Application of bedside fiberoptic bronchoscopy in extubation of COPD patients with mechanical ventilation

Abstract

Objective To evaluate the application value of bedside fiberoptic bronchoscopy in the extubation of chronic obstructive pulmonary disease （COPD） patients with mechanical ventilation. Methods A prospective controlled study was conducted in 64 patients with COPD who required endotracheal intubation and mechanical ventilation. All patients were randomly divided into the experimental and control groups， with 32 cases in each group. Patients in the control group were directly extubated after successfully passing the spontaneous breathing test （SBT）. Patients in the experimental group received 30-min bedside fiberoptic bronchoscopy after successfully passing SBT， followed by extubation. Gender， age， APACHE Ⅱ score before extubation， reintubation rate， white blood cell （WBC）， C-reactive protein （CRP）， procalcitonin （PCT）， indicators of arterial blood-gas analysis， the length of ICU stay after extubation， and 28-d mortality rate were statistically compared between two groups. Results There was no significant difference in gender， age and APACHEⅡ score before extubation between two groups （all P > 0.05）. Compared with the control group， the reintubation rate of patients was reduced， WBC， CRP， PCT and PaCO2 post-extubation were decreased， PaO2 and PaO2/FiO2 were increased， and the length of ICU stay was shortened （all P < 0.05）. However， there was no significant difference in the 28-d mortality rate between two groups （P > 0.05）. Conclusion Bedside fiberoptic bronchoscopy for COPD patients with mechanical ventilation before extubation can improve oxygenation， alleviate inflammatory reaction， reduce reintubation rate， and shorten the length of ICU stay.

Keywords

• chronic obstructive pulmonary disease|bedside fiberoptic bronchoscope|reintubation rate|mechanical ventilation|inflammatory reaction