Continuous positive airway pressure during fiberoptic bronchoscopy in hypoxemic patients - A randomized double-blind study using a new device

Fiberoptic bronchoscopy (FOB) may worsen oxygenation and clinical status in severely hypoxemic patients. We conducted a prospective, randomized double-blind trial to compare the delivery of continuous positive airway pressure (CPAP) as a tool for maintaining oxygenation during FOB, to the delivery of oxygen only. Thirty consecutive patients who needed FOB for diagnostic purposes were enrolled. Their arterial oxygen pressure (Pa-O2) to inspired oxygen fraction (Fl(O2)) ratio was below 300 mm Hg. CPAP was generated by a simple new device open to the atmosphere. During FOB and the 30 min thereafter, pulse oximetry values (Sp(O2)) were significantly higher in the CPAP than the Oxygen group (95.7 +/- 1.9% versus 92.6 +/- 3.1, p = 0.02). The lowest Sp(O2) values were observed in the Oxygen group (93.5 +/- 2.4% versus 88.6 +/- 3.4, p = 0.002). Arterial blood gases 15 min after FOB showed that Pa-O2 had increased in the CPAP group and decreased in the Oxygen group (Delta Pa-O2 = + 10.5% +/- 16.9 versus - 15% +/- 16.6, p = 0.01). Five patients in the Oxygen group, but none in the CPAP group, developed respiratory failure in the 6 h after FOB and required ventilatory assistance (p = 0.03). We conclude that in hypoxemic patients, the use of a new CPAP device during FOB allowed minimal alterations in gas exchange and prevented subsequent respiratory failure.