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VOLUME 23 , ISSUE 8 ( August, 2019 ) > List of Articles

Original Article

Noninvasive Ventilation-assisted Bronchoscopy in High-risk Hypoxemic Patients

Gurmeet S Chabbra, Sandip Bhattacharya

Keywords : Bronchoscopy, FOB, NIV, Noninvasive ventilation, Respiratory failure

Citation Information : Chabbra GS, Bhattacharya S. Noninvasive Ventilation-assisted Bronchoscopy in High-risk Hypoxemic Patients. Indian J Crit Care Med 2019; 23 (8):363-367.

DOI: 10.5005/jp-journals-10071-23219

License: CC BY-NC 4.0

Published Online: 00-08-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

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.


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  1. Goldstein RA, Rohatgi PK, Bergofsky EH, Block ER, Daniele RP, Dantzker DR, et al. Clinical role of bronchoalveolar lavage in adults with pulmonary disease. Am. Rev. Respir. Dis. 1990;142:481–486.
  2. Shelhamer JH, Toews GB, Masur H, Suffredini AF, Pizzo PA, Walsh TJ, et al. NIH conference. Respiratory disease in the immunosuppressed patient. Ann. Intern. Med. 1992;117:415–431.
  3. Sircar M, Ranjan P, Gupta R, Jha OK, Gupta A, Kaur R, et al. Impact of bronchoalveolar lavage multiplex polymerase chain reaction on microbiological yield and therapeutic decisions in severe pneumonia in intensive care unit. J. Crit. Care 2016;31:227–232.
  4. Hilbert G, Gruson D, Vargas F, Valentino R, Favier JC, Portel L, et al. Bronchoscopy with bronchoalveolar lavage via the laryngeal mask airway in high-risk hypoxemic immunosuppressed patients. Crit. Care Med. 2001;29:249–255.
  5. Antonelli M, Conti G, Riccioni L, Meduri GU. Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients. Chest 1996;110:724–728.
  6. Da Conceicao M, Genco G, Favier JC, Bidallier I, Pitti R. Fiberoptic bronchoscopy during noninvasive positive-pressure ventilation in patients with chronic obstructive lung disease with hypoxemia and hypercapnia. Ann. Fr. Anesth. Reanim. 2000;19:231–236.
  7. Maitre B, Jaber S, Maggiore SM, Bergot E, Richard JC, Bakthiari H, et al. Continuous positive airway pressure during fiberoptic bronchoscopy in hypoxemic patients. A randomized double-blind study using a new device. Am. J. Respir. Crit. Care Med. 2000;162:1063–1067.
  8. Antonelli M, Conti G, Rocco M, Arcangeli A, Cavaliere F, Proietti R, et al. Noninvasive positive-pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy. Chest 2002;121:1149–1154.
  9. Antonelli M, Pennisi MA, Conti G, Bello G, Maggiore SM, Michetti V, et al. Fiberoptic bronchoscopy during noninvasive positive pressure ventilation delivered by helmet. Intensive Care Med. 2003;29:126–129.
  10. Chiner E, Llombart M, Signes-Costa J, Andreu AL, Gomez-Merino E, Pastor E, et al. Description of a new procedure for fiberoptic bronchoscopy during noninvasive ventilation through a nasal mask in patients with acute respiratory failure. Arch. Bronconeumol. 2005;41:698–701.
  11. Trachsel D, Erb TO, Frei FJ, Hammer J, Swiss Paediatric Respiratory Research Group. Use of continuous positive airway pressure during flexible bronchoscopy in young children. Eur Respir J. 2005;26:773–777.
  12. Heunks LM, de Bruin CJ, van der Hoeven JG, van der Heijden HF. Non-invasive mechanical ventilation for diagnostic bronchoscopy using a new face mask: an observational feasibility study. Intensive Care Med. 2010;36:143–147.
  13. Scala R, Naldi M, Maccari U. Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia. Crit. Care 2010;14:R80.
  14. Baumann HJ, Klose H, Simon M, Ghadban T, Braune SA, Hennigs JK, et al. Fiber optic bronchoscopy in patients with acute hypoxemic respiratory failure requiring noninvasive ventilation--a feasibility study. Crit. Care 2011;15:R179.
  15. Clouzeau B, Bui HN, Guilhon E, Grenouillet-Delacre M, Leger MS, Saghi T, et al. Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients. Intensive Care Med. 2011;37:1969–1975.
  16. Agarwal R, Khan A, Aggarwal AN, Gupta D. Bronchoscopic lung biopsy using noninvasive ventilatory support: case series and review of literature of NIV-assisted bronchoscopy. Respir. Care 2012;57:1927–1936.
  17. Korkmaz Ekren P, Basarik Aydogan B, Gurgun A, Tasbakan MS, Bacakoglu F, Nava S. Can fiberoptic bronchoscopy be applied to critically ill patients treated with noninvasive ventilation for acute respiratory distress syndrome? Prospective observational study. BMC PulmMed. 2016;16:89,016-0236-y.
