title: Fiber optic bronchoscopy and remifentanil target-controlled infusion in critically ill patients with acute hypoxaemic respiratory failure: A descriptive study.
abstract: BACKGROUND
  Sedation optimizes patient comfort and ease of execution during fiber optic bronchoscopy (FOB). Our objective was to describe the safety and efficacy of remifentanil-TCI during FOB in non-intubated, hypoxaemic, thoracic surgery ICU patients.
  
  
  METHODS
  Consecutive spontaneously breathing adults requiring FOB after thoracic surgery were included if they had hypoxaemia (PaO2/FiO2<300mmHg or need for non-invasive ventilation [NIV]) and prior FOB failure under topical anaesthesia. The remifentanil initial target was chosen at 1ng/mL brain effect-site concentration (Cet), then titrated to 0.5ng/mL Cet increments according to patient comfort and coughing. Outcomes were patient-reported pain and discomfort (Visual Analogue Scale scores), ventilatory support intensification within 24hours after bronchoscopy, and ease of FOB execution.
  
  
  RESULTS
  Thirty-nine patients were included; all had a successful FOB. Their median PO2/FiO2before starting FOB was 187±84mmHg and 24 patients received NIV. Median [interquartile range] pain scores were not different before and after FOB (1.0 [0.0-3.0] and 0.0 [0.0-2.0], respectively). Discomfort was reported as absent or minimal by 27 patients (69%; 95% confidence interval [95% CI], 54-81%) and as bothersome but tolerable by 12 patients (31%; 95% CI, 19-46%). Mean FiO2returned to baseline within 2hours after FOB in 30 patients; the remaining 9 patients (23%; 95% CI, 13-38%) received ventilatory support intensification. Ease of execution was good or very good in 34 patients (87%; 95% CI, 73-94%), acceptable in 4 patients, and poor in 1 patient (persistent cough).
  
  
  CONCLUSIONS
  Sedation with remifentanil-TCI during FOB with prior failure under topical anaesthesia alone was effective and acceptably safe in non-intubated hypoxaemic thoracic surgery patients.
authors.affiliation: Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France. Electronic address: s.rezaiguia@ccml.fr.
authors.forename: Saïda
authors.initials: S
authors.lastname: Rezaiguia-Delclaux
authors.affiliation: Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France.
authors.forename: Florent
authors.initials: F
authors.lastname: Laverdure
authors.affiliation: Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France.
authors.forename: Talna
authors.initials: T
authors.lastname: Kortchinsky
authors.affiliation: Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France.
authors.forename: Léa
authors.initials: L
authors.lastname: Lemasle
authors.affiliation: Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Imbert
authors.affiliation: Cardiothoracic Intensive Care Unit, hôpital Marie-Lannelongue, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France; Université Paris Sud, Paris, France.
authors.forename: François
authors.initials: F
authors.lastname: Stéphan
mesh_terms: D000328:Adult; D000368:Aged; D001999:Bronchoscopy / Q000295:instrumentation* / Q000379:methods*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D000860:Hypoxia / Q000097:blood / Q000628:therapy*; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D010880:Piperidines / Q000008:administration & dosage*; D011446:Prospective Studies; D000077208:Remifentanil; D012131:Respiratory Insufficiency / Q000097:blood / Q000628:therapy*; D019616:Thoracic Surgical Procedures / Q000379:methods
chemical_list: D006993:Hypnotics and Sedatives; D010880:Piperidines; D000077208:Remifentanil
keywords: Fiber optic bronchoscopy; Hypoxaemia; Intensive care unit; Non-invasive ventilation; Remifentanil; Thoracic surgery