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Updated: May 17, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Flexible fiberoptic bronchoscopy and remifentanil target-controlled infusion in ICU: a preliminary study
Ludivine Chalumeau-Lemoine1, Annabelle Stoclin, Valérie Billard
1Service de Réanimation médico-chirurgicale, Institut Gustave Roussy, 114 rue Edouard Vaillant, 94805, Villejuif, France. ludivine.CHALUMEAU-LEMOINE@igr.fr
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.
Insights
Sedation with remifentanil target-controlled infusion (Remi-TCI) safely and effectively supports flexible fiberoptic bronchoscopy (FFB) in critically ill patients. This approach improved patient comfort and procedure conditions during FFB in the ICU.
Area of Science:
- Critical Care Medicine
- Anesthesiology
- Pulmonology
Background:
- Flexible fiberoptic bronchoscopy (FFB) is a vital diagnostic tool in intensive care units (ICUs).
- FFB can cause patient discomfort, pain, and compromise respiratory/hemodynamic stability in critically ill individuals.
- Remifentanil, an ultrashort-acting opioid, offers effective sedation for painful procedures in spontaneously breathing patients.
Purpose of the Study:
- To evaluate the safety and efficacy of remifentanil target-controlled infusion (Remi-TCI) for sedating patients undergoing FFB.
- To assess Remi-TCI's impact on critically ill patients with spontaneous ventilation during FFB in the ICU.
Main Methods:
- A monocentric prospective study involving fourteen patients undergoing FFB.
- Remifentanil target-controlled infusion (Remi-TCI) was administered, with initial concentrations titrated based on patient comfort and sedation levels.
- Respiratory, hemodynamic, comfort, sedation, FFB conditions, and recovery parameters were monitored before, during, and after the procedure.
Main Results:
- FFB was successfully completed in all patients with good sedation, comfort, and cough control.
- No severe respiratory or hemodynamic complications were observed during the FFB procedures.
- Patients reported low pain levels and high satisfaction, with maximum remifentanil concentrations averaging 2.5 ng/mL.
Conclusions:
- Sedation with Remi-TCI appears safe and effective for critically ill, spontaneously ventilating patients undergoing FFB.
- These findings suggest potential for broader application of Remi-TCI in managing uncomfortable or painful procedures within the ICU setting.
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