Fiberoptic bronchoscopy (FOB) is widely used as a diagnostic or therapeutic procedure in intensive care units. Patients with ARDS or COVID-19 disease often undergoes to these procedures. However, intensive care patients might suffer from serious side effects such as prolonged oxygen desaturation and adverse change in lung compliance and resistance. This study aims to evaluate these changes and determine their impact on patient stability.
Fiberoptic bronchoscopy (FOB) is widely used in intensive care units as a diagnostic or
therapeutic procedure. FOB in respiratory failure patients supported by mechanical
ventilation may worsen hypoxemia and hypercapnia, therefore FOB requires careful
consideration in this patient population. The generally accepted indications for FOB in
ventilated patients are removal of retained secretions, resolution of atelectasis and
evaluation of hemoptysis. A diagnostic indication is the bronchoalveolar lavage (BAL), to
sample the lower respiratory tract without contamination. Studies of FOB performed in
mechanically ventilated patients suggest an acceptable safety profile, except for the
occurrence of hypoxemia as the main adverse event. Bronchoalveolar Lavage (BAL) in normal
volunteers is reported to be safe and does not lead to measurable changes in pulmonary
function parameters. However, in intensive care patients may suffer from serious side effects
such as prolonged oxygen desaturation. Moreover, reductions in arterial oxygen tension (PaO2)
have been reported to persist in some patients for 4 h and more after the procedure. Authors
reported the BAL procedure is associated to a worsening of PaO2/FiO2 ratio, in several ARDS
patients the drop in PaO2 was higher than 30%. Moreover a physiological study in patients
undergoing FOB and BAL showed adverse change in lung compliance and resistance.
The purpose of this prospective study is to determine the alterations in respiratory
mechanics (regional compliance and resistance) and gas exchange induced by FOB and BAL up to
6 hours after the procedure. The lung regional ventilation evaluation will be made by
electrical impedance tomography (EIT).
Procedure: Fiberoptic Bronchoscopy (FOB)
FOB under full sedation (RASS sedation scale -5) and full paralysis.
Procedure: Bronchoalveolar Lavage (BAL)
BAL under full sedation (RASS sedation scale -5) and full paralysis. Lavage: NaCl 0,9% 50ml x 3 in lung region targetted according to RX/CT scan.
Diagnostic Test: Electrical Impedance Tomography (EIT)
Realtime thoracic impedance coupled with ventilation parameters recording.
Other Name: PulmoVista® 500 - Draeger
Diagnostic Test: Arterial Blood Gas test (ABG)
Multiples Arterial Blood Gas test (ABG) via arterial catheter.
Inclusion Criteria:
Mechanically ventilated ICU patients requiring a FOB or FOB + BAL
Exclusion Criteria:
- PaO2/FiO2 ratio <100
- Age < 18 years
- Pregnancy
- Unstable angina and recent (less than 1 week) myocardial infarction
- Uncontrolled cranial hypertension
- Major hemodynamic instability
- Any previous lung surgery (except for lung transplantation)
- Obesity (BMI > 50)
- Chest circumference > 150 cm
- Electronic implanted device (pacemaker, neurostimulator, etc.)
Patients who had undergone several bronchoscopy procedures could not be included twice.
Erasme University Hospital - Intensive Care Unit
Brussels, Belgium
Investigator: Francesco Ricottilli, MD
Contact: +32-2-5553344
francesco@ricottilli.eu
Francesco Ricottilli, MD
+32(02)5553344
francesco@ricottilli.eu