title: Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients.
abstract: OBJECTIVE
  In critically ill patients with acute respiratory failure (ARF), fiberoptic bronchoscopy and bronchoalveolar lavage (FOB-BAL) are important tools in diagnostic strategies. In nonintubated patients, the patient's agitation may lead to desaturation and compromise the realization of FOB. The aim of this study was to assess the feasibility and safety of target-controlled (TCI) propofol sedation during FOB-BAL in nonintubated hypoxemic patients.
  
  
  METHODS
  The first end point in our prospective investigation within an intensive care unit (ICU) was the avoidance of endotracheal intubation within 24 h. Secondary end points were changes in the PaO(2)/FiO(2) ratio, hemodynamic stability, patient comfort, occurrence of adverse effects, and quality of FOB. Patients self-evaluated their comfort after FOB.
  
  
  RESULTS
  Twenty-four FOBs were performed in 23 patients with ARF. PaO(2)/FiO(2) before FOB was 181 ± 50 (range 85-286). All patients tolerated FOB with BAL. None was intubated during the 2 h after FOB. Loss of consciousness was obtained with an effect site concentration of propofol of 1.49 ± 0.46 μg/mL (range 2.6-0.6). No significant adverse events occurred. TCI  propofol allowed us to obtain amnesia, patient comfort, and it did not impair airway protection. Any hemodynamic changes observed were modest and transient.
  
  
  CONCLUSIONS
  FOB-BAL, under NIV and TCI with propofol, is feasible and safe in nonintubated patients with ARF. The TCI of propofol during FOB-BAL reduces patient discomfort with no significant adverse effects.
authors: Medical Intensive Care Unit, Pellegrin Teaching Hospital, Place Amélie Raba-Léon, 33076, Bordeaux Cedex, France. benjamin.clouzeau@chu-bordeaux.fr
authors: Benjamin
authors: B
authors: Clouzeau
authors: Hoang-Nam
authors: HN
authors: Bui
authors: Emmanuelle
authors: E
authors: Guilhon
authors: Marieke
authors: M
authors: Grenouillet-Delacre
authors: Melanie Saint
authors: MS
authors: Leger
authors: Tahar
authors: T
authors: Saghi
authors: Jerome
authors: J
authors: Pillot
authors: Bruno
authors: B
authors: Filloux
authors: Solenn
authors: S
authors: Coz
authors: Alexandre
authors: A
authors: Boyer
authors: Frederic
authors: F
authors: Vargas
authors: Didier
authors: D
authors: Gruson
authors: Gilles
authors: G
authors: Hilbert
mesh_terms: D000328:Adult; D000368:Aged; D018686:Anesthetics, Intravenous / Q000008:administration & dosage*; D018893:Bronchoalveolar Lavage; D001999:Bronchoscopy / Q000379:methods*; D016503:Drug Delivery Systems; D023381:Endpoint Determination; D005240:Feasibility Studies; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D000860:Hypoxia; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011175:Positive-Pressure Respiration; D015742:Propofol / Q000008:administration & dosage*; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome; D012449:Safety; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D018686:Anesthetics, Intravenous; D015742:Propofol