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La fibroscopie bronchique chez le patient de réanimation hypoxémique et non intubé: modalités pratiques

Modalities of fiberoptic bronchoscopy in the critically ill non-intubated hypoxemic patients

  • Note Technique / Technical Note
  • Published:
Réanimation

Résumé

Malgré le développement d’outils diagnostiques non invasifs, la fibroscopie bronchique avec lavage bronchoalvéolaire (FB-LBA) garde toujours une place déterminante dans la quête diagnostique devant un patient admis en réanimation pour insuffisance respiratoire aiguë hypoxémiante. C’est parfois le seul examen qui permet d’apporter le diagnostic final. Elle permet aussi de mieux cibler les traitements et donc d’en réduire les effets secondaires. Pour être bénéfique au patient, la FB-LBA doit s’intégrer dans une démarche diagnostique raisonnée, être réservée à des populations ciblées et être pratiquée par des équipes entraînées. De nombreux travaux ont démontré que, sous couvert d’un certain nombre de précautions, ce geste peut être réalisé en toute sécurité même chez des patients profondément hypoxémiques et non intubés. La réalisation de la FB-LBA sous ventilation non invasive est un moyen d’en réduire le retentissement respiratoire. Certains auteurs ont également montré que l’ajout d’une sédation permet d’en améliorer la tolérance.

Abstract

Despite the development of non-invasive diagnostic tools, bronchoscopy with bronchoalveolar lavage (FB-BAL) still plays a key role in the diagnostic challenge faced while managing patients admitted to the intensive care unit with acute hypoxemic respiratory failure. FB-BAL often represents the most helpful test to assess the final diagnosis and to allow targeting treatments and reducing their side-effects. FB-BAL should be performed in selected patients by trained physicians. To be beneficial, FB-BAL should be integrated into a clear diagnostic strategy and its benefits balanced with its possible risks in the hypoxemic patients. Several studies have assessed that FB-BAL is safe even in spontaneously breathing hypoxemic patients. In these patients, non-invasive positive pressure ventilation has been shown to prevent any worsening in respiratory conditions and avoid tracheal intubation in comparison to conventional oxygen supply. Sedation was suggested to additionally improve FB-BAL safety.

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  1. Medical Intensive Care Unit, Pellegrin Teaching Hospital, place Amélie-Raba-Léon, F-33076, Bordeaux cedex, France

    B. Clouzeau & T. Saghi

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  1. B. Clouzeau
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  2. T. Saghi
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Correspondence to B. Clouzeau.

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Clouzeau, B., Saghi, T. La fibroscopie bronchique chez le patient de réanimation hypoxémique et non intubé: modalités pratiques. Réanimation 22, 100–106 (2013). https://doi.org/10.1007/s13546-012-0535-4

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  • DOI: https://doi.org/10.1007/s13546-012-0535-4

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