Use of continuous positive airway pressure during flexible bronchoscopy in young children

Abstract

Young children are at increased risk for hypoxaemia and hypercapnia during flexible bronchoscopy due to the small size and increased collapsibility of their airways. Various strategies are used to prevent hypoventilation and to provide oxygen during the procedure. The aim of this study was to assess the impact of continuous positive airway pressure (CPAP) on ventilation during flexible bronchoscopy in infants and young children.Tidal breathing was measured in 16 spontaneously breathing and deeply sedated children, aged 3-25 months, by ultrasound spirometry via an airway endoscopy mask. Measurements were made with the tip of the bronchoscope positioned in the pharynx with no CPAP, and in midtrachea with 0, 5 and 10 cmH 2 O of CPAP.Transition of the bronchoscope through the vocal cords was associated with significant decreases of tidal volumes (5.0¡0.5 versus 3.4¡0.5 mL?kg -1 ), peak tidal expiratory flows (78¡12 versus 52¡10 mL?s -1 ) and peak tidal inspiratory flows (98¡15 versus 66¡12 mL?kg -1). CPAP (5-10 cmH 2 O) induced almost complete reversal of these changes.In conclusion, it is shown here that flexible bronchoscopy in spontaneously breathing young children is associated with significant decreases in tidal volume and respiratory flow. These changes are largely reversible with continuous positive airway pressure.

Noninvasive positive pressure ventilation in the acute care setting: where are we?

“…NPPV has also been reported to be useful in performing successful bronchoscopy in hypercapnic COPD patients with pneumonia [104]. Flexible bronchoscopy in spontaneously breathing young children was associated with significant decreases in tidal volume and respiratory flow, which were reversed by CPAP [105]. The use of NPPV during fibreoptic bronchoscopy is supported by previous evidence and should be considered for use, especially when risks of ETI are high, such as in immunocompromised patients.…”

Unusual applications of noninvasive ventilation

“…NIV-assisted bronchoscopy has also been reported to be useful in hypercapnic COPD patients with pneumonia [16]. Flexible bronchoscopy in spontaneously breathing young children was associated with significant decreases in tidal volume and respiratory flow that were reversed by CPAP [17]. In patients with acute exacerbation of COPD due to community-acquired pneumonia, who were candidates for ETI due to their hypercapnic encephalopathy and inability to clear copious secretions, NIV with early therapeutic bronchoscopy performed by an experienced team was considered a feasible, safe and effective strategy [18].…”

Noninvasive mechanical ventilation and bronchoscopy: advantages and limits of a synergistic strategy

“…Any obstruction due to edema and lesions occupying space will exponentially increase the resistance to gas flow, limiting ventilation by significant reductions in tidal volume, peak inspiratory pressure and expiratory flow (59). In children, CPAP increases the width of the laryngeal space and reduces the tendency toward collapse of the lateral walls of the pharynx and counterbalances the FBO-induced shallow breathing pattern (60). These favorable effects of CPAP are particularly useful in infants with tracheobronchomalacia who are more vulnerable to airways collapse (61).…”