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CASE REPORT article

Front. Med.
Sec. Pulmonary Medicine
Volume 11 - 2024 | doi: 10.3389/fmed.2024.1361372
This article is part of the Research Topic Case Reports in Pulmonary Medicine 2023 View all 15 articles

The combined use of high flow nasal cannula oxygen therapy and repeated toilet bronchoscopies in respiratory failure secondary to abundant infected airway secretions: case report and subsequent case series from a non-intensive hospital ward

Provisionally accepted
Filippo Fimognari Filippo Fimognari 1*Francesco Baffa Bellucci Francesco Baffa Bellucci 1Giuseppe Armentaro Giuseppe Armentaro 2Flavio Fedele Flavio Fedele 3Simone Scarlata Simone Scarlata 4Angela Sciacqua Angela Sciacqua 2
  • 1 Unità Operativa Complessa di Geriatria, Dipartimento Medico Polispecialistico, Azienda Ospedaliera di Cosenza, Cosenzs, Italy
  • 2 Azienda Ospedaliera Universitaria Renato Dulbecco, Catanzaro, Calabria, Italy
  • 3 Health Agency of Cosenza, Cosenza, Italy
  • 4 Campus Bio-Medico University Hospital, Roma, Sicily, Italy

The final, formatted version of the article will be published soon.

    Fiberoptic bronchoscopy (FBO) has diagnostic or therapeutic purposes, but can cause respiratory deterioration, particularly in patients with pre-existing acute respiratory failure (ARF). Noninvasive ventilation (NIV) and high flow nasal cannula oxygen therapy (HFNC) are used as respiratory support for ARF and also to prevent significant oxygen deterioration during FBO. The combined use of NIV and early therapeutic FBO to clear retained abundant infected secretions from the airways may be an alternative to intubation and invasive mechanical ventilation (IMV), but no data exists on the combined use of FBO and HFNC. A 78-year male patient with ARF secondary to chronic obstructive pulmonary disease (COPD) exacerbation and pneumonia was admitted to our non-intensive geriatric ward. After an initial improvement, his respiratory conditions worsened.While continuing HFNC, he was submitted to a series of 8 FBO during 9 days, each one performed in occasion of a significant decrease of peripheral oxygen saturation (SpO2 ) with the aim of removing copious and occlusive infected secretions from the airways, and always obtaining good SpO2 recovery. After etiological targeted antibiotic therapy based on bronchial aspirate, the patient improved and was discharged. Afterwards, 6 consecutive similar ARF patients were managed with the same strategy combining HFNC and repeated toilet FBO performed within the ward to clear secretions. All patients improved and were discharged. The combination of HFNC and repeated toilet FBO could be a safe and effective intervention to apply in non-intensive wards for preventing intubation and IMV in frail and elderly patients with ARF secondary to copious and occlusive infected secretions in the airways. 8. Scala R, Guidelli L. Clinical Value of Bronchoscopy in Acute Respiratory Failure.

    Keywords: Fiberoptic bronchoscopy, toilet fiberoptic bronchoscopy, Acute Respiratory Failure, High flow nasal cannula oxygen therapy, Geriatric ward

    Received: 25 Dec 2023; Accepted: 02 Sep 2024.

    Copyright: © 2024 Fimognari, Baffa Bellucci, Armentaro, Fedele, Scarlata and Sciacqua. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Filippo Fimognari, Unità Operativa Complessa di Geriatria, Dipartimento Medico Polispecialistico, Azienda Ospedaliera di Cosenza, Cosenzs, Italy

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