Bronchoscopy in ICU
Indications:
A) Diagnostic:
1-Investigation of an infectious process:
➧ Bronchoscopy and broncho-alveolar lavage (BAL) are commonly used for the identification of pathogens in the lower airways in the following circumstances:
a) When it is not clear whether the presence of organisms represents infection or colonization.
b) When the infection is caused by organisms that show a predilection for the peripheral airways (e.g. Pneumocystis jirovesii).
c) When the infection is confined in a particular area of the lung (tuberculous and non-tuberculous mycobacteria as well as several fungal and opportunistic organisms).
2-Abnormal breath sounds:
➧ Abnormal breath sounds include: stridor, wheezes, or a combination of both and they are the most common indication of FOB in the NICU.
➧ In neonates, abnormal breath sounds are due to congenital abnormalities of the upper or lower airways.
➧ In older infants and children the causes are often iatrogenic (e.g. subglottic stenosis due to prolonged intubation, injury of the vocal cords, or of the recurrent laryngeal nerve causing paresis or paralysis).
3-Evaluation of the nature of abnormalities:
➧ Patients in the ICU often present with radiographic findings and/or symptoms of unclear etiology, e.g.: an airway filled with secretions can look radiographically identical to a completely compressed airway.
4-Others:
➧ Pneumonia, Trauma, Inhalation injury and burns, Tracheoesophageal fistula.
B) Therapeutic:
1-Placement of the endotracheal tube:
➧ The use of FOB for the placement of the endotracheal tube is reserved for cases in which high precision is required.
➧ e.g. placement of the ETT just above the carina in patients with very severe tracheomalacia; or selective intubation of one lung), or when congenital anatomical abnormalities or injuries preclude the proper opening of the jaw for direct laryngoscopy.
2-Placement of double-lumen ETT and confirmation of position
3-Extubation over FOB
4-Persistent or recurrent atelectasis
➧ Atelectasis is a major cause of clinical deterioration and/or of delay in the patients’ recovery, resulting from many causes such as; mucous plug, compression of the airways, alveolar destruction, and collapse.
5-Foreign body removal
6-Strictures and stenosis
7-Hemoptysis
Contraindications:
1-Full stomach
3-Severe pulmonary hypertension
4-Tuberculosis
5-Acute myocardial infarction or unstable angina
6-Coagulopathy
Complications:
1-Increase HR, Bl. P, ICP, IOP
2-Laryngospasm and bronchospasm
3-Hypoxemia
4-Arrhythmia
5-Bleeding
6-Post-bronchoscopy fever
7-Pulmonary infiltrate
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