Fiberoptic bronchoscopy supported with HFNC/NIV as promising management in patients with high risk of respiratory failure

Abstract

Introduction: Fiberoptic bronchoscopy (FOB) is a minimally invasive procedure which improves diagnostics and therapeutic management in patients with lung-related conditions. Although it is a generally well-tolerated intervention and there are only few contraindications for FOB, it has to be acknowledged that it causes acute narrowing of the airways and patients with inadequate oxygenation and respiratory acidosis may be disqualified from bronchoscopy due to an increased risk of respiratory failure (RF) development. Noninvasive techniques such as a high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV) are accepted methods of respiratory support in patients with RF, however, their usage in patients undergoing FOB is still poorly represented in the literature. Presentation of cases: Five patients requiring different bronchoscopy procedures were included in this retrospective case series. Two of them suffered from airway obstruction caused by laryngeal tumors, one from foreign body aspiration complicated with recurrent pneumonia, one from ventilator-associated pneumonia and one from RF in the course of ischemic stroke. FOB was safely performed in every patient despite the presence of relative contraindications in each case. Due to respiratory distress, FOB was supported with HFNC or NIV based on the patient’s overall condition and pathomechanism of RF. The parameters of HFNC and NIV were set according to ongoing randomized controlled trials. Conclusions: Active oxygen therapies, like HFNC and NIV, are promising methods of management in pa-tients with a high risk of RF during FOB.

Keywords

• fiberoptic bronchoscopy
• non-invasive ventilation
• high-flow nasal cannula
• airways diagnostics
• respiratory failure