Role of Therapeutic Bronchoscopy in Comparison to Standards of Care in Critically Ill Patients with Acute Respiratory Failure

Abstract

Abstract Background Acute respiratory failure (ARF) is a sudden failure of oxygenation, carbon dioxide clearance or both, Hypoxic ARF is most commonly caused by pneumonia, cardiogenic or noncardiogenic pulmonary edema, or pulmonary haemorrhage, while the underlying causes of hypercapnic ARF include drug overdose, neuromuscular disease, chest wall abnormalities and severe obstructive airway disorders. Treatment for respiratory failure includes clearing the airways by suction, use of bronchodilators, tracheostomy and endotracheal tube with ventilator support. Additionally, the treatment regimen includes antibiotics for infections, anticoagulants for pulmonary thromboembolism, and electrolyte replacement for fluid imbalance. Objective To evaluate difference between use of therapeutic bronchoscope to standards of care, including open and closed suctioning (no bronchoscopy) regarding patient outcome. Patients and Methods Study included 80 patients who were divided by alternation into two groups: Group A: 40 patients were subjected to traditional standards of care including chest percussion, closed and open suctioning. Group B: 40 patients were subjected to therapeutic bronchoscope (fibreoptic bronchoscopy) with endobronchial washing and suctioning in addition to traditional standards of care. Results Regarding ABG significant improvements were observed, (in terms of PaCO2, PaO2 and PaO2/FiO2 ratio) in group B (fibreoptic bronchoscopy) in comparison with group A (traditional standards of care) at all follow up periods (P < 0.05). Regarding the radiological improvement, in this study we observed significant improvement after 3 days, after 8 days and total improvement were observed in group B (fibreoptic bronchoscopy) compared to group A (traditional standards of care) (P < 0.05). Regarding the patient’s ICU length of stay, both groups demonstrated insignificant differences (8.24±3.06 in group A versus 6.78±4.09 in group B) (P > 0.05). Conclusion The current study revealed that fibreoptic bronchoscopy was associated with significant improvement compared to traditional standards of care, in ARF cases in terms of ABG parameters as well as radiological findings. However, ICU length of stay and duration of mechanical ventilation seemed to be comparable.