costa J. (2), Quintana  E., Soler JA, González Díaz G.  (1) Intensive Care Unit Hospital Morales Meseguer, Murcia, Spain. (2) Pneumology Department Hospital Sand Juan Alicante, Spain. (3) ICU Hospital Universitario de Canarias and FOB Working Group members. 

Objective: To evaluate the feasibility and safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) during noninvasive mechanical ventilation (NIMV) delivered by in patients with acute respiratory failure (ARF) with three interface systems for nasal or oral FOB. 

Design and Setting: Prospective, clinical, multicenter. Investigation in intensive care unit (ICU) and pneumology ward of two university hospital.

Patients, equipments and interventions: adult patients with ARF who underwent NPPV via three interface options: I: Nasal FOB by two faces mask: I-A) CPAP Boussigac system design for continuous positive arway pressure ( CPAP) I-B) Koo face mask with a specific seal connector placed allowed the passage of the bronchoscope and II) Oral FOB:  by a globe finger fitter into a mouth ward that act a valve. NIMV  by BiPAP Vision Ventilator ( Respironics, Inc Mu) was used in IB and II options, with two levels of pressure ( BiPAP mode)  and I-A option with CPAP mode with continuous oxygen flow. Continuous electrocardiorespiratory monitoring.

All patients are in ARF ( hypoxemic ≤ 300, respiratory rate ≥25, dysnea) and and required FOB with BAL for suspected pneumonia. Arterial blood gas levels, oxygen saturation, respiratory rate, heart rate, interface tolerance and technical problems were analysed during FOB.

Results: 50 adult in ARF were included in pneumology ward (n:2/50) and intensive care (n:48/50) distributed in IA= (n:7/50) , IB= (n:35/50), and II=(n:8/50) with two ventilatory modes (CPAP (14% n: 7) and BiPAP mode (86% n:43). NPPV avoided gas exchanges deterioration during FOB and BAL, with good tolerance with three interface options. During the procedure all patients presented tolerance with interface options. One patients had difficult control during bronchoscopy by important leaks ( II group). Four patients, need endotraqueal intubation for hipoxemic and shock after BAL. NIMV was continued in ICU after resolution of ARF in (n:45). Oxygenation and clinical conditions were stable during and after prebronchoscopic values immediately after the withdrawal of the bronchoscope.

Conclusions: FOB with NPPV with theses interface options allows a safe diagnostic FOB with BAL in patients with hypoxemic ARF, avoiding gas exchange deterioration, and endotracheal intubation.


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