8(th) International conference on management and rehabilitation of chronic respiratory failure: the long summaries – Part 3

Ambrosino, Nicolino; Casaburi, Richard; Chetta, Alfredo; Clini, Enrico; Donner, Claudio F.; Dreher, Michael; Goldstein, Roger; Jubran, Amal; Nici, Linda; Owen, Caroline A.; Rochester, Carolyn; Tobin, Martin J.; Vagheggini, Guido; Vitacca, Michele; ZuWallack, Richard

In a randomised controlled trial (RCT), mask Continuous Positive Airway Pressure (CPAP) reduced the risk of acute respiratory failure complicating bronchoscopy in severely hypoxaemic patients [15] . Another RCT in hypoxaemic patients showed that during bronchoscopy NIV increased the PaO 2 /inspiratory oxygen fraction (FIO 2 ) ratio, whereas the patients randomised to only oxygen therapy showed a worsening in oxygenation [16] . NIV during bronchoscopy is also useful in hypercapnic COPD patients with pneumonia [17] . CPAP was able to reverse reductions in tidal volume and respiratory flow associated to flexible bronchoscopy in spontaneously breathing young children [18] . In patients with acute exacerbation of COPD due to community-acquired pneumonia, in danger of ETI and unable to clear secretions, NIV with early therapeutic bronchoscopy was feasible, safe and effective [19] . A recent study suggests that in awake, critically ill patients with moderate to severe hypoxaemia undergoing bronchoscopy, the application of NIV is superior to High Flow Nasal Cannula Oxygen in oxygenation before, during and after the procedure [20] . NIV during bronchoscopy may be performed by means of commercial or modified oronasal or full-face masks [21] . These reports support the use of NIV during fiberoptic bronchoscopy especially when risks of ETI are high, such as in immunocompromised patients. However, an expert team with skills in both endoscopy and NIV should be available for any emergency [12] . In general, this should be performed in ICU.