Broncoscopia durante la ventilación mecánica no invasiva: revisión de técnicas y procedimientos

Esquinas, António M.; Zuil, Marcos; Scala, Raffaele; Chiner, Eusebi

doi:10.1016/j.arbres.2012.05.008

Cited by 30 publications

(9 citation statements)

References 58 publications

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“…Concerning the role of “therapeutic” use of FOB during NIV [34, 43, 44], in a matched case–control study Scala et al [16] compared 15 acutely decompensated COPD patients with copious secretion retention and hypercapnic encephalopathy due to pneumonia undergoing early FBO plus BAL during NIV in an expert RICU with 15 controls receiving IMV in the ICU. Two hours of NIV plus FBO significantly improved blood gases, sensorium and cough efficiency without major complications (cardiovascular events, emergent ETI, pneumothorax).…”

Section: Main Textmentioning

confidence: 99%

Challenges on non-invasive ventilation to treat acute respiratory failure in the elderly

Scala

2016

BMC Pulm Med

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Acute respiratory failure is a frequent complication in elderly patients especially if suffering from chronic cardio-pulmonary diseases. Non-invasive mechanical ventilation constitutes a successful therapeutic tool in the elderly as, like in younger patients, it is able to prevent endotracheal intubation in a wide range of acute conditions; moreover, this ventilator technique is largely applied in the elderly in whom invasive mechanical ventilation is considered not appropriated. Furthermore, the integration of new technological devices, ethical issues and environment of treatment are still largely debated in the treatment of acute respiratory failure in the elderly.This review aims at reporting and critically analyzing the peculiarities in the management of acute respiratory failure in elderly people, the role of noninvasive mechanical ventilation, the potential advantages of applying alternative or integrated therapeutic tools (i.e. high-flow nasal cannula oxygen therapy, non-invasive and invasive cough assist devices and low-flow carbon-dioxide extracorporeal systems), drawbacks in physician’s communication and “end of life” decisions. As several areas of this topic are not supported by evidence-based data, this report takes in account also “real-life” data as well as author’s experience.The choice of the setting and of the timing of non-invasive mechanical ventilation in elderly people with advanced cardiopulmonary disease should be carefully evaluated together with the chance of using integrated or alternative supportive devices. Last but not least, economic and ethical issues may often challenge the behavior of the physicians towards elderly people who are hospitalized for acute respiratory failure at the end stage of their cardiopulmonary and neoplastic diseases.

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Section: Main Textmentioning

confidence: 99%

Challenges on non-invasive ventilation to treat acute respiratory failure in the elderly

Scala

2016

BMC Pulm Med

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“…NIMV works in the treatment of acute respiratory failure, improving gas exchange abnormalities and reducing the signs of labored respiration, dyspnea, and activity of accessory respiratory muscles [ 32 ]. During the performance of bronchoscopy, the use of NIMV prevents the development of hypoxemia, and so acute respiratory failure, especially in patients with exacerbations of chronic respiratory disease like COPD, acute cardiogenic pulmonary edema and immunocompromised patients [ 33 , 34 ] in this context, NIMV should be the first choice of ventilation support for these patients that have evidence 1A.…”

Section: Other Uses Of Nimvmentioning

confidence: 99%

Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation

Romero-Dapueto¹,

Budini²,

Cerpa³

et al. 2015

TORMJ

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Noninvasive mechanical ventilation (NIMV) was created for patients who needed noninvasive ventilator support, this procedure decreases the complications associated with the use of endotracheal intubation (ETT). The application of NIMV has acquired major relevance in the last few years in the management of acute respiratory failure (ARF), in patients with hypoxemic and hypercapnic failure. The main advantage of NIMV as compared to invasive mechanical ventilation (IMV) is that it can be used earlier outside intensive care units (ICUs). The evidence strongly supports its use in patients with COPD exacerbation, support in weaning process in chronic obstructive pulmonary disease (COPD) patients, patients with acute cardiogenic pulmonary edema (ACPE), and Immunosuppressed patients. On the other hand, there is poor evidence that supports the use of NIMV in other pathologies such as pneumonia, acute respiratory distress syndrome (ARDS), and during procedures as bronchoscopy, where its use is still controversial because the results of these studies are inconclusive against the decrease in the rate of intubation or mortality.

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“…Evidence supports the use of NIV during fiberoptic bronchoscopy, particularly in subjects at high risk of endotracheal intubation (e.g., immunocompromised patients). [ 60 ] NIV treats acute respiratory failure by addressing gas exchange abnormalities and reducing the signs of respiratory effort and dyspnea, as well as the activity of the accessory respiratory muscles. Bronchoscopy is a key technique in studying respiratory diseases, and it is necessary for acute and critical patients, often only after endotracheal intubation due to the possible complications of the technique.…”

Section: Other Indications For Nivmentioning

confidence: 99%

“…The use of NIV during bronchoscopy should be considered as an alternative to avoid the complications related to intubation and mechanical ventilation in patients in severe conditions, particularly in subjects with COPD with a tendency to develop hypercapnia. [ 60 ] Other indications include transesophageal echocardiography, interventional cardiology, and pulmonology. In these circumstances, NIV can reduce the need for deep sedation or general anesthesia and may prevent the respiratory depression that results from deep sedation.…”

Section: Other Indications For Nivmentioning

confidence: 99%

Lights and shadows of non-invasive mechanical ventilation for chronic obstructive pulmonary disease (COPD) exacerbations

Lόpez-Campos¹,

Jara‐Palomares²,

Muñoz³

et al. 2015

Ann Thorac Med

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Despite the overwhelming evidence justifying the use of non-invasive ventilation (NIV) for providing ventilatory support in chronic obstructive pulmonary disease (COPD) exacerbations, recent studies demonstrated that its application in real-life settings remains suboptimal. European clinical audits have shown that 1) NIV is not invariably available, 2) its availability depends on countries and hospital sizes, and 3) numerous centers declare their inability to provide NIV to all of the eligible patients presenting throughout the year. Even with an established indication, the use of NIV in acute respiratory failure due to COPD exacerbations faces important challenges. First, the location and personnel using NIV should be carefully selected. Second, the use of NIV is not straightforward despite the availability of technologically advanced ventilators. Third, NIV therapy of critically ill patients requires a thorough knowledge of both respiratory physiology and existing ventilatory devices. Accordingly, an optimal team-training experience, the careful selection of patients, and special attention to the selection of devices are critical for optimizing NIV outcomes. Additionally, when applied, NIV should be closely monitored, and endotracheal intubation should be promptly available in the case of failure. Another topic that merits careful consideration is the use of NIV in the elderly. This patient population is particularly fragile, with several physiological and social characteristics requiring specific attention in relation to NIV. Several other novel indications should also be critically examined, including the use of NIV during fiberoptic bronchoscopy or transesophageal echocardiography, as well as in interventional cardiology and pulmonology. The present narrative review aims to provide updated information on the use of NIV in acute settings to improve the clinical outcomes of patients hospitalized for COPD exacerbations.

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Broncoscopia durante la ventilación mecánica no invasiva: revisión de técnicas y procedimientos

Cited by 30 publications

References 58 publications

Challenges on non-invasive ventilation to treat acute respiratory failure in the elderly

Challenges on non-invasive ventilation to treat acute respiratory failure in the elderly

Pathophysiological Basis of Acute Respiratory Failure on Non-Invasive Mechanical Ventilation

Lights and shadows of non-invasive mechanical ventilation for chronic obstructive pulmonary disease (COPD) exacerbations

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