PURPOSE: Fiberoptic bronchoscopy (FOB) and lung biopsy is an important diagnostic tool in patients with diffuse pulmonary infiltrates. However, these patients often have hypoxemic respiratory failure which makes the procedure risky. Noninvasive positive pressure ventilation (NIPPV) improves oxygenation in hypoxemic patients. We report the efficacy and safety of an innovative technique of NIPPV-assisted bronchoscopic lung biopsy (BLB) in hypoxemic patients with diffuse parenchymal infiltrates.
METHODS: Patients with bilateral diffuse parenchymal infiltrates and PaO2/FiO2 <200 requiring BLB were included. NIPPV (full-face mask, Servo i ventilator) was delivered at FiO2 of 1, starting 10 minutes before the procedure and continued for 30 minutes after the procedure. The pressures were titrated to maintain a pulse oximetric saturation of ≥92%. Nasal passage of bronchoscope was obtained through a swivel adapter and lung biopsy was obtained from the radiologically abnormal areas of the lung. Hemodynamic monitoring including continuous pulse oximetric saturation, heart rate, respiratory rate and blood pressure measured throughout the procedure.
RESULTS: Six patients (3 males, 3 females) with a mean (SD) age of 44.5 (11.6) years were included in the study. The median (IQR) PaO2/FiO2 ratio prior to lung biopsy was 164.5 (146.3-176.3) and the median (IQR) pressures used were 14 (12-15)/5 cm H2O. FOB was well tolerated and all patients maintained SpO2 >92% during the procedure. One patient required endotracheal intubation due to hemoptysis. A definite diagnosis was obtained in five (malignancy [n=2], lymphoma [n=1], sarcoidosis [n=1]) of the six patients. A repeat procedure was performed in one patient, which again yielded no diagnosis. No other periprocedural complications were encountered.
CONCLUSIONS: NIPPV-assisted BLB is a safe and effective method to establish the underlying diagnosis in hypoxemic patients with diffuse lung infiltrates.
CLINICAL IMPLICATIONS: NIPPV-assisted BLB is a safe and effective technique to obtain lung tissue in hypoxemic patients with diffuse pulmonary infiltrates, and may thus obviate the need of a more invasive surgical lung biopsy in these patients.
DISCLOSURE: The following authors have nothing to disclose: Ajmal Khan, Ritesh Agarwal, Ashutosh Aggarwal, Amanjit Bal, Dheeraj Gupta
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