Efficacy of noninvasive positive pressure ventilation during fiberoptic bronchoscopy: Bi-level vs CPAP valve

Background: Fiberoptic bronchoscopy (FOB) in severe acute respiratory failure patients may have risks and sometimes is contraindicated. Noninvasive Positive Pressure Ventilation (NPPV) application to assist spontaneous breathing during FOB can be an alternative. Objective: Compare the application of NPPV (Philips-Respironics BiPAP Vision and Airox Supportair) vs Continuous Positive Airway Pressure (CPAP) valve (Boussignac) (CV) during FOB, in hypoxemic and/or hypercapnic patients, with various etiologies. Patients and methods: Fifteen (5 female) with severe hypoxemia defined by PaO2/FiO2 45mmHg. Results median (iqr): In G1 an IPAP of 23 (3)cmH2O, EPAP of 8 (2)cmH2O were applied and a FiO2 of 70 (50)% and in G2 a oxygen flow of 20 (8,6) L/min, generating a CPAP of 6 (4)cmH2O and a FiO2 of 60 (17,5)%. PaO2 improved after FOB in the whole group: 62,7 (16,1) vs 102,3 (97,1) mmHg post FBO, p =0,002, as well as PaO2/FiO2: 141,6 (57,2) and 203,9 (206) post FBO, p =0,002, and the PaCO2 remained within normal limits. Average SpO2 during FBO was not significantly different in both groups, 95,0 (5,9) in G1 vs 97,2 (0,9) in G2, ( p =0,148). In G1 one patient was intubated. Conclusion: These results suggest that noninvasive positive pressure has an important role as adjunctive technique during FOB in severe hypoxemic patients (PaO2/FiO2<200). In this preliminary study no advantage of NPPV vs CV.