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Todisco Tommaso M.D.; Eslami, Amir M.D.; Scarcella, Loretta M.D.; Baglioni, Stefano M.D.; Scavizzi, Franco M.D.; Dottorini, Maurizio M.D.
Journal of Bronchology: July 1995
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Ten nonintubated patients with respiratory failure underwent 40 flexible bronchoscopies during iron lung mechanical ventilation in a pulmonary division. Six patients had chronic obstructive pulmonary disease, two had lung fibrosis, and two suffered from kyphoscoliosis/postpolio syndrome. Flexible bronchoscopy during iron lung ventilation was performed to remove tracheobronchial secretions, to look for other conditions leading to upper airway obstruction such as tracheomalacia, and to obtain protected brush samples for bacterial and fungal cultures. Fifty percent of the patients had bacteriologically positive samples. Following the period of negative pressure ventilation (2 h/4 t.i.d. for 3–6 days), the Pao2 (mean ± SD) increased from 34 ± 11 to 60 ± 10 mm Hg (p < 0.001), the Paco2 decreased from 96 ± 30 to 56 ± 8 mm Hg (p < 0.001), and the clinical conditions of the patients improved. After flexible bronchoscopic drainage of the large airways, the clinical conditions and Pao2 further improved in 80% of the patients. Flexible bronchoscopy was crucial in the early diagnosis of upper airway obstruction or compression (eight patients, 80%), leading to the simultaneous application of nasal continuous positive airway pressure during iron lung treatment. We conclude that flexible bronchoscopy is safe and very useful in the management of iron lung-ventilated patients.

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