THE EFFECT OF FIBEROPTIC BRONCHOSCOPY ON CEREBRAL HEMODYNAMICS IN PATIENTS WITH SEVERE HEAD-INJURY

Study objective: Concerns exist about the effect of flexible fiberopti c bronchoscopp (FFB) on intracranial pressure (ICP), We studied the ef fect of FFB on cerebral hemodynamics in patients with severe head inju ry. Design: Prior to FFB, patients were anesthetized and muscle relaxa nts were given as necessary to eliminate coughing. Comparisons were ma de of mean arterial pressure (MAP), ICP, and cerebral perfusion pressu re (CPP) prior to, during, and after FFB, as well as comparisons of me an cerebral hemodynamic values in an 8-hour period before and after FF B, Observations were made of changes in neurologic status post-FFB. Se tting: Surgical intensive care unit of Level 1 Trauma Center. Patient population: Fifteen patients with severe head injury in whom ICP was m onitored and who required FFB for diagnosis of nosocomial pneumonia or treatment of lobar collapse. Results: Pre-FFB ICP averaged 14.3 mm Hg (range, 6 to 26 mm Hg). During FFB, patients experienced a mean incre ase in ICP of 13.5 mm Hg above basal values (p = 0.0001), At peak ICP, MAP increased from a baseline of 92.3 mm Hg (SD +/- 16.1) to 111.5 mm Hg (+/- 13.9), Mean CPP was 83.7 mm Hg at peak ICP (range, 52 to 121 mm Hg), a 14.0% increase over baseline. The ICP and MAP returned to ba sal levels following bronchoscopy. No patient had a clinically signifi cant increase in ICP or demonstrated any deterioration in Glasgow Coma Scale score or neurologic examination findings post-FFB. Conclusions: Although FFB causes an increase in ICP in patients with severe head i njury, MAP also rises, and an adequate CPP is maintained. The ICP retu rns to basal levels after the procedure, When properly performed, FFB does not adversely affect neurologic status in patients with severe he ad injury.