Skip to main content

Advertisement

SpringerLink
Log in

Flexible fiberoptic bronchoscopy and remifentanil target-controlled infusion in ICU: a preliminary study

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Purpose

Flexible fiberoptic bronchoscopy (FFB) is a major diagnostic tool commonly used in intensive care unit (ICU). However, it generates discomfort and pain and can worsen respiratory and/or hemodynamic condition of critically ill patients. Remifentanil is an ultrashort-acting opioid drug that has been shown to provide effective sedation for painful procedures in spontaneous breathing patients. The aim of this study is to evaluate the safety and efficacy of sedation with remifentanil target-controlled infusion (Remi-TCI) in patients with spontaneous ventilation undergoing FFB in ICU.

Methods

Monocentric prospective study. All patients received Remi-TCI with initial effect-site target concentration of 2 ng/mL, progressively titrated according to their comfort and sedation. Respiratory and hemodynamic parameters were assessed before, during, and after the procedure, as well as comfort, level of sedation, FFB conditions, and recovery patterns. Global Remi-TCI data and potential complications of the procedure were also recorded.

Results

Fourteen patients were included. FFB was successful in all patients with good conditions (sedation, global comfort, and cough). No severe hemodynamic or respiratory complications occurred during procedure. Maximum target concentration and total dose of remifentanil were 2.5 ng/mL (2–4 ng/mL) and 1.4 μg/kg (0.7–2.4 μg/kg), respectively, over 10 min. Patients reported low level of pain and good satisfaction with the procedure.

Conclusions

FFB under sedation with Remi-TCI seems to be safe and effective in critically ill patients with spontaneous ventilation. Such results could be the first step towards wider use of Remi-TCI in patients experiencing awkward and/or painful procedures in this setting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gruson D, Hilbert G, Valentino R, Vargas F, Chene G, Bebear C, Allery A, Pigneux A, Gbikpi-Benissan G, Cardinaud JP (2000) Utility of fiberoptic bronchoscopy in neutropenic patients admitted to the intensive care unit with pulmonary infiltrates. Crit Care Med 28:2224–2230

    Article  PubMed  CAS  Google Scholar 

  2. Turner JS, Willcox PA, Hayhurst MD, Potgieter PD (1994) Fiberoptic bronchoscopy in the intensive care unit—a prospective study of 147 procedures in 107 patients. Crit Care Med 22:259–264

    Article  PubMed  CAS  Google Scholar 

  3. Trouillet JL, Guiguet M, Gibert C, Fagon JY, Dreyfuss D, Blanchet F, Chastre J (1990) Fiberoptic bronchoscopy in ventilated patients. Evaluation of cardiopulmonary risk under midazolam sedation. Chest 97:927–933

    Article  PubMed  CAS  Google Scholar 

  4. Matot I, Kramer MR (2000) Sedation in outpatient bronchoscopy. Respir Med 94:1145–1153

    Article  PubMed  CAS  Google Scholar 

  5. de Padua AI, de Castro M, Schmidt A, Coutinho Neto J, Terra Filho J, Martinez JA (2004) Clonidine as a pre-anesthetic agent for flexible bronchoscopy. Respir Med 98:746–751

    Article  PubMed  Google Scholar 

  6. Gonzalez R, De-La-Rosa-Ramirez I, Maldonado-Hernandez A, Dominguez-Cherit G (2003) Should patients undergoing a bronchoscopy be sedated? Acta Anaesthesiol Scand 47:411–415

    Article  PubMed  CAS  Google Scholar 

  7. Hwang J, Jeon Y, Park HP, Lim YJ, Oh YS (2005) Comparison of alfetanil and ketamine in combination with propofol for patient-controlled sedation during fiberoptic bronchoscopy. Acta Anaesthesiol Scand 49:1334–1338

    Article  PubMed  CAS  Google Scholar 

  8. Putinati S, Ballerin L, Corbetta L, Trevisani L, Potena A (1999) Patient satisfaction with conscious sedation for bronchoscopy. Chest 115:1437–1440

    Article  PubMed  CAS  Google Scholar 

  9. Ryu JH, Lee SW, Lee JH, Lee EH, Do SH, Kim CS (2012) Randomized double-blind study of remifentanil and dexmedetomidine for flexible bronchoscopy. Br J Anaesth 108:503–511

    Article  PubMed  CAS  Google Scholar 

  10. Colt HG, Morris JF (1990) Fiberoptic bronchoscopy without premedication. A retrospective study. Chest 98:1327–1330

    Article  PubMed  CAS  Google Scholar 

  11. Purugganan RV (2008) Intravenous anesthesia for thoracic procedures. Curr Opin Anaesthesiol 21:1–7

    Article  PubMed  Google Scholar 

  12. Abu-Shahwan I, Mack D (2007) Propofol and remifentanil for deep sedation in children undergoing gastrointestinal endoscopy. Paediatr Anaesth 17:460–463

    Article  PubMed  Google Scholar 

  13. Berkenbosch JW, Graff GR, Stark JM, Ner Z, Tobias JD (2004) Use of a remifentanil-propofol mixture for pediatric flexible fiberoptic bronchoscopy sedation. Paediatr Anaesth 14:941–946

    Article  PubMed  Google Scholar 

  14. Lallo A, Billard V, Bourgain JL (2009) A comparison of propofol and remifentanil target-controlled infusions to facilitate fiberoptic nasotracheal intubation. Anesth Analg 108:852–857

