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Noninvasive Ventilation-Facilitated Bronchofiberoscopy in Patients with Respiratory Failure

  • Szymon SkoczyńskiEmail author
  • Łukasz Minarowski
  • Ewelina Tobiczyk
  • Aleksandra Oraczewska
  • Klaudia Glinka
  • Karolina Ficek
  • Robert Mróz
  • Adam Barczyk
Part of the Advances in Experimental Medicine and Biology book series


Respiratory failure is one of the most important risk factors for diagnostic bronchofiberoscopy (BF), whereas therapeutic bronchoscopies are typically performed in intubated patients. Only a few published studies analyzed the outcomes of noninvasive mechanical ventilation (NIV)-facilitated BF. In this case series, we present our experiences with NIV-facilitated diagnostic and therapeutic BF performed in patients with respiratory failure that was associated with acute interstitial pulmonary disease, chronic obstructive pulmonary disease, cystic fibrosis exacerbation, foreign body aspiration, tracheal stenosis, pneumonia, and in a patient with a neuromuscular disease. All of the patients were initially hypoxic and some had PaO2/FiO2 < 200, which corresponded to moderate-to-acute respiratory distress syndrome (ARDS). NIV-facilitated BF were performed for the diagnostic or therapeutic purposes. The former consisted of bronchoalveolar lavage and bacterial sampling in a patient with impaired cough reflex, airway assessment in otherwise unexplained respiratory failure and hemoptysis, and the latter of mucous plugs resolution, foreign body removal, and assistance in weaning from mechanical ventilation. All procedures were carried out using NIV in the spontaneous timed (ST) or average volume assured pressure support (AVAPS) mode with oxygen supplementation. There were no procedure-related complications noticed during NIV-facilitated BF. We conclude that NIV is a useful and safe tool that facilitates the performance of BF in severe pulmonary diseases. Prospective studies are required to set the recommendations for the procedure and to define the optimum ventilatory modes to be used.


Airway assessment Bronchofiberoscopy Hypoxia Interventional bronchoscopy Mechanical ventilation Noninvasive ventilation Pulmonary disease Respiratory failure 



Supported by grants KNW-1-173/K/8/K of the Medical University of Silesia in Katowice and grant N/ST/ZB118/004/1203 of the Medical University of Bialystok in Poland.

