Bronchoscopy in the Intensive Care Unit

Abstract

Bronchoscopy is the endoscopic examination of the tracheobronchial tree. Flexible bronchoscopy has largely replaced rigid bronchoscopy as the procedure of choice for most endoscopic evaluations of the airway. Rigid bronchoscopy, however, is indicated for the removal of large foreign bodies, which may be difficult to remove with the flexible bronchoscope, and in the evaluation of patients with massive hemoptysis. Flexible bronchoscopy is easily performed, is associated with few complications, and allows greater visualization of the tracheobronchial tree than does rigid bronchoscopy. In intubated patients, the endotracheal tube provides easy access to the lower respiratory tract while still allowing ventilation. A size 8.0 mm or larger endotracheal tube is required to allow passage of the bronchoscope while allowing adequate ventilation (sometimes a size 7.5 tube may suffice). A number of diagnostic and therapeutic procedures can be performed with the fiberoptic bronchoscope including bronchoalveolar lavage (BAL), biopsy of intrabronchial lesions, protected microbiology specimen brush (PSB) and cytology sampling, as well as transbronchial biopsy. Many pulmonologists, however, are reluctant to perform transbronchial biopsy in ventilated ICU patients due to the high complication rate and low diagnostic yield in this setting.