Pope Francis experienced “two episodes of acute respiratory failure,” the Vatican said Monday, marking the latest in a series of medical crises the 88-year-old pontiff has endured since he was first hospitalized last month.
Monday’s episodes were caused by “significant accumulation of endobronchial mucus” and a consequent narrowing of the airways, the Vatican said.
Earlier in the day, the pope underwent two bronchoscopies and doctors removed a buildup of secretions.
In the afternoon, Francis was given oxygen through a mask to help with his breathing, according to the Vatican.
Throughout, the pontiff remained alert and cooperative, the Vatican said.
“It was a complicated afternoon,” Vatican sources said Monday evening, adding that the acute respiratory crisis, which lasted for part of the afternoon, is over, and that the pope was resting.
“The accumulation of the mucus is a result of the pneumonia and that causes coughing and spasm as the bronchi try to expel the mucus as it irritates them,” the sources said.
Dr. Theodore Iwashyna, professor of pulmonary and critical care medicine at Johns Hopkins University told CNN that a bronchoscopy is a moderately invasive procedure, and that “it is not good” to need two bronchoscopies within a short period of time to manage secretions.
“In a person that’s quite ill and requiring non-invasive ventilatory support, you would usually need to have a good reason to do it,” Iwashyna said, adding that mucus buildup is not a positive sign in a patient with pneumonia.
“As your pneumonia gets better you’ll produce less mucus. Sometimes as your pneumonia gets better you finally get strong enough to cough it up,” he said.
The Vatican sources said Monday that Francis’ blood tests remain the same and his prognosis remains “reserved.”
Dr. Jeremy Faust, a Boston-based emergency physician told CNN the “non-invasive mechanical ventilation” that Vatican sources said was a mask, is meant to help deliver oxygen with a little bit of pressure.
Pope Francis greets faithful during his weekly general audience at St. Peter’s Square in Vatican City, Vatican, on September 13, 2023.
“Non-invasive ventilation would be the step you would take before putting a patient on a mechanical ventilator with sedation and a breathing tube in their windpipe,” Faust said.
Such non-invasive treatment, Faust said, could be because a patient does not need or want to be intubated.
“The two reasons to use noninvasive ventilation is either that you’re not yet at the point where intubation and sedation are needed, or you are, but the patient has made it clear that they would not want that – which is a very reasonable thing to do if you’re an older person with a lot of medical problems and you don’t want to die on machines.”
In a previous update on Monday morning, Vatican said the pope “rested well” throughout the night and sources said he was receiving high flows of oxygen through nose cannulas.
