Safety of performing fiberoptic bronchoscopy in critically ill hypoxemic patients with acute respiratory failure |
| |
Authors: | Christophe Cracco Muriel Fartoukh H��l��ne Prodanovic Elie Azoulay C��cile Chenivesse Christine Lorut Ga?tan Beduneau Hoang Nam Bui Camille Taille Laurent Brochard Alexandre Demoule Bernard Maitre |
| |
Affiliation: | 1. Medical and Surgical Intensive Care Unit, Angoul??me Hospital, Angoul??me, France 2. Pulmonology Department, Medical Intensive Care Unit, Tenon Hospital, Paris, France 3. Pulmonology Department, Medical Intensive Care Unit, Piti??-Salp??tri??re Hospital, Paris, France 6. Medical Intensive Care Unit, Saint-Louis Hospital, Paris, France 12. Pulmonology Department, Medical Intensive Care Unit, Hotel Dieu Hospital, Paris, France 7. Medical Intensive Care Unit, Charles Nicolle Hospital, Rouen, France 8. Medical Intensive Care Unit, Pellegrin Hospital, Bordeaux, France 5. Pulmonology Department, Bichat Hospital, Paris, France 4. Intensive Care Division, University Hospital of Geneva, School of Medicine, University of Geneva, Geneva, Switzerland 10. Inserm U955, 94000, Cr??teil, France 11. Universit?? Paris Est, 94000, Cr??teil, France 9. Pulmonology Department and Medical Intensive Care Unit, Henri Mondor Hospital, 40 av du Mal de Lattre de Tassigny, 94000, Cr??teil, France
|
| |
Abstract: | Background The safety of fiberoptic bronchoscopy (FOB) in nonintubated critically ill patients with acute respiratory failure has not been extensively evaluated. We aimed to measure the incidence of intubation and the need to increase ventilatory support following FOB and to identify predictive factors for this event. Methods A prospective multicenter observational study was carried out in eight French adult intensive care units. The study included 169 FOB performed in patients with a PaO2/FiO2 ratio ??300. The main end-point was intubation rate. The secondary end-point was rate of increased ventilatory support defined as an increase in oxygen requirement >50?%, the need to start noninvasive positive pressure ventilation (NI-PPV) or increase NI-PPV support. Results Within 24?h, an increase in ventilatory support was required following 59 bronchoscopies (35?%), of which 25 (15?%) led to endotracheal intubation. The existence of chronic obstructive pulmonary disease (COPD; OR 5.2, 95?% CI 1.6?C17.8; p?=?0.007) or immunosuppression (OR 5.4, 95?% CI 1.7?C17.2; p?=?0.004] were significantly associated with the need for intubation in the multivariable analysis. None of the baseline physiological parameters including the PaO2/FiO2 ratio was associated with intubation. Conclusions Bronchoscopy is often followed by an increase in ventilatory support in hypoxemic critically ill patients, but less frequently by the need for intubation. COPD and immunosuppression are associated with the need for invasive ventilation in the 24?h following bronchoscopy. |
| |
Keywords: | |
本文献已被 SpringerLink 等数据库收录! |
|