The Indian Journal of Chest Diseases and Allied Sciences

Register      Login

VOLUME 64 , ISSUE 4 ( October-December, 2022 ) > List of Articles

CASE REPORT

Endobronchial Ultrasound Bronchoscopy in Patients with Acute Respiratory Failure on Noninvasive Ventilation: Report of Two Cases

Onkar K Jha, Sapna Yadav, Mrinal Sircar, Noopur Gupta

Keywords : Bronchoscopy, Endobronchial ultrasound, EBUS–transbronchial needle aspiration, Fiberoptic bronchoscopy, Noninvasive ventilation, Respiratory failure

Citation Information : Jha OK, Yadav S, Sircar M, Gupta N. Endobronchial Ultrasound Bronchoscopy in Patients with Acute Respiratory Failure on Noninvasive Ventilation: Report of Two Cases. Indian J Chest Dis Allied Sci 2022; 64 (4):292-296.

DOI: 10.5005/jp-journals-11007-0041

License: CC BY-NC 4.0

Published Online: 05-01-2023

Copyright Statement:  Copyright © 2022; The Author(s).


Abstract

Fiberoptic bronchoscopy (FOB) has simplified the direct examination of the lungs and is widely used for diagnosis and therapy. Fiberoptic bronchoscopes occupy a significant proportion of cross-section area of central airways, which can affect lung mechanics and gas exchanges that may lead to desaturation and cardiac arrhythmia. This makes bronchoscopy in critically ill patients with respiratory failure even more challenging. Use of noninvasive mechanical ventilation (NIV) may help to avoid use of invasive mechanical ventilation in selected patients with acute respiratory failure. It has been shown to be useful in hypoxemic patients to facilitate bronchoscopic examination for bronchoalveolar lavage, bronchial brushing, endobronchial biopsy (EBB), and transbronchial lung biopsy (TBLB). Noninvasive mechanical ventilation has also been used to facilitate other endoscopic procedures including transesophageal echocardiography (TEE) and upper gastrointestinal endoscopy for diagnostic and therapeutic interventions in hypoxemic patients. Endobronchial ultrasound (EBUS) bronchoscope, having a wider diameter than a conventional bronchoscope, may have a more pronounced effect on lung mechanics and gas exchanges, and its use in patients on NIV has not been reported. Contraindications of EBUS are mostly relative and similar to FOB. There are several studies suggesting the safety of NIV-supported FOB in hypoxemic patients. We describe our experience of the first two EBUS bronchoscopies and transbronchial needle aspiration (TBNA) was done in hypoxemic patients with NIV support.


PDF Share
  1. Murgu SD, Pecson J, Colt HG. Bronchoscopy during noninvasive ventilation: Indications and technique. Respir Care 2010;55(5): 595–600. PMID: 20420731.
  2. Vock P, Spiegel T, Fram EK, et al. CT assessment of the adult intrathoracic cross section of the trachea. J Comput Assist Tomogr 1984;8(6):1076–1082. DOI: 10.1097/00004728-198412000-00007.
  3. Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: Noninvasive ventilation for acute respiratory failure. Eur Respir J 2017;50(2):1602426. DOI: 10.1183/13993003.02426-2016.
  4. Antonelli M, Conti G, Riccioni L, et al. Noninvasive positive-pressure ventilation via face mask during bronchoscopy with BAL in high-risk hypoxemic patients. Chest 1996;110(3):724–728. DOI: 10.1378/chest.110.3.724.
  5. Maitre B, Jaber S, Maggiore SM, et al. Continuous positive airway pressure during fiberoptic bronchoscopy in hypoxemic patients: A randomized double-blind study using a new device. Am J Respir Crit Care Med 2000;162(3 Pt 1):1063–1067. DOI: 10.1164/ajrccm. 162.3.9910117.
  6. Sircar M, Jha OK, Chabbra GS, et al. Noninvasive ventilation- assisted bronchoscopy in high-risk hypoxemic patients. Indian J Crit Care Med 2019;23(8):363–367. DOI: 10.5005/jp-journals-10071- 23219.
  7. Guarracino F, Cabrini L, Baldassarri R, et al. Non-invasive ventilation-aided transoesophageal echocardiography in high-risk patients: A pilot study. Eur J Echocardiogr 2010;11(6):554–556. DOI: 10.1093/ejechocard/jeq019.
  8. Cabrini L, Nobile L, Cama E, et al. Non-invasive ventilation during upper endoscopies in adult patients: A systematic review. Minerva Anestesiol 2013;79(6):683–694. PMID: 23419342.
  9. Chiner E, Sancho-Chust JN, Llombart M, et al. Fiberoptic bronchoscopy during nasal non-invasive ventilation in acute respiratory failure. Respiration 2010;80(4):321–326. DOI: 10.1159/000314074.
  10. Matsushima Y, Jones RL, King EG, et al. Alterations in pulmonary mechanics and gas exchange during routine fiberoptic bronchoscopy. Chest 1984;86(2):184–188. DOI: 10.1378/chest.86.2.184.
  11. Lindholm CE, Ollman B, Snyder JV, et al. Cardiorespiratory effects of flexible fiberoptic bronchoscopy in critically ill patients. Chest 1978; 74(4):362–368. DOI: 10.1378/chest.74.4.362.
  12. Antonelli M, Pennisi MA, Conti G, et al. Fiberoptic bronchoscopy during noninvasive positive pressure ventilation delivered by helmet. Intensive Care Med 2003;29(1):126–129. DOI: 10.1007/s00134-002-1554-5.
  13. American Thoracic Society; American College of Chest Physicians. ATS/ACCP Statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 2003;167(2):211–77. DOI: 10.1164/rccm.167.2.211.
  14. Gil HI, Choe J, Jeong BH, et al. Safety of endobronchial ultrasound-guided transbronchial needle aspiration in patients with lung cancer within a year after percutaneous coronary intervention. Thorac Cancer 2018;9(11):1390–1397. DOI: 10.1111/1759-7714.12846.
  15. Chawla R, Dixit SB, Zirpe KG, et al. ISCCM guidelines for the use of non-invasive ventilation in acute respiratory failure in adult ICUs. Indian J Crit Care Med 2020;24(Suppl 1):S61–S81. DOI: 10.5005/jp-journals-10071-G23186.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.