无创机械通气辅助可弯曲支气管镜检查期间并发症的危险因素。

Risk factors of complications during noninvasive mechanical ventilation -assisted flexible bronchoscopy.

作者信息

Skoczyński Szymon, Ogonowski Maciej, Tobiczyk Ewelina, Krzyżak Damian, Brożek Grzegorz, Wierzbicka Anna, Trzaska-Sobczak Marzena, Trejnowska Ewa, Studnicka Aleksandra, Swinarew Andrzej, Kucewicz-Czech Ewa, Gierek Danuta, Rychlik Wojciech, Barczyk Adam

机构信息

Department of Pneumonology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland.

出版信息

Adv Med Sci. 2021 Sep;66(2):246-253. doi: 10.1016/j.advms.2021.04.001. Epub 2021 Apr 20.

DOI:10.1016/j.advms.2021.04.001

PMID:33892212

Abstract

PURPOSE

Flexible bronchoscopy (FB) causes airway narrowing and may cause respiratory failure (RF). Noninvasive mechanical ventilation (NIV) is used to treat RF. Until recently, little was known about noninvasive mechanical ventilation assisted flexible bronchoscopy (NIV-FB) risk and complications.

MATERIALS AND METHODS

A retrospective analysis of NIV-FB performed in 20 consecutive months (July 1, 2018-February 29, 2020) was performed. Indications for: FB and NIV, as well as impact of comorbidities, blood gas results, pulmonary function test results and sedation depth, were analyzed to reveal NIV-FB risk. Out of a total of 713 FBs, NIV-FB was performed in 50 patients with multiple comorbidities, acute or chronic RF, substantial tracheal narrowing, or after previously unsuccessful FB attempt.

RESULTS

In three cases, reversible complications were observed. Additionally, due to the severity of underlining disease, two patients were transferred to the ICU where they passed away after >48h. In a single variable analysis, PaO 69 ± 18.5 and 49 ± 9.0 [mmHg] (p < 0.05) and white blood count (WBC) 10.0 ± 4.81 and 14.4 ± 3.10 (p < 0.05) were found predictive for complications. Left heart disease indicated unfavorable NIV-FB outcome (p = 0.046).

CONCLUSIONS

NIV-FB is safe in severely ill patients, however procedure-related risk should be further defined and verified in prospective studies.

摘要

目的

可弯曲支气管镜检查（FB）会导致气道狭窄，并可能引发呼吸衰竭（RF）。无创机械通气（NIV）用于治疗RF。直到最近，关于无创机械通气辅助可弯曲支气管镜检查（NIV-FB）的风险和并发症仍知之甚少。

材料与方法

对连续20个月（2018年7月1日至2020年2月29日）进行的NIV-FB进行回顾性分析。分析FB和NIV的适应证，以及合并症、血气结果、肺功能测试结果和镇静深度的影响，以揭示NIV-FB的风险。在总共713例FB中，对50例患有多种合并症、急性或慢性RF、严重气管狭窄或之前FB尝试未成功的患者进行了NIV-FB。

结果

观察到3例可逆性并发症。此外，由于基础疾病的严重性，2例患者被转入重症监护病房，在48小时后死亡。在单变量分析中，发现PaO₂为69±18.5和49±9.0[mmHg]（p<0.05）以及白细胞计数（WBC）为10.0±4.81和14.4±3.10（p<0.05）可预测并发症。左心疾病表明NIV-FB结果不佳（p=0.046）。