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

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 sup-ported with periods of non-invasive ven-tilation (NIV), with a new mask. Because of large amounts of bronchial secretions that he was not able to expectorate, flex-ible fiberoptic bronchoscopy (FFB) was performed to remove the secretions, with-out interrupting NIV support. During the procedure, the patient remained hemody-namically 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 ventila-tion in patients in whom this respiratory support is required and its interruption may be harmful. 

non-invasive ventilation, acute respiratory distress syndrome, flexible fiber-optic bronchoscopy, intensive care unit

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