ICU Bronchoscopy
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First Things First (assess & treat for the following)
- Does pt have an indication for ICU bronchoscopy?
- Indications are the same as for non-ICU bronchoscopy.
- Diagnostic (most common ICU indications)
- Hemoptysis/hemostasis
- Diffuse parenchymal infiltrates of unknown etiology
- Unresolving infiltrate
- Acute inhalation injury
- Chest traumatic airways injuries (exclude fractured airway)
- Infection/ventilator-associated pneumonia
- Assessment of ETT placement
- Undiagnosed lung mass w/ associated respiratory failure
- Evaluation of bleeding or pneumothorax after lung resection
- Therapeutic (most common ICU indications)
- Lobar or segmental atelectasis
- Retained secretions or mucous plugging
- Unresponsive to chest physiotherapy
- Facilitate endotracheal intubation in difficult airways
- Extract foreign bodies
- Closure of bronchopleural fistulas
- Central obstructing lesions
- Assist w/ percutaneous dilational tracheostomy
- Lobar or segmental atelectasis
- Does pt have a contraindication for ICU bronchoscopy?
- Unable to obtain informed consent/patient refusal
- Experienced personnel unavailable
- Refractory hypoxemia
- Uncorrectable coagulopathy when biopsies (forceps or brush) are planned
- Unstable arrhythmias or active ischemia
- Refractory hypotension
- Uncontrolled bronchospasm
- Flexible vs. rigid bronchoscopy?
- Several advantages to flexible bronchoscopy
- Easier
- Fewer complications
- More comfortable for patient
- Better visualization of entire tracheobronchial tree
- Does not require general anesthesia
- Relative indications for rigid bronchoscopy
- Brisk hemoptysis (>200 mL/24 hrs)
- Pediatric or large foreign bodies
- Obstructing lesions of major airways
- Several advantages to flexible bronchoscopy
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First Things First (assess & treat for the following)
- Does pt have an indication for ICU bronchoscopy?
- Indications are the same as for non-ICU bronchoscopy.
- Diagnostic (most common ICU indications)
- Hemoptysis/hemostasis
- Diffuse parenchymal infiltrates of unknown etiology
- Unresolving infiltrate
- Acute inhalation injury
- Chest traumatic airways injuries (exclude fractured airway)
- Infection/ventilator-associated pneumonia
- Assessment of ETT placement
- Undiagnosed lung mass w/ associated respiratory failure
- Evaluation of bleeding or pneumothorax after lung resection
- Therapeutic (most common ICU indications)
- Lobar or segmental atelectasis
- Retained secretions or mucous plugging
- Unresponsive to chest physiotherapy
- Facilitate endotracheal intubation in difficult airways
- Extract foreign bodies
- Closure of bronchopleural fistulas
- Central obstructing lesions
- Assist w/ percutaneous dilational tracheostomy
- Lobar or segmental atelectasis
- Does pt have a contraindication for ICU bronchoscopy?
- Unable to obtain informed consent/patient refusal
- Experienced personnel unavailable
- Refractory hypoxemia
- Uncorrectable coagulopathy when biopsies (forceps or brush) are planned
- Unstable arrhythmias or active ischemia
- Refractory hypotension
- Uncontrolled bronchospasm
- Flexible vs. rigid bronchoscopy?
- Several advantages to flexible bronchoscopy
- Easier
- Fewer complications
- More comfortable for patient
- Better visualization of entire tracheobronchial tree
- Does not require general anesthesia
- Relative indications for rigid bronchoscopy
- Brisk hemoptysis (>200 mL/24 hrs)
- Pediatric or large foreign bodies
- Obstructing lesions of major airways
- Several advantages to flexible bronchoscopy
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