Ventilator settings for fiberoptic bronchoscopy during mechanical ventilation: a randomized adjudicator-blinded...

Area of Science:

• Critical Care Medicine
• Respiratory Therapy
• Pulmonary Medicine

Background:

• Bronchoscopy in mechanically ventilated patients increases airway resistance, peak airway pressure, and reduces tidal volume.
• Current ventilator settings may lead to serious adverse events during flexible fiberoptic bronchoscopy.

Purpose of the Study:

• To determine if specific ventilator settings (assist volume-controlled with reduced inspiratory flow and tidal volume) lower serious adverse events during flexible fiberoptic bronchoscopy compared to conventional settings.

Main Methods:

• Single-center randomized adjudicator-blinded controlled trial in intubated adult patients.
• Patients received either bronchoscopy-optimized settings or conventional ventilator settings.
• Primary endpoint was a composite of serious adverse events requiring premature termination.

Main Results:

• Optimized settings resulted in 4% serious adverse events versus 96% with conventional settings (p < 0.001).
• Conventional settings led to ventilatory failure due to pressure-alarm limitation.
• Optimized settings reduced peak airway pressure and restored adequate ventilation.

Conclusions:

• A bronchoscopy-optimized ventilation strategy substantially reduces pressure-alarm-limited ventilation events.
• This strategy enables adequate ventilatory support during flexible fiberoptic bronchoscopy.