Defining a Ventilation Strategy for Flexible Bronchoscopy on Mechanically Ventilated Patients in the Medical Intensive Care Unit.

Greenstein, Yonatan Y; Shakespeare, Eric; Doelken, Peter; Mayo, Paul H

Greenstein, Yonatan Y; Shakespeare, Eric; Doelken, Peter; Mayo, Paul H.

Afiliación

Greenstein YY; *Department of Medicine, Hofstra Northwell School of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, New Hyde Park Department of Medicine, Albany Medical Center, Albany, NY Department of Medicine, Einstein Healthcare Network, East Norriton, PA.

J Bronchology Interv Pulmonol ; 24(3): 206-210, 2017 Jul.

Article en En | MEDLINE | ID: mdl-28696966

RESUMEN

BACKGROUND: Flexible bronchoscopy (FB) in intubated patients on mechanical ventilation increases airway resistance. During FB, two ventilatory strategies are possible: maintaining tidal volume (VT) while maintaining baseline CO2 or allowing reduction of VT. The former strategy carries risk of hyperinflation due to expiratory flow limitation with FB. The aim of the authors was too study end expiratory lung volume (EELV) during FB of intubated subjects while limiting VT. METHODS: We studied 16 subjects who were intubated on mechanical ventilation and required FB. Changes in EELV were measured by respiratory inductance plethysmography. Ventilator mechanics, EELV, and arterial blood gases, were measured. RESULTS: FB insertions decreased EELV in 64% of cases (-325±371 mL) and increased it in 32% of cases (65±59 mL). Suctioning decreased EELV in 76% of cases (-120±104 mL) and increased it in 16% of cases (29±33 mL). Respiratory mechanics were unchanged. Pre-FB and post-FB, PaO2 decreased by 61±96 mm Hg and PaCO2 increased by 15±7 mm Hg. CONCLUSIONS: There was no clinically significant increase in EELV in any subject during FB. Decreases in EELV coincided with FB-suctioning maneuvers. Peak pressure limiting ventilation protected the subject against hyperinflation with a consequent, well-tolerated reduction in VT, and hypercapnea. Suctioning should be limited, especially in patients vulnerable to derecruitment effect.

Asunto(s)

Broncoscopía; Competencia Clínica; Neumonía/fisiopatología; Respiración Artificial; Adulto; Anciano; Anciano de 80 o más Años; Resistencia de las Vías Respiratorias; Femenino; Humanos; Unidades de Cuidados Intensivos; Masculino; Persona de Mediana Edad; Neumonía/terapia; Estudios Prospectivos; Volumen de Ventilación Pulmonar

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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neumonía / Respiración Artificial / Broncoscopía / Competencia Clínica Tipo de estudio: Observational_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged Idioma: En Revista: J Bronchology Interv Pulmonol Año: 2017 Tipo del documento: Article Pais de publicación: Estados Unidos

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