Prediction of intubation after bronchoscopy with non-invasive positive pressure ventilation support in patients with acute hypoxemic respiratory failure

Jae Uk Song, Su A. Kim, Min Kim Soo, Jung Choi Hee, Yeon Lim So, Young Park So, Young Suh Gee, Kyeongman Jeon

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Background: Non-invasive positive pressure ventilation (NPPV) ensures adequate gas exchange during bronchoscopy in spontaneously breathing, hypoxemic patients, thus avoiding endotracheal intubation. However, in some patients, endotracheal intubation is eventually required after bronchoscopy. This study investigated the incidence of intubation and predictors of a need for emergency intubation prior to NPPV bronchoscopy initiation. Methods: On a retrospective basis, we reviewed the medical records of 36 patients (median age, 55 years; interquartile range [IQR], 43-65 years) with acute hypoxemic respiratory failure who required NPPV during bronchoscopy between January 2005 and October 2007. Results: All patients were hypoxemic (median PaO2/F iO2 ratio 155; IQR 90-190), but tolerated bronchoscopy with NPPV support. SOFA score and SAPS II score immediately before NPPV initiation were 4 (3-7) and 36 (30-42), respectively. Seventeen (47%) patients needed endotracheal intubation at a median time of 22 (2-50) hours after bronchoscopy. Patients who needed intubation after bronchoscopy had a higher in-hospital mortality (11 [65%] vs. 4 [21%], p=0.017). Upon multiple logistic regression analysis, the need for intubation after bronchoscopy was independently associated with a PaO2/FiO 2 ratio (OR, 0.961; 95% CI, 0.924-0.999; p=0.047) immediately before NPPV initiation for bronchoscopy. Conclusion: The severity of the hypoxemia immediately prior to NPPV initiation for bronchoscopy was associated with the need for intubation after bronchoscopy in patients with hypoxemic respiratory failure. Copyright

Original languageEnglish
Pages (from-to)21-26
Number of pages6
JournalTuberculosis and Respiratory Diseases
Volume67
Issue number1
DOIs
StatePublished - Jul 2009

Keywords

  • Anoxia
  • Bronchoscopy
  • Intubation
  • Positive-pressure respiration

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