Although bronchoscopy can be safely performed through endotracheal tube in most intubated critically ill patients, sometimes it could lead to complications such as hypoxia and high airway pressures. Theoretically, transglottic bronchoscopy (TGB) does not interfere with mechanical ventilation and could avoid these complications. In a two-period crossover study, we compared this technique with trans-endotracheal tube bronchoscopy (TEB) in normal anesthetized sheep.
In five sheep, we did TGB first. The bronchoscope was introduced through the nasal nares and passed into the trachea via space between endotracheal tube and vocal folds. Heart rate, V T, P peak, and O2 saturation were recorded. One week later, we did TEB. In another five sheep, we did TEB first and TGB later.
P peak increased and V T and O2 saturation decreased during TEB (53.2 ± 5.7 vs. 27.6 ± 0.6, P = 0.002; 210 ± 32 vs. 285 ± 26, P = 0.002; 94.3 ± 1.3 vs. 97.5% ± 0.5, P = 0.041, respectively), but not during TGB. The only statistically significant abnormal finding during TGB was a mild tachycardia (96.7 ± 5.7 vs. 94.7 ± 5.5, P = 0.034).
Although TGB is time consuming and less convenient than TEB, it has minimal interference with mechanical ventilation. Expertise with this technique could be useful in patients with anticipated significant hypoxia and high airway pressures during bronchoscopy.
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This work was supported by Tehran University of Medical Sciences (Project No. 132-4987).
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Amanpour, S., Abtahi, H., Rabbani, S. et al. Feasibility and safety of transglottic bronchoscopy in mechanically ventilated sheep. J Anesth 26, 525–530 (2012) doi:10.1007/s00540-012-1352-3
- Transglottic bronchoscopy
- Trans-endotracheal tube bronchoscopy
- Mechanical ventilation