Feasibility analysis of flexible bronchoscopy in conjunction with noninvasive ventilation for therapy of hypoxemic patients with Central Airway Obstruction: a retrospective study

Abstract

Background Interventional bronchoscopy for hypoxemic patients with central airway obstruction (CAO) is typically performed under general anesthesia. This approach poses remarkable challenge for both bronchoscopist and anesthesiologist. Noninvasive ventilation (NIV) during flexible bronchoscopy (FB) has been successfully used in hypoxemic patients, but rarely in the treatment of hypoxemic patients with CAO. Objective To evaluate the feasibility of therapeutic FB assisted with NIV for therapy of hypoxemic patients with CAO. Method Twenty-nine hypoxemic CAO patients treated with FB from December 2010 to May 2016 in our hospital were retrospectively reviewed, either aided with NIV under sedation (NIV group ) or through artificial airway under general anesthesia (control group). Interventional procedures included balloon dilation, electrocautery and argon plasma coagulation Result Fifteen patients were enrolled in the NIV group and 14 in the control group. The success rate (93.3% VS 92.9%, p = 1.0), procedure time (60.5 ± 4.2 min VS 67.8 ± 5.6 min, p = 0.31) and oxygenation improvement between the two groups have no significant difference. Less reduction of systolic blood pressure and heart rate during procedure was observed in the NIV group. The NIV group showed shorter admission time before procedure than the control group (35.1 ± 4.6 h VS 55.6 ± 5.6 h, p < 0.01). In addition, procedure fee in the NIV group was significantly less than that in the control group (540.7 ± 62.8$ VS975.4 ± 69.5$, p < 0.0001). Conclusion FB assisted with NIV is a safe, efficient and economic method for therapy of selected hypoxemic patients with CAO.

Oxygenation strategies during flexible bronchoscopy: a review of the literature

“…The use of NIV during FOB has been also extended to more complicated procedures, such as transbronchial lung biopsy [ 33 ] and interventional procedures, including balloon dilation, electrocautery and argon plasma coagulation [ 34 ]. In keeping with the above-mentioned studies, NIV guaranteed a stable oxygenation [ 33 , 34 ] and good patients’ tolerance [ 33 ], whereas minor complications [ 34 ], as well as the number of patients requiring intubation after the procedure [ 33 ], were quite low. Similar findings have been also reported for patients with chronic [ 35 ] and acute-on-chronic [ 36 , 37 ] respiratory failure.…”