title: Fiberoptic bronchoscopy during nasal non-invasive ventilation in acute respiratory failure.
abstract: BACKGROUND
  Various methods have been described for safely performing fiberoptic bronchoscopy (FB) while applying non-invasive positive pressure ventilation (NIPPV) in patients with acute respiratory failure (ARF).
  
  
  OBJECTIVE
  To evaluate the safety of a new method to perform FB in patients with ARF.
  
  
  METHODS
  Patients with ARF in whom FB was indicated were studied. The primary end-point was a mean drop in oxygen saturation (S(a)O(2)) after the procedure. During nasal NIPPV, FB was performed via the mouth using a bite block sealed with an elastic glove finger allowing bronchoscope insertion.
  
  
  RESULTS
  Thirty-five patients were included in the final study (63 ± 17 years, 74% men, P(a)O(2)/F(i)O(2) ratio 168 ± 63). A total of 35 bronchoaspirates, 21 protected brushings, 11 bronchoalveolar lavages and 8 bronchial biopsies were done. The cardiorespiratory variables at the start and end of FB were: S(a)O(2) 93 ± 3 to 94 ± 5%, heart rate 95 ± 17 to 99 ± 22 b.p.m. and respiratory rate 24 ± 11 to 25 ± 11 respirations/min. The lowest S(a)O(2) value reached during the procedure was 86 ± 3% and the maximal ETCO(2) rise was 41 ± 4 mm Hg. Leakage was <50 ml/s in 32 patients. The clinical course was favorable in 66%. Invasive ventilation was necessary in 11%, 5 ± 4 days after FB. Twelve patients (33%) died 3 ± 2 days after FB as a result of their underlying disease.
  
  
  CONCLUSIONS
  The system allowed to perform FB safely in patients with ARF. Although there is a relatively high rate of intubation and invasive mechanical ventilation due to illness severity, there was no worsening of oxygenation or complications attributable to the procedure.
authors.affiliation: Pulmonology Section, University Hospital of Sant Joan d'Alacant, Sant Joan d'Alacant, Spain. chiner_eus @ gva.es
authors.forename: E
authors.initials: E
authors.lastname: Chiner
authors.forename: J N
authors.initials: JN
authors.lastname: Sancho-Chust
authors.forename: M
authors.initials: M
authors.lastname: Llombart
authors.forename: C
authors.initials: C
authors.lastname: Senent
authors.forename: A
authors.initials: A
authors.lastname: Camarasa
authors.forename: J
authors.initials: J
authors.lastname: Signes-Costa
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001999:Bronchoscopy / Q000295:instrumentation*; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000175:diagnosis*