Bronchoscopic intubation during continuous nasal positive pressure ventilation in the treatment of hypoxemic respiratory failure.
Endotracheal intubation is difficult in patients with hypoxemic respiratory failure who deteriorate despite treatment with noninvasive positive pressure ventilation (NIPPV). Maintaining NIPPV during intubation may prevent alveolar derecruitment and deterioration in gas exchange. We report a case series of 10 nonconsecutive patients with NIPPV failure who were intubated via a flexible bronchoscope during nasal mask positive pressure ventilation. All 10 patients were intubated in the first attempt. Hypotension was the most frequent complication (33%). Mean decrease in oxyhemoglobin saturation during the procedure was 4.7 ± 3.1. This method of intubation may extend the benefits of preoxygenation throughout the whole process of endotracheal intubation. It requires an experienced operator and partially cooperative patients. A prospective trial is necessary to determine the best intubation method for NIPPV failure.
Division of Pulmonary and Critical Care Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
Igor
I
Barjaktarevic
Division of Pulmonary and Critical Care Medicine, Weill Cornell Medical College, New York, NY, USA berlind@med.cornell.edu.
David
D
Berlin
D000368:Aged; D020680:Bronchoscopes; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000628:therapy*; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D008297:Male; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000628:therapy*
bronchoscopy; complications of endotracheal intubation; noninvasive positive pressure ventilation; severe hypoxemic respiratory failure