Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients

Clouzeau, Benjamin; Bui, Hoang-Nam; Guilhon, Emmanuelle; Grenouillet-Delacre, M.; Leger, Melanie Saint; Saghi, Tahar; Pillot, J.; Filloux, Bruno; Coz, S; Boyer, Alexandre; Vargas, Frédéric; Gruson, Didier; Hilbert, Gilles

doi:10.1007/s00134-011-2375-1

Cited by 62 publications

(35 citation statements)

References 32 publications

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“…In our procedure, mechanical ventilation is immediately applied to maintain the appropriate minute volume if the sedatives suppress the patient's spontaneous breathing. Furthermore, the mean percentage of BALF volume recovered was higher in this report than in previous studies involving the use of NPPVassisted FOB-BAL (21,25,28). Positive pressure ventilation may allow for a sufficient volume of BALF to be recovered, thus providing diagnostic information.…”

Section: Discussioncontrasting

confidence: 47%

“…The feasibility and safety of NPPV using a full-face mask for FOB-BAL has been reported in previous studies (5,(21)(22)(23)(24)(25)(26)(27)(28). However, in the majority of these studies, bronchoscopy was performed with only topical anaesthesia (5, 22-24, 26, 27), and essential problems included low tolerance to mask fitting and FOB-BAL in conscious patients.…”

Section: Discussionmentioning

confidence: 87%

“…However, in the majority of these studies, bronchoscopy was performed with only topical anaesthesia (5, 22-24, 26, 27), and essential problems included low tolerance to mask fitting and FOB-BAL in conscious patients. Patient agitation may lead to desaturation and possibly compromise the success of the FOB-BAL procedure (25). One previous study described the difficulties in performing bronchoscopy without sedation, with analgosedation used in all patients (14).…”

Section: Discussionmentioning

confidence: 99%

“…The administration of propofol enables the level of sedation to be adjusted, with rapid elimination of the drug. The majority of previous studies have used this medication to both insert the LMA (15,32) and perform FOB (9,14,21,25,33). Fentanyl is a strong analgesic and antitussive that can be employed to reduce the amount of propofol required.…”

Section: Discussionmentioning

confidence: 99%

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Safety and Efficacy of Bronchoalveolar Lavage Using a Laryngeal Mask Airway in Cases of Acute Hypoxaemic Respiratory Failure with Diffuse Lung Infiltrates

et al. 2015

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Objective Fibre-optic bronchoscopy with bronchoalveolar lavage (FOB-BAL) is an important tool for diagnosing and selecting treatment for acutely hypoxaemic patients with diffuse lung infiltrates. However, FOB-BAL carries a risk of significant hypoxaemia and subsequent tracheal intubation during and after the procedure. The application of FOB-BAL using a laryngeal mask airway (LMA) in combination with continuous positive airway pressure (CPAP) may minimize the incidence of hypoxaemia; however, the safety and efficacy of this procedure have not been investigated. Methods A retrospective chart review was performed from April to September 2013. Data regarding the recovered volume of BAL fluid, incidence of tracheal intubation within eight hours after the completion of FOB-BAL, respiratory and haemodynamic parameters and treatment modifications were collected for the evaluation. Results Ten trials of FOB-BAL using an LMA and CPAP were performed in nine patients with severe acute hypoxaemia associated with diffuse lung infiltrates. The BAL fluid recovery rate was 56%, and the procedure was completed without subsequent complications. In addition, the percutaneous arterial oxygen saturation decreased to 95.7%±3.8%, although it was never lower than 90.0% during the procedure, and no patients required intubation. Furthermore, the arterial blood pressure significantly but transiently decreased due to sedation, and the procedure yielded diagnostic information in all nine patients. Conclusion FOB-BAL using LMA and CPAP appears to be safe and effective in patients who develop severe acute hypoxaemia.

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Section: Discussioncontrasting

confidence: 47%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Safety and Efficacy of Bronchoalveolar Lavage Using a Laryngeal Mask Airway in Cases of Acute Hypoxaemic Respiratory Failure with Diffuse Lung Infiltrates

et al. 2015

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“…2). 88 Despite the number of reports describing the use of NIV during bronchoscopy, [87][88][89][90][91][92][93][94][95][96] …”

Section: Bronchoscopymentioning

confidence: 99%

Noninvasive Ventilation for Acute Respiratory FailureDiscussion

2013

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Precision and Bias of Target‐Controlled Prolonged Propofol Infusion for General Anesthesia and Sedation in Neurosurgical Patients

Cortegiani

Pavan²,

Azzeri

et al. 2018

The Journal of Clinical Pharma

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The aim of this study was to determine the relationship, precision, and bias of a propofol target-controlled infusion (TCI) system during prolonged infusion in neurosurgical patients. We retrospectively included patients undergoing general anesthesia for elective neurosurgical removal of brain tumors and postoperative sedation in the intensive care unit over a period of 3 months. TCI of propofol (Diprifusor - Marsh model) and remifentanil were used for general anesthesia and sedation. We compared propofol blood concentration (C ) measured by liquid chromatography-mass spectroscopy with predicted concentrations (C ) by the TCI system at 40 minutes (T0), 2 hours (T1), and 4 hours (T2) and every 8 hours after starting the drug infusion and at the time of emergence from sedation. Ninety-four paired determinations of C and C from 15 adult ASA I patients (8 men and 7 women 54.9 ± 13 years old; BMI, 24 ± 3.2 kg/m ) were analyzed. Mean duration of drug administration was 31 ± 6 hours. The coefficient of determination (R ) of the linear regression model for the relationship of C and C was 0.43. At the time of emergence, C was 0.5 ± 0.18 μg/mL. The bias of the TCI system (median performance error) was -34.7%, and the precision (median absolute performance error) was 36%. Wobble and divergence were 0.3% and 12.3%, respectively. This study found bias of the system out of the range of tolerability and showed a high tendency toward overestimation. These findings may lead to undersedation when propofol TCI is used for prolonged infusion.

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Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients

Abstract: FOB-BAL, under NIV and TCI with propofol, is feasible and safe in nonintubated patients with ARF. The TCI of propofol during FOB-BAL reduces patient discomfort with no significant adverse effects.

Cited by 62 publications

References 32 publications

Safety and Efficacy of Bronchoalveolar Lavage Using a Laryngeal Mask Airway in Cases of Acute Hypoxaemic Respiratory Failure with Diffuse Lung Infiltrates

Safety and Efficacy of Bronchoalveolar Lavage Using a Laryngeal Mask Airway in Cases of Acute Hypoxaemic Respiratory Failure with Diffuse Lung Infiltrates

Noninvasive Ventilation for Acute Respiratory FailureDiscussion

Precision and Bias of Target‐Controlled Prolonged Propofol Infusion for General Anesthesia and Sedation in Neurosurgical Patients

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