Fiberoptic bronchoscopy (FBO) as rescue-strategy for non-invasive ventilation (NIV) failure in acute respiratory failure (ARF) in a respiratory intensive care unit (RICU)

Abstract

Objectives: Evaluate feasibility, safety and effectiveness of FBO in enlarging success of NIV in ARF-patients at risk of failure due to excessive secretions Methods: All consecutive ARF-patients failing NIV because of accumulated secretions in our 4-bed RICU in the years 2013-2015 were recruited. NIV failure was defined as need of endotracheal intubation (ETI). Timing, technical issues and sedation for FBO were analyzed. Primary outcome was: success of FBO+NIV as rescue-strategy of NIV failure. Secondary outcomes were: 1)complications (within 24 hrs): a)worsening of blood gases; b)cardiovascular events; c) haemoptysis; d) bronchospasm; e)pneumothorax; 2)hospital-mortality. Results: 48 out 608 ARF-patients requiring NIV were recruited: 28 with acidotic hypercapnia (pH 7,28+/-0,07; PaCO2 69,4+/-7,1 mmHg) and 19 with hypoxemia (PaO2/FiO2 173+/-50) under ventilation. FBO was performed after 3,4+/-3,6 hours of ventilation with BAL (all cases) and transbronchial biopsy (n.3 cases) The most used interface was total-face mask (n.38); FBO was more frequently introduced orally (n.35). Length of FBO-procedures was of 12+/-5 minutes. Sedation was performed with propofol (n.35), midazolam (n.13), petidine plus propofol (n.22) or midazolam (n. 5). Transitory hypoxemia occurred in 3/48 cases with no other complications. Combined NIV+FBO succeeded in avoiding NIV failure in 34/48 cases (70,8%). ETI was performed in 7/14 non-DNI patients with hospital-mortality of 27% (13/48). Conclusions: According to our RICU9s experience, FBO is a feasible, effective and safe rescue-strategy for NIV failure due to excessive secretions.