Skip to main content

Role of bronchoscopy during non-invasive ventilation in hypercapnic respiratory failure


Non-invasive positive-pressure ventilation (NIPPV) is the first-line treatment for hypercapnic acute respiratory failure (ARF) secondary to COPD exacerbation in selected patients. Limited data exist supporting the use of fiberoptic bronchoscopy (FOB) during this clinical setting. The aim of this study is to assess the role of FOB during NIPPV in patients with decompensated COPD acute exacerbation.


This study is a randomized prospective case-control pilot study carried out on 50 patients admitted to critical care units at Alexandria University Hospital, Egypt suffering from hypercapnic ARF secondary to COPD exacerbation with Kelly Matthay Score from 2 to 4. All patients received NIPPV. Patients were divided randomly into two equal groups: group I (cases, 25 patients) were subjected to additional intervention, early FOB during the first 6 to 12 hours from admission; while group II (control, 25 patients) received the conventional treatment and NIPPV only. Outcome parameters measured were changes in ABG data, duration of NIPPV, rate of its success, ICU stay and mortality as well as the safety of FOB and possible complications.


No significant difference was detected between the two groups regarding the baseline characteristics. No serious complications happened from FOB, oxygen desaturation occurred in 4/25 patients (16%), tachycardia in 2/25 patients (8%). In group I, 23 patients (92%) were successfully weaned from NIPPV versus 16 patients (64%) in group II (P = 0.037). Total duration of NIPPV was 28.52 hours in group I versus 56.25 hours in group II (P = 0.001). Length of ICU stay was 4.84 days in group I versus 8.68 days in group II (P = 0.001). Only one patient died in group I versus three patients in group II (P = 0.609).


The early application of FOB during NIPPV in patients with ARF due to COPD exacerbation was shown to be safe. Significant improvement in the outcome of patients who underwent FOB was noticed in terms of improved ABG data, shorter duration of NIPPV, higher percentage of success and shorter ICU stay while no significant difference was detected in mortality.


  1. Scala R, et al.: Crit Care. 2010, 14: R80. 10.1186/cc8993

    Article  PubMed Central  PubMed  Google Scholar 

  2. Ambrosino N, et al.: Eur Respir J. 2008, 31: 874-886. 10.1183/09031936.00143507

    Article  CAS  PubMed  Google Scholar 

  3. Heunks LM, et al.: Intensive Care Med. 2010, 36: 143-147. 10.1007/s00134-009-1662-6

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Rady, W., Abouelela, A., Aly, A. et al. Role of bronchoscopy during non-invasive ventilation in hypercapnic respiratory failure. Crit Care 17 (Suppl 2), P136 (2013).

Download citation

  • Published:

  • DOI:


  • Acute Exacerbation
  • Acute Respiratory Failure
  • Oxygen Desaturation
  • Early Application
  • Critical Care Unit