RT Journal Article
SR Electronic
T1 Bronchoscopic Lung Biopsy Using Noninvasive Ventilatory Support: Case Series and Review of Literature of NIV-Assisted Bronchoscopy
JF Respiratory Care
FD American Association for Respiratory Care
SP 1927
OP 1936
DO 10.4187/respcare.01775
VO 57
IS 11
A1 Ritesh Agarwal
A1 Ajmal Khan
A1 Ashutosh N Aggarwal
A1 Dheeraj Gupta
YR 2012
UL http://rc.rcjournal.com/content/57/11/1927.abstract
AB BACKGROUND: Fiberoptic bronchoscopy and lung biopsy are important diagnostic tools in patients with diffuse pulmonary infiltrates. However, these patients often have hypoxemic respiratory failure that makes this procedure hazardous. Noninvasive ventilation (NIV) has been shown to improve oxygenation in hypoxemic patients. OBJECTIVE: To report the efficacy and safety of an innovative technique of NIV-assisted bronchoscopic lung biopsy in a small case-series of hypoxemic subjects with diffuse parenchymal infiltrates; also to systematically review the literature on NIV-assisted bronchoscopy. METHODS: Subjects with bilateral diffuse parenchymal infiltrates and PaO2/FIO2 < 200 mm Hg underwent bronchoscopic lung biopsy under NIV support. NIV was initiated 10 min before the procedure and continued for 30 min after the procedure. The primary outcomes were performance of successful procedure and episodes of decline in SpO2 < 90%. Secondary end points were the change in the respiratory and hemodynamic parameters during the procedure and occurrence of complications such as pneumothorax, hemorrhage, and endotracheal intubation. RESULTS: Six subjects, with a mean ± SD age of 44.5 ± 11.6 years, were included in the study. The median (interquartile range [IQR]) PaO2/FIO2 prior to lung biopsy was 164.5 mm Hg (146.3–176.3 mm Hg), and the median (IQR) inspiratory and expiratory positive airway pressures were 14 cm H2O (12–15 cm H2O) and 5 cm H2O. Fiberoptic bronchoscopy was well tolerated and all subjects maintained SpO2 > 92% during the procedure. One subject required endotracheal intubation due to hemoptysis. A definite diagnosis was obtained in 5 of the 6 subjects. A repeat procedure was performed in one subject, which again yielded no diagnosis. No other periprocedural complications were encountered. CONCLUSIONS: NIV-assisted bronchoscopic lung biopsy is a novel method for obtaining diagnosis in hypoxemic patients with diffuse lung infiltrates. However, this approach should be reserved for centers with extensive experience in NIV. More studies are required to define the utility of this approach.