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Intensive Care Medicine
Published in: Intensive Care Medicine 12/2011

01-12-2011 | Original

Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients

Authors: Benjamin Clouzeau, Hoang-Nam Bui, Emmanuelle Guilhon, Marieke Grenouillet-Delacre, Melanie Saint Leger, Tahar Saghi, Jerome Pillot, Bruno Filloux, Solenn Coz, Alexandre Boyer, Frederic Vargas, Didier Gruson, Gilles Hilbert

Published in: Intensive Care Medicine | Issue 12/2011

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Abstract

Purpose

In critically ill patients with acute respiratory failure (ARF), fiberoptic bronchoscopy and bronchoalveolar lavage (FOB-BAL) are important tools in diagnostic strategies. In nonintubated patients, the patient’s agitation may lead to desaturation and compromise the realization of FOB. The aim of this study was to assess the feasibility and safety of target-controlled (TCI) propofol sedation during FOB-BAL in nonintubated hypoxemic patients.

Methods

The first end point in our prospective investigation within an intensive care unit (ICU) was the avoidance of endotracheal intubation within 24 h. Secondary end points were changes in the PaO2/FiO2 ratio, hemodynamic stability, patient comfort, occurrence of adverse effects, and quality of FOB. Patients self-evaluated their comfort after FOB.

Results

Twenty-four FOBs were performed in 23 patients with ARF. PaO2/FiO2 before FOB was 181 ± 50 (range 85–286). All patients tolerated FOB with BAL. None was intubated during the 2 h after FOB. Loss of consciousness was obtained with an effect site concentration of propofol of 1.49 ± 0.46 μg/mL (range 2.6–0.6). No significant adverse events occurred. TCI propofol allowed us to obtain amnesia, patient comfort, and it did not impair airway protection. Any hemodynamic changes observed were modest and transient.

Conclusions

FOB-BAL, under NIV and TCI with propofol, is feasible and safe in nonintubated patients with ARF. The TCI of propofol during FOB-BAL reduces patient discomfort with no significant adverse effects.
Appendix
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Metadata
Title
Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients
Authors
Benjamin Clouzeau
Hoang-Nam Bui
Emmanuelle Guilhon
Marieke Grenouillet-Delacre
Melanie Saint Leger
Tahar Saghi
Jerome Pillot
Bruno Filloux
Solenn Coz
Alexandre Boyer
Frederic Vargas
Didier Gruson
Gilles Hilbert
Publication date
01-12-2011
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 12/2011
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-011-2375-1

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