ICU Bronchoscopy

ICU Bronchoscopy is a topic covered in the Pocket ICU Management.

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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
  • 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

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Last updated: May 5, 2010