    Article  PubMed  CAS  Google Scholar 

  15. Machata AM, Gonano C, Holzer A, Andel D, Spiss CK, Zimpfer M, Illievich UM (2003) Awake nasotracheal fiberoptic intubation: patient comfort, intubating conditions, and hemodynamic stability during conscious sedation with remifentanil. Anesth Analg 97:904–908

    Article  PubMed  CAS  Google Scholar 

  16. Neidhart G, Bremerich DH, Kessler P (2001) Fiberoptic intubation during remifentanil propofol sedation. Anaesthesist 50:242–247

    Article  PubMed  CAS  Google Scholar 

  17. Puchner W, Egger P, Puhringer F, Lockinger A, Obwegeser J, Gombotz H (2002) Evaluation of remifentanil as single drug for awake fiberoptic intubation. Acta Anaesthesiol Scand 46:350–354

    Article  PubMed  CAS  Google Scholar 

  18. Yeganeh N, Roshani B, Azizi B, Almasi A (2010) Target-controlled infusion of remifentanil to provide analgesia for awake nasotracheal fiberoptic intubations in cervical trauma patients. J Trauma 69:1185–1190

    Article  PubMed  CAS  Google Scholar 

  19. Billard V (2009) Anesthésie intraveineuse à objectif de concentration de morphinique en pratique clinique. Le praticien en anesthésie réanimation 13:34–40

    Article  Google Scholar 

  20. De Castro V, Godet G, Mencia G, Raux M, Coriat P (2003) Target-controlled infusion for remifentanil in vascular patients improves hemodynamics and decreases remifentanil requirement. Anesth Analg 96:33–38

    PubMed  Google Scholar 

  21. Rai MR, Parry TM, Dombrovskis A, Warner OJ (2008) Remifentanil target-controlled infusion vs propofol target-controlled infusion for conscious sedation for awake fibreoptic intubation: a double-blinded randomized controlled trial. Br J Anaesth 100:125–130

    Article  PubMed  CAS  Google Scholar 

  22. Olofsen E, Boom M, Nieuwenhuijs D, Sarton E, Teppema L, Aarts L, Dahan A (2010) Modeling the non-steady state respiratory effects of remifentanil in awake and propofol-sedated healthy volunteers. Anesthesiology 112:1382–1395

    Article  PubMed  CAS  Google Scholar 

  23. De Vito A, Agnoletti V, Berrettini S, Piraccini E, Criscuolo A, Corso R, Campanini A, Gambale G, Vicini C (2011) Drug-induced sleep endoscopy: conventional versus target controlled infusion techniques—a randomized controlled study. Eur Arch Otorhinolaryngol 268:457–462

    Article  PubMed  Google Scholar 

  24. Gueret G, Billard V, Bourgain JL (2007) Fibre-optic intubation teaching in sedated patients with anticipated difficult intubation. Eur J Anaesthesiol 24:239–244

    Article  PubMed  CAS  Google Scholar 

  25. Clouzeau B, Bui HN, Guilhon E, Grenouillet-Delacre M, Leger MS, Saghi T, Pillot J, Filloux B, Coz S, Boyer A, Vargas F, Gruson D, Hilbert G (2011) Fiberoptic bronchoscopy under noninvasive ventilation and propofol target-controlled infusion in hypoxemic patients. Intensive Care Med 37:1969–1975

    Article  PubMed  CAS  Google Scholar 

  26. Chastre J, Trouillet JL, Vuagnat A, Joly-Guillou ML, Clavier H, Dombret MC, Gibert C (1998) Nosocomial pneumonia in patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 157:1165–1172

    PubMed  CAS  Google Scholar 

Download references

Acknowledgments

Ludivine Chalumeau-Lemoine: conception and design of study, acquisition of data, analysis and interpretation of data, drafting the article, approval of the final version. Annabelle Stoclin: conception and design of study, interpretation of data, approval of the final version. Bruno Raynard: conception and design of study, acquisition of data, approval of the final version. Agnès Laplanche: analysis and interpretation of data, approval of the final version. Valérie Billard, François Blot: conception and design of study, analysis and interpretation of data, codrafting the article, and approval of the final version.

Conflicts of interest

The authors declare no financial conflict of interest with both Fresenius Vial and GlaxoSmithKline companies.

Author information

Authors and Affiliations

  1. Service de Réanimation médico-chirurgicale, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France

    Ludivine Chalumeau-Lemoine, Annabelle Stoclin, Bruno Raynard & François Blot

  2. Service d’Anesthésie, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France

    Valérie Billard

  3. Service de Biostatistiques et d’Epidémiologie, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France

    Agnès Laplanche

Authors
  1. Ludivine Chalumeau-Lemoine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Annabelle Stoclin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Valérie Billard
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Agnès Laplanche
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bruno Raynard
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. François Blot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ludivine Chalumeau-Lemoine.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 64 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chalumeau-Lemoine, L., Stoclin, A., Billard, V. et al. Flexible fiberoptic bronchoscopy and remifentanil target-controlled infusion in ICU: a preliminary study. Intensive Care Med 39, 53–58 (2013). https://doi.org/10.1007/s00134-012-2697-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-012-2697-7

Keywords

Search

Navigation