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Abdelmalak BB, Khanna AK, Culver DA, Popovich MJ (2015) Therapeutic whole–lung lavage for pulmonary alveolar proteinosis a procedural update. J Bronchology Interv Pulmonol 22(3):251–258Google Scholar
  2. Agarwal R, Khan A, Aggarwal AN, Gupta D (2012) Bronchoscopic lung biopsy using noninvasive ventilatory support: case series and review of literature of NIV–assisted bronchoscopy. Respir Care 57(11):1927–1936Google Scholar
  3. Ambrosino N, Guarracino F (2011) Unusual applications of noninvasive ventilation. Eur Respir J 38(2):440–449Google Scholar
  4. American Thoracic Society (1987) Medical Section of the American Lung Association Guidelines for fiberoptic bronchoscopy in adults. Am Rev Respir Dis 136(4):1066Google Scholar
  5. Antonelli M, Conti G, Rocco M, Arcangeli A, Cavaliere F, Proietti R, Meduri GU (2002) Noninvasive positive–pressure ventilation vs. conventional oxygen supplementation in hypoxemic patients undergoing diagnostic bronchoscopy. Chest 121(4):1149–1154Google Scholar
  6. Cabrini L, Nobile L, Cama E, Borghi G, Pieri M, Bocchino S, Zangrillo A (2013) Non–invasive ventilation during upper endoscopies in adult patients. A systematic review. Minerva Anestesiol 79(6):683–694Google Scholar
  7. Dooms C, Seijo L, Gasparini S, Trisolini R, Ninane V, Tournoy KG (2010) Diagnostic bronchoscopy: state of the art. Eur Respir Rev 19(117):229–236Google Scholar
  8. Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S, Mandal S, Martin J, Mills J, Navani N, Rahman NM, Wrightson JM, Munavvar M, British Thoracic Society Bronchoscopy Guideline Group (2013) British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE. Thorax 68(Suppl 1):i1–i44Google Scholar
  9. Esquinas A, Zuil M, Scala R, Chiner E (2013) Bronchoscopy during non–invasive mechanical ventilation: a review of techniques and procedures. Arch Bronconeumol 49(3):105–112Google Scholar
  10. Esquinas AM, Berlin DA, Barjaktarevic I (2015) Oxygenation during high–flow nasal cannula in tracheal intubation: do we know the “red desaturation line”? Crit Care Med 43(6):e215–e216Google Scholar
  11. Estella A (2012) Analysis of 208 flexible bronchoscopies performed in an intensive care unit. Med Int 36(6):396–401Google Scholar
  12. Facciolongo N (2011) Contraindications, risks, complications in interventional pneumology. Monaldi Arch Chest Dis 75(1):54–59Google Scholar
  13. Fecci L, Consigli GF (2011) Bronchoscopy in intensive care unit. Monaldi Arch Chest Dis 75(1):67–71Google Scholar
  14. Goldstein RA, Rohatgi PK, Bergofsky EH, Block ER, Daniele RP, Dantzker DR, Davis GS, Hunninghake GW, King TE Jr, Metzger WJ et al (1990) Clinical role of bronchoalveolar lavage in adults with pulmonary disease. Am Rev Respir Dis 142(2):481–486Google Scholar
  15. Katz AS, Stawicki J, Michelson EL, Holford FD (1981) Cardiac Arrhythmias. Frequency during fiberoptic bronchoscopy and correlation with hypoxemia. Arch Intern Med 141(5):603–606Google Scholar
  16. Korkmaz Ekren P, Basarik Aydogan B, Gurgun A, Tasbakan MS, Bacakoglu F, Nava S (2016) Can fiberoptic bronchoscopy be applied to critically ill patients treated with noninvasive ventilation for acute respiratory distress syndrome? Prospective observational study. BMC Pulm Med 16(1):89Google Scholar
  17. Maitre B, Jaber S, Maggiore SM, Bergot E, Richard JC, Bakthiari H, Housset B, Boussignac G, Brochard L (2000) Continuous positive airway pressure during fiberoptic bronchoscopy in hypoxemic patients. A randomized double–blind study using a new device. Am J Respir Crit Care Med 162(3 Pt 1):1063–1067Google Scholar
  18. Murgu SD, Pecson J, Colt HG (2010) Bronchoscopy during noninvasive ventilation: indications and technique. Respir Care 55(5):595–600Google Scholar
  19. Payne CB Jr, Goyal PC, Gupta SC (1986) Effect of transoral and transnasal fiberoptic bronchoscopy. Endoscopy 18(1):1–3Google Scholar
  20. Peñuelas O, Frutos–Vivar F, Esteban A (2007) Noninvasive positive–pressure ventilation in acute respiratory failure. CMAJ 177(10):1211–1218Google Scholar
  21. Pérez–Frías J, Moreno Galdó A, Pérez Ruiz E, Barrio Gómez De Agüero MI, Escribano Montaner A, Caro Aguilera P, Sociedad Española de Neumología y Cirugía Torácica (2011) Pediatric bronchoscopy guidelines. Arch Bronconeumol 47(7):350–360Google Scholar
  22. Petrella F, Borri A, Casiraghi M, Cavaliere S, Donghi S, Galetta D, Gasparri R, Guarize J, Pardolesi A, Solli P, Tessitore A, Venturino M, Veronesi G, Spaggiari L (2014) Operative rigid bronchoscopy: indications, basic techniques and results. Multimed Man Cardiothorac Surg 2014:mmu006. Scholar
  23. Rabinstein AA (2016) Noninvasive ventilation for neuromuscular respiratory failure: when to use and when to avoid. Curr Opin Crit Care 22(2):94–99Google Scholar
  24. Ramirez J, Nyka W, McLaughlin J (1963) Pulmonary alveolar proteinosis: diagnostic techniques and observations. N Engl J Med 268:165–171Google Scholar
  25. Ranieri V, Rubenfeld GD, Thompson B, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS, Antonelli M, Anzueto A, Beale R, Brochard L, Brower R, Esteban A, Gattinoni L, Rhodes A, Vincent JL, Bersten A, Needham D, Pesenti A (2012) Acute respiratory distress syndrome: the Berlin Definition. JAMA 307(23):2526–2533Google Scholar
  26. Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S, Navalesi P Members Of The Steering Committee, Antonelli M, Brozek J, Conti G, Ferrer M, Guntupalli K, Jaber S, Keenan S, Mancebo J, Mehta S, Raoof S Members of the Task Force (2017) Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 50(2):1602426.–2016CrossRefGoogle Scholar
  27. Schramm D, Yu Y, Wiemers A, Vossen C, Snijders D, Krivec U, Priftis K, Eber E, Pohunek P (2017) Pediatric flexible and rigid bronchoscopy in European centers–availability and current practice. Pediatr Pulmonol 52(11):1502–1508Google Scholar
  28. Skoczynski S, Wyskida K, Rzepka–Wrona P, Wyskida M, Uszok–Gawel E, Bartocha D, Krzych L, Pierzchala W, Barczyk A (2018) Novel method of noninvasive ventilation supported therapeutic lavage in pulmonary alveolar proteinosis proves to relieve dyspnea, normalize pulmonary function test results and recover exercise capacity: a short communication. J Thorac Dis 10(4):2467–2473Google Scholar
  29. Torrego Fernández A (2012) Flexible bronchoscopy in critical care units. Med Int 36(6):385–386Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Szymon Skoczyński
    • 1
    Email author
  • Łukasz Minarowski
    • 2
  • Ewelina Tobiczyk
    • 1
  • Aleksandra Oraczewska
    • 1
  • Klaudia Glinka
    • 1
  • Karolina Ficek
    • 1
  • Robert Mróz
    • 2
  • Adam Barczyk
    • 1
  1. 1.Department of Pneumology, School of Medicine in KatowiceUpper-Silesian Medical Center, Medical University of SilesiaKatowicePoland
  2. 2.Second Department of Lung Diseases and TuberculosisMedical University of BialystokBialystokPoland

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