Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia. | Scala et al. Critical Care 2010 14 R80 http content 14 2 R80 c CRITICAL CARE RESEARCH Open Access Early fiberoptic bronchoscopy during non-invasive ventilation in patients with decompensated chronic obstructive pulmonary disease due to community-acquired-pneumonia Raffaele Scala Mario Naldi and Uberto Maccari Abstract Introduction Inefficient clearance of copious respiratory secretion is a cause of non-invasive positive pressure ventilation NPPV failure especially in chronic respiratory patients with community-acquired-pneumonia CAP and impaired consciousness. We postulated that in such a clinical scenario when intubation and conventional mechanical ventilation CMV are strongly recommended the suction of secretions with fiberoptic bronchoscopy FBO may increase the chance of NPPV success. The objective of this pilot study was firstly to verify the safety and effectiveness of early FBO during NPPV and secondly to compare the hospital outcomes of this strategy versus a CMV-based strategy in patients with decompensated chronic obstructive pulmonary disease COPD due to CAP who are not appropriate candidates for NPPV because of inefficient mucous clearance and hypercapnic encephalopathy HE . Methods This is a 12-month prospective matched case-control study performed in one respiratory semi-intensive care unit RSICU with expertise in NPPV and in one intensive care unit ICU . Fifteen acutely decompensated COPD patients with copious secretion retention and HE due to CAP undergoing NPPV in RSICU and 15 controls matched for arterial blood gases acute physiology and chronic health evaluation score III Kelly-Matthay scale pneumonia extension and severity receiving CMV in the ICU were studied. Results Two hours of NPPV significantly improved arterial blood gases Kelly and cough efficiency scores without FBO-related complications. NPPV avoided intubation in 12 15 patients 80 . Improvement in arterial blood gases was similar in the two groups except for a greater PaO2
