Utility of noninvasive ventilation in high-risk patients during endoscopic retrograde cholangiopancreatography

Abstract

Background:There is little evidence on noninvasive ventilation (NIV) preventing respiratory complications in high-risk patients undergoing endoscopy procedures.Objectives:The objective of this study is to demonstrate that the application of NIV through a nasal interface can prevent the appearance of ventilatory alterations during endoscopic retrograde cholangiopancreatography (ERCP) in patients with risk factors associated with the development of hypoventilation.Patients and Methods:A non-randomized interventional study was performed on 37 consecutive high-risk patients undergoing ERCP. During the procedure, 21 patients received oxygen by nasal cannula (3 L/minute) and sixteen received NIV through a nasal mask. Arterial blood gas analyses were conducted before and immediately after the ERCP. An Acute Physiology and Chronic Health Evaluation (APACHE) score pre-ERCP was recorded. The complications during the procedure were recorded.Results:The groups with and without NIV were comparable. A post-ERCP pH of <7.35 was found in eight patients, who did not receive ventilatory support (38.1%) compared to zero patients in the NIV group (P = 0.006). A post-ERCP pCO2 >45 mmHg was found in one case (6.3%) in the NIV-group and in nine cases in the nasal cannula group (42.9%; P = 0.01). The median pCO2 post-ERCP was lower (36.5 ± 6.2 vs. 44.5 ± 6.8 mmHg) (P = 0.001) and median pH post-ERCP was higher (7.41 ± 0.4 vs. 7.34 ± 0.5) (P = 0.001) in patients treated with NIV. In the multivariate analysis, after adjusting for gender, the APACHE score, pH and pCO2 pre-ERCP, age, propofol doses, and procedure duration, the following differences were maintained (pCO2 difference = 5.54, 95% Confidence Interval (CI) =2.3 – 8.7, pH difference = 0.047, and 95% CI = 0.013 – 0.081). Among the 37 procedures, four complications occurred: One in the NIV group and three in the nasal cannula group. None of them was related to NIV.Conclusions:Our preliminary results demonstrate that in high-risk patients undergoing ERCP, hypercapnia and respiratory acidosis are frequent. NIV prevents the appearance of these complications.

Noninvasive Ventilation-assisted Bronchoscopy in High-risk Hypoxemic Patients

“…12 Few randomized control trials of NIV versus Oxygen supplementation 7,8 and NIV versus mechanical ventilation 13 have all reported benefit of from using NIV during FOB. Even upper gastrointestinal endoscopy, 36 endoscopic retrograde cholangiopancreatography 37 and transesophageal echocardiography 38 have been successfully done under NIV support. In yet another study COPD patient in exacerbations with mild encephalopathy and inability to clear secretions were randomized to only NIV versus NIV combined with early FOB for bronchial toileting and latter had superior clinical outcomes.…”