Uso de mascarilla laríngea para fibrobroncoscopía en lactantes durante ventilación mecánica

Abstract

Laryngeal mask (LM) has been used to manage airways during general anesthesia, in both children and adults, to avoid tracheal intubation. Lately its use has been extended to perform flexible bronchoscopy (FB). In an infant under mechanical ventilation (MV), most of FB require an endotracheal tube # 4.5 because the smallest instrument with a suction channel has a 3.5 mm diameter. Our objective was to evaluate the use of LM while performing FB in patients on MV. Patients were sedated (atropine- midazolam and vecuronium), and monitored with transcutaneous oxygen saturation and cardiorespiratory monitor in an Intensive Care Unit setup. LM was introduced, and its position was verified by clinical auscultation. FB Olympus BF C-30, with 3.5 mm diameter was used. From December 1997 to October 1998 eleven procedures were done in 6 patients. Their mean age was 6.2 months (range: 0.5-33), weight 4.9 kg (2.7-10.5). MV parameters were FiO2 0.45 (0.4-1), MIP 28.4 cm H2O (20-60) and PEEP 5,18 cm H2O (3-8). In all patients we used LM # 1.0, with an internal diameter 5.25 mm. Indications for FB were: atelectasis (6), tracheobronchomalacia (2), hemoptisis (2) and subglotic stenosis (1). LM was introduced during the first attempt in 9 procedures, without complications. We maintained positive pressure ventilation without displacements of LM. After the FB, the patients were reintubated, with similar parameters compared to prior procedure. To sum up, we found that LM provides a safe artificial airway to ventilate patients who need FB during mechanical ventilation on small endotracheal tubes. This technique allows bronchial visualization, and aspiration and to perform bronchoalveolar lavage to carry out cell counting and cultures