A Technique of Awake Bronchoscopic Endotracheal Intubation for Respiratory Failure in Patients With Right Heart Failure and Pulmonary Hypertension. Issue 9 (September 2017)

• Record Type: Journal Article
• Authors: Johannes, Jimmy; Berlin, David A.; Patel, Parimal; Schenck, Edward J.; West, Frances Mae; Saggar, Rajan; Barjaktarevic, Igor Z.
• Is Part Of: Critical care medicine. Volume 45:Issue 9(2017)
• Publication Date: 2017-09
• Subjects: awake bronchoscopic intubation -- difficult airway -- high-flow nasal cannula -- noninvasive ventilation -- right heart failure; Critical care medicine -- Periodicals; Soins intensifs -- Périodiques; 616.028
• DOI: 10.1097/CCM.0000000000002586
• Languages: English
• ISSNs: 0090-3493

Abstract

Abstract : Objective: Patients with pulmonary hypertension and right heart failure have a high risk of clinical deterioration and death during or soon after endotracheal intubation. The effects of sedation, hypoxia, hypoventilation, and changes in intrathoracic pressure can lead to severe hemodynamic instability. In search for safer approach to endotracheal intubation in this cohort of patients, we evaluate the safety and feasibility of an alternative intubation technique. Data Sources: Retrospective data analysis. Study Selection: Two medical ICUs in large university hospitals in the United States. Data Extraction: We report a case series of nine nonconsecutive patients with compromised right heart function, pulmonary hypertension, and severe acute hypoxemic respiratory failure who underwent endotracheal intubation with a novel technique combining awake bronchoscopic intubation supported with nasally delivered noninvasive positive pressure ventilation or high-flow nasal cannula. Data Synthesis: All patients were intubated in the first attempt without major complications and eight patients (88%) were alive 24 hours after intubation. Systemic hypotension was the most frequent complication following the procedure. Conclusions: Awake bronchoscopic intubation supported with a noninvasive positive pressure delivery systems may be feasible alternative to standard direct laryngoscopy approach. Further studies are needed to better assess its safety and applicability. Abstract : Supplemental Digital Content is available in the text.