  18. Rady W, Abouelela A, Abdallah A, Youssef W. Role of bronchoscopy during nonivasive ventilation in hypercapnic respiratory failure. Egypt J Chest Dis Tuberc 2014;63:1003–1011.
  19. Simon M, Braune S, Frings D, Wiontzek AK, Klose H, Kluge S. High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy--a prospective randomised trial. Crit. Care 2014;18:712,014-0712-9.
  20. Sircar M, Chabbra GS, Bhattacharya S. Bronchoscopy in Hypoxemic ICU Patients using Noninvasive Ventilation. Critical Care Med 2008;36:A133.
  21. Lindholm CE, Ollman B, Snyder JV, Millen EG, Grenvik A. Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients. Chest 1978;74:362–368.
  22. Albertini R, Harrel JH, Moser KM. Letter: Hypoxemia during fiberoptic bronchoscopy. Chest 1974;65:117–118.
  23. Jolliet P, Chevrolet JC. Bronchoscopy in the intensive care unit. Intensive Care Med. 1992;18:160–169.
  24. Lindholm CE, Ollman B, Snyder J, Millen E, Grenvik A. Flexible fiberoptic bronchoscopy in critical care medicine. Diagnosis, therapy and complications. Crit. Care Med. 1974;2:250–261.
  25. Matsushima Y, Jones RL, King EG, Moysa G, Alton JD. Alterations in pulmonary mechanics and gas exchange during routine fiberoptic bronchoscopy. Chest 1984;86:184–188.
  26. Zavala D. Bronchoscopy, lung biopsy, and other procedures. In: Murray J, Nadel J, editors. Textbook of respiratory medicine Philadelphia London Toronto Montreal Sydney tokyo: Saunders; 1988. p. 562-595.
  27. Campos JH. Fiberoptic bronchoscopy guidelines for the anesthesiologist. Revista Mexicana de Anestesiología 2011;31:S264-9.
  28. Barrett CR, Jr, Vecchione JJ, Bell AL, Jr. Flexible fiberoptic bronchoscopy for airway management during acute respiratory failure. Am. Rev. Respir. Dis. 1974;109:429–434.
  29. Chhajed PN, Aboyoun C, Malouf MA, Hopkins PM, Plit M, Grunstein RR, et al. Management of acute hypoxemia during flexible bronchoscopy with insertion of a nasopharyngeal tube in lung transplant recipients. Chest 2002;121:1350–1354.
  30. Trouillet JL, Guiguet M, Gibert C, Fagon JY, Dreyfuss D, Blanchet F, et al. Fiberoptic bronchoscopy in ventilated patients. Evaluation of cardiopulmonary risk under midazolam sedation. Chest 1990;97:927–933.
  31. Schlobohm RM, Falltrick RT, Quan SF, Katz JA. Lung volumes, mechanics, and oxygenation during spontaneous positive-pressure ventilation: the advantage of CPAP over EPAP. Anesthesiology 1981;55:416–422.
  32. Borowiecki B, Pollak CP, Weitzman ED, Rakoff S, Imperato J. Fibro-optic study of pharyngeal airway during sleep in patients with hypersomnia obstructive sleep-apnea syndrome. Laryngoscope 1978;88:1310–1313.
  33. Popper RA, Leidinger MJ, Williams AJ. Endoscopic observations of the pharyngeal airway during treatment of obstructive sleep apnea with nasal continuous positive airway pressure--a pneumatic splint. West. J. Med. 1986;144:83–85.
  34. Chiner E, Sancho-Chust JN, Llombart M, Senent C, Camarasa A, Signes-Costa J. Fiberoptic bronchoscopy during nasal non-invasive ventilation in acute respiratory failure. Respiration 2010;80:321–326.
  35. Bove T, Votta CD, Ciriaco P, Papalardo F, Oriani A, Frau G, et al. Bronchoscopy during non-invasive ventilation in a patient with acute respiratory distress syndrome. SIGNA VITAE 2017;13:103–104.
  36. Cabrini L, Nobile L, Cama E, Borghi G, Pieri M, Bocchino S, et al. Non-invasive ventilation during upper endoscopies in adult patients. A systematic review. Minerva Anestesiol. 2013;79:683–694.
  37. Folgado MA, De la Serna C, Llorente A, Rodriguez S, Ochoa C, Diaz-Lobato S. Utility of noninvasive ventilation in high-risk patients during endoscopic retrograde cholangiopancreatography. Lung India. 2014;31:331–335.
  38. Guarracino F, Cabrini L, Baldassarri R, Cariello C, Covello RD, Landoni G, et al. Non-invasive ventilation-aided transoesophageal echocardiography in high-risk patients: a pilot study. Eur. J. Echocardiogr. 2010;11:554–556.
  39. Dreher M, Ekkernkamp E, Storre JH, Kabitz HJ, Windisch W. Sedation during flexible bronchoscopy in patients with pre-existing respiratory failure: Midazolam versus Midazolam plus Alfentanil. Respiration 2010;79:307–314.
  40. Hilbert G, Clouzeau B, Nam Bui H, Vargas F. Sedation during non-invasive ventilation. Minerva Anestesiol. 2012;78:842–846.
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