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 o f oxygen only. Thirty consecutive patients who needed FOB for diagnostic pu rposes were enrolled. Their arterial oxygen pressure (Pa-O2) to inspired ox ygen fraction (Fl(O2)) ratio was below 300 mm Hg. CPAP was generated by a s imple new device open to the atmosphere. During FOB and the 30 min thereaft er, pulse oximetry values (Sp(O2)) were significantly higher in the CPAP th an the Oxygen group (95.7 +/- 1.9% versus 92.6 +/- 3.1, p = 0.02). The lowe st 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 P a-O2 had increased in the CPAP group and decreased in the Oxygen group (Del ta 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 fai lure in the 6 h after FOB and required ventilatory assistance (p = 0.03). W e conclude that in hypoxemic patients, the use of a new CPAP device during FOB allowed minimal alterations in gas exchange and prevented subsequent re spiratory failure.