Evaluation of Cardiopulmonary Risk under Midazolam Sedation
The approach to the diagnosis of diseases of the chest increasingly involves the use of flexible fiberoptic bronchoscopy. The risk inherent in such an examination appears slight in alert, spontaneously breathing patients, although the associated occurrence of cardiac arrhythmias, hypoxemia, or laryngo-spasm is not unusual. In intubated patients in the ICU, the flexible fiberoptic bronchoscope has gained restricted use for the diagnosis and treatment of airway problems that occur during mechanical ventilation. The generally accepted indications for bronchoscopy in nonimmunocompromised ventilated patients are removal of retained secretions, resolution of atelectasis, and evaluation of hemoptysis.
Patients with endotracheal tubes are at a particularly high risk of nosocomial pneumonia, and the clinical distinction between bacterial colonization and true infection is often difficult. One of the most important aids to the definitive diagnosis of bacterial infection, and, specifically, of bacterial pneumonia, lies in the proper collection of specimens. Therefore, recent efforts have been made to sample the lower respiratory tract without contamination. For this purpose a catheter brush that is protected by a telescoping double sheath with a polyethylene glycol plug and passed through the suction channel of a flexible fiberoptic bronchoscope has been developed by Wimberley and associates. This brush has been documented to have reasonable precision in diagnosing nosocomial pneumonia when associated with quantitative culture techniques. Following these observations, the use of brief fiberoptic bronchoscopy has increased dramatically in ICUs; however, the morbidity associated with this procedure has been minimally investigated in large cohorts of critically ill patients. You are always welcome to shop for efficient medications and Buy Symbicort Online at the best pharmacy you could ever come across, making your purchase with confidence and always be sure you will be taken great care of as a customer.
Thus, the purpose of this prospective study was to determine the alterations in blood gas levels and hemodynamic status induced by brief fiberoptic bronchoscopy in 107 critically ill patients undergoing mechanical ventilation. It was also our aim to establish, if possible, the main risk factors for the development of hypoxemia and hemodynamic disturbances.