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Song, Kim, Choi, Kim, Choi, Lim, Park, Suh, and Jeon: Prediction of Intubation after Bronchoscopy with Non-invasive Positive Pressure Ventilation Support in Patients with Acute Hypoxemic Respiratory Failure
Original Article
Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2009; 67(1): 21-26.

Published online: 31 July 2009

DOI: https://doi.org/10.4046/trd.2009.67.1.21

Prediction of Intubation after Bronchoscopy with Non-invasive Positive Pressure Ventilation Support in Patients with Acute Hypoxemic Respiratory Failure

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

Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address for correspondence: Kyeongman Jeon, M.D. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, 50, Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. Phone: 82-2-3410-3429, Fax: 82-2-3410-6956 kjeon@skku.edu

Received 5 June 2009       Accepted 24 June 2009

Copyright©2009. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

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/FiO2 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/FiO2 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.

Keywords: Positive-pressure respiration, Bronchoscopy, Intubation, Anoxia

Figures and Tables

Figure 1
Comparison of PaO2/FiO2 (P/F) ratio before bronchoscopy with non-invasive positive pressure ventilation (NPPV) support between patients who were and were not intubated after bronchoscopy (horizontal line, median; box, 25~75th interquartile range; whiskers, range) (p=0.045).
trd-67-21-g001
Table 1
Baseline characteristics and clinical outcomes of 36 patients who underwent bronchoscopy with non-invasive positive pressure ventilation (NPPV)*
trd-67-21-i001

SAPS: simplified acute physiology score; SOFA: sequential organ failure assessment; CPAP: continuous positive airway pressure; PSV: pressure support ventilation.

*Data are presented as medians and interquartile ranges (25th and 75th percentiles) for continuous variables and as number (percentages) for categorical variables, †Others included ulcerative colitis (n=1), liver cirrhosis (n=1), and valvular heart disease (n=1), ‡The data of NPPV mode was not available in one patient.

Table 2
Comparisons of physiologic and laboratory data before bronchoscopy with non-invasive positive pressure ventilation (NPPV) between patients who were and were not intubated after bronchoscopy*
trd-67-21-i002

SAPS: simplified acute physiology score; SOFA: sequential organ failure assessment; BP: blood pressure; CPAP: continuous positive airway pressure; PSV: pressure support ventilation.

*Data are presented as medians and interquartile ranges (25th and 75th percentiles) for continuous variables and as number (percentages) for categorical variables, †The data of NPPV mode was not available in one patient.

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