Bronchoscopy in the Intensive Care Unit

Sadoughi, Ali; Chen, Alexander

doi:10.1002/9781119389231.ch27

Cited by 1 publication

(2 citation statements)

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“…Theoretically, when the bronchoscope is advanced from ETT, it causes a significant increase in airway pressures in this patient group. Peak inspiratory pressure and intrinsic PEEP increase and might cause significant decreases in ventilation per minute, 8 , 9 which in turn may cause an increased risk of barotrauma pneumothorax and hemodynamic deterioration. However, in our study group, none of these complications was observed.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertension, hypotension, and electrocardiographic changes may occur during FB. 4 , 8 Since arrhythmia is frequently related to oxygen desaturation, an increase may be expected in cardiovascular complication risks in critical patients. In our study, no hemodynamic deterioration that would require the discontinuation of the procedure occurred during FB; however, 1 patient developed severe hypotension after the procedure, which required an increase in vasopressor support in the first 24 h. We think that this may not be attributable only to the FB procedure itself as about one-third of the patients were receiving vasopressor treatment.…”

Section: Discussionmentioning

confidence: 99%

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The Safety of Fiberoptic Bronchoscopy in Airway Pressure Release Ventilation Mode in Critically Ill Patients with Severe Acute Respiratory Distress Syndrome: A Preliminary Study

Küçük¹,

Uğur²,

Cömert³

et al. 2022

Turk Thorac J

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OBJECTIVE: The most appropriate ventilatory mode during fiberoptic bronchoscopy is still not yet known clearly for patients with acute respiratory distress syndrome. Airway pressure release ventilation is used as a recovery treatment for patients with severe acute respiratory distress syndrome. In this study, the aim was to evaluate the safety of the fiberoptic bronchoscopy process in patients with severe acute respiratory distress syndrome ventilated with airway pressure release ventilation mode and its effect on gas exchange and respiratory mechanics. MATERIAL AND METHODS: Single-center retrospective observational study was performed in the intensive care unit of a tertiary referral center from September 2018 to November 2019. Patients with severe ARDS ventilated with APRV mode and undergoing FB were included. Fiberoptic bronchoscopy was performed by an expert intensivist-pulmonologist. All ventilator parameters set by the clinician were kept stable, and no change was made other than O 2 concentration. The mechanical ventilation parameters and arterial blood gas values before and after the procedure and fiberoptic bronchoscopy-related complications were recorded for the first 24 hours. Results: A total of 14 acute respiratory distress syndrome patients who were ventilated with airway pressure release ventilation were enrolled. No significant deteriorations were detected in gas exchange, pulmonary compliance, and airway resistance values in our case series. It was observed that a small reduction in PaO 2 and an increase in PaCO 2 were present after the 1st hour; however, both were returned to baseline values in the 24th hour. Only 1 patient developed fiberoptic bronchoscopy-induced hypoxemia (7.1%). Complications, such as fiberoptic bronchoscopy-induced barotrauma, pneumothorax, hemodynamic deterioration, and bleeding, were not detected. Conclusion: According to our preliminary findings, performing fiberoptic bronchoscopy under airway pressure release ventilation mode by an experienced bronchoscopist does not bring additional complication risks in patients with severe acute respiratory distress syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%