Abstract
Background: Atelectasis frequently develops in critically ill patients and may result in impaired gas exchange among other complications. The long-term effects of bronchoscopy on gas exchange and the effects on respiratory mechanics are largely unknown.Objective: To evaluate the effect of bronchoscopy on gas exchange and respiratory mechanics in intensive care unit (ICU) patients with atelectasis.Methods: A retrospective, single-center cohort study of patients with clinical indication for bronchoscopy because of atelectasis diagnosed on chest X-ray (CXR).Results: In total, 101 bronchoscopies were performed in 88 ICU patients. Bronchoscopy improved oxygenation (defined as an increase of PaO2/FiO2 ratio > 20 mmHg) and ventilation (defined as a decrease of > 2 mmHg in partial pressure of CO2 in arterial blood) in 76 and 59% of procedures, respectively, for at least 24 h. Patients with a low baseline value of PaO2/FiO2 ratio and a high baseline value of PaCO2 were most likely to benefit from bronchoscopy. In addition, in intubated and pressure control ventilated patients, respiratory mechanics improved after bronchoscopy for up to 24 h. Mild complications, and in particular desaturation between 80 and 90%, were reported in 13% of the patients.Conclusions: In selected critically ill patients with atelectasis, bronchoscopy improves oxygenation, ventilation, and respiratory mechanics for at least 24 h.
Highlights
Atelectasis frequently develops in critically ill patients and may result in impaired gas exchange among other complications
Patients with a low baseline value of PaO2/FiO2 ratio and a high baseline value of partial pressure of CO2 in arterial blood (PaCO2) were most likely to benefit from bronchoscopy
In intubated and pressure control ventilated patients, respiratory mechanics improved after bronchoscopy for up to 24 h
Summary
Atelectasis frequently develops in critically ill patients and may result in impaired gas exchange among other complications. The long-term effects of bronchoscopy on gas exchange and the effects on respiratory mechanics are largely unknown. Mechanical ventilation might cause ventilator-induced lung injury and hospital-acquired pneumonia, both conditions promote atelectasis and stagnant secretions that may worsen oxygenation and delay weaning from ventilator [1, 2]. Treatment of atelectasis in intensive care unit (ICU) patients has been focused on blind airway suctioning, bronchoscopy with or without adjuncts such as nebulization of N-acetylcysteine, and chest physiotherapy. The superiority of bronchoscopy over blind airway suctioning on clinical relevant endpoints, such as gas exchange, has not been established [4]
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