Noninvasive Ventilation During Endoscopic Procedures: Rationale, Clinical Use, and Devices

Endoscopic procedures, such as transesophageal echocardiography, gastroscopy, and airway fibroscopy, routinely are performed in a heterogenous population of patients for diagnostic/interventional purposes (eg, transfemoral aortic valve replacement, airway fibroscopies, and intubation). Sedation frequently is administered to achieve an appropriate degree of patient compliance and procedure success. Patients with reduced respiratory reserve or those who are overly sedated, however, may develop hypoxia and respiratory failure during endoscopies, necessitating premature termination of the examination itself. In recent years, periprocedural noninvasive ventilation has been used to improve oxygenation and avoid general anesthesia. New technology has been developed, and noninvasive ventilation masks that allow for the insertion of an endoscopic probe have become available in clinical practice. Positive preliminary results have been reported in several clinical contexts, including traditional and hybrid operating rooms and intensive care units. Ventilatory support has been delivered during prolonged transesophageal cardiac examinations and interventions, broncoscopic maneuvers, and in difficult airway scenarios. Furthermore, the availability of innovative dedicated devices has allowed for some interventional procedures that require endoscopy to be peformed with the patient under sedation and on ventilatory support with noninvasive ventilation instead of general anesthesia. These approaches might be further expanded in the future and possibly reduce costs, organizational requirements, and complications compared using standard management with general anesthesia.