Continuous Positive Airway Pressure during Fiberoptic Bronchoscopy in Hypoxemic Patients

Abstract

Fiberoptic bronchoscopy (FOB) may worsen oxygenation and clinical status in severely hypoxemic patients. We conducted a prospective, randomized double-blind trial to compare the delivery of continuous positive airway pressure (CPAP) as a tool for maintaining oxygenation during FOB, to the delivery of oxygen only. Thirty consecutive patients who needed FOB for diagnostic purposes were enrolled. Their arterial oxygen pressure (Pa(O(2))) to inspired oxygen fraction (FI(O(2))) ratio was below 300 mm Hg. CPAP was generated by a simple new device open to the atmosphere. During FOB and the 30 min thereafter, pulse oximetry values (Sp(O(2))) were significantly higher in the CPAP than the Oxygen group (95.7 +/- 1.9% versus 92.6 +/- 3.1, p = 0.02). The lowest Sp(O(2)) values were observed in the Oxygen group (93.5 +/- 2.4% versus 88.6 +/- 3.4, p = 0.002). Arterial blood gases 15 min after FOB showed that Pa(O(2)) had increased in the CPAP group and decreased in the Oxygen group (DeltaPa(O(2)) = +10.5% +/- 16.9 versus -15% +/- 16.6, p = 0.01). Five patients in the Oxygen group, but none in the CPAP group, developed respiratory failure in the 6 h after FOB and required ventilatory assistance (p = 0.03). We conclude that in hypoxemic patients, the use of a new CPAP device during FOB allowed minimal alterations in gas exchange and prevented subsequent respiratory failure.

Clinical practice guidelines for the use of noninvasive positive-pressure ventilation and noninvasive continuous positive airway pressure in the acute care setting

“…One RCT using noninvasive positive-pressure venti lation 118 and a second using continuous positive airway pressure by mask 119 suggested benefit in terms of oxygenation when these interventions were used during bronchoscopy. However, few patients were included (total of 56 for the two RCTs), and the impact on endotracheal intubation (0.28, 95% CI 0.05-1.64) was inconsistent.…”

Is BAL useful in patients with acute myeloid leukemia admitted in ICU for severe respiratory complications?

“…This 10% risk (6.5% risk of intubation) in our study may also be considered as acceptable but much higher rates of intubation following FOB-BAL have been reported in hypoxemic patients. 28 This result may be related to several factors such as the frequent use of noninvasive ventilation, the adequate training of the physicians who were all respiratory care physicians, platelets transfusion immediately before FOB procedure and a very close continuous monitoring during and following FOB.…”

Pneumatic Performance of the Boussignac CPAP System in Healthy Humans

“…1) allows pressure measurement or delivery of supplemental oxygen. 2,3,12,13 The Boussignac CPAP system is considered easy to use and it requires only a flow meter that delivers oxygen or air to create a continuous positive airway pressure. 10,14,15 When oxygen is used, the amount of oxygen delivered to the patient and the CPAP level cannot be adjusted separately.…”