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. 2019 Aug;23(8):363-367.
doi: 10.5005/jp-journals-10071-23219.

Noninvasive Ventilation-assisted Bronchoscopy in High-risk Hypoxemic Patients

Mrinal Sircar  1 , Onkar K Jha  1 , Gurmeet S Chabbra  2 , Sandip Bhattacharya  3
Affiliations

Noninvasive Ventilation-assisted Bronchoscopy in High-risk Hypoxemic Patients

Mrinal Sircar et al. Indian J Crit Care Med. 2019 Aug.

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.

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.

Keywords: Bronchoscopy; FOB; NIV; Noninvasive ventilation; Respiratory failure.

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Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
Fiber-optic bronchoscopy through non-invasive ventilation. (a) Anesthesia face mask; (b) Fiber-optic bronchoscope; (c) Trap for BAL collection; (d) Catheter mount; (e) Bite guard; (f) Oxygen enrichment connector; (g) Oxygen tubing; (h) Pulse oximeter; (i) Noninvasive BP cuff
See this image and copyright information in PMC

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