Safety of performing fiberoptic bronchoscopy in critically ill hypoxemic patients with acute respiratory failure
- 16 October 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Intensive Care Medicine
- Vol. 39 (1), 45-52
- https://doi.org/10.1007/s00134-012-2687-9
Abstract
The safety of fiberoptic bronchoscopy (FOB) in nonintubated critically ill patients with acute respiratory failure has not been extensively evaluated. We aimed to measure the incidence of intubation and the need to increase ventilatory support following FOB and to identify predictive factors for this event. A prospective multicenter observational study was carried out in eight French adult intensive care units. The study included 169 FOB performed in patients with a PaO(2)/FiO(2) ratio ≤ 300. The main end-point was intubation rate. The secondary end-point was rate of increased ventilatory support defined as an increase in oxygen requirement >50 %, the need to start noninvasive positive pressure ventilation (NI-PPV) or increase NI-PPV support. Within 24 h, an increase in ventilatory support was required following 59 bronchoscopies (35 %), of which 25 (15 %) led to endotracheal intubation. The existence of chronic obstructive pulmonary disease (COPD; OR 5.2, 95 % CI 1.6-17.8; p = 0.007) or immunosuppression (OR 5.4, 95 % CI 1.7-17.2; p = 0.004] were significantly associated with the need for intubation in the multivariable analysis. None of the baseline physiological parameters including the PaO(2)/FiO(2) ratio was associated with intubation. Bronchoscopy is often followed by an increase in ventilatory support in hypoxemic critically ill patients, but less frequently by the need for intubation. COPD and immunosuppression are associated with the need for invasive ventilation in the 24 h following bronchoscopy.Keywords
This publication has 23 references indexed in Scilit:
- Interventional Pulmonary ProceduresSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2003
- Safety of Bronchoscopy, Biopsy, and BAL in Research Patients with COPDSocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2002
- Noninvasive Positive-Pressure Ventilation vs Conventional Oxygen Supplementation in Hypoxemic Patients Undergoing Diagnostic BronchoscopySocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2002
- Ventilator-associated PneumoniaAmerican Journal of Respiratory and Critical Care Medicine, 2002
- Predictors of failure of noninvasive positive pressure ventilation in patients with acute hypoxemic respiratory failure: a multi-center studyIntensive Care Medicine, 2001
- ROLE OF BRONCHOSCOPY IN MODERN MEDICAL INTENSIVE CARE UNITClinics in Chest Medicine, 2001
- THE FLEXIBLE BRONCHOSCOPE: A Tool for AnesthesiologistsClinics in Chest Medicine, 2001
- Alterations in Pulmonary Mechanics and Gas Exchange during Routine Fiberoptic BronchoscopySocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1984
- Deaths and Complications Associated with Fiberoptic BronchoscopySocial psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 1976