Alterations in Pulmonary Mechanics and Gas Exchange during Routine Fiberoptic Bronchoscopy

Matsushima, Y.; Jones, Richard L.; King, Elizabeth G.; Moysa, Gerald L.; Alton, John

doi:10.1378/chest.86.2.184

Cited by 134 publications

(72 citation statements)

References 12 publications

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“…Preferably it is performed through a tight seal connector allowing mechanical ventilation during suctioning. However the few bench and patient studies that exist suggest that these manoeuvres produce side-effects comparable to an open suctioning [71][72][73]. These findings were confirmed in the water lung model and patient study (Paper IV) as FOB suctioning induced marked decreases in lung volume, compliance and tracheal pressure.…”

Section: Open Versus Closed System Suctioningmentioning

confidence: 75%

“…Few patient data exist on the subject but several studies indicate that the procedure has the potential to create an unwanted lung collapse with respiratory and circulatory side-effects comparable to an open suctioning procedure [71][72][73]. ___________________________________________________________________________ [79] 443 less/more no diff.…”

Section: Introduction _______________________________________________mentioning

confidence: 99%

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Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography

et al. 2006

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Section: Open Versus Closed System Suctioningmentioning

confidence: 75%

Section: Introduction _______________________________________________mentioning

confidence: 99%

Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography

et al. 2006

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“…Additionally, functional residual capacity increases by 30% and forced expiratory volume in one second (FEV 1 ) decreases by 40%. ( Matsushima et al,1984) The decrease in the delivered tidal volume leads to hypoventilation and gas exchange abnormalities resulting in hypoxia and hypercapnea. Suctioning during bronchoscopy limits the delivered tidal volume further and up to 200 to 300 ml of delivered volume can be removed with each suctioning.…”

Section: Bronchoscopy On Patients On Mechanical Ventilationmentioning

confidence: 99%

Role of Flexible-Bronchoscopy in Pulmonary and Critical Care Practice

Diaz‐Fuentes¹,

Venkatram²

2012

Global Perspectives on Bronchoscopy

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“…Gas exchange is impaired through a process of alveolar filling, 12,14 especially after bronchoalveolar lavage, for example, when hypoxemia may persist for up to 6 hours. 15 This problem has prompted the American Thoracic Society to recommend avoiding bronchoscopy altogether in patients with hypoxemia that cannot be corrected to at least a PaO 2 of 75 mm Hg or to an oxygen saturation greater than 90%. 16,17 Intravenous sedation, usually necessary to ensure patients' comfort, can further compromise ventilatory status, especially in children and in patients with awake hypercapnia, obstructive sleep apnea, or obesity hypoventilation syndrome, who may have sedation-related increased collapsibility of the central airways.…”

Section: Physiological Basis For Nppv-assisted Bronchoscopymentioning

confidence: 99%

“…18 Finally, bronchoscopy can lead to air trapping and respiratory distress in patients with severe COPD because functional residual capacity increases when the scope is inserted nasally. 15 To enhance patient safety and overcome many of these procedure-related risks, endotracheal intubation is often recommended before flexible bronchoscopy is performed.…”

Section: Physiological Basis For Nppv-assisted Bronchoscopymentioning

confidence: 99%

Flexible Bronchoscopy Assisted by Noninvasive Positive Pressure Ventilation

Murgu

Pecson

Colt

2011

Critical Care Nurse

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endotracheal intubation in order to ensure airway patency and minimize risks of procedure-related respiratory insufficiency. [4][5][6][7] In many instances, however, bronchoscopy can be safely performed while the patient receives NPPV, sparing patients the discomfort and risks of refractory hypoxemia, intubation, and mechanical ventilation. The limited available published evidence indicates that NPPVassisted flexible bronchoscopy is used about 3 times per month in tertiary academic centers. 4,7 Critical care nurses have an essential role in the preparation and performance of this procedure, as well as in surveillance after the procedure, and, as part of the multidisciplinary health care team, in patient care decisions. The objectives of this article, therefore, are to review the physiological basis for NPPV-assisted bronchoscopy; describe its indications, contraindications, and techniques; and identify ways in which critical care nurses can further influence patient care before, during, and after this airway procedure. Critically ill patients with the aforementioned comorbid conditions may require diagnostic or therapeutic flexible bronchoscopy to diagnose or treat causes of airway obstruction, atelectasis, and pneumonia. Standard practice in these instances is to recommend bronchoscopy with high-flow supplemental oxygenation via face mask, or to proceed with sedation and N oninvasive positive pressure ventilation (NPPV) is defined as any form of ventilatory support applied without endotracheal intubation. 1An often-used alternative to endotracheal intubation, NPPV reduces the need for invasive mechanical ventilation in patients with hypoxic respiratory failure due to cardiogenic pulmonary edema or immunocompromised state. NPPV is also used to improve postoperative hypoxemia; reduce pulmonary complications after cardiac, upper abdominal, Noninvasive positive pressure ventilation is an alternative to intubation in critically ill patients with respiratory insufficiency or poor gas exchange who may require flexible bronchoscopy for diagnostic or therapeutic purposes. This ventilatory technique might help decrease the risk of bronchoscopy-related complications in patients with refractory hypoxemia, postoperative respiratory distress, severe emphysema, obstructive sleep apnea, and obesity hypoventilation syndrome and allows bronchoscopic assessment of patients with severe dyspnea from expiratory central airway collapse. In this review, the physiological rationale, indications, contraindications, techniques, and monitoring requirements for flexible bronchoscopy assisted by noninvasive positive pressure ventilation are described, with an emphasis on the role of critical care nurses in this procedure. (Critical Care Nurse.

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Alterations in Pulmonary Mechanics and Gas Exchange during Routine Fiberoptic Bronchoscopy

Cited by 134 publications

References 12 publications

Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography

Regional lung derecruitment after endotracheal suction during volume- or pressure-controlled ventilation: a study using electric impedance tomography

Role of Flexible-Bronchoscopy in Pulmonary and Critical Care Practice

Flexible Bronchoscopy Assisted by Noninvasive Positive Pressure Ventilation

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