title: Fiberoptic bronchoscopy during noninvasive positive pressure ventilation delivered by helmet.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) during noninvasive positive pressure ventilation (NPPV) delivered by helmet in patients with acute respiratory failure (ARF) and suspected pneumonia.
  
  
  METHODS
  Prospective, clinical investigation in a general intensive care unit (ICU) of a university hospital.
  
  
  METHODS
  Four adult patients with ARF who underwent NPPV via the helmet and required fiberoptic BAL for suspected pneumonia.
  
  
  METHODS
  NPPV was delivered through the helmet in the pressure support ventilation mode. The specific seal connector placed in the plastic ring of the helmet allowed the passage of the bronchoscope, maintaining assisted ventilation. Arterial blood gas levels, pH, oxygen saturation, respiratory rate, heart rate, and mean arterial blood pressure were monitored during the study.
  
  
  RESULTS
  Helmet NPPV avoided gas exchanges deterioration during FOB and BAL, with good tolerance. During the procedure heart rate increased by 5% and mean arterial blood pressure by 7% over baseline; these levels returned to prebronchoscopic values immediately after the withdrawal of the bronchoscope. Endotracheal intubation was never required during the 24 h after the procedure. BAL yielded diagnostic information in three of four patients.
  
  
  CONCLUSIONS
  NPPV through the helmet allows a safe diagnostic FOB with BAL in patients with hypoxemic ARF, avoiding gas exchange deterioration, and endotracheal intubation.
  
  
  BACKGROUND
  is available if you access this article at http://dx.doi.org/10.1007/s00134-002-1554-5. On that page (frame on the left side), a link takes you directly to the supplementary materials.
authors.affiliation: Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Policlinico A Gemelli, Largo A Gemelli 8, 00168 Rome, Italy. m.antonelli@rm.unicatt.it
authors.forename: Massimo
authors.initials: M
authors.lastname: Antonelli
authors.forename: Mariano Alberto
authors.initials: MA
authors.lastname: Pennisi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Conti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bello
authors.forename: Salvatore Maurizio
authors.initials: SM
authors.lastname: Maggiore
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Michetti
authors.forename: Franco
authors.initials: F
authors.lastname: Cavaliere
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Proietti
mesh_terms: D000328:Adult; D000368:Aged; D018893:Bronchoalveolar Lavage / Q000379:methods; D001999:Bronchoscopy / Q000379:methods*; D005260:Female; D005336:Fiber Optic Technology; D006260:Head Protective Devices; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis*; D011175:Positive-Pressure Respiration / Q000295:instrumentation*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000175:diagnosis*; D018709:Statistics, Nonparametric