Öztürk Mehmet Celal, Küçük Murat, Uğur Yasin Levent, Cömert Bilgin, Gökmen Ali Necati, Ergan Begüm
Division of Intensive Care, Department of Anaesthesiology and Reanimation, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
Division of Intensive Care, Department of Internal Medicine, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
Turk Thorac J. 2022 Nov;23(6):403-408. doi: 10.5152/TurkThoracJ.2022.21241.
The most appropriate ventilatory mode during fiberoptic bronchoscopy is still not yet known clearly for patients with acute respiratory distress syndrome. Airway pressure release ventilation is used as a recovery treatment for patients with severe acute respiratory distress syndrome. In this study, the aim was to evaluate the safety of the fiberoptic bronchoscopy process in patients with severe acute respiratory distress syndrome ventilated with airway pressure release ventilation mode and its effect on gas exchange and respiratory mechanics.
Single-center retrospective observational study was performed in the intensive care unit of a tertiary referral center from September 2018 to November 2019. Patients with severe ARDS ventilated with APRV mode and undergoing FB were included. Fiberoptic bronchoscopy was performed by an expert intensivist-pulmonologist. All ventilator parameters set by the clinician were kept stable, and no change was made other than O2 concentration. The mechanical ventilation parameters and arterial blood gas values before and after the procedure and fiberoptic bronchoscopy-related complications were recorded for the first 24 hours.
A total of 14 acute respiratory distress syndrome patients who were ventilated with airway pressure release ventilation were enrolled. No significant deteriorations were detected in gas exchange, pulmonary compliance, and airway resistance values in our case series. It was observed that a small reduction in PaO2 and an increase in PaCO2 were present after the 1st hour; however, both were returned to baseline values in the 24th hour. Only 1 patient developed fiberoptic bronchoscopy-induced hypoxemia (7.1%). Complications, such as fiberoptic bronchoscopy-induced barotrauma, pneumothorax, hemodynamic deterioration, and bleeding, were not detected.
According to our preliminary findings, performing fiberoptic bronchoscopy under airway pressure release ventilation mode by an experienced bronchoscopist does not bring additional complication risks in patients with severe acute respiratory distress syndrome.
对于急性呼吸窘迫综合征患者，在纤维支气管镜检查期间最适宜的通气模式仍未明确知晓。气道压力释放通气被用作重症急性呼吸窘迫综合征患者的一种恢复治疗方法。在本研究中，目的是评估在采用气道压力释放通气模式通气的重症急性呼吸窘迫综合征患者中纤维支气管镜检查过程的安全性及其对气体交换和呼吸力学的影响。
于2018年9月至2019年11月在一家三级转诊中心的重症监护病房进行单中心回顾性观察研究。纳入采用气道压力释放通气模式通气且正在接受纤维支气管镜检查的重症急性呼吸窘迫综合征患者。纤维支气管镜检查由一位专家级重症监护医师 - 肺科医生进行。临床医生设置的所有呼吸机参数保持稳定，除了氧气浓度外未作其他改变。记录操作前和操作后的机械通气参数、动脉血气值以及纤维支气管镜检查相关并发症，记录时间为最初24小时。
总共纳入了14例采用气道压力释放通气的急性呼吸窘迫综合征患者。在我们的病例系列中未检测到气体交换、肺顺应性和气道阻力值有显著恶化。观察到在第1小时后动脉血氧分压有小幅下降，动脉血二氧化碳分压有所升高；然而，两者在第24小时均恢复至基线值。仅1例患者发生纤维支气管镜检查诱发的低氧血症（发生率为7.1%）。未检测到纤维支气管镜检查诱发的气压伤、气胸、血流动力学恶化和出血等并发症。
根据我们的初步研究结果，由经验丰富的支气管镜检查医师在气道压力释放通气模式下进行纤维支气管镜检查，对于重症急性呼吸窘迫综合征患者不会带来额外的并发症风险。
