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Revista americana de medicina respiratoria

On-line version ISSN 1852-236X


CHERTCOFF, Martín et al. Utilización de la ventilación no invasiva en situaciones especiales: Reporte de serie de casos. Rev. amer. med. respiratoria [online]. 2013, vol.13, n.3, pp.162-168. ISSN 1852-236X.

Noninvasive ventilation (NVI) is a first line tool for the treatment of acute and chronic respiratory failure. It was demonstrated that early noninvasive support has reduced invasive ventilation and its complications in particular patients. Objective: To describe the usefulness of NVI in a series of patients treated with minimally invasive procedures which had a high risk for orotracheal intubation because of sedation or the underlying disease. Materials and Methods: This is an observational study carried out at the British Hospital in Buenos Aires. It included nine patients admitted to the ICU with acute respiratory hypoxemic failure who required minimally invasive procedures such as bronchoscopy, percutaneous endoscopic gastrostomy, techniques of endoscopic interventions and transesophageal echocardiogram, with subsequent mechanical respiratory assistance. Results: NIV was used as support in nine patients. In seven patients the support was during a bronchoscopy: endobronchial valves placement in two COPD patients and bronchoalveolar lavage (BAL) in five patients: four immunocompromised patients and a patient with suspicion of cryptogenic organizing pneumonia before steroids treatment. NIV was also performed as support while executing one endoscopic gastrostomy in an inpatient with amyotrophic lateral sclerosis, and in another patient during a transesophageal echocardiogram with severe COPD acute exacerbation which needed electric cardioversion because of auricular fibrilation. Only two patients needed intubation and mechanical ventilation after bronchoscopy, mostly related to the clinical evolution of the underlying disease, rather than related to the procedure itself. Both patients died during this intervention. Conclusion: NIV with minimally invasive procedures might be a valid and safe option to reduce orotracheal intubation and its complications in high risk patients.

Keywords : Non invasive ventilation; Sedation; Intubation.

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