ArticleJournal of intensive care2026
Standardized low-flow ventilation with PEEP maintenance during bronchoscopy in mechanically ventilated ICU patients: a pilot trial.
Article in Journal of intensive care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
18 authors.
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Abstract
backgroundFiberoptic bronchoscopy in mechanically ventilated ICU patients can markedly increase airway resistance and peak inspiratory pressure (PIP), limit effective tidal volume delivery, and provoke transient hypoxemia, hypercapnia, dynamic hyperinflation, and hemodynamic instability. However, per-procedural ventilator management remains heterogeneous.
methodsThis single-center trial with before-and-after design assessed the feasibility and safety of implementing a standardized low-flow ventilation protocol, and characterized its physiological effects (particularly peak inspiratory pressure), during bronchoscopy in adults intubated and ventilated in volume-assist-control mode.
resultsDuring the observational phase (n = 36), ventilator settings reflected usual practice (increased pressure alarm and reduced PEEP; no routine flow reduction). Following a 1-month training period, the intervention phase (n = 35) implemented an inspiratory flow rate of 20 L/min, unchanged PEEP, and a reduced respiratory rate to achieve an I:E ratio of 1:2. Physiologic and ventilator data were automatically recorded at 1-min intervals. The primary endpoint was peak inspiratory pressure (PIP), a physiological endpoint reflecting the mechanical effect of the intervention. Secondary endpoints included minute ventilation (MV), end-tidal CO2 (EtCO2), oxygenation metrics, ventilator alarms, and hypotension, feasibility and procedural safety. PIP decreased substantially (45 [35, 65] cmH2O vs. 82 [59, 93] cmH
conclusionsThis protocol implementation study demonstrates that standardized low-flow ventilation with PEEP maintenance is feasible and safe during bronchoscopy in mechanically ventilated patients, with a significant reduction in peak inspiratory pressure as a robust mechanical signal. Alveolar ventilation and hemodynamic tolerance were preserved. These findings support the conduct of further research to evaluate clinical outcomes.
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