Noninvasive mechanical ventilation and bronchoscopy: advantages and limits of a synergistic strategy

Bronchoscopy and noninvasive mechanical ventilation (NIMV) are largely applied in respiratory and general intensive care units. Bronchoscopy plays a crucial role for the diagnosis of lung infiltrates of unknown origin and the treatment of bronchial mucous plugging, massive haemoptysis and airways obstruction of different etiologies in critical patients. NIMV is the first-choice ventilatory strategy for acute respiratory failure (ARF) of different causes as it could be used as prevention or as alternative to conventional mechanical ventilation (CMV) via endotracheal intubation (ETI). Some scenarios represent contraindications for these techniques, like severe hypoxemia for bronchoscopy and accumulated tracheo-bronchial secretions for NIMV. In these contexts, ETI is not risk-free. In this Chapter, the rationale, the clinical indications, the scientific evidence, the practical issues and the risks for the synergistic use of bronchoscopy during NIMV are reported