Noninvasive ventilation with add-on fiberoptic bronchoscopy in patients with chronic obstructive pulmonary disease

Abstract

Introduction Noninvasive ventilation (NIV) is a valuable treatment for acute respiratory failure, which has many advantages and lessens the risk of tracheal intubation with its associated complications. Retained bronchial secretions are one of the most common causes of NIV failure and even can contraindicate its use. Aim The aim was to assess the therapeutic utility of fiberoptic bronchoscopy as an add-on therapy in patients with acute respiratory failure on NIV, in a trial to decrease the possibility of invasive ventilation. Patients and methods Patients with COPD were divided randomly into two groups: group I (20 patients) was subjected to NIV and medical therapy, and group II (20 patients) was subjected to NIV, medical therapy, and fiberoptic bronchoscopy for suctioning the retained secretions while on NIV. The cardiorespiratory parameters and complications were recorded during and after the procedure. Results A total of 26 (65%) male and 14 (35%) female patients were enrolled in the study, with mean age of 47.55±11.56 years (range: 27–68 years). The mean duration of bronchoscopy was 3.5–7 min (range: 5.2±1.2 min) with no major complications. The amount of the aspirated secretions was 17.55±5.96 ml (range: 9–29 ml). There was significant difference on follow-up between the two groups regarding mean pH, PaO2/FiO2, and PaCO2, with more obvious improvement in group II than group I and with better outcome. Conclusion Bronchoscopy on NIV in patients with COPD with acute respiratory failure and copious bronchial secretions can be an alternative to intubation with all its associated risks.