Noninvasive positive-pressure ventilation vs conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy

Massimo Antonelli, Giorgio Conti, Monica Rocco, Andrea Arcangeli, Franco Cavaliere, Rodolfo Proietti, Gianfranco Meduri

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Objective: We have reported previously on the use of noninvasive positive-pressure ventilation (NPPV) to assist spontaneous breathing in high-risk hypoxemic patients (ie, PaO2/fraction of inspired oxygen [FIO2] ratio, ≤ 100) who are undergoing diagnostic fiberoptic bronchoscopy (FOB). The efficacy of this intervention in patients with less severe forms of hypoxemia (ie, PaO2/FIO2 ratio, < 200) is unknown. Patients and methods: Twenty-six patients with PaO2/FIO2 ratios ≤ 200 who required bronchoscopic BAL for suspected nosocomial pneumonia were entered into the study. Thirteen patients were randomized during FOB to receive NPPV, and 13 patients were randomized to receive conventional oxygen supplementation by Venturi mask. The primary end points were changes in the PaO2/FIO2 ratio during FOB and within 60 min of terminating the procedure. Results and outcome: At study entry, the two groups were similar in terms of age, simplified acute physiologic score II values, and cardiorespiratory parameters. During FOB, the mean (± SD) PaO2/FIO2 ratio increased by 82% in the NPPV group (261 ± 100 vs 139 ± 38; p < 0.001) and decreased by 10% in the conventional oxygen supplementation group (155 ± 24 to 139 ± 38; p = 0.23). Sixty minutes after undergoing FOB, the NPPV group had a higher mean PaO2/FIO2 ratio (176 ± 62 vs 140 ± 38; p = 0.09), a lower mean heart rate (91 ± 18 vs 108 ± 15 beats/min; p = 0.02), and no reduction in mean arterial pressure in comparison to a 15% decrease from the baseline in the control group. One patient in the NPPV group and two patients in the control group required nonemergent intubation. Major bacterial isolates included Staphylococcus aureus (7 of 30 isolates; 23%) and Pseudomonas aeruginosa (12 of 30 isolates; 40%). Conclusion: In patients with severe hypoxemia, NPPV is superior to conventional oxygen supplementation in preventing gas-exchange deterioration during FOB with better hemodynamic tolerance.

Original languageEnglish (US)
Pages (from-to)1149-1154
Number of pages6
JournalChest
Volume121
Issue number4
DOIs
StatePublished - Jan 1 2002

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Positive-Pressure Respiration
Bronchoscopy
Oxygen
Dimercaprol
Control Groups
Masks
Intubation
Pseudomonas aeruginosa
Staphylococcus aureus
Pneumonia
Arterial Pressure
Respiration
Heart Rate
Gases
Hemodynamics
Outcome Assessment (Health Care)

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Noninvasive positive-pressure ventilation vs conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy. / Antonelli, Massimo; Conti, Giorgio; Rocco, Monica; Arcangeli, Andrea; Cavaliere, Franco; Proietti, Rodolfo; Meduri, Gianfranco.

In: Chest, Vol. 121, No. 4, 01.01.2002, p. 1149-1154.

Research output: Contribution to journalArticle

Antonelli, Massimo ; Conti, Giorgio ; Rocco, Monica ; Arcangeli, Andrea ; Cavaliere, Franco ; Proietti, Rodolfo ; Meduri, Gianfranco. / Noninvasive positive-pressure ventilation vs conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy. In: Chest. 2002 ; Vol. 121, No. 4. pp. 1149-1154.
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abstract = "Objective: We have reported previously on the use of noninvasive positive-pressure ventilation (NPPV) to assist spontaneous breathing in high-risk hypoxemic patients (ie, PaO2/fraction of inspired oxygen [FIO2] ratio, ≤ 100) who are undergoing diagnostic fiberoptic bronchoscopy (FOB). The efficacy of this intervention in patients with less severe forms of hypoxemia (ie, PaO2/FIO2 ratio, < 200) is unknown. Patients and methods: Twenty-six patients with PaO2/FIO2 ratios ≤ 200 who required bronchoscopic BAL for suspected nosocomial pneumonia were entered into the study. Thirteen patients were randomized during FOB to receive NPPV, and 13 patients were randomized to receive conventional oxygen supplementation by Venturi mask. The primary end points were changes in the PaO2/FIO2 ratio during FOB and within 60 min of terminating the procedure. Results and outcome: At study entry, the two groups were similar in terms of age, simplified acute physiologic score II values, and cardiorespiratory parameters. During FOB, the mean (± SD) PaO2/FIO2 ratio increased by 82{\%} in the NPPV group (261 ± 100 vs 139 ± 38; p < 0.001) and decreased by 10{\%} in the conventional oxygen supplementation group (155 ± 24 to 139 ± 38; p = 0.23). Sixty minutes after undergoing FOB, the NPPV group had a higher mean PaO2/FIO2 ratio (176 ± 62 vs 140 ± 38; p = 0.09), a lower mean heart rate (91 ± 18 vs 108 ± 15 beats/min; p = 0.02), and no reduction in mean arterial pressure in comparison to a 15{\%} decrease from the baseline in the control group. One patient in the NPPV group and two patients in the control group required nonemergent intubation. Major bacterial isolates included Staphylococcus aureus (7 of 30 isolates; 23{\%}) and Pseudomonas aeruginosa (12 of 30 isolates; 40{\%}). Conclusion: In patients with severe hypoxemia, NPPV is superior to conventional oxygen supplementation in preventing gas-exchange deterioration during FOB with better hemodynamic tolerance.",
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T1 - Noninvasive positive-pressure ventilation vs conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy

