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).
Study Type
OBSERVATIONAL
Enrollment
15
FOB under full sedation (RASS sedation scale -5) and full paralysis.
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.
Realtime thoracic impedance coupled with ventilation parameters recording.
Erasme University Hospital - Intensive Care Unit
Brussels, Belgium
RECRUITINGRegional Compliance Variation
The variation of regional compliance, calculated by electrical impedance
Time frame: From FOB/BAL to 6 hours later
Regional Resistance Variation
The variation of regional resistance, calculated by electrical impedance
Time frame: From FOB/BAL to 6 hours later
Regional Compliance and FOB duration
Relation between regional compliance variation and FOB duration
Time frame: From FOB/BAL to 6 hours later
Regional Compliance and PaO2
Relation between regional compliance variation and PaO2 variation
Time frame: From FOB/BAL to 6 hours later
Atelectasis areas and BAL flooded areas
Relation between atelectasis impedance-detected areas and BAL flooded impedance-detected areas
Time frame: From FOB/BAL to 6 hours later
PaO2 and PaO2/FiO2 ratio
Variation of PaO2 and PaO2/FiO2 ratio post FOB/BAL
Time frame: From FOB/BAL to 6 hours later
PaCO2
Variation of PaCO2 post FOB/BAL
Time frame: From FOB/BAL to 6 hours later
Endotracheal tube size and Fiberscope size
Relation between the endotracheal tube/fiberscope size ratio and gas exchanges
Time frame: From FOB/BAL to 6 hours later
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Multiples Arterial Blood Gas test (ABG) via arterial catheter.
Hemodynamic variations
Heart rate (HR), Blood Pressure (BP)
Time frame: From FOB/BAL to 6 hours later