Abstract
PurposeFlexible fiberoptic bronchoscopy is frequently used in intensive care unit, but is a source of discomfort, dyspnea and anxiety for patients. Our objective was to assess the feasibility and tolerance of a sedation using remifentanil target-controlled infusion, to perform fiberoptic bronchoscopy in awake ICU patients.Materials, patients and methodsThis monocentric, prospective observational study was conducted in awake patients requiring fiberoptic bronchoscopy. In accordance with usual practices in our center, remifentanil target-controlled infusion was used under close monitoring and adapted to the patient’s reactions. The primary objective was the rate of successful procedures without additional analgesia or anesthesia. The secondary objectives were clinical tolerance and the comfort of patients (graded from “very uncomfortable” to “very comfortable”) and operators (numeric scale from 0 to 10) during the procedure.ResultsFrom May 2014 to December 2015, 72 patients were included. Most of them (69%) were hypoxemic and admitted for acute respiratory failure. No additional medication was needed in 96% of the patients. No severe side-effects occurred. Seventy-eight percent of patients described the procedure as “comfortable or very comfortable”. Physicians rated their comfort with a median [IQR] score of 9 [8–10].ConclusionRemifentanil target-controlled infusion administered to perform awake fiberoptic bronchoscopy in critically ill patients is feasible without requirement of additional analgesics or sedative drugs. Clinical tolerance as well as patients’ and operators’ comfort were good to excellent. This technique could benefit patients’ experience.
Highlights
Pain management remains a major challenge in intensive care units (ICU), and common ICU procedures, such as fiberoptic bronchoscopy (FOB) may induce important levels of pain [1,2,3,4]
Seventy-eight percent of patients described the procedure as “comfortable or very comfortable”. Physicians rated their comfort with a median [IQR] score of 9 [8,9,10]
Remifentanil target-controlled infusion administered to perform awake fiberoptic bronchoscopy in criti‐ cally ill patients is feasible without requirement of additional analgesics or sedative drugs
Summary
Pain management remains a major challenge in intensive care units (ICU), and common ICU procedures, such as fiberoptic bronchoscopy (FOB) may induce important levels of pain [1,2,3,4]. Caron et al Ann. Intensive Care (2021) 11:48 associated with diagnostic or treatment procedures” [5], of which an inadequate management may have major consequences. Patients in the ICU often experience several procedures, or the same procedure repeated several times, such as central line or arterial catheters insertion, diagnostic or therapeutic fiberoptic bronchoscopies. Under-treated, suffering has medical consequences, and impairs the condition under which the examinations are performed, with major risk of patients’ agitation and failure of the procedure. Evaluating and treating pain is of paramount importance and is a simple means to decrease duration of mechanical ventilation and ICU length of stay by limiting the use of sedatives and neuromuscular blockers [12]
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