Noninvasive ventilation support during fiberoptic bronchoscopy-guided nasotracheal intubation effectively prevents severe hypoxemia

Abstract

a b s t r a c t a r t i c l e i n f o Available online xxxxKeywords: Noninvasive ventilation Intubation Fiberoptic bronchoscopy PreoxygenationPurpose: This study investigated the feasibility and efficacy of continuous noninvasive ventilation (NIV) support with 100% oxygen using a specially designed face mask, for reducing desaturation during fiberoptic bronchoscopy (FOB)-guided intubation in critically ill patients with respiratory failure. Materials and methods: This was a single-center prospective randomized study. All patients undergoing FOBguided nasal tracheal intubation were randomized to bag-valve-mask ventilation or NIV for preoxygenation followed by intubation. The NIV group were intubated through a sealed hole in a specially designed face mask during continuous NIV support with 100% oxygen. Control patients were intubated with removal of the mask and no ventilatory support. Results: We enrolled 106 patients, including 53 in each group. Pulse oxygen saturation (SpO 2 ) after preoxygenation (99% (96%-100%) vs. 96% (90%-99%), p = .001) and minimum SpO 2 during intubation (95% (87%-100%) vs. 83% (74%-91%), p b .01) were both significantly higher in the NIV compared with the control group. Severe hypoxemic events (SpO 2 b 80%) occurred less frequently in the NIV group than in controls (7.4% vs. 37.7%, respectively; p b .01). Conclusions: Continuous NIV support during FOB-guided nasal intubation can prevent severe desaturation during intubation in critically ill patients with respiratory failure. Trial registration: ClinicalTrials.gov, NCT02462668. Registered on 25 May 2015, https://www.clinicaltrials.gov/ ct2/results?term=NCT02462668.

Association between oxygen saturation level during bronchoscopy and post-bronchoscopy adverse events: a retrospective cohort study

“…In patients with diffuse interstitial lung disease undergoing BAL or transbronchial lung biopsy, supplemental oxygen reduced significant hypoxemia events [ 1 ]. Continuous NIV support during bronchoscopy-guided nasal intubation prevents severe desaturation in critically ill patients [ 43 ]. In our study, 74% of patients in the low oxygen saturation group experienced desaturation events, and 11% experienced prolonged and significant (> 4% change or SpO 2 < 90%) desaturation.…”

Comparison of the Effects of Esketamine/Propofol and Sufentanil/Propofol on the Incidence of Intraoperative Hypoxemia during Bronchoscopy: Protocol for a Randomized, Prospective, Parallel-Group Trial

“…Hypoxemia is the most frequent complication, and the risk in patients undergoing this procedure is approximately 26–69.1%, due to the different choices of anesthesia and inconsistent indicators for evaluating hypoxemia [ 12 , 20 , 21 , 22 , 23 , 24 , 25 ]. Many patients could not tolerate a bronchoscopic procedure without sedation for anxiety and intense stimulation.…”