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 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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