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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Bronchoscopy during non-invasive ventilation in a patient with acute respiratory distress syndrome

Abstract

A 72-year-old man was transferred to our hospital for refractory severe acute respiratory syndrome. On arrival, he was intubated and mechanically ventilated. Furthermore, he required veno-venous extracorporeal membrane oxygenation. Two days later, he was extubated and supported with periods of non-invasive ventilation (NIV), with a new mask. Because of large amounts of bronchial secretions that he was not able to expectorate, flexible fiberoptic bronchoscopy (FFB) was performed to remove the secretions, without interrupting NIV support. During the procedure, the patient remained hemodynamically stable, breathing spontaneously and with just a mild reduction in oxygen saturation (SpO2) (97.9% vs. 96.8%). This case report highlights the possibility of performing upper endoscopic procedures, such as FFB, during non-invasive ventilation in patients in whom this respiratory support is required and its interruption may be harmful.

Key words: non-invasive ventilation, acute respiratory distress syndrome, flexible fiberoptic bronchoscopy, intensive care unit

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Beneficial effects of nasal high flow oxygen therapy after weaning from non-invasive ventilation: A prospective observational study

Abstract

It remains unknown whether application of nasal high flow (NHF) is effective after liberation from non-invasive ventilation (NIV). This study was aimed at investigating the effect of NHF in patients ready for weaning from NIV.

With institutional ethic committee approval, patients receiving NIV due to hypoxemic respiratory failure for more than 24 hours were enrolled. After passing the weaning criteria with continuous positive airway pressure (CPAP) mode [fraction of inspiratory oxygen (FIO2) ≦0.5, positive end expiratory pressure (PEEP) 4 cmH2O], patients received NHF (Flow 50 L/min, FIO2 ≦0.5) immediately after liberation from NIV. Before the initiation of the study, eight sequential patients who received oxygen via face mask after NIV treatment, served as the historical control. Respiratory parameters [partial pressure of arterial oxygen (PaO2) to FIO2 ratio (P/F ratio), respiratory rate (RR)] 1 hour after liberation from NIV were evaluated with those during NIV as the primary outcome. The frequency of rescue NIV therapy, intubation, and respiratory failure were also recorded.

Nine eligible patients received NHF therapy after liberation from NIV. P/F ratio and RR did not change significantly compared with those during NIV (231 ± 43.6 versus 250.7 ± 34.2 mmHg, 20.8 ± 2.3 versus 21 ± 1.6 /min), while P/F ratio decreased significantly in the historical control group (194.3 ± 20.1 versus 255.9 ± 58.1 mmHg, p=0.013). Rescue NIV therapy, intubation, and respiratory failure never occurred in the NFH group, although two patients received NIV rescue therapy, of whom one was intubated in the historical control.

NHF after liberation from NIV might be effective in patients recovering from hypoxemic respiratory failure.

Registration number: UMIN000014133 (UMIN-CTR)

Key words: hypoxemic respiratory failure, weaning, non-invasive ventilation, nasal high flow oxygen therapy, weaning failure, rescue therapy

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