Bronchoscopy in chronic respiratory failure using Boussignac system with CO 2 new device

Introduction The diagnostic bronchoscopy, in chronic hypoxemic patients with normo/hypo/hypercapnia is not always feasible, although the standard oxygen delivery, for the clinical severity or comorbidity, was possible by Continuous Positive Airway Pressure (CPAP) system with bite block of end tidal CO 2 (EtCO 2 ) new device. Objectives We employed the Boussignac CPAP (B-CPAP) system with EtCO 2 device, in the chronic respiratory failure, to cope further hypoxemia related with the procedure itself and especially in the bronchoalveolar lavage (BAL) and in the biopsy techniques. Methods 38 patients, in topical anesthesia, spontaneously breathing (23 men, 15 women, median age 64,58 years, partial pressure for oxygen/fraction of inspired oxygen PaO 2 /FiO 2 238-280, pCO 2 28-53 mmHg) received B-CPAP system applied to a facemask, monitoring oximetry, heart rate, EtCO 2 through a special mouthpiece. Results In our study, the bronchoscopy has been completed in all patients without subsequent complications with application of B-CPAP system through a bite block of EtCO 2 device. 10 TBNA, 9 biopsies, 5 bronchial aspirations in COPD were made with saturations in O 2 94%, PaO 2 /FiO 2 350 also in 14 BAL, that cause desaturation with a significant hypoxemia. Moreover, in a patient with EtCO 2 of 53mmHg, the bronchoscopy, limited to a fast airway inspection with aspiration, did not give complications, even with a moderate CO 2 increase. Conclusions B-CPAP system, during bronchoscopic maneuvers, for oximetry, EtCO 2 , for the reduction of dyspnea, formed, in our experience, an alternative procedure to the endotracheal intubation and mechanical ventilation, expecially in COPD patients with tendency toward hypercapnia.