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.