Effect of Therapeutic Bronchoscopy in Critically Ill Patients in Terms of Oxygenation and Respiratory Mechanics

INTRODUCTION: Fiberoptic bronchoscopy isrelatively a safe procedure for making diagnosis of different respiratory pathologies. Bymeans of FOB we can directly visualize the lung pathology or take bronchioalveolar lavageand even biopsy to reach the diagnosis. FOB gains popularity for therapeutic indication in cases of foreign body aspiration, lung lavage, ablation debulking of endobronchial masses, airway stenosis. OBJECTIVES: Primary objective – To study the effect of fibreoptic bronchoscopy in critically ill patientson a mechanical ventilator in terms of oxygenation and ventilation through different parameters [SpO(2), PaO(2), PaCO(2), PaO(2)/FiO(2), Ppeak, Pplat and static lung compliance]. Secondary objective- To study the post-procedure complications of fiberoptic bronchoscopy. MATERIALS AND METHODS: Study Design: Prospective, Observational Study: Study Duration: 18 months. Study Population: Critically ill patients with respiratory ailments. Sample Size: 27 patients. INCLUSION CRITERIA: Age 18 to 65 years. On mechanical ventilator. Infiltrates/opacities on chest x-ray. EXCLUSION CRITERIA: Recent myocardial infarction. Coagulation disorders. Platelet count <50,000. Raised intracranial pressure. PaO(2)<55mmHg or SpO(2)<90%. Unstable arrythmia. RESULTS: 1. Before the procedure, the mean SpO(2) was 94.3 with a standard deviation of 1.8. Post-procedure, significant improvements in SpO(2) levels were observed, with mean values of 99.2, 99.8, and 99.9 recorded at 1 hour, 12 hours, and 24 hours after the procedure, respectively. These increases were statistically significant (p < 0.001). 2. Before the procedure, the mean PO(2) was 75.0 with a standard deviation of 12.3. Following the procedure, there were substantial increases in PO(2) levels, evidenced by mean values of 127.8, 151.3, and 178.0 recorded at 1 hour, 12 hours, and 24 hours post-procedure, respectively. 3. Before the procedure, mean ratio of partial pressure of arterial oxygen and fraction inspired of oxygen(PaO(2)/FiO(2)) ratio was 146.8 with a standard deviation of 23.9. Post procedure, increases in the PaO(2)/FiO(2) ratio were observed, mean values of 245.9, 296.7, and 351.5 recorded at 1 hour, 12 hours, and 24 hours after the procedure, respectively. DISCUSSIONS/CONCLUSIONS: The primary goals of a diagnostic work-up are to see blockages in the airway system & to detect respiratory infections using bronchoalveolar lavage (BAL) and tissue sampling where necessary. Aspiration of bronchial secretions—more often required in patients with artificial airways—removal of the mucus plug to treat atelectasis (total or lobar), and aspiration of blood during hemoptysis are the major treatments.