Fiberoptic Bronchoscopy during Nasal Non-Invasive Ventilation in Acute Respiratory Failure

Background: Various methods have been described for safely performing fiberoptic bronchoscopy (FB) while applying non-invasive positive pressure ventilation (NIPPV) in patients with acute respiratory failure (ARF). Objectives: To evaluate the safety of a new method to perform FB in patients with ARF. Methods: Patients with ARF in whom FB was indicated were studied. The primary end-point was a mean drop in oxygen saturation (S a O 2 ) after the procedure. During nasal NIPPV, FB was performed via the mouth using a bite block sealed with an elastic glove finger allowing bronchoscope insertion. Results: Thirty-five patients were included in the final study (63 ± 17 years, 74% men, P a O 2 /F i O 2 ratio 168 ± 63). A total of 35 bronchoaspirates, 21 protected brushings, 11 bronchoalveolar lavages and 8 bronchial biopsies were done. The cardiorespiratory variables at the start and end of FB were: S a O 2 93 ± 3 to 94 ± 5%, heart rate 95 ± 17 to 99 ± 22 b.p.m. and respiratory rate 24 ± 11 to 25 ± 11 respirations/min. The lowest S a O 2 value reached during the procedure was 86 ± 3% and the maximal ETCO 2 rise was 41 ± 4 mm Hg. Leakage was