AU - Antonelli, Massimo

AU - Conti, Giorgio

AU - Rocco, Monica

AU - Arcangeli, Andrea

AU - Cavaliere, Franco

AU - Proietti, Rodolfo

AU - Meduri, Gianfranco

PY - 2002/1/1

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N2 - Objective: We have reported previously on the use of noninvasive positive-pressure ventilation (NPPV) to assist spontaneous breathing in high-risk hypoxemic patients (ie, PaO2/fraction of inspired oxygen [FIO2] ratio, ≤ 100) who are undergoing diagnostic fiberoptic bronchoscopy (FOB). The efficacy of this intervention in patients with less severe forms of hypoxemia (ie, PaO2/FIO2 ratio, < 200) is unknown. Patients and methods: Twenty-six patients with PaO2/FIO2 ratios ≤ 200 who required bronchoscopic BAL for suspected nosocomial pneumonia were entered into the study. Thirteen patients were randomized during FOB to receive NPPV, and 13 patients were randomized to receive conventional oxygen supplementation by Venturi mask. The primary end points were changes in the PaO2/FIO2 ratio during FOB and within 60 min of terminating the procedure. Results and outcome: At study entry, the two groups were similar in terms of age, simplified acute physiologic score II values, and cardiorespiratory parameters. During FOB, the mean (± SD) PaO2/FIO2 ratio increased by 82% in the NPPV group (261 ± 100 vs 139 ± 38; p < 0.001) and decreased by 10% in the conventional oxygen supplementation group (155 ± 24 to 139 ± 38; p = 0.23). Sixty minutes after undergoing FOB, the NPPV group had a higher mean PaO2/FIO2 ratio (176 ± 62 vs 140 ± 38; p = 0.09), a lower mean heart rate (91 ± 18 vs 108 ± 15 beats/min; p = 0.02), and no reduction in mean arterial pressure in comparison to a 15% decrease from the baseline in the control group. One patient in the NPPV group and two patients in the control group required nonemergent intubation. Major bacterial isolates included Staphylococcus aureus (7 of 30 isolates; 23%) and Pseudomonas aeruginosa (12 of 30 isolates; 40%). Conclusion: In patients with severe hypoxemia, NPPV is superior to conventional oxygen supplementation in preventing gas-exchange deterioration during FOB with better hemodynamic tolerance.

AB - Objective: We have reported previously on the use of noninvasive positive-pressure ventilation (NPPV) to assist spontaneous breathing in high-risk hypoxemic patients (ie, PaO2/fraction of inspired oxygen [FIO2] ratio, ≤ 100) who are undergoing diagnostic fiberoptic bronchoscopy (FOB). The efficacy of this intervention in patients with less severe forms of hypoxemia (ie, PaO2/FIO2 ratio, < 200) is unknown. Patients and methods: Twenty-six patients with PaO2/FIO2 ratios ≤ 200 who required bronchoscopic BAL for suspected nosocomial pneumonia were entered into the study. Thirteen patients were randomized during FOB to receive NPPV, and 13 patients were randomized to receive conventional oxygen supplementation by Venturi mask. The primary end points were changes in the PaO2/FIO2 ratio during FOB and within 60 min of terminating the procedure. Results and outcome: At study entry, the two groups were similar in terms of age, simplified acute physiologic score II values, and cardiorespiratory parameters. During FOB, the mean (± SD) PaO2/FIO2 ratio increased by 82% in the NPPV group (261 ± 100 vs 139 ± 38; p < 0.001) and decreased by 10% in the conventional oxygen supplementation group (155 ± 24 to 139 ± 38; p = 0.23). Sixty minutes after undergoing FOB, the NPPV group had a higher mean PaO2/FIO2 ratio (176 ± 62 vs 140 ± 38; p = 0.09), a lower mean heart rate (91 ± 18 vs 108 ± 15 beats/min; p = 0.02), and no reduction in mean arterial pressure in comparison to a 15% decrease from the baseline in the control group. One patient in the NPPV group and two patients in the control group required nonemergent intubation. Major bacterial isolates included Staphylococcus aureus (7 of 30 isolates; 23%) and Pseudomonas aeruginosa (12 of 30 isolates; 40%). Conclusion: In patients with severe hypoxemia, NPPV is superior to conventional oxygen supplementation in preventing gas-exchange deterioration during FOB with better hemodynamic tolerance.

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